 Okay, good morning everybody. I'm glad to see that you guys all rolled out of bed and came to our presentation. Very happy to be here and getting the day off well and then I can relax the rest of the day so it's kind of nice for us to go first. We are both clinicians and I'm a family doctor. Lauren is a naturopathic doctor doing general medicine and as you can see from our title we think that's pretty awesome and so we're very happy to be here. Just to let you guys know a little bit about who we are. So I'm Dr. Lauren Noelle. I am a naturopathic doctor as Rick said and I am the owner of Shine Natural Medicine. It's a naturopathic medical clinic in Solana Beach so North County San Diego and I'm also the host of Dr. Low Radio so I host a weekly podcast. Been doing it for about three and a half years and it's super fun and that's what I do. And like I said I'm a family physician. I'm actually do academics. I work at the University of Utah in the Department of Family and Preventive Medicine. I spend most of my time actually teaching medical students. I teach third and fourth year medical students and so that takes up the bulk of my time administering that course and then I spend about a third of my time in clinic with everyday patients. Most of them are the kind of university community patients that I see and a full general practice. I see young kids to old adults and that's my Twitter and also Instagram if you wanna watch my pictures of my kids. So anyway, that's fun. So this is actually a little bit of a continuation from a workshop that we did last year at HS and that first session we had a little more time and a little more interactive with our providers but what we were able to do is we really related kind of our approach to patient care talking a little bit differences between how I was trained and how Lauren was trained and some of the similarities in what we do in our clinics and then we presented three cases at that point on acting, depression, anxiety and functional balasores with three different patients that we described went through those cases. We're gonna have a few different cases today, some similarities but if you wanna look back on that we do have our slides if you're interested in looking at that first part. So just as a recap from that, we look at patient care and a lot of us will look at differently depending on how you're trained, you are going to have a different approach to how you see patients and there are many different approaches to clinical diagnoses, a different way that you come up with your treatment plans and this really differs on training degree and your anecdotal evidence and finding a provider that works for you as a patient is really important for our patients. So sometimes people will gravitate towards one provider another and that's great, we have no problems. I think it's great when someone finds a good provider it's gonna help them out and if it doesn't work for them or what not, we have different approaches to a way that we see patients. I think the key is that we collaborate as providers when we're seeing the same patient oftentimes that those differences in the way we approach patients can sometimes be a barrier. The more we can learn about how we approach and how we treat our patients the more that we can work together in better communication to find better outcomes for our patients. This is a little bit of a frame of how I see patients when I'm looking at how we determine what I do or what can I do for management of helping a patient out. And the first thing I have to look at is appointment timeframe. So a lot of providers had the luxury of having an hour or hour and a half, two hours to sit down or view patient notes or look at things with patients a lot of time. That is not something that I have a luxury of having a kind of general practice doctor in a family medicine clinic. I work within the insurance system. I take Medicaid, I take Medicare. So I have to follow those rules and guidelines. So most of my visits are gonna be 15 or 20 minutes. I have 40 minutes for a new patient and then subsequent visits I have 15 or 20 minutes. But what that does allow me is I can actually see my patients repeated times. So the most all of my patients are local and they can come back on more frequent intervals than they might for another type of provider. What that does allows me is to have this more longitudinal course than it might not otherwise be possible. I also take insurance and if patients have insurance that's something that's nice for them because they're not out of pocket a lot of money. So a lot of my patients if they have Medicaid for example I can see them and be able to help them in a way that another provider might not be able to help. And that's part number two is I have to look at what is their ability to pay. So there are treatments for example, a lot of functional medicine regimen for example is not necessarily covered by insurance. So I have to figure out ways that I can work within that system of what that patient has and their ability to pay to be able to determine my treatment program. And then obviously also what's the patients level of motivation. Most of my patients are coming to me because they have to come to somebody that has their insurance and usually they're coming to a