Functional Medicine Research with Dr. Nikolas Hedberg

For clinicians in functional medicine, these cases are all too familiar. While antibiotics, herbal medicines, biofilm disruptors, and immune support are key in managing Lyme disease, restoring quality sleep is just as essential. Without sleep, healing stalls. It is during deep sleep that glymphatic clearance occurs, immune cells regenerate, and the nervous system resets. Herbal solutions can help patients with Lyme-related insomnia achieve deep, restorative sleep. This article explores how Lyme disrupts sleep physiology and how Moss Nutrition's new Sleep Select Herbal—a blend of saffron, valerian, American skullcap, passionflower, and Ziziphus spinosa—can help restore calm and rest. These botanicals are supported by clinical trials and tailored to address the unique neuroimmune dysregulation seen in Lyme disease. The Limits of Conventional Sleep Aids Many Lyme patients are prescribed benzodiazepines, sedative antihistamines, or off-label antidepressants for insomnia. While these may offer temporary relief, they rarely address root causes. Over time, they can disrupt sleep architecture, desensitize GABA receptors, and create dependency or withdrawal problems. By contrast, botanical nervines and adaptogens support endogenous pathways—enhancing GABA, modulating cortisol, and recalibrating circadian rhythm—without suppressing natural neurotransmission. This is the core strategy behind Sleep Select Herbal. How Lyme Disease Disrupts Sleep and Creates Nervous Tension 1. Neuroinflammation and Cytokine Overload Borrelia and its coinfections invade the central nervous system, triggering microglial activation and the release of inflammatory cytokines like IL-6, TNF-alpha, and IL-1β. These cytokines interfere with the function of sleep-promoting areas in the brain, such as the hypothalamus and suprachiasmatic nucleus. Impact: Reduced sleep drive, disrupted circadian signaling, and altered neurotransmitter synthesis. 2. Cortisol Dysregulation and HPA Axis Dysfunction Patients with chronic Lyme disease often exhibit abnormal cortisol rhythms—typically low in the morning and elevated at night. This flipped curve perpetuates insomnia, often manifesting as nighttime awakenings or difficulty falling asleep. Impact: Low melatonin, nighttime anxiety, impaired parasympathetic tone, and reduced vagal tone. 3. GABA and Serotonin Imbalance Lyme disease inflammation can disrupt the synthesis and receptor sensitivity of GABA and serotonin—the primary calming neurotransmitters. This leads to hyperarousal, panic, and light, unrefreshing sleep. Impact: Reduced GABAergic tone increases muscle tension, rumination, and sympathetic dominance. Five Botanicals to Restore Sleep in Lyme Disease Each herb in Sleep Select Herbal addresses a distinct but overlapping mechanism contributing to insomnia and nervous tension. Clinically formulated Sleep Select Herbal supports deep, restorative sleep for patients with Lyme-related insomnia and nervous tension. 1. Saffron (Crocus sativus) – The Circadian Calibrator In a 2021 double-blind, placebo-controlled study of 120 adults with poor sleep, saffron (affron®) at 14–28 mg improved sleep quality, reduced insomnia severity, and increased evening melatonin levels without next-day sedation (Lopresti et al., 2021). Mechanisms: Increases nighttime melatonin Reduces evening cortisol Improves sleep onset and continuity Patient Profile: Individuals with delayed sleep phase, high evening cortisol, or mood disturbances upon waking. 2. Valerian (Valeriana officinalis) – The GABAergic Grounder Valerian root enhances GABA signaling by inhibiting its breakdown and modulating GABA-A receptors. A clinical trial showed valerian significantly improved total sleep time, reduced latency, and enhanced sleep efficiency (Shekhar et al., 2024). Mechanisms: Binds GABA-A receptors without habituation Reduces anxiety and muscle tension

If you're struggling with chronic fatigue syndrome (ME/CFS) or debilitating tiredness that just won't go away, you're not alone—and you're not imagining things. Millions of people suffer from persistent fatigue that conventional medicine often fails to resolve. Fatigue and stress can make everyday tasks like working at a computer feel overwhelming, as seen in this image, which represents the experience of many with chronic fatigue syndrome (ME/CFS) At the Hedberg Institute, I'm always researching botanical compounds that support microcirculation, mitochondrial health, and immune regulation—all vital in restoring energy. That's why I formulated VascuSelect, a synergistic supplement that contains three powerful plant extracts: Ginkgo biloba, grape seed extract, and mango whole fruit powder. Let's dive into why Ginkgo biloba, in particular, stands out for those dealing with ME/CFS and how it works alongside other ingredients in VascuSelect to support your energy and vitality. An Important Study: Ginkgo Biloba for ME/CFS A recent paper published in Frontiers in Pharmacology (2022) titled “A Botanical Product Containing Cistanche and Ginkgo Extracts Potentially Improves Chronic Fatigue Syndrome Symptoms in Adults: A Randomized, Double-Blind, and Placebo-Controlled Study” sheds important light on Ginkgo's role in combating chronic fatigue. In this gold-standard clinical trial, 101 adults with ME/CFS received a botanical supplement combining Ginkgo biloba extract (120 mg/day) and Cistanche tubulosa extract (300 mg/day) or a placebo for 60 days. The results were impressive: Significant reductions in fatigue severity Improved physical performance and VO₂ max Enhanced antioxidant status and reduced oxidative stress markers Improved sleep quality and concentration Enhanced quality of life (QOL) and sexual life (SLQ) scores Decreased blood levels of lactic acid and ammonia (both fatigue biomarkers) What's particularly exciting is that Ginkgo biloba played a central role in this formulation. The authors noted that Ginkgo's flavonoids and terpenoids contribute to neuroprotection, vasodilation, and mitochondrial support, all of which are key areas of dysfunction in ME/CFS patients. This study confirms that Ginkgo biloba, known for enhancing blood flow and antioxidant activity, can play a central role in reducing the burdens of ME/CFS. How Ginkgo Biloba Helps Fight Fatigue Ginkgo biloba (standardized to 24% flavonol glycosides and 6% terpenes) is one of the most studied botanical extracts for circulatory and cognitive health. But its applications go far beyond brain support—especially for those with energy-depleting illnesses like ME/CFS. Ginkgo biloba is one of the oldest and most studied medicinal plants. It's been used for centuries in Traditional Chinese Medicine, but modern science is now validating its applications for conditions like ME/CFS, fibromyalgia, and Long COVID. 1. Improves Microcirculation Ginkgo biloba increases blood flow, especially in the small vessels of the brain and extremities. This is critical in ME/CFS, where impaired oxygen delivery to tissues can worsen fatigue. 2. Supports Mitochondrial Function Many people with ME/CFS experience dysfunctional mitochondria—the energy-producing engines of cells. Ginkgo has been shown to protect mitochondrial membranes and improve ATP production, helping the body generate more usable energy. 3. Reduces Oxidative Stress Oxidative stress is a hallmark of ME/CFS and contributes to inflammation, brain fog, and fatigue. Ginkgo's rich flavonoid profile helps neutralize free radicals and reduce oxidative damage. In the study mentioned above, participants taking Ginkgo and Cistanche showed significant increases in antioxidant enzymes like SOD and CAT. 4. Enhances Neurotransmitter Function Ginkgo biloba modulates neurotransmitters like dopamine, serotonin, and norepinephrine—chemicals that regulate mood,

I'm thrilled to announce the launch of my new podcast: Infection Connection — a show dedicated to uncovering how stealth infections and hidden pathogens are driving the rise of complex chronic illnesses. If you've followed my work at the Hedberg Institute or listened to past podcast episodes, you know I'm passionate about investigating the root causes of conditions that conventional medicine often struggles to explain. That passion has now evolved into Infection Connection — a focused exploration of the link between infections and the growing epidemic of chronic disease. What You'll Hear on Infection Connection Each episode will take a deep dive into how infections contribute to (or trigger) some of the most challenging chronic illnesses we see today, including: Long COVID Myalgic Encephalomyelitis / Chronic Fatigue Syndrome (ME/CFS) Lyme Disease and coinfections Mast Cell Activation Syndrome (MCAS) Mold and Mycotoxin Illness Autoimmune Disease …and many others I'll be drawing on the latest research, clinical experience, and the powerful tools of functional medicine to help practitioners and patients understand how to identify and address these complex drivers of disease. Who Is This Podcast For? Whether you're a health practitioner, a patient on your own healing journey, or simply someone fascinated by the science of chronic illness, Infection Connection will offer insights you won't find anywhere else. Expect evidence-based strategies, cutting-edge perspectives, and real-world case studies that connect the dots between infection and dysfunction. Why the Change? If you've been subscribed to my previous podcast, you'll automatically receive new episodes of Infection Connection — no need to re-subscribe. The updated title and direction reflect where my work has naturally evolved: a deeper focus on infectious root causes and the protocols that work. What's Coming Up The first few episodes will cover: Ginkgo biloba and ME/CFS Herbal and supplement strategies for Long COVID The best herbs for infection-driven insomnia Stay Connected Subscribe wherever you get your podcasts, and don't forget to leave a review if you find the content helpful — it really helps others discover the show. To subscribe on your favorite podcast platform, click here: Subscribe to Infection Connection Podcast

A new study entitled, “The Efficacy of Palmitoylethanolamide (Levagen+) on the Incidence and Symptoms of Upper Respiratory Tract Infection-A Double Blind, Randomised, Placebo-Controlled Trial” aimed to evaluate the effectiveness of a signaling lipid called Palmitoylethanolamide (PEA) in reducing the occurrence, duration, and severity of upper respiratory tract infections(URTIs). The results showed that participants who took PEA experienced fewer URTI episodes and had reduced symptoms compared to those who took a placebo, suggesting that PEA may be a safe and effective treatment option for URTIs. Palmitoylethanolamide (PEA) is a lipid compound that belongs to the N-acylethanolamine (NAE) family and has similar properties to endocannabinoids. In the context of cold and flu infections, PEA is suggested to regulate interleukins and inhibit mast cell production, thereby reducing inflammation. PEA activates NF-κB pathways through peroxisome proliferator-activated receptors (PPAR), particularly PPAR-α, and concentration-dependent mechanisms to decrease NLRP3 and inflammasome activation, ultimately leading to a decrease in the expression of cytokines and alleviation of upper respiratory tract infection symptoms. It is worth noting that the natural levels of PEA in the body and the use of PEA supplements have been found to be ineffective in producing significant clinical results due to poor absorption, resulting in low levels of PEA in the bloodstream. However, when PEA is combined with dispersion technology, such as Levagen+, the absorption of PEA is greatly improved, leading to higher concentrations in the bloodstream, which may enable a therapeutic effect. This study was conducted over a period of 12 weeks. It was a double-blind, randomized, placebo-controlled trial, where participants were divided into two groups: an active group receiving 300 mg of Levagen+ PEA twice a day and a placebo group receiving maltodextrin. The purpose of the study was to investigate the efficacy of Levagen+ PEA compared to the placebo in terms of the incidence, severity, and duration of upper respiratory tract infections (URTI).   During the study, 87 participants out of the total enrolled experienced at least one URTI, resulting in a total of 103 URTI episodes. The group receiving Levagen+ PEA reported significantly fewer URTI episodes (39) compared to the placebo group (64), and a lower number of participants who fell sick at least once during the study (32 vs. 55) when compared to the placebo group. Participants in the Levagen+ PEA group reported a significantly lower severity score for scratchy throat and cough. Overall, compliance with the study was high for both groups in terms of capsule consumption. The findings of the study indicate that individuals in the Levagen+ PEA group had a significantly lower number of upper respiratory tract infection (URTI) episodes compared to the placebo group. The study suggests that Levagen+ PEA could be a viable treatment for preventing upper respiratory tract infections (URTIs) and alleviating symptoms of cold and flu. The findings indicate that Levagen+ PEA is safe and effective in reducing the frequency of URTI episodes and relieving scratchy throats and coughing in individuals with URTI symptoms. I use PEA Luteolin Select from Moss Nutrition, which contains 300 mg of Levagen+ PEA and 50 mg of the flavonoid luteolin per capsule. PEA and luteolin have been shown to work synergistically in COVID-19-related illnesses such as Long COVID. I have patients take 1 capsule twice a day with meals of PEA Luteolin Select during COVID-19, cold, and flu season for prevention and then increase to 2 capsules three times a day when they feel like they're coming down with something. Hedberg Institute Members can download my latest upper respiratory tract infection protocols by logging in. Click here to learn more about the Hedberg Institute Membership.

A new paper entitled “Isorhamnetin protects porcine oocytes from zearalenone-induced reproductive toxicity through the PI3K/Akt signaling pathway” investigated the effects of a natural flavonoid called isorhamnetin on the damage caused by a toxin called Zearalenone (ZEA) to pig oocytes (immature egg cells). Zearalenone (ZEA) is a harmful mycotoxin found in moldy grain like corn, oats, and millet that can cause irreversible damage to the reproductive system of animals and humans. It can cause reproductive disorders by binding to estrogen receptors and has been shown to impair the development of sperm and oocytes in humans and animals. ZEA can cause oxidative stress that leads to the production of reactive oxygen species (ROS), which can be harmful and contribute to cell death. ZEA can also disrupt pregnancy, inhibit the meiosis of oocytes, and induce mitochondrial damage and stress in the maturation of oocytes. Since ZEA is heat-stable and cannot be completely eliminated from the food chain, it is important to explore potential compounds that can protect against ZEA-induced damage to oocytes. In recent years, natural substances called flavonoids, which have antioxidant properties, have gained attention for their ability to support the development of oocytes. For example, quercetin has been found to increase the proportion of porcine oocytes developing into blastocysts, while kaempferol has shown potential in reducing the negative effects of aging on the development of porcine oocytes by improving mitochondrial function and reducing oxidative stress. Isorhamnetin is a compound found in the herb ginkgo biloba and in foods like pears, onions, and peanuts. It has various pharmacological activities, such as being an antioxidant, anti-inflammatory, and antiviral.     Isorhamnetin acts as an antioxidant by decreasing the production of reactive oxygen species (ROS) and increasing the expression of SOD2 protein, which helps protect against oxidative stress. This study found that isorhamnetin can protect the oocytes from ZEA-induced damage by improving their development, reducing oxidative stress, preventing mitochondrial dysfunction, and inhibiting apoptosis. This research provides a potential solution for reproductive toxicity caused by ZEA and treating female infertility. Mold Toxicity and Ginkgo Biloba Clinical Applications Ginkgo biloba is rich in isorhamnetin as well as other powerful flavonoids like quercetin, kaempferol, and luteolin which makes it the perfect herb for patients with mold toxicity. Ginkgo biloba has many benefits including anti-inflammatory, antioxidant, antiviral, anticoagulant, anti-obesity, hypolipidemic, hypotensive, anti-diabetic, anti-cancer, adaptogenic, and it protects the brain, eye, inner ear, heart, liver, cardiovascular system, reproductive system, lungs, and kidneys. Patients with mold toxicity tend to have reactivated herpes viruses like EBV, CMV, and HHV-6 and ginkgo biloba is effective against these types of viruses as explained in this article. I use VascuSelect from Moss Nutrition which contains 120 mg of standardized ginkgo biloba extract along with grape seed extract and mango extract to further support microcirculation. 120 mg of ginkgo biloba twice a day is the usual dose for this versatile herbal medicine. If you're a practitioner who sees patients with mold toxicity and/or infertility, then VascuSelect should be considered an important part of your protocol. Click here to learn more about the Hedberg Institute Membership to take your functional medicine practice to the next level.

A new paper published in the journal Science entitled, “Persistent complement dysregulation with signs of thromboinflammation in active Long Covid” sheds light on the causes of Long COVID. The authors begin by pointing out the current hypotheses about the causes of Long COVID, including persistent inflammation, autoimmunity, tissue damage, and viral reservoirs. In this study, researchers followed 39 healthy individuals and 113 COVID-19 patients for up to a year to identify biomarkers associated with Long COVID. At the 6-month follow-up, 40 patients still experienced Long COVID symptoms. They collected blood samples and measured over 6500 proteins to identify potential biomarkers using computational tools and experimental evaluation. In patients with Long COVID, there was an increased activation of the complement system, which is a part of the immune system that helps fight pathogens and damaged cells. This activation persists even after the acute phase of the disease. The complement system can cause damage to cell membranes, and in Long COVID patients, there is an imbalance in the formation of a complex called the terminal complement complex (TCC), also known as the membrane attack complex (MAC), which contributes to tissue damage. Long COVID patients experienced increased markers of tissue injury in their blood, along with a thromboinflammatory signature. This means that there are signs of damage to tissues and an abnormal immune response involving the activation of endothelial cells and the breakdown of red blood cells. These findings suggest that Long COVID is associated with ongoing inflammation and potential blood clotting issues. In patients with Long COVID, there are lower levels of antithrombin III, a protein that helps regulate blood clotting. This leads to increased cleavage by thrombin, which is a key factor in the formation of terminal complement complexes (TCCs). Additionally, Long COVID patients show elevated markers of platelet activation and the presence of monocyte-platelet aggregates, particularly in cases where Long COVID symptoms persist for 12 months or more. These patients also exhibit signs of antibody-mediated activation of the classical complement pathway, which is associated with increased levels of antibodies against cytomegalovirus (CMV) and Epstein-Barr virus (EBV). In this study, the researchers also used a sensitive test to measure antinuclear antibodies (ANA) in patients with Long COVID. They found that patients with Long COVID had a higher prevalence of positive ANA results compared to those without Long COVID. Positive ANA tests can indicate autoimmunity. Based on the data presented, it is suggested that Long COVID patients should undergo early cardiovascular assessment due to potential cardiovascular complications. Additionally, antiviral medications targeting SARS-CoV-2 or herpesviruses may help reduce inflammation and blood clotting in Long COVID patients. Therapies that target the terminal complement pathway could also be explored as potential treatment strategies for Long COVID and other post-infection syndromes. Long COVID Clinical Applications This paper confirms that inflammation of the blood vessels is common in Long COVID. Supporting microcirculation with herbs like ginkgo biloba, grape seed extract, and mango fruit powder can help reduce this inflammation and repair damaged blood vessels. These three herbs also are effective anti-viral agents against viruses like Epstein-Barr Virus (EBV) and Cytomegalovirus (CMV). Ginkgo biloba has been shown to help improve the symptoms of Long COVID. I use VascuSelect from Moss Nutrition which contains standardized forms of ginkgo biloba, grape seed extract, and mango fruit powder. I also use palmitoylethanolamide (PEA) combined with luteolin to reduce inflammation and fight chronic viruses. Both of these are found in PEA Luteolin Select from Moss Nutrition.

