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Speaker 2: Hello.

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Speaker 1: This is the Itchy and Bitchy Podcast because being itchy

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is bitchy and our medical system sucks. I'm doctor Keith Nolica,

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a vetnary, allergist and dermatologist.

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Speaker 2: And I'm Stephen Miller, a doctor of nursing practice and

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a Q Care nurse practitioner.

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Speaker 1: Send us your questions at ask at itch not dot com.

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We love you, but we're not your doctors. The information

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we discuss is not direct medical advice. Please talk to

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your provider who is the expert on your care. The

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Itchy and Bitchi podcast is sponsored by doc Itchy Medical

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Pets supplements designed to optimize your pet's health with the

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latest veterinary medical research. Visit docichi dot com or find

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us on Amazon and please click that follow button and

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send us a question at it ask at itchn dot com.

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Thanks hello, and welcome back to Itchy and Bitchy podcast.

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How are you, doctor Miller?

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Speaker 2: We are so good?

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Speaker 1: Okay, So this is our first first episode of questions

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that we got from our listeners, and we actually probably

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Karen has listeners from all over the world actually, so

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we definitely have some from the United States, but we

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also have dozens of listeners in Australia about Canada, Europe, Alaska.

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Speaker 2: Hello out there.

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Speaker 1: Yeah, big wide world. So hello to everyone, and thank

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you guys for listening to us.

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Speaker 2: Thank you, yeah, thanks for listening.

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Speaker 1: So we got some questions from our listeners and we're

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gonna ask us many our answer as many as we

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can as we go along. We don't want to make

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this too tedious, but we picked out some of the

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most interesting and useful to answer. Doctor Miller also got

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a screenshot of us recording and we're wearing our Puerto

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Rican San Jose bling. We have a studio set up

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in Puerto Rico that we visit sometimes, so that's why

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we're all decked out in our Puerto Rican attire.

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Speaker 2: So we are we support the island.

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Speaker 1: If you're interested in that, you can check out our

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website at where would the website be Itchy and Bitchy.

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Speaker 2: Dot combitchi dot com or please go on and like

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I and b Podcast on Facebook.

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Speaker 1: Yep, okay, so ready, So we're gonna divide this up

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and we're gonna have a few breaks. We're going to

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try to get to as many questions as we can.

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Are you ready care, captain, We're ready to roll. Okay,

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So the first question is from Tiffany from Atlanta. She's

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fifty six years old female, and she asked us that

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her doctor. She said, my doctor started me on GLP

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one and HRT simultaneously, so at the same time. And

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then she says Reddit went crazy and she wants to

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know am I over medicating? And so my opinion is, doctor,

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Reddit is not a thing, So check with your provider.

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Your provider is the expert on you, and that would

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be my first response to that. Probably there's some medical

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data as far as GLP ones and HRT.

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Speaker 2: Yeah, so it's worrisome, but you know, when you and

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your particular situation have a therapy change and you put

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that out there in the world, and so then all

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kinds of people with varying opinions weigh in, and so

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I think it's important to definitely trust your provider and

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at least balance ideas and questions off your provider. Now,

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on the hormone side, it is the interesting More and

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more information is coming out on the GLP one ras

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and in women with PCOS, which is polycystic ovarian syndrome

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which can be tied to obesity and hyperinsulinism. In this

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and that there is an issue related to testosterone levels

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rising as part of PCOS and so lyriglue tide is

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found to reduce serum testosterone levels over about a three

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month period, which then it leads to improved androgen profiles.

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And so it's important to remember too with weight loss

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that all the six hortomones are fat soluble hormones, so

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there's this shift that happens. This particular study came from

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a systematic review of glp ones in patients that had

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metabolic syndrome.

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Speaker 1: Okay, so that was a lot of information. So what

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I got from that is that the hormones and the

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glp ones are definitely interacting. When you start losing weight,

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some of the hormones that have been deposited in the

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fat are going to be released. You're going to have

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fluctuations there. It sounded to me like you need to

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have an expert that would be your provider monitoring hormone

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levels and checking and really doing a frequent revisit monitoring

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rather than in every six months kind of situation.

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Speaker 2: Yeah.

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Speaker 1: It also you mentioned and polycystic ovary disease. How common

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is that?

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Speaker 2: It's extremely common, certainly as BMI goes up, people start

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to develop pcos and then there's also some reproductive repercussions

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that come from that. And so the GLP one a

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is also are thought to impact estrogen mediated pathways and

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reduce viseral fat, which then can potentially have impact on

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gonatal effects and weight loss mediated effects for reproduction.

