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Disc bulge and disc herniation are some of the most common conditions affecting the spine of both young and middle-aged patients. It is estimated that approximately 2.6% of the US population annually visits a clinician to treat spinal disorders. Roughly $ 7.1 billion alone is lost due to the time away from work.
Disc herniation is when the whole or part of the nucleus pulposus is protruded through the torn or weakened outer annulus fibrosus of the intervertebral disc. This is also known as the slipped disc and frequently occurs in the lower back, sometimes also affecting the cervical region. Herniation of the intervertebral disc is defined as a localized displacement of disc material with 25% or less of the disc circumference on an MRI scan, according to the North American Spine Society 2014. The herniation may consist of nucleus pulposus, annulus fibrosus, apophyseal bone or osteophytes, and the vertebral endplate cartilage in contrast to disc bulge.
There are also mainly two types of disc herniation. Disc protrusion is when a focal or symmetrical extension of the disc comes out of its confines in the intervertebral space. It is situated at the intervertebral disc level, and its outer annular fibers are intact. A disc extrusion is when the intervertebral disc extends above or below the adjacent vertebrae or endplates with a complete annular tear. In this type of disc extrusion, a neck or base is narrower than the dome or the herniation.
A disc bulge is when the outer fibers of the annulus fibrosus are displaced from the margins of the adjacent vertebral bodies. Here, the displacement is more than 25% of the circumference of the intervertebral disc. It also does not extend below or above the margins of the disc because the annulus fibrosus attachment limits it. It differs from disc herniation because it involves less than 25% of the disc’s circumference. Usually, the disc bulge is a gradual process and is broad. The disc bulge can be divided into two types. In a circumferential bulge, the whole disc circumference is involved. More than 90 degrees of the rim is involved asymmetrically in asymmetrical bulging.
Normal Intervertebral Disc Anatomy
Before going into detail about the definition of disc herniation and disc bulge, we need to look at the standard intervertebral disc. According to spine guidelines in 2014, a standard disc is something that has a classic shape without any evidence of degenerative disc changes. Intervertebral discs are responsible for one-third to one-fourth of the height of the spinal column.
One intervertebral disc is about 7 -10 mm thick and measures 4 cm in anterior-posterior diameter in the lumbar region of the spine. These spinal discs are located between two adjacent vertebral bodies. However, no discs can be found between the atlas and axis and the coccyx. About 23 discs are found in the spine, with six in the cervical spine, 12 in the thoracic spine, and only five in the lumbar spine.
Intervertebral discs are made of fibro cartilages, forming a fibrocartilaginous joint. The outer ring of the intervertebral disc is known as the annulus fibrosus, while the inner gel-like structure in the center is known as the nucleus pulposus. The cartilage endplates sandwich the nucleus pulposus superiorly and inferiorly. The annulus fibrosus comprises concentric collagen fiber sheets arranged in a radial tire-like structure into lamellae. The fibers are attached to the vertebral endplates and oriented at different angles. With their cartilaginous part, the endplates anchor the discs in their proper place.
The nucleus pulposus is composed of water, collagen, and proteoglycans. Proteoglycans attract and retain moisture, giving the nucleus pulposus a hydrated gel-like consistency. Interestingly, throughout the day, the amount of water found in the nucleus pulposus varies according to the person’s level of activity. This feature in the intervertebral disc serves as a cushion or a spinal shock-absorbing system to protect the adjacent vertebra, spinal nerves, spinal cord, brain, and other structures against various forces. Although the individual movement of the intervertebral discs is limited, some form of vertebral motion like flexion and extension is still possible due to the features of the intervertebral disc.
Effect of Intervertebral Disc Morphology on Structure and Function
The type of components present in the intervertebral disc and how it is arranged determine the morphology of the intervertebral disc. This is important in how effectively the disc does its function. As the disc is the most important element which bears the load and allows movement in the otherwise rigid spine, the constituents it is made up of have a significant bearing.
The complexity of the lamellae increases with advancing age as a result of the synthetic response of the intervertebral disc cells to the variations in the mechanical load. These changes in lamellae with more bifurcations, interdigitation and irregular size and number of lamellar bands will lead to the altered bearing of weight. This in turn establishes a self-perpetuated disruption cycle leading to the destruction of the intervertebral discs. Once this process is started it is irreversible. As there is an increased number of cells, the amount of nutrition the disc requires is also increasingly changing the normal concentration gradient of both metabolites and nutrients. Due to this increased demand, the cells may also die increasingly by necrosis or apoptosis.
Human intervertebral discs are avascular and hence the nutrients are diffused from the nearby blood vessels in the margin of the disc. The main nutrients; oxygen and glucose reach the cells in the disc through diffusion according to the gradient determined by the rate of transport to the cells through the tissues and the rate of demand. Cells also increasingly produce lactic acid as a metabolic end product. This is also removed via the capillaries and venules back to the circulation.
Since diffusion depends on the distance, the cells lying far from the blood capillaries can have a reduced concentration of nutrients because of the reduced supply. With disease processes, the normally avascular intervertebral disc can become vascular and innervated in degeneration and in disease processes. Although this may increase the oxygen and nutrient supply to the cells in the disc, this can also give rise to many other types of cells that are normally not found in the disc with the introduction of cytokines and growth factors.
The morphology of the intervertebral disc in different parts of the spine also varies although many clinicians base the clinical theories based on the assumption that both cervical and lumbar intervertebral discs have the same structure. The height of the disc was the minimum in the T4-5 level of the thoracic column probably due to the fact that thoracic intervertebral discs are less wedge-shaped than those of cervical and lumbar spinal regions.
From the cranial to caudal direction, the cross-sectional area of the spine increased. Therefore, by the L5-S1 level, the nucleus pulposus was occupying a higher proportion of the intervertebral disc area. The cervical discs have an elliptical shape on cross-section while the thoracic discs had a more circular shape. The lumbar discs also have an elliptical shape though it is more flattened or re-entrant posteriorly.
What is a Disc Bulge?
The bulging disc is when the disc simply bulges outside the intervertebral disc space it normally occupies without the rupture of the outer annulus fibrosus. The bulging area is quite large when compared to a herniated disc. Moreover, in a herniated disc, the annulus fibrosus ruptures or cracks. Although disc bulging is more common than disc herniation, it causes little or no pain to the patient. In contrast, the herniated disc causes a lot of pain.
Causes for Disc Bulging
A bulging disc can be due to several causes. It can occur due to normal age-related changes such as those seen in degenerative disc disease. The aging process can lead to structural and biochemical changes in the intervertebral discs and lead to reduced water content in the nucleus pulposus. These changes can make the patient vulnerable to disc bulges with only minor trauma. Some unhealthy lifestyle habits such as a sedentary lifestyle and smoking can potentiate this process and give rise to more severe changes with the weakening of the disc.
General wear and tear due to repeated microtrauma can also weaken the disc and give rise to disc bulging. This is because when the discs are strained, the normal distribution of weight loading changes. Accumulated micro-trauma over a long period of time can occur in bad posture. Bad posture when sitting, standing, sleeping, and working can increase the pressure in the intervertebral discs.
When a person maintains a forward bending posture, it can lead to overstretching and eventually weakness of the posterior part of the annulus fibrosus. Over time, the intervertebral disc can bulge posteriorly. In occupations that require frequent and repetitive lifting, standing, driving, or bending, the bulging disc may be an occupational hazard. Improper lifting up of items, and improper carrying of heavy objects can also increase the pressure on the spine and lead to disc bulges eventually.
The bulging intervertebral discs usually occur over a long period of time. However, the discs can bulge due to acute trauma too. The unexpected sudden mechanical load can damage the disc resulting in micro-tears. After an accident, the disc can become weakened causing long-term microdamage ultimately leading to bulging of the disc. There may also be a genetic component to the disc bulging. The individual may have a reduced density of elastin in the annulus fibrosus with increased susceptibility to disc diseases. Other environmental facts may also play a part in this disease process.
Symptoms of Disc Bulging
As mentioned previously, bulging discs do not cause pain and even if they do the severity is mild. In the cervical region, the disease will cause pain running down the neck, deep pain in the shoulder region, pain radiating along the upper arm, and forearm up to the fingers.
This may give rise to a diagnostic dilemma as to whether the patient is suffering from a myocardial infarction as the site of referred pain and the radiation is similar. Tingling feeling on the neck may also occur due to the bulging disc.
In the thoracic region, there may be pain in the upper back that radiates to the chest or the upper abdominal region. This may also suggest upper gastrointestinal, lung, or cardiac pathology and hence need to be careful when analyzing these symptoms.
The bulging discs of the lumbar region may present as lower back pain and tingling feeling in the lower back region of the spine. This is the most common site for disc bulges since this area holds the weight of the upper body. The pain or the discomfort can spread through the gluteal area, thighs, and to the feet. There may also be muscle weakness, numbness or tingling sensation. When the disc presses on the spinal cord, the reflexes of both legs can increase leading to spasticity.
Some patients may even have paralysis from the waist down. When the bulging disc compresses on the cauda equine, the bladder and bowel functions can also change. The bulging disc can press on the sciatic nerve leading to sciatica where the pain radiates in one leg from the back down to the feet.
The pain from the bulging disc can get worse during some activities as the bulge can then compress on some of the nerves. Depending on what nerve is affected, the clinical features can also vary.
Diagnosis of Disc Bulging
The diagnosis may not be apparent from clinical history due to similar presentations in more serious problems. But the chronic nature of the disease may give some clues. Complete history and a physical examination need to be done to rule out myocardial infarction, gastritis, gastro-oesophageal reflux disease, and chronic lung pathology.
MRI of Disc Bulge
Investigations are necessary for the diagnosis. X-ray spine is performed to look for gross pathology although it may not show the bulging disc directly. There may be indirect findings of disk degeneration such as osteophytes in the endplates, gas in the disc due to the vacuum phenomenon, and the loss of height of the intervertebral disc. In the case of moderate bulges, it may sometimes appear as non-focal intervertebral disc material that is protruded beyond the borders of the vertebra which is broad-based, circumferential, and symmetrical.
Magnetic resonance imaging or MRI can exquisitely define the anatomy of the intervertebral discs especially the nucleus pulposus and its relationships. The early findings seen on MRI in disc bulging include the loss of normal concavity of the posterior disc. The bulges can be seen as broad-based, circumferential, and symmetrical areas. In moderate bulging, the disc material will protrude beyond the borders of the vertebrae in a non-focal manner. Ct myelogram may also give detailed disc anatomy and may be useful in the diagnosis.
Treatment of Disc Bulging
The treatment for the bulging disc can be conservative, but sometimes surgery is required.
Conservative Treatment
When the disc bulging is asymptomatic, the patient does not need any treatment since it does not pose an increased risk. However, if the patient is symptomatic, the management can be directed at relieving the symptoms. The pain is usually resolved with time. Till then, potent pain killers such as non-steroidal anti-inflammatory drugs like ibuprofen should be prescribed. In unresolved pain, steroid injections can also be given to the affected area and if it still does not work, the lumbar sympathetic block can be tried in most severe cases.
The patient can also be given the option of choosing alternative therapies such as professional massage, physical therapy, ice packs, and heating pads which may alleviate symptoms. Maintaining correct posture, tapes, or braces to support the spine are used with the aid of a physiotherapist. This may fasten the recovery process by avoiding further damage and keeping the damaged or torn fibers in the intervertebral disc without leakage of the fluid portion of the disc. This helps maintain the normal structure of the annulus and may increase the recovery rate. Usually, the painful symptoms which present initially get resolved over time and lead to no pain. However, if the symptoms get worse steadily, the patient may need surgery
If the symptoms are resolved, physiotherapy can be used to strengthen the muscles of the back with the use of exercises. Gradual exercises can be used for the return of function and for preventing recurrences.
Surgical Treatment
When conservative therapy does not work with a few months of treatment, surgical treatment can be considered. Most would prefer minimally invasive surgery which uses advanced technology to correct the intervertebral disc without having to grossly dissect the back. These procedures such as microdiscectomy have a lower recovery period and reduced risk of scar formation, major blood loss, and trauma to adjacent structures when compared to open surgery.
