Neuroveda Podcast for Complex Health

There are more neurons in the gut than in the spinal cord. WHAT?! Dr Katja Kovacic is a pediatric gastroenterologist who specializes in the gut-brain connection especially through the perspective of the autonomic nervous system. She discusses the complex and difficult to treat functional gut disorders including IBS, cyclic vomiting syndrome, gastroparesis and chronic abdominal pain. Her experience is extensive. She describes the symptoms that come along with these conditions and some of the testing to diagnose these conditions. We then spend the second half of the show discussing treatment options. Dr Kovacic starts with a simple listing of some of the medication options (many for migraine and mood) and then we go deep into neuromodulation options. These can be vagal stimulators, deep brain stimulators, and sacral and tibial neuromodulation. We then turn our attention to the IBStim, an auricular (ear) neuromodulator that is FDA approved for IBS. Dr Kovacic shares her experience with hundreds of patients in clinic and in research. Our last device discussion is about the Safe & Sound Protocol which is acoustic neuromodulation (music therapy) based on Steven Porges work evolving the Polyvagal Theory. Finally, we review how hypermobile disorders, including Ehlers Danlos Syndrome, are inherently linked to altered autonomic activity with 90% of patients suffering from severe gut dysfunction- this is where the research is going next, and she describes a number of the studies being run through her clinic at the University of Wisconsin. These are incredible common but ultimately complex conditions being blown open by Dr Kovacic’s unique approach for understanding, diagnosing, treatments and research into these neurogastroenterologic conditions.  Listen and learn. Find more about Dr Kovacic & see some of her other lectures: https://childrenswi.org/physician-directory/k/kovacic-katja-k

Alan Cash got curious about why our energy pathways fail us. Armed with an MS in physics, he's found himself innovating commercial production methods for oxaloacetate, a metabolite in the citric acid cycle that sits squarely within our mitochondria and are fundamental in producing the ATP that fuel every energy-requiring process in the body. In this episode, we review the nitty gritty details of energy production from the perspective of how oxaloacetate (brand names Benagene and Jubilance) can impact us from the systemic perspective. We don't typically discuss one commercial product on our show, but we have many patients using oxaloacetate and wanted to give a much more complete picture than we can in a clinic visit. Taking oxaloacetate has been shown to decrease NF-kB activation, reduce fasting glucose by ~25% (research from the late 1960's), increase NAD to NADH ratios, increase AMPK, decrease emotional symptoms of PMS (as the product Jubilance) and favorably shift cellular redox. Preliminary data from Mr Cash's current research is showing reduction in fatigue for CFS/ME patients. Remarkably,  oral oxaloacetate seems to be able to cross the blood brain barrier (it's a very small molecule!) and can decrease brain glutamate levels. Most remarkably, taking exogenous oxaloacetate can mimic caloric restriction and has increased the lifespan of laboratory animals. It's been used in doses ranging from 100 to 6000mg daily (like for glioblastoma) and has been well-tolerated even at high doses. It's important to know that the commercial products Benagene and Jubilance contain the same ingredients: 100mg of oxaloacetate stabilized by 150mg of vitamin C. To answer another common question, there's no mechanism to turn oxaloacetate into the undesirable 'oxalate' compound in the human body. This tiny molecule really can pack a molecular and anti-inflammatory punch- listen in to find out more! Resources:  https://benagene.com/ https://jubilance.com/ Oxaloacetate to reduce emotional symptoms in PMS: placebo-controlled, cross-over clinical trial with 48 women (2020): https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7073356/ Safety and target engagement profile of two oxaloacetate doses (500mg & 1000mg twice daily) in 15 Alzheimer's patients (2021) showed the higher dose increased frontal & frontoparietal brain glucose & glutathione per FDG PET scanning despite no changes in serum levels or cognitive scoring. https://pubmed.ncbi.nlm.nih.gov/32715609/ Oxaloacetate activates brain mitochondrial biogenesis, enhances the insulin pathway, reduces inflammation & stimulates neurogenesis (2014) in mice injected with 1-2g/kg once daily dosing x 1-2 weeks. https://pubmed.ncbi.nlm.nih.gov/25027327/ Oxaloacetate supplementation increases lifespan in Caenorhabditis elegans (roundworms) by 25% median & 13% maximal lifespan through an AMPK/FOXO-dependent pathway (2009). https://onlinelibrary.wiley.com/doi/10.1111/j.1474-9726.2009.00527.x Oxaloacetate: A novel neuroprotective for acute ischemic stroke (2012) via modulation of the glutamate pathway which would also be applicable for other types of brain injury, like TBI (traumatic brain injury). https://pubmed.ncbi.nlm.nih.gov/22085530/ Neuroprotective effect of oxaloacetate in a focal brain ischemic model in the rat (2015) through pathways of glutamate scavenging. https://pubmed.ncbi.nlm.nih.gov/24807461/ Neuroprotective effects of oxaloacetate in closed head injury in rats is mediated by its blood glutatmate scavenging activity (2009). https://pubmed.ncbi.nlm.nih.gov/19543002/ Effect of alpha-ketoglutarate & oxaloacetate on brain mito DNA damage & seizures (2003). https://pubmed.ncbi.nlm.nih.gov/12749815/ Oxaloacetate acid supplementation as a mimic of caloric restriction: https://benthamopen.com/contents/pdf/TOLSJ/TOLSJ-3-22.pdf

