#88 - The Gallbladder Recovery Toolkit

[music] Hey, we're the turn nerds. We're glad you're here. Before we take the plunge, let us introduce ourselves. I'm Dr. Becca Sand, a naturopathic physician and licensed acupuncturist, specializing in digestive, microbiome, and hormone conditions, and integrative fertility. I'm Dr. Ami Kapadia. I'm a medical doctor trained in family medicine and functional medicine, with a special interest in combining standard therapies with lifestyle and nutrition-based interventions. And I'm Dr. Lada Gervic. A naturopathic physician, licensed acupuncturists, and a fellow of the American Board of Natural Pathic Gastroenterology. I specialize in IBD, IPS, and other functional GI disorders. Let's dive in. [music] The following discussion is for educational purposes only and not intended to diagnose or treat any diseases or conditions. Please consult your doctor before incorporating any of this information into your care. The information presented on this podcast is not medical advice. [music] We are here with Dr. Sand doing part three of the Gobladder series. This one will be what you can actually do when you have all of these complicated situations. Which is the guidance of your doctor. Right, so let's just go for it. So we do talk about some ideas here that are probably thinking outside the box a little bit. This isn't going to be specifically stones, but if you listen to Parts 1 and 2 of this series, learning all about the Gobladder and the Microbiome and the Gobladder and the hormone system, specifically estrogen for people. So now let's talk a little bit about what we do. Just to kind of recap maybe some of the conventional approaches. Yeah, you go a little bit around. Yeah, that's it. Yeah, first thing, take it out, laparoscopically, hopefully, and just remove it. The Udka, Tedka. These are kind of used in pregnancy. -Brile cells. -Yeah. Just supplementing them. You can use Oxbile as a supplement, but that isn't going to do as much as it really helps digest your food, like with digestive directly with eating is sort of when you see it. What's your experience? Oxbile. Yeah, sometimes for some people, but not it's not reliable. Yeah, it's like cool and theory, but I don't really see it do a ton. So low fat diet counseling is also generally what's recommended. It's hard. It's hard. It doesn't taste good. Even though I will say there was an entire like generation. Yeah, 90s. Yeah, the low fat tasty cakes. And those low fat chips are fat for chips, remember, that just made everybody put their brains out. Yeah, the left straw. Yes. Yeah. What was it? A left straw. Yes. It's still a prescription. They were marketed for diarrhea. I would never give it to anyone. For weight loss. But you are signing yourself up for some diarrhea. Yeah. I remember when those chips came out, I was in like elementary school or something, and they were so well marketed that I was like begging my mom for them. I'm not because I wanted to lose weight or anything. They were just like so cool and new. And yeah, I remember the low fat tasty cakes that chocolate ones with the white. Yeah. Huh. I love fat so much. I mean, that was marketed, right? That entire generation. I know. Just replaced fat for cards. Yeah. And that's where we are now. Yeah. Exactly. I know. It's a huge thing. And I still have a lot of patients who deal with fat like fears. You know, because they were taught it's bad. And I'm like, man, if you want to regulate your insulin, if you want to feel good in your body, have energy and have a brain work, like you really need fats. But we really bred this generation of people who are afraid of it. I can remember when I was in a natural path, it's well, maybe just out. I may introduce me to a book called Eat Fat, lose that. Like, yeah, like blue eyes. Because you're so full with protein. Like just eat fat and protein. You're not even going to want dinner by the end of it anyway. So that's one option and then by less than sequestrance, which we use all the time to, but that's that's sort of like the mainstay of conventional approaches. So here is what I think conventional medicine approaches largely miss. Everything. Not everything we use those tools to hear go about if you need it, you know, like don't mess around with that. The post pull call us to sectomy, microbiome consequences. They don't part to you about that. For sure. They definitely don't part to you about that. They also just never think about it really in what happens afterwards. Metabolic downstream effects, mass, LD, etabolic syndrome, all of these like liver disease that can happen from that. The estrogen biomecrobiome interplay and metaposal or paramedicoposal patients. Which if we're honest, I didn't think about it until the last episode. Yeah, thought about it, but not as much as I needed to. I didn't really understand the physiology of what was going on then and how to intervene. Yeah, also in the episode two. And then the concept of addressing why the