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MORE Evolution of Thinking

I try not to be one to write for the sake of writing. When I do, it is usually not worthwhile reading material. Occasionally my brain goes into overdrive (usually at 4 AM) and a LOT of things start spontaneously forming inside my head that I feel like I need to share. This, of necessity, produces something quite lengthy so, not generally conducive to the modern sound-bite mentality. The issues that I bring up are the product of the constant flux and change of understanding and practice of medicine, especially of the functional type. I will expose you to my changing practice which may unnerve some of you. Some of this you have already heard, e.g. my worries about acetaminophen use. Some concepts will be new and current. Some comes from experiences with you. Most comes from the medical literature, the functional training and conferences that I regularly attend, and some from functional docs and practitioners who state things better than I can. So, as usual, hang onto your hats!!! This will be fun! (addendum, now a month down the road and I probably just need to share what I have and do the second half later…to avoid writing 50 pages!

1. Mitochondria

We are seeing more evidence of acquired mitochondrial function in our kiddos. These little organelles in all our cells produce the power that makes us run. They are our batteries. When mitochondria do not functional well, our energy becomes low, we become more tired more frequently, our muscles become weak and our overall tone drops, our brain becomes foggy, our immune system becomes weak, and our gut becomes dysfunctional. Our environment contributes strongly to how our batteries maintain their charge. Heavy metals such as Arsenic and Fluoride in our water, Fluorine-containing medications such as fluoroquinolones (Cipro, Levaquin, Floxacin) and lipid lowering agents (Lipitor, Mevacor, Crestor), Mercury in our fish, air (from coal burning), and dental fillings, Lead in our homes, pipes, and water, and Aluminum in our cookware, soil, and vaccines gum up the energy producing processes in our mitochondria. Here is a chart of drugs that are mito poisons for your weeping pleasure: .

Even our antidepressants are making us sicker! Poor fat intake also makes the membranes of these organelles less efficient and more stiff. High ratio of omega 6 to omega 3 and also high intakes of trans fats contribute to this membrane dysfunction. Our societal push to a low fat diet has also affected energy production because mitochondria most efficiently use fats to produce ATP. A brief illustration to understand how these batteries actually work: Imagine a kit peddling hard to move water uphill using the bicycle contraption shown. Now imagine another bicyclist just in front and just above him that takes the first water flow and raises it further. And now imagine another two in front of that one. We can raise that water up pretty high. This gives us a lot of “potential energy” that can be used to maybe drive a water wheel as that higher water flows over a dam and turns a paddle wheel which is connected to a generator which lights a bulb. The mitochondria do something similar to this by using the energy of electrons (equivalent to our peddling kid) to push Hydrogen ions out into the “inter-membranous space”, (equivalent to our dam behind which our water accumulates). Instead of water, however, the mitochondria use hydrogen! When enough hydrogen has been “raised” behind our dam, they can cascade back into the inside space (matrix) of the mitochondria like a waterfall over the side of the dam while turning the “turbine” called ATP synthase. It literally looks and acts like a turbine. This video illustrates the turbine nature of ATP synthase. Quite intriguing.

Kid (electron) uses energy to pump water (hydrogen) uphill. This happens four times in Complex 1, 2, 3, and 4.

Complex 5 is ATP synthase which is comparable to a waterwheel that is turned as water (our hydrogen ions) drops from a higher level (higher energy) to a lower level (lower energy). This turns a generator, also part of ATP synthase, and provides energy to light a bulb (create ATP, the energy molecule of the body).

You can see the three proteins on the left pumping H+ ions out into the inter-membranous space. They then drive the yellow turbine on the right as a waterfall would on a waterwheel. This produces ATP from ADP. This ATP is then used in the body for muscle contraction, digestion, thinking, growth, etc.