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Speaker 1: Yeah, so previously we did an episode and I compared

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this whole hormone pituitary cascade, like having fifteen toilets interlinked,

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and you have all of these water flows and crazy

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ups and downs and feedback loops and everything, and it

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really is a very very complicated system just with the

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HRT and the hormone issue, but then you add on

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to that the GLP one which can have some dreg

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influence on hormones, but also as you start degrading the

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fat and losing the weight, then that also changes the

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water level and the tanks and the hormone levels. So

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it gets really really complex. So would you would have

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if this were your patient, and we're not your we're

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not your doctors, but it would have been better to

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do one for six months and then do the other,

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or is it bad to do both at the same time?

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If they're not, you know, and this depends on.

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Speaker 2: How I think it met it possible to make that

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call because we just don't have enough information on this

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particular evaluate the patient, and so I think a full

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evaluation with full hormone levels. I do think that we

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underestimate the impact of weight gain, and certainly even among men,

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there's been some association with gp one ras and increases

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in testosterone levels as people lose weight as well.

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Speaker 1: So definitely contact your your doctor. Taught asked these questions

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to them. But Reddit is not really a great source.

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You know, I've been involved in Reddit and various marketing

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and science and data and you know, I have a

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textbook that I've written, and Reddit is public source and

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there's some usefulness in that. But these are not people

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that know your situation. They can say, you know, space

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aliens came down and stole your ovary and there's just

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no you know, rhyme or reason to some of the

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stuff on Reddit. So talk to your provider. Definitely, there

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can be some interactions. If you're definitely having any symptoms

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that seem a typical, absolutely get evaluated again. Okay, any

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last thoughts on on.

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Speaker 2: Tiffany Tiffany Yeah, thank you so much for engaging with us.

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And I think you are certainly inquisitive and would like

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more information, so make sure that you follow up with

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your hormonal expert that you're seeing perfect.

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Speaker 1: Yes, So Reddit's not a doctor and we're not your

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experts on you your provider, so seek more information. Okay, we're

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going to do one more question, then we're going to

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take a break. So this is from Luke, who's fifty

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nine years old from New York and this is actually

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a guy, so that's good. So mainly we have women

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listening to the podcast because of all the work Karen's done.

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So Luke wants to know do I have brain fog

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or Alzheimer's And he doesn't really give much more detail

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than that. So definitely, we're not your provider. We're not

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your doctor, so seek medical assistance. But I think this

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is a really common question. I'm fifty eight. I think

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maybe fifty nine. I'd have to calculate. I'm not so

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great at math. But I actually ask this to my

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groc I have a Tesla so it comes with free

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groc Ai and I couldn't remember what day of the

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week it was, like, I really had trouble remembering if

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it was Thursday or Friday. I have a housekeeper that

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comes on Friday, so that's important if I have to

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get the house set up. I really couldn't remember, so

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on the way to work, I actually used the AI

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in the car and asked, do I have early on

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set dementia or Alzheimer's if I can't remember what day

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of the week it was? And it said, what do

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you think?

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Speaker 2: It said doctor Miller, Well, I mean dementia among our

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age group, early dementia is very rare, very rare.

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Speaker 1: Correct, so statistically probably not. And then it also said

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that really most likely not, that you're probably stressed, fatigued,

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overwhelmed with other issues. That true, Alzheimer's is not necessarily

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dementia is not really forgetting where you park the car,

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but it's totally forgetting that you have a car and

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that you can drive, like way more serious.

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Speaker 2: And the issue really comes down to figuring out what

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the root cause is. Right, So root cause of that

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scenario in a fifty year old man would be something

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like anxiety and depression and chronic stress or sleep disorder. Medication, polypharmacy,

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metabolic and indricin causes chronic alcohol substance use and then

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is subjective cognitive declimb. But again the point being that

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it's important to do a root cause and make sure

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that you're following up with someone to if it becomes

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a persistent problem.

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Speaker 1: Yes, so I actually for two weeks about horribly uncontrolled

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migraine headaches because my insurance company wouldn't cover my Ajovi,

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which was working great for a year. That's a whole

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another episode of why this system sucks. But so my

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not being able to remember what day of the week

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it was is probably related to stress activities and work,

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but also my severe migraines for two weeks. Yeah.

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Speaker 2: Yeah, so certainly we've got to get that evaluated and

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checked out.

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Speaker 1: Yeah, Okay, we're going to take a break and then

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we'll come back and we'll answer a couple more questions. Anything,

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last comments before we take a break. No, great question, perfect, Yes,

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And just those questions, Luke and Tiffany, we really appreciate them. Okay,

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we're back. I hope you hung with us after the break,

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And so we have a couple more questions from our listeners. Again,

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these are probably actually Karen's listeners, but thank you very much.

