Dr Lynese Lawson: Beyond Testosterone Lecture

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Nelson Vergel

Founder, ExcelMale.com


Nelson: Hello everybody, Nelson Vergel here with ExcelMale.com. I'm very happy to have Dr. Lawson from the Washington DC area. She's a long term friend of Excel Male and the work we do with men's health and testosterone replacement therapy, among other things. Dr. Lawson is the founder and the Medical Director of Proactive Wellness Center of Vienna, Virginia.

The center was founded in 2006 and is one of the leading anti-aging and functional medicine specialty practices in the Metropolitan DC area, serving patients from Northern Virginia and Maryland, Washington DC and surrounding areas. Some people even fly over a thousand miles to see Dr. Lawson. Lawson specializes in treating men and women with hormone replacement, weight management, and a functional approach to treating and preventing chronic disease and therapies to reverse the symptoms of aging and enhancing overall wellness and longevity. Dr. Lawson is a Board Certified in anti-aging and regenerative medicine with the American Board of Anti-Aging and Regenerative Medicine and is a board certified anesthesiologist (retired) and an avid researcher. She's here today to share with us aspects of testosterone replacement therapy and beyond that we usually do not consider either when we're thinking about starting therapy or when we're [monitored 00:01:39] while we're doing testosterone replacement. Welcome Dr. Lawson. Thank you so much for volunteering for this new experiment we're doing today, showing the PowerPoint slides while you're speaking. Thank you so much and welcome.

Lynese: Thank you so much. I'm happy to be here.

Nelson: Why don't we start with your first introduction of the slides and what your topics will be?
Lynese: Good. Today, we'll be talking about low thyroid function, insulin resistance, heart disease prevention, and CIRS. That standards for chronic inflammatory response syndrome.
Nelson: Why are these different topics important to consider in men beyond TRT? Why don't you go through the first one which is low thyroid?

Lynese: A lot of men come to me and they really are fatigued. They just don't have the zest that they have for life. They think that testosterone replacement therapy is the only answer. Oftentimes, that does make a big difference but many times, people suffer from hypothyroidism which is low thyroid function. There's hyperthyroidism but it's more common to have a patient who presents with hypothyroidism. Hypothyroidism frequently does go undiagnosed though because doctors tend to look only at the lab results and overlook the clinical symptoms of fatigue, difficulty losing weight, cold intolerance, brittle nails. It's so obvious to me that we have to look at the thyroid, but so many times, physicians just don't really even ask the questions and a lot of times, they just think that it's because of low testosterone levels and they ignore the thyroid, but there are certain ways that we have to look at thyroid function and it goes along with doing the right tests.

Nelson: Yeah. That's the tricky part.

Lynese: It's tricky. It really is. When I do a thyroid function panel on someone, I check for the TSH which is thyroid stimulating hormone, the T3 Free, the T4 Free, and the Thyroid Peroxidase antibodies. Now, most doctors just check for a TSH which is thyroid stimulating hormone, as I just mentioned before, but thyroid stimulating hormone is a pituitary hormone and it doesn't always line up with what's happening peripherally with the actual thyroid hormones. Now, the T3 Free is one of the most important lab test that we need to look at but most of the time again, doctors will just look at TSH and Free T4 if they look at the T3 T4 Free at all.Many doctors miss a lot of people just by not doing the right tests.

Nelson: Before we move on, I just want to make this open discussion. Why do you think there is such a barrier here when it comes to hypothyroidism or hyperthyroidism diagnosis? Why are we using this TSH test as a main diagnosis test when we know we have data that that may actually be not the only indicative factor involved?

Lynese: That's a great question. That's just the way doctors are taught. They're taught that way in medical school. They just look at the TSH. For example, the reference range for a thyroid stimulating hormone is .4 to 4.5. A lot of doctors will look at the TSH and if it's above 3 or 3.5, then they will say, "Oh, you have hypothyroidism. You have low thyroid function," but there are people who have a TSH at that lower end of that reference range, and again that's a pituitary hormone so sometimes the pituitary is not giving the best indicator of what's happening in the body but that's just the way they've been taught and it's been hard to shift a lot of doctors beyond that teaching that they've known for years and years and years.

A lot of the integrative doctors these days are doing the right tests to come up with the diagnosis and the other thing is, you look at the labs but you can't just look at the labs only. A person is not a sheet of paper. You have to look at the labs and you have to look at what's going on clinically in order to really make a diagnosis.

Nelson: Good point. I'm glad you reviewed that. All right.