Ginkgo biloba, known for its distinctive fan-shaped leaves, has been used in traditional medicine for centuries, particularly in Asia. Ginkgo biloba is often touted as an herb for brain health, such as improving memory and cognition. This reputation does a great disservice to the most versatile herb in the world. Ginkgo biloba can be used as a potent antiviral agent for a variety of viruses. Ginkgo biloba has some key bioactive antiviral components: Flavonoids and Terpenoids: Ginkgo leaves contain high levels of flavonoids and terpenoids, compounds known for their antioxidant properties. These substances contribute to the antiviral activity of the plant. Ginkgolides and Bilobalides: These are unique terpene trilactones found in Ginkgo biloba, which have specific antiviral activities. Ginkgo Biloba's Mechanisms of Antiviral Action The antiviral properties of Ginkgo biloba are multi-faceted, involving multiple mechanisms: Inhibition of the fusions and synthesis of proteins in the viruses herpes simplex 1 and 2 (HSV-1 and HSV-2). Inhibition of genome replication in cytomegalovirus (HCMV) and Zika virus (ZIKV). Inhibition of viral fusion proteins in HIV, Ebola virus (EBOV), influenza A virus (IAV), and Epstein-Barr virus (EBV). Inhibition of the targeting protein and DNA of coronoviruses (SARS-CoV-2), varicella zoster virus (VZV), and measles virus. Inhibition of Viral Entry and Replication: Some studies suggest that Ginkgo biloba extracts can interfere with the ability of viruses to enter host cells or replicate. This is a key step in preventing the spread of viral infections. Immune System Modulation: Ginkgo biloba might enhance the body's immune response against viral infections. By modulating immune functions, it could help in controlling viral spread and severity. Anti-inflammatory Effects: The anti-inflammatory properties of Ginkgo biloba can be beneficial in reducing the severity of symptoms associated with viral infections. Research on Ginkgo Biloba's Antiviral Properties Anti-MERS-CoV and Anti-HCoV-229E Properties: A study focused on the antiviral activities of Ginkgo biloba leaf extracts against Middle East Respiratory Syndrome Coronavirus (MERS-CoV) and Human Coronavirus 229E (HCoV-229E). Inhibition of Enveloped Viruses: Research published in Scientific Reports discussed how ginkgolic acid, a component of Ginkgo biloba, inhibits the fusion of enveloped viruses. The study found that ginkgolic acid had a strong inhibitory effect on Human Cytomegalovirus (HCMV) and also tested its effects on Herpes Simplex Virus-1 (HSV-1) and Zika Virus (ZIKV). Researchers also found broad spectrum inhibition by ginkgolic acid of all three classes of fusion proteins including HIV, Ebola virus (EBOV), influenza A virus (IAV) and Epstein Barr virus (EBV). In addition, inhibition was found of a non-enveloped adenovirus. The authors conclude that ginkolic acids may potentially be used to treat acute infections (e.g. Coronavirus, EBOV, ZIKV, IAV and measles), and also topically for the successful treatment of active lesions (e.g. HSV-1, HSV-2 and varicella-zoster virus (VZV)). It was observed that ginkgolic acid could inhibit the entry of these viruses into cells, thereby blocking viral replication. Another study entitled, “Ginkgolic acids inhibit SARS-CoV-2 and its variants by blocking the spike protein/ACE2 interplay” found that ginkgolic acids from ginkgo biloba inhibited the SARS-CoV-2 virus from binding to the ACE2 receptor and thus could potentially be helpful in acute COVID-19 infections. I use VascuSelect from Moss Nutrition which contains 120 mg of ginkgo biloba, 100 mg of grape seed extract, and 100 mg of mango fruit powder per capsule for acute and chronic viruses dosed 1 capsule once or twice a day with or without food. Grape seed extract and mango fruit powder have also been shown to have antiviral properties. This trio of herbs not only has antiviral prop...

For people with food sensitivities and chronic digestive disorders, the holiday season can be tough. Invitations to indulge in forbidden foods are everywhere—from checkout lines and television ads to office parties and family gatherings. For many, resisting temptation may be an insurmountable challenge. Sometimes, the visceral presence or memory of how a particular savory dish or sweet treat made one feel in the past is enough to cause one to forget (or simply not care) how that food will make one feel in the present. Which is to say: lousy. Bloated, flatulent, running to the toilet, or in pain. The aftermath of a holiday feast can leave anybody feeling a little sluggish the next day, but those with a medical reason to avoid certain foods might need extra support to recover. A “3-Day Gut Reset” incorporating a full elemental diet is probably the quickest way to restore digestive function and comfort following such dietary indiscretions. This brief, modified, protein-sparing fast is easy to implement with a product such as Elemental Select™, Moss Nutrition's tasty, vanilla flavored meal replacement powder. Elemental Select™ contains all the essential vitamins, minerals, and macronutrients needed for proper physiologic function, in their “elemental” predigested forms. When mixed with water, this complete, easy-to-absorb nutritional shake can be consumed throughout the day without putting any strain on the digestive organs, enabling rapid intestinal healing and repair over the brief course of a three-day period. Both full and partial elemental diets are recognized as important management strategies for people with digestive disorders. A full elemental diet, for example, was recently shown to prevent surgical recurrence of severe inflammatory bowel disease at a dose of 1200 calories per day. Decreasing intestinal inflammation, reversing leaky gut syndrome and intestinal permeability, rebalancing the microbiome, and improving digestive health are among the clinically researched benefits of elemental diet therapies. Typically, elemental diets are employed over a period of two to six weeks. But shorter, intensive applications can help with rapid recovery from a relapse, such as may occur when patients with compromised digestion indulge in a holiday spree. A few days of full elemental diet protocol can make a significant difference in helping these folks get back on track and quickly feel their best. One 30-serving container of Elemental Select™ is sufficient to complete an entire 3-Day Gut Reset. The patient simply consumes ten scoops of the product per day, and nothing else. (Each scoop contains 150 calories of bioavailable nutrition; therefore, ten scoops provide 1500 calories, enough energy for most people to function normally.) The ten daily scoops may be divided in various ways, depending entirely on individual patient preferences. The most popular method is as follows: In a blender, combine two scoops of Elemental Select™ with 8 to 10 ounces of water. Consume five times per day, at regular intervals.  While two scoops, five times a day is ideal for most people doing a 3-Day Gut Reset, some may prefer to mix a single scoop in 8 ounces of water, and repeat ten times per day, generally on the hour. Others may opt to divide their daily ten scoops into three or four equal servings, and replicate a “breakfast, lunch, and dinner” routine, with optional snack. (In this latter case, at least 16 ounces of water should be used to blend each “meal,” since several scoops of powder will be taken at once.) All these dosing options are absolutely fine. Whatever schedule is chosen, it is critical to remember that Elemental Select™ is an extremely nutrient dense formula. Its nutrient density requires that Elemental Select™ must always be sipped slowly, never gulped. Using a straw may be helpful in ensuring this aim is met. If the product is consumed too quickly, stomach upset may occur.

Long COVID, also known as post-acute sequelae of SARS-CoV-2 infection (PASC) or long-haul COVID, refers to a condition where individuals experience persistent symptoms or develop new symptoms after recovering from the acute phase of COVID-19. Long COVID can affect individuals who had mild, moderate, or severe initial COVID-19 infections and can persist for weeks or months after the initial illness. The specific symptoms and their duration can vary widely between individuals, but common symptoms of long COVID include fatigue, shortness of breath, cough, joint pain, chest pain, muscle weakness, brain fog, difficulty concentrating, memory problems, sleep issues, depression, anxiety, and other neurological or psychiatric symptoms. It can also affect multiple organs in the body, such as the heart, lungs, kidneys, and brain. How does COVID-19 affect microcirculation? Microcirculation refers to the circulation of blood in the smallest blood vessels, including arterioles, capillaries, and venules. While COVID-19 primarily affects the respiratory system, there is evidence suggesting that it can have systemic effects, including impacts on the cardiovascular system and microcirculation. Here are some potential ways in which COVID-19 may affect microcirculation: Endothelial Dysfunction: COVID-19 has been associated with endothelial dysfunction, which is a condition where the cells lining blood vessels (endothelial cells) do not function properly. Endothelial dysfunction can lead to impaired regulation of blood flow and increased permeability of blood vessels. In severe cases, viral infection and the resulting immune response may damage endothelial cells, contributing to a pro-inflammatory state and a potential disruption of microcirculation. Blood Clotting and Thrombosis: COVID-19 is known to be associated with an increased risk of blood clot formation (thrombosis). The formation of blood clots can potentially affect microcirculation by blocking small blood vessels. The hypercoagulable state observed in some COVID-19 patients may contribute to microvascular thrombosis, leading to impaired blood flow in affected tissues. Inflammatory Response: The body's inflammatory response to the virus can also impact microcirculation. Inflammation can lead to the release of inflammatory mediators, causing vasodilation (widening of blood vessels) and increased permeability, which may affect blood flow in the microcirculation. Hypoxia and Tissue Damage: Severe cases of COVID-19 may lead to respiratory distress and hypoxia (low oxygen levels). Hypoxia can have detrimental effects on tissues and organs, potentially impacting microcirculation. Tissue damage and inflammation in the lungs may trigger a systemic response that affects microvascular function in other organs. Impaired Oxygen Delivery: In severe cases of COVID-19, where acute respiratory distress syndrome (ARDS) develops, oxygen exchange in the lungs becomes compromised. This can lead to inadequate oxygen delivery to tissues and affect microcirculation. What is grapeseed extract? Grapeseed extract is a dietary supplement derived from the seeds of grapes. It is rich in antioxidants, particularly compounds known as oligomeric proanthocyanidin complexes (OPCs). Additionally, grape seed extract contains flavonoids, another class of polyphenols with antioxidant properties. These antioxidants help protect the body against damage from harmful free radicals, which can play a role in various chronic diseases. Grapeseed extract is commonly used for its potential health benefits, including improved cardiovascular health, reduced inflammation, enhanced immune function, and anti-aging effects. How does grapeseed extract improve microcirculation in Long COVID? The proanthocyanidins in grape seed extract help improve blood flow and circulation. By promoting the dilation of blood vessels, the extract supports the cardiovascular system's ...

SARS-CoV-2, the virus that causes COVID-19, can severely damage the body's circulatory vessels, which inhibits oxygen, hormones, and nutrients from getting to vital body tissues. Patients with Long COVID have been shown to have impaired microcirculation up to 18 months after infection, and possibly even longer if those vessels aren't repaired. Damaged microcirculation can lead to many of the symptoms of Long COVID including fatigue, difficulty recovering from exercise, brain fog, sluggish brain function, muscle weakness, depressed mood, loss of smell and taste, to name a few of the most common symptoms. Mango fruit powder has been shown to improve microcirculation in a couple of excellent studies I will cover below. Mango (Mangifera indica) has the following properties: · Rich in polyphenols · Activates Sirt-1 – antioxidant, improves endothelial function, anti-inflammatory, enhances metabolism · Activates AMPK – improves muscle glucose uptake and fatty acid oxidation, hepatic fatty acid oxidation, lipid homeostasis, balances blood sugar, improves endothelial function · Improves eNOS – improves endothelial function, increases energy, antioxidant · Supports mitochondrial neogenesis The first study entitled “Effects of Mangifera indica (Careless) on Microcirculation and Glucose Metabolism in Healthy Volunteers” was a double-blind, randomized study. The name “Careless” was changed to “Careflow” for good reason because it is more descriptive of the benefits of mango fruit powder. 204 subjects were divided into three groups. One group took 100 mg a day of mango fruit powder. The second group took 300 mg of mango fruit powder. And the third group was the placebo group. Mango fruit powder was taken every day for 4 weeks. Microcirculation and endothelial function were assessed. Microcirculatory reactive hyperemia flow increased, especially in the 100 mg group. 300 mg of the mango fruit preparation reduced postprandial glucose levels compared to placebo, accompanied by significantly lower HbA1c values compared to baseline. 300 mg intake significantly improved postprandial endothelial function in individuals with decreased endothelial function after high-dose glucose intake. Both doses were well tolerated without side effects. The second study entitled “In Vitro Activation of eNOS by Mangifera indica (Careless™) and Determination of an Effective Dosage in a Randomized, Double-Blind, Human Pilot Study on Microcirculation” showed similar results on microcirculation. In this study, a dose of 100 mg or 300 mg of mango fruit powder was given to see the effects on microcirculation in a randomized, double-blind, crossover pilot study in ten healthy women. Both doses improved cutaneous blood flow, indicating improved microcirculation. Both doses were well tolerated without side effects. Both of the above studies clearly show the benefits of mango fruit powder on microcirculation which can help patients with Long COVID. Why not just eat mangos? Careflow, the mango fruit powder used in these studies, is standardized to 0.03% mangiferin which is vital for maximum effectiveness. Additionally, the mango subspecies used in Careflow is called “Kili-mooku” as opposed to the “Alfonso” mangos found in supermarkets. Mangos are cultivated in the South of India in the Tamil Nadu region as opposed to Brazil and Peru where commercial mangos come from. Kili-mooku mangos are harvested just at the right time when the beneficial plant ingredients are at their highest levels and manufactured in Germany to the highest standards. I designed VascuSelect by Moss Nutrition to contain 100 mg of Careflow standardized mango whole fruit powder along with grape seed extract and ginkgo biloba to repair and restore microcirculation. This makes VascuSelect a perfect formula for those suffering with Long COVID. I use one capsule twice a day with my patients suffering from Long COVID.

5 case reports were reported in an excellent paper on ginkgo biloba and Long COVID symptoms. Patients with Long COVID were given 80 mg of ginkgo biloba extract (EGb 761) twice a day. Patient 1 took ginkgo biloba for 11 weeks, and he had a substantial improvement in cognitive concerns, decreased perception of fatigue and an improvement in olfaction. He completely regained his sense of smell. Patient 2 took ginkgo biloba for 13 weeks and reported improvement in concentration and fatigue. Patient 3 took ginkgo biloba for 4 months and reported significant improvement in cognitive deficits. Patient 4 took ginkgo biloba for 7 weeks and reported improved concentration and fatigue. Patient 5 took ginkgo biloba for 6 weeks and reported improvement in depression, fatigue, irritability, and hyposmia. Two of these patients reported complete remission of their cognitive symptoms. None of the patients had any adverse effects. SARS-CoV-2, the virus that causes COVID-19, has been shown to damage the microcirculation blood vessels resulting in decreased blood flow to vital tissues such as the heart, kidney, muscle tissue, ear, eyes, liver, brain and nervous system. Ginkgo biloba has been shown to protect and repair large and small blood vessels, as well as a host of other body tissues. Ginkgo biloba has antioxidant properties, improves circulation, repairs and protects the brain, nervous system, eye, ear, kidney, intestine, heart, and cardiovascular system. This makes ginkgo biloba a perfect herbal medicine for Long COVID, and the results of these case reports are not surprising. How best to take ginkgo biloba? Ginkgo biloba is usually dosed 120-240 mg a day in one or two doses with or without food. It can disrupt sleep, so some people may need to take it in the morning and no later than the early afternoon. The dose used in this study was 80 mg twice a day totaling 160 mg a day. But the author's point out that a higher dose may have yielded even better results. I normally use 120 mg twice a day with my patients. Ginkgo biloba side effects such as headache only occur in 2% of people who take it. It can take up to six weeks to notice the full effects of ginkgo biloba so give it some time to work. My formula VascuSelect from Moss Nutrition contains 120 mg of ginkgo biloba per capsule with added grape seed extract and mango fruit powder. Grape seed extract and mango also support and repair microcirculation for a synergistic effect with the ginkgo biloba. Ginkgo biloba should be standardized to 24% flavonol glycosides and 6% terpenes for maximum effectiveness. Please be sure to consult with your licensed healthcare professional before supplementing with ginkgo biloba due to potential risks of bleeding disorders. Certain medications can increase the risk of bleeding when combined with ginkgo biloba. Long COVID is having devastating consequences on society and new natural treatments are constantly emerging to help. Ginkgo biloba is now part of my evidence-based core Long COVID protocol. Hedberg Institute members can log in and download my latest Long COVID protocol.

The endogenous compound PEA (palmitoylethanolamide) is a natural anti-inflammatory agent which works in affiliation with the endocannabinoid system to help modulate pain. PEA was first discovered in the 1950s after being isolated from the lipid fraction of egg yolk. In recent years, PEA research has largely focused on neuropathic pain states and mast cell related disorders. However, earlier research often was directed toward the ability of PEA to support upper respiratory health, a line of inquiry stemming from prior observations regarding the efficacy of egg yolk in preventing rheumatic fever. PEA for Cold and Flu During the 1970s, six large placebo-controlled trials were conducted to investigate PEA as a cold and flu therapy. For this research, commercial grade PEA (trade name Impulsin) was used. These early studies, which engaged close to 4,000 subjects in total, yielded remarkable results. Trials conducted during the flu season demonstrated significant efficacy in both prophylaxis and treatment, with no adverse effects reported. In a study where adult subjects took 600 mg of PEA three times per day or an identical placebo, incidence of disease over a twelve-week period was reduced by up to 40% in the PEA group. In another trial, subjects with cold or flu who took PEA missed significantly fewer days of work, and experienced significantly less fever, headache, and sore throat than subjects taking placebo. Follow-up studies designed to replicate these findings further showed a significant reduction in acute respiratory infections after administration of PEA. The ability of PEA to downmodulate proinflammatory cytokine activity was proposed as a primary mechanism of action. In the decades since this early research was performed, enhanced absorption PEA enabling higher efficacy at lower doses has been developed. One such PEA formulation, Levagen+, exhibits up to 75% increased absorption compared to commercial PEA, and has been clinically researched in humans for a variety of uses, including upper respiratory health. PEA and COVID-19 A recent, double-blind, placebo-controlled study gave 600 mg of Levagen+ PEA or placebo twice daily to non-vaccinated outpatients with verified mild to moderate COVID-19 infection. Serum inflammatory biomarkers were evaluated at baseline, and after four weeks of treatment. At the end of the study period, only subjects in the Levagen+ group exhibited significant reductions in inflammatory biomarkers, most notably in levels of P-selectin, a thromboinflammatory marker known to be elevated in cases of severe COVID and other conditions marked by increased inflammation and thrombosis, for example, cardiometabolic disease. Levagen+ is the form of PEA used in Moss Nutrition PEA Luteolin Select™. The product also contains luteolin, an antioxidant bioflavonoid shown to work synergistically with, and enhance, the benefits of PEA. Hedberg Institute members can log in to access the COVID-19, Long COVID, cold, and flu protocols. Practitioners who are interested in learning more about the Hedberg Institute Membership click here for more details. References: Keppel Hesselink JM, de Boer T, et al. Palmitoylethanolamide: A Natural Body-Own Anti-Inflammatory Agent, Effective and Safe against Influenza and Common Cold. Int J Inflam. 2013;2013:151028. Fessler SN, Liu L, et al. Palmitoylethanolamide Reduces Proinflammatory Markers in Unvaccinated Adults Recently Diagnosed with COVID-19: A Randomized Controlled Trial. J Nutr. 2022 Oct; 152(10): 2218–2226.

Palmitoylethanolamide (PEA) is a naturally occurring endocannabinoid-like lipid mediator naturally found in many plants. PEA is analgesic, immunomodulatory, neuroprotective, antipyretic, antiepileptic, anti-inflammatory, anticonvulsant, antibacterial and antiviral. PEA also increases endocannabinoids and it down regulates mast cell activation.  PEA can improve immune system function without increasing inflammation. PEA also regulates fatty acid metabolism, reduces oxidation of fats, and inhibits excessive nitric oxide. PEA may contribute to enhanced muscle recovery and improved cognition, mood and sleep. PEA may be indicated for anti-aging, immunoenhancement, brain health, allergies, and joint health. These properties make PEA a perfect compound for managing the difficult symptoms of Long COVID. Studies on PEA and Long COVID A recent study entitled, “The Use of Palmitoylethanolamide in the Treatment of Long COVID: A Real-Life Retrospective Cohort Study” looked at the potential benefits of PEA for Long COVID symptoms. Some of the most common Long COVID symptoms include fatigue, brain fog, headache, exercise intolerance, trouble breathing, memory lapse, anosmia, dysgeusia, depression, anxiety, psychosis, nervous asthenia, PTSD, insomnia, delirium and anhedonia. How was the study done? 33 (10 male and 23 female) patients were given 600 mg PEA twice a day for 3 months. All patients were administered the post-COVID-19 Functional Status (PCFS) scale, to assess meaningful function, before (T0) and at the end of the treatment (T1). None of the patients had any side effects from the PEA. Study results All the patients experienced improvement in their Long COVID symptoms as measured by the Post-COVID-19 Functional Status scale. PEA, Luteolin, and Long COVID Studies The combination of PEA and Luteolin has been studied extensively, with multiple published papers showing the synergistic benefits of these two compounds. PEA and luteolin have been shown to reduce neuroinflammation by modulating microglia and reducing reactive oxygen species (ROS). Luteolin is a flavonoid, specifically a flavone, found naturally in fruits, vegetables, and herbs such as celery, parsley, lettuce, spinach, peppers, broccoli, cabbage, carrots, onions (leaves), and apples (skins). Luteolin is similar in structure to quercetin, but luteolin is more potent and is sometimes referred to as a “supercharged” quercetin. Luteolin has the following properties: Anti-inflammatory Anti-neurodegenerative (neuroprotective) Mast cell stabilizer Antioxidant Anticancer Antiallergy Antihypertensive Antiviral Antidiabetic Another study entitled, “What Is the Role of Palmitoylethanolamide Co-Ultramicronized with Luteolin on the Symptomatology Reported by Patients Suffering from Long COVID? A Retrospective Analysis Performed by a Group of General Practitioners in a Real-Life Setting” looked at the medical charts of 49 patients with Long COVID who were treated by one of nine doctors in Rome, Italy. The patients were treated with 700 mg of PEA and 70 mg of luteolin twice a day for 90 days. No side effects were reported during treatment, nor any drug interactions with their medications. The authors conclude, “Supplementation with PEALUT (PEA and Luteolin) helped to improve all patient-reported symptoms, especially pain, anxiety and depression, fatigue, brain fog, anosmia and dysgeusia, leading to an overall improvement in patients' health status.” PEA and luteolin have been found to be effective for post-COVID loss of smell (anosmia) and memory loss. The first study entitled, “Ultramicronized Palmitoylethanolamide and Luteolin Supplement Combined with Olfactory Training to Treat Post-COVID-19 Olfactory Impairment: A Multi-Center Double-Blinded Randomized Placebo- Controlled Clinical Trial” was done for 90 days on subjects who took 700 mg of PEA and 70 mg of luteolin once a day combined with olfac...