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I hope you hang with the podcast as we transition

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and make the transition. And so I mentioned that we

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have people all over the world listening to us, mainly

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from the United States. So this next question is from

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Violet from Dallas, and Violet didn't say how old she

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is or what the exact situation she is, but she

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said my dog is fat, that she have menopause, And

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we tend to answerpomorphize that means we put human characteristics

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on dogs. And so this is kind of thinking, Okay, well,

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I'm getting older and maybe having some menopause symptoms. Probably

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I don't know how old Violet is or her situation.

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I'm not her provider, and you know, kind of transposing

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this onto the dog who's also gaining weight. And it

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turns out dogs don't have menopause. So the way they

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go through cycles and the way they're ovaries and uterus

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work is that they never really extinguish all of the

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population of eggs and hormones and have the depletion of

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the ovaries and hormones, which then caused the feedback loops

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of the pituitary to go crazy. So the weight gain

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in dogs. Unfortunately in America, we tend to have really

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heavy dogs, and that is also reflected in the human population.

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Speaker 2: But so I'm curious like that, how do we know

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if a dog has Yeah, so menopause, So we're not

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so menopause.

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Speaker 1: I thought you were going to ask me if they're

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overweight or not. So if they're overweight dogs, you should

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be able to feel their ribs, but not see their

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ribs as kind of a good standard, they shall also

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have a little bit of a waste, but for menopause.

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So we actually and dogs can do really things that

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you can't do in people. So a lot of studies.

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We can actually put them in a kennel and for

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twenty four hours, seventy two hours, seven days. We can

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know exactly how many calories we're giving them. We can

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collect their p and poop so we know exactly what's

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coming out of them. We can do culture's DNA analysis

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on the feces. We can do like crazy things analysis.

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So we can also do hormone levels and actually do

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monitoring of hormone levels every hour for seventy two hours

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and every week for five years in a research setting,

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which would be really really difficult to do in humans.

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So we actually have much much more fine granular data

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in a lot of our animal species because we can

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do better, more detailed research that you really could never do.

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Speaker 2: In a huge female.

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Speaker 1: Dogs have estrogen, yes, so they do cycle and they

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have eggs. But the whole menopause system is that the

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ovaries get depleted and then they stop producing the hormones,

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which then the pituitary gland goes crazy and tries to

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get the body to produce more and more sex hormones

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because the ovaries have kind of burned out, and dogs

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never get to that burned out station. There are situations,

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so you can actually have a very old dog that's

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still going through heat cycles metabolically. They may not be

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able to get pregnant because of the nutrition and variety

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of other reasons, but they can still cycle, so they

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still have the hormones at the appropriate levels. And so

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menopause is not really the lack of reproduction. It's the

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lack of sex hormones and the balance in the body.

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Speaker 2: And those sex hormones among older dogs start to drop

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off just the same way as with they do.

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Speaker 1: But yeah, so in humans, as we age, our hormones

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and males and females drop and pretty much all the

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hormones drop, so melatonin and thyroid and everything, and that

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absolutely does happen in dogs. Dogs only live nowadays about

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fifteen years, but absolutely there's an age related decline, and

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some of that we don't even understand. So now we

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have a geriatric hormone imbalance that seems to respond to melatonin.

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So it's a geriatric hymns is what we've been calling it.

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But that's still not a menopause situation. So for instance,

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twenty percent of large breed dogs over thirty pounds will

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have true hypothyroidism, and up to forty fifty percent of

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small breed dogs as they get older will have cushions

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or atypical cushions, which we now cause this call this

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a geriatric hymns melotonin responsive hormone imbalance, but it's not

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true menopause.

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Speaker 2: To me, it seems like we don't really know. No,

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I think we absolutely do. Flashes and all of those

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symptoms you can't really assess in a dog, right, I mean.

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Speaker 1: Correct, I mean they can't tell us if they're having

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a hot flash, but they're not panting and things like that,

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except our older dog, which that's another story. But we

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actually do know for sure. So if you call menopause

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like the symptoms of menopause, they can't really tell us that.

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But if we look at the hormone levels and what's

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happening with the ovaries, the uterus, and the pituitary, we

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know that what's happening in human primates and whales is

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very very different than what's happening in dogs, cats, horses, cows,

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so very very different. So the overweight from Violet who

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asked the question, going back to the original is from

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calories in calories out, American lifestyle, not menopause.

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Speaker 2: And so that was a violent just maybe should cut

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back on the feeding a bit.

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Speaker 1: Yeah, calories in calories out, so you know, it would

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be good to get up and move for both Violet

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and puppy dog. That's always good. So that would be excellent. Okay,

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so you want to do one more question or take

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a quick break here and come back.