Lynese: Next, I will speak a little bit about treating low thyroid. The most common thyroid medication is the T4 medication. Examples of those are Synthroid, Levothyroxine. Those are T4-only preparations. A lot of people need T3. They're low in T3. They don't convert T4 to T3 very well, and a lot of people do not do that, so if you don't check the T3 level and if you don't replace it, a lot of times, people won't get better. There are options for a T3/T4 thyroid medication. We can compound it. We love our compounding pharmacies and I hope they continue to flourish and thrive. Compounding pharmacies can make very specific dosages of T3 and T4. We can get commercial preparation such as Armour Thyroid. That's a desiccated thyroid medication. Armour's not the only one. There are other derivatives that have different [pillar 00:07:20] such as Westhroid, Nature-Throid, but it's the T3 that really makes the difference in a lot of people. I've seen people who have been on thyroid medication. They still felt tired. They still weren't losing weight. Then as soon as we add the T3 to their regimen, it's like something magical happens and they're much better so you have to look. If any of you think that you have a problem with your thyroid function, you definitely want to have your doctor do a Free T3, a Free T4 and I like to see the Free T3 and in the high 3s to the low 4s. We can talk about that at another time, but this is informational just to give you what you want to look for.

One more thing I want to mention is thyroid antibodies. A lot of us have autoimmune disease and that's when our immune system starts to attack our own cells, our own tissues. For example, I saw a lady who had thyroid antibodies greater than 1,000. Depending on the lab that you go to, they should be less than 34 for [Quest 00:08:28], less than 9 for a LabCorp lab result. Her thyroid antibodies were greater than a thousand. I said, "Has anybody ever tested that?" that's an indication that a person has Hashimoto's thyroiditis. She had been on thyroid medication for 20 years and no one had ever tested. You know if you have one autoimmune disease, you are at risk for others so you really want to make sure that you figure out why the body is attacking itself and address that as well.

Nelson: That's a good point. It's often misdiagnosed or not even looked at. I've known a few men that had TSH of 3.8 and their doctor told them, "You're okay." They had all the symptoms and they went ahead and some men and women are obviously accessing online blood testing. I have a company called the [inaudible 00:09:21]. They say, "You know, I'm still having all the symptoms. My doctor told me I was okay." They go in, get their full thyroid panel like you said Free T3, Free T4, and antibodies. I happen to know 2 people that had really high antibodies so they had Hashimoto's and the doctor had told them that their TSH was fine. If it wasn't because they took that extra step, obviously, they switched doctors, they might never found out.

Lynese: Right. It's nice that patients have access to be able to get the labs if they get resistance from their physician.

Nelson: Yeah. One of them was wondering why testosterone was not working and that was a good reason why.

Lynese: Exactly.

Nelson: We're starting now with the insulin resistantance issue.

Lynese: Right. Insulin resistance is very common these days and it's a precursor to diabetes, type 2 diabetes. Now, diabetes is the fifth leading cause of death in the United States. It's a fast growing health issue. I see people who are insulin resistant who never knew that they were. They will tell me, "My blood sugar's fine," but they are insulin resistant and wewill go over why we determine or how we determine actually that they are insulin resistant. Let's go to the next slide.

When the glucose level rises after a meal, the pancreas secretes insulin. Insulin is secreted in order to bring glucose into the cells or into the tissues to be utilized as energy. When you eat a sugary or carbohydrate meal, the insulin level is going to rise, but sometimes when we eat too much sugar, then our insulin levels become very, very high and over time, it causes us to not be able to really utilize our insulin properly. In summary, you eat a sugary meal, the insulin level goes up to bring the blood sugar down. Sometimes it overshoots, the glucose gets too low, the person gets irritated, they have low blood sugar. We really got to look at our diet and make sure we're not challenging our bodies with too much sugar. Too much sugar is probably the main reason why most people have diabetes. It's a lifestyle issue, really.

Nelson: Yeah. We are bombarded with food that contains sugar or hidden sugars.

Lynese: Exactly. They say that the standard American diet, it really is sad, but the average American consumes 150 pounds of sugar per year. Isn't that amazing?

Nelson: That's crazy.

Lynese: That's a lot of sugar.

Nelson: Our ancestors never had any need for sugar.

Lynese: I know. Then a lot of people are deceived and the food industry really deceives us in that they will say, "Oh, something sugar-free. If they're sugar-free and it's sweet, it's got artificial sweeteners on it. Artificial sweeteners do the same thing with the insulin levels as does sugar, even worse. Actually sugar is even healthier to eat then artificial sweeteners. We don't look at labels closely enough. Anything that pretty much ends in ose; maltose, dextrose, sucrose, sucralose. That's what's in Splenda, but those are not good for us and they lead to insulin resistance.

Nelson: Good point.

Lynese: Again, I had said earlier that people will come. They'll say, "My blood sugar is fine. My doctor said it's fine." One more point that I'd like to make is, often times I'll ask patients, do you have a copy of your lab work? "No, the nurse just called and said everything was okay." What does okay mean? I tell them, "You wouldn't not get your bank statement. You need to have a copy of your labs. You need to keep a notebook so you can follow trends and see really what's going on and track what's going on with your health." A fasting glucose is not adequate. It is not enough to tell us whether or not a person is at risk for diabetes or if they're pre-diabetic.

