 Hey everybody. Good afternoon. We're back and today I'm with Dr. Sharon Koiner and I'm really, really excited about our topic of mood, memory, and cognition. And we're going to dive deep into some new genetic testing and some stuff that's really changed not only my life but the lives of my patients. You know, I know a lot of you out there are listening or either practitioners that are dealing with complex, difficult cases or your patients. They're in the midst of a health struggle and if it's not you, it's probably someone you love. And what I found in my experience over the years is I remember, you know, 15 years ago doing functional medicine and having someone with thyroiditis come in or menopausal symptoms or maybe fatigue or headaches. And it always seemed like, you know, getting to the root cause was fairly straightforward. We'd fix the gut, we'd treat the hormones and within three to six months the patients would be feeling great. And what I've seen now is the complexity of the illness and the types of patients that are seeing me at least. And I think this is real common to my colleagues if you're listening or if you're a patient you're nodding your head too, is so much greater. And I would say it is rare if ever that I have a case where there's one problem or one solution or that it's simple. And I think if I talk about the background there, I think some of it is our environmental toxic load is continually increasing, our stress levels are increasing, our electromagnetic radiation is increasing. So there's a lot of strains and stresses on our immune system and on our body and it's almost like the straw that broke the camel's back. And we're reaching this equilibrium here where we're reaching, you know, the speed at which our immune system can't keep up anymore. And it's sad. And of course, you know, as I bring people to interview and we talk about topics, what I always want to bring is just great information to help you, whether it's what our histamines, what our EMS, how to deal with this stuff. Because the more information you have, the more empowered you are to either as a clinician help your patients or as a patient ask questions that get to the root cause. So that's, that's just a little background here. I want to introduce Dr. Cohen today and just so excited to have her here. I know you're going to love the information she has. If you want to find us, you can find me on the website, JillKarnahan.com. You can also find this video and all of my 60 plus other videos on my YouTube channel. If you just go to JillKarnahan on YouTube search and you'll find all the videos there and you can rewatch these. And this one, of course, will be replayed as well. So without further ado, I'm going to introduce Dr. Sheeran. And then we will jump right in. So she's a chief medical officer and co-founder of Intellect's DNA and Resilient Health, Austin. And we're going to be talking about some of this genetic testing that she's developed. I'm so excited for that. She received both her master's and medical degree from Harvard Medical School. She's a fellow of the American Academy of Failing Medicine and a diplomat of the American Board of Integrated Medicine. Dr. Hausman Cohen has been in the field of integrated medicine for over 25 years. She and her co-founder developed Intellect's DNA as an answer to an unmet need in the integrative and functional medicine community. The need for accurate evidence-based genomics tool geared to helping functional and integrated physicians practice personalized medicine. And again, as you heard in my intro, this is why I'm so excited because I'll tell you in a few minutes some of the changes that's helped in my own health and in some of the health of, in the health of some of my most complex patients. They envisioned and created a tool that could help identify root causes of cognitive decline, environmental acquired illness, and other chronic illnesses. And one that could also help clinicians know how to address these genomic factors. That's another thing. Again, you're going to see this, but when I love about her tool and her testing that she's helped to develop is that there's really practical interventions. So many of these things my patients bring in this 200-page report and they're like, I don't know what to do with this. And the doctor doesn't know either. So the great thing about this is I feel like we've got lots of practical tips and tools of how to actually use the data because data isn't the problem. We have thousands of pages and ways to get data. It's how do we use that data? She loves to combine her passion for science and medicine and using her scientific mind to integrate large amounts of complex data. I love this. Dr. Sharon, same as me. She's taught extensively around the country at conferences for physicians as well as for community members and will be featured in a documentary being released this year in the future of healthcare. As she's published many, many papers and worked along co-authors such as Dr. Dale Bredesen on the landmark paper, Reversal of Cognitive Decline. So thank you so much, Sharon, for being here. I am absolutely delighted. Thank you so much for having me. You're welcome. So I would love to hear first is how did you, we talked just a little bit about your background in that, but there's always a little bit of a personal journey. How did you get into creating this company and tell us a little about your journey to get here? Well, as I said, I left academia. I thought I was going to do a PhD in medicine, but it didn't really take me very long to figure out that I was not a one pathway type of girl. I didn't want to spend my whole life on one pathway of the brain or one hormone. So I did a complete switch, went to medical school and became a family physician because I was interested in so many different things and said I'd always get back to research when I found the right project. I had had a strong background in genetics before I had gone to medical school. And then the 23 me revolution