A new study entitled, “Coenzyme Q10 + alpha lipoic acid for chronic COVID syndrome” has been published in the journal Clinical and Experimental Medicine which found that supplementation with Coenzyme Q10 (CoQ10) and alpha lipoic acid (ALA) may be helpful in Long COVID. COVID-19 can deplete CoQ10 levels and damage the mitochondria which are important for energy production and immune system function. CoQ10 and alpha lipoic acid can both be helpful in protecting and supporting mitochondrial function by reducing oxidative stress. CoQ10 deficiency can lead to decreased energy production resulting in fatigue and increased free radical production. Fatigue is by far the most common symptom reported in Long COVID so CoQ10 is at the top of the list of supplements to try with this condition. Alpha lipoic acid is a powerful antioxidant, and it is involved in mitochondrial energy production. ALA also has immunomodulatory properties and may actually be an anti-viral as well. The properties of both nutrients in theory make them a promising combination in the treatment of Long COVID. How was the study done? 174 patients (51% male and 49% female) aged 18-81 (mean of 51) who had COVID-19 previously and met the 2015 National Academy of Medicine diagnostic criteria of myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS). 52% had comorbidities including chronic lung disease (16%, 28/174), diabetes mellitus (13%,23/174), psychiatric diseases (7.5%, 13/174), and rheumatic diseases (9.8%, 17/174). 17.8% (31) of patients had been previously hospitalized for severe respiratory SARS-CoV-2 pneumonia. 82.2% had mild/moderate symptoms during the acute phase. The mean duration of Long COVID symptoms was 5.9 months. The most common symptoms were fatigue (80%), impaired concentration (68%), sleep disorders (85%) disturbed smell and/or taste (60%), memory loss (45%), dyspnea (21%) and arthromyalgias (64%). Patients were divided into two groups. The first one (116 patients) received coenzyme Q10 (ubiquinone form) and alpha lipoic acid taken every day for two months at a dose of 100 mg of CoQ10 and 100 mg of alpha lipoic acid twice a day. The control group of 58 patients did not take either supplement. The characteristics of the patients in the two groups were similar at baseline. Patients in both groups also received a variety of medications including paracetamol, codeine, NSAIDS, antidepressants (duloxetine), anticonvulsants and analgesics (pregabalin and gabapentin). They also undertook psychological and psychiatric counseling, physio-kinesiotherapy, yoga, and Pilates. What were the results? “The primary end-point was to evaluate the effectiveness of the association of coenzyme Q10 and alpha lipoic acid in reducing fatigue, expressed as a reduction in Fatigue Severity Scale (FSS), at the second month (T1), of at least 50% (complete response) from the baseline (T0) or at least 20% (partial response) from the baseline (T0). A reduction in FSS < 20% from baseline at T1 was considered as a non-response. A complete FSS response was reached most frequently in the treatment group compared to the control group. An FSS complete response was reached in 62 (53.5%) patients in the treatment group and in two (3.5%) patients in the control group. A reduction in FSS score < 20% from baseline at T1 (non-response) was observed in 11 patients in the treatment group (9.5%) and in 15 patients in the control group (25.9%) (p < 0.0001).” Author's Conclusion “Despite the short follow-up period, we demonstrated a clinical benefit, suggesting the rapid effect of this therapy. On the other hand, because of the short follow-up duration, we do not know if this clinical benefit persists over time. Our results, all based on subjective indices, were definitely in favor of the treatment group.” Dr. Hedberg's Comments on Long COVID, CoQ10, and Alpha Lipoic Acid This study shows promising results in the use of coenzyme Q10 and...

The elemental diet dates back to 1932 and is one of the most utilized tools by functional medicine practitioners. It is useful for a variety of gut-related conditions and even conditions outside the gut. The elemental diet is a liquid diet that reduces inflammation in the gut, heals the gut barrier, and has an antibacterial effect.The elemental diet is done with Elemental Select powder from Moss Nutrition. A full elemental diet can be done with 100% of daily calories coming from Elemental Select or a partial elemental diet with 25-75% of calories coming from Elemental Select and the rest from whole food sources. Elemental Select is mixed with water or in a blender with ice and consumed by slowly sipping the mixture over the entire day in divided doses. Click here to learn more about the Hedberg Institute Membership. The elemental diet may be helpful for the following conditions: IBS-C and IBS-D SIBO Crohn's disease Ulcerative colitis Diversion colitis Eosinophilic gastroenteritis and esophagitis GERD Gastritis Multiple food sensitivities Leaky Gut Constipation and diarrhea Short bowel syndrome High ileostomy output Ileal fistulas Pancreatitis Pancreatic insufficiency Pancreatic fistulas Bile-acid-induced diarrhea Refractory Celiac disease (gluten-free diet fails to resolve issues) Malabsorption Rheumatoid arthritis Eczema Psoriasis Stroke recovery Critical illness recovery COVID-19 and other viral illnesses MCAS Histamine intolerance Anemia Asthma Dermatitis herpetiformis Chronic kidney disease Cystic fibrosis HIV Cerebral palsy How does an elemental diet work? The elemental diet is purely vitamins, minerals, amino acids, medium chain triglycerides for fat, and simple carbohydrates. This means that digestion is not required so almost everything gets absorbed regardless of gut function. It is also void of any food-based compounds such as whey, pea, hemp, rice, soy, gluten, dairy, eggs, nuts etc. which makes it entirely hypoallergenic. There is virtually nothing in the elemental diet that the immune system can react to. This is a game-changer for those with food sensitivities and gut problems. There is also no fiber in the elemental diet, so it won't exacerbate SIBO or IBS. The elemental diet also allows your digestive organs to rest. The stomach doesn't have to pump out as much hydrochloric acid, the pancreas doesn't have to make so many enzymes, and the gall bladder can rest as well. The elemental diet contains all the right amino acids for healing the gut barrier. For those with leaky gut syndrome or malabsorption, it can rapidly heal the gut. The elemental diet reduces pathogenic bacteria in the gut and can also improve healthy bacteria diversity. This helps reduce inflammation in the gut so the microbiome can become more balanced. This is why the elemental diet is so effective for SIBO, IBS, and IBD. How to follow an elemental diet? Elemental Select from Moss Nutrition contains 150 calories per scoop, and total daily calories should be determined by a healthcare professional.  The first option is a Full Elemental Diet with 100% of daily calories consumed from Elemental Select. Sample 1,500 calorie/day protocol: 10 total scoops/day = 1,500 calories 4 scoops in the AM divided into 4 separate 8-ounce glasses of water. Mix 1 scoop with 8 ounces of water and sip slowly over a 20-60 minute period. Repeat for the next 3 scoops. Alternatively, all 4 scoops can be mixed with 32 ounces of water and sipped slowly over a 1-4 hour period. 3 scoops around lunch time. Same consumption guidelines as noted above sipped slowly over a 1-3 hour period. 3 scoops around dinner time. Same consumption guidelines as noted above sipped slowly over a 1-3 hour period. Alternatively, all 10 scoops in 10 glasses of water can be sipped slowly over the entire day without breaks.

Zinc Functions Zinc is an essential trace element required by almost every biological process in the human body including growth and development, immune function, wound healing, protein and DNA synthesis, and cell division. It is used in over 300 enzymatic reactions, serves as an anti-inflammatory and an antioxidant, and is important for sight, hearing, and taste. The system-wide ubiquity of zinc increases the clinical importance of detecting and supporting a deficiency when present. Unfortunately, it is frequently underutilized in clinical practice. Gaining a deeper understanding of the many roles zinc plays in human health, learning the appropriate methods for assessing deficiency, reviewing which conditions may benefit from supplementation with zinc, along with supplementation guidelines and recommendations will increase the clinician's confidence in the appropriate use of zinc with patients. Zinc Select Click here to learn more about the Hedberg Institute Membership. Causes of Zinc Deficiency The most common reasons for a zinc deficiency are increased losses of zinc, increased requirements for zinc, inadequate dietary intake, or reduced bioavailability/absorption of zinc. Increased losses can come from gastrointestinal diseases, surgery, trauma, oral contraceptives, and zinc lost in ejaculate with excessive sex. The requirement for zinc increases during periods of rapid growth, pregnancy, and lactation. Common examples of inadequate dietary intake include teenagers and college students as well as individuals following plant-based diets. Diets high in fiber are also rich in phytates which inhibit absorption. Dietary factors, such as the consumption of alcohol or following a vegetarian/vegan diet, can impair zinc absorption. Decreased absorption increases the risk for deficiency. Plant-based diets and diets high in seeds, legumes, and unprocessed whole grains contain phytates that bind with zinc, inhibiting its absorption. Soaking, sprouting, and/or fermenting can reduce the phytic acid content of these foods, increasing the bioavailability of zinc. It has been shown that the process of sour leavening to make sourdough bread reduced the phytate content by ~ 25% and increased the rate of zinc absorption by 30-50%. Other dietary factors that reduce the absorption rate include coffee, calcium in dairy products, increased fiber intake from fruits and vegetables, and a high fat diet (> 100g/day) in those with fat malabsorption issues. Deficiency can also be present in those with gastrointestinal issues that impair absorption such as Celiac disease, Crohn's disease, or bypass surgery, and in those with hypochlorhydria (commonly seen with aging). Assessment of Zinc Status Laboratory Assessment A zinc deficiency is not always easy to recognize. It can manifest as a variety of symptoms and routine laboratory testing does not provide a reliable indicator of zinc status. Low plasma stores of zinc (~0.1%) cause the standard blood test for plasma zinc concentrations to lack sensitivity and specificity, making it unreliable as a marker of deficiency. Therefore, an assessment of zinc status and a diagnosis of deficiency is largely based on clinical findings. Clinical Zinc Assessment Zinc homeostasis is primarily regulated by the amount of zinc in the diet. Clinical evaluation should include a detailed review of the patient's dietary eating patterns to determine if a deficiency is likely. The physical examination may reveal white spots on their fingernails and/or patches of dry skin. The patient history should be reviewed for associated conditions or medications known to cause impaired zinc absorption and a therapeutic trial of zinc may be recommended in those instances. A Zinc Taste Test provides a quick and inexpensive evaluation of zinc levels that can be conducted during the office visit. This test is not completely reliable due to the dependence on individual variances in self...

Berberine is an isoquinolone alkaloid that is bitter and bright golden yellow in color. It is derived mainly from the roots, stems and rhizomes of plants such as Coptis chinensis (Chinese golden thread), Hydrastis canadensis (goldenseal), Berberis aquifolium (Oregon grape), and Berberis vulgaris (barberry). It has been used for thousands of years in traditional Chinese and Ayurvedic medicine and is generally considered safe, though it should be avoided during pregnancy and lactation. Berberine Click here to learn more about the Hedberg Institute Membership. Gastrointestinal side effects may occur due to berberine's impact on bowel motility. These include abdominal pain, distention, nausea, vomiting, and constipation. Side effects appear to be dose dependent, with increased symptoms such as low blood pressure, dyspnea, and flu-like symptoms at higher doses. Berberine is commonly used as an antibacterial, antiviral, antimicrobial, antifungal, and antihyperlipidemic agent. The many therapeutic applications of berberine are due to its antioxidant and anti-inflammatory properties, making it one of the top supplements of choice in clinical practice. It has traditionally been used for gastrointestinal related issues as well as issues involving liver dysfunction, digestive complaints, blood sugar regulation, inflammation, and infectious diseases. While berberine has exhibited a bioavailability of

Background Information—Form and Function of B12 Vitamin B12 Form Cyanocobalamin has no known biochemical function. It must be converted to become active. It gets converted for use into hydroxocobalamin, methylcobalamin, or adenosylcobalamin. These three forms are equal in bioavailability.An exception to this is for the use of adenosylcobalamin in infants with a rare inborn error of synthesis.Methylcobalamin and adenosylcobalamin are coenzyme forms of B12.Hydroxocobalamin can be converted into the above two forms. Click here to learn more about the Hedberg Institute Membership. Vitamin B12 Function Vitamin B12 is used for DNA synthesis, homocysteine metabolism, S-adenosylmethionine, red blood cell formation, nervous system and immune system function.Vitamin B 12 is necessary for folate to be metabolized properly into Methionine and Succinyl-CoA. Low levels of B12 and increased levels of folate are associated with higher concentrations of methylmalonic acid (MMA) and total plasma homocysteine (HCY). Vitamin B12 Sources The average American diet contains adequate amounts of vitamins B12, ranging from 5-15 mcg/day. Meat, poultry, fish, eggs, and dairy, constitute the primary food sources. It is not found in most non-animal food sources. Individuals consuming a plant-based diet are at an increased risk of deficiency. Non-meat food sources such as chlorella, spirulina, nori, and fermented soy contain mostly B12 analogues which have no activity in humans. Fifty-one percent of those following a macrobiotic diet were found to be deficient.Vegan Diets 0.3-0.4 mcg/dayLacto-vegetarians 1.4 mcg/day Recommended Dietary Allowances (RDA)Males >14 years: 2.4 mcg/dayFemales >14 years: 2.4 mcg/dayPregnancy: 2.6 mcgLactation: 2.8 mcg Absorption of B12 Pepsin and hydrochloric acid (HCL) are necessary for cleaving B12 from protein in stomach.Individuals with low levels are at a greater risk of deficiency due to decreased break down for absorption.B12 supplements (crystalline B12) do not require HCL or pepsin to bind to intrinsic factor (IF).B12 supplements are absorbed normally in hypochlorhydria.Intrinsic factor (IF) is made in the stomach and necessary for carrying B12 from the stomach to intestines for absorption.Individuals with genetic SNPs impairing intrinsic factor (IF) production are also at a greater risk of deficiency and must rely on B12 injections, bypassing the need for IF.IF becomes fully saturated at 2 mcg of B12.Large doses can be absorbed through passive diffusion which doesn't require IF. This accounts for 1-2% of absorption.1000 mcg/day can overcome loss of IF due to pernicious anemia.Pernicious anemia is an autoimmune disease characterized by the destruction of parietal cells which produce IF. Possible Causes of Vitamin B12 Deficiency Pernicious anemia—Auto antibodies against parietal cells and IFGastric disease or surgeryChronic atrophic gastritis—parietal cell death/autoimmuneUse of gastric acid inhibitors (antacids, histamine receptor 2 antagonists, proton pump inhibitors)Pancreatic disease or pancreatectomyOther intestinal diseases: parasitic infections, bacterial overgrowth, ileal resection, impaired B12/IF absorption.Medications, such as cholestyramine and metformin, that impair B12 absorption or metabolism.Limited/poor food sources/choices that result in general malnutrition. Examples include vegan or vegetarian diet.Chronic alcoholismInherited disorders involved in B12 trafficking and metabolismMiscellaneous: including HIV and nitrous oxide anesthesiaConditions that result in chronic diarrhea or malabsorption states, such as celiac disease and Crohn's disease.Helicobacter pylori infection results in hypochlorhydria. Eradicating H Pylori can improve B12 levels.Long term psyllium supplementation (> 1 year)Genetic factors can affect absorption and transport. Individuals with genetically higher methylmalonic acid levels will require higher-than-normal B12 dose...

Many factors in our modern society increase the risk of magnesium deficiency, placing a vast number of individuals at risk of suboptimal levels. An individual's magnesium level can become depleted from issues such as medication usage, chronic diseases, poor magnesium content in crops and soil, and the increased consumption of refined and processed foods. Magtein Magnesium L-Threonate Click here to learn more about the Hedberg Institute Membership. Magnesium L-threonate offers a cost effective, safe for long term use, and well tolerated form of magnesium that provides optimum levels. It has been shown to be the only form of magnesium capable of increasing magnesium levels in the brain and cerebrospinal fluid (CSF). This ability to cross the blood brain barrier (BBB) increases its efficacy for use in many chronic disease states, especially those associated with central nervous system (CNS) dysfunction. Conditions that respond to magnesium l-threonateMagnesium L-Threonate and PainMagnesium is useful for treating chronic pain and inflammation that occurs due to the activation of the NMDA receptor during trauma. The NMDA receptor, which is normally not activated, becomes activated during traumatic physical or emotional events. During periods of excitotoxicity, calcium shuttles through the NMDA receptor and causes increased immune system responses (release of substance P, mast cells, immune cells, oxidative stress). Magnesium works to inhibit calcium influx through the NMDA receptor thereby decreasing oxidative stress as well as decreasing inflammation by blocking substance P. Blocking the NMDA receptor also serves to inhibit cortical spreading depression (CSD).3 Magnesium L-Threonate and MigraineMagnesium is also useful in treating migraine due to its ability to inhibit platelet activation. Platelet activation stimulates the release of serotonin which triggers spasming of blood vessels in the central nervous system (CNS) resulting in migraine. Magnesium inhibits calcitonin gene related peptide (CGRP) mediated vasodilation, another driver of migraine.3 Magnesium threonate is especially useful for the treatment of migraine as it is capable of crossing the blood brain barrier (BBB) and providing Mg2+ directly to the affected area. Magnesium L-Threonate and the EarMagnesium helps protect against hearing loss from noise as well as drug ototoxicity by decreasing the oxidative stress created by these stressors. Magnesium is also protective in sudden sensorineural hearing loss due to issues such as viral infections, vascular impairment, CNS disorders, inner ear abnormalities, or immune related mechanisms. Magnesium provides protection from hearing loss due to its ability to function as a Ca2+ antagonist, vasodilator, antioxidant, and a non-competitive NMDA antagonist.3 Magnesium threonate, with the ability to enter the CNS, is particularly useful in working with individuals with tinnitus. Protecting and Repairing the Hippocampus: Learning, Memory, and Emotion Alzheimer's diseaseAlzheimer's disease (AD) is associated with a magnesium deficiency in the serum or brain.7 Yu, Guan, Gu (2015) found that magnesium L-threonate enhanced the clearance of amyloid beta, the plaquing seen in AD. They demonstrated that magnesium L-threonate was able to slow the progression of AD.7 Magnesium threonate treatment was even effective at preventing synapse loss and memory decline when used in mice with end-stage AD.8 It has also demonstrated the ability to be neuroprotective against oxidative stress and hippocampal neuronal apoptosis.9 Chemotherapy-induced memory/emotional deficitsMagnesium L-threonate prevented oxaliplatin(OXA)-induced behavioral and synaptic changes in a 2020 study conducted using rats. This study showed that magnesium L-threonate prevented the OXA-induced upregulation of inflammatory cytokines such as tumor necrosis factor alpha (TNF-α) and nuclear factor-kappaB (NF-кB).