What it really looks like:

The Krebs Cycle supplies the high energy electrons to the electron transport chain to be able to pump protons into the inter-membranous space. Those high energy electrons come from the high quality food we eat. The fats are broken down at the top of the Krebs Cycle to enter the cycle as Acetyl CoA. When the quality of food is poor, the ability to extract high energy electrons for the electron transport chain is decreased. If the various steps are inhibited by heavy metals, drugs, and organic toxins, this also reduces high energy electron extraction for ATP production. Sometimes we can support the functions of the Krebs Cycle and the electron transport chain by higher doses of B complex vitamins, lipoic acid, CoQ10, and Magnesium which are all cofactors in the Krebs cycle and electron transport chain. We are currently working on developing just such a “mitochondrial cocktail” for those kiddos with fatigue, poor muscle tone, poor brain function, and even poor gut function. In the meantime, I am quite impressed with the content of most of these nutrients in the Restore Family multi-nutrient powder You can get this off their web site, at my office, or the office of Katie Packwood.

2. Snacking All Day Long? Not so good!

High carb breakfast like boxed cereals spike blood sugar and start on a rollercoaster ride for blood sugar and emotions that follow. By mid morning, “hanger” sets in and a snack is in order, usually crackers or chips or other forms of carb. Then the cycle starts all over again. Better to give a high fat and protein breakfast such as eggs, bacon, smoothie, and even cooked oats. If a snack needs to be given, then a stick of string cheese is better. Don’t allow snacking all day long. Mealtime appetite is adversely affected when a youngster has been snacking. I was totally gratified to see one of your families in my exam room with the kids pulling out a snack box full of baby carrots, celery, olives, cherry tomatoes, and Tillamook cheese sticks.

3. Get rid of ALL boxed cereal

Honey Oat Cheerios are not a health food. A recent report in none other than the NY times looked at the sugar content of this popular cereal and showed it was the second highest of all cereals, second only to Fruity Pebbles! And more sugar than three Chips Ahoy cookies! The comparison was with 1 cup of cereal, the supposed size of one serving. This is a marketing gimmick because the total quantity of cereal that satisfies an appetite is twice that. The food industry understands the addictive nature of sugar. If your child has behavioral issues, anger, volatility, anxiety, or obesity, other inflammatory problems like asthma, gut issues, eczema, stop all processed boxed breakfast cereals. One to two eggs daily will go a long way into stabilizing these, assuming there is no egg allergy. Once a family is weaned off these non-foods, sweetening can be accomplished with things like monk fruit and stevia, or by serving sweet potato or yams. Small amounts of raw unprocessed local honey is also a good substitute.

4. Take your vitamins

I have not been a big proponent of multivitamins in the past. As we do more lab testing on your kiddos, we are finding more and more deficiencies that have needed to be addressed. We find a LOT of vit D, Magnesium, B complex, omega 3 fatty acids, Vit C, zinc, etc. I have assumed that a good diet would take care of all these. Well, apparently, it does not! I have a strong suspicion based on testing and literature that our food supply is lower in quality, even the organic foods, likely due to our depleted soil. This depletion occurs do to the kinds of fertilizer we use (N,P,K) and the use of Roundup. Short anecdote: in the mid 20th century, glyphosate in Roundup was originally a chemical used to clean industrial metal pipes from accumulations of other metallic scum and crust. It avidly binds to metals. This is the way it kills plants. So what do you suppose happens to nutritional metals like magnesium in the soil? We have attempted to address these deficiencies as the first layer of intervention in your complex kids. This, as some of you know, has resulted in quite a list of supplements to be taken. Over the past couple of years, some of you may remember helping me try to find a healthful, complete, good tasting supplement for the kids which would combine all these nutrients. It has been quite a chore to find something not loaded with sugar and that contains adequate amounts of nutrients. As you know, I have spent 9 months experimenting on myself using Restore Professional, and now, with some prompting to the company, the Restore Family. I have been very impressed with the thought put into this multivitamin/mineral/nutrient/amino acid/phospholipid/mitochondrial support/anti-inflammatory support product. It is a bit spendy, however, it is cheaper than the list of nutrients I was giving you previously and much easier to give. Now that I have actually found something of exceptional quality, I am recommending that any kiddo with ANY medical issues be placed on this wonderful nutritional. This includes any kid with constipation, chronic diarrhea, eczema, autism, ADHD, asthma, thyroid issues, and on and on….. As with anything functional, start low and go slow. Dose on the Restore Family is 1/5 scoop per year of age up to age 5 then full scoop up to mid to late teens. At that point, the adult version can be used, the Restore Professional. The Family version is dairy free. The Professional version comes as whey or pea protein based for those allergic to dairy. Always report positive and negative reactions. I should mention that for those worried about over-methylation, the active folate is limited to 400 mcg which is the RDA.