Previously, laminectomy and discectomy have been a mainstay of treatment. However, due to the invasiveness of the procedure and due to increased damage to the nerves these procedures are currently abandoned by many clinicians for disc bulging.
Disc bulging in the thoracic spine is being treated surgically with costotransversectomy where a section of the transverse process is resected to allow access to the intervertebral disc. The spinal cord and spinal nerves are decompressed by using thoracic decompression by removing a part of the vertebral body and making a small opening. The patient may also need a spinal fusion later on if the removed spinal body was significant.
Video-assisted thoracoscopic surgery can also be used where only a small incision is made and the surgeon can perform the surgery with the assistance of the camera. If the surgical procedure involved removing a large portion of the spinal bone and disc material, it may lead to spinal instability. This may need bone grafting to replace the lost portion with plates and screws to hold them in place.
What is a Disc Herniation?
As mentioned in the first section of this article, disc herniation occurs when there is disc material displaces beyond the limits of the intervertebral disc focally. The disc space consists of endplates of the vertebral bodies superiorly and inferiorly while the outer edges of the vertebral apophyses consist of the peripheral margin. The osteophytes are not considered a disc margin. There may be irritation or compression of the nerve roots and dural sac due to the volume of the herniated material leading to pain. When this occurs in the lumbar region, this is classically known as sciatica. This condition has been mentioned since ancient times although a connection between disc herniation and sciatica was made only in the 20th century. Disc herniation is one of the commonest diagnoses seen in the spine due to degenerative changes and is the commonest cause of spinal surgery.
Classifications of Disc Herniation
There are many classifications regarding intervertebral disc herniation. In focal disc herniation, there is a localized displacement of the disc material in the horizontal or axial plane. In this type, only less than 25% of the circumference of the disc is involved. In broad-based disc herniation, about 25 – 50 % of the disc circumference is herniated. The disc bulge is when 50 – 100 % of the disc material is extended beyond the normal confines of the intervertebral space. This is not considered a form of disc herniation. Furthermore, the intervertebral disc deformities associated with severe cases of scoliosis and spondylolisthesis are not classified as a herniation but rather adaptive changes of the contour of the disc due to the adjacent deformity.
Depending on the contour of the displaced material, the herniated discs can be further classified as protrusions and extrusions. In disc protrusion, the distance measured in any plane involving the edges of the disc material beyond intervertebral disc space (the highest measure is taken) is lower than the distance measured in the same plane between the edges of the base.
Imaging can show the disc displacement as a protrusion on the horizontal section and as an extrusion on the sagittal section due to the fact that the posterior longitudinal ligament contains the disc material that is displaced posteriorly. Then the herniation should be considered an extrusion. Sometimes the intervertebral disc herniation can occur in the craniocaudal or vertical direction through a defect in the vertebral body endplates. This type of herniation is known as intravertebral herniation.
The disc protrusion can also be divided into two focal protrusion and broad-based protrusion. In focal protrusion, the herniation is less than 25% of the circumference of the disc whereas, in broad-based protrusion, the herniated disc consists of 25 – 50 % of the circumference of the disc.
In disc extrusion, it is diagnosed if any of the two following criteria are satisfied. The first one is; that the distance measured between the edges of the disc material that is beyond the intervertebral disc space is greater than the distance measured in the same plane between the edges of the base. The second one is; that the material in the intervertebral disc space and material beyond the intervertebral disc space is having a lack continuity.
This can be further characterized as sequestrated which is a subtype of the extruded disc. It is called disc migration when disk material is pushed away from the site of extrusion without considering whether there is continuity of disc or not. This term is useful in interpreting imaging modalities as it is often difficult to show continuity in imaging.
The intervertebral disc herniation can be further classified as contained discs and discs that are unconfined. The term contained disc is used to refer to the integrity of the peripheral annulus fibrosus which is covering the intervertebral disc herniation. When fluid is injected into the intervertebral disc, the fluid does not leak into the vertebral canal in herniations that are contained.
Sometimes there are displaced disc fragments that are characterized as free. However, there should be no continuity between disc material and the fragment and the original intervertebral disc for it to be called a free fragment or a sequestered one. In a migrated disc and in a migrated fragment, there is an extrusion of disc material through the opening in the annulus fibrosus with a displacement of the disc material away from the annulus.
Even though some fragments that are migrated can be sequestered the term migrated means just to the position and it is not referred to the continuity of the disc. The displaced intervertebral disc material can be further described with regard to the posterior longitudinal ligament as submembranous, subcapsular, subligamentous, extra ligamentous, transligamentous, subcapsular, and perforated.
The spinal canal can also get affected by an intervertebral disc herniation. This compromise of the canal can also be classified as mild, moderate, and severe depending on the area that is compromised. If the canal at that section is compromised only less than one third, it is called mild whereas if it is only compromised less than two-thirds and more than one third it is considered moderate. In a severe compromise, more than two-thirds of the spinal canal is affected. For the foraminal involvement, this same grading system can be applied.
The displaced material can be named according to the position that they are in the axial plane from the center to the right lateral region. They are termed as central, right central, right subarticular, right foraminal, and right extraforaminal. The displaced intervertebral disc material’s composition can be further classified as gaseous, liquefied, desiccated, scarred, calcified, ossified, bony, nuclear, and cartilaginous.
Before going into detail on how to diagnose and treat intervertebral disc herniation, let us differentiate how cervical disc herniation differs from lumbar herniation since they are the most common regions to undergo herniation.
Cervical Disc Herniation vs. Thoracic Disc Herniation vs Lumbar Disc Herniation
Lumbar disc herniation is the most commonest type of herniation found in the spine which is approximately 90% of the total. However, cervical disc herniation can also occur in about one-tenth of patients. This difference is mainly due to the fact that the lumbar spine has more pressure due to the increased load. Moreover, it has comparatively large intervertebral disc material. The most common sites of intervertebral disc herniation in the lumbar region are L 5 – 6, in the Cervical region between C7, and in the thoracic region T12.
Cervical disc herniation can occur relatively commonly because the cervical spine acts as a pivoting point for the head and it is a vulnerable area for trauma and therefore prone to damage in the disc. Thoracic disc herniation occurs more infrequently than any of the two. This is due to the fact that thoracic vertebrae are attached to the ribs and the thoracic cage which limits the range of movement in the thoracic spine when compared to the cervical and lumbar spinal discs. However, thoracic intervertebral disc herniation can still occur.
Cervical disc herniation gives rise to neck pain, shoulder pain, pain radiating from the neck to the arm, tingling, etc. Lumbar disc herniation can similarly cause lower back pain as well as pain, tingling, numbness, and muscle weakness seen in the lower limbs. Thoracic disc herniation can give rise to pain in the upper back radiating to the torso.
Epidemiology
Although disc herniation can occur in all age groups, it predominantly occurs between the fourth and fifth decade of life with the mean age of 37 years. There have been reports that estimate the prevalence of intervertebral disc herniation to be 2 – 3 % of the general population. It is more commonly seen in men over 35 years with a prevalence of 4.8% and while in women this figure is around 2.5%. Due to its high prevalence, it is considered a worldwide problem as it is also associated with significant disability.
Risk Factors
In most instances, a herniated disc occurs due to the natural aging process in the intervertebral disc. Due to the disc degeneration, the amount of water that was previously seen in the intervertebral disc gets dried out leading to the shrinking of the disc with the narrowing of the intervertebral space. These changes are markedly seen in degenerative disc disease. In addition to these gradual changes due to normal wear and tear, other factors may also contribute to increasing the risk of intervertebral disc herniation.
Being overweight can increase the load on the spine and increase the risk of herniation. A sedentary life can also increase the risk and therefore an active lifestyle is recommended in preventing this condition. Improper posture with prolonged standing, sitting, and especially driving can put a strain on the intervertebral discs due to the additional vibration from the vehicle engine leading to microtrauma and cracks in the disc. The occupations which require constant bending, twisting, pulling and lifting can put a strain on the back. Improper weight lifting techniques are one of the major reasons.
When back muscles are used in lifting heavy objects instead of lifting with the legs and twisting while lifting can make the lumbar discs more vulnerable to herniation. Therefore patients should always be advised to lift weights with their legs and not the back. Smoking has been thought to increase disc herniation by reducing the blood supply to the intervertebral disc leading to degenerative changes of the disc.
Although the above factors are frequently assumed to be the causes for disc herniation, some studies have shown that the difference in risk is very small when this particular population was compared with the control groups of the normal population.
There have been several types of research done on genetic predisposition and intervertebral disc herniation. Some of the genes that are implicated in this disease include vitamin D receptor (VDR) which is a gene that codes for the polypeptides of important collagen called collagen IX (COL9A2).
Another gene called the human aggrecan gene (AGC) is also implicated as it codes for proteoglycans which is the most important structural protein found in the cartilage. It supports the biochemical and mechanical function of the cartilage tissue and hence when this gene is defective, it can predispose an individual to intervertebral disc herniation.
Apart from these, there are many other genes that are being researched due to the association between disc herniation such as matrix metalloproteinase (MMP) cartilage intermediate layer protein, thrombospondin (THBS2), collagen 11A1, carbohydrate sulfotransferase, and asporin (ASPN). They may also be regarded as potential gene markers for lumbar disc disease.
Pathogenesis of Sciatica and Disc Herniation
The sciatic pain originated from the extruded nucleus pulposus inducing various phenomena. It can directly compress the nerve roots leading to ischemia or without it, mechanically stimulate the nerve endings of the outer portion of the fibrous ring and release inflammatory substances suggesting its multifactorial origin. When the disc herniation causes mechanical compression of the nerve roots, the nerve membrane is sensitized to pain and other stimuli due to ischemia. It has been shown that in sensitized and compromised nerve roots, the threshold for neuronal sensitization is around half of that of a normal and non-compromised nerve root.
The inflammatory cell infiltration is different in extruded discs and non-extruded discs. Usually, in non-extruded discs, the inflammation is less. The extruded disc herniation causes the posterior longitudinal ligament to rupture which exposes the herniated part to the vascular bed of the epidural space. It is believed that inflammatory cells are originating from these blood vessels situated in the outermost part of the intervertebral disc.
These cells may help secrete substances that cause inflammation and irritation of the nerve roots causing sciatic pain. Therefore, extruded herniations are more likely to cause pain and clinical impairment than those that are contained. In contained herniations, the mechanical effect is predominant while in the unconfined or the extruded discs the inflammatory effect is predominant.
Clinical Disc Herniation and What to Look for in the History
The symptoms of the disc herniation can vary a great deal depending on the location of the pain, the type of herniation, and the individual. Therefore, history should focus on the analysis of the main complaint among the many other symptoms.
The chief complaint can be neck pain in cervical disc herniation and there can be referred pain in the arms, shoulders, neck, head, face, and even the lower back region. However, it is most commonly referred to as the interscapular region. The radiation of pain can occur according to the level at the herniation is taking place. When the nerve roots of the cervical region are affected and compressed, there can be sensory, and motor changes with changes in the reflexes.
The pain that occurs due to nerve root compression is called radicular pain and it can be described as deep, aching, burning, dull, achy, and electric depending on whether there is mainly motor dysfunction or sensory dysfunction. In the upper limb, the radicular pain can follow a dermatomal or myotomal pattern. Radiculopathy usually does not accompany neck pain. There can be unilateral as well as bilateral symptoms. These symptoms can be aggravated by activities that increase the pressure inside the intervertebral discs such as the Valsalva maneuver and lifting.
Driving can also exacerbate pain due to disc herniation due to stress because of vibration. Some studies have shown that shock loading and stress from vibration can cause a mechanical force to exacerbate small herniations but flexed posture had no influence. Similarly, activities that decrease intradiscal pressure can reduce the symptoms such as lying down.