gallbladder needed to be removed in the first place. Yeah, so if it needs to come out great, but like also let's figure out what predisposed you to that and what else you might be bruised. Yeah, so you might be brewing something happened. It wasn't a fluke, something happened and maybe we can figure out why. Let's talk about how we can help on. So what were those amino acids that we really want to focus on? Why? Why do those matter? Because they conjugate the bile salt. That's right. They are used to conjugate bile salts from the liver so we can actually use them in a better way to digest our food. These are going to be particularly helpful in people who have low stomach acid states. Oh, wow. So think about that. Also people who have liver stress, which could be defined really broadly, but if the liver is underdressed for whatever reason, maybe medications, they're on lifestyle choices, things like that. They may also benefit from adding these amino acids in. And obviously people who have their gallbladder out. It makes sense. Yeah. So think about that supplementation bitter herbs. I love bitter. Do you want to name some of your fifth? I love djension, but man, is it better? You can mix it with something, right? What do we have in the way? Yeah. Yeah. Is it clear? No. No. It might taste worse. It's very good. Mix it with like orange peel, vermin, which is really bitter. Jensen's really bitter. Yeah, it is. But the Jensen's churilaria mixture is a little bit of magic. Yeah. Yeah. It does wonders for people. But yeah, including your gallbladder, these are classic colagogs, which you know is related to the gallbladder. And they stimulate bile flow and support contractility. So based on my last episode, what populations might this be really helpful in? Somebody who is paramedic possible. Yes. Yes. Bitter. Bitter. So let's use them. And they also help with digestion and like everything else in the body. What do you guys think of those Swedish bitters that commercial? Yeah. That is actually what I recommend. Patients see that. Just go to the liquor store, get the moonshine bitters, mix it with water. That's your cocktail before you're cooking dinner. Yeah. If you're cooking dinner. Yeah. And if not, bring to the restaurant with you. But you can also do it after if you forget. Also, there's cream. And that should you just like hit your mouth with it. So start with a desu process. Yeah. They're amazing. And they're really helpful for your gallbladder. Fast, physical, coline and lethacin. Lessifin. Yeah. To weird one. Lessifin. What did I say? Something else. Lethacin. I tripped over my tongue on that one. So these help keep cholesterol soluble in the bile and reduces stone formation. Because they are the building block of the cholesterol molecule. That's right. That's kind of rad. Yeah. And this is a population. So stone formation is high estrogen states. So people in high S, which you dip in and out of in paramedic eyes. But this is a huge problem in pregnancy. Because your estrogen is through the roof for these people. Oral contraceptives that have combined contraceptives have estrogen. And all my pregnant patients get cold. Nonnegotiable. All of them are cold. And that is to support the estrogen. Why is the colon there? The colon is for the baby development. And then postpartum is for preventing mastitis. This is the new folate. Yes, yes, yes. Oh, really? And most prenatal. Most prenatal students do not have any year enough coline. How much do you need? I do 400. Oh, I'm looking at 100. I'm like looking for a prenatal 100. It depends on where you're at in pregnancy. Okay. But the max is about 400. But now I know it has all these benefits for your own pregnancy. And then the next one is the most prenatal. And then the next one is the most prenatal 100. Okay. But now I know it has all these benefits for your own brain and memory. Because anyone who's pregnant knows a brain does not work, right? For a while, you know, afterwards. But it also helps your gallbladder and prevents stones. You have to eat about four, I think, at least to get enough every day. For a day. Yeah. I mean, I might be wrong about that. It might be, I don't remember how much colina is in it. But that's my interest. That's my favorite food. Yeah. So, colina you can get like super cheap 400, 550 milligram tablets. And just supplement that. Add it to your prenatal. Interesting. Some prenatals have that much most don't. It's like the prenatals where you have to take eight pills per day. I will say I am you. I think it's a good one if it's got 100. So that's good to know. Exactly. Yeah. Exactly. Yep. So add the colon for your prego patients. CM, which we love. Which we love for everyone. Also great for paramedics. For so many reason. But it's specifically for the gallbladder supports smooth muscle functioning. Do we know what type of magnesium glycinate? Glicinate. I do glycinate. That makes sense. Yeah. It's kind of the winner for if you want it absorbed. Yeah. But for