Yoga was one of the key tools Olympic-hopeful snowboarder Kevin Pearce found to reorient to himself as able, connected and calm after his severe head injury on a practice run in January 2012 left him comatose for weeks. Despite high-tech and caring medical attention, devoted family support and extensive neurorehabilitation, Kevin's identity remained rooted in his life as a professional athlete and snowboarder for years after his accident. After traumatic brain injury (TBI), however, we may not return to our 'former' self and the struggle to find our new self, identity and value is a worth search. In response to the benefits Yoga inspired for Kevin & his family, they founded and run the LoveYourBrain Foundation which develops research-based, practical and FREE, accessible programming offering Yoga back to the TBI community. Kyla Pearce (Kevin's sister-in-law), Yoga professional and PhD/Post-Doc trained researcher serves as Senior Director of Programs for LoveYourBrain. In this episode, she reviews their three types of programs (Retreats, Yoga, and Mindset Online), the research behind them and the principles and values that drive them. "Yoga is a about coming home to yourself" which can be mobility, community-building, stress coping, relaxation, athleticism in strength and balance and/or simple curiosity about self. These programs have been offered at 65 Yoga studios and 25 hospital/neuro-rehabilitiation facilities across the US and Canada. In total, just about 10,000 individuals with TBI have been served with LoveYourBrain programs. All programs are designed based on the science of resilience, including the growth vs fixed mindset discussed by research Carol Dweck of Stanford and the 10 principles of resiliency by MDs Dennis Charney & Steven Southwick of Mt Sinai Icahn School of Medicine in New York. Programs focus on reframing the difficulties of the TBI experience as a springboard to greater connection to self and potential as a human. It's resiliency over recovery and it's an inspiring program to learn about. Please engage with them at whatever levels best serves you personally and share widely as their in-person programs begin to ramp back up with the (fingers-crossed) quieting of the COVID-19 pandemic.  Resources:  https://www.loveyourbrain.com/ More about Carol Dweck: https://profiles.stanford.edu/carol-dweck?tab=publications More about the 10 principles of resiliency from Drs Dennis Charney & Steven Southwick: https://icahn.mssm.edu/files/ISMMS/Assets/About%20the%20School/Leadership/CRTV-3841-ICAHN_Charney_10StepPrescription_Resilience_Infographic_Nov_20.pdf

Dr Shae Datta, MD, is a Sports NeuroTrauma Neurologist and the current Director of Concussion & Neuro-Cognition at New York University, Long Island. Dr Datta specializes in helping people heal from brain injuries, especially including traumatic brain injuries and concussion (also called mTBI = mild traumatic brain injury). In this incredible episode, we wind our way first through the anatomy and physiology of the central nervous system, meaning the brain, spinal cord and associated microglia, astrocytes, relay neurons and the glymphatic clearance system of the CNS. Dr Datta then illuminates an understanding of the gut-brain axis with a special focus on psychbiotics, naming some of the specific types of probiotics that impact mood, cognition and the nervous system. She notes, ‘unhappy gut = unhappy brain’. The show returns to prognosis after brain injury and that every head injury is a unique story and very dependent on functional level, age, stress, co-morbidities, prior TBI and history of migraines. She reviews a bit of the TBI evaluation, which, barring a bleed in the head visible on CT, can often present with subtle findings regarding balance and ocular or vision changes that can potentially reflect outsized cognitive, sensory and/or motor challenges. We end the show with an exploration of a wide variety of treatments, some common (physical and occupational therapy) and some unique to Dr Datta’s integrative training: choline, creatine, vitamins and others. Learn more from Dr Datta from her co-authored chapter on TBI in the Integrative Neurology textbook in the Andrew Weil Series:  https://www.elliottbaybook.com/book/9780190051617 To see Dr Datta as a patient, find her at NYU Langone: https://nyulangone.org/doctors/1720493141/shae-datta