medical doctor not expecting certain aspects. So if they're coming to me not thinking that they're going to be doing a lot with nutrition and diet I have to kind of see where their motivation level is to make that change. And my process is oftentimes a very slow process getting them to a place where I can see those changes that I wanna make are gonna be beneficial. Other providers for example, the patients will seek them out and be very motivated and sometimes that happens with me as well. Now that I'm online and people can find my profile they come to me specifically wanting an ancestor health or that kind of background. So in those patients they're very highly motivated. So if I have two different types of patients I have to certainly create this different type of plan. And then the last one is what the patients desires for treatment. I have patients that come in and they only want meds and that's all they want. They don't wanna work with anything else. And I have to work within that framework as well to find the best outcomes. So using that frame we're gonna go through a few of our patients. So this first patient, this is actually a patient that I had as a resident. This is before I started working in ancestral health. And this is our easy kind of simple case that we're kinda dealing with. This is a pretty standard case. A patient that I see now all the time. And this is a patient that I saw like I said a few years ago. So this is a 50 year old female. She was a BMI of 40. She was overweight and for a long time had been looking to lose weight, become healthier. She had searched and gone through a large process with many different doctors before she got to me. She was very active job working in an animal vivarium. So she was feeding animals all day long, very active, lifting, moving kind of all day long. Like I said, trying to lose weight for a long time. She was, in addition to her heavy job, she was kinda doing the treadmill thing, the rat race and really that treadmill of trying to have that high energy output than also cutting her calories. She was very detail oriented and kept a very detailed low calorie type of diet. Now she was also very motivated. Unfortunately most of the doctors were really not believing her that she was doing the things that they were telling her to do. And people kept telling her to eat less and work out more. So she came to me and I unfortunately fueled that process forward and I was very frustrated as a provider. I was like I cannot figure out how to help this patient. I want to help her and nothing seems to be working. So what could we do with this patient? And I'm gonna turn the timer to Dr. Lowe and see like what would she have done in this situation? It's funny, we're just seeing each other's cases pretty much for the first time. So I would say for me, I mean it sounded like maybe cost is an issue for her. So I'd look into just educating her, having her do some of her own education, maybe reading a book. I always recommend it starts with food for most patients because it's a great background nutrition wise and then maybe have her listen to the podcast because it's free. So at least just kinda have her understand a little bit more about it's not calories in, calories out and then see what else motivation wise she's willing to do from there, I would say. What did you do? So that's what I would have done. Unfortunately, I've been graduated and I wasn't able to take care of her and now honestly I feel bad to this day that I was not able to help that patient out. Luckily I have other patients that I can help out now. But really, yeah, so I mean the baseline for her really getting her on a better nutrition, better exercise regimen, more information and in her case, that foundation was not in place. So she really needed that foundation and then later we could have figured out if other techniques would have been needed but really that start, exercise, nutrition, sleep, stress reduction is where she needed to start. Okay, so this is my more complicated patient. This patient actually came to me specifically because I was a paleo doctor, he found me online and this is 69 year old with a large number of medical complaints. As you can see from the list here, I know some of you in the far back might not be able to read this but he's had diabetes, type two since 1996, Grave's disease, which is a thyroid disorder, severe psoriasis, which is a very bad skin disorder, prostate cancer, which was treated with radiation as in remission. It ocular myosthenic gravus, which is a muscle disorder that causes the muscles of your eyes to spasm and then to not work very well. And then he also had severe back pain which he'd had previous spinal surgery and then also had insomnia due to muscle cramps. So this guy had a long list, so he came to my clinic with this very long list of complaints and I had to see where could I go from here or what could I work on. And this is a patient who had been paleo, quote, paleo for about four months. And fortunately he came to me very happy. He's a very happy 69 year old and had a very positive attitude, very motivated to make changes. So here's the list of the medications he was on. He was on Pia Glutazone and Aglubiaride and Metformin, all three of those are diabetes medications. The Pia