The main complaint in lumbar disc herniation is lower back pain. Other associated symptoms can be a pain in the thigh, buttocks, and anogenital region which can radiate to the foot and toe. The main nerve affected in this region is the sciatic nerve causing sciatica and its associated symptoms such as intense pain in the buttocks, leg pain, muscle weakness, numbness, impairment of sensation, hot and burning or tingling sensation in the legs, dysfunction of gait, impairment of reflexes, edema, dysesthesia or paresthesia in the lower limbs. However, sciatica can be caused by causes other than herniation such as tumors, infection, or instability which need to be ruled out before arriving at a diagnosis.
The herniated disc can also compress on the femoral nerve and can give rise to symptoms such as numbness, tingling sensation in one or both legs, and a burning sensation in the legs and hips. Usually, the nerve roots that are affected in herniation in the lumbar region are the ones exiting below the intervertebral disc. It is thought that the level of the nerve root irritation determines the distribution of leg pain. In herniations at the third and fourth lumbar vertebral levels, the pain may radiate to the anterior thigh or the groin. In radiculopathy at the level of the fifth lumbar vertebra, the pain may occur in the lateral and anterior thigh region. In herniations at the level of the first sacrum, the pain may occur in the bottom of the foot and the calf. There can also be numbness and tingling sensation occurring in the same area of distribution. The weakness in the muscles may not be able to be recognized if the pain is very severe.
When changing positions the patient is often relieved from pain. Maintaining a supine position with the legs raised can improve the pain. Short pain relief can be brought by having short walks while long walks, standing for prolonged periods, and sitting for extended periods of time such as in driving can worsen the pain.
The lateral disc herniation is seen in foraminal and extraforaminal herniations and they have different clinical features to that of medial disc herniation seen in subarticular and central herniations. The lateral intervertebral disc herniations can when compared to medial herniations more directly irritate and mechanically compress the nerve roots that are exiting and the dorsal root ganglions situated inside the narrowed spinal canal.
Therefore, lateral herniation is seen more frequently in older age with more radicular pain and neurological deficits. There is also more radiating leg pain and intervertebral disc herniations in multiple levels in the lateral groups when compared to medial disc herniations.
The herniated disc in the thoracic region may not present with back pain at all. Instead, there are predominant symptoms due to referred pain in the thorax due to irritation of nerves. There can also be predominant pain in the body that travels to the legs, tingling sensation and numbness in one or both legs, muscle weakness, and spasticity of one or both legs due to exaggerated reflexes.
The clinician should look out for atypical presentations as there could be other differential diagnoses. The onset of symptoms should be inquired about to determine whether the disease is acute, sub-acute, or chronic in onset. Past medical history has to be inquired about in detail to exclude red flag symptoms such as pain that occurs at night without activity which can be seen in pelvic vein compression, and non-mechanical pain which may be seen in tumors or infections.
If there is a progressive neurological deficit, with bowel and bladder involvement is there, it is considered a neurological emergency and urgently investigated because cauda equine syndrome may occur which if untreated, can lead to permanent neurological deficit.
Getting a detailed history is important including the occupation of the patient as some activities in the job may be exacerbating the patient’s symptoms. The patient should be assessed regarding which activities he can and cannot do.
Differential Diagnosis
Degenerative disc disease
Mechanical pain
Myofascial pain leading to sensory disturbances and local or referred pain
Hematoma
Cyst leading to occasional motor deficits and sensory disturbances
Spondylosis or spondylolisthesis
Discitis or osteomyelitis
Malignancy, neurinoma or mass lesion causing atrophy of thigh muscles, glutei
Spinal stenosis is seen mainly in the lumbar region with mild low back pain, motor deficits, and pain in one or both legs.
An epidural abscess can cause symptoms similar to radicular pain involving spinal disc herniation
Aortic aneurysm which can cause low back pain and leg pain due to compression can also rupture and lead to hemorrhagic shock.
Hodgkin’s lymphoma in advanced stages can lead to space-occupying lesions in the spinal column leading to symptoms like that of intervertebral disc herniation
Tumors
Pelvic endometriosis
Facet hypertrophy
Lumbar nerve root schwannoma
Herpes zoster infection results in inflammation along with the sciatic or lumbosacral nerve roots
Examination in Disc Herniation
Complete physical examination is necessary to diagnose intervertebral disc herniation and exclude other important differential diagnoses. The range of motion has to be tested but may have a poor correlation with disc herniation as it is mainly reduced in elderly patients with a degenerative disease and due to disease of the joints.
A complete neurological examination is often necessary. This should test muscle weakness and sensory weakness. In order to detect muscle weakness in small toe muscles, the patient can be asked to walk on tiptoe. The strength of muscle can also be tested by comparing the strength to that of the clinician. There may be dermatomal sensory loss suggesting the respective nerve root involvement. The reflexes may be exaggerated or sometimes maybe even absent.
There are many neurologic examination maneuvers described in relation to intervertebral disc herniation such as the Braggart sign, flip the sign, Lasegue rebound sign, Lasegue differential sign, Mendel Bechterew sign, Deyerle sign both legs or Milgram test, and well leg or Fajersztajin test. However, all these are based on testing the sciatic nerve root tension by using the same principles in the straight leg raising test. These tests are used for specific situations to detect subtle differences.
Nearly almost all of them depend on the pain radiating down the leg and if it occurs above the knee it is assumed to be due to a neuronal compressive lesion and if the pain goes below the knee, it is considered to be due to the compression of the sciatic nerve root. For lumbar disc herniation detection, the most sensitive test is considered to be radiating pain occurring down the leg due to provocation.
In the straight leg raising test also called the Lasegue’s sign, the patient stays on his or her back and keeps the legs straight. The clinician then lifts the legs by flexing the hip while keeping the knee straight. The angle at which the patient feels pain going down the leg below the knee is noted. In a normal healthy individual, the patient can flex the hip to 80- 90? without having any pain or difficulty.
However, if the angle is just 30 -70? degrees, it is suggestive of lumbar intervertebral disc herniation at the L4 to S1 nerve root levels. If the angle of hip flexion without pain is less than 30 degrees, it usually indicates some other causes such as tumor of the gluteal region, gluteal abscess, spondylolisthesis, disc extrusion, and protrusion, malingering patient, and acute inflammation of the dura mater. If pain with hip flexion occurs at more than 70 degrees, it may be due to tightness of the muscles such as gluteus maximus and hamstrings, tightness of the capsule of the hip joint, or pathology of sacroiliac or hip joints.
The reverse straight leg raising test or hip extension test can be used to test higher lumbar lesions by stretching the nerve roots of the femoral nerve which is similar to the straight leg raising test. In the cervical spine, in order to detect stenosis of the foramina, the Spurling test is done and is not specific to cervical intervertebral disc herniation or tension of the nerve roots. The Kemp test is the analogous test in the lumbar region to detect foraminal stenosis. Complications due to the disc herniation include careful examination of the hip region, digital rectal examination, and urogenital examination is needed.
Investigation of Disc Herniation
For the diagnosis of intervertebral disc herniation, diagnostic tests such as Magnetic resonance imaging (MRI), Computed tomography (CT), myelography, and plain radiography can be used either alone or in combination with other imaging modalities. Objective detection of disc herniation is important because only after such a finding the surgical intervention is even considered. Serum biochemical tests such as prostate-specific antigen (PSA) level, Alkaline phosphatize value, erythrocyte sedimentation rate (ESR), urine analysis for Bence Jones protein, serum glucose level, and serum protein electrophoresis may also be needed in specific circumstances guided by history.
Magnetic Resonance Imaging (MRI)
MRI is considered the best imaging modality in patients with history and physical examination findings suggestive of lumbar disc herniation associated with radiculopathy according to North American Spinal Society guidelines in 2014. The anatomy of the herniated nucleus pulposus and its associated relationships with soft tissue in the adjacent areas can be delineated exquisitely by MRI in cervical, thoracic, and lumbosacral areas. Beyond the confines of the annulus, the herniated nucleus can be seen as a focal, asymmetric disc material protrusion on MRI.
On sagittal T2 weighted images, the posterior annulus is usually seen as a high signal intensity area due to radial annular tear associated with the herniation of the disc although the herniated nucleus is itself hypointense. The relationship between the herniated nucleus and degenerated facets with the nerve roots which are exiting through the neural foramina are well-demarcated on sagittal images of MRI. Free fragments of the intervertebral disc can also be distinguished from MRI images.
There may be associated signs of intervertebral disc herniation on MRI such as radial tears on the annulus fibrosus which is also a sign of degenerative disc disease. There may be other telling signs such as loss of disc height, bulging annulus, and changes in the endplates. Atypical signs may also be seen with MRI such as abnormal disc locations, and lesions located completely outside the intervertebral disc space.
MRI can detect abnormalities in the intervertebral discs superiorly to other modalities although its bone imaging is a little less inferior. However, there are limitations with MRI in patients with metal implant devices such as pacemakers because the electromagnetic field can lead to abnormal functioning of the pacemakers. In patients with claustrophobia, it may become a problem to go to the narrow canal to be scanned by the MRI machine. Although some units contain open MRI, it has less magnetic power and hence delineates less superior quality imaging.
This is also a problem in children and anxious patients undergoing MRI because good image quality depends on the patient staying still. They may require sedation. The contrast used in MRI which is gadolinium can induce nephrogenic systemic fibrosis in patients who had pre-existing renal disease. MRI is also generally avoided in pregnancy especially during the first 12 weeks although it has not been clinically proven to be hazardous to the fetus. MRI is not very useful when a tumor contains calcium and in distinguishing edema fluid from tumor tissue.
Computed Tomography (CT)
CT scanning is also considered another good method to assess spinal disc herniation when MRI is not available. It is also recommended as a first-line investigation in unstable patients with severe bleeding. CT scanning is superior to myelography although when the two are combined, it is superior both of them. CT scans can show calcification more clearly and sometimes even gas in images. In order to achieve a superior imaging quality, the imaging should be focused on the site of pathology and thin sections taken to better determine the extent of the herniation.
However, a CT scan is difficult to be used in patients who have already undergone laminectomy surgical procedures because the presence of scar tissue and fibrosis causes the identification of the structures difficult although bony changes and deformity in nerve sheath are helpful in making a diagnosis.
The herniated intervertebral discs in the cervical disc can be identified by studying the uncinate process. It is usually projected posteriorly and laterally to the intervertebral discs and superiorly to the vertebral bodies. The uncinate process undergoes sclerosis, and hypertrophy when there is an abnormal relationship between the uncinate process and adjacent structures as seen in degenerative disc disease, intervertebral disc space narrowing, and general wear and tear.
Myelopathy can occur when the spinal canal is affected due to disc disease. Similarly, when neural foramina are involved, radiculopathy occurs. Even small herniated discs and protrusions can cause impingement of the dural sac because the cervical epidural space is narrowed naturally. The intervertebral discs have attenuation a little bit greater than the sac characterized in the CT scan.
In the thoracic region, a CT scan can diagnose an intervertebral disc herniation with ease due to the fact that there is an increased amount of calcium found in the thoracic discs. Lateral to the dural sac, the herniated disc material can be seen on CT as a clearly defined mass that is surrounded by epidural fat. When there is a lack of epidural fat, the disc appears as a higher attenuated mass compared to the surrounding.
Radiography
Plain radiography is not needed in diagnosing herniation of the intervertebral discs, because plain radiographs cannot detect the disc and therefore are used to exclude other conditions such as tumors, infections, and fractures.
In myelography, there may be deformity or displacement of the extradural contrast-filled thecal sac seen in herniation of the disc. There may also be features in the affected nerve such as edema, elevation, deviation, and amputation of the nerve root seen in the myelography image.
Diskography
In this imaging modality, the contrast medium is injected into the disc in order to assess the disc morphology. If pain occurs following injection that is similar to the discogenic pain, it suggests that that disc is the source of the pain. When a CT scan is also performed immediately after discography, it is helpful to differentiate the anatomy and pathological changes. However, since it is an invasive procedure, it is indicated only in special circumstances when MRI and CT have failed to reveal the etiology of back pain. It has several side effects such as headache, meningitis, damage to the disc, discitis, intrathecal hemorrhage, and increased pain.