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Speaker 2: Who can do another question?

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Speaker 1: I take that. The next question is from Amy who

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is in Alaska. So thanks for listening to us, Amy

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and Alaska, and she's fifty nine years sorry, fifty two

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years old. And this is pretty typical maybe for the

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Canadian and Alaska listeners, but Amy's question is is drinking

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as bad as people say or is this just another

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health panic? And I think this actually goes back to

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Tiffany's question, which is interesting that Tiffany is the one

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that's on GLP one and HRT and is taking Reddit

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seriously and very worried about what Reddit says, doctor Reddit,

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and Amy is the opposite, wanting to ignore the information

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from people. We don't really know who the people is,

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but it sounds like Amy wants to keep drinking. So

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I guess the question is is alcohol how much alcohol

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is good and bad? My belief I drink. I do

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love wine oftentimes this we have a podcast. Sometimes we

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have a glass of wine. But it is a neurotoxin

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alcohol absolutely.

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Speaker 2: And the current recommendations is actually moved toward greater caution.

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And you know, the only entirely risk free behavior is

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no alcohol at all. Now, the reality of it is

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that the dietary guidelines for Americans from they did an

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evaluation from twenty twenty to twenty twenty five, and for

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men it's less than are equal to two drinks per day,

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and for women it was less than one drink per

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day and one drink equal a twelve ounce beer, five

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ounces of wine, or one and a half ounces of

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some distilled liquor. And the reason that there are differences

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among sexes is because there was a trending toward cancer

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among women who went beyond one alcoholic beverage day. So

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it's important to point out that, you know, the US

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Surgeon General Advisory says, this is a toxic substance that

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you're taking into your body.

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Speaker 1: So two added little comments here. So one is five

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ounces of wine is not very much. When we go

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to restaurants, they all ask us if we want to

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see sounds for nine ounce poor so they don't even

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offer a five ounce por So the amount of alcohol

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that's considered safe is really small compared to what most

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of us drink. The other kind of funny thing I

330
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think about this, we have various acquaintances, and you know,

331
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if you're taking vitamin supplements or going to the METI

332
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spot to get IV treatments so that you can drink

333
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more wine and more alcohol, you know, you're kind of

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taking a toxin and then you know, over amping the

335
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recovery phase on the back end, and that's kind of

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an illogical process. So if you really want to be

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as healthy as possible, don't drink alcohol.

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Speaker 2: Well, major healthcare organizations have shifted their opinions, and those

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opinions have shifted more recently. The American Heart Association basically

340
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says avoid alcohol entirely, and the American Cancer Society says

341
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it's best not to drink alcohol. The World Health Organization

342
00:19:53,559 --> 00:19:56,400
says there's no level of alcohol consumption that's safe for

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your health, and of course, the American Diabetes Associated advises

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against drinking it, the point being that it is a toxin,

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and if you are going to drink alcohol, you should

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do it in moderation and certainly take into consideration the

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current findings from our recommendations from the dietary guidelines.

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Speaker 1: So I used to lecture for a living traveling all

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over the country and internationally, and one of the things

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I would point out is with various medications for allergies

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and dogs have a lot of side effects. And so

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I'd ask the audience, well, you know, this is like

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asking your provider how many cigarettes is safe? So what's

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the different way? How many cigarettes is safe? Doctor Miller? Zero? Okay,

355
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So how many drinks are safe?

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Speaker 2: The shift is now towards zero. Now it's interesting for our.

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Speaker 1: So we like wine and we like to drink, is

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why we are so hesitant to give up. But the

359
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answer the question is zero.

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Speaker 2: Well, it's also interesting for our Canadian listeners, which I

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think they'll find this interesting. Is at in twenty twenty three,

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Canada their guidelines went to a continuum of risk approach

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rather than a single threshold approach, so they consider the

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Canadian entities consider low risk less than two standard drinks

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per week week, moderate risk was three to six drinks

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per week, and increased high risk was greater than are

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equal to seven drinks per week. So kind of differing

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opinions around the world on this topic, but culturally.

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Speaker 1: The ultimately how many cigarettes are saved zero? How many

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drinks of alcohol are safe? Zero?

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Speaker 2: Alcohol is a Grade one carcinogen.

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Speaker 1: There you go, So okay, we're going to take a

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quick break and when we come back, we're going to

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go a little bit faster and try to get as

375
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many questions in as we can. Thank you very much,

376
00:21:46,920 --> 00:21:51,000
Amy and Violet for sitting us questions and Alaska from Amy,

377
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I think that's just kind of part of Canada. So

378
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there you go saying okay, listen stay tuned, come back,

379
00:21:57,119 --> 00:22:11,519
and we'll be right back. All right, we're right back.