5. Take your probiotics

Till recently, we have followed the general recommendations of using probiotics for 1-2 months then stopping. If you wanted to use longer, then I advised rotation them. The purpose of this recommendation was to avoid creating a monoculture. The broader the variety of gut flora the better. With the evolution of extremely high quality probiotics with excellent numbers of bacteria both numerically and in variety, the worry about monoculture is mute. We have also determined that probiotics do not generally stay put in the gut over the short term. Once you stop taking them, they cease to be helpful. The prebiotics become much more important for the establishment of a good colony. This comes in certain foods such as Raw Chicory Root, Raw Jerusalem Artichoke, Raw Dandelion Greens, Raw Garlic, Raw Leeks, Raw Onion, Cooked Onions, Raw Asparagus. Some of your kids will actually eat some of these, but most will not, so having a good probiotic that contains prebiotics is good. Bottom line is that use of probiotics with prebiotics on a chronic basis is likely very beneficial. This is especially true for any gut damage caused by infection, use of antibiotics, use of acid inhibitors, being born by C/S, formula fed, and yeast overgrowth. Aim toward around 5 billion cfu for kids under 1 yr, 10 billion for 1-5 y/o’s, 15-20 billion for 5-10 y/o’s, and 25-50 billion for teens and adults. I am still suggesting the Garden of Life brand because it is the outlet that Dr. David Perlmutter used for his Dr. Formulated line that addresses the gut-brain interactions. I strongly suspect that the buy-out by Nestle will not affect quality. If quality drops, I cannot imagine Dr. Perlmutter keeping his probiotic line with the company. That would create a huge drop in revenue for Nestle, so I think they will be watching their “p’s” and “q’s”. for the Kids and here is an example for adult version

6. Higher dosing of Vitamin D

As we gain more experience with Vit D3 use and testing, I become more flabbergasted at the low levels of vit D that is allowed to pass for RDA recommendations! 400-600 u is the RDA. This is based on effects of Vit D on bone. The explosion of research and understanding of Vit D function in the body makes these numbers totally obsolete. Most of you are familiar with the use of vit D in depression and mood disorders, no? There is a reason that people in chronically overcast cities generally have more seasonal affective disorder. It is the lack of sunshine. Some of you are familiar with the effects of Vit D on the immune system. It upregulates 300+ genes that produce the “ammunition” for your fighting “military”, your white cells. To gain some understanding of the strength of Vit D as an intervention, think of it this way. When you send your military into battle, if you give them side arms, e.g. pistol, they can pick off one enemy at a time and then run out of ammo. Vit C is that way. It will neutralize one oxidant at a time. Better to send your military with unlimited air cover and precision “bombing” capability that will multiply their efforts a thousand-fold or even a million-fold. Vit D is just such military cover. It is a hormone that acts by binding to your DNA and upregulating (stimulating the production of) many hundreds of genes that code for things like antibodies, antiviral proteins, anti TB proteins, antibacterial proteins, etc. When this production machinery is stimulated, this production line is capable of producing millions of support ammo per vit D molecule!!! This is why I suggest tripling your Vit D intake at the very onset of an illness. If you can upregulate your immune system early, in many cases it will make short work of the virus or bacteria before it has a chance to settle in and do a lot of damage. There is a growing groundswell of interest in re-evaluating the RDA’s for this vitamin as these numbers are based on outdated information. Remember that 30 minutes in direct summer sun will give you 10,000 units. I think we get “freaked out” by these high sounding numbers until you realize that 10,000 units is only 250 micrograms of Vit D3!!! This is STILL a relatively small amount. I am a big proponent of Vit D3 testing. Our testing for 99% of the kids supports the dosing schedule of the Vit D Counsel. I typically use the rough numbers of 1,000 u per year of age up to 5 then level off. Once into your mid teens, bump up to 10,000 daily through adulthood during the cold and flu season. You should check your 25 hydroxy vit D level while on your supplement in order to adjust. If you are particularly genetically endowed with the ability to metabolize Vit D level, you can adjust downward.

A paper out of U of Missouri Kansas City School of Medicine bemoans the current recommendations as being “grossly inadequate for correcting low serum concentrations of 25 hydroxyvitamin D in many adult patients.” They then go on to propose 5,000 u as being more appropriate for replenishment.