happened and patients started bringing me their genomics and going, can you help me prevent cognitive decline? Can you help me prevent heart disease? What can, what does this all mean? And I realized there was not a tool that was developed for clinicians, especially those of us in functional and integrative medicine that was accurate or useful at being able to take that genomic information and translate it into what is the root cause or what are the many root causes of what's going on for the patient and how can I help them? So at that time I had just left a bigger practice and founded Resilient Health with my co-founder Carol Billich and she came up with the idea of saying let's reach out and see if we can get a custom report developed for our needs as a functional medicine office. That ended up evolving to us just creating intelligent DNA and offering it then to clinicians across the country because obviously when we realized it would take tens of thousands of hours and lots and lots of research staff and money and all those things to develop that it needed to be something more than just for our office. And so now we're really proud that it's being used by clinicians like you across the country like Dr. Bredesen and his studies. And we've had so much success with helping people, whether it be with environmentally acquired illness or cognitive decline, or just trying to understand their osteoporosis or heart disease or diabetes and improve it without all the solutions being medication. Yeah and I'll just tell you a little bit my personal experience as a clinician and even my own testing because I've done this myself. You know Sharon it was so interesting because I've had these patients where you do everything that should work and they're just stuck and they're not getting well. And a lot of the patients I deal with have mold related environmental toxicity. They have Lyme disease and co-infection. So lots and lots of toxicity issues and infectious burden and they're just stuck. And I remember the very first one we tested. She had weight gain, edema, really, really difficulty with any sort of antibiotic or herbal regimens for the Lyme and tick-borne infections and was really gaining weight like excessively and had no ability to lose that weight. Well she had because of some pancreatitis related to one of the infections had gone on a very low fat high carb diet. And it was still complex carbs. It wasn't like she was eating junk food but that worked better at the time for her pancreas but she gained all this weight. And I remember you might know the name of the gene. I just know the functions because I remember what we did to intervene. But there was a specific gene around carbohydrate metabolism and sugar intolerance that you call it. It's not a technical term but you guys listening will know what I mean. And literally we're like you have to go off all the carbs especially anything remotely sugar related or refined. She lost 40 pounds in a month or two. I mean a very, very quick weight loss. I don't know if you remember that at all or even the I think she had problems with her adiponectin pathway and so when she was eating the wrong foods she just couldn't metabolize starch as well at all because of her genomics. So yeah and the inflammation too right wasn't there a real pathway around those that particularly for her was very, very inflammatory which it is for all of us but like for her it was like on fire. I don't remember the other details but what I do remember is we talked about the genetic interventions. You and I actually went over that test and it was my first one and then I put into place a lot of the steps that we talked about and within three months we really saw a turnaround. So that was when I became a believer and again I loved what your work was but this is a lot of information and so for me to implement it it took that case and now I have three or four cases and every one of them has been game-changing like really truly game-changing. Another patient was almost bed bound with muscle weakness and he had an inability for his muscles to use carnitine for it to get into the muscles that remember that and then also I remember really well yes right and then also an ability to convert T4 to T3. Now we saw what's so strange is he had all the symptoms of hypothyroid he had you know clinical evidence of a low ish T4 normal TSH and when we gave him T4 he just crashed he did terrible so no wonder right and so he's someone we just made some interventions on and haven't seen the change yet but I expect we're going to also see a turnaround there. So totally game-changing I have one more that I'm going to review soon so we'll report back on that and then myself oh gosh so I had breast cancer 25, Crohn's at 26, grip on a farm with lots of toxic chemicals and one of the most fascinating things to me so it's I had to write it down because I don't know the names of the gene NQ01 and I it was only seven percent so a really rare gene and again you can clarify this for me but it was related to like solvent and benzene inability to process. Do you want to say a little bit more about the gene and then I'll tell how it's affected. And I think that's a really good point Jill we as physicians we can't memorize hundreds of genes I mean there are 25,000 different genes in the genome and it would just take up useless parts of the brain to memorize it and that's exactly why we built the tool because even the most experienced most proficient functional medicine doctors that's not what they want to spend their time on and so what we did is built this tool that explains the gene and the gene function but that gene that NQ01 which is an NADPH quinone reductase is basically recycler of your antioxidants. So there is a famous NQ01 snip that is what one of the dirty genes well that one's pretty common that's one's in 30 percent of the population but this one is even more serious it's only in seven percent of the population and NQ01 is needed to keep CoQ10 in its active