The combination of hydrochloric acid, lipase, and pepsin combine to create the acidic gastric juices found in the stomach. These healthy stomach acid levels serve as a first line of defense for the gastrointestinal system, preventing infectious agents from reaching the intestines. A normal gastric pH is considered to be present with pH values >3, with values below 4 capable of killing bacterial invaders within 15 minutes. Gastric juices with a pH >3 mark the beginning stages of hypochlorhydria. As the pH increases above 4, there is an increased prevalence of bacterial overgrowth. Achlorhydria is defined as a pH >7. Betaine HCL Click here to learn more about the Hedberg Institute Membership. There are two main categories of hypochlorhydria: iatrogenic and acquired. Iatrogenic hypochlorhydria is the most common, resulting from the use of medications to reduce gastric acid secretions. Proton pump inhibitors (PPIs) are one of the top ten most prescribed drugs in the world, contributing to the rise in iatrogenic hypochlorhydria. Malnutrition is the leading cause of acquired hypochlorhydria. Individuals taking PPIs generally have a pH between 5-7. Individuals with hypochlorhydria are at an increased risk for infection and disease due to a loss of this protective barrier. Research conducted by Martinsen, Fossmark, and Waldum (2019) demonstrated that individuals with hypochlorhydria were at an increased risk of a variety of infections including bacterial, fungal, and parasitic infections. One study they reviewed reported a significant decrease in Shannon's diversity of the GI microbiome and changes in 20% of the bacterial taxa in PPI users versus non-users. The increased use of PPIs makes it necessary to review current medications, both prescribed and over the counter, at each patient encounter. Nutritional status should also be evaluated utilizing blood labs, anthropometrics, diet diaries, food allergies/sensitivities, etc. Other useful factors in screening a patient for gastric hypoacidity include assessing gender, age, stress levels/eating behaviors, geographic origin/nationality, testing of stomach acid levels, and labs to rule out concurrent diseases such as Helicobacter pylori, chronic gastritis, parietal cell autoantibodies, hypothyroidism, etc. Keep in mind that there can be discrepancies between different testing methods and cutoff values depending on the labs used. Malnutrition can be the cause of or the result of hypochlorhydria. Malnutrition that leads to a deficiency in the nutrients needed to make HCL can cause hypochlorhydria. These include chloride, sodium, potassium, zinc, and iodine. Malnutrition can also develop as a result of hypochlorhydria. Decreased gastric acidity impairs nutrient absorption resulting in possible nutrient deficiencies for most of the essential vitamins and minerals including protein, iron, calcium, magnesium, zinc, vitamins A and E, copper, and all of the B vitamins. The presence of both malnutrition and hypochlorhydria increases the risk of enteric infections. There is also an increased prevalence of food allergies in individuals with reduced gastric acidity as they lose the ability to sufficiently denature proteins. With hypochlorhydria, larger protein peptides remain which can trigger an immune system response, resulting in allergic symptoms. Therefore, screening for hypochlorhydria should be conducted in individuals that suffer from malnutrition and/or food sensitivities/allergies. There is also an increased prevalence of food allergies in individuals with reduced gastric acidity as they lose the ability to sufficiently denature proteins. With hypochlorhydria, larger protein peptides remain which can trigger an immune system response, resulting in allergic symptoms. Therefore, screening for hypochlorhydria should be conducted in individuals that suffer from malnutrition and/or food sensitivities/allergies. Stress management is also important in regulating gastric...

A new paper entitled, “Impaired Vagal Activity in Long-COVID-19 Patients” sheds light on the vagus nerve's involvement in Long-COVID-19. COVID-19 is divided into three phases of infection: 1. “Acute COVID-19” (signs and symptoms of COVID-19 infection up to 4 weeks). 2. “Ongoing symptomatic COVID-19” (from 4 weeks up to 12 weeks). 3. “Post-COVID-19 syndrome” (signs and symptoms persist beyond 12 weeks). Click here to learn more about the Hedberg Institute Membership. Study Methods 30 Long-COVID-19 patients were compared to 20 control subjects who never had COVID-19. 21 patients were classified based on their experience while having COVID-19 as mild/moderate and 9 as severe/critical. 7 patients had no/negligible functional limitations, 6 had slight functional limitations, and 17 had moderate/severe functional limitations. No significant differences were found among study subjects and controls regarding gender, demographics, medical history, drug use, and vital signs. However, previous studies have shown that females are more affected by Long-COVID-19. Heart rate variability was measured through ECG. Heart rate variability parameters are controlled by the parasympathetic nervous system. The sympathetic nervous system promotes inflammation through catecholamines and beta-adrenergic stimulation in contrast to the parasympathetic nervous system which is anti-inflammatory. COVID-19 causes an imbalance between these two systems, thus driving inflammation and a procoagulative state. Study Findings Heart rate variability was found to be lower in the Long-COVID-19 patients. Left ventricular ejection fraction was lower in Long-COVID-19 patients. When SARS-CoV-2 comes into contact with the eye, it may reach the central nervous system via the trigeminal nerve. And when the virus contacts the nasal mucosa, it may reach the brain through the olfactory nerve. It may also travel to the central nervous system via the vagus nerve from the respiratory system, the heart, the digestive system, the kidneys, bladder, uterus, and testicles. This occurs through neuronal retrograde transport to the axonal terminal. SARS-CoV-2 has been detected in the vagus nerve, thus persistent damage to this nerve could explain impairment of the parasympathetic nervous system in Long-COVID-19 patients. SARS-CoV-2 can also invade the brain through a dysfunctional blood-brain barrier, which has been damaged by cytokine storm. SARS-CoV-2 binds to the ACE2 receptor found in the respiratory airway, lung, vascular endothelia, kidney cells, and small intestine. ACE2 receptors are also found in neurons and glia in the brainstem regions responsible for cardiovascular function and regulation. SARS-CoV-2 neuronal invasion drives epinephrine and norepinephrine from the adrenal gland known as the “catecholamine surge” which causes cardiovascular, lung, and brain injury. NT-proBNP levels were found to be increased in Long-COVID-19 patients, which reflects myocardial strain due to increased vascular pressure. This persistent myocardial strain may drive the dysautonomia, or it could be due to increased ischemia and inflammation. D-dimer can have prolonged elevation in Long-COVID-19 patients, which can lead to increased thromboembolic complications. Dysautonomia, neurotropsim, inflammation, and the persistence of a procoagulative state with an elevated myocardial strain may explain vagus nerve impairment in these patients. However, the authors state, “...it remains unclear whether dysautonomia associated with Long COVID-19 directly results from post-infectious immune-mediated processes or from the autonomic-virus pathway.” The authors call for research on evaluation of cholinergic nerve fiber damage in Long-COVID-19 patients to confirm impaired vagal activity. How to improve vagus nerve function? I have patients do a variety of exercises throughout the day such as singing, humming, gargling with water,

Histamine is often overlooked as a cause of chronic health problems yet the fix for this issue can be quite straightforward. In this article, I cover the details of histamine and how to follow a low histamine diet. Histamine intolerance (HIT) affects approximately 1% of the population. Approximately 80% of those affected are middle-aged.1 Histamine intolerance occurs when an individual has more histamine in their system than they can breakdown. Excess systemic concentrations of histamine can result from overproduction, overconsumption, and/or having a reduced ability to clear out histamine from the body. For those with HIT, eating a diet that results in increased histamine can contribute to chronic inflammation due to the ongoing exposure to histamine. This excess histamine often accumulates as a result of decreased diamine oxidase (DAO) activity.2, 3 The resulting excess histamine contributes to the physical symptoms associated with HIT. Following a low-histamine diet along with supplemental DAO is often recommended to decrease the symptoms associated with HIT. Eating a low-histamine diet involves more than simply eliminating foods that are high in histamine. This article will help to explain the challenges with following a low histamine diet and will highlight the many ways excess histamine can occur in food and in the body. Histamine Synthesis and Degradation Excess histamine concentrations may be exogenously released from food or endogenously produced. Histamine is synthesized by a variety of cells in the body including mast cells, basophils, platelets, histaminergic neurons, and enterochromaffin cells. Endogenous histamine is released in response to a variety of immune and inflammatory related stimuli as well as certain foods, alcohol, or drugs which can activate release.1 Endogenous histamine supplies are also controlled by genes that code for the enzymes that synthesize and degrade histamine. Genetic polymorphisms in histamine receptors and DAO can decrease the rate of DAO activity, reducing the rate of clearance and increasing systemic histamine concentrations.3 Exogenous sources of histamine mainly comes from ingested foods. Several factors in food processing and storage can increase the histamine content of certain foods as well. Histamine is normally metabolized by amine oxidases in healthy individuals. These amine oxidases include monoamine oxidase (MAO), DAO, and histamine N-methyltransferase (HNMT), with DAO being the primary enzymes for metabolism of histamine.5 It is thought that low gastrointestinal levels of DAO contributes to an individual being unable to break down histamine in the intestines, resulting in the increased sensitivity to histamine found in common foods. As excess levels accumulate, intolerance symptoms develop.1, 2, 6, 7 Symptoms Associated with Histamine Intolerance There is great heterogeneity in the presentation of symptoms in those with HIT, making it difficult to define a clear clinical picture. Histamine intolerance is generally suspected when symptoms appear after the ingestion of histamine containing food.3 Symptoms may develop immediately or can be delayed as much as three hours following ingestion.5 Histamine receptors are found ubiquitously throughout the body, making different organ systems susceptible to adverse reactions due to excess histamine concentrations. This results in a wide variety of symptoms that may be exhibited by an individual, contributing to the difficulty in diagnosis. These symptoms include gastrointestinal issues such as abdominal pain, bloating, diarrhea, and constipation. Extraintestinal complaints may affect neurological, respiratory, dermatological, and/or hemodynamic systems.2 Histamine has vasoactive properties that may result in flushing, headaches, and/or hypertension.5 Other common symptoms related to HIT include brain fog, fatigue, dizziness, itching, and difficulty swallowing, low blood pressure, nasal congestion, sneezing,

The National Institutes of Health (NIH) states that five out of every 100 Americans over the age of 12 have hypothyroidism. The prevalence of this disease increases with age.(1) This makes hypothyroidism the most common disease arising from a hormonal insufficiency.(2) Gender is an influencing factor, as women are three to seven times more likely to develop hypothyroidism than men.(1) Known risk factors that increase the likelihood of developing this disease include having a family history of hypothyroidism and pregnancy.(1) Recent research by the British Medical Journal (2021) suggests that taking birth control pills, or oral contraceptives (OCs), may also increase the odds of developing hypothyroidism.(3) Birth Control Pills Statistics Oral contraceptives are a widely used form of birth control by women. Many individuals turn to these medications for reasons other than birth control such as relief from symptoms such as abnormal uterine bleeding, endometriosis, hormonal and menstrual irregularities, etc.(3)Approximately 6 million women in the US, aged 15-49, take oral contraceptives (OCs) each year.(4) The National Survey of Family Growth (2015-2017) reported that OCs are the second most common method of contraception used by women between the ages of 15-49.(4) The use of OCs is higher among younger populations and decreases with age. Approximately 90% of women taking birth control pills are < 40 years old and 54% are under the age of 20.(1)Therefore, an association between the use of OCs and the risk of hypothyroidism could potentially affect a significant number of individuals. These individuals, when presented with other options for contraception and/or better monitoring of thyroid function, may be able to avoid the increased risk of morbidity and mortality associated with hypothyroidism. Birth Control Pills and Risk of Hypothyroidism The British Medical Journey (2021) recently stated that women with a history of taking OCs for more than 10 years have greater odds of developing hypothyroidism (OR, 3.837; 95% CI 1.402-10.500; p=0.0090). Their finding was the result of a retrospective, cross-sectional study derived from information gathered in the National Health and Nutrition Examination Survey (NHANES) 2007-2012. This large epidemiological survey included a total of 30,442 participants. Of this number, 5116 females met the inclusion criteria for participation in the study. These individuals were divided into two groups: those with a history of OC usage (n=3034) and those that had never used OCs (n=2082). Approximately 16% (830) of the combined individuals were identified as hypothyroid. Hypothyroidism was more frequently diagnosed in those with a history of taking OCs (17.7% vs 14.1%). The state of being hypothyroid was defined as either those taking levothyroxine, regardless of thyroid stimulating hormone (TSH) or those with a TSH >5.6 mIU/L.(3) Women should therefore consider the long-term health effects of OCs and the increased odds of developing hypothyroidism associated with their use. This study had several strengths, including the large population surveyed, and the strict criteria used to control for confounders. Limitations were also inherent in this type of study. One of the main limitations is the lack of data to differentiate between the types of OCs used, including their chemical composition. Knowing the types of contraceptives used, i.e.: combined contraceptives containing estrogen and progestin versus progestin only contraceptives, may have provided different outcomes. Other limitations included possible recall bias due to the use of self-reported data from individuals, which can often be incorrect. These factors may have skewed the results obtained. It is also important to recognize a cross-sectional, retrospective analysis can only demonstrate an association between the OCs and hypothyroidism and cannot establish causation.(3) According to the National Institute for Health (NIH),

In this episode of Functional Medicine Research, I interview Palmer Kippola on how to beat autoimmune disease and her new book "Beat Autoimmune: The 6 Keys to Reverse Your Condition and Reclaim Your Health". We had a great talk walking through her F.I.G.H.T.S. protocol which includes food, infections, gut health, hormones, toxins, and stress. Our focus in this interview was on practical strategies for those with autoimmune disease to implement right away into their lives. Palmer has dealt with autoimmune disease herself, so she offers a unique perspective. Full Transcript on How to Beat Autoimmune Disease with Palmer Kippola Dr. Hedberg: Greetings everyone, and welcome to "Functional Medicine Research." I'm Dr. Hedberg, and I'm looking forward to my conversation today with Palmer Kippola. She's a best-selling author, speaker, and functional medicine certified health coach who specializes in helping people reverse and prevent autoimmune conditions. She developed a framework called F.I.G.H.T.S, which stands for food, infections, gut health, hormone balance, toxins, and stress to help others beat autoimmune conditions based on her two-decade battle to overcome multiple sclerosis. Her book is "Beat Autoimmune: The 6 Keys to Reverse Your Condition and Reclaim Your Health," with a foreword by Mark Hyman. And as she shares the science stories and strategies to help people heal and thrive, today she provides total health transformation programs for people who seek to heal from any autoimmune condition by addressing the root causes head-on with functional lab testing and comprehensive mind-body strategies. She also serves a growing community of people in a guided online membership program called Beat Autoimmune Academy. Palmer, welcome to the show. Palmer: Thank you so much, Dr. Hedberg. It's such a pleasure to be here. Dr. Hedberg: Right. So, as I mentioned in the bio, you dealt with multiple sclerosis. So, I'm sure there's a story there. So, why don't you walk us through your healing journey, what that was like, and that whole process? Palmer: Sure, sure. I do need to take you back in time a little bit because I was diagnosed at 19. Let me tell you the story. I was a happy, healthy, well-adjusted 19-year-old, by all accounts. I was home for summer after my freshman year of college, and I was working as a hostess in a restaurant. And one day I woke up and the soles of my feet were tingling, like that feeling you have when you've slept on a limb too long, when the blood flows back, it gets all tingling. But this particular morning, the blood wasn't flowing back. But I thought it'll just go away, so I went off to work. And the tingling just continued to creep up my legs like a vine. It got to my knees and by that time, I knew something was really wrong. So, I called my parents who called the family doctor who said, "Get her over to the neurologist at UCLA today." And we did. That's where we were that afternoon. And this particular neurologist had me do really simple heel-toe walking across her floor and tapped my reflexes. And after about five or six minutes, pronounced that she was 99% certain that I had MS, multiple sclerosis. And if she was right, there was nothing I could do except take medication. And we were absolutely shocked. Remember, this was in the mid-80s, so there was no guidebook, there was nothing. We had never heard of MS. And we just left that office completely confused, devastated, and with very little hope. But I was sent home and that night, my mom lay in bed with me and she was holding me and I was crying and she was crying and it turned out that all of the parts of my body that had been tingling, which by the time I got to the neurologist's office, it had reached right under my collarbone, so all the way up, full body. And then by the time we got into bed that night, all my body went completely numb from the neck down and I would stay numb for a full six weeks. So,

Functional medicine practitioners often take a “Foods First” approach, recommending dietary modifications to improve health. However, for those with low stomach acid, diet alone may not be enough to ensure adequate nutrition. Low stomach acid can impair digestive ability, causing nutritional deficiencies even in those individuals consuming an optimal diet. This article will focus on the main digestive chemical associated with the stomach, hydrochloric acid. The causes of low stomach acid and the associated symptoms will be covered. In addition, natural treatment options for low stomach acid, such as betaine HCL and herbal bitters will be discussed. What is Digestion? Digestion is the process of breaking food down into particles small enough so that the nutrients in the food can be absorbed and then transported throughout the body. Digestion begins in the mouth with the mechanical process of chewing along with salivary enzymes that begin the digestive process. This process is continued as the food passes into the stomach, activating the release of hydrochloric acid. The bolus of food then passes to the small intestines where the majority of digestion takes place. The useful nutrients are digested and absorbed and the waste products are sent through the large intestines for evacuation as feces. Why Does the Stomach Contain Hydrochloric Acid? The stomach is a naturally acidic environment, especially following a meal, with a normal pH value of 3 and an absence of stomach acid (achlorhydria) is obtained with a pH > 7.1 This acidity comes from the hydrochloric acid that is secreted by the parietal cells in the lining of the stomach. Healthy stomach acid levels serve as an immune system barrier, providing a first line of defense against unwanted bacterial or microbial invaders that enter the stomach. Hydrochloric acid is also necessary for the digestion of proteins. Proteins are a conglomeration of amino acids folded together into different shapes. Stomach acid serves to denature (unfold) the proteins and expose the bonds that hold the amino acids together. These bonds can then be cleaved by pepsin, which breaks the protein down into smaller, easier to digest, amino acids. The formation of pepsin from pepsinogen is dependent on sufficient stomach acid levels as well. Hydrochloric acid is also responsible for deactivating the enzymes of salivary amylase as it enters the stomach and for stimulating the release of cholecystokinin in the small intestines. Both processes are essential for healthy digestive function. Certain vitamins and minerals depend on hydrochloric acid to liberate them from their carriers, such as vitamin B12 and calcium. Having low stomach acid levels can impair all of these functions. What causes low stomach acid levels? Factors that contribute to low stomach acid include: Chronic stress Aging Poor diet Infections Medication use Stress—Stress impairs digestion. Chronic stress may decrease the production of hydrochloric acid in the stomach due to associated nutrient deficiencies.2 Stress also causes the vagus nerve to lose its proper tone. The vagus nerve is a major part of the parasympathetic nervous system, and it is deeply involved in stomach acid production. With chronic stress it loses its ability to fire properly which disrupts normal stomach acid production. Aging—Low levels of stomach acid following a meal are more common with aging. Studies that compared stomach acid levels in young individuals (mean age 25) versus older individuals (mean age 75) found that older individuals experienced low levels of stomach acid following a meal for a greater length of time than their younger counterparts. It took 89 minutes for the elderly participants versus 42 minutes for the younger participants to regain normal stomach acid levels (pH 3.0) following a “standard meal”.1, 3,

In this episode of Functional Medicine Research, I interview Sally Norton in a discussion about how oxalates affect your thyroid and your health. We covered what oxalates are and how they can damage the body. We also discussed how oxalates affect gut health, liver health, thyroid health as well as all the symptoms and associated conditions connected to oxalates. If you're really struggling to get well, but your diet appears to be healthy, oxalates may be the missing link. Full Transcript on Oxalates and Thyroid Health Dr. Hedberg: Well, welcome everyone to "Functional Medicine Research." I'm Dr. Hedberg, and I'm really looking forward to my conversation today with Sally Norton. Sally is a consultant writer, educator, and speaker with over 30 years in the health promotion and wellness field. Sally specializes in helping people improve their health with an oxalate-avoiding diet. Sally holds a nutrition degree from Cornell University and a Master's of Public Health degree from the University of North Carolina at Chapel Hill. She worked in the field of medical education at UNC Medical Schools Program on Integrative Medicine and as a research grant writer and research administrator at the Virginia Commonwealth University School of Medicine. Despite a healthy lifestyle, she struggled for over 30 years with seemingly unanswerable health challenges, including chronic pain and fatigue. When she finally discovered the cause and turned her health around, she committed to teaching and reaching out to others stuck in similar frustrating situations. Sally, welcome to the show. Sally: Thank you. It's great to be here. Dr. Hedberg: Yeah, I'm looking forward to this and we were kind of discussing this early on. Oxalates is something that I've always kept my eye on for the last 17 years and I was really looking forward to this conversation. So why don't we lay a little bit of bedrock for the listeners? And if you could just talk about what are oxalates, and do we know why plants actually have oxalates? Sally: Yes. Plants are a major producer of oxalate and obviously, it's also ubiquitous in nature itself. Soil is loaded with it. Even apparently sea spray produces some oxalate and polluted air produces oxalates, so, in really heavily polluted cities, the air has got oxalate in it too. So oxalate is this really minuscule molecule that its parent compound is called oxalic acid. And acids ionize and become charged particles because they drop off the acidic protein and so they become these negatively charged ions that attract positively charged things and oxalates can have a one negative or two negative. It is a tiny, tiny little compound. It has four oxygens, which is a heavy load of oxygen on just two little carbon molecules. So it's very oxygen-heavy, which is probably partly why it's such a pro-oxidant molecule, you know. Oxidation is very bad for tissues, membranes, mitochondria, and it is a great mitochondrial poison, membrane destroyer, and troublemaker. And it's not just the oxygen, though. It's much more about this reactivity that the charge creates where it bonds with minerals and becomes salts. And so, salt is a chemical term for things that can dissolve, but when it...because it can have two negative charges, it will also hook up with minerals that won't dissolve well. So calcium, for example, is a two positive charge mineral. With that double-positive and double-negative marriage between the two, you create an insoluble oxalate, which is the backbone of oxalate you see in nature because calcium is everywhere in soils and in nature, and plants are having to manage their calcium. And one of the ways they do that...because too much calcium can be toxic to the plant. So one of the ways they do that is they make oxalic acid. Often they make vitamin C first, very similar compounds, and vitamin C naturally degrades just hanging around into oxalic acid and oxalates. So plants will create vitamin C and they'll cre...