380
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We're going to take a few more questions and a

381
00:22:15,240 --> 00:22:16,920
couple of breaks in between, but we're going to go

382
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a little bit faster. So this next question is from

383
00:22:18,960 --> 00:22:23,440
Brenda from Baltimore, who's actually says she's turning sixty this week,

384
00:22:23,839 --> 00:22:30,480
so bretty birthday, Happy birthday, Brenda. So Brenda wants to

385
00:22:30,519 --> 00:22:33,400
know can I get addicted to my GLP ones?

386
00:22:34,319 --> 00:22:36,880
Speaker 2: Yeah, there's been no evidence at this point to show

387
00:22:36,920 --> 00:22:41,119
that GLP one is having any addictive property at all.

388
00:22:41,440 --> 00:22:44,440
Speaker 1: So that I think going taking a step back is

389
00:22:44,519 --> 00:22:48,039
what's the definition of addiction. So if you stop taking

390
00:22:48,079 --> 00:22:50,720
the GLP ones, will you have withdrawal and get sick

391
00:22:50,759 --> 00:22:54,240
like a heroin addict? No? Probably not, most likely not

392
00:22:54,319 --> 00:22:55,279
based on everything we know.

393
00:22:55,519 --> 00:22:59,119
Speaker 2: But if you have not modified your diet your exercise regimen,

394
00:22:59,519 --> 00:23:03,160
then clearly once the GLP one A washes out, then

395
00:23:03,720 --> 00:23:09,440
certainly dositiety and diet and exercise returning to get and

396
00:23:09,480 --> 00:23:11,480
you have to continue to moderate that.

397
00:23:11,759 --> 00:23:16,559
Speaker 1: So if you lost weight with the GLP one and

398
00:23:16,599 --> 00:23:19,359
you stop it, you will gain weight unless you've changed

399
00:23:19,440 --> 00:23:24,039
your lifestyle with exercise, food and all of those things.

400
00:23:24,079 --> 00:23:28,160
So is that addiction? You know, again, the definition of

401
00:23:28,160 --> 00:23:31,920
addiction can be flexible. The other definition of addiction it

402
00:23:31,960 --> 00:23:35,480
relates to abuse. And what is this o zimpic face

403
00:23:35,559 --> 00:23:39,000
that I've been seeing on social media and TikTok A's

404
00:23:39,079 --> 00:23:42,279
that skeletal face when you take too much ozimpic or

405
00:23:42,880 --> 00:23:45,240
any of the GLP ones. I'm not just picking on ozimbic.

406
00:23:45,319 --> 00:23:48,039
Speaker 2: Well, I mean, I think there are some patients who

407
00:23:48,079 --> 00:23:54,319
are pursuing utilization of GLP one a's who clearly need

408
00:23:54,359 --> 00:23:59,519
to pull back on therapy healthy therapy, which.

409
00:23:59,319 --> 00:24:01,680
Speaker 1: Is kind of the pfinition of abuse. Is that if

410
00:24:01,720 --> 00:24:05,599
you're damaging your body by using a drug or product,

411
00:24:05,720 --> 00:24:09,480
then that's also a flexible version of addiction.

412
00:24:09,799 --> 00:24:13,599
Speaker 2: Well, and they are FDA regulated drugs with FDA indications,

413
00:24:13,640 --> 00:24:17,839
and so if you are on them, you need to

414
00:24:17,880 --> 00:24:22,960
be routinely seeing your a provider to evaluate the dose

415
00:24:23,079 --> 00:24:26,839
response and where you are health wise, you know you

416
00:24:27,119 --> 00:24:31,880
are you below and optimal weight and now looking malnourished.

417
00:24:32,440 --> 00:24:35,079
But so I think that all has to be tethered

418
00:24:35,680 --> 00:24:38,640
with the having accountability.

419
00:24:38,920 --> 00:24:41,559
Speaker 1: So I would divide this question into three answers. I

420
00:24:41,559 --> 00:24:45,759
would say, are you addicted that's the question. I would

421
00:24:45,759 --> 00:24:50,039
say that if you stop the drug, will you likely

422
00:24:50,079 --> 00:24:53,519
gain weight? Yes, you are. You probably going to require

423
00:24:53,559 --> 00:24:56,599
the drug to maintain the low level or weight loss

424
00:24:56,640 --> 00:25:00,200
that you've had. So yes, you stop the drug, the symptom,

425
00:25:00,319 --> 00:25:03,240
the weight gain will come back. So that's one definition.