Glutazone and Aglubiaride are medications that will cause insulin secretion. Metformin causes an increase in sensitivity to insulin. And then he was also on Levothyroxine, Vitamin D3 at 5,000 units, which was great. And then this Pyrrodusticamine, which I can never say, was for the eye disorder that he had. And then also some Gabapentin for neuropathic pain due to the diabetes. So this long list of medications. His diet, what he'd been doing is pretty actually pretty mainline Ancestor Health or Paleo, eggs for breakfast, not eating any wheat and chicken fish and doing really well actually with his diet. His son told him to do this. So he'd been doing this for about four months. He was eating potato and rice occasionally. And he also at times had some nausea, which the only thing that helped him with his nausea was a slice of bread. So he was doing that occasionally. And then so what improvements had happened in the last four months? So he had lost some initial weight. He was about 200 pounds. I mean, he had gone up and down in the last four months. He was very frustrated because, he'd read all his success stories of people losing a lot of weight and he really wasn't able to lose that weight and get his disease under control. He's still on all of his medications. So what's the frame? So first off, there's no way I could take care of everything in one visit. He had so many things going on. I needed to have multiple short visits with him. And that was possible. He was a Medicare patient, but that also he had no outside income. He really didn't have any way of paying for anything else outside of what Medicare would pay for. He was, like I said, highly motivated and he wanted to lose weight. The cramps were a big problem in his life and then he wanted to, he was motivated to stop some of his medications. So what would you have done at this start? Well, in my situation with patients I see, typically they're seeking me out. They do have some more, you know, income that they can do some testing. So if I had the option of doing testing, I would probably look for hidden infections. It sounds like diet wise, he's been dialed in for about four months. He's had some improvements, but I would just want to do a little bit more digging. Maybe look at hidden infections, maybe in the gut. We know that gut infections can definitely contribute to diabetes. Maybe look at doing some cortisol testing, hormone testing, that kind of thing. Cause he's doing a lot of the lifestyle things already. And then also a lot of micronutrient deficiency testing. Maybe he's deficient in chromium. Maybe he's deficient in zinc. You know, look at, see if there's something that way that is really getting in the way of that blood sugar regulation. So, but I think you're on the right track. Why don't you say what you did? Okay, so I did not do all that. Some of it was constrained by my knowledge. I don't know how to do all those fun, like different tests, all the micronutrients. I just don't simply do that in my practice very often. But also constrained by a lot of the funds that he had. He really didn't have a lot of funds to do a lot of that testing. So what did I do? My initial patient instructions really were, okay, keep doing what you're doing and I need more time to figure out how to help you. We didn't actually make any changes that first visit. I wanted to build that rapport with that patient first before I kind of threw a lot of different changes that I wanted him to do. He really had high expectations to make changes and he really needed a perspective that he was 69 and been living with these diseases for a long time. It was gonna take a long time to get him back to a place of better health. And this is actually a word for word. I just copy and pasted my instructions to him from a couple years ago when I saw him. So then I wanted to see him back and he had already had some lab tests already done by his previous provider. So rather than just doing those tests again, I wanted those back so I didn't have to incur more costs. So three weeks later, he came back. His weight had not changed in three weeks. He kept that diet. So what we decided to do is to stop both his peoglutazone and his gliburide but to continue his metformin. In my mind, what I thought is if we stopped these insulinogenic medications, hopefully what would happen is he would then have this ability maybe to lose some more weight in a frame that would work better. What we had hoped in general is that if since he's already eating much better at a lower carb diet, his A1C, which is the way we track diabetes, would stabilize and not increase. And that was the fear is that if he had his A1C go up after we stopped these two medications then we're gonna be in real trouble and we would maybe have to start them again because really what we wanna do is to not have any end-organ damage losing his eyesight or worsening neuropathy for him. He also had these muscle cramps. This was one of his biggest issues. He just simply couldn't sleep. He had been on magnesium in the past which helped. Unfortunately that magnesium made his eye disease a lot worse and he had trouble seeing. So we really couldn't do a lot of magnesium. He was on about 2,000 milligrams of magnesium a day which is where it was that helped but this was