A second paper, much earlier, by Reinhold Vieth at U of Toronto was much more aggressive in his assessment. “Except in those with conditions causing hypersensitivity, there is no evidence of adverse effects with serum 25 hydroxy vit D concentrations <140 nmol/L (56 ng/ml), which requires a total vit D supply of 250 mcg (10,000 u) daily to attain. Published cases of toxicity with hypercalcemia…all involve intake of >40,000 u/d for prolonged periods.

The numbers we follow are from the Vit D Council. They aim to a blood level of 50 ng/ml (125 nmol/L). This is half way between the normal range of 30-80 ng/ml. You cannot budge the vit D level much at all with 400 or 600 u of dietary Vit D.

Bottom line: check blood levels; aim to 50 ng/ml; short 2-3 day double or triple of dosing will not cause toxicity; use of magnesium and Vit K2 will guarantee lack of hypercalcemia with high doses of Vit D. These two nutrients shunt calcium to the bone where it belongs and away from soft tissues like artery walls, kidneys, gall bladder, and tendons. Also remember sunshine during summer. You don’t have to supplement during summer months.

Lastly, here is the evidence for Vit D function in producing antimicrobial peptides (proteins). “Vitamin D deficiency has been correlated with increased rates of infection. Since the early 19th century, both environmental (i.e., sunlight) and dietary sources (cod liver) of vitamin D have been identified as treatments for TB. The recent discovery that vitamin D induces antimicrobial peptide gene expression explains, in part, the ‘antibiotic’ effect of vitamin D and has greatly renewed interest in the ability of vitamin D to improve immune function.” Think about why people who acquired TB in the early 1900’s prior to antibiotics were sent into sanatoriums up in the fresh air and sunshine of the mountains. It was for the vit D!!! That is what cured them.

7. High fat diet is good for you

This comment is likely to startle you because it goes against everything that has been thrown at us over the past 30 years. As it turns out, and some of you well read folks know this, the recommendations of a low fat diet was based on faulty science. Since this diet was foisted upon us, the rates of obesity have skyrocketed, the rate of Alzheimer disease has skyrocketed, and the rates of other fat-dependent disorders like acquired mitochondrial disorders has also skyrocketed. To be sure, there certainly WAS a problem with fat intake, but it was “bad” fat. When you eat coconut oil, olive oil, avocados or avocado oil, or grass fed butter, these are the “healthy” fats that build fluidity into cell membranes and give energy to our mitochondria. When the low fat diet came about, the butter was replaced with margarine that was loaded with the infamous “trans-fats”. These, along with the very high use of omega 6 fatty acids (ratio of 20 or 30:1 of omega 6 fat to omega 3 fats in our diet), have created an inflammatory cascade that have destroyed our cell membranes and our mitochondrial energy production and this has affected every organ system from brain to heart. And the American Heart Association still to this day pushes this agenda based on special interest funding! Look at their recent diatribe against saturated fats, i.e., coconut oil! “…randomized controlled trials that lowered intake of dietary saturated fat and replaced it with polyunsaturated vegetable oil reduced CVD by ≈30%, similar to the reduction achieved by statin treatment.”

And here with the last word is Dr. Perlmutter who makes mincemeat of the AHA recommendations. He tears to shreds all their wrong basic premises on cholesterol, saturated fats, coronary artery disease causation, bad lipids, good lipids, etc. This is an example of an entrenched organization further entrenching their position based on old bad data that are influenced by special interest. “Though they didn’t completely eliminate saturated fats from their recommendations, the AHA further mislead their audience by recommending polyunsaturated vegetable oils over coconut oil and other saturated fats, and this is unforgivable. The AHA took it one step further and made the disturbing recommendation to replace saturated fats with polyunsaturated fats – in the form of vegetable oils such as corn and soy oil.”

Bottom line that I am recommending based on less biased data: eat plenty of grass fed meat and dairy that has high in omega 3 fatty acids. Eat NO vegetable oils, in spite of what AHA states. Eat plenty of coconut oil, 1-2 Tbsp daily if you can. Cook with olive, avocado, flax seed, and coconut oils. The last (coconut oil) will tolerate higher heat when frying or sautéing. This will feed the mitochondria a rich fuel source for energy and will build flexible responsive cell membranes. Eat plenty of avocado, nuts, and grains like quinoa, grass fed open range eggs, and grass fed butter. And don’t forget lots of veges and fruits.