426
00:25:04,400 --> 00:25:08,440
Are you will you suffer symptoms of withdraw and have

427
00:25:08,519 --> 00:25:12,880
physical discomfort or pain like a heroin addict from the

428
00:25:13,119 --> 00:25:17,359
stopping the GLP one? No? And then psychologically, are you

429
00:25:17,519 --> 00:25:23,119
using the drug for sort of abnormal physical appearance or

430
00:25:23,279 --> 00:25:27,240
body morphism or problems that you're having that you're dependent

431
00:25:27,400 --> 00:25:30,559
on the GLP one psychologically, but it's not a true

432
00:25:30,640 --> 00:25:34,920
chemical dependence, and that definitely can be So, you know

433
00:25:34,960 --> 00:25:37,200
a lot of people are taking glp ones that don't

434
00:25:37,240 --> 00:25:40,319
really meet the FDA guidelines and they're taking it for

435
00:25:40,400 --> 00:25:43,440
cosmetic reasons and that can easily go too far.

436
00:25:44,000 --> 00:25:46,599
Speaker 2: Well, and then you also have to take into account

437
00:25:46,680 --> 00:25:54,200
that people are food addicted, and so the class is

438
00:25:54,240 --> 00:25:57,960
that it tends to have some impact on addictive substances

439
00:25:58,039 --> 00:26:02,599
and for example, decreases an alcohol intake. And from that so,

440
00:26:02,920 --> 00:26:05,480
I mean, I think it's important to weigh that in

441
00:26:05,599 --> 00:26:10,519
a bit. If someone has an underlying eating disorder.

442
00:26:10,240 --> 00:26:13,240
Speaker 1: So will that addiction come back? That and it could

443
00:26:13,240 --> 00:26:16,359
be shopping addiction, por an addiction, whatever kind of addiction

444
00:26:16,720 --> 00:26:19,839
definitely seems to go away with the GLP ones or

445
00:26:19,839 --> 00:26:23,200
at least diminish, and that would come back if you

446
00:26:23,200 --> 00:26:24,240
stop the GLP one.

447
00:26:24,440 --> 00:26:28,240
Speaker 2: But seeking proper care to address the eating addiction I

448
00:26:28,279 --> 00:26:31,240
think is more important, So that focus on.

449
00:26:31,359 --> 00:26:33,720
Speaker 1: So the answer is how you define addiction. So, okay,

450
00:26:33,759 --> 00:26:35,319
we're going to take a quick break and then answer

451
00:26:35,359 --> 00:26:39,799
another question and hang tight. Will be here on the

452
00:26:39,799 --> 00:26:52,880
other side. All right, we're back. We're actually going to

453
00:26:52,960 --> 00:26:57,319
do two questions real fast here and then say goodbye.

454
00:26:57,720 --> 00:27:00,160
So the next question is from Jason and they and

455
00:27:00,279 --> 00:27:03,799
say where or how old? But they wanted to know

456
00:27:04,400 --> 00:27:08,759
why does every woman I know have autoimmune disease? And

457
00:27:08,759 --> 00:27:10,599
maybe that's why they didn't tell us where they're from.

458
00:27:10,599 --> 00:27:13,039
That seems a little snarky. I don't think every woman

459
00:27:13,119 --> 00:27:16,839
has autoimmune disease unless he's working in a loopus room

460
00:27:16,920 --> 00:27:21,079
and toward arthrotists practice or something. So we're actually going

461
00:27:21,160 --> 00:27:23,920
to do an episode. The next episode is going to

462
00:27:23,920 --> 00:27:28,039
be on autoimmune diseases like lupus, pemphigus and we'll talk

463
00:27:28,119 --> 00:27:31,599
about the risk rates and statistics in women and men,

464
00:27:31,960 --> 00:27:35,599
in older, younger, middle aged people. So listen for the

465
00:27:35,640 --> 00:27:38,240
next episode and we'll answer that question. So then our

466
00:27:38,279 --> 00:27:41,680
final question comes from Becky from Canada. So you mentioned

467
00:27:41,680 --> 00:27:45,240
Canada before, so thank you very much Canadians. Becky is

468
00:27:45,319 --> 00:27:49,319
fifty five year old woman and she says, or wants

469
00:27:49,359 --> 00:27:53,000
to know that I've been taking probiotics every day for

470
00:27:53,039 --> 00:27:55,839
two years and I have no idea if it's helping.