causing problems with eyesight. So what we decided to do is just right now hold on to that and see if we can improve that over time but really not make changes there. He also, we started him on a higher dose of fish oil and we continued the 5,000 in subitamin D. So what were the results? First off we were able to maintain his diabetic control. So this was in May that I saw him first or when we made the changes. His A1C was 5.9. We wanna keep an A1C below seven to have good diabetic control. In July when we rechecked it a few months later it was 6.2. So I was very happy with that. We did see a little bit of a bump or probably within the range of error of our test but really we're still doing very well. This is after stopping both of those medications. So I was very happy and then as you can see in October we were able to maintain that. And this was like I said, this is in 2012, it's about two years ago. And this is the most exciting thing of what happened. So as you can see, he was able to have significant weight loss. This was after stopping those two medications that caused that insulin production. He was continuing on very much the same diet. We had made no changes. Actually, sorry, we did cut his carbs a little bit more from what he had been doing but really no significant changes of what he'd been doing the previous four months where he hadn't been able to lose weight. So in this case, I think the direct result of stopping those two medications was that weight loss. As you can see, he had this nice steady weight loss until he got down to a better level here. So here's the problem though. He's still having severe back pain which limited his ability to move, exercise, et cetera. Sorry, not that first visit but in between some of those visits we had decided to try a magnesium again but at a lower dose. It did help out a little bit but it did worsen his eyes. So his cramps were ongoing. So he wasn't able to figure out anything to do with his cramps at that point. And then we saw a significant improvement in his skin psoriasis. And that was actually one thing that he really felt very positive about was that his psoriasis was getting much better. And that was four months of his diet and then six months after seeing me. So it took about 10 months for his skin really to start improving after improving his diet. Okay, so now what? So this is where we are. We've gotten to this point. Now what were we doing? I want you guys to think as clinicians here what would you have done at this point with this patient? Where could you go? What changes could you make at this point? What are some long-term things and what are some limitations? Maybe I can take like one or two people if they just have one suggestion of maybe something that they would have tried. From the, for the myosinia, the ocular. This is a personal view. You know, since, you know, 35 years with it. So, and the mesonon, the drug that he takes will cause a really significant insomnia. I don't know how much he's on, but I don't know if you were aware of that or picked that up in the literature, but. I wasn't aware of that. Yeah, yeah. But that drug in and of itself can do that. Yeah, so trying to find that balance of the side effects of the medication versus his vision, it's really hard to know. And that's somewhere where I as a general physician really kind of put that in the other wheelhouse. Maybe I could have taken a more active role in working with that. What was that? Thyoma. Thyoma, okay. What was that after him, correct? He did not have thyoma. No, he did not. Okay, so good. So looking at possible other diagnoses that could be causing some of these issues, maybe broadening our differential to look at other things. Is this on? I would look to see what's happening with his back pain. Just because he's on Neurontin doesn't mean that he's actually going to be helped. And maybe there's something that you can actually do about that. Maybe there's some specific problem. And I like to send people with back pain to physical therapy for evaluation because it is covered by insurance. So I would look at that more because that sounds like another significant problem for him. Okay, good, yeah. So that's actually what we did. One of his majors who was that back pain was preventing him from having some of the other outcomes. So he did go through some physical therapy. He went back to his back surgeon to get another review. And that's something that he continued to work on. He continued to try to exercise and started swimming and doing some other types of exercise that didn't require, didn't cause an increase in his back pain. So let's look at what happened long-term. So this is where we are now in the intervening years. We've done quite a few different treatments for him. We have tried changes in his diet. We've tried super low car. We've tried a variety of aspects to try to improve what's been going on. I don't want to kind of talk all about those, but in the two years that I've had him, his A1C has basically stayed at the exact same place, which has been very reassuring. We haven't changed his medications. He's been on his diet and it's been very good. His A1C has been controlled and that's been probably the most promising thing is that that has stayed in a good place. One thing that has been