As the daughter of a public school teacher/administrator and an electrical engineer, who was also the commander of the local Black Panther Party, Nzinga was raised as an advocate who always knew she would become a doctor and a teacher. In medical school, her world was upended by a psychiatry rotation that drove her into mental health care within the context of social & political factors. Compassion, connection, and relationships drive health. Coming correct to substance use disorder treatment means bringing the compassion and resource we offer cancer patients and the biological, social, & cultural interventions we use to manage the lifelong chronic illness that is diabetes. We wouldn’t drop off a newly diagnosed diabetic who just spent 5 days in the ICU stabilizing their blood sugar into their old neighborhood without medication, education, and connection to ongoing care and social support because this doesn’t make any sense. Why do we do this with people suffering with substance use disorders?  With joy, humor incredible wisdom, and a take-no-prisoners attitude, Nzinga points out how perceptions of safety or threat (not necessarily present-day reality as intergenerational trauma informs current day perceptions) can drive behavior. We discuss ‘safety pie’ and how equity means the hungriest person gets the biggest piece and some people might not get any today because they had a lot yesterday and just don't really need it.  Nzinga pulled all of this brilliance together into the company she co-founded and serves as Chief Medical Officer, Eleanor Health, which offers wrap-around harm-reduction care for people with substance use disorders. Lest you think she’s an idealistic hippie, you have to know that in its first year open, Eleanor Health reduced hospitalizations by 85% for its served population- better than you find with any pharmaceutical.  Please listen to this show- the majority of us have people in our lives who have suffered or are suffering in various stages of substance use disorders. Learning how to come correct and that Eleanor Health is available in multiple states across the country is elemental for us to heal ourselves, each other and our communities. https://www.eleanorhealth.com/ http://www.nzingaharrisonmd.com/

Dr Sri Ganeshan, MD and physician scientist, dives into the weeds on folate and mitochondria Please note, even though we discuss folate doses in depth, we are NOT recommending that using folate in any form is right for you or your child. A podcast conversation is never a replacement for personalized and direct medical care.  Did you know mitochondria is involved in fighting viral infections including COVID? Listen all the way through to get this info!  It’s a soup-to-nuts discussion about the types of folate, functions of folate across the lifespan, location of receptors on the body, deficiency symptoms, genetics of folate (including MTHFR), and supplementation options (including oral and/or injectable). Dr Ganeshan then discusses the FRAT test (Folate Receptor Antibody Test) which is a blood test that evaluates autoimmune activity against the folate receptors, possibly interrupting folate uptake & usage, especially by the brain, which has been associated with neuroinflammatory conditions like autism and chronic infections. He discusses the role of dairy in triggering autoinflammatory conditions. Regarding mitochondria, Dr Ganeshan weaves around mitochondrial structure, numbers, locations, functions and dysfunction/ deficiency symptoms by complex in the electron transport chain (thyroid dysfunction, diabetes, cancer, schizophrenia, bipolar disorder, Parkinson's, Alzheimer's and others). Historically, mitochondrial disease that is severe has a genetic contribution and is found in childhood, but secondary dysfunction that may be environmentally triggered and found as mitochondrial dysfunction in children or adults. He discusses some of the subtle (aka vague) lab findings as well as the gold standards for mitochondrial evaluation (muscle biopsy and/or genetics). MitoSwab test per research is 85% as accurate as the much more invasive muscle biopsy and can be completed with a simple cheek swab and shipped in the mail for assessment. It can be used with children 2 years old and up. Finally, we review treatment options for supplements and the importance of protecting from light and oxygen to reduce oxidation.  We close with some interesting patient cases of children with autism and an adult with Parkinson's.  Put on your science hat! This is a fun, technical, ride through these two vital aspects of our metabolism.  Of note, Center for Healing Neurology does offer both FRAT & MitoSwab testing. Please schedule an appointment if you are interested in this testing. 