471
00:27:56,000 --> 00:28:00,079
How do I know if they're working? And this is

472
00:28:00,079 --> 00:28:03,359
actually one of my favorite pet peeves is that the

473
00:28:03,480 --> 00:28:09,960
whole gut neuro skin axis, the gut immune system axis

474
00:28:10,039 --> 00:28:13,680
is definitely a known thing. We have hundreds of species

475
00:28:13,680 --> 00:28:17,200
of bacteria in our gut, over a trillion organisms, and

476
00:28:17,519 --> 00:28:21,000
the probiotics that we have are very few probiotics, and

477
00:28:21,000 --> 00:28:25,160
they're based on really limited understanding of how we influence

478
00:28:25,240 --> 00:28:28,839
the gut bacteria. So we know that there's a problem,

479
00:28:28,920 --> 00:28:32,359
we know that there's a link between inflammation, neurology, skin

480
00:28:32,599 --> 00:28:35,920
allergies even but we really don't know how to fix it.

481
00:28:35,960 --> 00:28:39,960
So we're at the infancy of really understanding how to

482
00:28:40,119 --> 00:28:43,680
modulate the gut bacteria and then how that affects the

483
00:28:43,759 --> 00:28:47,160
disease and symptoms that we're having. In dogs, we actually

484
00:28:47,160 --> 00:28:49,519
have a few more studies than they do in people. Again,

485
00:28:49,559 --> 00:28:51,559
we can do kind of weird dog research that they

486
00:28:51,559 --> 00:28:54,480
couldn't do in people. So, for instance, we have organisms

487
00:28:54,480 --> 00:28:58,160
that we know improve dental tartar. We have organisms that

488
00:28:58,200 --> 00:29:03,119
we know improve infections and allergies of the skin and ears.

489
00:29:03,480 --> 00:29:06,480
We know, so we have very select bacteria, species specific

490
00:29:06,559 --> 00:29:10,519
bacteria that affects certain diseases and symptoms in the body.

491
00:29:10,680 --> 00:29:15,079
Speaker 2: Right. And then also for our audience, I mean veterinary medicine,

492
00:29:15,119 --> 00:29:18,119
their studies are very very small ye, and so the

493
00:29:18,240 --> 00:29:22,920
confidence intervals are a little wider on that data set. However,

494
00:29:23,400 --> 00:29:27,720
it is important to remember that probiotic supplementation is not

495
00:29:27,920 --> 00:29:32,839
recommended just for generalized daily use in the US. It's

496
00:29:33,119 --> 00:29:38,240
strained specific, and it is indication specific, and we just

497
00:29:38,640 --> 00:29:44,160
really don't understand a whole lot but sort of indications.

498
00:29:44,200 --> 00:29:48,119
You know, you're looking at things like, you know, antibiotic

499
00:29:48,200 --> 00:29:51,079
associated diarrhea or C deficile you know.

500
00:29:51,480 --> 00:29:55,440
Speaker 1: Yeah, so after you disinfect your GI tract then repopulating

501
00:29:55,519 --> 00:29:57,759
it with bacteria, it's not a bad idea. So one

502
00:29:57,799 --> 00:29:59,759
of the other questions I'm sure you do this as well,

503
00:30:00,240 --> 00:30:02,400
is when I have patients in the room and they say, hey,

504
00:30:02,440 --> 00:30:05,759
I've given this or supplement or whatever it is, and

505
00:30:06,119 --> 00:30:07,680
they say, what do you think about that? And I

506
00:30:07,720 --> 00:30:10,519
asked them, well, do you think it helped? And if

507
00:30:10,559 --> 00:30:12,839
you can't tell it helped, I say, we'll try stopping

508
00:30:12,839 --> 00:30:14,839
it and see what happens. And if you can't really

509
00:30:14,880 --> 00:30:17,480
tell a difference between taking it and not taking it,

510
00:30:17,920 --> 00:30:21,839
then you know, probably it's not doing anything obviously good.

511
00:30:22,480 --> 00:30:24,799
The good news with probiotics is that they don't seem

512
00:30:24,839 --> 00:30:26,400
to be harmful. We don't have a lot of side

513
00:30:26,400 --> 00:30:28,640
effects that we know of, so you're not doing any

514
00:30:28,720 --> 00:30:31,119
damage as far as we know. But are you really

515
00:30:31,160 --> 00:30:35,039
having benefit? Maybe maybe not, So you can try stopping them. Again,

516
00:30:35,079 --> 00:30:38,119
we're not your provider. Check with your provider, but you

517
00:30:38,160 --> 00:30:40,839
may be wasting your time and money, or you may stop.

518
00:30:41,160 --> 00:30:43,839
They will take a few weeks to really kind of

519
00:30:43,920 --> 00:30:47,119
kick in, and also the benefits to kind of clear out.

520
00:30:47,240 --> 00:30:51,519
Speaker 2: There actually are two conditions where the American Gaess Rentrology

521
00:30:51,519 --> 00:30:57,000
Association Association recommends against using probiotics, and that's with Crohn's

522
00:30:57,000 --> 00:31:01,400
disease and all sort of colidis. So it gets complex

523
00:31:01,480 --> 00:31:03,759
when you start getting in the weeds on this.