Treatment of Herniated Disc
The treatment should be individualized according to the patient-guided through history, physical examination, and diagnostic investigation findings. In most cases, the patient gradually improves without needing further intervention in about 3 – 4 months. Therefore, the patient only needs conservative therapy during this time period. Because of this reason, there are many ineffective therapies that have emerged by attributing the natural resolution of symptoms to that therapy. Therefore, conservative therapy needs to be evidence-based.
Conservative Therapy
Since the herniation of the disc has a benign course, the aim of treatment is to stimulate the recovery of neurological function, reduce pain, and facilitate early return to work and activities of daily living. The most benefits of the conservative treatment are for younger patients with hernias that are sequestered and in patients with mild neurological deficits due to small disc hernias.
Bed rest has long been considered a treatment option in herniation of the disc. However, it has been shown that bed rest has no effect beyond the first 1 or 2 days. The bed rest is regarded as counterproductive after this period of time.
In order to reduce the pain, oral non-steroidal anti-inflammatory drugs such as ibuprofen and naproxen can be used. This can relieve the pain by reducing inflammation associated with the inflamed nerve. Analgesics such as acetaminophen can also be used although they lack the anti-inflammatory effect seen in NSAIDs. The doses and the drugs should be appropriate for the age and severity of the pain in the patient. If pain is not controlled by the current medication, the clinician has to go one step up on the WHO analgesics ladder. However, the long-term use of NSAIDs and analgesics can lead to gastric ulcers, liver, and kidney problems.
In order to reduce the inflammation, other alternative methods such as applying ice in the initial period and then switching to using heat, gels, and rubs may help with the pain as well as muscle spasms. Oral muscle relaxants can also be used in relieving muscle spasms. Some of the drugs include methocarbamol, carisoprodol, and cyclobenzaprine.
However, they act centrally and cause drowsiness and sedation in patients and it does not act directly to reduce muscle spasm. A short course of oral steroids such as prednisolone for a period of 5 days in a tapering regime can be given to reduce the swelling and inflammation in the nerves. It can provide immediate pain relief within a period of 24 hours.
When the pain is not resolved adequately with maximum effective doses, the patient can be considered for giving steroid injections into the epidural space. The major indication for the steroid injection into periradicular space is discal compression causing radicular pain that is resistant to conventional medical treatment. A careful evaluation with CT or MRI scanning is required to carefully exclude extra discal causes for pain. The contraindications for this therapy include patients with diabetes, pregnancy, and gastric ulcers. Epidural puncture is contraindicated in patients with coagulation disorders and therefore the foraminal approach is used carefully if needed.
This procedure is performed under the guidance of fluoroscopy and involves injecting steroids and an analgesic into the epidural space adjacent to the affected intervertebral disc to reduce the swelling and inflammation of the nerves directly in an outpatient setting. As much as 50% of the patients experience relief after the injection although it is temporary and they might need repeat injections at 2 weekly intervals to achieve the best results. If this treatment modality becomes successful, up to 3 epidural steroidal injections can be given per year.
Physical therapy can help the patient return to his previous life easily although it does not improve the herniated disc. The physical therapist can instruct the patient on how to maintain the correct posture, walking, and lifting techniques depending on the patient’s ability to work, mobility, and flexibility.
Stretching exercises can improve the flexibility of the spine while strengthening exercises can increase the strength of the back muscles. The activities which can aggravate the condition of the herniated disc are instructed to be avoided. Physical therapy makes the transition from intervertebral disc herniation to an active lifestyle smooth. The exercise regimes can be maintained for life to improve general well-being.
The most effective conservative treatment option that is evidence-based is observation and epidural steroid injection for the relief of pain in the short-term duration. However, if the patients so desire they can use holistic therapies of their choice with acupuncture, acupressure, nutritional supplements, and biofeedback although they are not evidence-based. There is also no evidence to justify the use of trans electrical nerve stimulation (TENS) as a pain relief method.
If there is no improvement in the pain after a few months, surgery can be contemplated and the patient must be selected carefully for the best possible outcome.
Surgical Therapy
The aim of surgical therapy is to decompress the nerve roots and relieve the tension. There are several indications for surgical treatment which are as follows.
Absolute indications include cauda equina syndrome or significant paresis. Other relative indications include motor deficits that are greater than grade 3, sciatica that is not responding to at least six months of conservative treatment, sciatica for more than six weeks, or nerve root pain due to foraminal bone stenosis.
There have been many discussions over the past few years regarding whether to treat herniation of intervertebral disc disease with prolonged conservative treatment or early surgical treatment. Much research has been conducted in this regard and most of them show that the final clinical outcome after 2 years is the same although the recovery is faster with early surgery. Therefore, it is suggested that early surgery may be appropriate as it enables the patient to return to work early and thereby is economically feasible.
Some surgeons may still use traditional discectomy although many are using minimally invasive surgical techniques over recent years. Microdiscectomy is considered to be the halfway between the two ends. There are two surgical approaches that are being used. Minimally invasive surgery and percutaneous procedures are the ones that are being used due to their relative advantage. There is no place for the traditional surgical procedure known as a laminectomy.
However, there are some studies suggesting microdiscectomy is more favorable because of its both short-term and long-term advantages. In the short term, there is a reduced length of operation, reduced bleeding, relief of symptoms, and reduced complication rate. This technique has been effective even after 10 years of follow-up and therefore is the most preferred technique even now. The studies that have been performed to compare the minimally invasive technique and microdiscectomy have resulted in different results. Some have failed to establish a significant difference while one randomized control study was able to determine that microdiscectomy was more favorable.
In microdiscectomy, only a small incision is made aided by an operating microscope and the part of the herniated intervertebral disc fragment which is impinging on the nerve is removed by hemilaminectomy. Some part of the bone is also removed to facilitate access to the nerve root and the intervertebral disc. The duration of the hospital stay is minimal with only an overnight stay and observation because the patient can be discharged with minimal soreness and complete relief of the symptoms.
However, some unstable patients may need more prolonged admission and sometimes they may need fusion and arthroplasty. It is estimated that about 80 – 85 % of the patients who undergo microdiscectomy recover successfully and many of them are able to return to their normal occupation in about 6 weeks.
There is a discussion on whether to remove a large portion of the disc fragment and curetting the disc space or to remove only the herniated fragment with minimal invasion of the intervertebral disc space. Many studies have suggested that the aggressive removal of large chunks of the disc could lead to more pain than when conservative therapy is used with 28% versus 11.5 %. It may lead to degenerative disc disease in the long term. However, with conservative therapy, there is a greater risk of recurrence of around 7 % in herniation of the disc. This may require additional surgery such as arthrodesis and arthroplasty to be performed in the future leading to significant distress and economic burden.
In the minimally invasive surgery, the surgeon usually makes a tiny incision in the back to put the dilators with increasing diameter to enlarge the tunnel until it reaches the vertebra. This technique causes lesser trauma to the muscles than when seen in traditional microdiscectomy. Only a small portion of the disc is removed in order to expose the nerve root and the intervertebral disc. Then the surgeon can remove the herniated disc by the use of an endoscope or a microscope.
These minimally invasive surgical techniques have a higher advantage of lower surgical site infections and shorter hospital stays. The disc is centrally decompressed either chemically or enzymatically with the use of chymopapain, laser, or plasma (ionized gas) ablation and vaporization. It can also be decompressed mechanically by using percutaneous lateral decompression or by aspirating and sucking with a shaver such as a nucleosome. Chemopapin was shown to have adverse effects and was eventually withdrawn. Most of the above techniques have shown to be less effective than a placebo. Directed segmentectomy is the one that has shown some promise in being effective similar to microdiscectomy.
In the cervical spine, the herniated intervertebral discs are treated anteriorly. This is because the herniation occurs anteriorly and the manipulation of the cervical cord is not tolerated by the patient. The disc herniation that is due to foraminal stenosis and that is confined to the foramen are the only instances where a posterior approach is contemplated.
The minimal disc excision is an alternative to the anterior cervical spine approach. However, the intervertebral disc stability after the procedure is dependent on the residual disc. The neck pain can be significantly reduced following the procedure due to the removal of neuronal compression although significant impairment can occur with residual axial neck pain. Another intervention for cervical disc herniation includes anterior cervical interbody fusion. It is more suitable for patients with severe myelopathy with degenerative disc disease.
Complications of the Surgery
Although the risk of surgery is very low, complications can still occur. Post-operative infection is one of the commonest complications and therefore needs more vigorous infection control procedures in the theatre and in the ward. During the surgery, due to poor surgical technique, nerve damage can occur. A dural leak may occur when an opening in the lining of the nerve root causes leakage of cerebrospinal fluid which is bathing the nerve roots. The lining can be repaired during the surgery. However, headache can occur due to loss of cerebrospinal fluid but it usually improves with time without any residual damage. If blood around the nerve roots clots after the surgery, that blood clot may lead to compression of the nerve root leading to radicular pain which was experienced by the patient previously. Recurrent herniation of the intervertebral disc due to herniation of disc material at the same site is a devastating complication that can occur long term. This can be managed conservatively but surgery may be necessary ultimately.
Outcomes of the Surgery
There has been extensive research done regarding the outcome of lumbar disc herniation surgery. Generally, the results from the microdiscectomy surgery are good. There is more improvement of leg pain than back pain and therefore this surgery is not recommended for those who have only back pain. Many patients improve clinically over the first week but they may improve over the following several months. Typically, the pain disappears in the initial recovery period and it is followed by an improvement in the strength of the leg. Finally, the improvement of the sensation occurs. However, patients may complain of feeling numbness although there is no pain. The normal activities and work can be resumed over a few weeks after the surgery.
Novel Therapies
Although conservative therapy is the most appropriate therapy in treating patients, the current standard of care does not address the underlying pathology of herniation of the intervertebral discs. There are various pathways that are involved in the pathogenesis such as inflammatory, immune-mediated, and proteolytic pathways.
The role of inflammatory mediators is currently under research and it has led to the development of new therapies that are directed at these inflammatory mediators causing damage to the nerve roots. The cytokines such as TNF ? are mainly involved in regulating these processes. The pain sensitivity is mediated by serotonin receptor antagonists and ?2 adrenergic receptor antagonists.
Therefore, pharmacological therapies that target these receptors and mediators may influence the disease process and lead to a reduction in symptoms. Currently, cytokine antagonists against TNF ? and IL 1? have been tested. Neuronal receptor blockers such as sarpogrelate hydrochloride etc have been tested in both animal models and in clinical studies for the treatment of sciatica. Cell cycle modifiers that target the microglia that are thought to initiate the inflammatory cascade have been tested with the neuroprotective antibiotic minocycline.
There is also research on inhibiting the NF- kB or protein kinase pathway recently. In the future, the treatment of herniation of the intervertebral disc will be much more improved thanks to the ongoing research. (Haro, Hirotaka)
Dr. Alex Jimenez DC, MSACP, RN, CCST
A disc bulge and/or a herniated disc is a health issue that affects the intervertebral discs found in between each vertebra of the spine. Although these can occur as a natural part of degeneration with age, trauma or injury as well as repetitive overuse can also cause a disc bulge or a herniated disc. According to healthcare professionals, a disc bulge and/or a herniated disc is one of the most common health issues affecting the spine. A disc bulge is when the outer fibers of the annulus fibrosus are displaced from the margins of the adjacent vertebral bodies. A herniated disc is when a part of or the whole nucleus pulposus is protruded through the torn or weakened outer annulus fibrosus of the intervertebral disc. Treatment of these health issues focuses on reducing symptoms. Alternative treatment options, such as chiropractic care and/or physical therapy, can help relieve symptoms. Surgery may be utilized in cases of severe symptoms. – Dr. Alex Jimenez D.C., C.C.S.T. Insight
Curated by Dr. Alex Jimenez D.C., C.C.S.T.