Next, I will describe how we diagnose Insulin Resistance. These are conservative ranges but for a normal person, a fasting blood sugar should be less than 100. In pre-diabetes, the fasting blood sugar will between 100 and 125. With diabetes, it's 126 or higher. That's not enough. If someone has a fasting glucose of 99, I'm not going to say, "Well, let's just watch it." I'm going to be aggressive about doing something about it because even a hundred is too high in my mind. I really like to get the person's fasting blood sugar below 80. We can look at more than just the fasting blood sugar by looking at what's called the Hemoglobin A1c. The Hemoglobin A1c gives us an indication of what's been going on with the patient's blood sugar over a 90-day period. For a normal person that's not pre-disposed to diabetes, the A1c will be less than 5.7%. In pre-diabetes, it'll be 5.7 to 6.4%. In diabetes, it's 6.5% or higher.

If a person's 5.7%, a lot of doctors will say, "Well, that's fine. Everything looks good," but again, I like to have my patient's lab results in optimal ranges and do something before it becomes a problem. I really actually strive for my patient's A1c levels to be even in the low 5s to high 4s, although I don't see that very often because we drink too much alcohol at times. As I said before, we eat processed foods andfast foods. We really want to check more than just the blood sugar. We want to look at the A1c. Another good marker which is not on this chart is the fructosamine. That shows what your blood sugar levels have been over a 2 to 3 week period.

Nelson: Really?

Lynese: Yeah. Fructosamine.

Nelson: Tell us a little bit more about that. I know we're trying to keep the presentation short, but I never really heard about that test.

Lynese: For example, you can know you're having lab work done and eat really well for 2 or 3 days prior to the blood test. You get a deceptively normal looking level of sugar, the blood sugar that's in your system, but Hemoglobin A1c shows just the glucose that's on the hemoglobin and we turn red blood cells over every 90 days. It's not a perfect marker, but it definitely can give us an indication as to how much sugar is on that red blood cell. A similar thing happens with fructosamine but it gives us a shorter window of time as to what that patient's blood sugar has been like over a 2 to 3 week period. All those are good. Then another thing I want to mention before we go to the next slide, is fasting insulin levels.

I like to see the fasting insulin level below 10. There's a lot of controversy on whether fasting insulin levels are really accurate and reliable, but for example, if I see someone who has a blood sugar of 99 but their fasting insulin level is 59, and I see that all the time, I know that person is putting up a lot of insulin in order to keep that blood sugar low or normal and that mechanism is going to break over time. You've got to look at all of those markers and look at what's going on clinically with the person's weight, are they weight loss resistant? All that information arms us with what we need to do to help get that patient back to a normal glucose and insulin balance.

Nelson: Yeah. What do you think about the glucose tolerance test? Is that too much trouble to go through like a separate sampling after ingesting glucose, they do that curve?

Lynese: Yeah. Right.

Nelson: Two-hour GTT or ...

Lynese: Right. I think it's a great test. Patient's don't really want to do it, but I think it gives us a lot of good information, so I recommend it from time to time. I don't do it all the time because if I just see that the person has signs of insulin resistance and their lab work indicates that they have it, I move to the next step and it's with a medication that you recommend frequently and that's Metformin. I tend to just treat. I don't always do a glucose tolerance test, I do very few, but I think it is a great test.

Nelson: Great. Thank you so much.

Lynese: Next, I will discuss treatment for insulin resistance. The first line of treatment is obviously diet and exercise since earlier we said that diet is one of the major contributing factors to the rise of insulin resistance.. You need a diet that mainly focuses on low glycemic fruits, vegetables and low-fat proteins. Metformin is one of my favorite medications to use and it was originally a botanical, so people get paranoid about using it. They'll say, "That's for diabetes." I'll tell them that, "We want to prevent you from developing diabetes." Metformin has so many other benefits other than improving insulin sensitivity. It actually decreases the incidence of a lot of different cancers; breast cancer, prostate cancer, colon cancer, lung cancer, even pancreatic cancer. I use Metformin on a regular basis. That's one of my first go-to medications to use for insulin resistance.

Nelson: There's actually a large study ongoing right now, funded by the US government to look at Metformin for survival and aging, so it's encouraging. Even the US, the NIH is looking into Metformin. Hopefully, it's really good.

Lynese: Yeah. I'm excited about that. Believe it or now, people have come to me who don't have insulin resistance and they are interested in taking Metformin because it's not going to just drop your blood sugar. It's just going to improve the way your insulin works. Cancers feed off of sugar and insulin, so getting your glucose balance and insulin balance under control is extremely important.

Nelson: I also tell people though that starting Metformin isnot an open door to eating higher sugar foods, you still need to eat a sensible diet. .

Nelson: Like a passport to get you into cheating more often.

Lynese: Right. Exactly. Now, let’s talk a little bit about cardiovascular disease because it is a leading cause of death in men and women. It's primarily due to atherosclerosis which is plaque build-up in the walls of the arteries. What happens is the plaque will cause narrowing in the arteries. It makes it harder for blood to flow through the arteries. A lot of times, a clot can form in the artery which can block the arterial blood flow and that can increase ones risk for a heart attack or stroke. We definitely want to do everything we can do to diagnose cardiovascular disease and treat it and be aggressive about it when we find that a person does have risk factors for cardiovascular disease.