gallbladder contractility, which you know is very responsive to our hormones. So think about that. That's a projection. Yep. And it's magnesium is commonly deficient in paramedic, pausol and menopausal women. Also, every woman and every man. And everyone in America. Can't tell her is I recently learned. Oh. Very mineral deficient. That makes sense. Because what do they eat? French rice. Yeah. And chicken. And chicken. Oh, who is a lot of french fries. My kid eats french fries and chicken nugs. Oh, really? I mean, best on her whole day. She's out of ramen. I told you to stop eating yogurt, post in butter. That's basically french fries and chicken nuggets. No. For a very white diet. I mean, that happens as like ego big and then it gets more. I know. And then now I think my 10 year old is just coming out of the little little bit. He's willing to experiment. Yeah. He likes the same frozen pizza as I like. Oh, my God. He loves frozen pizza. Now I think what I'm going to do is then pizza for dinner. He like throws a party. Yeah. I saw him last time he bought him. Same with us. I've been on the phone with you. Are you've been guiding him in a cooking frozen pizza? Uh-huh. Um, cause what does work? This is like a no brainer. But I'm seeing an action is we now have a garden in our backyard. Oh, my God. She loves it. Yeah. She goes and eats like sorel kale right off the stock. My son actually, because we had a garden. He would eat kale and we were at the grocery store once. I think I told the story in the podcast. Ready? We were at the grocery store and he was like, mom, mom, mom, it's kale. Can I get kale? Can I get kale? And somebody was like looking at him and looking at me and she was like so poor. - You're right. - You did something so right that your kid is jumping for a kale. - Yeah. - But I think it's rowing right. - Yeah. - Yeah. - We're not there. - We're not there, right? - Or is that always buddy thing? - Yeah, that happens later. - For sure. - If it's Sonic or I don't tell her. Protein. (laughs) - It's really okay. - It's too much. - It's too much for that sense. - I know, I'm with it. - It's okay, I don't know how to cook it. - Okay, so now let's dive into what we can do to just kind of generally support people who have their gold blood are out. - Okay, that's me. - Yeah. Like if they're kind of symptomatic. - Or some things we might not be able to do. - So you definitely want to do by-last and see questions. - Yeah, if it's bad enough and that doesn't cause constipation, yeah. Adding fat soluble vitamins, just probably a good idea for most of these people. - I think most of us have on our radar vitamin D. - For sure. - Yeah, we are an Oregon. - Do you want to layer in the other fat soluble? - The A, D, and K. - There's some good vitamin Ds that have all of them actually. - Yeah, yep, yep. - Well, it's at the E. - It's hard to find a couple of the E. - But they often have A, D, and K. - Yeah, yeah, yeah. So that's just gonna be more relevant for these people. Obviously fat soluble vitamins, you can overdo. They do store up in the body. So you don't want to just down these willy nilly. It's just the only one we can reliably test for is D. The other ones don't have good testing 'cause of their storage. So just have that on your radar. We talked about a lot of these, the Oxbile, the other Biles digestive supports, but digestive enzymes. My question for you on this was, you can get digestive enzymes with vegan lipase in it. - Mm-hmm. - What do you think about vegan lipase versus the animal-based - Great question. So vegan lipase is made as a byproduct of mushroom fermentation. And I would say that for some people, it works well. - Just as, I mean, is it because it's in combination with other enzymes and that works? - So that there's a lot of different products out there. There is now a pink-rear lipase equivalent that's made from fermented mushrooms. It's 100% matches USP of the lipase that we have. - I'm very curious about company that you use. - Different company. - It's the only product that's on the more product. - Wait, a pharmaceutical? - Nope, no supplement. - But is it reliable? For some people, it is very effective. For some people, it works better. For some people it works worse. - Dozing the same. - You joeced it based on the same USPs that you would joeced lipase. - Great. - And well, that's encouraging. - And it's not like, 'cause most of the lipase that we're seeing from vegetarian sources are like very low joeced like 5,500. And they're using Huts usually, which should be a one-to-one conversion to USP. But our lowest joeced that we're using regularly is 25,000. So 1,500 lipase. - Right. - Those enzymes might work, but they're working because they're supporting the cellulasis and all the plant matter. - Yep. - Do ribbons. - They're totally different. - Yeah, because of the fat. - We have a whole episode on this, don't we? They just don't go to. - I think so too. - Check what we've talked about. It's been a good for