form to recycle vitamin E to its active form and we know that those antioxidants are so important for getting rid of toxins and toxicants which can contribute to the risk of a lot of different things including cancer. Wow it made so much sense to me and later I recently interviewed my grandmother my only living grandmother as I'm writing my book to get history and one of the most fascinating things I learned about her history and then I wrote an article about benzene toxicity based on this and I didn't even know that I had this genetic but what I found out was she and her siblings lived over a their father moved into town and bought a car dealership when she was about 14 or 15 and they moved over the auto dealership but right their house their apartment was right over a auto shop with diesel fuels and back in the day they didn't ventilate well and those fuels and the fumes and the solvents from that benzene and Pry lead came right up into the apartment and my grandmother's mother so my great grandmother would get so sick with migraines and she was back in the day when now we have all these people I'm gluten sensitive I'm dairy sensitive I can't eat peanuts I'm sensitive I go in this aisles of the grocery store I get sensitive this multiple chemical sensitivity is a sign of toxic overload and it's super common right like now we see it all the time back in the 1940s or whenever that 30s even that was not common and my great grandmother had that like she would drink the wrong water and like react and so I look back I'm like oh this pattern well here's the interesting thing they all lived in there my grandmother got married very early and so she left after like two years of being in that apartment so she wasn't there very long she had the least exposure and she's doing pretty well but she had her father died of liver cancer her mother died of liver failure and her sibling died of metastatic cancer to the liver like there was this pattern and when I saw that I was like wow this is so profound because of course my genes come from ancestry I bet there was some benzene issues with them with this NQ01 as well and doesn't that make sense and it's so interesting that there's a specific exposure to likely benzene in my family and yeah absolutely and it's not even just benzene it's yeah so many of the inhaled and the aromatic hydrocarbons and some you know the different toxicants and it's really interesting because you talked about migraines well what is one of the natural treatments for migraines? CoQ10 and so with this you don't make enough CoQ10 you can't keep it in this active form then the other thing is you talked about liver cancer and these breast cancer and all these cancers well one of the things that up regulates NQ01 because if you have one gene that's really not working at all then you can push the other one a little bit more is sulforaphane and sulforaphane there were studies done at Johns Hopkins showing that sulforaphane had breast cancer benefits and then they've used that same formulation to show that it has liver cancer benefits in China and so it really all comes together it's really exciting and you mentioned the NADPH when I first got mold toxic back in 2015 I remember being very intolerant to glutathione and later I realized glutathione reduction oxidation involves NADPH and I was probably so depleted at that point of NADPH I couldn't tolerate any glutathione I think you got all reduced or it was just completely gone and when I started it was actually several years into it that I started doing NAD as a precursor and nicotine in my riboside or several precursors it was a game changer for me and I bet my whole entire life prior to that I had been really really deficient on that nutrient for NADPH recycling and NAD also pushes that N201 so those are both things that really help you sulforaphane and NAD it makes sense and so that's the whole point of why we would do genomics because as a functional medicine physician you could do trial and error and go this makes me feel good this doesn't but isn't it great when someone can come to you and you have this kind of book of them that you can use as a beginning guide to help make those decisions and that's what Intellect's DNA does. Sharon it's amazing and I only talk about stuff I totally love and believe that which is why you're here because for me again I was like wow because we know in our head oh maybe dim maybe calcium deglugrate maybe sulforaphane to be helpful for breast cancer but for me the sulforaphane has an extra power because of my genetics so I can very much find to it same with the patients like who would have known this person had T4 to T3 conversion issues or this person had intolerance to glucose or whatever we're seeing so I've been super excited. I'd love for you to share a little bit with us I think you have some cases so we can jump in. Sure we were talking about the fact that this is this has been a crazy year and anxiety has been a big issue so I think that a good case to do would be an anxiety case. I think that before I did the anxiety case what I would love to do if it's okay with you is just bring everyone up to date on what a SNP is. Perfect and so if you make it so they can share my screen or do I need to do that? I think you can share and if you just hit a share screen and if that doesn't work I just hit multiple. Try it out if it does not go to share. Let me just then sorry I'm in second. So no worries. I'm not seeing at the very bottom under share screen it went to a black screen. Let me see if we can. The other option if you send me your slides I can share them for you but I think it should be much easier if you could share for the sake of it. I think I'm going to do it. Yes I'm just trying to get it back to the SSK. In the meantime let's see I'm thinking of a few other things that oh B12 for me so I have all of the like problems with B12 whether it's MTRR or again you know some of the names better than I do but basically getting into the cells absorbing it