The lipid panel is one of the key lab tests used by physicians today to diagnose cardiovascular disease. I'm sure that most people have had their lipid panel done and most people will say to me, "No, my cholesterol is fine. It's 190," and "My HDLs are high." HDL is the healthy cholesterol. The LDLs are the lousy cholesterol. Most people are deceived into believing that because their cholesterol is less than 200 and their HDLs are greater than 60 that they're okay, but I find with the testing that I do that goes beyond just blood testing, that I have seen people who have cholesterol levels of 385 who have no plaque in their arteries and I've seen people who have cholesterol levels of 170 and they have a significant amount of plaque in their arteries.

The point here is that Lipid panels scores or cholesterol levels are really a poor indication of whether you're at risk for cardiovascular disease. It's a marker and it's an important one because if it's high, it helps us to look beyond just that particular result and we look a little bit deeper, but if it's normal, it doesn't mean that we don't need to look for cardiovascular disease risk.

Nelson: Good point. We're talking about fasting lipids, right?

Lynese: Fasting. Exactly. Fasting lipid panel, correct. The things that I do in my practice and I've been doing this for several years now, we actually have a ultrasound, specialized ultrasound that we measure the plaque formation and the arterial wall thickness. It's called a CIMT scan, carotid intima-media thickness. It's an ultrasound that we do here in the office. We look at what's going on with the arterial wall, is it thickened or not, because that's an indication of atherosclerosis. We'd look at whether or not there's any narrowing in the artery. This test tells whether or not there mixed plaque or soft plaque in the arteries. Soft plaque is vulnerable to rupture, so if the person has soft plaque or mixed plaque which is a combination of calcified and soft plaque, we really want to be aggressive with their therapy. We really want to make sure that we eliminate their risk factors for developing heart disease.

Other markers that we look at are lab test that go beyond the standard lipid panel. There's a marker called an Apo B. It's just an advanced marker. It would take a long time to explain the significance of all of these markers. LP(a), lipoprotein(a), it's another marker and we can even lower LP(a) by even just giving Niacin. Typically, I'll give 1,000 milligrams of Niacin. I don't use the flush free Niacin, I use the Niacin that makes you flush. There's another marker called the Lp-PLA2. It's sometimes called a plaque score. That'll tell us whether a person has arterial inflammation. The fibrinogen level is another marker that increases our risk for clotting. If your fibrinogen level is high and you're a smoker, you need to stop because that causes the fibrinogen levels to rise even further. If I see an elevated fibrinogen level, I'm going to give a supplement called Nattokinase, Lumbrokinase. There are interventions that we can do to improve this inflammation and increase of propensity to clotting, but we need to know that there's a problem so we could do something about it.

The other thing with LDLs, a person's LDL cholesterol can be normal, it can be less than a hundred, but what matters is the size of those LDL particles. For example, if a person has a lot of small dense particles, they are more at risk for developing plaque. I explained to everybody that the inside of our artery is like a tennis net. There's an endothelial lining inside that artery. I'm telling my age now, if you throw a jack ball or a marble up against the tennis net, they can go through the hole and get to the other side. If you have very small LDL particles, they can go through the little hole in that endothelial lining, go to the other side, oxidized in the artery and cause plaque. If you have larger LDL particles, they tend to bounce off that artery and keep flowing. You want larger LDL particles and the small ones are bad, but again, we need to know that they're there so we know how to proceed with treatment.

Nelson: That's a great analogy. Thank you.
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Defy Medical TRT clinic doctor

Nelson Vergel

Founder, ExcelMale.com

Lynese: Next, let's talk about how we treat cardiovascular disease. Statin drugs are the first line of treatment for elevated lipid panels, but again, if a person has a high cholesterol level and they have zero plaque in their arteries, and we look at other inflammatory markers such as a cardio CRP and they have very little inflammation, then it shouldn't be just a knee-jerk reaction to just prescribe a statin. Now, there are so many people who are totally anti-statin and I'm not anti-statin at all but I think that statins should be prescribed for people who really need them. Some people do need them. For example, if you have a lot of plaque in your artery, you have a lot of inflammation. For example, the cardio CRP level should be less than 1. If it's between 1 and 3, that puts you at an average cardiovascular risk. If the cardio CRP is greater than 3, it puts you at a high cardiovascular risk.

You want a statin for its anti-inflammatory benefits and it helps to stabilize and calcify plaque, but if a person does need a statin, then they really do need to take a high dose of CoQ10, Coenzyme Q10. It's an enzyme that we make in our bodies but statins deplete the production of CoQ10. When you have low CoQ10 levels, that predisposes one to heart failure. It has been said that heart failure is primarily due to a CoQ10 deficiency and so many people are on statins who don't need to be on them and there are people that do need to be on them but they're not taking any CoQ10. If you're going to give the drug, you need to make sure that you're not going to get the side effects of what that drug can do by decreasing the CoQ10 levels in production.

Nelson: Yeah. Low levels of CoQ10 can also affect muscle regeneration and there's a lot more myopathy and muscle-related issues with people taking statins. They will complain of pains and aches.