you. - He's been a lot of time in the closet. - Yeah, that's fine. All right, and then one other shout out. - Do you want to guess? - Shout out. - Oh, a trillion. - Oh, yeah. - A trillion. - Just a general. - Just a trillion. So, Sillium Fiber, one of my true loves in life, binds excess bile acids in the colon, reduces bile acid absorption, and feeds your good bacteria. So it's a triple threat. It does a lot for the gut. Yeah, love it, love it. And it doesn't contribute to gas load. - Does the prime matter tie it in the co-estiramine and coestiparate? - Of course, yeah, and it's not going to work as well. - Yeah, so if people are pooping their pants, Sillium probably won't help too much. - I will say it's tricky because for some people it works better. - Yeah. - You don't mean like, depending on the mechanism, it's a classification reaction from the bile acid sequesterine. - Yeah. - That soluble versus soluble and insoluble therapy has more efficacy. It's so person-dependent. - It is. - I mean, that's why I'm working with somebody who understands the nuance is helpful, but I know it's not always possible. - They're true. - They're just a protocol. - An algorithm? - Yeah, for this. And muterate supplementation. - Oh, muterate supplementation. - Oh, they have a very bad plan. - They have very bad skin. - But if people say it works, patients have said it works. - Yeah, I think you have to do this to kind of hide some of your experience. - So I would do this whole thing where I was like using like very, very high dose muterate for IBD, - Reducally? - Reducally orally. - Yeah, yeah. - I didn't see anything. Then I started, like forgot about it. I was like, no, no, no, no. And then I kind of sort of liturized it on again and started using it again. And yeah, I feel like, I mean, not insanely high doses. Like, 1200 to 2400 milligrams, once a couple of times a day, could actually have some efficacy for the right person. - Yeah. - Yeah. - So that, you know, you can take a pill. You can also supplement, feed your muterate producers, which we talked about. And I think episode one of this series. - Yes. - Basically the bugs that make muterate for you and your colon, which is excellent to do. And that's resistance starches, psyllium, flax, and that's kind of it. - Any fiber. - Any, yeah, any fiber. - You want to do fibers, but the resistance starches, especially they love to chomp on. - Okay. So let's get into specifics now about the estrogen microbiome gobladder access. - And we can say the astrobloam, the astrobloam. - Strobloam. - Stobloid. - Right? - That would be saying the same thing. - Yeah. - But with less words. - Yeah. - And we have a lot of different different types of bacteria. - Yeah. - And we have a lot of different types of bacteria. - Yeah. but similar. - Cowsim de-glucorant. - Yes, that's your favorite step problem. - My favorite step problem. - They work synergistically, especially when we're talking about gallbladder though. - And that's true, yeah. - That's true. - Yes, yes, yes. So calcium de-glucorate inhibits beta-glucoronadase activity. Beta-glucoronadase is an enzyme made by-- - Calcium de-glucorate inhibits beta-glucoronadase activities, which means that it increases the amount of estrogen that's circulating? - No, beta-glucoronadase, so you can think of it as, like, beta-glucoronadase recycles estrogen that was meant to leave the body. - Okay, so in a dysbiotic situation in our microbiome, we have more beta-glucoronadase, which makes estrogen be recirculated when the body never wanted it to. It was supposed to leave with our poop, but beta-glucoronadase is likely like, you let's stick around. So we want to inhibit beta-glucoronadase activity with calcium de-glucorate, so that estrogen that was slated to leave the body, leaves the body, and stops causing estrogen symptoms, like excess binding to the gallbladder and whatnot. So think about this, I mean, we think about this in like the high estrogen states anyway, but paramanopause is a good one, PMS, PMDD, you know, our good ones. It also works for the gallbladder. Okay, dim. Dimm does a couple different things here that are worth noting. So it supports that two OHS-drogen pathway. In the context of gallbladder and bilirium health, this matters more than maybe we thought. - Oh, I know, I just learned that last episode. - Yeah, yeah. So dim promotes phase one hepatic hydroxylation. So to this weaker, less proliferative, less lipophilic estrogen metabolite, that's what we're talking about with these different types of estrogen. There are tests on the market that can kind of help you determine if your body tends towards certain types or not, but there are different types of estrogen in the body that cause more problems for people. You want a good healthy balance of them. None of them are bad. It's just where your body is shunting it to. So the alternative pathway is the 408 and 16 alpha hydroxyestrogens produce more reactive, more lipophilic metabolites that are more