hypochlorhydria like everything you could I I had pernicious anemia all the genetics really and I always knew that I did well in B12 but when we started talking about the genetics from my test it was really a ha for me because not only do I do well with B12 I need high doses and that was one of the other things that really was profound for me because I've always done a very high dose and I knew I needed it and I never got toxic of course and it was one of those profound ahas when I realized the reason behind that need for B12 and as you mentioned when we went over the genetics um B12 of course deficiency can relate to cancer as well so who knew if that would have played into not only did I have a gut that wasn't absorbing it but I had genetics that weren't getting into the cells so that was a pretty big um interesting find when I when I realized about the B12 as well so what I'm going to do Jill I'm going to share this with you and I'm going to start to talk about genomics while it is being sent to you okay I'm sorry about that so I think that the thing is everybody kind of uses that term genomics and people are like well what does it mean and I what when we think of genomics um we think of you know we like know what the gene is but genomics is a little different than a genetic illness so genetic illnesses are things like TASACS trisomy 21 they tend to be pretty big genetic events often caused by one gene or a piece of a gene that's what I would call a macroscopic event whereas genomics is looking at those single letter changes of DNA so our DNA is made up of four different letters and ATC and G and when you and when you um change one letter so you change an A to a G or a C to a T that tiny little change doesn't usually have a profound effect and in fact sometimes it has no effect at all but what can happen is sometimes it can completely change the recipe so there's kind of on off switches in genes and if that is in what's called the promoter then it's going to make that gene be much more of something if that same effect is something that has a changes it to stop it's going to make you have less of transcription or less of making that protein so I kind of think about it as our genomics is recipes and if you think about we have recipes for all these different enzymes and proteins it's kind of like having a recipe for cooking if you change one word of a recipe from blend to stir no big deal but you change a recipe from bake to broil and it's a big deal and that's really what we see with genomics so when you get this case I'm going to tell you a little bit about the case and did you email those I'll just I did so I don't know if you got it yet I did I'll keep watching here oh there we go I think uh oh not not yet I'll keep watching you can start if you okay well I'm wondering I was well I'll tell you about so let's start with a case and when you get it it's slide 21 um is the case of anxiety and um let me make sure so I sent it to your to the doctor karnahana email got it okay so um when so this case is a case of a woman who is a nurse and she has intermittent anxiety and she's going through menopause right now she has been an oncology nurse for 30 years we're going to call her grace any of the cases we're using of course we've changed the names and grace has symptoms of just kind of this anxiety that comes and goes but particularly she notices that when she's stressed she is a person who spends a lot of time with a high attention to detail she's very hard working has a family history of some anxiety and ocd type symptoms in her daughter and she comes to me saying what can we do about this um and I won't know when you're sharing your screen since my computer is doing something funny but just let me know yeah and I'm not it's one of those let's be the moon or something I mean we'll I'll make sure it got sent but otherwise we'll just do it with you got it we obviously we can talk just talk through it because it's fascinating the way it is yeah and I'm I'm going to forward it to your other emails as well okay perfect you got it one of them will have that right okay all right so sorry about that so I just forward it to a couple other of your emails so anyway so she has um she has a lot of genes when we look at genomics we look at hundreds of genes but we have a particular panel that we call our mental wellness we particularly did not want to call it mental health because somebody who is dealing with stress or some mild depression symptoms or even chronic depression or ocd to label that as a disease as opposed to trying to support them at better understanding themselves doesn't make sense and so we looked at her genomics and the reason I want to share her case is classically what do we do for anxiety and depression uh benzodiazepines or a theanine or your drugs or or medic or even herbals but we just give them something for it right right and the most classic prescription medicine is are like the serotonin medicines prozac and paxil and and stiloft to raise serotonin well none of the genes that were in in grace's genomics related to serotonin so the first one I want to talk about that she had I got it and we're up so oh and I can see it now okay okay good if you go to the slide 22 you got it okay perfect start there if you want to put up the view but we can do it just like this if you don't want the whole screen whatever way you want it's great and the only thing is known for me on google drive that's all right we'll just do it this way okay we're good we got it so anyway so she's got a bunch of different genes and um if we go to there you go you know so some of the ones she has a neuropeptide s receptor a diiodinase and esr2 none of those have that word serotonin in them because none of them are serotonergic genes and um if you and you'll see some of them two copies are in 20 percent the estrogen ones and seven percent if you go to the next slide you'll see that this one gene that she has the npsr1 it is not an anxiety gene as much as it's a wakefulness gene so