frustrating for him especially is we saw this initial great weight loss. And this is, so the last slide I showed you was right here. So 177 he got down to, so this was 200. So his BMI was 32. He got down to here and then in the next year, the next year he was able to drop down to 160. So he dropped another 15 pounds of body fat. To where BMI who's very happy, then what happened is I actually didn't see him for about six months. Our follow-up wasn't as tight as it had been and he actually gained quite a bit of weight. And on this kind of inflection point, we're able to kind of stabilize here. But something that's happened is we don't, I looked at a variety of things and haven't really been able to figure out why he hasn't had more weight loss. And I think part of this was the back pain. He really became even more limited than he was before and really had a hard time at this point. Now the good news is this isn't terrible for someone with diabetes, sticking out this way probably isn't the worst thing is A1C is controlled and is this the worst? I would say I'm fairly okay or happy with what way things are going, but I think it would be improvement to get him to a little bit healthier weight. This is his lipid profile. A lot of, with some with diabetes, we're always looking at someone's cholesterol, making sure that that is at an appropriate level. And in the literature, some with diabetes should have much tighter control than other people. These are his lipids over the last two years. Actually, this is in 2010 before he started anything paleo before he saw me at all. I was able to pull that from the records. His total cholesterol was 154 and his LDL was 89, which when Dr. Lowe saw this first, she was like, oh wow, that was really low. And his cholesterol improved through time as he had better nutrition. One thing that I saw when I was here in November 2013 as you see this very upward trend, his LDL was going up and up and up and I was actually getting a little worried that if it kept going up, what am I gonna do as a provider that really should be thinking by the literature of putting him on an intensive statin therapy. If this patient is not on intensive statin therapy, I have to be able to justify that in some way. And then what happened actually earlier this year, more stabilized around 116 as his LDL. And I think for him, this is probably a healthy cholesterol panel. And I actually decided not to make any change with that. In the past, because of his other medical problems, he hasn't even been able to take a statin for very long because he had muscle issues that happened. But that's something that ongoing needing to look at as a provider in the system is making sure that this isn't completely out of control and so I do test to make sure that his lipids are in a good balance. And really not make, decided not to make any changes from there. So other issues, kind of long term over the last couple of years, his cramps have improved. So over the last two years, without much other treatment besides the nutrition and actually increase in his exercise, the cramps have improved greatly. He did have an additional spinal surgery. And that was about six months ago that he had that. And actually his mobility has greatly improved. We don't always recommend someone to have surgery, but for him it was the right choice. And actually his exercise tolerance and mobility has improved a lot. So he's been able to get out and exercise a lot more and his mood and everything else has been improved. Unfortunately he also then recently had IBS like symptoms that had started that he didn't have in the past. This helped with low FODMAP, but now that Dr. Low brought up gut infections, this is maybe starting to think like maybe something else is going on, his inability to lose weight and maybe I should be looking at something like that. So all right, so any other thoughts for my patient, Dr. Low? Well I'm really impressed. I think there's a ton of improvements with him. I mean getting him off of the couple of different medications and his BMI has improved a ton. But I would look maybe a little bit more of the root of what's happening. And we know autoimmune disease is caused from leaky gut. So maybe there's something going on there. I mean the psoriasis, the myocenia, grabbis, those are both autoimmune conditions. So seeing if there's an infection there and then maybe he has chronic high cortisol. Maybe that's making it hard for him to lose weight and his weight is just staying on. So just doing a little bit more digging if he's able to financially. But I mean I think he's been really obviously helped a lot. So just a couple of little areas to dig further I would say. But yeah. Okay. All right thank you. So that was my patient. Obviously there's a lot more information there that we can talk about later if you're interested in talking about him. I'm gonna turn the timer over to Dr. Low. And then forward is this one right here. Yeah. Okay cool. Okay awesome. So I'm gonna chime in and talk about a couple of cases in my practice and then I'd love to have Dr. Henriksen give any other ideas if there's something that maybe I miss and maybe big like red flags or something and I'm kind of glancing over. But so okay. So patient number one. So this is a 37 year old African