Lynese: Absolutely. Yes. There are even some genetic test that can help determine risk and treatment. Specifically, some of the advanced cardiovascular labs do a genetic test to predict whether a person will have a statin myopathy or not. If a person needed a statin and we knew they were at risk for the myalgias that go along with it, a lot of times they need to be given CoQ10 even prior to starting a statin and also magnesium as well. That is a good point that you made earlier about the myopathy. You do have to be real careful about the muscle pain that can occur with it and it does happen.

Nelson: Good point. Before we go on, I know the statin industry, the pharmaceutical industry has been pushing for the use of statins even for people with lower LDL levels, why are so many doctors prescribing them instead of looking at other ways to address the problem or even the diagnostics of it? What do you think they're such a barrier? Is that only pharmaceutical lobbying or the education lectures and CME programs that doctors take? Why is the cardiology world not embracing issues around looking into other factors before statin therapy, before they actually jump into that treatment?

Lynese: Right. There's a lot of money that is involved in the prescribing of statins. It's a 40 billion dollar industry. The other thing is that I think a lot of doctors, they don't know and they don't know that they don't know, and that's just what they've been taught. The other thing is that they don't realize that 60% of people who have a first time heart attack have normal cholesterol levels. They've just been trying to think that the cholesterol is the enemy and we know that is not the case because we even need cholesterol to make our hormones. We need it to make our testosterone, our estradiol, all of our reproductive hormones.. They don't have time oftentimes to really look at other risk factors. They have 6 to 8 minutes. I think there are multiple reasons why they continue to prescribe statins in spite of the lack of supporting evidence but I think it's just because that's what they've always done. The pharmaceutical reps come in. They tell them about a new statin and that's just the only tool in their toolbox.

Nelson: Yeah. Anyway you see also they're barriers to getting the insurance companies to pay for some of the diagnostic test that go beyond just a lipid panel .

Lynese: That is true.

Nelson: That really gets in the way of for even doctors to ... They're working within the insurance reimbursement system to even trying to use this diagnostic test. Also they'll get validated eventually but yes, we already know the insurance situation in this country. Even though we're having more access, there are more limitations on what they pay for.

Lynese: Exactly. Yeah. One thing I want to point out, and this is when I learned about the thyroid and the cholesterol link. I had a lady a few years ago and she ran up the stairs to my office and she worked out every day and she played tennis every day and she was really healthy. She wasn't overweight. She didn't have any signs of hypothyroidism at all, but her cholesterol was 385, but her Free T3 was 1.9. I really like to see it in the high 3s, low 4s. I said, "You know, there must be some connection between low thyroid function and cholesterol."

I validated the test result since labs do make errors, so if a lab test doesn't make sense, you do have to repeat it sometimes. Then, I treated her with the equivalent of 1 grain which is 60 milligrams of Armour Thyroid and her cholesterol came down 200 points. It came down from 385 to 185 in 6 weeks, and that was just giving thyroid medications. You have to have a broad understanding of what could be going on with the patient, why do they have elevated cholesterol levels. I see people who have low testosterone levels who have elevated cholesterol levels. You've really got to look at in a lot of different areas.

Nelson: That's a very good point, very good point. Anything else you want to expand on this slide?

Lynese: Not really. I will say one thing. I see men who come to me that have Low Testosterone. They're on a statin, they have a cholesterol level of 119 and they're fatigued and their testosterone levels are low. I tell them, "You can't even make testosterone if your cholesterol levels are that low." We could go on about this for hours but just know that there are other reasons for cholesterol levels being high other than your body is just taking too much of it and you need to lower it with statin.

Nelson: Good. Good point.

Lynese: I think we mainly covered most of what's here but I will say that a lot of people come to me who have high blood pressure and they are on 2 or 3 different blood pressure medications. I learned this from Dr. Stephen Sinatra. He's an integrative cardiologist. He has a book entitled Reverse Heart Disease Now. He uses hawthorn, magnesium, D-Ribose, and CoQ10 to lower blood pressure. Those are 4 different supplements that one has to use in order to bring the blood pressure down but I've seen it work beautifully. I would rather get to the root of why my blood pressure is high than to just give a blood pressure medication. It was kind of funny, I had a lady call me the other day. We optimized her hormones and she had been on 3 different blood pressure medications. She called me and she said, "Do these hormones lower my blood pressure?" She said, "My blood pressure, it's really low now." I said, "Well, we can probably start to wane you off of some of these blood pressure medications that you're on. She's off all 3 blood pressure medications and as again, I said, she was on 3 of them. Even just balancing hormones can make such a huge difference in our overall health, blood pressure included.

Nelson: Weight loss which also when you get your hormones balanced, you also tend to have some weight loss too and that controls blood pressure too. Blood pressure medications affect sexual function in men.

Lynese: Absolutely.

Nelson: A lot of guys, we have over 14,000 guys on Excel Male, they're terrified of blood pressure medications and looking for other natural ways to decrease blood pressure. Some of them do have issues with increased blood pressure with taking higher doses of testosterone and other things too. It is a big, big topic in my world.