yeah it's really exciting oh I see the coffee there I was just going to go there is it adenosine related or related to that wakefulness so this one is not adenosine but there is interestingly there's an adenosine receptor gene that's related to multiple chemical sensitivity just which is a total separate aside this one is related to orexin and you and I of course know orexin as that pathway that was discovered after we graduated medical school and we're like what's that yeah it's a new hormone that was discovered only about 1015 years ago and it's a wakefulness hormone so it's kind of the opposite of GABA which makes you sleepy and there's a whole new class of medicines that lower orexin that help people sleep but this pathway makes you have higher orexin and higher histamine and again think about antihistamines they make you sleepy and having a little bit of histamine can be good for focus makes you awake having a little orexin is good but this when you have two copies of this you have 10 times as much so that makes you if you're that awake you feel anxious wow and so the thing about it the symptoms of it and this was totally Grace when she got stressed she said her friend family her friends her employer could all tell because in front of rubs she would get kind of red and flushed and people would think she was embarrassed and it would just happen without controlling when she got stressed and that's that histamine so once we knew what was going on we could talk about well you can take pycnogenol you can take quercetin you can take bromelain you could take regular antihistamines and those will help that reaction but we also could tell her about things that could kind of help turn off that wakefulness pathway because she didn't sleep well when she got stressed and so whether she wanted to use luteolin or melatonin or balsamra which is a prescription at least now she had an understanding and options oh this is great and i'm wondering is that would that be a common well there's other histamine pathways right so there could be other reasons why someone flushed on their chest because i can hear our listeners going well i flush like that do i have this gene and i'm guessing that this is one of the genes that can cause that but there's probably others too right absolutely there's a whole bunch of different histamine pathways because there's histamine that affects the brain and histamine that affects the gut and histamine that affects allergies but so yeah there's a lot of reasons for all of these things that's actually why i think that in spite of the direct to consumer genomics movement i think it's really great if you can have a physician as a guide and that's why intelligent cna is really a collaboration it's something that a physician orders and helps a patient interpret i'm glad you clarified that because that was one of the questions at the beginning i want to make sure as we're talking because there's a lot of consumers listening which is great i i love to inform the consumers and you can ask your doctor to order this and we'll talk on the end of how you can do that but i wanted to say this is actually i i am all for getting labs to patients and nowadays it's very common but this kind of complexity and especially sometimes the people get really afraid of having this data and not knowing what to do about it so i think in this case it's incredibly important that you work with your doctor on the data because the pathways are complex and uh and i know some of my patients have great respect because they know as much as i do about certain pathways but then i can help be the quarterback and kind of guide them on the journey and it's it's actually a whole different category and so it's considered a clinical decision support tool and because there's so much information in our genomics report we can legally only release it to licensed healthcare professionals so MDs, DOs, NACTRA pass their license, nurse practitioners, PAs etc wonderful ready sir you just kind of tell me when to go on that's great so grace also had this rare type of estrogen receptor and the reason i say rare type is there's two parts of estrogen receptors and kind of we classically think of high estrogen states or estrogen receptors as being related to endometriosis and fibroids and breast tenderness and all those kind of high estrogen things but there's another kind of estrogen receptor called ESR2 and ESR2's job is to turn off ESR1 to keep it from getting overactive and in the absence of any estrogen you get more inflammation and you need even more ESR2 to kind of calm things down so post-menopausal ESR2 is involved in cognition it's involved in you know perimenopause type symptoms including anxiety and she had a variant that's only in seven percent and you can switch the slide that is associated with less ESR2 activity so then you go well what can we do about that because that makes her have more than double the brisk of anxiety post-menopausally go ahead and switch right there again so things that you can do is you can use you don't really want to use estrogen per se because that's going to give a kind of a balanced ESR1 ESR2 you want to use either Genestine or a rhubarb extract because that's going to bind 20 times more tightly to ESR2 than ESR1 and that's going to really help her in fact you have to be a little careful with hormone replacement in somebody who has this because progesterone can sometimes make anxiety symptoms worse with the SNP and estrogen you're going to increase kind of balance study ESR1 and 2 very fine and then Grace is also this I remember this one we're talking about in your other patient one of the DIO2 SNPs which makes it that you don't convert T4 to T3 particularly in the brain so that was a really easy switch you switch someone from a little bit of synthroid to a little bit of lyothyronine or cytomel and in fact her daughter has hypothyroidism and we before and now we have her daughter's genomics but before we had her daughter's genomics we're like wait her