8. Flu Shots

Flu shots not what they are cracked up to be. This has been a scary flu season with more deaths than the previous few years. The H3N2 version of flu has the tendency to send more people to the hospital. These kinds of years give fodder to CDC, AAP, and FDA to push yet harder on the mantra of “get your flu shot”! There has been growing suspicion that the flu shot is not doing what it is supposed to do… protect us from the flu. You will remember that the nasal spray was removed from use 2-3 yrs ago when it was determined that it was only 1% effective in reducing flu. I always have suspicions about how CDC arrives at their data and that 1% is likely to be closer to 0%! So what about the injectable flu shot? The reason for suspicion over CDC statistics is that there is big money involved and the risk of bias is great. So when an independent organization like the Cochrane Collaboration comes up with unbiased apprisals of the situation, I pay closer attention. Last month, they published yet another review of high quality blinded and controlled studies that give a picture of efficacy that is closer to reality. Bottom line…the vaccine has some modest effect, but VERY modest. In order to prevent 1 flu case, you have to vaccinate 71 people. In other words, efficacy is between 1 and 2%, not even the lowball 30% that CDC claims. There does not appear to be any drop in hospitalization rate with or without vaccine and no decrease in loss of work days. Protection in pregnant mothers is even lower than this 1-2%.

Now, this was a study in the healthy population. CDC claims that in a sick population with underlying medical issues like asthma, cardiac disease, cystic fibrosis, immune problems, older age, etc, there is a reduction in hospitalizations. This review seems to indicate that asthma symptoms were somewhat reduced in adults and kids who did get their flu shot compared to those that did not. I am still of the opinion that for those with underlying medical conditions, the benefit likely outweighs the risk of getting a flu shot.

What about the dramatic push to vaccinate all health professionals? A somewhat lower quality review (lower quality due to lack of randomization of subjects in the studies available) by Cochrane demonstrated that there was little or no effect on reducing flu or hospitalizations in people over 60 in extended care facilities by vaccinating of the health workers. “Our review findings have not identified conclusive evidence of benefit of HCW vaccination programmes on specific outcomes of laboratory-proven influenza, its complications (lower respiratory tract infection, hospitalisation or death due to lower respiratory tract illness), or all cause mortality in people over the age of 60 who live in care institutions.”

Lastly, and this is the zinger…There appears to be some evidence that the more flu shots you get, the more likely you are to get the flu!! Why don’t we hear about this more? It is not convenient!! Several studies indicate that back during the 2009 H1N1 flu season, the likelihood of getting the H1N1 flu was higher in those people that had gotten previous flu shots compared to those who had not been vaccinated. Folks, we may be shooting ourselves in the proverbial foot! We are setting ourselves up for disaster when the next flu pandemic hits.

Based on the 2014/15 flu season, the Canadian Medical Association published an estimate that you were 3X more likely to get the flu in that particular season if you had gotten annual flu shots in previous years.

So, what do we do? Keep your immune system strong. Avoid sugar which suppresses immune function. Keep your Vit D levels up in the therapeutic range. Some have estimated that Vit D3 supplementation is 10X more effective in preventing flu than flu shot.