524
00:31:04,000 --> 00:31:08,599
Speaker 1: Is that because of the absorption that your barrier is

525
00:31:08,680 --> 00:31:11,319
broken down, you can absorb the bacteria more directly than

526
00:31:11,400 --> 00:31:12,279
get septic made.

527
00:31:12,359 --> 00:31:19,480
Speaker 2: So there are multiple reasons to take probiotics. Certainly follow

528
00:31:19,640 --> 00:31:23,319
someone that you're seeing. That's a healthcare person's advice, but

529
00:31:24,720 --> 00:31:28,960
you know there's some impact with cardiovascular risk factors and

530
00:31:29,200 --> 00:31:33,160
gut microbiotom modulation and immune factors and vational health and

531
00:31:33,200 --> 00:31:34,759
mental health and autoimmune disease.

532
00:31:34,880 --> 00:31:38,720
Speaker 1: Potential benefits really amazing. My prediction is that in five

533
00:31:38,759 --> 00:31:41,640
to ten years, we're going to know that if you

534
00:31:41,680 --> 00:31:45,319
have this disease, these symptoms, you take this bacteria the species,

535
00:31:45,359 --> 00:31:48,200
and you'll know the dose and the duration, and that

536
00:31:48,279 --> 00:31:53,039
it'll be very specific. Basically a biological treatment for a

537
00:31:53,079 --> 00:31:56,519
disease and a symptom set. We are nowhere near that yet,

538
00:31:57,440 --> 00:32:01,160
but you know, I would I would tell that if

539
00:32:01,200 --> 00:32:03,480
you're not sure, tries stopping them and see what happens.

540
00:32:03,799 --> 00:32:07,000
But as always, talk to your provider. Okay, any last

541
00:32:07,000 --> 00:32:09,200
words were We ran out of time for our Legit

542
00:32:09,279 --> 00:32:13,599
and Bullshit section. So any wrap up comments, Doctor Miller.

543
00:32:13,559 --> 00:32:16,559
Speaker 2: Yeah, I would just say, don't just go out and

544
00:32:16,599 --> 00:32:20,960
start popping pills randomly off the countertop because TikTok or

545
00:32:20,960 --> 00:32:27,000
whoever talked or TikTok. I just think we are over supplemented.

546
00:32:27,079 --> 00:32:30,240
I have had patients in the past who are on

547
00:32:30,680 --> 00:32:35,400
five indicated pills, medications that are prescribed, and then in

548
00:32:35,440 --> 00:32:38,960
addition to those five, they are on ten or fifteen

549
00:32:39,039 --> 00:32:42,920
supplements for which they haven't brought them into the office

550
00:32:42,920 --> 00:32:45,039
and had those adjudicated. So just use caution.

551
00:32:45,680 --> 00:32:48,480
Speaker 1: Yeah, I mean a lot of these supplements we don't know,

552
00:32:48,720 --> 00:32:51,119
and the lack of information does not mean that we

553
00:32:51,279 --> 00:32:54,359
have good information or bad information. It's just no information.

554
00:32:54,519 --> 00:32:57,519
So do they help? Maybe? Do they hurt? Maybe? Do

555
00:32:57,599 --> 00:32:59,759
they interact with other medications you're taking?

556
00:33:00,079 --> 00:33:03,079
Speaker 2: Maybe interesting, it's a lot of money to spend either

557
00:33:03,119 --> 00:33:05,240
to poop it down or pee it down the drain.

558
00:33:05,359 --> 00:33:07,599
Speaker 1: You know, that's a lot of audiomens. If you take

559
00:33:07,640 --> 00:33:09,480
too much that you just kind of pee or poop

560
00:33:09,559 --> 00:33:12,240
them out is where that comment comes, you know. But ultimately,

561
00:33:12,240 --> 00:33:14,200
if you can't tell a difference, then I would definitely

562
00:33:14,200 --> 00:33:18,119
be suspicious. That would be my trigger. Any last words

563
00:33:18,559 --> 00:33:20,759
all right, so thank you for listening. Sorry we ran

564
00:33:20,799 --> 00:33:23,240
out of time for legitter bullshit. If you really liked

565
00:33:23,279 --> 00:33:25,960
that episode or that segment, let us know. Send us

566
00:33:25,960 --> 00:33:29,400
an email at ask at itch not dot com. As always,

567
00:33:29,440 --> 00:33:33,359
stay safe, stay well, and get up and move Okay,

568
00:33:33,400 --> 00:33:34,480
bye bye guys,