daughter has anxiety too let's switch her daughter at the same time so that was an easy fix and again you don't think of thyroid as being part of anxiety no or hypo wow yeah and it's really amazing because it's 1.5 times the risk of anxiety just when you can't make enough T3 in the brain and 1.5 times the risk of depression as well so that was important that's a almost a 50% increased risk and so again the reason I wanted to share this pathway with you or this patient is had I not had this I would have been talking to her about things that would increase serotonin and that is at the top of the anxiety panel some SNPs that affect serotonin but it wasn't the answer for her and so that is why it was so helpful I love it and I just want to comment again as a clinician I would think okay anxiety is it GABA is it serotonin is it you know too much stimulants is it too much stress and none of these things would have been on the top of my radar estrogen SNP T3 T4 you know so this is so so relevant because and I'm sure if there's clinicians listening they can understand that too how helpful this is to have the details do you want to do another case about cognition yes let's do and is it okay right after this one perfect okay yeah we have an ADHD one as well but I think that today too will probably be planning and this is I chose this case because I know that a lot of the people that you work with are younger and people often are embarrassed when they start to have word finding problems in their 40s but it's common a lot of people have word finding or memory issues in the 40s and it can be because of detox pathways that you can't transport mercury or different toxins out of your brain it can be because of issues with different nutrients there's so so many pathways it can be with that you don't make enough choline I mean it goes on and on with nutritional pathways but this was a 52-year-old engineer where it became significant enough that she was thinking she might have to switch careers yeah it was a big deal for her because she said it's problematic at work because if you're having problems with your math and you're an engineer that that's really hard she did have a family history of Alzheimer's but she said her mom didn't get symptoms till she was 70 and that her father also has some memory issues but he died of heart disease and so she was really surprised to see this coming on so early and really terrified and so we go to the next slide just again to remind the people who are listening about ApoE4 ApoE4 is that gene that we label often as the Alzheimer's gene and the reason it gets labeled that way is because 65% of people who have Alzheimer's do have at least one ApoE4 gene variant it can range from 40 to 80 percent depending on the population and each copy can convey depends on kind of what it's combined with about two or three fold risk sometimes four-fold risk if you have two copies it can be a 13 times fold risk and so this is a big deal and what we'll what you'll see is that Sandy did have this but she only has one copy and so that doesn't usually cause problems until the age of 65 it's called late odds of Alzheimer's so then we had to go well what else is going on and that's where having a robust kind of genomics tool with hundreds of pathways that have been studied really helps and there's a whole bunch of other pathways we looked at genes that are right next to ApoE4 that have an additive effect kind of like a light switch mitochondrial pathways pathways that help to break down acetylcholine inflammation factors detox we can kind of go on and on but for Sandy one of the biggest factors okay so we used lots and lots of things for Sandy two of the most important snips related to her inflammation pathways and I always say that anytime you see the letter alpha in medicine you know think about the alpha male dog so alpha is kind of like that really important so TNF alpha in aisle one alpha refer to some important cytokines and before the year 2020 a lot of people who weren't in medicine would have no idea what a cytokine is yeah but thanks to COVID I think we've all kind of heard of cytokines and cytokines are these little chemicals that get released and cause an inflammatory mess sometimes a storm of inflammation the alpha ones both TNF alpha and aisle one alpha are really important because they can cross the blood brain barrier so they're more important for cognition and Alzheimer's risk than some of the other interleukins and this particular snip that she had is only is an 18% of the population but it's on a complete this TNF alpha and the aisle one alpha is only on 9% but it's the issue with it it's combined with ApoE4 and that's a completely different gene and so one of the things that we know if you go to the next line is that TNF alpha can be more problematic in people with ApoE4 and that's because ApoE4 individuals already have a problem with brain inflammation for those of you who don't really know as much as you want about ApoE4 the reason ApoE4 is such a big deal is it's not a gene that makes codes just for one protein it's a gene that binds the that the product of the gene binds to 1700 different genes throughout the genome and helps to turn them on so it creates its own kind of storm in the brain and the body that makes you have lots of problems and that so the issue with it when you have TNF alpha and ApoE4 together is you get more inflammation but one study showed you can have an up to six-fold increased risk of Alzheimer's because this inflammation storm and elevated TNF alpha makes it so you can't clear your amyloid well that kind of gunks up the nerves it causes neuronal cell death and that leads to dementia so we knew we had to address TNF alpha the question about the garbage collector because that's really how it is right like it's cleaning up the waste and we do that when we I love to have a sleep someone's going to insert that here because this a lot of times happens when we're sleeping in our deep sleep some of the brain is is