Lynese: Right. I know. Offline, we can talk about some of the things I've done to improve blood pressure. We can talk about that but there definitely are options beyond just taking a blood pressure medication.

Nelson: Thank you.

Lynese: We're on a home stretch now. CIRS, chronic inflammatory response syndrome. I'm really very excited about this. It's also called the Biotoxin illness. I learned about this about 18 months ago. I had a guy that came into my office and he had a left-sided tremor. He had a tremor in his left hand and his left leg. He had been treated for Parkinson's disease, but his wife said, "He's not getting any better with the medication. I think that it's something else." She actually said, "You know, I've been reading about mold toxicity." I didn't really know that much about it at that time but again, I'm always interested to learn something new.

Chronic inflammatory response syndrome is a response that people have. It's inflammation that's due to being exposed to inflammagens, molds, toxins that are in a water-damaged building. Not only just water-damaged buildings but even certain fish like red snapper, grouper, amberjack, eel. They can contain a toxin called ciguatera. Some of us genetically are just unable to clear our bodies of those toxins so the toxins begin to continue to circulate throughout the systemic circulation and can cause a lot of different issues and health concerns. Some of the concerns mimic what's going on with low testosterone levels. We can look at the Biotoxin pathway, that's the next slide.

Nelson: Interesting topic that nobody talks about.

Lynese: Obviously, we're not going to go through every single step of this Biotoxin pathway but over on the left-hand side, it says the body acquires the Biotoxin or toxin-producing organism from food, water, air, or bug bites. We test for HLA genetic susceptibility. That's the human leukocyte antigen that's on chromosome 6. On the left-hand side, we have a desired outcome and a healthy patient. If the patient is not HLA susceptible to not being able to clear toxins, what will happen is the adaptive immune response will respond. Understand that we have 2 types of immune response. There's adaptive immune response. The adaptive immune response sees the foreign invader, sees this toxin, develops an antibody, and gets rid of it. It specifically targets that toxin and eliminates that antigen or that foreign agent that has entered the body. That's what you want to happen. Adaptive immune response is like a trained sniper. It's very targeted. It picks off that particular toxin and gets rid of it.

Next let's look at what happens at that point if a person is HLA susceptible meaning that 25% of people, believe it or not, are genetically not able to clear these particular Biotoxins. What will happen is that their adaptive immune system is not able to remove the toxin then their innate immune system takes over. The innate immune system, I liken that onto someone in a room that's blindfolded with a gun or a rifle or a machine gun and he's just shooting at everything, just trying to take out everything. This is when people start to develop autoimmunity and there are tests that we do that I had never heard of other than when I started to study this over the last 18 months but there's TGF-β1. There's C3a, C4a. It's a complement system.

The one that is most important down in the middle with those orange arrows going off from it, it says reduced MSH, that's melanocyte stimulating hormone. When a susceptible person is exposed to toxins that they cannot rid their bodies off, they will develop low melanocyte stimulating hormone levels that can cause all sorts of issues in a patient. It can cause sleep disturbances, chronic pain, gastrointestinal issues, and prolonged illness. Believe it or not, it can also even cause low testosterone levels, low hormone levels in people. It can also cause people to become leptin resistant. I've had patients who are weight loss resistant and they'll me, "I've gained 30 pounds over the last year. I've not eaten anything any differently. I exercise all the time." They might not have a lot of the symptoms that most people have who have chronic inflammatory response syndrome but I have looked for Biotoxin exposure in these patients and a lot of these patients who have weight loss resistance actually have CIRS.

It's really an interesting field. I've had patients with fybromyalgia and fatigue and they really had CIRS. I've had patients with migraine headaches, because what will happen is this inflammatory response will cause certain parts of our brain to develop edema and so you can see certain fingerprints when you look at an MRI. There's an add-on to an MRI called a NeuroQuant. With this test we can see changes in the brain. We can see changes in the blood work. There's a new cutting-edge genomic testing that will be available, well, it's actually available now. It's very expensive but we can see exactly how to treat a patient and it's the best that we have in offering personalized medicine. When you think about 25% of people being susceptible to developing this type of inflammatory response, I'm just seeing so many people who are being treated based upon their symptoms but were not getting to the root of the issue.

Nelson: I'm really looking forward to getting this test done myself. I'm telling you. Obviously, I have an immune deficiency myself and I do have inflammatory issues. [inaudible 00:43:40] carrier. I'll be writing something about my experiences. I'm going to be using your services for this for sure.

Lynese: I'll definitely tell you all of the test that you need. It can be a scary thing for people. My mother, and I'll close it with this, but I knew about CIRS and probably it was meant for me to know so that I could really help to save my mom's life.

Nelson: Really?

Lynese: She lived in Michigan. I knew her basement was moist. I know she used dehumidifiers but she told me one day, "You know, I've been really emptying these dehumidifiers every day, all 3 of them. One of them had some black sediment in it." I thought, "That sounds like mold." Although not all molds are black. Stachybotrys is black, but there are other molds that have no color at all. Then you can have patients or people who can live in a home with black mold growing all up the wall and they don't get sick, but then there are others that will. Anyway, I did her lab test and I found out they were worst than anybody's test that I had ever seen before.