In this episode of Functional Medicine Research, I interview Dr. Theodore Belfor in a discussion on cranial facial development and airway resistance. If you have read James Nestor's new book "Breath" then you are aware of Dr. Belfor's work. We talked about the causes of abnormal cranial development and how this causes airway resistance and a number of health problems including sleep apnea, insomnia, IBS, bruxism, and more. Our cranial bones don't form properly when we aren't breastfed and eat a modern diet of processed foods. Dr. Belfor's oral appliances help to correct these abnormal developments to restore proper facial bone structure and improve the airway. Full Transcript with Dr. Theodore Belfor Dr. Hedberg: Well, welcome everyone to "Functional Medicine Research." I'm Dr. Hedberg, very, very excited today to have Dr. Theodore Belfor on the podcast. I first heard about Dr. Belfor in James Nestor's new book called "Breath." And we're gonna be talking about all of that today on the show. And Dr. Belfor, he's a graduate of New York University College of Dentistry, and a senior certified instructor for the International Association for orthodontics. In the 1960s, Dr. Belfor was sent to Vietnam to work as the sole brigade dentist for 4000 soldiers of the 196 Light Infantry from the jungles of Vietnam to Park Avenue in Manhattan. Upon his return, he opened his own private dental office in New York City, and has been in private practice for more than 40 years. And Dr. Belfor specializes in the treatment of the cranial facial system, and that's what we're going to be diving into today. So, Dr. Belfor, welcome to the show. Dr. Belfor: Well, thank you for having me. It's my pleasure. Dr. Hedberg: Excellent. So, why don't we start by talking about how this all began, and go back to, you know, what happened that changed the cranial bones, the cranial structure, our skulls, that led to this epidemic of airway issues, breathing issues, and all of the health issues that come with that? Dr. Belfor: Well, how we develop, how we grow and develop is based on how we breathe, how we swallow, and how we chew. So, just looking at how we chew, according to the U.S. Department of Agriculture today, in the U.S., 63% of our diet is processed and refined foods. So, without the proper stimulation to the body, we are not fully expressing our genes, we're not developing to our full potential. Because of that, particularly when our jaws do not grow forward enough, the retrusion of those jaws helps to push the tongue backwards into the airway and down the throat, so now we have compromised sleep and breathing. Dr. Hedberg: So, it's a combination of things. I know Dr. Nestor talks about it in his...or James Nestor talks about in his book, the changes in diet, soft food, not enough hard foods, not breastfeeding. Can you talk a little bit more about these changes in our society and some of these predisposing factors that can cause an abnormal airway? Dr. Belfor: Well, for me, the enlightenment came, when almost 20 years ago, I was treating performing artists who couldn't wear braces and they wanted straighter teeth, and I used an appliance and had a unilateral bite block, which basically, in essence replaces the missing hard food in our diet. And guess what? The actors, performers were coming in, and their makeup artist was telling them that their faces are changing, and the singers were coming in and saying they were reaching higher notes. So, that's what set me on the path. You see, the concept in dentistry is to balance the bite all the time. And it's kind of an anathema to have, when you bite down, to hit on one side. However, if I give you a stick of gum to chew, nobody on the planet is going to chew on both sides at the same time. We chew on one side then we chew on the other. And apparently from the research, many articles that have been written, the latest one in August 2018,

In this episode of Functional Medicine Research, I interview Dr. Ron Parks in a discussion about COVID-19 and the mental health crises. Dr. Parks has written a new book "COVID-19 and Mental Health Crises" which we discuss as well as a variety of other topics that can help those afflicted by this pandemic. The mental health aspects of COVID-19 are often overlooked with more of a focus on the physical aspects of the illness, medications, vaccines etc. As usual in the United States, mental health is pushed to the back of the bus with little to no dialogue or support for those who need psychological support. Dr. Parks provides a voice for those in need with his excellent new book. Full Transcript on COVID-19 Mental Health Crises Dr. Hedberg: Well, welcome, everyone, to Functional Medicine Research. I'm Dr. Hedberg. Very excited today to have my good friend and colleague, Dr. Ron Parks, on the show. And we're gonna be talking about his new book. And Dr. Parks is a respected physician, teacher, book author, writer, and mentor, with an integrative and holistic perspective. He especially trained in internal medicine, nutrition, preventive medicine, and board-certified in psychiatry. Currently, Dr. Parks is the medical director and psychiatrist for The Center for Spiritual Emergence and Katharos Sanctuary in Asheville, North Carolina. He has an MD from the University of Maryland and a master's degree in public health and health service research from the University of California at Los Angeles. He has completed specialty training and internal medicine at George Washington University, preventive medicine at UCLA, and psychiatry at the University of Maryland. Dr. Parks is a former assistant professor at the Albany and University of Miami Medical School, chief of internal medicine at the Homestead Air Force Base Hospital in Florida, former director of the Center for Preventive and Nutritional Healthcare in Baltimore, Maryland, and founder of the MacroHealth Medicine, a comprehensive and holistic consultative and treatment service, formerly in Asheville, North Carolina. Dr. Parks, welcome to the show. Dr. Parks: Well, thank you, Nik. Thank you for having me. Dr. Hedberg: Yeah. I'm looking forward to this. So, you've written a new book, it's called "COVID-19 and Mental Health Crises." So, we're gonna dig into that. But before we do that, can you just talk a little bit about how you got into integrative functional medicine and psychiatry? Dr. Parks: Well, that's a good question. Actually, it started when I was very young. I think I write a little bit about this in the book. I came down one summer as a kid with polio. And it was very upsetting, of course. And I compared it to the current COVID crisis. Back then there was no treatment and everybody had been waiting 10 years, 8 to 10 years for a vaccine. But here I was, a young, healthy, athletic kid that suddenly was running high fevers and a stiff neck. So, I ended up in the hospital at a children's ward. And back then the only treatment they had was more of a natural treatment called the Sister Kenny treatment. It was like a heat treatment. They wrap you in warm towels. And so that was my first exposure to, you know, what I would call functional medicine or holistic medicine. Though I had a sweat through it, but luckily, I didn't end up with the paralytic form of it, but sometimes I do think I have some of the long...they're talking about with a new virus, the long hauler syndrome. But with polio, there were some aftermaths there, and I think maybe some of the weakness I had some time in the legs and things like that might be from that. But anyway, that got me started on the path of interest in broader treatment programs. But a lot of it came, though, from my being formally, formally trained in internal medicine, where everything was about labels and diagnosis. And I remember in training, I got yelled at by the pathology teacher because I looked at a slide and ...

In this episode of Functional Medicine Research, I interview Tom Fabian, PhD in a detailed discussion about the GI-MAP stool test interpretation. We covered virtually every aspect of the GI-MAP stool test including what the test results mean and how to use them in clinical practice. Dr. Fabian has tremendous knowledge of the gut microbiome and the intricacies of the GI-MAP stool test markers. This is a vital interivew to listen to if you're utilizing the GI-MAP stool test in your practice. Full transcript of the GI-MAP Stool Test Interpretation interview with Dr. Tom Fabian: Dr. Hedberg: Well, welcome, everyone to Functional Medicine Research. I'm Dr. Hedberg, and I'm looking forward today to my conversation with Dr. Thomas Fabian. He is a PhD., and he's a clinical laboratory consultant, translational science expert, functional nutrition practitioner, educator, and speaker. He is a former biomedical research scientist and deep expertise in the role of the human microbiome and health, chronic disease and aging. As a leading expert in translational applications of microbiome research and functional medicine and integrative health settings, Tom's primary focus is on providing educational resources and consulting services for practitioners and scientific advisory and consulting services for clinical testing laboratories. Dr. Fabian, welcome to the show. Dr. Fabian: Thanks so much, Nik. It's great to be here today, and I'm looking forward to the conversation. Dr. Hedberg: Excellent. So, we're gonna be talking about the diagnostic solutions, lab, GI-MAP test, and we're gonna cover interpretation, you know, what these markers mean. And so, for all the practitioners listening, they'll have a strong idea of how to approach this test and how to use these things clinically. So, why don't we start with...take it from the top in the pathogen section? And I wanted to ask you specifically about C-diff. There's toxin A and toxin B Clostridium difficile markers on this test. And what is your interpretation of this if it's positive and the patient is symptomatic, and then you treat them, and then they're no longer symptomatic, but the toxin still shows up on the stool test? Can you elaborate a little bit on that type of presentation? Dr. Fabian: Sure. No, I haven't personally seen that particular scenario but, in general, it's important to keep in mind a lot of people can be carriers of C-diff. So, the majority of the time that we see it detected positive, whether it's low levels or high levels, typically, patients don't have the classic symptoms. So, that suggests that they're probably just a carrier. And there's, sort of, kind of, a gray area in between where there still may be some effects of C-diff. Of course, that's one of the purposes of looking at the markers on GI-MAP like calprotectin, zonulin, etc. to see if there seems to be any evidence that may be have an impact, even if there aren't symptoms. So, we're also learning a lot more from research about factors that can control or influence the ability of various pathogens to thrive and also whether or not they can cause infection or if they have their, you know, typical pathogenic effects. So, that's essentially factors that influence virulence. So, one of the first things I want to mention is all the microbial markers on GI-MAP are assessed based on detection of DNA. So, when you're looking at DNA, you're looking at detection of the organisms or the genes but not necessarily whether the genes are being expressed. And that's definitely true for toxins. So, lots of research has been coming out in research years in terms of, again, as I mentioned, things that regulate toxins, and it's very specific. So, pathogens tend to only express those toxins under very specific conditions when conditions are favorable for them. So, for example, if you've detected C-diff and it really syncs up with what's going on with the patient, symptomatically,

In this episode of Functional Medicine Research, I interview Robb Wolf about his new book and documentary Sacred Cow. We had a great conversation dispelling some of the myths about meat and saturated fat as well as climate change, plant-based diets, sustainable agriculture, veganism, cattle and methane, and the ethics of eating animals. This was a well-rounded interview packed with information that should help people make better decisions about what they eat but also become educated about the facts around meat. I highly recommend watching the Sacred Cow documentary and reading the book which goes into tremendous detail on these issues. Full Transcript of Sacred Cow with Robb Wolf Interview Dr. Hedberg: Well, welcome, everyone, to "Functional Medicine Research." I'm Dr. Hedberg. And I'm really looking forward to my conversation today with Robb Wolf. And Robb is a former research biochemist, and he's a two-times "New York Times," "Wall Street Journal" bestselling author of two books, "The Paleo Solution" and "Wired to Eat." And he coauthored a book with Diana Rodgers, which we'll be talking about today, called "The Sacred Cow," and that explains why well raised meat is good for us and good for the planet. Robb has transformed the lives of hundreds of thousands of people around the world via his top ranked iTunes podcast, books and seminars. He's known for his direct approach and ability to distill and synthesize information to make the complicated stuff easier to understand. Robb, welcome to the show. Robb: Doc, a huge honor to be here. Thank you. Dr. Hedberg: Great. Yeah, I had Diana on last year. And we talked a little bit about plant-based diets and meat and things like that. And then since then, we've had the "New Sacred Cow" book that you co-authored, and the documentary, which is excellent. And so, why don't we begin by...I'd really like to focus on helping the listeners understand some of, you know, the misunderstandings and the truths and the myths about eating meat versus plants and things like that. And so why don't we start with a discussion about why meat has become a scapegoat. And I think, and you can expand on this, of course, but I think part of this probably goes to Ancel Keys' work in the 20th century, his promotion of misinformation on saturated fat. Can you take us from that point up to where we are now, and why you think meat has been getting such bad press? Robb: Yeah, you know, it's interesting and worth noting the book covers the health, environmental, and ethical considerations of a meat or animal product-inclusive food system. You know, so the raising and the selling and the slaughter and the whole deal. And all of those points are important, and all of those points have some really interesting, historical antecedents, I guess, kind of describing why in different cultures meat would become vilified to varying degrees. And like, food is an interesting cultural tool for defining self from non-self. Like, if we look within the Abrahamic religions, there are some very specific delineations of what is and is not allowed within, say, Judaism versus Christianity versus Islam. And we see similar things within different Buddhist traditions and whatnot, so I mean it...Or even just within Christianity itself, you have like the Seventh Day Adventists versus, you know, certain rules and followings within Catholicism, you know. And so, it's interesting that food is a powerful tool for defining self from non-self. And not infrequently it is the beginning point of creating out of accepted groups of people. Like, there's some pretty ugly historical examples of where the different food practices of one religion or one type of people start being used as a means of, kind of, ostracizing and, kind of, walling those folks off. But we have these three different pieces that if we're really gonna do diligence on this topic that we have to address. And, you know,

In this episode of Functional Medicine Research, I interview Ashok Gupta about his limbic system retraining program. Trauma of any kind can change the brain and nervous system in a way that prevents one from getting well. Many people never get well because they don't address the underlying trauma that has triggered or contributed to their health challenges. If you've tried eating right, exercising, sleeping well, taken the best supplements, and managed your stress, but you still aren't feeling well, your brain and nervous system may be out of balance. The Gupta Program is designed to change the neuroplasticity of your brain and nervous system so you can heal and feel well again. We discuss a new and exciting published paper that validates this method of limbic system retraining. Full Transcript on Limbic System Retraining Interview Dr. Hedberg: Well, welcome everyone to "Functional Medicine Research." I'm Dr. Hedberg, and I'm very excited today to talk to Ashok Gupta about limbic system retraining. And Ashok is an internationally renowned speaker, filmmaker, and health practitioner who has dedicated his life to supporting people through chronic illness and achieving their potential. Ashok suffered from myalgic encephalomyelitis or chronic fatigue syndrome about 25 years ago when he was studying at Cambridge University, and through neurological research that he conducted, he managed to get himself 100% better. He then set up a clinic to treat others and then published the well-known recovery program known as "The Gupta Program" in 2007. He's published several medical papers and he's continually researching these conditions. You can find out more information at guptaprogram.com. Ashok, thanks for coming on the program. Ashok: Thank you so much for inviting me. Very excited to be here. Dr. Hedberg: Yeah. So, the limbic system is something that I've been interested in since I started practicing 17 years ago, and you know, I have a variety of recommendations that I give to patients for that. You know, things like meditation, mindfulness training, therapy, or just a number of things, but your particular limbic system-intensive program, I heard about it recently and became very interested in it. And why don't we begin by talking about just the limbic system itself? Can you give people kind of an overview of what the limbic system does and why it's important? Ashok: Yes. So, there are many different ways of describing the limbic system. I think primarily if we start with this idea of it being a defensive system to ensure survival, right? So, most people would associate the limbic system with our emotional responses and medicine often separates the kind of psychology and the emotional responses from defense responses as if they're something different, you know, physiological defense responses versus emotional defense responses. But I see the limbic system as the automatic survival systems that we've inherited over generations of different animals and whatever that actually create responses that ensure survival. And so, a fight or flight response, a fear response, an anger response, a memory of a previous experience, all of these things are designed to ensure survival. So, that is for me the primary motive or motivation of that limbic system. And within that limbic system, there are different structures that play specific roles. And a lot of our research focuses on the amygdala, which are two almond-shaped structures that sit behind our eyes that essentially are taking all the incoming information from the outer world and the inner world, process it according to the previous experiences we've had in life, our memories, and then creates a coordinated response across the brain to ensure survival, yeah? And one way to look at this Dr. Hedberg, which I find fascinating is to ask the biggest question of all, you know, why are we here? And we can answer that question from a philosophical perspective,

In this episode of Functional Medicine Research, I interview Dr. Deb Matthew about her new book on male sexual health "Why Can't I Keep Up Anymore?: A Guide to Regaining Energy, Focus, and Peak Physical & Sexual Performance for Men Over 40". We discussed the causes of male sexual dysfunction, lab testing, causes of low testosterone, stress and cortisol levels, sex hormone binding globulin, testosterone replacement methods, how sleep affects hormones and much more. This book isn't just for men. If your male partner is showing signs of low testosterone then this book is a must-read with resources on how to find the right kind of doctor to get well. Male Sexual Performance with Dr. Deb Matthew Interview Transcript Dr. Hedberg: Well, welcome, everyone, to "Functional Medicine Research." I'm Dr. Hedberg, and I'm really excited today to have Dr. Deb Matthew on the show. Dr. Matthew is a medical doctor, and she's also known as the happy hormones doctor. She's a best-selling author, international speaker, educator, wife, and mother of four. And after suffering for years with fatigue and irritability, her quest to resolve her personal health led her to change everything about her practice of medicine. She has been featured on national podcasts, radio, and broadcast shows, including NBC, ABC, CBS, and Fox. Dr. Matthew, welcome to the show. Dr. Matthew: Thank you so much. It's great to be here. Dr. Hedberg: So, we're going to be talking about your new book, "Why Can't I Keep Up Anymore?: A Guide to Regaining Energy, Focus, and Peak Physical & Sexual Performance for Men Over 40," which I read recently. It's an excellent book. Wanted to have you on and talk about something that is...well, I would say most male issues are overlooked, but testosterone is really a big one and so is sexual performance and male hormones. So, why don't we begin by talking about why testosterone is so important for men? Dr. Matthew: Yeah. You know, hormones, in general, play a big role in how we feel on the inside, how we relate to the world around us, how we react to other people. And so, testosterone drives a lot of how men feel and even behavior, and it really plays a role in men feeling like a man. So, it's important for drive and for motivation so that when you wake up in the morning and your boots hit the floor, you're ready to take on the world. And when testosterone levels are not quite right, men just don't quite feel right. And for women, when we go through our hormonal changes, it's pretty obvious. We either get menstrual problems or, you know, we get hot flashes. And so, there's some pretty obvious things that happen at some pretty obvious times in our life in order to notify us that our hormones may be changing. But for men, it's much more subtle. So, it is something that often happens gradually over time. And so, what I hear men say a lot is, you know, "I just don't quite feel like myself anymore. I'm just not quite keeping up the same way that I used to. But you know, maybe it's just my age." I hear that all the time, "It must just be my age. I'm not 18 anymore." And so, you know, maybe it's not fair to compare to an 18-year-old, but if you're 40 or 50, like let's not blame it on age. If you're 95, okay, fine. We'll blame it on your age. But when you're younger, even though things change, they don't have to feel that way. And so, one of the things that could be contributing to not quite feeling like yourself anymore is low testosterone. Dr. Hedberg: One of the things I see in practice is men who, you know, they're diagnosed with low testosterone or they have the symptoms and they see their conventional medical physician and they try a testosterone, but it doesn't work at all. Sometimes they get a little bit worse. Sometimes there's really no change. What do you think the conventional medical approach is missing when something like that happens to a man? Dr. Matthew: Oh,