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In today’s podcast, Dr. Alex Jimenez and Dr. Mario Ruja discuss how health and immunity play a role in the human body to achieve overall health and wellness.
How To Protect Our Health & Immunity?
[00:00:00] Dr. Alex Jimenez DC*: And it is going live, Mario. How are you doing, man? Today we’re doing a presentation, my brother on health and immunity. How are you doing, my brother?
[00:00:12] Dr. Mario Ruja DC*: Excellent. You know what, this is a topic that everyone’s talking about, and we all deserve to have a great conversation and, most of all, to support each other with knowledge and with positive intent. Absolutely.
[00:00:32] Dr. Alex Jimenez DC*: Mario, what we’re going to do today is you and I, as we discuss, we want to present this information for the public so that they can understand that first of all, this is by no means any treatment, this is a disclaimer. I have to say that a licensed doctor must perform all treatments. This is only for educational purposes. It is not treated and is not used for diagnosis and treatment as standard disclaimer would go. Typically, I’d had that presented, but what we’re going to be doing now is going to be doing a webinar series, Mario and I. We’re going to be doing a four-series webinar where we will discuss health and immunity and how we can improve our immunity in getting our bodies strong enough. Now we’ve been going through this process of COVID 19 and the SARS and all the SARS-CoV-2 viruses. And what we want to do is give ourselves a better option, a better treatment protocol that is there for us so that we can kind of come up with a plan to help our body support itself. So Mario and I put together these program protocols here. And what we want to do is we want to present an excellent presentation where we’re going to go over natural approaches and natural forces to help in immunity. Now, Dr. Ruja practices on the central side of town. I practice in the far east of El Paso, and what we provide our patients is quite a bit of information, but people often want to know what they can do. So what we’re going to start doing today is we’re going to start talking about what we can and cannot control the virus. One of the things that we’ve learned is that separation is probably the best key, and we’re using social distancing as one of the things that prevent us from getting close now. I like to give people some insight into what we’re doing in our offices to prevent the virus from spreading. Mario, tell us a bit of what you’re doing in your particular practice when you’re doing prevention for treating patients, and you’re working through your protocols with your patients?
[00:02:33] Dr. Mario Ruja DC*: In my office, we have a system through which we use the enviro masters in each of the rooms that fumigate each room, and then we utilize U.V. light for the specific use of disinfectant from bacteria, virus and fungus, U.V. light. And the other thing that we use is the masks. We wear masks inside we space patients, and we also ask them if they can wait in the car until they get to be seen and they can call us directly. And that way, they feel more comfortable. So if we get more than, let’s say, three patients at one time where we can’t place them in different rooms and we like to put everyone in separate rooms, so they’re not together next to each other, we ask them to wait in the car and then we will call them and let them know we are ready for you. And then they walk in. They go directly into the room and do a procedure is done. And so those are things that we’re doing. And then, of course, you know, we’re, you know, disinfected tables. We’re doing all of that. We use a lot of U.V. lighting that is positive in terms of prevention. You know, when everyone washes their hands, when they walk in, the first thing they do is wash their hands. And we’re encouraging people to do the same thing when they get home. So we want to be a model to our community to say, Look, don’t just do this because you come to my office, do this at home with your family. How about that?
[00:04:29] Dr. Alex Jimenez DC*: We’re likewise in terms of our office; we’ve taken the no-touch approach. One of the things that we do is we don’t have any sitting areas in our office, no more. We have quite a few rooms. So what we have is the ability to open the door. And we make sure that everybody has a mask when we walk them in. Now they don’t touch anything. We are touchless. We walk straight into the room. We have them lay down. We have the tables covered with special paper that prevents viral static. And also, once we work on them, they get up, walk out a different door, and don’t touch anything other than the table. So one of the things is that we don’t allow anyone to get near each other and they walk in, walk out almost in the design of our office. It’s a flow-in and flows out process. There’s no treatment in the sense of touching the diagnostic treatment protocols, such as the computers. None of that goes on. We ask all the questions and the moment before the patient comes in. We sterilize a room, and after the room, they’re also sterilized. So it’s a great process because if we look at the area of contact, the doctors are wearing gloves, our face masks are protected. We have masks on and provide the mask for the patient itself. So we try to give it the most comfortable thing like yourself. We also do the process by which we had them wait in the car until they were ready. Once they call, we go, OK, we’re ready. And as soon as we got the room ready cued, it allowed us to bring in a patient. So one of the most important things is to do the pre-post-treatment protocols on the viral static processes. And that’s the way we control the host. You know, sort of we are the potentials, right? So together with the doctor, the mask, and the staff with the mask and gloves. This prevents all the processes from occurring, at least in our area, because in your side of town, we’ve noticed that there’s also there’s this predisposition as well as on our side. My side of town has a more significant number, so many shows up. So we have to be very careful to control those hosts in that capacity now. I want to go over and begin the presentation, and we’re going to talk about the things that create our predispositions, and you and I were going over this. We coronary vascular disease is one of the highest predisposing factors. Diabetes, we’ve talked about things like obesity, hypertension, age. Tell me a bit about your situation with Mario. When you look at this list here, when you’ve seen that in the studies, what have you learned about the predisposing factors that are also out there causing dramas to our patients?
[00:07:23] Dr. Mario Ruja DC*: You know Alex, that is something that we all have not just to be mindful of, but we need to motivate people towards the highest level of health, which means decreasing your inflammatory process or inflammatory state of your body. OK. So when we’re talking about cardiovascular disease, diabetes, obesity, hypertension. I connect that with metabolic syndrome, which we’ve had other shows before I can remember. And this is unbelievable because we talked about that before three or four months. I mean, do you remember that, Alex?
[00:08:09] Dr. Alex Jimenez DC*: Yeah, we were talking about it.
[00:08:10] Dr. Mario Ruja DC*: Yeah, we talked about it before anything COVID 19. And we wanted to inspire our community and everyone to decrease their risk for metabolic syndrome again, which is one of the biggest ones because obviously, you know, 150 plus triglycerides, the belly fat about obesity, and type two diabetes. So that is huge. So this is such a, I should say it’s a connection. It’s follow-through with our insightful conversation you and I had three or four months ago, Alex. Absolutely.
How To Protect Our Health?
[00:08:54] Dr. Alex Jimenez DC*: You know, the studies were presented, and it became evident early on in the COVID 19 saga that it’s still going on that those that were unhealthy were the predisposed ones. It’s seamless when you are the, I hate to say, but you could sometimes tell people were morbidly obese; it wiped out the whole family. And in one case where you could see that many were, you have to ask yourself, Well, why does the entire family? But then we found out there were underlying issues regarding their health, whether they had diabetes or had hypertension issues. One of the ones that are also really big is chronic kidney disease. I heard the number, and then the statistics show that up from two percent higher increase mortality to over 16 times more mortality rate with kidney disease. There’s a clear link between the blood pressure, the ability for the body to profuse that gets limited when the oxygen level goes down, that the failure of the kidneys and the heart and the liver gets compounded by this disorder that affects the alveoli of the lungs. From what we’re understanding, it’s not so much the virus that kills us. It’s the inflammatory cytokine storm that causes this drama. So they’ve learned that people with radiation therapy, people with predisposing chemotherapies, their lungs are predisposed to injuries, autoimmune conditions like lupus. Some disorders like even chronic neurological diseases like M.S. Those people are predisposed because their immune system is in a different, responsive state. So when we talk about these treatment protocols, one of the things that we have to do is how do we squelch? How do we deal with these reactive oxygen species that cause this cytokine storm? So our goal and our emphasis are until we have an inoculation or a vaccine for this process as we develop it, our job is to mitigate the inflammatory reaction. And there are quite a few things that naturally we can do to minimize this inflammatory response. Now what we’re going to do is we’re going to continue with the hearing, and we’re going to take a look at specific areas here. We talk about co-morbidities. Mario tells us a bit of what we’ve seen here regarding co-morbidities. And by the way, we have all the studies here. So as we do this presentation, all the links will be provided at the bottom so that you can look at these studies individually, and they make more sense to you when you pull them up.
[00:11:29] Dr. Mario Ruja DC*: Alex, as we spoke earlier, three or four months ago, when we started going…
[00:11:38] Dr. Mario Ruja DC*: Across the aisle…
[00:11:43] Dr. Mario Ruja DC*: Thanks for the intro music, Alex,
[00:11:50] Dr. Alex Jimenez DC*: No problem.
[00:11:51] Dr. Mario Ruja DC*: Was that Van Halen or what?
[00:11:53] Dr. Alex Jimenez DC*: No, Alexander’s music is actually.
[00:11:57] Dr. Mario Ruja DC*: OK, I’ll tell Alex. Thank you. So getting back to what we’re talking about again. Again, our natural innate immune system is that blueprint through our DNA, RNA in our recovery resilient pattern within our cells. We can adapt and thrive and get through all of these variables in life; I mean, we’re dealing with viruses all the time, Alex. I mean, last year it was again influenza. You know, 50000 people again, I don’t have the exact numbers, but 50000 people die. OK. And you know, through that, we’re looking at who the risk factors are? What are the co-morbidities? What are those things that set us up for the most significant failure rate? So when we’re looking at 71 percent and 78 percent of those cases that are not working through and creating that resilience and working through the COVID 19 or other things? I mean, again, that’s what we spoke about three-four months ago. I mean, I want to say like, we’re psychic, you know, like, wow, you know.
[00:13:32] Dr. Alex Jimenez DC*: It affects it, you know? And one of the craziest things is that the school’s out, and you know, as well as I do, is that every time we hear about this, we may find out that this virus is present in our population way before we’re even talking about it. We’re talking about it’s gone from March to February to now, early January. We’re going to hear about facts that this thing was present even in mid-December. You’re going to see.
[00:13:56] Dr. Mario Ruja DC*: I was not surprised. I wouldn’t be surprised.
[00:13:59] Dr. Alex Jimenez DC*: There is no logic behind the fact that it keeps on in Greece other than the fact that this thing got out of hand way before even there were notifications.
[00:14:08] Dr. Mario Ruja DC*: And you know what, Alex? Just to, you know, beyond the point with what you mentioned, the three things whether it’s COVID 19 or whether it’s influenza or whether it’s anything, you know, stressing our immune system, we will fail if we have these predispositions. Alex, which is one diabetes just like diabetes, gives us a predisposition for cancer. Yes, it does. Diabetes provides us with a predisposition for cardiovascular disease, correct? Yes. Diabetes gives us all that. And then you’re looking at chronic lung disease, obviously, because the ecosystem where COVID 19 thrives is that respiratory environment. So, of course, if that is at risk or altered or at a shallow resilience pattern, of course. I mean, you will know people who have asthma. Like my wife, Karen has asthma and chronic health issues. I mean, my gosh, you know, it’s critical that we are aware and we are mindful again; let’s not panic. OK, but we’re aware, mindful, and strategic planning to deal with and work through these times. So if you have diabetes, type two diabetes, or type one diabetes, please be extra cautious. If you have asthma and any chronic lung disease, please know. I mean, you know what? You’ve got to decrease your exposure because your body cannot deal with it, right?
[00:16:00] Dr. Alex Jimenez DC*: And when the craziest components of this virus are that it’s very silent in most cases and most of the situation as we see the numbers come in. Those in the 70s and 80s range are suffering the most significant amount. So many times, it’s the kids who are bringing it to their homes. And when we look at places like Italy, we look at places like Pakistan, where there’s a high concentration of populations and youth; it’s almost like they’re inoculating their homes. And then those with these predisposing issues become the victims. So clearly, we’re seeing that the individuals who may have nothing to do with being exposed are indirectly exposed by those who visit them. So that’s why we, as a population, you’re going to hear it everywhere in the news; as you listen to it consistently, we have to be mindful of those that we surround ourselves with.