likely to be secreted into the bile. So I didn't really think I know that. - Yeah, that gets into the bile or not, but it's problematic not for all the cancer reasons and growing tissues reasons is also problematic for our gallbladder. And when in there, it may contribute to cholesterol, super saturation and stone formation. - Wow, that's interesting. - So dim supports liver phase two liver detoxification as well, glucuronidation and sulfation, working synergistically with calcium deglucurase and so use them together to stop reactivating these estrogens and also ensure that we have the less reactive form of estrogen binding. - So here's my question. I have a patient, she's a gallstone patient, right? So she's got to at least, we know she's got some kind of dysfunction in her gallbladder. She doesn't want to get it out. She is HRT in that appausal patients, right? So should I just for protection, is the HRT enough of a protective factor for the gallstones or should I be introducing something like support of these pathways to improve? - You know, maybe at time that testing isn't the worst idea. - Horrible with testing. - To see what her body is doing with estrogen metabolites. - Okay, can you give her a urchidial? - Well, giving her stuff to break down the stone. - Okay, so I'm working on blood. - She is a gallbladder person. - So she is a gallbladder person? - Yes, I would say yes. I would say if you're thinking that there could be a gallbladder thing that you don't know that maybe test. - Yeah, yeah, yeah. - In her definitely, I would give calcium deglucurase and dim. - Interesting. But wouldn't that make HRT less effective? - No. - Just change the recycling, I guess, right? - Yes, so these do not affect your endogenous hormones or what you're putting in through HRT. What they do is hormones that your liver decided need to go. It's like when things get in the way, when your physiology gets in the way to help it go, it sends it back in. But the body never wanted to keep those estrogen. - Oh, okay. - So it's not going to increase estrogen levels that your body is using. - That's an interesting concept. - Yeah. - Yeah. - So it's not like calcium deglucurase, everyone's like, oh, it made me too low estrogen, that's not a thing. It's not a thing that does it really just works on the microbiome. - For my body at least, calcium deglucurase, like borderline magic for PMS. - Just parathidium, if there's a gold blutter. I mean, parathidium for a lot of reasons, but parathidium for gold blutter issues. So to just kind of recap, together, the calcium deglucurate and dim, both address both the quantity, how much estrogen is being recirculated and the quality which metabolites are circulating because they're not all the same for all reasons, but for the gold blutter as well. - So then we also can talk about liver supports like milk thistle. - My love milk thistle. - We love milk thistle. Yeah, it's a pad of a jack protective. So it's good for your liver. It supports bio-flow and it's anti-inflammatory, which cover a lot of the bases of what can go wrong here. NAC, why would we consider NAC? This was a big one that, I mean, we give NAC out for kind of everything, but why specifically for the gold blutter in like poll, 'cause it helps those so for a nation pathways. - Mm-hmm. But antioxidants. - I don't think that's a good idea. - So interesting, I know what's an amyoxin. I just don't think it that way. - Totally, yeah, it helps. So I think I actually probably primarily use it as an antioxidant. I use it a lot in fertility support and endometriosis because our ovaries are so susceptible to inflammation in the body and NAC can help with ovulation for all these reasons. But also the gallbladder is very susceptible to inflammation and the way that estrogen is we learned about in the last episode affects the inflammation or removing the gallbladder or going through menopause, you're more predisposed to having inflammation affect our biliary system. NAC can help with that. - Oh, do you guys also use castoropax? - Great idea. They're just a lot of work. - It's like an astropathic thing. - Yeah, it's like an astropathic staple. And I think some patients use them and love them. - Yeah. - It is a lot of work for me personally. - Yeah. - You have to get your like set up. I think if you do it enough to notice the benefit, it's great. - Can we, I feel like all of you said, you just have people use the roll on it and then put that cloth on that you would get that. - Yeah, so what I do when I have it is now, I mean, now there's a roll on it. I used to just use the lid head. And then I'd have them sleep like a tank top. And then I put a towel that they don't really like on their belly and they just go to sleep on it. And that is helpful because it won't stay in the sheets. But you also should not be attached to your seats 'cause it's thick and oily and greasy. - Right, maybe some people have nicer sheets than ours. - Yeah. - See everyone probably. - Well, yeah. I mean, I think castoropia great idea. - Yeah, I don't think you know her. - They can move things though. So you gotta be a little careful with stones. Especially if there's a risk of a fog or something like that. I mean, I hear it, but I don't think I would give it to my patient that we talked about two episodes ago. - Right, we've got a nap. - We've got a stone her nap. - Exactly, but maybe just like motility and stuff where you're not worried about something's obstructing. - If there's an active stone issue, maybe don't. - Okay, really? 