American female. I've been seeing her for about a year and a half, two years now. And she presented to me. She had already been doing paleo for several months. She was a heavy cross fitter. She had severe cystic acne. So I mean it's probably the worst case of acne I've ever seen. I wish I had a picture to show you guys but it was like her face was just covered with cystic acne. She had a history of PCOS, a polycystic ovarian syndrome and did have a history of ovarian cyst because you don't always have cyst in that condition but she actually did. And she had irregular cycles. She was just really tired and difficulty losing weight despite eating paleo and exercising. I think she's doing cross fit like four or five times a week. She had significant gas and bloating. She felt like she was like three months pregnant most of the time and just felt really depressed, anxiety. She had been seeing a counselor for a while and it was making some improvement but just still was just feeling kind of blah. She also mentioned that she had difficulty remembering things and she would slur her speech sometime. She'd be talking to someone and just lose her train of thought and then just start stuttering. So that was really affecting her. So these are the different labs that we ran. So my practice is a little different. We can do out of pocket testing so I can run the full gamut of tests which is nice. Not everyone can do that but this is what we did for her. So we ran complete blood count, comprehensive metabolic panel. We ran her vitamin D, CRPs looking at inflammation, home assisting lipids and then a full thyroid panel which included TSH, free T3, free T4 and her antibodies. So just seeing if she has any autoimmune process with that. We ran a stool test so OMP times three, bacteria culture and then looked for H. pylori. And then we did salivary cortisol testing and sex hormones on day 21 of her cycle to see how especially her progesterone peak looked. And then we also did micronutrient deficiency testing to see what vitamins and minerals she was low in. And then our initial plan we did a liver cleansing smoothie which is a rice protein powder so I do some rice protein for patients when they tolerate it. We did 30 billion CFUs of probiotics and then 3000 milligrams of omega-3s to start and then we started also on IM injections. So B6, B12, MIC which is methionine and acetylcholine and those are liver lipotropic so they start to help the liver detox and process fats and then also started on injections of vitamin A. So we saw her back a few weeks later and she mentioned that her digestion had felt better. She had no more dizziness which I forgot to mention she was feeling really dizzy. She's lost 10 pounds since we started and her lab testing showed that she had elevated liver enzymes so AST and ALT and also high ferritin. I think her ferritin was in the upper like maybe 270. Also elevated blood sugar, elevated A1C. She had elevated nighttime cortisol which contributed to insomnia which I didn't mention and then decreased progesterone. She had elevated testosterone and then low serotonin. We also did urine neurotransmitter testing and then she had positive H. pylori. So looking at all these things it's like, oh my gosh, what do we do first? So what I initially started her with, I treated her H. pylori so I've used Matula T for that so I've learned that I don't have to use antibiotics. It's worked 100% of the time. It's amazing. Matula T is just incredible for H. pylori and you can order it online. I don't even carry it in my office but there's a website. I can give you guys the link if you want it. But if you end up re-testing and it's actually positive you get your money back for the tea so they really stand behind it. And the website looks really sketchy. It looks like it's like an internet scam but it's legit, I promise. So this is her micronutrient testing. So she was deficient in glutathione, CoQ10, and selenium which interestingly those are all antioxidants. And she lives in LA in a pretty highly populated neighborhood so it's kind of an interesting connection to see with that. So we addressed those deficiencies with supplementation. So here's what I did with her and some of this is in the beginning some of this is eventually, this is over time but we did liver support of herbs so milk thistle and dandelion root. We did blood sugar support with chromium and zinc and also some glandulars so liver, pancreas and pituitary to support the HPA axis. We also did maca. Zia gold is a heavy metal key later and that also I found can decrease ferritin when it's elevated which I'll show you the lab work but we did see that decrease her ferritin. I started on deep penital which is my version of metformin basically so it helps to sensitize the cells to insulin. We put her on selenium for the deficiency and also for liver or thyroid support. I changed up her shot formula so I added in methylfolate, glutathione and also CoQ10 based on her deficiency. I also told her to go donate blood because I thought her ferritin was just a little high and then I did start her on progesterone in the luteal phase and then the matulati. Fortunately, she didn't mind taking pills. So, saw her back a few months later. Her skin was 70 to 80% better and we didn't do anything topical. That's