Next we tested the home. That's another long story and I don't want to keep people online too much longer, but we actually tested her home looking at a test that looked at the DNA of the molds that were in her home. For example, it's called an ERMI test, Environmental Relative Moldiness Index. The scale goes from -10 to 20. You really want to see that ERMI score below 2. My mother's was 19.3 so I knew there was a really bad problem. I had somebody go out and inspect her house who was really qualified person to look for areas for water intrusion and breaches in the building envelope and what not. The woman told me, she said, "You mom's house is beautiful. It doesn't look like there's an issue, but it's like a super model with bone cancer. Because her house was so bad and her labs were so compromised by this immune response that she was experiencing, she had to get rid of everything porous, furniture, mattresses, you can wash your clothing. It's really an interesting field. The sicker the patient is, the more aggressive you need to be with the remediation and some people have to move out of their home, but it's really a fascinating field.

Nelson: Your mom feeling better?

Lynese: You know, believe it or not, my mom really didn't feel bad. She had a little bit of a sore throat, and I really think it's because she was in really good overall health... You can have, let's go over the symptoms actually, chronic fatigue, fibromyalgia, Lyme disease, depression. These are diseases that CIRS is easily confused with. In the case of my mother, I really believed and I can't validate it or verify it, but I really think it's because her hormones have always been balanced. We have her blood sugars under control. She's on Metformin. She takes fish oil. She does all of the things that we do in a integrative practice and so I really think that kept her from really being ill.

Nelson: Good. Some doctors actually even minimize the existence of these issues. Obviously we're talking about education again.

Lynese: Right. Actually Lyme is a Biotoxin. The borrelia causes the toxin to be maintained in the body and the immune response reacts to that toxin, but believe it or not, a lot of people that I've seen with Lyme disease actually have CIRS. Get this, there's a girl who's 15. She was diagnosed with Lyme disease. She came to me for IV vitamin treatments. Her doctor had sent her to me for that and so we did that. She felt a little bit better but she really wasn't getting as healthy as her mother wanted her to be. The mother came to me and said, "You've got to look further. Something else is going on." We did the blood test to look for CIRS but we did an MRI of her brain and looked at the NeuroQuant that I mentioned before. There are certain fingerprints on a NeuroQuant that are indicative of mold toxicity and there are certain fingerprints that are indicative of Lyme disease.

I'm not saying she never had Lyme, but Lyme wasn't what was impacting her health at that point. We discontinued her antibiotics. We treated her for her mold toxicity, and there are a lot of steps to doing that, but she had been home schooled because she wasn't able to really ... She didn't have the stamina and energy to be in school full time but I just found out that she has gone back to school now. She went back this fall. It really made a difference in her overall health.

Nelson: Wow. Great success story.

Lynese: Right.

Nelson: Go to the next slide?

Lynese: Yes, I will just say a little more about diagnosing CIRS. I think I'm just going to say this briefly because I could go on and on, but there's a visual test that you do. There is a website called VCS Test, Visual Contrast Sensitivity testing, so VCSTest.com. It tests what is going in with the optic nerve because when you have CIRS or chronic inflammatory response syndrome, the optic nerves don't get good blood flow and so your visual perceptions of certain images and being able to distinguish certain patterns is compromised. One of the things that we use to monitor a patient's improvement is their VCS test. There are 37 symptoms that are associated with CIRS, if a patient has 8 or more symptoms that are on that list of 37 and their Visual Contrast Sensitivity test is positive for Biotoxins, there's a 98% chance that that person does have CIRS. It gives us more information. It's just a multisystem, multi-symptom disease, and we have to use multiple methods in order to diagnose it. VCS testing is one that we definitely use. We can go to the next slide.

Nelson: This is such a new field, at least for me.

Lynese: Right. Let's summarize on the topic of diagnosing and treating CIRS. I talked about ERMI testing. I talked about genomics. I talked about the MRI with NeuroQuant. I didn't specifically talked about each lab. There are a lot of steps. It's a 12-step program to treating a patient who does have CIRS. We won't go into all of that but one of the key things we want to do is if the CIRS is really due to being exposed to a water-damaged building, you have to remove the patient from exposure. Then we do use binders such as Welchol and cholestyramine to help bind those toxins and get them out of the body through the GI tract. It's a big process to treating these patients but the outcomes are just so wonderful when the patients get better. Their MRIs, their brain actually improves, so that's really exciting as well.

Nelson: Wow.

Lynese: All right. I think I've already said all of that. The bottom line, Nelson, is each of us is genetically unique and different. We can't treat patients in a cookie-cutter fashion. We have to look at each person and provide the best personalized approach for that particular patient because all of us are different.

Nelson: I really have to thank you because I do a few of these lectures online with different doctors and today you have brought a very different view of other factors that could be impacting a lot of my audience that they have no awareness of. I'm one of them. This CIRS topic, completely new to me.