'Cause you just don't want to be the last name on that. - Yeah, that's a great issue. - But I am thinking more about NAC for people who had their gallbladder removed and now we're going through menopause. - Right. - That's kind of how I'm thinking of that. - It's restoring that antioxidant function. - Right, right, that makes perfect sense. - Yep, yep, yep, for biliary health. - Okay, so hormone therapy considerations. So anyone want to recap some of that that we learned last time? - If you're thinking about a patch is generally considered safe. - And oral is a little bit less safe, progesterone to those motility even more. - Yeah, so be careful with oral estrogen in any form, birth control, any of it for someone who has active gallbladder disease. And really what I do now is a more thorough GI intake that involves gallbladder issues to see if that would be a good fit for them or if we really should be pushing for a transdermal route. - Yeah, I guess I was like percolating through all these episodes that we've been talking about. I'm like, should I be imaging these women who have a predisposition more? - I don't know, I wouldn't say definitely yes. - No. - You guys are already talking about incidental oma. Is that a NACO imaging people? - I feel like I'm high to scan. - Anything you get, okay, a high to scan, I don't see anything negative that could come out if they're symptomatic. - Any other imaging tests? - Please do not get any of it. - Right up a quadri-pane, right? - Then you have to get something. - Yeah, that's really what I'm saying. - Yeah, then you have to get something. - If they're like generally like with gut stuff, you know, I'm probably just gonna work up gut stuff, but I'm gonna be more careful about asking about right up a quadri-pane, but it is gonna level up a little bit my differential if they're also in perimenopause. - Yeah, I was just, I was thinking that was gonna be just to see image people that are just for menopausal, perimenopausal. - First term. - With gut, you know, symptoms. - Yeah, symptoms are gonna have symptoms. - Yeah, what I mean is that, you know, I have very sorry, everybody's anything that lives from the color bone to the pubic bone to be caused by anything that lives from the color bone to the pubic bone, so just because it's an upper right, just because traditionally we see upper right quadri-pane, that's not what we always see. - Sometimes that pain is also diverse. - Yeah, I had shoulder pain with my appendicitis. - Very. - Complete opposite side. - Oh, weird. - Yeah, they had no idea it was gonna live from the color bone. - It's the pubic bone. - Yeah, I was pushing the color bone limit. Yeah, it's crazy. - I mean, that makes sense. You have to get imaging then after having pain, but. - Yeah, yeah, yeah. - Yeah, interesting. - Yeah, so I think the high-discance specifically, it's gallbladder ejection fraction is what we're looking at, but, - Yeah. - Paramedic also people. - That's not a very sensitive test. - No. - I think it's just the test we have. - And it's perfect. - Like I've had people with normal high-discance who were having terrible gallbladder dyscanism. - Yeah, you know? - Yeah, yeah, yeah. - Okay, so what other tests maybe let's just jump into that? What other tests might we wanna consider for people with gallbladder stuff that outside the usual ultrasound, like now knowing all this information. - I mean, microbiome testing is definitely on my list. - Yep, yep, yep. - Also maybe looking at their vial salt breakdowns. - Yeah. - I feel like that just to see. - Yeah, it's in a lot of the microbiome panels anyway, but yeah, that's a distinction with different types of vial acid dysfunction that you can have. I'm gonna be looking more at short-chain fatty acid producers. - Might you look at the microbiome that makes. - Yeah. - Yeah. - And seeing if they're super depleted. - I mean, a lot of the testing that is available in the functional space is also looking at stool. Short-chain fatty acid. - Yeah, so looking at those and their producers, which go hand in hand, but none of these tests are perfect. Like there's so much nuance with these tests. I think having both sides of that lens might be helpful and maybe you consider buterate for those people to kind of help level it out. Obviously, you wanna be looking at liver enzymes, you wanna be looking at cholesterol because we build vial from our cholesterol, but you don't want too much of it. So much causes you to be able to fat soluble vitamins, especially if they've gotten their gallbladder out. We talked about that. Are you using oat tests at all? Organic acid tests. - Sometimes. - Sometimes. - Yeah, you're probably not at all. - You used to. - You used to. - Yeah, I used to. - Did you find the news? - I had another question and we can come back to. I wonder if there's a, and do people who are on statins have more gallbladder issues? 