[00:16:51] Dr. Mario Ruja DC*: I want to jump in and make this correlation that you just mentioned right now, the youth with the elderly and the secondary morbidity risk factors within our population. And I honor and respect the fact that we as a nation, as a society and a city, I’m just going to verbalize this. I know it’s not comfortable. I know it’s very irritable. It has economic effects. It has emotional consequences. It has all of these things. But let me say this, OK? Number one. The youth, the children, they’re not going to school. The child care facilities are shutting down. That makes a lot of sense, doesn’t it, Alex, because now the symptoms were children. You don’t have any symptoms. I mean, we have seen a study right here. Dr. Robert Redfield, Director of CDC, March 31, 2020. We’re talking about less, you know, 25 percent have symptoms. So for children…
How To Protect Our Immune System?
[00:18:02] Dr. Alex Jimenez DC*: And the studies, 25 percent, as you said, 20 percent of people.
[00:18:06] Dr. Mario Ruja DC*: What happens is those children have they’re very resilient. They’re very strong. So now, if they are exposed, they have multiple exposures with other children and teachers. With all that, they go back to their parents, and then their parent is either diabetic or has, you know, Crohn’s disease, fibromyalgia, or asthma. They are actually putting their own family at risk. So, it’s such a sensitive area, Alex. And nobody wants to stay at home, and we want our kids at school. I mean, I can tell you right now, you know, it gets to the point where it gets irritable. But I think for the greater good right now, and it’s absolutely good.
[00:18:54] Dr. Alex Jimenez DC*: When we got this on the fact that these underlying issues, you know, as the studies are 60 percent of the people, as you see right, there has one underlying issue. Even if these one, just one, whether it’s heart disease, kidney disease, a chronic liver disorder, these are the underlying diseases that basically and asthma and asthma is an issue, OK? So these are of the three.
[00:19:18] Dr. Mario Ruja DC*: Let me ask you what the percentage is? OK, you may or may not know this, but it just came to mind. What percentage of our population is dealing with asthma or asthma-related issues? What are they?
[00:19:33] Dr. Alex Jimenez DC*: It’s a pretty good substantial amount. I mean, I don’t know the percentage; it’s at least about five percent of the population is chronic or has a predisposing issue with asthma, and if not there in the triggering zones as they trigger that area, let’s assume they get it. Their body becomes distressed in some capacity, and they launch themselves into an asthma attack. That’s just the asthma of not including the inflammatory response of this virus. In terms of the cytokine storm, you know?
[00:20:03] Dr. Mario Ruja DC*: You know, Alex, earlier this year, my wife Karen had to go to the E.R. due to respiratory issues and things like that. And I mean, it was a trigger again, December, January. You know, it’s like the flu. You know that that time where if you’re on edge, that’s it. OK, that’s it. You won’t recover. And it’s like, Thank God that that happened then instead of now, Alex. Absolutely. I think it, I mean, and then my oldest son, Gabrielle, he’s always had challenges, you know, kind of like that. It’s like, man, it’s so frustrating for children. But I could just imagine this is devastating for people 50 and older.
[00:20:54] Dr. Alex Jimenez DC*: Exactly. It is. It’s an issue that what we have to do is we have to figure out what’s going on. We’re noticing it’s most likely males are 1.3 times the chance to see this.
[00:21:07] Dr. Mario Ruja DC*: More males again. Why is it, males?
[00:21:09] Dr. Alex Jimenez DC*: Oh, yes. We’ll look at this percent smoking two point five times a morbidity risk COPD congestive obstructive pulmonary disease 2.5 to 11 times. Smoking is almost devastating. If you’ve done it and you’ve been ill overnight.
[00:21:30] Dr. Mario Ruja DC*: This is a game-changer. And I want to advocate and motivate and support and show love. Suppose you are smoking, not just smoking, but vaping. Also, I’m just going to throw that out. Absolutely not. You have to agree with me, but hear me out again for the greater good. OK. Vaping, smoking, any of those things, please, it will put you at risk, and of course, certain people need to, you know, again, medications, I mean, I have, you know, patients that are using cannabis and CBDs and all that for chronic pain. And you know what, I understand. Again, it’s for the greater good. But the thing is, do you notice Alex within our conversations that we started five months ago, six months ago? Do you notice the same culprits showed themselves over and over and over again? Do you see that? Look at this. I mean, metabolic syndrome. Did we have the same conversation four months ago? Look at smoking males. Do males remember smoking in overweight? Remember that one? Yeah, crazy. Yeah, it’s crazy for me.
[00:22:47] Dr. Alex Jimenez DC*: With the kidneys, I mean, if you can see the disparity between two and 50 percent, that’s one that kind of is. It’s perplexing because of the range. But when you understand kidney pathology, there are five stages of kidney disorder from kidney stage level one, which is a mild amount of kidney issue to the severe extent. Usually, we have a blood test going to test that. But if you’re in stage five or stage four…
[00:23:11] Dr. Mario Ruja DC*: You will have kidney dialysis, I mean, come on, Alex. I mean, this is going to…
[00:23:17] Dr. Alex Jimenez DC*: Affect…
[00:23:18] Dr. Mario Ruja DC*: Your liver.
[00:23:19] Dr. Alex Jimenez DC*: No, the ability to break down the the the byproducts and to purify the blood, so to speak, and to clean it, so to speak, is going to be diminished if the kidney function is impaired in any way. So these are things that we have to look at in terms of what we’re doing now. We have some studies here in China, and they’re already coming in and saying that three percent of the 80-year-olds were the first reports. Of this, 87 percent of the people live between the ages of 30 and 79 years of age, eight percent, 80 percent, only eight percent are in their 20s. Moral OK. However, it’s a negligible mortality rate in the 20s, teens less than one percent. We live in a very culturally similar environment, such as we’re like in Italy, where the children and the grandparents do co-mingle, and specifically, we rate we stay. And, commonly, grandmas live with their families, and the young are involved in that situation. It’s like the perfect storm if the kid gets it and brings it to the parent. Well, that’s precisely what’s going on, the love of the passion of hugging those children, though they carry it, and they don’t have the presentation of the symptoms, which most, you know, a large number of people don’t have this presentation at all. They don’t have symptoms. Eighty percent of people don’t even have symptoms. So when they get that 20 percent of that of mortality, that’s the ones that associate with people with issues. And when they’re in their 80s and 90s, that’s what happens here. We have fatality rates averaging in the U.S. Go ahead, go ahead of two point three percent.
[00:24:57] Dr. Mario Ruja DC*: When you threw this out, we’re talking about China now; we’re not talking about the U.S.
[00:25:03] Dr. Alex Jimenez DC*: No, but this was China, but if you look at this, this is the fatality rate in China, so this is the same, very similar to what’s going on in Italy, right?
[00:25:13] Dr. Mario Ruja DC*: What I’m thinking about it because I’m looking at three percent, 80 years old and older. Right. And then huge 87 percent, 30 to 79. And I’m thinking. It should be a lot more for a more senior right, Alex. I’m just thinking, you know? Oh, sure.
[00:25:36] Dr. Alex Jimenez DC*: The reason is I say, Well, no, it’s not so much. At the elderly age, the immune system isn’t as vigorous as when you’re younger. So as what they’re seeing is that the immune system when you’re younger is a much more explosive potential, right? So in that situation, someone in their late 80s and 90s, because we’re having even in our own town, we’ve only had one person over over 80s that passed away. The majority of our people are again in exactly these ranges, which is what they say.
[00:26:07] Dr. Mario Ruja DC*: And Alex, they said this because I want to understand the article from February with JAMA. Are they saying that the mortality is three percent death or three percent survival?
[00:26:21] Dr. Alex Jimenez DC*: No mortality percent is mortality. The death rate.
[00:26:24] Dr. Mario Ruja DC*: OK, so that’s what I’m saying. I was expecting 80 and older to have higher mortality. That’s right.
[00:26:32] Dr. Alex Jimenez DC*: Yeah. OK, so that makes sense.
[00:26:34] Dr. Mario Ruja DC*: Yeah, I mean, it’s expensive for them to be like 90.
[00:26:37] Dr. Alex Jimenez DC*: No, and actually, if you look at El Paso Times and the Apostle presentation, you’ll see that the parabolic curve actually happens between the 70s and 60s. So that’s where a significant number of people pass away.
[00:26:51] Dr. Mario Ruja DC*: Obviously, there’s more. You know what? I’m trying to like, understand the y factor, Alex. So what I’m thinking about is those people from 30 to 79, they have more interaction, social interaction with diversity, people who are 80. Again, I hate to say this; they’re pretty much secluded, like on their own, if we visit like grandma once a month. Exactly, yes. So that’s one thing that’s got to play into, right?
[00:27:19] Dr. Alex Jimenez DC*: That’s got to play into it. Because the reality is when I see my elderly, many of them want to live on their own. And many of them do. And the perfect storm is having the elderly come cooped up together. And that’s where we have the rest homes where people are actually in the health care, in the hospice areas, in the elderly are sick homes. Those people have high numbers. And you see in the news where those areas are huge, and we see that happening. So I think there’s a lot to be learned as we’re going in this. One of the things that we’re trying to do here is to give people a heads up about what’s going on. And we’ve noticed that an early sign of susceptibility or that you’re being exposed to this is anosmia. Do you believe that Mario? Anosmia, the lack of smell.
How Inflammatory Factors Affect Our System
[00:28:10] Dr. Mario Ruja DC*: That was very surprising. For me, like the inability to smell if you’re OK because of the damage, like, you know, what’s happening? But again, I’m thinking because of the pathway, the pathogenic path, you’re breathing in all of that. And then there is taste.
[00:28:36] Dr. Alex Jimenez DC*: As they both go into effect in the match of the smell is what we taste on. So we see that these kinds of parables or parallels are being noticed. One of the things that we’re witnessing is high inflammation burn induced by vascular inflammatory myocarditis. So in the inflammatory response, we’re seeing if the person is having some sort of inflammatory response. It goes from the lungs to the heart and the liver; these people have myocardial issues in inflammatory areas because they work on the type two receptors, the type two receptors easy to remember type two, there’s two lungs, two valves, two kidneys. OK, so those areas that have the two in there. Type 2s are the ones that are going to get pounded really hard. So when we see that, we understand that there is an association with inflammatory vascular issues for that. Now we also noticed that there’s a lag time. Now we’ve seen here that there’s a five-day lag time. Now the influenza virus hits two at a rate of almost two days. We’ve had a range between actually it’s nearly seven, but they’ve averaged the number to five days, meaning by the time the symptoms are present, you can know that someone’s affected you. The influenza virus nails you at two to three days, a very fast-moving bug. This one doesn’t move as fast, but it has symptoms within five days.
[00:30:06] Dr. Mario Ruja DC*: Getting back to what you’re saying about, can you move back to the previous one, please? Absolutely. So again, I just want to reiterate in our conversation, the first five minutes of the conversation when we talked about was about inflammatory processes of the body. Yes, that reaffirms that anything in your body is at a risk factor of inflammation, whether it’s your heart, your lungs, or your kidneys. Those are direct, specific markers, risks, and morbidity factors, all of our outcomes with COVID 19. Absolutely right. There’s no question, so if you are dealing with heart issues, on heart medication, or beta-blockers, please be not just mindful if you’re in that conversation. Again, don’t panic, but listen to our discussion on our podcast and in our, you know, future presentations because we want you to plan and understand, but not to panic and, you know, be all over the place. You see, we want to make it through this time, you know, and not just buckshot, you know, wear a mask. And because I wear a mask, I’m going to be OK. No, you’re not.