Lynese: Right. I'm happy to share what I know. I've learned a lot about it and I'm happy to share it with you and anybody who's willing to listen.

Nelson: Yeah. I really want to thank you. I can tell this is going to be the first of several lectures with you because I'm sure you can talk for hours about different topics.

Lynese: Yeah.

Nelson: I definitely wanted to do one specifically focusing on women. Although my site is called ExcelMale.com, we have a folder forum section that is called Excel Female, it's for women, because every man has a woman that they care for either a spouse or their mother.

Lynese: Right. Exactly.

Nelson: When they come in to my site, they end up asking questions about how ... Our guys are actually starting testosterone. They feel better and it makes a huge difference. They're feeling better and their wives or their girlfriends are still not feeling as good as they are, so I'd bring them up to that level. I'm seeing more and more interest even to educate men about women's health for that purpose. I'm definitely going to be bothering you again for another one of these.

Lynese: It's not a bother at all. I love to do it. I'm happy that you invited me to do this. It's been a lot of fun. We'll be talking.

Nelson: Yeah. One more thing. How do people get a hold of your clinic, website, phone number?

Lynese: My website is ProactiveWellness.com. Our phone number is 703-822-5003. You can even email at [email protected] and someone will respond to you if you have any questions.

Nelson: Thank you so much once again and we're looking forward to the next one.

Lynese: Thanks Nelson. Take are.

Nelson: You have a nice weekend. You take care. Bye.

Lynese: You, too. Bye.


Lynese: Right. I know. Offline, we can talk about some of the things I've done to improve blood pressure. We can talk about that but there definitely are options beyond just taking a blood pressure medication."

Nelson is there a thread to what the doctor might have talked about offline concerning high blood pressure?

Joe Sixpack

Active Member
Lynese: Right. I know. Offline, we can talk about some of the things I've done to improve blood pressure. We can talk about that but there definitely are options beyond just taking a blood pressure medication."

Nelson is there a thread to what the doctor might have talked about offline concerning high blood pressure?

Nelson, I'd like to resurrect this old thread to ask about options for blood pressure control besides meds. Did you get a chance to document what you and Lynese spoke about, if anything offline regarding blood pressure?

Joe Sixpack

Active Member
Thank you Nelson. Much appreciated. Magnesium is always recommended and I wish I could take it. I have tried all different forms, even the chelated ones. The recommendations are always for hundreds of MG's. I find that anything more than 30mg at a time gives me the squirts. It may mean that I am adequate in mag. But it's hard to tell. Testing for mag is difficult.
Thank you Nelson. Much appreciated. Magnesium is always recommended and I wish I could take it. I have tried all different forms, even the chelated ones. The recommendations are always for hundreds of MG's. I find that anything more than 30mg at a time gives me the squirts. It may mean that I am adequate in mag. But it's hard to tell. Testing for mag is difficult.
Have you heard of or tried the magnesium water? Google it and I think our friend Vince here has made some posts about it.

Joe Sixpack

Active Member
Have you heard of or tried the magnesium water? Google it and I think our friend Vince here has made some posts about it.
I have heard of mineral water but have not tried it. I remember reading about it at one time but had completely forgotten about it. Thanks for the reminder. I will see if I can find those posts. IIRC mag water is suposedly super absorb-able. I have tried topical mag which theoretically should bypass the gut. But I get the squirts from even topical mag.


Super Moderator
I have heard of mineral water but have not tried it. I remember reading about it at one time but had completely forgotten about it. Thanks for the reminder. I will see if I can find those posts. IIRC mag water is suposedly super absorb-able. I have tried topical mag which theoretically should bypass the gut. But I get the squirts from even topical mag.
I was always told the best way to take magnesium is by drinking magnesium water. I started making it for my wife (I also drink it) one small glass before bed took away all her leg cramps.

Magnesium Water: From Wheat Belly Total Health | Dr. William Davis


New Member
I have been following all of you (Jay, Crisler, etc) for a very very long time (I am 49 years old). I am gathering as much information as possible on reversing heart disease methodologies as it pertains to supplementation. Has the information here changed from two years ago? In light of the passing of Dr. Crisler, I would love to read of TRT peeps who susccefully revesed heart disease. If you could point me to a link, I would greatly appreciate it. I have plaque (Heart Disease) in my LAD but it is not too bad - yet... I am on a quest to remain on TRT and reverse the plaque! Thanks for all you do.

Joe Sixpack

Active Member
Awesome! Thanks for the speedy response. Hopefully others will start chiming in with their own stories of plaque reversal.
Plaque reversal does not happen very often. You have to find the root cause for the plaque and address it. The 2 biggest items to consider are keeping blood pressure under 120/80 and making sure your blood sugar is well controlled. Over 50% of the population is pre-diabetic or full blown diabetic. High blood sugar is a potent cause of plaque formation. See this excellent video


New Member
I know this is an old interview, Nelson, but just read it and so helpful!

I don't know of any other platform that offers the wealth of knowledge found here and just the sheer breadth and range of knowledge!
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