9. It takes TIME to heal

We live in a fast paced society where the norm is “fix me NOW so I can go back to living my life the way I live it!” For symptom based problems and fixes, this is fine. For an ear infection, assuming you don’t develop resistance, you are back on your feet in 2-3 days. (BTW, for 90% of kids, that is about how long it takes to start feeling better without antibiotics) For a fever and aches, your Tylenol kills that. For your congestion and cough, your Nyquil or Dayquil helps until the immune system kicks the bug. But what about for those chronic joint or muscle aches? What about the behavioral issues, the anxiety, the hyperactivity, the sleep issues, the gut issues, the allergy issues, etc.? As you are already likely familiar, we advocate starting with gut healing, then addressing issues further. We start with eliminating toxins, artificial food-like substances, microbes, heavy metals, etc that hamper health. We then replace with wholesome real food, nutrients that are deficient, and precursors for areas where our bodies are weak, e.g. L theanine for those whose GABA production is poor. So, how long does one have to do this before seeing effects? It depends on what the organ system is and how many things are contributing to the problem. Here is the bottom line: each system in the body regenerates itself over time. Every cell dies and is replaced by a similar cell. This is a good thing as it allows for improvement over time. The raw materials with which a new cell builds itself comes from one of two sources, the dead and dying cells around them, or the fresh intake of nutrients from the diet. If the diet is poor, then the new generation of cells is no higher quality than the old generation of cells. If the diet is rich in nutrients that the cell needs to function optimally, then the succeeding generations of cells with gradually improve in quality. So, if the gut, for example, regenerates in 3-4 days, then improvement can occur rapidly. Certainly, we have seen kids with belly pains improve within days of removing fast food and replacing it with real food! If there are toxins or pathogens present, it takes longer because these can be difficult to remove. If you are trying to heal blood cells (e.g. anemia), the RBC regeneration takes 4 months. That’s why we treat with added iron for 2-3 months before testing again. If you are trying to heal brain, now THAT is a bit more of a challenge. The glial support and immune cells regenerate in about 8 years. So, change in behaviors and the psychiatric realm can take significant time. The new cells need membranes that are much more pliable, so liberal dosing of omega 3 fatty acids are in order. The new cells will need liberal doses of B complex vitamins which are so important for neurotransmitter production and energy production for all that brain work. Removal of those toxins also takes time. If you try to remove them rapidly, you get very sick indeed!! The bottom line on fixing issues is that life style change needs to be permanent and that reversal of existing problems takes time commensurate with the number of contributing factors (diet, toxins, metals, microbiome damage, infection, and genetics) and the length of time those factors have been at play, and the organ system that is targeted. Patience is in order and a willingness to discard the “fix me now” mentality.

10. Does sugar affect immune function?

Before I quit, I need to relay my own foray into recent illness and what I perceive as being the underlying causation. My vit D level is wonderfully high!!. My vit C level is also high. So why did I succumb to a virus this past week that cause me to take yesterday off work? I was following what I preach. Well…. Not totally… I have been sporting an intermittent throat tickle for weeks while everyone around me at home and work were suffering from full blown viral crud. I became overconfident and felt that my lofty levels of Vit D and C were going to protect me from surrounding viruses. That was a good assumption, however, they were NOT likely to protect me from MYSELF! What do I mean? A week ago, precisely 3 hours prior to onset of my respiratory symptoms, I indulged myself in several “gluten-free” brownies at the office for a Birthday celebration. Alas, they were not sugar free. Within the subsequent minutes and hours, I descended into immune chaos as the virus that my body was keeping at bay started bearing down. So what happened to my previously strong immunity? Back to my military illustration: When we send troops into the battle field, they do not last long if we don’t give them the armaments with which to fight, right? Our white cells cannot last long without proper armaments, e.g. Vit C, Vit D, Zinc, Vit A, etc. These get used up in a hurry and require rapid replacement during illness. But I DID have my white cells supplied with lots of armaments! What happened to them? So, further illustration: Our military will also not survive long even with proper weapons if we send them into the battle field drunk!!!!! THAT is what happened to my white cells. The sugar load literally paralyzed them. Here is an interesting small study done at my alma mater, Loma Linda University, several decades ago showing that sugar literally reduces the ability to our white cells to fight, literally makes them “drunk” and ineffective. When I ran this concept by my partner many years ago, he scoffed and said “no way is that related!” Well, it is!! Traditional medicine still does not believe this.

Bottom line…do the Vit D3, Zn, Vit C, Vit A, Elderberry as advised; but for crying out loud…avoid the sugar!!

Here are the topics I did not get to. Stay tuned😉

11. Heavy metal toxicity has become a major problem.

12. Body tissues and blood is not sterile.

13. Alzheimer and autism can be improved and even reversed in some cases.

14. Yeast is a growing problem for mental and immune health.

15. Gluten free diet:

16. Ketogenic diet is of high benefit.

17. Environment CAN change your genes!!!

18. DON’T use Tylenol (acetaminophen)!

19. Saccharomyces boulardii – a superbug that fights superbugs.

20. Here is direct evidence that fast food is highly inflammatory:

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