Melainie Rogers speaks about Emotional Eating with Dr. Ben Weitz.

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Podcast Highlights

5:22  Losing weight is difficult, which is why 70% of the population is overweight.  One of the problems is that many people overeat or binge eat for emotional reasons. When our clients are feeling anxiety, they tend to eat carbohydrate foods, which tend to increase the amount of serotonin in the brain.  And while we are in this global COVID-19 pandemic, we are seeing a lot of anxiety and lot of this type of overeating.

7:34  When working with a weight loss client, we have to try to help our clients to understand their eating behavior and then work backwards to try to understand what feelings are triggering their behavior.

9:12  Not everybody who’s eating for emotional reasons have an eating disorder, but many do.  A good acronym is HALT, which refers to eating for the following reasons: 1. feeling hungry, 2. feeling angry, 3. feeling lonely, or 4. feeling tired.  If you do this occasionally, this could be normal, but if you’re doing this two or three times per week and feeling out of control, this is an eating disorder.

10:18  The difference between overeating and binge eating is that if you ate a whole pizza and then felt really full, that would be overeating. But if you did it and felt out of control and great distress by doing it, that would be binge eating.

11:00  One of the best strategies is to sort out what is biological or physiological from what is emotional. If someone skips breakfast and eats very little for lunch, then it is biological to be extremely hungry and to overeat because of that.  If they binge at this time it would be considered a physiological binge. For patients with emotional eating problems it is important to eat consistently throughout the day.

12:20  Eating consistently is important for emotional eaters to break their cycle, but in the Functional Medicine world now the hottest trend is to skip either breakfast or dinner so that you 12-14 hours without eating, which is referred to as intermittent fasting, which is considered to have anti-aging properties. Melainie said that if intermittent fasting works for you and you don’t binge at the end of the day, then continue doing it.  But if you find yourself overeating during that 8 hour window, then that may not be the right program for you. During Ramadan where you fast from sunrise to sunset, they often gain weight, since they tend to overeat or gorge at night. 

15:22  The difference between physiological and emotional binging is that if the client is eating food consistently throughout the day and meeting their nutritional needs and they are still overeating or binging, this is emotional because they are hungry or angry or lonely or tired.  It is important to make clients aware of this.

16:26  Mindfullness is being aware of what you are eating. Paying attention to whether or not you are really hungry.  You should not eat when you are distracted, such as by watching t.v..  It can be helpful to jot down on a notepad how hungry you are on a 1 to 5 pt scale before the meal and how you feel after.  It can also be helpful to write down what you are eating throughout the day, so you are aware of how much you ate.

20:15  The app Recovery Record can be helpful for clients with eating disorders.

20:50  Negative body image can be the motivation for eating disorders, so it is important to work towards having a positive body image or at least get to body neutrality, which means I just appreciate what my body can do for me.

Dr. Mark Pimentel speaks with Dr. Ben Weitz and the Functional Medicine Discussion Group meeting about New Developments in IBS and SIBO.

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Podcast Highlights

9:15  The story about SIBO and IBS is similar to the story about peptic ulcers and H. pylori.  We’ve known about peptic ulcers since the 1980s and then they discovered that H. pylori is the cause of 60-70% of cases of peptic ulcers. We didn’t change the name to H. pylori disease. About 60-70% of IBS is caused by SIBO, but just like there are a bunch of people with H. pylori that don’t have ulcers, there are a bunch of patients with SIBO that don’t have IBS.  There could be narcotics or adhesions as the cause or something else.

10:49  Dr. Pimentel discovered that many cases of SIBO have an autoimmune origin. It starts with a bout of food poisoning related to a bacteria like E. Coli, salmonella, shigella or campylobacter. These bacteria can all secrete Cytolethal Distending Toxin, which can create a response from the immune system, creating antibodies. Those antibodies can cross react with a similar structural protein in the intestinal wall called vinculin and this can damage the ability of the nerves to control the Migrating Motor Complex, which produces cleansing waves that help keep the intestines clear of too much bacteria.  Thus by damaging this normal motility, there is an increased likelihood of bacterial overgrowth of the small intestines.  Dr. Pimentel has also developed a blood test to measure these anti-CDT and anti-vinculin antibodies, the IBS Smart Test. The higher the anti-vinculin antibodies, the more difficult the patient is to treat.