In this episode of Functional Medicine Research, I interview my friend and colleague Cass Nelson-Dooley, M.S. in a discussion on how to heal your oral microbiome. Cass recently published the book "Heal Your Oral Microbiome" and we discussed many important topics about this often overlooked health issue. We discussed what conditions may be connected to a dysbiotic oral microbiome, how oral microbiome dysbiosis affects your health, health sweeteners, strategies to heal the oral microbiome, testing, dental products and more. If you're struggling with healing your gut or have a health issue that won't resolve, your oral microbiome may be the missing link. Full Transcript on How to Heal Your Oral Microbiome Dr. Hedberg: Well, welcome, everyone, to "Functional Medicine Research." I'm Dr. Hedberg. And I'm very excited today to have my friend and colleague, Cass Nelson-Dooley, on the show. And Cass studied medicinal plants in the rainforests of Panama in 2003 as a Fulbright Scholar and then launched a career in science and natural medicine. She researched the pharmacology of medicinal plants at the University of Georgia and AptoTec, and then joined the innovators at MetaMetrics clinical laboratory and Genova. She enjoys teaching, presenting, writing, and researching how to address the underlying causes of disease, not just the symptoms. She has over a decade of experience teaching doctors about integrative and functional laboratory results. In 2013, she started Health First Consulting, a medical communications company with a mission to improve human health using the written word. She created innovative videos and patient education handouts to improve practice efficiency and motivate patients. Miss Nelson-Dooley is the author of the book "Heal Your Oral Microbiome," which we'll be focusing on today. And has published case studies, book chapters, journal articles about natural medicine, nutrition, and laboratory testing. Her website is healthfirstconsulting.com. Cass, welcome to the show. Cass: Thank you, Nick. So happy to be here. Dr. Hedberg: Yes. It's been a while. We were just kind of reminiscing about the days at MetaMetrics and I read your new book, "Heal Your Oral Microbiome." So, I was excited to have you on about that because no one's really talking about it. So, why don't we talk about, kind of, the foundation of what we're talking about here, which is periodontal disease? And so can you just talk a little bit about what that is? Cass: Sure. Sure. So, yeah, it's great talking with you after all these years and in the starting out, getting to know you in the functional lab industry. But, yeah. So, this book was a really fun book to write, especially from the jumping-off point of gut health, right, which is kind of a central tenet in functional medicine. And that's some of the testing that we used to talk about years ago. So, so much of what we know about the gut really just perfectly translates to the mouth. And periodontal disease, you know, I kind of like to just simply say that it is a dysbiosis. It's an oral dysbiosis that...and an aberrant or an over-reactive immune response to that dysbiosis. So, one of the fascinating things, when I was writing this book, was realizing that so many of the things that plague our mouths are really just dysbiosis, you know, which we talk about all the time in regards to the gut. So, periodontal disease is an imbalance of oral bacteria that triggers an immune response that attacks and destroys bone and teeth. Cavities are a bacterial dysbiosis in the mouth. Root canal infections are bacterial imbalance in the pulp of the tooth. And then you can get cavities on the root of a tooth, which is, again, dysbiosis. So, it was pretty fun to realize, wow, all of these problems just go back to the oral microbiome and we just need to try to rein in that oral microbiome and make it healthier in order to prevent these diseases. Dr. Hedberg: Yeah.

In this episode of Functional Medicine Research, I interview dietician Tracey Long in a deep discussion about how to overcome mold and biotoxin illness. Tracey has firsthand experience with mold and biotoxin illness so she brings a unique and valuable perspective to this topic. We discussed Tracey's personal journey with mold and biotoxin illness, how to test your home for mold, lab testing, associated conditions, symptoms, and management strategies to get well. Full transcript on How to Overcome Mold and Biotoxin Illness Dr. Hedberg: Well, welcome, everyone, to "Functional Medicine Research." I'm Dr. Hedberg. Really excited today to have my good friend and colleague, Tracey Long, on the show. Tracey is a registered dietician, with specialty certification training in Integrative and Functional Medical Nutrition Therapy and The Bredesen Protocol to End Alzheimer's. She owns a private practice, Big Picture Health in Hendersonville, North Carolina, where she sees clients via video consultations. She specializes in working with clients with neurodegenerative conditions, biotoxin illnesses, gastrointestinal conditions, and nutrigenomics. She is a published author and teaches health coaches for Chris Kresser's Health Coach Training Program. Tracey's education includes a master of public health, an emphasis on nutrition and exercise physiology from the Colorado School of Public Health, where she studied under Dr. Loren Cordain who many of you may know as the author of "The Paleo Diet." And she's also a registered yoga teacher and certified exercise physiologist. Her personal interest include hiking with her husband and dog, urban farming, teaching yoga, foraging for mushrooms in the mountains of Western North Carolina, growing medicinal herbs and produce, paddleboarding, and visiting her three grown daughters in Colorado. Tracey, welcome to the show.   Tracey: Thank you so much, Nik. I'm so happy to be here with you today. Really appreciate the opportunity. Dr. Hedberg: Yes. Yeah. It's gonna be fun. So why don't we begin by talking about your personal journey with mold? And that's gonna be the topic of today, mold and biotoxin illness. So why don't you share your personal journey? Tracey: You bet I'd love to. And really, my personal journey, Nik, really started with a professional journey in that I became very interested in neurodegenerative conditions and I completed Dr. Bredesen's training, as you mentioned, The Bredesen Protocol to End Alzheimer's. And Dr. Bredesen has sub-categorized underlying causes of Alzheimer's, and one of those underlying causes he refers to as type three Alzheimer's that's really related to toxins. And he's identified three categories of primary toxins. The first one is heavy metals and the second one is biotoxins. And in that category, biotoxins, certainly, mold is included and also tick-borne illnesses. And now even recently we've added COVID-19, especially from the standpoint of, you know, people who have had COVID-19 and they haven't recovered. You know, we're referring to them as long haulers. And I bring that up. I'll tie that all in in just a minute. The third type of toxin Dr. Bredesen addresses are organic compounds. So there are things like herbicides and pesticides, things that we can be highly exposed to in the environment. It was interesting in that journey that I had that training and I started working with clients with all the subtypes of Alzheimer's, little did I know that I would end up having my own personal experience. So I was assisting clients who had been exposed to mold, certainly, and then we ended up moving to North Carolina. It's in the South. It's very moist here, as you know, I know you live here too. So, you know, we've had a year of record rainfall here. So I moved from Colorado, which was very hot and dry to the Southeast, which is living like in the tropics, really. We're living in a rental house. And when we found the house,

The Paleo Diet is a popular diet that can work well for many chronic diseases, especially autoimmune diseases like Hashimoto’s disease. However, the Paleo Diet can be somewhat restrictive which can result in deficiencies if the dieter doesn’t carefully review their food and micronutrient intake. Iodine is one important micronutrient that may become depleted on a Paleo Diet. The Autoimmune Paleo Diet is an even more restrictive diet so the same deficiency may happen. Let’s review what the research shows about the Paleo Diet and iodine deficiency. A paper published in the European Journal of Clinical Nutrition entitled, “A Paleolithic-type diet results in iodine deficiency: a 2-year randomized trial in postmenopausal obese women” sheds some light on this question. Introduction to this study on the Paleo Diet and iodine deficiency This study was done in Sweden and the authors begin by stating >50% of iodine intake comes from iodized table salt followed by dairy and seafood. The Paleo Diet is void of dairy, grains, legumes, refined sugar, processed oils, and salt thus removing two important sources of iodine. 150 micrograms of iodine per day is recommended by the Nordic Nutrition Recommendations (NNR) but the thyroid can function at 70 micrograms of iodine per day. Urinary iodine concentration (UIC) by spot urine is recommended for determining iodine status. Adequate iodine intake is a UIC of 100-199 ug/l. Mild iodine deficiency is a UIC of 50-99 ug/l. Moderate iodine deficiency is 20-49 ug/l. Severe iodine deficiency is

I would like to report on the new product GI Meal Select from Moss Nutrition. With the increasing prevalence of gut disorders, we need more strategies to help patients get well quickly and effectively. GI Meal Select has been carefully formulated to address many aspects of gut healing in an affordable and effective product. GI Meal Select is designed to provide optimal nutrient sustenance so it can act as a stand-alone meal replacement. It is easy to digest, pleasant tasting, and reasonably priced. One of the issues with many meal replacement products is the carbohydrate and fat content which can cause gut issues like gas and bloating so this product has almost completely eliminated both. It also contains no protein powder such as whey and pea which most people with gut issues can no longer tolerate. Instead, it uses the Reginator amino acid blend to maintain muscle mass and promote tissue repair. Resting the digestive organs can be paramount in helping to enable proper gut healing and repair, provided there is an ongoing presence of protein building blocks (essential amino acids) to prevent tissue breakdown, and sufficient micronutrient cofactors to enable enzyme function and structural support. GI Meal Select provides these requisites along with two targeted gut health nutrients: a potent 2 grams of immunoglobulin rich IgY Max plus 1.75 grams of pure L-Glutamine, the primary fuel of enterocytes (cells lining the digestive tract). All the nutrient components in GI Meal Select are provided in their basic, predigested or “elemental” forms, taking a great burden off the digestive organs. In this sense, GI Meal Select offers restorative and reparative benefits similar to those of elemental formulas. However, GI Meal Select is very low in calories and free from added carbohydrates and fats, macronutrients which may trigger symptoms in GI patients. Individuals who do tolerate fats may be advised to add one teaspoon of a liquid omega-3 supplement such as EPA/DHA HP Select (high potency fish oil), Icelandic Cod Liver Oil (also a good source of vitamins A & D3) or flaxseed oil to their GI Meal Select shake. While not appropriate for extended use as the sole source of daily nutrition, GI Meal Select can be taken one or more times per day, as directed, in place of a regular meal or between meals. By allowing the digestive organs to temporarily rest, removing dietary components that feed gut microbes, supplying the body with elemental nutrition and directly nourishing the gastrointestinal tract with immunoglobulins and amino acids, GI Meal Select may help to promote repair of the intestinal lining, decrease the severity of inflammatory GI conditions, diminish the incidence of small intestine bacterial overgrowth (SIBO) and help to reset overall gut health, structure and function. A COMPREHENSIVE MULTIPLE VITAMIN/MINERAL Each serving of GI Meal Select contains a complete array of vitamins and minerals. Fat soluble vitamins A, D3, E and K2 help to heal mucous membranes and support healthy immune function, bone and vascular health. B-complex vitamins in bioactive forms, featuring methylated folate and B12, and vitamin B6 as P-5-P, promote healthy energy production, detoxification and nerve cell transmission. Buffered vitamin C is gentle on the stomach. Full spectrum minerals, essential for countless physiological mechanisms, are provided in natural, carrier-free forms to minimize the potential for irritation in hypersensitive gut patients. Moderate rather than therapeutic V/M dosing allows GI Meal Select to be taken more than once daily if needed. FREE-FORM ESSENTIAL AMINO ACIDS (EAA) represent the microscopic building blocks for all the proteins in the body—from skeletal and smooth muscle tissue to enzymes and antibodies. In contrast to food-bound proteins and protein powders such as whey, rice or pea protein, free-form EAAs are already broken down or “predigested” hence they require no effort to process,

In this episode of Functional Medicine Research, I interview Dr. Sam Yanuck in a discussion about his latest paper on COVID-19, written with co-authors Drs. Joseph Pizzorno, ND, Helen Messier, MD, PhD, and Kara Fitzgerald, ND.  Their excellent paper outlines a phased approach to COVID-19 with specific strategies on prevention, management throughout the infection, and into the recovery period.  Dr. Yanuck has an erudite understanding of the immune system which you'll find to be extremely useful in navigating this virus. Below is a transcript of the interview with Dr. Yanuck on a phased approach to COVID-19 Dr. Hedberg: Well, welcome, everyone, to Functional Medicine Research. I'm Dr. Hedberg. And I'm really looking forward to my conversation today with Dr. Sam Yanuck. And Dr. Yanuck is the CEO and Director of Education for cogenceimmunology.com. It's an online functional immunology course whose growing community includes nearly 5,000 clinician participants from more than 60 countries around the world. He's an adjunct assistant professor in the program on integrative medicine in the Department of Physical Medicine and Rehabilitation at the University of North Carolina School of Medicine where he teaches topics in functional immunology. Dr. Yanuck is clinical director of the Yanuck Center for Life and Health, a functional medicine clinic in Chapel Hill, North Carolina where he sees patients with complex autoimmune disorders and other immunologically challenging cases. Dr. Yanuck has been seeing patients from everywhere since 1992. He also provides online consultations to clinicians around the world. And you can connect with the Yanuck Center at yanuckcenter.com. And today, we're gonna be talking about Dr. Yanuck's paper and his colleagues. They recently published a functional medicine perspective on COVID-19. And that paper is entitled "Evidence Supporting a Phased Immuno-Physiological Approach to COVID-19 From Prevention Through Recovery." Dr. Yanuck, welcome to the show. Dr. Yanuck: Thanks, Dr. Hedberg. It's a pleasure to be here. Dr. Hedberg: Great. So, this is an excellent paper outlining four phases of approach to COVID-19. Before we jump into those phases, why don't we just talk a little bit about who is at the greatest risk of developing COVID-19? And what would make someone at a greater risk for contracting the virus and having a difficult time with this particular virus? Dr. Yanuck: Sure. Well, this is really a moving multifactorial equation. There are ways that a person can be surprisingly predisposed to having a severe case of the illness that may not be obvious. Those are kind of wild cards that relate to things like antibodies against interferon, and so on. And so the challenge here is that we can come up with a sensible sort of view of who is and is not at higher risk, and yet, it's important to understand that those views, those descriptions are going to be inherently imperfect because of this wildcard effect where there are cases that have been characterized where the idiosyncrasies of a person's own diminished capacity to kill this kind of virus may only become apparent when the person is in the ICU, when the person gets the virus. And despite the fact that there are, you know, 22 or something, they may nonetheless have a terrible time of it and end up dying of COVID-19, surprisingly, despite not meeting the usual profiles. So, that's kind of a caveat to any such attempt to describe or profile who is or is not at risk. And I can tell you just personally that I'm personally connected to someone, you know, by about a two-steps level of separation, a person who was, you know, feeling flu-like on a Friday. This is like a guy in his 40s who's healthy and fit and so on. Feeling flu-like on a Friday and found dead on Monday. So, that's a kind of a cautionary tale about any attempt to say, "Here's who is and here's who isn't at risk." Now, having said that,

“Adrenal Fatigue” is a term used for many years by alternative medicine practitioners but does it exist? This is certainly a term that I have used for some time but not in the way that most practitioners use it. I will use terms at times that are widely searched for on the internet so that I can spread the science behind these terms but it doesn’t necessarily mean that I endorse the term or subscribe to the existence of a condition. There are a few published papers that tackle this very issue that I’ll cover in this article on “adrenal fatigue”. What does the research show about "adrenal fatigue"? The first paper I’d like to mention is entitled, “We are tired of ‘adrenal fatigue’” by Ross et al. The title of this paper quickly gives you the underlying frustration of the authors about this term. This paper is a position statement and not a clinical trial, review, or analysis of any kind. The authors begin by outlining the adrenal fatigue theory and that is doesn’t exist as a defined medical condition. The authors do point out a valid adrenal disorder called adrenal insufficiency which is characterized by insufficient cortisol production after an adrenocorticotropic (ACTH) hormone stimulation test. They also mention Addison’s disease which is true adrenal failure. Interestingly, those who suffer from fatigue actually showed a greater rise in cortisol with an ACTH stimulation test which indicates excessive cortisol production not insufficient cortisol production in those with adrenal insufficiency. And another study actually found no difference in salivary cortisol levels taken throughout the day in two-thirds of healthy subjects compared to those who suffered from fatigue. Dehydroepiandrosterone sulphate (DHEA-S) has also been used as a marker for adrenal fatigue but research has shown this to be unreliable. The most recent systematic review of adrenal fatigue is entitled, “Adrenal fatigue does not exist: a systematic review” by Cadegiani and Kater. The authors searched 3,470 published papers but only 58 of them fulfilled proper criteria for evaluation. Of the 58 studies, only 10 actually used the term “adrenal fatigue” but none of them did any kind of testing to validate this false condition. Some studies tried to use the term “burnout” instead of “adrenal fatigue” but no scientific evidence was presented in these papers. None of the studies in the above review were able to validate any of the functional tests used to assess adrenal hormone production including cortisol and DHEA. Additionally, no valid information was found in these tests to assess HPA axis dysfunction which is one of the hallmarks of “adrenal fatigue”. The authors rightly point out that anytime there is a suspected issue of HPA axis dysfunction, the following must be ruled out as a cause of this dysfunction: 1. Sleep apnea 2. Adrenal insufficiency 3. Mental illness 4. Overwork 5. Night-shift workers 6. Other hormonal imbalances 7. Liver and kidney dysfunction 8. Heart conditions 9. Lung disease 10. Autoimmune disease Some alternative practitioners are not adequately assessing each patient for the above list of potential issues and jumping into treatment of “adrenal fatigue”. The authors conclude that there is no demonstrated evidence that “adrenal fatigue” is a real condition. Their two final statements are: 1. “The results of previous studies were contradictory using all the methods for assessing fatigue and the HPA axis.” 2. “The most appropriate methods to assess the HPA axis were not used to evaluate fatigue.” It is clear from reviewing the above paper that the methodology in all the studies reviewed was very poor and did not provide any valid scientific support of “adrenal fatigue”. What about corticosteroids? Many integrative practitioners are prescribing oral corticosteroids to treat adrenal fatigue which can have many negative consequences.