'Cause they don't have building blocks for vial. Or does it only deplete what's in the blood at the time, but they're still body stores? I've heard that. - Well, generally people on statins have plenty of cholesterol. - I don't like it there. - I just like it there too much. - Well, we're bringing it down pretty low. - Now we are. - Yeah. - I mean, now we are. - So I think if they're any studies on life, they develop more. - That's what that's for another day. - Totally. - Yeah. - Yeah, if we lose the building. But you know where I see that be a problem, not really statins, but too low of cholesterol's for hormones. 'Cause we've been building our sex hormones out of it as well. - Okay, so if they're on the medications, they're having maybe more hormone issues sometimes. - It's so real. - I mean, obviously my people, my people who have like hypothelamic amenorrhea are like eating a knife, you know? - I think they didn't really do. - Lose their period kind of stuff. But it's really my fertility folks. And they're not as much the folks taking statins. - Right. - Obviously that's a, - Okay. - Yeah. - Anyway, so. But I mean, yeah, I think that all those systems overlap. Who would have thought? I learned that for mitochondrial function markers on the Otesia, I know I get you. - I know mitochondria. - So pyruvate lactate, alpha-ketoglutarate, succinic acid, fumerate malac acid, took Krebs cycle. That might be reminding you of that Krebs cycle length. I had a point in college where I was like, "Shall I just get a tattoo of the Krebs cycle?" 'Cause I'm tested on this so much. - Really? - I mean, you missed your opportunity. - Well, I was just like, right right here. - Yeah, I know. I was just like, I have to memorize this like every part. It never just stuck in my brain. - 'Cause like you never use it. - No, yeah. - Well, apparently on Otes, you can look at that. But these are relevant because chronic fat malabsorption, reduces our fat soluble nutrient availability and mitochondria need these. - Yeah, and you know, mitochondria is made of that phospholipid by the air, that lipid is in there. - Yes. - And so it needs stability. - Yeah, so I don't know if I'm gonna do, generally Otesying people come to me and already have had it. And that's where I'm like, oh yeah, this maybe looks like you can't need it. You know, whenever I use it, I use it in the context of toxins. - Oh yeah. - Like if I can't figure out what's wrong with them, like I have a couple of patients right now that I'm managing their weight loss with and they're not losing any weight. - Wait, do you mean on their own G.L.P.Y.? - They aren't real holy. - They're not losing any weight. And I cannot figure out why. And so it's that population where I'll be like, I think if she looks at your toxins, yeah, like look at your toxins load. So see what I'm missing. And like that's where that kind of testing comes in helpful for me. I guess I wasn't aware that there was so much that could tell you about fat absorption patterns and bile patterns. And that was new to me. But yeah, I don't know that it's gonna, that test in and of itself isn't gonna change too much on treatment right now, but it might help elucidate like some of the pathways that are broken. - Yeah, I think the place where that test is useful, I think is if there's like that chronic constipation, there's obviously some kind of dysregulation of the bile and the microbiome. That is another useful way of me looking for fungal discharge with a genus totally. That's where I also think that test is useful. But are you ordering it for that? - Sometimes if I stall out and I can't figure out what's happening, I think. - But like I can fix your little bit. - First it's a really good history. And if the history doesn't tell me then I'm gonna look at the microbiome. Like as I'm peeling back layers and not getting better, then I'm like, okay, what pathway am I missing? - Yep, yep, yep. So there's many to miss. - Are there the other just kind of like last test in here? And like we talked about microbiome. I wanna like just shout out to that one. - Yeah. - That's a lot that we just kind of said microbiome testing, but that's almost all of our episodes. - Yes. - That includes things like SIBO and biofilms and all the other stuff that can go. And elastase, you know, looking at stool elastase 'cause that will mess up this whole flow as well. - Hormone testing. - Oh yeah. - I wouldn't say maybe do hormone testing for your gallbladder, but if someone comes back with like a 400 estrogen, estradiol and