[00:31:53] Dr. Alex Jimenez DC*: Mario, we talked about the common symptoms presented because there’s a lot of confusion about I’m sneezing, and I got it. Right? Yeah. So one of the things is is that we have to look at the common presentation. The virus stimulates interleukin six and interleukin nine interleukin eight to these particular ones, affecting the hypothalamus through the prostate gland and approaching what that does. That creates the immediate response for temperature. So the body, once the body releases those are inflammatory cytokines. It causes the immune system to kick off. So at the immune system gets kicked off. It’s usually done at the launching of the hypothalamus. The hypothalamus raises the body temperature, the first one of people’s very first signs. So when we look at this, it’s not. It’s not uncommon that the most common symptom in this presentation is a fever. The fever is the thing that we assess, which; you mentioned that one of the things that we also do is to assess these dynamics to determine if you have a fever. In the beginning, people were sneezing, and it caught us at the same time as the hay fever stuff, you know, in the sneezing that happens locally. So almost if you sneeze, you feel like you were exposed to it. But the reality of sneezing is not the presentation that is noticed on this virus. This virus starts replicating. And by the end, it makes its heyday when it hits the lungs. So by the time it hits and causes a reactionary thing at the lung wall or the alveoli, it causes the inflammatory reaction to spilling out the cytokines that trigger the temperature change. So it’s like it does not like normal. Like, I got hay fever, I got nasal congestion. These people are being affected in a much more drastic way. It goes directly to the lungs. It enters the blood system. It goes, and it trends later does translations of the DNA. And once it starts producing that the body identifies it, the cells die, and then the immune system kicks in. By that time, you begin having congestion. So the cough and the fever are somewhat kind of misplaced sometimes. So we had the one that usually tipped us off the earliest is the fever.
[00:34:13] Dr. Mario Ruja DC*: And this is where again. It is the same pattern, the same pattern as the flu. Exactly. It would be mindful. I mean, this is not something; it’s not a different animal. No, it’s another species, but it’s in the same family. OK, so we’re talking about fever as the body’s response to fight the virus, correct? Correct. So that’s what it’s doing. Your body responds to fight and increase temperature and look at the correlation again. I want to make things simple because sometimes we get so complicated and things like that. I want to kind of bring it down to the common conversation. Number one, what do you hear in the news and media? The higher temperature in your environment, once it goes over 80 degrees, the COVID 19 decreases. Is that what we’re hearing?
[00:35:14] Dr. Alex Jimenez DC*: Absolutely. That’s it.
[00:35:15] Dr. Mario Ruja DC*: Matter of fact, it escalates with fever. So now the body is attempting to do the same thing. The body is fighting to increase its own heat for lack of better words to fight the virus. OK. And then with that, you’re talking about coughing now. Again, cough, shortness of breath. Now it gets a little more specific because, again, it’s not just a runny nose. Many people, you know, all have runny noses and say, Oh, I have COVID 19. Well, that’s not such a significant marker because I have shortness of breath and I have a fever. OK, with coughing. Now that one, we need to get real. Because just for you, coughing without fever and shortness of breath is a different conversation, Alex.
[00:36:08] Dr. Alex Jimenez DC*: One of the common things is that people have headaches. They have dizziness. These are all the chills. That’s a big one that people sometimes start feeling overall aches. They start having shortness of breath. Once the lungs are involved in the pulmonary exchange of oxygen is limited. That’s where the body starts trying to produce. The heart kicks up the same receptors, and temperature increases to tachycardia. So these are the areas that are being identified so we can see a correlation between those coronary issues that are secondary sputum production. So from here to here, we can see that we got the majority of symptoms from this area. We do end up having headaches. But look, where you notice nasal congestion, it’s way down there. Two percent to five percent of the people have the presentation and COVID virus of nasal congestion. OK? There are cases where we’ve noticed that the method and mode of transmission sadly is hand-washing touching the face in the triangular region of the eyes and the nose area in the mouth. This is an area. Also, oral-fecal is a place with the virus propagates. So when we’re looking at that, we have to make sure that we wash our hands very well when it comes to oral-fecal. It seems disgusting, but the reality is in our population, people may sometimes not wash their hands, or if they do wash their hands, they touch the faucet before they wash their hands. Does it make sense? So at that point, someone comes in after and handles the faucet in a public restaurant. And bam, you got it, and you touched your face.
[00:37:48] Dr. Mario Ruja DC*: It makes sense, and you don’t want that, Alex. This same conversation, again, is nothing new. So people need to use common sense. They need to be mindful and focused. When you and I go to the gym, OK, let’s forget COVID 19, forget all this stuff, OK? You know, going to the gym to work out. You have everybody’s stuff on the bench, on the dumbbells, on everything. Correct? It will get everyone very aware. So let’s look at it this way again. Go back to the basics of life. Number one, wash your hands before you eat. Wash your hands after you go into a different environment. Wash your hands. Sanitation. Hygiene. Let’s step it up, everybody. Step up your hygiene. Don’t take it for granted, OK? And just because you wear a mask, but you’re not washing your hands. Well, let me tell you, you have your mask over your nose in your mouth, correct? Right. Happens to your eyes. Exactly. That’s a conversation, right?
[00:39:03] Dr. Alex Jimenez DC*: So you realize that it comes in through the eyes as well.
[00:39:06] Dr. Mario Ruja DC*: And then let’s say you eat what you’re going to have to take your mask off to eat. So this is where that exposure is if you don’t wash your hands. And many people are using these hand sanitizers like crazy, right? And they’re dumping it. My point is to wash your hands, correct? Absolutely. And do that. So that’s an excellent point, Alex. Again, when we go to the gym and work out, how often do we wash our hands after leaving the gym? How many times, Alex?
[00:39:37] Dr. Alex Jimenez DC*: Every single time we don’t leave. We don’t leave until we wash our hands.
[00:39:42] Dr. Mario Ruja DC*: We wash at least three times before leaving.
[00:39:44] Dr. Alex Jimenez DC*: We wash it the first time, the second time you get the bugs off, and then spend a little bit cleaning the arms and the elbows down because you have to.
[00:39:52] Dr. Mario Ruja DC*: And then we are finished? No. Three times, you want to get that movement in and wash it all the way here. You know, like all the way to this, not just here. Don’t just rinse your fingers.
How To Stop Inflammation?
[00:40:04] Dr. Alex Jimenez DC*: The virus protects itself by an outer coating that is liposomal? So one of the crazy things is just thinking about it. How do you get grease off your dishes? You wash them with soap. Soap destroys the cell wall of the bacteria. So in a situation, you can see that just hand-washing. That’s why everyone talks about it is one of the main reasons we can discuss that. We noticed that the eyes we heard early reports that that the eyes would be like almost they’d all have, like bloodshot eyes. In the beginning, it was a very common presentation. Well, the reason is the immune system is protected very much at the eye level, at the conjunctival level. So one of the things, if something enters through the conjunctiva, you will have a reactionary response at that level. So often, you’re going to see many people producing kind of eye weeping, and because it enters through the eyes as well, it’s not as common as it does in the nose, in the mouth. But it is an area which is which goes to your point. We have to have eye protection. So in that sense, the best thing we can do if we’re in an environment such as a clinic is to have at least some sort of face coverage to prevent that stuff from occurring from floating around anywhere that it goes. Did you want to add anything to that particular point?
[00:41:25] Dr. Mario Ruja DC*: Yeah. You know, what I wanted to add is, again, the connections with other viruses. You see, I remember what we were dealing with AIDS, right? Fluid exchange eyes. You know, again, aids, HIV, those things need to be renewed in our daily usage and function. Likewise, be aware that just because you’re not touching your mouth, you’re touching your eyes. That’s an open portal. Going to see it is it’s an open portal to our blood-brain barrier. It’s an open portal to our system. And so with that, we mustn’t be only aware of it, but we protect ourselves in those areas. And what I would say is overall, the distancing, you know, I think this is the distancing. I mean, we’re not going to wear goggles everywhere we go, OK? The distancing is essential. And again, that spread, that coughing, OK, you’re not going to catch it by walking next to someone, and all of a sudden, it jumps into your eye. That’s right. Is that OK? To say yes, I’m going to jump into your eye?
[00:42:55] Dr. Alex Jimenez DC*: No. But yeah, that’s what they’re talking about.
[00:42:58] Dr. Mario Ruja DC*: So what we’re talking about is we’re talking about those things. So I don’t want people to get confused and go, Oh my gosh, I got to wear goggles all day everywhere.
[00:43:09] Dr. Alex Jimenez DC*: So in terms of once it breaks into the cells and once it does that, one of the great is that once inside the cell, the virus can make up, then 10000 copies itself per hour. 10000 copies. Mario, the cell, once it enters the liposomes in the ribosomes, it takes over the system. It uses an Android system where it just recreates its body parts and creates all the parts to propagate 10000 per hour. That’s per cell.
[00:43:40] Dr. Mario Ruja DC*: Hey, Alex. And I love this quote by Andrew Pecos. I love that guy, John Hopkins, who knows exactly what is going on. I love this quote. It’s like, you have these unexpected visitors breaking into your house, and they’re there for a while, and they’re going to eat your food. You know what? They’re going to use your furniture, and they’re going to produce 10000 babies and just trash it. And there it is. I love that because that’s where our own immune system has to block these unexpected visitors; say, No, you know what? We’re going to quarantine you, and we’re going to kick you out. And that’s where the older we are, the more susceptible we are, the less resilient we are. And with our secondary morbidities of CVD, diabetes, obesity, stress, sleep, we didn’t talk about that; Alex, lack of sleep we seeing right now. Are you? You and I haven’t come up to deal with these guys.
[00:44:52] Dr. Alex Jimenez DC*: We will be discussing at length the things that we can do, Mario, regarding the treatment protocols because what we’re just doing is the beginning of this process. But here we discussed, and we discussed this earlier. We talked about the ranges. You can see here that the fatality rate is one point thirty-eight, but you can see that the ratio is the highest in this particular group here. And as you look at that age group between the 60s and the 70s, that much falls in line with our town. And what we’re seeing is that in ours, ours is more like this in this town, and it’s going like this in our side. We don’t have this because we’ve usually done an excellent job, and we were able to identify early that the carriers of these things were non-symptomatic. So we’ve been able to hold that number of the elderly.
[00:45:45] Dr. Mario Ruja DC*: We are doing a great job. Yeah, in our town. So you know what I mean? We looked at the ratio from the Chinese model earlier, Alex. But again, I want to elucidate and complement the mayor, Mayor Margo, and all county and city officials working diligently. Veronica Escobar and the other representatives, you know what? We are doing great. We’re doing a great job, are doing exceptionally well compared to Houston, Dallas, Austin. We’re doing tremendous, and we need to pull together, work together, support each other to do this.
[00:46:38] Dr. Alex Jimenez DC*: I got to tell you this Mario, at that point, Dee Margo, had like a linear cut to this day as soon as we had 65 that were positive. He shut the downtown. He shut the town down. He just basically shut it off instantly. He put into the effects of the greater order, which was the governor’s orders. He put that into effect, closing down the schools, closing down all the aspects, closing down the parks, closing down everything. Because he knew then that his job was before us having one loss of life, just one loss of life, that’s before all that happened. Our mayor jumped on it, and we’re actually fortunate in this particular town where we live that we’ve been able to stop the massive hits that happened because we triggered the parachute push or the pull to slow down the city way before most towns would ever. I doubt there were very many towns that, after 65 people, positively shut it down. We are the 17th largest city in the United States. We are bigger than guess where? We are bigger than Miami. Mario, do you realize that we are bigger than Miami, and we were able to stop it? So to your point? Our mayor did very well by shutting down the city and threatening those promises during those tough times.
[00:47:55] Dr. Mario Ruja DC*: Leaders have to make tough decisions. Period. You know, we have to they have to step up. May not be popular, may not be, you know. Warm and fuzzy. But for the higher good.
[00:48:15] Dr. Alex Jimenez DC*: The higher the good, exactly,
[00:48:16] Dr. Mario Ruja DC*: Exactly. We have to do that. And in another component, I’m not sure if you have a slide on this one, but in terms of our exposure, you know, with our sister city Juarez, Mexico. It’s a different conversation, isn’t it? Yeah. If that were to be considered delineation because they shut down the border.