In this episode of Functional Medicine Research, I interview naturopathic physician Dr. Ilana Gurevich on overcoming inflammatory bowel disease.  We had a deep discussion about testing and treatment options for inflammatory bowel diseases including Crohn's disease and ulcerative colitis.  We covered diagnostic testing, the pros and cons of stool test markers, probiotics, fiber, digestive enzymes and hydrochloric acid, gut healing nutrients, diets like the Specific Carbohydrate Diet, helminths, and much more.  It was a pleasure to have Dr. Gurevich's expertise on inflammatory bowel disease. Below is a transcript on How to Overcome Inflammatory Bowel Disease with Dr. Ilana Gurevich Dr. Hedberg: Well, welcome everyone to "Functional Medicine Research" I'm Dr. Hedberg, really looking forward to my conversation today with Dr. Ilana Gurevich. She is a naturopathic physician and acupuncturist. She graduated from the National University of Natural Medicine in 2007, with her doctorate in naturopathic medicine, and in 2008, with her masters of Oriental medicine. She is currently co-owner of two large integrated medical clinics, one in Northwest Portland and one in Northeast Portland. She runs a very busy practice specializing in treating inflammatory bowel disease, which we'll be talking about today, as well as IBS, SIBO and other functional GI disorders. She lectures extensively and teaches about both conventional and natural treatments for gastrointestinal conditions, including inflammatory bowel disease, SIBO, and IBS. She's one of the foremost experts on the intersection of IBD and IBS and how treating one resolves the other. Dr. Gurevich also acts as a mentor in the naturopathic community, educating and consulting with physicians about GI disorders. She supervises residents and consults with doctors about their most difficult GI cases. She was nominated as one of Portland's top docs by the Portland Monthly in 2014, 2016 and 2020. So Dr. Gurevich, thanks for coming on the show. Dr. Gurevich: Thank you so much for having me. Dr. Hedberg: Yeah. So this is gonna be really interesting. I've heard you talk before and I wanted to have you on because you're extremely a research-based, you know, scientifically sound. And of course, you have tremendous experience in inflammatory bowel and SIBO and IBS. So why don't we just lay some groundwork? And if you could just talk a little bit about what have you found to be the real causes, the triggers of inflammatory bowel in your patients? Dr. Gurevich: You know, it is such a multifactorial disease. So with inflammatory bowel disease, there are these two peaks of when people generally get diagnosed. The first is, you know, adolescence, right around puberty to like the mid-30s or 40s. And then the second is menopause, andropause in your 60s, 70s, 80s. And those patients tend to get found a lot just on their basic screening colonoscopy. And so, you know, because there are these bi-modal peaks of diagnosis, it really makes me think that one of the issues is hormonal changes that happen. And, you know, we're learning more and more recently about how hormones affect the GI, mainly using the estrobolome as an example, and then how the estrobolome affects how you conjugate or process your hormones. And so there's definitely a hormonal component. Research is also exceptionally clear that diet is a huge component. You know, in parts of the world where they don't really see inflammatory bowel disease like Africa, like Asia, when people from those countries move to a Western civilization, they start getting diagnosed with inflammatory bowel disease equal to people of the West, which means that the way that we're eating is definitively changing our microbiome, which is then causing onset of inflammatory bowel disease. What's interesting is the opposite now is also happening as we introduce the Western diet into more diverse countries that in the past were, you know,

In this episode of Functional Medicine Research, I interview a very distinguished guest, Ethan Taylor, PhD about his published research on selenium, glutathione, and COVID-19.  Dr. Taylor has a wealth of knowledge and research experience on pandemics, selenium, glutathione, vitamin D, viruses, antimicrobial drug resistance, and how human relationships with animals causes so many of our health problems and climate change.  I was extremely grateful to have someone like Dr. Taylor on the show to share his expertise. Dr. Hedberg: Well, greetings everyone and welcome to Functional Medicine Research. I'm Dr. Hedberg and I'm really looking forward to my conversation today with Dr. Ethan Will Taylor. And Dr. Taylor is a pharmacologist, computational chemist, and virologist. He has a Bachelor of Science in chemistry from the University of Winnipeg and a PhD in pharmacology and toxicology from the University of Arizona. He began his career as Assistant Professor of Medicinal Chemistry, and later, Professor of Pharmaceutical and Biomedical Sciences at the University of Georgia College of Pharmacy. He's currently Professor of Chemistry and Biochemistry at the University of North Carolina, at Greensboro, where he has also served as a founding member of the Department of Neuroscience and as Director of the Biosafety Level 3 Laboratory. Dr. Taylor has been engaged in research on HIV, Ebola, and other emerging infectious diseases for over 25 years and is best known for his work on the role and mechanisms of the dietary trace element selenium in reducing the pathophysiological effects of various RNA viruses. He's also an amateur musician. And with his wife Maria he operates the Dharma Farm Animal Refuge and Vegan Event Center in Archdale, North Carolina. Dr, Taylor, welcome to the show. Dr. Taylor: I'm happy to be here. Dr. Hedberg: Excellent. Great, so I wanna have someone on the show who has some excellent expertise in some of our biggest issues today in the world. Some of this will revolve around the current pandemic as well as we'll talk about how the consumption of animals is leading to pandemics and how it's affecting our environment. Before we jump into those details, can you give us just a general overview of your research interests and the work that you've done? Dr. Taylor: Sure. As you stated in the bio, my background was in pharmaceutical sciences. Which means you're looking at drugs and how drugs work and designing better drugs. And so, I had that kind of background and I was a pharmacy professor for 18 years. But the more I studied drugs and how they work, you come to realize that most of the drugs we have, a lot of them treat symptoms. We have some phenomenal drugs, they're really great to have when you're doing surgery on people and things like that. And many of the drugs work well but a lot of them really just treat symptoms. And I became kind of more interested in, what's really the underlying cause of this pathogenic effect. And that led me inevitably to nutrition and being interested in nutrition. And part of it was a serendipitous, almost accidental discovery that I made when I was studying HIV, that led me to this trace element of selenium that you mentioned. And so, that has kind of been my background but I essentially evolved into this area of looking at...became very interested in antioxidants, selenium in particular and its role in viral diseases, particularly RNA-virus diseases. And along the way, just my family were vegetarians and my kids became vegans before my wife and I did, and then we became vegans. For a lot of reasons, and people do that for different reasons, kind of health reasons, but there's also environmental reasons, ethical reasons. And I became kind of interested as a sideline in this whole topic of, what does the fact that humans exploit animals to such an extent made primarily to eat them, what are the implications of that for things like diseases. Because,

In this episode of Functional Medicine Research, I interview Dr. Liz Lipski in a discussion about how to choose the best therapeutic diet for gut health.  We discussed the low FODMAP diet, comprehensive elimination diet, Simple Carbohydrate Diet (SCD), GAPS diet, Paleo diet, histamine, pancreatic elastase and low HCL levels.  Liz discussed why we would choose each one of these diets for an individual and what each diet entails.  I use all of these diets in my practice so it was nice to have an overview of each diet from one of the top experts in gut health. Dr. Hedberg: Well, welcome everyone to "Functional Medicine Research." I'm Dr. Hedberg. And I'm really looking forward to my conversation today with Dr. Liz Lipski. And Dr. Lipski, she's a Professor and the Director of Academic Development for the Nutrition Programs at Maryland University of Integrative Health. She has a PhD in Clinical Nutrition, two board certifications in nutrition, one in functional medicine, and she's a fellow of the American College of Nutrition. She's the author of the fantastic book "Digestive Wellness" which I highly recommend. And she's the founder of the Innovative Healing Academy. She's on faculty for the Institute for Functional Medicine and the Metabolic Medicine Fellowship in Integrative Medicine. She's been a pioneer in the field of functional nutrition for four decades. Liz, welcome to the program. Dr. Lipski: Thanks, Nick. It's so nice to be with you today. Dr. Hedberg: Yeah. This is gonna be a great talk. We're gonna be talking about how to choose the best diet for gut therapy. And why don't we start by just a general question about, you know, what is the best overall diet for GI health? Do we really know, based on the research at this point, what the vast majority of the population should follow? Do we have any insights on that? Dr. Lipski: I do. I think a lot about what's different between people who are healthy and wanna work on tweaking their health or preventive health, and then people who are already in a deep hole where already their health is compromised. And hands down, when we look at research, it looks like a whole foods diet based on a Mediterranean-type diet is the very best diet. When we look at it, cancer rates go down and diabetes rates go down and cardiovascular disease rates go down, but we also have some research on GI. And one of the main issues in the way that we're eating... And I know you see this in your practice, Nick. What we see is, when you ask people, "Well, how do you eat?" And what do they tell us? They say, "I eat pretty well." Right? Don't you hear that all the time? Dr. Hedberg: Yeah. Yeah. Dr. Lipski: And then you look at somebody's food diary and maybe they do, but usually they don't. And so for me, steering somebody at first to a whole foods diet is the most important thing because what we know is that according to a recent study based on kind of looking at every food that has a barcode and it represented, you know, any food company that had more than, you know, a tiny share of the market, they looked and they said 70.9% of the foods that we Americans are eating are ultra-processed. Ultra-processed. And so we now have other studies that say, "Well, if you have more than two servings a day of these ultra-processed foods, we have a 62... For each 10% increase in ultra-processed foods, we increase our risk of cardiovascular disease by 12%, and heart disease by 13%, and strokes by 11%." So, we also have some research on cancers as well. And so, you know, it's not that we can have a treat. It was just my son's birthday and I made a cake and we all had cake. It's not like, you can't have some treats, but at least I made the cake. I knew every ingredient that was in it. And most of us are just eating, the majority of our food is fast, easy, cheap, and filled with all kinds of additives and highly-processed foods. And so the first step is moving towards a whole foods d...

I’d like to share with you all the things I’ve been doing since the COVID-19 pandemic started to better myself and stay as healthy as possible. I like the quote, “Whenever one door closes, another door opens.” Of course, I miss doing many of the things I normally do to have fun and interact with other people but this has been a time to take advantage of the many opportunities available. No matter what kind of health issues you’re dealing with, some of these ideas can have significant impact on your overall health. Birding Birding or birdwatching has been a growing passion of mine for the last few years but quarantine has given me more time to dedicate to this fascinating hobby. Recent research by Cox and Graston found that people living in neighborhoods with more birds are less likely to suffer from anxiety, depression, and stress. The study participants had lower levels of depression, anxiety, and stress simply by looking at birds, trees, and shrubs. The more birds the participants could see, the better their mental health. The study participants who spent less time outdoors had higher levels of anxiety and depression. Dr Daniel Cox, who led the study, stated: "This study starts to unpick the role that some key components of nature play for our mental well-being." Birds around the home, and nature in general, show great promise in preventative health care, making cities healthier, happier places to live." Here are my tips to get into birding so you can avoid any of the mistakes I made: 1. Only buy Squirrel Buster feeders from Brome. These will save you a lot of time and money if a squirrel finds your feeder. Squirrels will eat all the food and sometimes destroy a feeder, but they have no chance of getting the food in a Squirrel Buster feeder. “Fiery Hot” squirrel food blends that are supposed to burn the squirrel’s mouth with hot pepper oil just don’t work well so save your money. 2. Avoid bird mix blends that are filled with millet, milo, and wheat. These are cheap fillers that most birds won’t eat so it may seem like you’re saving money by buying cheap bird food but most of it will just be thrown to the ground by the birds. Start out with just black oil sunflower seeds which will attract the most amount of birds. 3. A water feature is just as important as a bird feeder to attract birds to your property. 4. When you put up a new feeder, sprinkle some seed below the feeder on the ground to attract birds. 5. 120 million birds die every year flying into windows. Put up some stained-glass features or buy anti-bird stickers to put on your windows near the feeder so no one ends of dying. Whenever I’m stressed I like to sit outside on my porch and watch the birds come to my feeders. It always puts a smile on my face no matter how stressed I may be. Astronomy I’ve been into astronomy for many years but it had fallen by the wayside the last few years. You don’t necessarily need a telescope to get started as you can use binoculars in the beginning. The stars and the planets are always there for you to enjoy. I just saw the moons of Jupiter and the rings of Saturn the other night and I’m still in awe of how amazing it was. You can install an astronomy application called Stellarium on your computer or cell phone which tracks the entire night sky. It makes it easy to find any planet, the moon, or stars with a built-in compass so you can find anything quickly by whatever direction you’re facing. Astronomy makes you realize how vast the universe really is and the great astrophysicist Carl Sagan really puts things in perspective with his Pale Blue Dot narrative: Coding Learning how to code is very easy these days due to the sheer number of free resources. I am currently learning HTML, CSS, and JavaScript, so I can build my own websites and web applications. The key to learning to code is to have a passion project that you can begin working on right away.

We have known since the early 1970s that infections can trigger autoimmune diseases and now we have an interesting hypothesis on the potential triggering of Hashimoto’s disease by COVID-19 infection. A recent case study out of Singapore published in the Singapore Medical Journal entitled, “COVID-19 complicated by Hashimoto’s thyroiditis” presents an individual who developed Hashimoto’s thyroiditis after contracting COVID-19. COVID-19 can cause a hyperinflammatory state in the body which is a potential recipe for developing autoimmune disease. The authors begin by pointing out the most current literature on COVID-19 connections to the autoimmune diseases antiphospholipid syndrome, autoimmune thrombocytopenia, autoimmune hemolytic anemia, and Guillain-Barre syndrome. This patient was a 45-year-old Chinese man who developed a non-productive cough and rhinorrhea for one day after exposure to COVID-19 in his dormitory. On the second day of his symptoms he was diagnosed with confirmed COVID-19 infection. His symptoms went away after 7 days, but he reported new onset of severe generalized fatigue and muscle weakness. Before these symptoms happened, he was in good health, not taking any medications or supplements, working productively, and no history of smoking. He had no family history of autoimmune disease. His physical examination was unremarkable and his thyroid was normal without goitre. However, his TSH level was high at 6.49 and his free T4 was low at 9.19 which is a classic presentation for hypothyroidism. His thyroid peroxidase antibody was extremely high at >2,000 confirming Hashimoto’s disease. His inflammatory markers were normal as well as electrolytes and other metabolic tests. Chest x-ray was completely normal. He was prescribed 25mcg of levothyroxine once a day and five weeks later he reported increased energy, and he had started running again. His TSH was 6.59 and free T4 was 10.91 so those markers did not improve despite the medication and his energy improving. The authors state that the onset of his symptoms from the time he first developed COVID-19 to the time he developed Hashimoto’s disease was similar to the onset of the other 4 autoimmune disease connections noted above in previous studies. The authors conclude that the hyperinflammatory state triggered by COVID-19 also known as a “cytokine storm” can predispose patients to developing autoimmune diseases such as Hashimoto’s thyroiditis. Dr. Hedberg’s Comments Some patients will develop Hashimoto’s disease after getting the flu or other infections such as Epstein-Barr virus, H. pylori, Yersinia enterocolitica, Blastocystis hominis, Parvovirus-B19, Hepatitis C, and Herpes 6 to name some of the most common triggers. Infections can cause abnormal shifts in the immune system thus triggering autoimmunity in predisposed individuals. Normally, it takes three important factors to trigger autoimmune disease: 1. A genetic predisposition. 2. A gut problem such as leaky gut or intestinal dysbiosis. 3. A triggering event such as infection, physical or emotional trauma, giving birth, mold exposure, medications, radiation exposure, excessive iodine exposure, or toxin exposure such as mercury. What is interesting about this case is that he did not have a genetic predispostion at least not that we knew of or was stated in this paper. We also don’t know if he had any gut problems. The cytokine storm caused by COVID-19 can be quite intense compared to other infections so perhaps any predisposing factors were overriden by the storm. This is just speculation on my part but with only a single study subject and not more data about this individual, there isn’t much more to go on other than what we know about how the immune system responds to infections and how autoimmune diseases are triggered. Additional speculation on my part would be that if you have an autoimmune disease like Hashimoto’s disease,

It this episode of Functional Medicine Research, I interview Dr. Lucy Mailing in a discussion about the best diet for your gut microbiome.  We had a fascinating discussion focused on all of the different diets out there and how they affect the gut microbiome including the ketogenic diet, plant-based diets, high-fat, low FODMAP, and the autoimmune paleo diet.   We also talked about fiber, protein, hydrogen sulfide, resistant starch, butyrate, gluten, lectins, stool testing, and whether or not you should take probiotics after taking antibiotics.  I think you'll find this conversation quite eye-opening about a number of exciting topics related to the gut micobiome. Below is a transcript on the best diet for your gut micobiome: Dr. Hedberg: Well, welcome, everyone to "Functional Medicine Research". I'm Dr. Hedberg and I'm really looking forward to my conversation today with Dr. Lucy Mailing, PhD. She is a microbiome researcher, educator and passionate scholar of integrative, evidence-based gut health. Lucy received her bachelors in biology from Kalamazoo College and her PhD in nutritional sciences from the University of Illinois where her graduate research focused on the impact of diet and exercise on the gut microbiota. She has authored numerous peer reviewed journal articles, regularly presents at national, international conferences and was named an emerging leader in nutritional sciences by the American Society for Nutrition in 2017. Lucy is the founder and sole author of lucymailing.com, a website dedicated to integrative, evidence-based articles about the gut microbiome, health and nutrition science. Dr. Mailing, welcome to the show. Dr. Mailing: Thanks so much for having me. Dr. Hedberg: Great. So you've done some great writing and research on some topics that a lot of people are interested in. That's why I wanted to have you on. So why don't we begin by really focusing on diet and the gut microbiota and what the research is really showing at this point? So why don't we start with one of the very popular diets out there which is the ketogenic diet and we can kind of lump in just the high-fat diet in general with that. So what can you tell us about high-fat diets, ketogenic diets and how it affects the gut microbiota? Dr. Mailing: Sure, yeah. That's a great place to start. I think one of the key things to keep in mind here is that we're still in the infancy of microbiome research and especially in our understanding of what constitutes a healthy microbiome. And we have certainly done a number of studies looking at how diet can impact the microbiome. A lot of this has been done in animal models where we can essentially really control the diet of the animals and determine what effects that has on their microbiome. So a lot of the studies with the high-fat diet in the literature are kind of misleading because they're labeled as a high-fat diet but they're really more accurately a diet that is very high in refined fats and also high in refined sugar and low in fiber. So we can't really take that and compare it to the equivalent of a very healthy, like a health-conscious ketogenic diet that's got lots of non-starchy vegetables, healthy fats. There's just really not much comparison we can make there. And the other thing is that the gut microbiome has really evolved with us, often in the context of periodic ketosis. So if we think about human evolution, we've been coevolving with our gut microbiome for thousands of generations. And the environment we evolved in required regular adaptation to changing conditions. When there was nutrient scarcity or even just carbohydrate scarcity, our metabolism would shift to reflect what was available in our environment to consume. And so we have that metabolic flexibility in our host genome, right. As humans, we have the ability to metabolize carbs or metabolize fats in periods of carbohydrate scarcity. So the real question is why would our bodies not have this....