There's been so much upheaval in our social, political & physical world that it's timely to remember what determines our health, which is not necessarily what happens in the doctor's office. This was one of our first shows, originally released Jan 2, 2020, because the importance of talking about how our health flows (or doesn't) from our economic structure.  Dr Stephen Bezruchka, MD, MPH, teaches us that healthcare as an industry doesn’t inevitably result in a healthy population. In fact, despite spending the most money of any country in the world on healthcare, we are #36 in lifespan, just behind Chile. Dr Bezruchka peels down the layers of what creates population health, namely, how the health of a population is not just the health of many individuals together and dives deeply into the roles consumerism (including marketing, advertising and social media), and social and political structures have played in constructing our health crisis which can be summed by noting that only two counties in the world currently suffer from shortening lifespans: the US & Syria. Listen in to understand how we got here, why we are still here, how to ask the right questions, and some considerations (like nurse-new family partnerships) for changing our trajectory. Notes: · Book: Triumph of Injustice by Saez & Zucman: https://www.elliottbaybook.com/book/9781324002727 · Hawaii Department of Health Report on the Social Determinants of Health: https://health.hawaii.gov/chronic-disease/files/2013/12/CD_BurdenReport_FINAL.pdf · Bill Moyers article on the intentional consolidation of wealth which has driven economic inequality from 2011: https://www.thenation.com/article/how-wall-street-occupied-america/ · Books: The Spirit Level and The Inner Level both by · UN health of nations report and the “Health Olympics”: https://inequality.org/research/health-olympics-medals/ · The United Kingdom strategy for addressing loneliness & social disconnection:article: https://www.gov.uk/government/news/pm-launches-governments-first-loneliness-strategy; the actual report: https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/750909/6.4882_DCMS_Loneliness_Strategy_web_Update.pdf · US Health in International Perspective: Shorter Lives, Poorer Health from January 2013: http://www.nationalacademies.org/hmd/~/media/Files/Report%20Files/2013/US-Health-International-Perspective/USHealth_Intl_PerspectiveRB.pdf

It's the right time to repost this incredible episode in which the beauty of Islam is beamed through the words and spirit of Sufi Imam Jamal Rahman. It was one of our opening podcasts on January 2, 2020 and is in the top 3 of my favorite podcasts we've ever produced. Listen in and heal.  From 1/2/2020:  Sufi Imam Jamal Rahman reveals insights from Rumi, Hafiz and other poets into the ways that Koranic verses can nourish personal, community, racial, economic and environmental healing. According to the Koran, a good life is built “50% of the visible and 50% of the invisible” meaning rooted in the work of the heart and the spirit. This can be supported by building in internal circle of love within oneself and/or an external authentic community centered in care for one another, trust in each other’s inherent vulnerability and common aspirations of truth and patience. Imam Rahman also shares practices to incorporate therapeutic silence, embracing emotions without attachment and having the moral courage to talk about where religion has gone astray. His perspective is deeply informed by his nearly two-decade long partnership in the Interfaith Amigos with Pastor Donald Mckenzie and Rabbi Ted Falcon. Find more about Imam Rahman from JamalRahman.com, InterfaithCommunitySanctuary.com, InterfaithAmigos.com and enjoy 50-60 short videos (2-6 minutes each) about Islam, Sufism, and various meditations on his YouTube channel at Call of Compassion Northwest by searching his name Jamal: https://www.youtube.com/results?search_query=call+of+compassion+nw+jamal

Dr Manish Butte, MD PhD, is a pediatrician & Division Chief of Immunology, Allergy & Rheumatology, and is also a surprisingly down-to-Earth kind of guy. In this show, he causally lays it all out there from the perspective of a scientist and compassionate clinician who works at the edges of what we know regarding genetics and rare diseases to give us a view of the whole playing field of immunology, including allergy, autoimmunity and infection (especially the post-infectious drive towards autoimmunity). We discuss Lyme, EBV (Epstein Barr Virus) and the ways in which the B cells & T cells function to mount, address & recede from their battle stations (did you know regulatory T cells even a part of the initial cytotoxic T cell response to infection?). Dr Butte then dives into the mechanobiology components of T cell activation (did you know stiff vs soft, aka swollen/edematous tissues vs non-traumatized tissue, trigger different T cell responses?) with some fascinating conjecture about the interaction between hypermobile tissues & T cell activity. We seem to end the conversation with a deep discussion about IVIG (IV immunoglobulin G) and rituximab which address aberrant antibodies but then truly finish with some discussion about the importance of immunogenetics and COVID antibody & T-cell evaluations. All in all, a fabulous show for which we are grateful for Dr Butte's generous participation. 

Neuropathy is dysfunction or damage (or both!) to the nerves and is a source for movement disorders as well as burning, tingling and numbness. It's a condition that can result from so many different triggers. Did you know ~40% of neuropathies remain 'idiopathic' in cause, meaning of unknown origin? In this podcast, MD Dan Olesnicky walks through them all. Step by step, he discusses the central vs peripheral nervous system (the peripheral being the end 'rootlets' of very small nerves that can enervate our hands and feet but also wrap around our gut and heart), and then goes into mono vs polyneuropathy. We talk about everything from mechanical compression to toxic insult to acute or chronic infection to hereditary sources for neuropathy. Then we talk about treatment options, including the innovative treatments he offers in his clinic that include stem cell and PRP (platelet rich protein) injections into nerve trigger points that has given some of his toughest neuropathy patients relief. Dr Olesnicky shares some elements of the cardiac neuropathy he experienced from Lyme Disease and how this has resolved with IV stem cell therapy. Fascinating N of 1 case!