serum, maybe ask about how their gallbladder function's going. - That's a good point. - Do you check blood serum hormone levels regularly? - Yeah. - On the same bed, same like the five. - Yeah, that's not good. - Yeah, regularly. And I tell people like this is a point in time, especially if you're in paramedicase, expect them to fluctuate. It may not change what we recommend for you. I don't change doses based on serum levels, but if I test you and I catch that your estradiol is 450, that does change what I do. - You're doing D3 to 52. I thought you were supposed to check progesterone further along. - I don't test progesterone. - Most people are trying to get pregnant. - So you're mostly testing estradiol. - Me too. - I do estradiol, sex hormone binding, globular, antistastosterone, free and total DHEA. - And I tell everybody that estradiol is a very crappy test. It means your estradiol goes up and down a day long. - Yeah, and it's so-- - So, the estradiol influence it. So usually you want to do both. - So I always say the only reason I'm doing the estradiol is really to tell me if the FSH is real. 'Cause I'm trying to figure out how close I may to my�. - Yeah, but that fluctuates too. - That is not. - So it's a point in time, huge caveats, but I don't think it's useless. - Yes. - I also don't think that the extra dials use for you to get the FSH's accurate. - Elevated extra dial can suppress FSH. And the progesterone is released when we ovulate. So I wanna be really clear about that. I see so many people being put on progesterone because they're progesterone zero. Meanwhile, they tested it during the wrong day. - You shouldn't have progesterone unless you're pregnant. - Well, if you are gonna test it, right? Day 21-ish. - But then that's a looking back. That's 21 on a 28-day cycle. - If you want to test it, - Seven days before you're, - Depends on your day 28-ish. - Yeah, and in our 40s, like you're gonna ovulate wonderful, maybe even double sometimes. You're not gonna ovulate certain times. You're gonna have not a robust dilution sometimes. - I let you hear on the herbal that you recommended when I talked to you three years ago. - By text, I help. - I always say, - During pregnant applause, just like the rest of you, your ovaries go rogue. - Yeah. - They're figuring out their new job, you know? - It's cool. - It's great. - They've been shooting out eggs for a long time. - That's what I say. - They're never tired. It's amazing. - Can we retire? - I don't wanna resign. - So how does change my practice just short? 'Cause that's kind of what I'm capping these with. Post-cholestosectomy patients now get microbiome support. Like I think we talked a lot about the different strains of the very common probiotics. We prefer food sources, but I don't skimp on that now. And if you come to me and your menopausal, we talk about probiotics, even if your gut is fine. And then I've become much more intentional about touring and glycine conversation. - I love touring and glycine for-- - And glycine also. - Oh my God, it's so good. - It's calming. - It's amazing. - It opens the doors with a hycine help to sleep even more. - It's an excellent combo. - Yeah. - It just also is great to do the longer. - It's a nice magnesium glycine combination product. I feel like. - Oh. - Or maybe that's another country. Sorry, I don't know. - After Biden recommended in their book, and I can't remember if we can actually give it to people here. - Yeah, and also it's from magnesium in there. - You know, magnesium glycine. - Yeah, I couldn't. - That's true. I feel like those are all powders, or I think they're gonna take the glycine powder. - It's a little bit nicer, I feel like. - Than pills. - And then I can do a nightcap. - Yeah, that's what I do. My night-tenty chef, I love that. - I know you put glycine in there, huh? - Glicine touring in the nostril. - And nostril is very smooth. - And magnesium. - And magnesium. - Yeah, nostril is great. Should we recap? - Yeah. - So what do we do? - We support the hormones. - Yeah. - We support digestion with bitters. We support bile production, with glycine, with touring, with tutka, with mesosan. - And enzymes if you know. - And enzymes. - Yeah. - Yeah, microbiome, I think is just huge here, 'cause it's what we talk about here anyway, but there could be a microbiome conversion issue going on. So don't miss that for people. Support the liver. Did you say that one? - Support the liver. - Yeah. - What did you say? - Yeah, and then calcium deglucrate dim. Just that grade. - That's it, that was burly. - Thanks, thanks. - We have about 12 episodes in the series, right? - Exactly, probably. By the time I have another patient in the room, just like, wait a minute, wait a minute. But yeah, thanks for joining us. - Thanks for joining us. - Thanks for joining us today. Stay tuned. We release episodes every two weeks. If you liked this episode, please subscribe and don't forget to rate and review us to help spread the turd nerd word.