In this episode of Functional Medicine Research, I speak with therapist Martina Barnes about how EMDR can help people overcome trauma.  I have personally used EMDR with great success in overcoming trauma and I routinely refer for EMDR to help patients get well.  One of the most important aspects of practicing functional medicine is understanding how much trauma can be connected to chronic illness.  Many patients won't get well until they address their past and how it is affecting their current health issues.  All the healthy diets, supplements, exercise, sleep, exposure to nature, community etc. won't be enough if there is underlying trauma history wearing you down.   Mental health professionals are severely underutilized yet they should be the first line of therapy for the majority of patients with chronic illness.  Unfortunately, they usually end up being the last.  This interview should help shed some light on the benefits of EMDR and how it can help you heal and get well for lasting health and well-being. Below is a transcript on overcoming trauma with EMDR Dr. Hedberg: Well, welcome everyone to "Functional Medicine Research." I'm Dr. Hedberg and really excited today to have Martina Barnes on the show. Martina has a Master's Degree in Counseling Psychology from Western Carolina University and that was completed in the year 2000. So, many, many years of experience and Martina's theoretical underpinnings are informed by attachment theories of human development which determine our interpersonal basis for relationships. And when working with individuals together, we seek to understand the attachment wounds developed in childhood and how your style impacts your relationship with yourself and others. And Martina says you can transform your life by transforming the way your brain and nervous system are wired. She utilizes a range of evidence-based yet cutting-edge holistic modalities such as Trauma Resilience Model, EMDR, which is what we're gonna be talking about today in detail, Internal Family Systems, Neuro-Linguistic Programming, and mindfulness, and Martina has been a speaker and educator at trauma recovery conferences and seminars for victims of murder, suicide, and even sudden death. So, Martina, welcome to the show. Martina: Thanks, Nick, and great to be here. I'm excited to share what I know about EMDR. Dr. Hedberg: Yeah. I'm excited as well. This is something that I've been wanting someone on the show for a long time to talk about EMDR. This is something that I've used myself and recommended to many patients. So, why don't we just talk about some of the basics and why don't you give us an idea of what exactly is EMDR and what does it stand for? Martina: Yeah. Great. So, EMDR stands for Eye Movement Desensitization Reprocessing. And it's a modality that originally only used eye movements to help give the brain bilateral stimulation to help clear trauma. It's gone to incorporate other types of bilateral stimulation. Maybe hand taps or also bilateral auditory tones can be incorporated as well. And it's one of the most powerful trauma recovery modalities that I've ever utilized. It was discovered in 1988. So, it's been around quite a long time. Dr. Hedberg: And who invented EMDR? Martina: Francine Shapiro who was a psychologist invented EMDR quite by accident. She loved to take long walks and when she was walking, she would notice if she was thinking about something that's setting or something disturbing that her eyes would dart back and forth, back and forth, and then they would stop darting, and she would notice that she had cleared that disturbing thought. So, it occurred to her that she might be able to develop some kind of protocol that would involve the eye movements to help clear disturbing thoughts. And she first decided to try this on veterans who had PTSD. Dr. Hedberg: Fascinating. And so, this modality, so, like you said,

In this episode of Functional Medicine Research, I interview Dr. Tommy Wood on the question of whether commercial genetic testing for SNPs is helpful or harmful.  This is a topic I have wanted to cover in detail for a long time so when I read Dr. Wood's paper and listened to him speak, I knew his expertise would be invaluable to this conversation.  It is important that practitioners and patients know the truth about the current state of genetic testing and whether or not it is scientifically valid or invalid. Dr. Wood has done the necessary research to outline all of the reasons why genetic testing is not a valuable tool in practice and he presents compelling data that it can be more harmful than helpful.  As stated in the interview, this is an area that I have never bought into because the science simply doesn't support genetic testing or interventions to address SNPs in clincial practice.  I think you'll find this interiew invaluable to your understanding of genetic testing. If you have any published papers to refute any of this information, myself and Dr. Wood would love to read these papers. Below is a transcript of the interview if genetic testing is helpful or harmful: Dr. Hedberg: Well, welcome, everyone, to "Functional Medicine Research." I'm Dr. Hedberg and very excited today to have Dr. Tommy Wood on the show. We're gonna be talking about genetics and genetic testing. And Dr. Wood is a research assistant professor of pediatrics in the University of Washington, Division of Neonatology. Most of his academic work is focused on developing therapies for brain injury in newborn infants but also includes adult neurodegenerative and metabolic diseases, as well as nutritional approaches to sports performance. Tommy received an undergraduate degree in biochemistry from the University of Cambridge before obtaining his medical degree from the University of Oxford. After working as a doctor in central London, he moved to Norway for his PhD, and then to the University of Washington as a postdoc. So, in addition to his academic training, he's coached athletes and dozens of sports, weekend warriors to Olympians and world champions. He's the outgoing President of the Physicians for Ancestral Health Society, a Director of the British Society of Lifestyle Medicine, and sits on the Scientific Advisory Board of Hinson performance, which includes researching performance optimization strategies for Formula One drivers. Tommy's current research interests include the physiological and metabolic responses to brain injury and their long-term effects on brain health, as well as developing easily accessible methods with which to track human health performance and longevity. So, Dr. Wood, welcome to the show. Dr. Wood: Thanks so much for having me. I'm excited to be here. Dr. Hedberg: Great. So, before we got on, we were just talking about a lot of the big issues in functional medicine include, unscientific and unvalidated testing and therapies and things like that. And so that's why I was really looking forward to this because genetics is something that I've never really got on board with as far as testing and treating patients. So, why don't we lay some bedrock for the listeners? And if you could just let us know, what is the current academic position by scientists on commercial genetic testing for SNPs and the interventions that some practitioners are using? Dr. Wood: That's a great question. And having spent a lot of time sort of straddling both traditional allopathic medicine, traditional academic research, and then also functional medicine, particularly with athletes, but also with various clients with chronic health conditions, there's this real tension between the two in terms of, you know, what's done and the evidence that supports it. And I think that's where some of these genetics stuff comes into play. And when I started really looking into this, you see very rapidly that academic geneticists who h...

Adrenal adaptogens are one of the most commonly prescribed supplements by functional medicine practitioners due to the impact of chronic stress on the majority of sick patients. Stress breaks your body down in every way imaginable so mitigating the negative effects of stress is priority number one in most patients. I’ve been using adrenal adaptogens in my practice for over 15 years now and I’d like to share my favorite adrenal adaptogens that may help you feel better. Adrenal adaptogens can cause negative reactions in some patients so do not take any of these without proper evaluation from a healthcare practitioner to avoid side effects. What is an adrenal adaptogen? An adaptogen has “non-specific” activity and acts by increasing resistance of the organism to a broad spectrum of adverse biological, chemical, and physical factors. Adaptogens act by regulating and normalizing organ and system function in the body.  Adaptogens work primarily by affecting the Hypothalamic-Pituitary-Adrenal (HPA) axis and the autonomic nervous system. Thus, adaptogens modulate our response to stress (physical, environmental, or emotional) and help regulate the interconnected endocrine, immune, and nervous systems. Your adrenal glands produce cortisol and adrenaline which make you more susceptible to infections and weaken the immune system. Adaptogens can help with infections through immune-building properties over time. Adrenal adaptogen myths Adrenal adaptogens do not increase cortisol levels above that of normal physiologic levels. Adrenal adaptogens do not lower cortisol levels below that of normal physiologic levels. Adrenal adaptogens will only help to normalize levels that may be too high or too low. “Adrenal fatigue” does not exist based on the most recent scientific evidence. There is no doubt that adrenal gland and HPA-axis dysfunction exists but not in the way that adrenal fatigue has be traditionally described. I still use the term on this website since it is searched for online so I want people to be educated when they come to this website. Rhodiola Rosea Rhodiola rosea is a flowering perennial native to sub-Arctic regions around the globe, notably Scandinavia and Russia, where it has been studied extensively since the 1960’s. Traditionally used in Russia and Mongolia for the treatment of long-term illness and weakness caused by infection, Rhodiola root has been studied for its favorable effect on central nervous system activity and neurotransmitter levels (e.g. dopamine, monoamines and beta-endorphins). Widely regarded as an effective natural antidepressant, rhodiola is distinguished by its lack of side effects. In addition to mood health, rhodiola has been shown to help improve sleep quality, memory and learning, to help reduce binge eating and to help increase stress tolerance in astronauts. Rhodiola is rich in potent antioxidants including vitamin C, catechins, organic acids, proanthocyanidins and the active compounds salidroside and rosavin. Rhodiola has the following positive effects on the body: Enhances utilization of glucose Increases serotonin levels in the brain Improves energy and stamina Balances norepinephrine (adrenaline) Improves dopamine levels Reduces anxiety Enhances memory and brain function Antioxidant properties Stimulates healing Increases work productivity High altitude sickness Improves Depression Antimicrobial Cardio-protective Neuroprotective Immunomodulatory Improves female fertility Although low in potential side effects, Rhodiola can be over-stimulating for some patients and can actually cause insomnia. Recommended dose is 200-600mg a day in divided doses in the morning and around noon with the above caution in mind. Don’t take Rhodiola anytime after the lunch hour. Ashwagandha Ashwagandha (Withania somnifera) is a well-researched, multipatented herbal extract, standardized to contain uniquely high levels of withanoli...

There have never been any studies on leaky gut and Hashimoto’s disease but now we have a new study on this connection. Leaky gut was something rejected by conventional medicine despite the fact that papers on leaky gut date back to the 1970s. For many years functional medicine practitioners have been testing for it and treating it which has helped many patients overcome their chronic illnesses. There are currently over 500 published scientific papers on leaky gut so there is no doubt it exists. Before we get to the new paper, there was an interesting paper published in 2004 which looked at the gut barriers of patients with Hashimoto’s disease. The paper is entitled “Ultrastructural changes in enterocytes in subjects with Hashimoto’s thyroiditis” by Sasso et al. The authors biopsied the small intestine of patients with Hashimoto’s disease and compared the microvilli to healthy controls. The results showed that patients with Hashimoto’s disease did in fact have structural changes in their microvilli which are the finger-like structures that line the gut barrier. Healthy microvilli are required for proper absorption of nutrients as well as preventing unwanted particles from entering the blood stream. These patients with Hashimoto’s disease had abnormal looking microvilli under the microscope compared to normal looking microvilli of the healthy controls. The authors also performed a lactulose/mannitol test which is used to assess gut permeability. The results showed that the patients with Hashimoto’s disease had abnormal lactulose/mannitol test results indicating abnormal intestinal permeability. Now let’s cover the new paper on leaky gut and Hashimoto’s disease entitled “Children With Hashimoto’s Thyroiditis Have Increased Intestinal Permeability: Results of a Pilot Study”. The authors begin by discussing the connection between increased intestinal permeability (IIP) and autoimmune diseases. Zonulin is a compound that controls the tight junctions in the gut barrier which are involved in movement of nutrients in and out of the gut. The higher the zonulin levels, the more severe the increased intestinal permeability. Higher zonulin levels have also been found in patients with autoimmune disease and in those leading up to the onset of autoimmune disease. How was the study done on Leaky Gut and Hashimoto's Disease? 30 children and adolescents with Hashimoto’s disease and 30 age, gender, and BMI matched patients with congenital hypothyroidism. Blood tests included zonulin, TSH, free T4, anti-TPO antibodies, and anti-TG levels. What were the study results? Serum zonulin levels were significantly higher in the subjects with Hashimoto’s disease compared to the control group. Free T4 levels were higher in the control group but differences in TSH levels were not statistically significant. Anti-TPO and anti-TG antibody levels were higher in those with Hashimoto’s disease as we would expect. Higher zonulin levels correlated with higher thyroid medication dose (levothyroxine). Zonulin levels did not correlate however with anti-TPO or anti-TG antibody levels. Author Discussion and Conclusion Increased intestinal permeability is a key component of autoimmune diseases. The tight junctions in the gut are key regulators of not only nutrient absorption but also the immune system. Increased zonulin levels are linked to aging and obesity so with our population continuing to become more obese, this may be one of the key factors in the increased incidences of autoimmune diseases. Patients with Hashimoto’s disease need more thyroid medication based on their zonulin levels which may indicate the severity of the disease. The authors do point out that this pilot study is limited due to the small sample size and because the control group wasn’t healthy. The authors conclude, “Higher zonulin levels in children and adolescents with Hashimoto’s thyroiditis suggested increased intestinal permeability in these patients...

There is a new exciting paper on the connection between eradicating the intestinal parasite Blasctocystis hominis and improving Hashimoto’s disease. I previously reported this infection connection in a case study which revealed an individual with Hashimoto’s disease getting better after eradicating Blastocystis hominis. Case studies aren’t the strongest scientific proof of a particular therapy but now we have and excellent paper with three research groups including a much-needed control group. This paper is entitled, “Improving Hashimoto’s thyroiditis by eradicating Blastocystis hominis: Relation to IL-17” published in the journal Therapeutic Advances in Endocrinology and Metabolism by El-Zawawy et al. The author’s begin by pointing out a very important fact that Hashimoto’s thyroiditis was once thought to be a TH1-mediated disease but once TH17 cells were discovered it became clear that it is a TH17-mediated disease. TH17 cells drive autoimmunity through production of the cytokine IL-17. Blastocystis hominis is the most common intestinal parasite in humans and most individuals never get any symptoms. This parasite is opportunistic however so if your gut or immune system becomes compromised, it can multiply and cause gut symptoms such as constipation and diarrhea, joint pain, drive autoimmunity and a host of other health problems. Blastocystis hominis has a prevalence of 1.6% to 16% in developed countries and up to 60% in developing countries. You can get this parasite from contaminated food or water. How was this study done on Hashimoto's Thyroiditis and Blastocystis hominis? 60 patients aged 19-57 with 19 females and 1 male in each group. Group 1: 20 patients recently diagnosed with Hashimoto’s thyroiditis without Blastocystis hominis infection. Group 2: 20 patients recently diagnosed with Hashimoto’s thyroiditis with confirmed Blastocystis hominis infection. Group 3: 20 healthy subjects without Hashimoto’s thyroiditis and not infected with Blastocystis hominis infection. All subjects in group 1 and 2 had a history of fatigue. 9 patients in group 1 and 7 patients in group 2 had a history of constipation. 6 patients in group 2 had a history of diarrhea. Interestingly, all subjects in group 2 who were infected with Blastocystis hominis had significantly higher blood pressure than the other 2 non-infected groups. The following tests were done on all subjects: Free T4 Free T3 TSH Anti TPO antibodies IL-17 Stool analysis CBC (complete blood count) ALT and AST (liver enzymes) Albumin Bilirubin Cholesterol Triglycerides BUN (blood urea nitrogen) Creatinine Group 2 which was infected with Blastocystis hominis was treated with the medication Nanazoxid for 3 days to eradicate the parasite and then retested 6 weeks later. What were the study results? TSH levels were higher in groups 1 and 2 compared to the healthy group 3 as expected. Free T4 was lower in group 1 compared to group 3 however group 2 did not have lower levels than group 3. Free T3 was significantly lower in group 2 compared to group 3. Free T3 levels in group 1 were not significantly different than the control group. TPO antibodies were the same between group 1 and group 2. Group 1 and group 2 had significantly higher levels of IL-17 compared to the healthy control group. However, group 2 had significantly higher levels of IL-17 compared to group 1 because group 2 was infected with Blastocystis hominis. They also found that high levels of IL-17 correlated with higher levels of anti-TPO antibodies and lower levels of Free T3. What happened to the patients treated for Blastocysis hominis? 10 patients in group 2 reported improvement in fatigue and 5 patients had improved constipation. Diarrhea completely resolved in all 6 patients. Blood pressure in group 2 which was significantly higher before treatment did not change after treatment.

I was very excited to interview therapist Samantha Osborne in a discussion about anxiety, irritable bowel syndrome (IBS), insomnia and cognitive behavioral therapy (CBT).  I had been wanting to interview someone for a long time on CBT because it is so effective for conditions like anxiety, insomnia, and IBS.  We discussed why we develop the thoughts that we do as well as beliefs and emotions and the many triggers of these conditions.  We also covered some excellent CBT strategies to overcoming these conditions that you can do on your own. Below is a transcript on Anxiety, IBS, Insomnia and Cognitive Behavioral Therapy Dr. Hedberg: Well, welcome everyone to "Functional Medicine Research." I'm Dr. Hedberg. And I'm really looking forward to my conversation today with Samantha Osborne. And Samantha is an Asheville based therapist and she serves busy professionals with anxiety and irritable bowel syndrome. She's certified in cognitive behavioral therapy and integrated mental health techniques. Samantha uses a variety of approaches to help clients move from feeling burned out and overwhelmed by their to do's to engaged and excited by their work and life. She earned her master's degree at the University of North Carolina at Greensboro and has been a featured speaker in several publications including "The Funk'tional Nutrition Podcast" and "Abundant Practice Podcast." And when she's not serving clients, you'll find her taking long walks with her poodle and listening to her favorite podcast. So welcome to the show, Samantha. Samantha: Thank you so much. Dr. Hedberg: So I've been wanting to have someone on for a long time to talk about cognitive behavioral therapy. So this was really serendipitous. And why don't we begin by just laying some bedrock information about, you know, what is the cognitive behavioral model and how does it explain where our thoughts, emotions, and our behaviors come from? Samantha: So CBT is basically a model of therapy that says that circumstances are really neutral. So no matter what happens in the world, that's not really what's determining our thoughts, emotions, and behaviors, it's just information, is an invitation to that. And then we have thoughts about those circumstances that lead to our emotions that lead to behavior that ultimately determine our results. And so CBT says that our thoughts really originate from, you know, different circumstances that we've had in our lives, you know, all kinds of home media, cultural expectations. Essentially they're formed really early, these core beliefs are, and then they're sort of hardened and solidified over time with different input that we're getting from the environment. Dr. Hedberg: And kind of that behavioral therapy is based on the ancient philosophy of stoicism, is that correct? Samantha: I believe so. Dr. Hedberg: Some of my patients know I'm a big fan of stoicism, stoic philosophy, which, you know, it's my understanding that CBT comes from that particular philosophy. And, I know that, you know, from what I know about CBT, it's very effective for anxiety and other mood disorders and insomnia and also IBS, which we'll be talking about today. So if our thoughts don't come from circumstances, where do they really originate from? Samantha: So our thoughts really come from core beliefs about ourselves and the environment. So you know, when we are kids we have different kinds of experiences that teach us about who we are and what the world is like fundamentally. And then those beliefs about ourselves and the world are then solidified over time with different experiences. So for instance, you know, if you grow up in an environment that's really unsafe and abusive then you think that the world is a really unsafe place and then you might have other experiences that reinforce that over time. So then when you're met with circumstances like, you know, someone approaching you at night, you're sort of primed to think, oh no,

Human herpesvirus 6 or HHV-6, is a herpes virus just like Epstein-Barr Virus, Cytomegalovirus, Chicken pox (varicella zoster), HHV-7, HHV-8 and Herpes simplex 1 and 2.  There are two types of this virus including HHV-6A and HHV-6B. 100% of human beings get infected with HHV-6B by the age of three which results in fever, diarrhea and a rash called roseola. In rare cases it can cause seizures and encephalitis.  There are many infection connections to autoimmune diseases like Hashimoto's disease and in this article I'll cover the connection between HHV-6 and Hashimoto's disease. Less is known about HHV-6A which was found in a small study in 50% of adults.  HHV-6A is said to be the most problematic of the two types and it is the type found inside the thyroid glands of some people with Hashimoto’s thyroiditis. Just like other herpes viruses, HHV-6 can reactivate (occurs in the thyroid gland, GI tract, brain, heart, kidneys, uterus, and lungs) later in life when the immune system is compromised resulting in a variety of conditions including: Hashimoto’s thyroiditis Sjogren's syndrome Lupus Rheumatoid arthritis Sarcoidosis Guillan-Barre Multiple Sclerosis Infertility Chronic fatigue syndrome Fibromyalgia HIV progression to AIDS Epilepsy Seizures Immune suppression Certain types of cancer Kidney, liver, lung disease Heart disease Encephalitis Colitis Transplant recipient issues Bone marrow suppression Autoimmune hepatitis What is the link between HHV-6 and Hashimoto’s disease? Here are some studies supporting the connection between HHV-6 and Hashimoto's disease: Rizzo et al. in 2016 found a direct connection among natural killer cell activation, thyroid antibodies, and HHV-6 in patients with Hashimoto's disease.  This study found that the HHV-6 virus causes an increase in natural killer cells against the virus which causes an ongoing inflammatory process in the thyroid gland that correlates with thyroid peroxidase and anti-thyroglobulin antibodies.  This means that an active HHV-6 infection in the thyroid gland drives the elevation of thyroid antibodies and increases inflammation in the gland resulting in increased damage to thyroid tissue. A study published in 2012 entitled "Virologic and Immunologic Evidence Supporting an Association between HHV-6 and Hashimoto's Thyroiditis" by Caselli et al. found that a high percentage of patients in the study with Hashimoto’s disease have active HHV-6A infections inside the thyroid gland.  This increases inflammation in the thyroid gland since the immune system is concerned about Human herpesvirus 6 and due to antibodies against the thyroid gland. A follow-up study by Caselli et al. in 2017 entitled "HHV-6A in vitro infection of thyrocytes and T cells alters the expression of miRNA associated to autoimmune thyroiditis" also found a connection between HHV-6 and Hashimoto's disease. Sultanova et al. in their 2017 paper entitled "Association of active human herpesvirus-6 (HHV-6) infection with autoimmune thyroid gland diseases" found a statistically significant higher level of persistent HHV-6 infection in those with Hashimoto's disease compared to the control group.  They also biopsied thyroid tissue of patients with Hashimoto's disease compared to a control group without Hashimoto's disease, and they found a statistically significant higher level of HHV-6 in those with Hashimoto's disease compared to the control group (18/44 (41%) vs. 1/17 (6%)). Seyyedi et al. in their 2019 paper entitled "Human herpesvirus 6A active infection in patients with autoimmune Hashimoto's thyroiditis" consisting of 242 patients found 57 out of 151 (38%) of patients with Hashimoto's disease had active HHV-6A infections.  5 out of 59 (8%) patients with non-autoimmune thyroid disorders had active HHV-6A infections.  And 0 out of 32 (0%) patients with normal thyroid function had active HHV-6A infections. Why does it reactivate in some people?