restoring cleaning up toxins and also one of the important reasons why sleep is so important with you know anyone dealing with cognitive issues absolutely and yeah and we didn't really talk I didn't talk too much about that so I'm glad you brought it up Jill but yes we need those garbage collectors you don't want too much inflammation in them though because then you get scarring so all of you guys have watched TV well most of you people watching you probably watched TV and heard those late night commercials or regular commercials ask your doctor about when they're talking about psoriasis or you know Crohn's disease or any of these illnesses that are autoimmune and so TNF alpha is also a really important autoimmune pathway and so we have these drugs for autoimmune disease but the problem with them is they're all injectable biologics really big molecules that don't cross the brain and they in fact have studied those biologics and TNF alpha inhibitors and Alzheimer's by injecting them into the spine and they can get rapid improvement in cognition I know the only problem is it's not feasible to get a spine injection every week right the four thousand dollar medication right so it was more of a proof of concept so then you go well what can we do to lower TNF alpha naturally also you know Sandy's not that bad she's got mild cognitive impairment she was have her score on that one to 30 was around a 24 but it wasn't it wasn't bad enough that we would even do that well it turns out there's some natural products and my favorite of it is lion's mane mushroom that are really really good at inhibiting TNF alpha there's a there's a new amazon movie about called fantastic fungi that talks I just heard friends that you must watch this it's on my list yes I think all of us in the natural world is a worthwhile four-dollar investment so anyway that's one of my favorite things to lower TNF alpha and one of the ones we used for sandy but because she was really in a crisis we've used a lot of these things we use sulforaphane because it also helps with nerve repair and helps with detox we use curcumin because it also is really good at inflammation we had her drink more green tea and many of these have human memory trials and the good thing is the same things lower interleukin one alpha so I didn't have to come up with a whole complete different list for her other inflammatory pathways that's why I loved what COVID taught at least for me any mess in this world it's kind of like no duh right yes there's been like with LPS endotoxinia the same cytokines have been you know causing damage to the body and they underline all kinds of heart disease and cardiovascular disease and a diabetes and obesity and mood disorders and of course COVID mimic that too but only because it produced the same cytokine storm like this is actually common to a lot of different illnesses whether it's brain dysfunction or post COVID long haulers we'll have to get on a separate call just to talk about all that inflammation Jill because there's really fascinating genomics regarding NRP and the inflammasomes and interacting with the when I'm guessing it's almost like those ones that get turned on and not stop like the people who genetically get turned on the cytokines get turned on and they don't stop it's same with mold in a way because those of us who have had mold related illness not only do our cytokines get turned on it's this inflammatory pathway that perpetuates itself and we also aren't very good at tagging and talking to get rid of them in general those are some of the underlying issues. Absolutely so some people it's they turn on inflammation and can't stop it and that's one pathway and then your patient that had kind of neural line that we talked about he couldn't make nerve two to turn it to turn on the anti-inflammatory so it's either that you can't turn on the anti-inflammatory or you overturn on the inflammatory there's there's lots of really interesting uh interesting genomics but Sandy also has so she had her own inflammation but we all know that mitochondrial pathways are super important for neurodegenerative diseases whether it's Alzheimer's Parkinson's and you know MS any of these things and she had this mitochondrial pathway that's found in about 11 percent of the population but it's not the typical mitochondrial pathway that responds to fasting and you know coq 10 and garnatine and alfalfoc acid it's a mitochondrial pathway for synthesizing purines which is basically a way of saying for bait for the mitochondria to be able to make its own DNA well the mitochondria can't make its own DNA you're going to have problems with their functioning because they can't kind of stay alive and this particular this particular SNP is addressed with phylinic acid making sure you have enough B12 enough choline things that wouldn't be my go to with someone who had cognitive decline so that was really helpful and then when we looked at um her nutrigenomics and anytime we're doing anything in functional medicine we always look at gut we always look at detox we always look at nutrition but this allows us with genomics to look at it in much more detailed and it turns out she had genes in the choline synthesis pathway choline is estrogen dependent um in terms of how we make it um one of the genes involved is called PEMT well what age is she she's getting perimenopausal so we need to support her choline synthesis because she's losing her estrogen B6 is needed for brain to work and so all of these things we were able to address B6 B12 lion's mane um mitochondrial vitamin support and then within three months her cognitive scores and cognitive skills were back where she was like okay i don't have to retire at 52 which was problematic for many reasons amazing and again what i love is there are some we've we've been in deal present groups and talked about these cases and what's difficult is there's some that are moderate to severe cognitive decline and sometimes there's not a lot no matter how much genetics you know