the exciting part about that. We treated her gut, we treated her hormones, her deficiencies and her skin just got so much better. Her bloating was gone. We retested her for H. pylori and it was gone. Her dizziness was gone, continued weight loss. By the way, I also had her cut back on her exercise. I said no more CrossFit. You can't CrossFit for three months. And it was like a death sentence for her. She was so sad but she just started walking when she hated but it really helped her because she was just way too stressed. I mean her adrenal panel was just off the charts and she was just really wiped out and that really helped and now she's getting back into CrossFitting again. Her mood improved, her cycles became more regular and then her, now she has occasional migraines which I did mention she was getting them on a pretty consistent basis. So this is her labric progression over a year and a half. So initially she had an elevated MCV so really megaloblastic anemia suggesting the B12 and folate deficiency and over time that did go down. Her ferritin was at 252 which is showing either inflammation or high iron and that also did decrease over time as well. And really I found that working on the liver can very much help to do that. And then her AST and ALT also dropped as well. Upon retesting about six months later we found she didn't have any micronutrient deficiencies. This is through spectrocell. This is who I run my micronutrient deficiency testing through. And then Dr. Henrichson, any? Well, it seems like you did just about everything there. I had some suggestions but then you talked about them. The first one I was gonna talk about overtraining. So it seemed like she was probably overtrained and one thing you didn't really address as much is what was her sleep like? And in this case I think probably improving her sleep. It sounds like you did try to, that could have been a big part of it. And then this could have been the case where Metformin could have been an effect for that patient. It's hard though because she started with gut issues. So given someone Metformin which can cause some side effects with the gut is a problem but it could sensitize it and improve some of the symptoms. But it sounds like you were using, I don't even know what that. The deep pentatol. Deep pentatol which has a similar action. And deep pentatol is very expensive. I think it's per bottle it's like 100 something dollars. So in some situations Metformin might be better. I'm not anti-Metformin. I think it could be a great drug for many people. You just have to watch out for B12 deficiency with that. So second patient I'll, I think how am I doing on time? I have eight minutes I can do that. Okay so this is patient number two and after this if I have time I'd love to hear from you guys if there's any other ideas that you have. So this is a 30 year old female mother of two. She was referred to me by her gastroenterologist which was really exciting because I didn't even know who this person was. This is like a first like whoa okay. This is a compliment you know and medical doctors are referring to me is great. So her history ulcerative colitis. She was being treated with mesalamine and prednisone suppositories and she was hospitalized for severe colitis. They found it in her descending sigmoin and her rectum. So descending and sigmoin colon and rectum. And at one point her weight loss was so bad. She was 93 pounds and she's having two bowel movements every hour. So she was really, really, really sick and she had a history of being gluten free. She had one slip up and she had more blood in her stool than she had ever had before. So she was just incredibly sensitive. Significant gas and bloating. She looked like she was seven months pregnant and she wasn't. So she was so frustrated because she was actually really thin but she came in and it was like whoa. Her stomach was just so distended. Her energy was so low. She had so much anxiety. She had really bad insomnia and her hair was like straw. It just looked so dull. I mean she looked like she was very unhealthy. You know just I mean really you could see the pale skin. It was almost like a grayish tone to it. So she brought in some lab work from her primary care. She was in urgent care soon before that and her white blood cell count was really, really high. So ideally I like to see the white count between five and eight and hers at 17.9. So real acute infection. And her neutrophils were at 91% so it was really shifted towards the bacterial side. And lymphocytes were 6%. I'd never seen lymph so low. Her vitamin D was at 18 and her stool, we did a stool test and she had elevated lactoferrin which is something that differentiates S from IBD. So it was confirming that it was inflammatory bowel disease. And then she also had a deficiency in biotin, calcium and copper. I'm gonna just break in real quick. I mean like this patient is very sick. When I see this, I mean almost the point of admission. I mean she's very sick. So she did say, you know, I did have more recent lab work. I'm getting the results. So they faxed them over to the office and they were much different a couple weeks later. So it showed that that acute flare had passed. That way I felt more comfortable treating her because if I were to see this, I'd