17:15  This cross-reactivity of anti-CDT and anti-vinculin antibodies proves that this model of cross reactivity of antibodies can lead to autoimmunity and in the Functional Medicine world we use this concept of immune cross reactivity to explain how reactions to gluten or dairy or to toxins or to infections can result in autoimmunity. Dr. Pimentel remarked that when he was conducting his Reimagine Study, where he and his colleagues mapped the microbiome of the small intestine, he was surprised that they found that patients who went gluten free but did not have celiac disease, tended to have lower cytokines in their blood and that they were less inflammatory.

20:05  In a recent paper, the ACG Clinical Guidelines for SIBO, you list 6 factors that are important for helping to maintain small bowel ecology and for preventing SIBO.  You talk about 1. hydrochloric acid, 2. digestive enzymes, 3. bile, 4. motility, 5. the ileocecal valve, and 6. the gut immune system.  Yes, acid kills bacteria, but acid blocking medications like PPI use is not necessarily associated with SIBO and Dr. Pimentel’s group did not find really significant changes in the microbiome in patients who took PPIs.  If you have IBS and you’re on a PPI, we didn’t see more SIBO. But if you’re a healthy individual with no GI symptoms, just GERD, and you’re taking a PPI, there is higher risk of getting SIBO.  But because methane organisms eat hydrogen, and because hydrochloric acid contains hydrogen, patients on PPIs had less methane SIBO.  Dr. Pimentel has found that GI motility is the most important factor in preventing SIBO.  The Migrating Motor Complex (MMC) refers to waves of peristaltic contractions that occur when you haven’t eaten for several hours and these help keep the intestine clear of too much bacteria. It is like a dishwasher. This MMC is what gets inhibited by vinculin antibodies or by opiate medications.

Dr. Howard Elkin provides his Integrative Cardiologist’s perspective on COVID-19 with Dr. Ben Weitz.

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Podcast Highlights

7:25  While many of us think of COVID-19 as a respiratory infection, it tends to have a significant effect on the heart, the blood vessels, the kidneys, and on blood clotting and this is part of why it’s so lethal and distinguishes COVID-19 from other respiratory tract infections, like the seasonal flu.  At least 20-30% of patients with COVID-19 tend to have an elevation of troponin, which is an enzyme that indicates injury to the myocardium of the heart, such as when patients have a heart attack.

8:48  A lot of patients with COVID-19 have elevations of D-dimer, which is related to the fact that they have increased blood clotting. Normal levels of D-dimer are zero and we’re seeing levels as high as 3,4, or 5000, levels that are unfathomable.  This is leading to blood clots being formed rapidly and we are even seeing reports of patients in their 30s and 40s dying of strokes from blood clots.  The actor, Nick Cordero, age 41 had to be hospitalized for two months, ventilated, placed into a medically induced coma and have his leg amputated from COVID-19 and is still having some complications. Doctors and researchers are still trying to understand what is going on in these cases of COVID-19. When patients are in the ICU, intubated, in end stage disease, they can develop DIC (disseminated intravascular coagulopathy) where you get fibrin split products that cause small thrombosis throughout the body in the legs, the kidneys, etc.  DIC typically occurs when patients have sepsis or acute respiratory distress syndrome.  But it is highly unusual to see such clotting in patients in their 30s and 40s.

11:50  Some patients with COVID-19 end up with low oxygen levels and for some patients what is happening is that the iron is being liberated from the heme group in the bloodstream. This free iron ends up feeding the normally inactive bacteria that we all have in our bloodstream and these bacteria grow and secrete toxins which leads to sepsis and this hypercoagulable state.  What’s not clear is what is causing what.  We’ve learned that these patients don’t respond the way that other patients with acute respiratory distress syndrome (ARDS) that can result from more typical bacterial or viral pneumonias.  More typical cases of ARDS usually respond to positive end-expiratory pressure (PEEP) which involves using a ventilator to force more oxygen around the body, but patients with COVID-19 often don’t do as well with PEEP and may do better with a C-pap machine or just oxygen or being placed on a prone position.

15:04  What can we do from a natural prospective to prevent blood clots?  We should make sure to include fish oil in our daily supplements and it would be a good idea to combine some vitamin E in the form of mixed tocopherols or tocotrienols can help to protect the omega 3 oils from oxidation, both of which have a mild blood thinning effect.  Also omega 3 is a natural anti-inflammatory and we want to reduce the likelihood of having a cytokine storm if we do get infected with coronavirus.  Garlic and ginger are also natural blood thinner and can also be helpful. On the other hand, we might not want to thin the blood out too much in case we need to do surgery on these patients. 

18:00  Patients with existing hypertension, heart disease, and diabetes have an increased risk of being hospitalized or of dying from COVID-19.