when there's a certain amount of dysfunction past a certain level just like if your pancreas has autoimmune type 1 diabetes and it fails and you've had so much damage no matter what you do you can't reverse it same with the brain but in these cases these are very exciting to me and to you as well because these early cases and these younger people that have it often if there's pieces of the puzzle that we find out like in this case we can actually really reverse the cognitive impairment and i think what we're learning with the work of dr bretizen and combining that with genomics what we're seeing in both the study that dr bretizen has been using our genomics at and in our own work at resilient health is the threshold for reversal is actually um in the dementia range i mean we are having not all the time but we've had good success with people that are in the early dementia as well so but i agree the earlier you can catch it the easier it is if you have someone who so that scoring goes from 0 to 30 19 is kind of mild dementia 2021 if we can catch them even when they're in the mild dementia range we can get them back to being highly functional even sometimes they have back to normal so again the the reason we would choose genomics is to allow for personalized medicine and be able to look at the right the root cause and then if you want to go for how people can get into it i was wondering i like why did i see the questions coming in the biggest thing is it's a spit kit it's really easy um go to the next slide and it's only ordered through clinicians then a clinician this is dr pichardo in our office sorry did i go too quickly that's fine and then going to the next slide if you want to learn more we're happy to give you a list of physicians that um and providers that are trained on intelligence dna there is on our website a sheet that you can download and take to your physician if you have an integrative or functional medicine physician that you're working with that then tells them how to contact us and get trained we now have online training which makes it a lot easier that we used to have live conferences which were really fun but we now have both options and um they can also learn more just from the website awesome i will be sure and put that in the chat and uh i'm sure you guys are all like excited it's the worst thing is you give this awesome solution like oh where do i get it and but you can go there you can get find a physician or like Sharon said you can actually ask your physician to order this and um it was actually through another doc who had ordered through my first for my first patient now i knew about it but and i will just say as a clinician i felt overwhelmed i was like oh no another test but this is so powerful i am totally going to be ordering this on many of my patients at least those ones who um who went to uh and i think it's super powerful she and that's such great information i love the anxiety and how it was stuff that we would have never suspected and then the cognitive decline and how many people don't have some sort of brain fog and what would i find there to even in 30 and 40 and young people there's often these little snips or things that relate to transport of a nutrient into the brain or a detox pathway right yeah 20 of the population almost like 18 19 percent they can have plenty of b12 circulating in their blood but they can't get it into their brain so something as simple as b12 can make a difference and for for clinicians that are watching that are worried about gosh i don't know if i want to learn this because it's going to be difficult we've actually added what i call the key points but it's really the it's really the cliff notes of genomics that kind of give you the easy answer as to how the gene works and the potential interventions but we also walk our new clinicians through their first three reports because it is eventually like riding a bike but it's a lot to just change your you know to change your paradigm of how you practice medicine and like you said it's it's been a lot of physicians have said that it's been game changing because they can get so much farther in one consult and so just know that if you are a clinician that we help you and in fact it's a we have a support group of fellow clinicians as well that you can also ask of people who are using it yeah i felt very supported because again i'm just i was like oh i don't know if i want to get into a test but it's been great Sharon just nothing but good i am so grateful of your journey and the fact that it led you hearing and i can't say enough good about what you're doing in the world your brilliance i love when we get to talk about test and thank you for being you thank you for bringing this and just been a delight to talk to you i think we're gonna have to part two though i would love to do part two jill it's always a pleasure to talk with you and the conversations we've had about patients have been so exciting because that's why i love doing the physician walkthroughs is i'm like wow i now have hundreds of extra cases that i've heard and i often get to hear the successes um and follow up and it's just so much fun you know both of us we're we're women who've been around for a couple of decades we don't have to say how many that we do most of us with functional medicine we do what we do because we want to make a difference and i know that both my co-founder and i that was why we did this it we're like we can do this and we're actually doing work with autism so if any of your listeners want to hear about that work it is right now we only have seven users in the united states because the pilot was done in australia with the australian center for genomic analysis but we're going to be training a lot more doctors in that in september so they can reach out to us if they're interested in that work as well and the work is doing really um it's great it's going quite well fantastic well thank you again shiren so nice to have you today thanks great to see you jill