say you need to go back to the ER. I can't see you yet. You're just a little bit too sick. So the plan, what we did for her once she did come back and her labs were a bit better is we put her on the specific carbohydrate diet with our dietitian. We work with Stephanie Granky. She's amazing if you guys ever need a dietitian. And we put her on a gut healing smoothie which had a significant amount of glutamine in it. So it was a rice protein powder with glutamine. We put her on a high dose probiotics of 225 billion per day and then a tablespoon of cod liver oil. And then we started her on IVs. She lives up in I think North LA and I'm in San Diego and I said you need to come down here every week. We need to start doing IVs for you. And that was really hard for her to swank because she had two kids. She was really busy but she made it happen and that made a huge difference for her. So prescribed it two times a week. She only was able to do once a week but we did magnesium, selenium, zinc, all the B vitamins, calcium, trace minerals, vitamin C and glutathione. And then we also did twice a week of IM injections that she took home. I was doing this, so kept those in the fridge and did those at home. So also I had her do blood sugar balancing formula as well which made a big difference for her because she was very jittery. Whenever she skipped a meal, she felt really dizzy. We put her on saccharomyces bilardi, HCL and pepsin for absorption, selenium, biotin and then calcium magnesium citrate based on her nutrient deficiency tests. So I've been working with her for about maybe six to eight months and now the update is she has so much more energy. She goes once a day, so about a moment once a day she has no blood or mucus in her stool. She is still in the specific carbohydrate diet. I think she's still in phase one or two so it's still a very restrictive diet but she's happy to do it because it's making a big difference for her and eventually we'll get her to the next phases. Her mood is better. She's now able to play with her kids and she said that's just made a huge difference because before she had to just sleep all day. She wasn't able to really be there for them. Her bloating is much better. Now she looks about maybe three months pregnant so she still is bloated and I would love to maybe hear more ideas of what you guys have with that. And this is her recent lab. So her white count 4.1, neutrophils and limbs were in normal range. Her vitamin D shot up to 74. She is negative for SIBO because I wanted to look into that but we found out recently that she is positive for Epstein-Barr virus so now we're treating that. So the treatment just continued the plan. I did put her on a homeopathic remedy for Epstein-Barr and just some other support. Mona Lauren is antiviral and then prescriptocyst. I switched her to a different probiotic and we're gonna be retesting her labs. So for the sake of time I'm gonna just jump into the next section. Do you have any other ideas? For the sake of time, why don't we just move on? Okay, we'll just move on. Okay, so I just wanna share a couple different ideas I have for working with other providers. So number one is if you're a medical doctor and you're working with NDs or vice versa, just number one, please just show respect to the other providers. Never talk bad about providers to the patient. I hear doctors do this a lot of times where they just talk crap about each other and it's just not, it looks really unprofessional so just don't ever do that. Keep other doctors in the loop. So in this situation with the patient with those sort of colitis, I could have done a better job of staying in contact with her medical doctors and I just didn't do that and I definitely see an area of improvement for me. Leave the ego at the door. Don't feel like you gotta puff yourself up and like you know better than other providers. You know, keep that humility and if another provider is rude don't take it personally. It's probably their own stuff and has nothing to do with you. So to NDs, DCs, other holistic providers, triple check drug-urban interactions. There's a lot of different interactions. Not all herbs are safe. Just because it's natural, it doesn't mean it's safe. Arsenic is natural and that's definitely not safe. So make sure to just check on that and just have open communication with other providers. And then to MDs and DOs, please have honesty. If you don't know something, please be real about it. You don't have to say, oh, don't take that. If you don't know, look into it. Have an open mind about it. And so if it's something foreign to you, be open about learning that and then just be open with other providers. This is our contact information and do you wanna say anything? I guess just so these are two websites you can go to, Dr. Lauren's website is pretty great. If you're in the San Diego area, check her out. And then if you are MD or DO, this is our website for our organization called Physicians and Ancestral Health. It's at ancestraldoctors.org and we are meeting with a few far physician friends, MD and DOs at noon today. We love working with other types of providers and if you wanna collaborate in any way, we would love to collaborate with you guys and that would be fantastic. So thank you for your time and that's it.