[00:48:44] Dr. Alex Jimenez DC*: What happened in terms of, let’s say, our sister city has a lot to do with the awareness, also the proximity and the close quarters of how people live here. We’re probably a little bit more spaced out. We closed down the city and did many mitigating factors to prevent distinct from getting out of hand on us. So as we looked at this, we have been able to respond in a bit much more aggressive fashion than what most people would have been able to do. So why does it spread so quickly? This is what we were talking about earlier we were talking about. This is getting to the mechanics of the ACE2 area or receptors. This virus has these tiny prongs and these little spikes they call, and it’s engulfed. It’s a bilipid layer area that protects it. And inside, it has an RNA molecule, a chain that will deploy on you. But the question is, it will land on some body component. And what we’re learning and this goes to the treatment protocols that we’re going to be discussing a little bit later than when we discussed these areas, we can see that the receptors in these areas are the ones that receive it. And from there, it deploys its pod. And once it deploys its pod, the virus actually enters the system through that area. This area, through the membranes, typically through a membrane wall, usually at the alveoli or the tissue that it affects. So these are the areas where the body works on it. So the Antigua’s antibodies treatment disrupts the interaction between the virus and the receptors. So what we’ve been trying to do is to stop it here. We’ve been trying to vaccinate against it directly. And then now, when we do natural effects, we go from the insides’ ability to mitigate the messy reaction in this area. OK. So those are the dynamics of what’s going on. It’s not so much that the virus itself makes the killing, but the inflammatory reaction that the body strikes against it causes the direct response to the virus. So because once the virus kills the cells, the cell membrane dies. Then what? Because macrophages, granular sites, and all the cool things we’ve been talking about actually cause inflammation in the body. This is the virus that we have seen. We talk about the spikes. This is the spike. This is where the ACE2 blocker or the receptor is received, which would be the cell in this area. So in that particular region, that’s how the science of soap, because this right here, this is what you and I were talking about that layer. There is a bilipid layer that gets disrupted with Mario, soap. So just hand-washing would be very useful in this area. I know you’ve been doing a lot of hand-washing in your office, correct? Yes. To avoid certain foods. OK, so you know, we have a DNA of foods, anti-inflammatory diets. We talked about that, you know, one of the things that you and I were discussing: the metabolic diet, the metabolic syndrome diets. You know, these Mediterranean diets, when we’re dealing with anti-inflammatory dyes, are what we would be focusing on. And what we’re going to be talking about now is explicitly focusing on anti-inflammatory foods and foods that prevent sensitivities to our body that cause immune reactions. Because if we mitigate the inflammation, it’s almost like we slow down the inflammatory process in our body or almost create a body that is less susceptible to inflammation. That’s the kind of treatment protocol we want to focus on. Now, when you look at these diets, what sort of proper diets would you recommend in terms of helping with the immunity of your patients?
What Is The GPS In The Body?
[00:52:45] Dr. Mario Ruja DC*: Very simple. If you can, go back to the previous slide. So let’s look at this one. Let’s look at that GPS conversation. Can you circle that one right there? Excellent check. Yes. Number one. Get rid of gluten foods. Gluten, again, really simple. Gluten is all about the glue that is the glue in your foods, in your breads, preservatives get it out. Eat raw. OK, there you go. Or gluten-free? You can’t go wrong with popcorn. It’s going to be all right. The other thing that we’re looking at again is to decrease the processed foods, Alex. P is for processed. So if it’s in a can, if it’s in a box and it’s been sitting there for more than twenty-four hours or 48 hours, you know what? Let’s not put in your body because obviously those artificial flavorings, those preservatives, which are what chemicals preserve the taste and the process of that food right for storage. That is not something that your body needs. It’s not. You know what? I just need more preservatives to my body because I want to be stronger and increase my immune system. So that’s the P. The P is for preserves. Get rid of them, OK? And then the S is our favorite, and it’s not for supersonic. It’s sugar. Sugar. Get rid of it because sugar is the most potent inflammatory sizzle. It’s that atomic nuclear bomb. OK.
[00:54:48] Dr. Alex Jimenez DC*: You see, and this is when you and I go to the store. We’ve noticed that everything is gone in the process and the sugar aisles.
[00:54:55] Dr. Mario Ruja DC*: Yes. From there, the shelves are empty. If it’s a box, it’s gone. And then you go, and then you go into produce man guacamole, you got tomatoes, and you got the spinach is there, but we got the boxes.
[00:55:17] Dr. Alex Jimenez DC*: You know, that’s amazing.
[00:55:19] Dr. Mario Ruja DC*: Of course, the feel-good foods. And we need to be mindful of that because the longer you stay in your house, you will start to munch and crunch and start to have snacks. And usually, those snacks are not baby carrots and celery sticks. No, they’re not. There are those snacks that you buy the Dollar General. For a dollar, and they have a lot of sugars, so that is what we call emotional foods, balanced emotional foods, you want to feel good, you know, drink some wine. Let’s not forget about the wine. You’re emotional. Yes, I did throw that just because I love you.
[00:56:04] Dr. Alex Jimenez DC*: I don’t do wine.
[00:56:06] Dr. Mario Ruja DC*: Anyway, I know you used to be part of it. We want to be mindful of red wine, especially.
[00:56:14] Dr. Alex Jimenez DC*: You know, stop the inflammation. And as we’re looking at those anti-inflammatory foods, the same kind of approach to a metabolic-free diet, even a ketogenic diet, is the whole focus is stopping inflammation, and inflammation is at the core of this. If we can squelch the inflammation in our bodies, we prepare our bodies in the event that we become exposed to this virus. So it is a simple approach to almost whenever you prepare your body for an event, a competition, you want to allow it to be as ready as possible. You don’t want it to be beaten down with processes that are inflammatory or reactionary that can burden itself. So it’s a critical component that what you’re saying, no, we have to look at a proper diet equals increased enhanced immunity. It’s as simple when we look at it. A poor diet impairs the immunity reaction, which will cause a more reactive oxygen species. Our processes, known as the body, are a way to destroy things that are reasonable winning control, but anything in excess causes the issues. Suppose our body is already cued up if we have inflammatory foods. If your BMI is above, the main number we’re using was 26, if your BMI, and that’s a measurement of waist versus hip and height. So we have to look at those numbers, and you start to notice that people that are not as healthy, that don’t exercise to a certain extent, those are the people that are more predisposed to this event when it happens. So it’s wise now, under a doctor’s watchful eye, to exercise, do cardiovascular exercising, drink the right amount of water, and make sure you get the proper sleep? Simple things like that will go very far in the healing process or prepare your body for it. Let’s say an event where, as they’re saying at this point in New York, they did a sample of the population. They said that at present, even of the non-symptomatic population that they’re testing in the suburbs, thirteen point nine percent only 14 percent of people already have been exposed to it. So when we’re looking at that, if this thing is going to go throughout a population at the rate that it is, it is wise to prepare our bodies. It is wise to prepare our bodies in an anti-inflammatory way. It is wise to get sleep. It’s wise to get the body mentally prepared and give ourselves this opportunity to eat appropriately to actually prevent a massive assault in inflammation or an inflammatory way that helps the body so things that we can do here to support our immune system. Take a look at that, Mario, so we have that.
[00:59:04] Dr. Mario Ruja DC*: You love this stuff, Alex.
[00:59:06] Dr. Alex Jimenez DC*: So when we look at, you know, wild, you know, smash fish, OK, so we look at that…
[00:59:14] Dr. Mario Ruja DC*: What is smashed fish, Alex? Is it like salmon?
[00:59:20] Dr. Alex Jimenez DC*: It is basically organic fish.
[00:59:23] Dr. Mario Ruja DC*: When you look at organic, wild salmon.
[00:59:34] Dr. Alex Jimenez DC*: Yeah, we call it smash fish.
[00:59:34] Dr. Mario Ruja DC*: Call me on my hotline. We all put my hotline at the bottom, Alex; I think we need to.
[00:59:42] Dr. Alex Jimenez DC*: I will ensure that. And by the way, we’re going to get to this one in a few minutes. So in terms of the plant-based diet, we want to make sure that that goes on too. So what kind of things do you do for a plant-based diet, Mario?
[00:59:54] Dr. Mario Ruja DC*: You know, I will say this. I am basically vegan, Alex, with this wonderful COVID 19. I have become vegan. Yes, that’s right. So I am doing lentil soup. I am doing spinach with balsamic vinaigrette. Oh man, I’m telling you, I’m going crazy.
[01:00:20] Dr. Alex Jimenez DC*: Fruits and vegetables?
[01:00:24] Dr. Mario Ruja DC*: Oh, all the time.
[01:00:26] Dr. Alex Jimenez DC*: Grass-Fed meats?
[01:00:28] Dr. Mario Ruja DC*: I don’t know if they’re grass-fed, Alex, but I’m still looking for those.
The Gut-Lung Connection
[01:00:35] Dr. Alex Jimenez DC*: What we’re talking about here is we’re also going to be talking, and we’re going to have a unique addition to this process because one of the areas we’ve learned that the gut-brain is a well-connected organ system. The hypothalamus-pituitary-adrenal connection is established. Now we’ve known of a great one, which is the intestine two long connection. OK, so we’re starting to see that the intestine and the flora in the intestine have much to do with the reactionary or inflammatory response in the lung. I’m going to be discussing that, too. Here we got a lot of amazing stuff that we will be talking about.
[01:01:18] Dr. Mario Ruja DC*: The gut-lung connection.
[01:01:20] Dr. Alex Jimenez DC*: The gut lung connection, right? So we’re going to be discussing that. So when we’re dealing with things like high fiber, the whole purpose of the fiber is to feed our bugs right to provide our probiotics or our bacteria that are evident at different stages of the colon. So what we want to make sure is to establish that a high fiber diet does not have roughage. But a variety of fibers is not good to have one type of kale, but different kinds of vegetable green leafy to different hard celery. All other fiber types assist different stages of bacterial growth in the intestinal colon. So we must do this in terms of the nuts and the seeds. The oils. Chicken soup? Yeah. Yeah, you know, chicken soup. Why would chicken soup be so good? We’ve learned that when we look at the ingredients in chicken soup, it has everything from the enzymes to the bio mechanisms that help our body heal better. The bioflavonoids, all those things that help our body heal properly, are in the chicken soup.
[01:02:29]Dr. Mario Ruja DC*: I hear this; I don’t know if it’s correct, but it’s an excellent old wives tale, and it goes something like this. Chicken soup is Jewish penicillin or Mexican penicillin. I’m not sure. But you know what? It’s powerful. Yeah, because I mean, you hear that it’s like all of a sudden.
[01:02:56] Dr. Alex Jimenez DC*: It allows the body to react to all these things, right? So when we look at these kinds of things, we see that these foods are all put together in chicken. You know, it’s great. It’s got everything it needs, man. So when we deal with snacks, we deal with ginger. We deal with turmeric.
[01:03:14] Dr. Mario Ruja DC*: Turmeric is awesome. Turmeric is what I call liquid gold for your immune system. Anti-inflammatory liquid gold.
[01:03:27] Dr. Alex Jimenez DC*: Yes, organic coffee. And one of the things about coffee is that when we look at the coffees if it doesn’t say organic, it’s full of pesticides. So we need to make sure that all are our coffee and your tea is very organic. The oils, the avocados, the macadamias. These are important because they establish normal inflammatory responses.
[01:03:54] Dr. Mario Ruja DC*: I love guacamole. Avocados. Great fats, plentiful, I mean, I’m telling you that one, I can eat that for like breakfast, lunch, and dinner.
[01:04:05] Dr. Alex Jimenez DC*: I can too. And there’s the problem that it’s too good; actually, it’s kind of really good. We got all these things like the turkey tail. Mario, do you like that turkey tail? Now, why would turkey tails be so good, huh?
[01:04:19] Dr. Mario Ruja DC*: Turkey tail is so good when you think about that.
[01:04:22] Dr. Alex Jimenez DC*: Culturally speaking, my parents would love that. They eat that as the essential part of the rest of the turkey. Oysters, lion’s mane. We’re going to have to kind of figure out where to get these kinds of things.
[01:04:36] Dr. Mario Ruja DC*: OK, I’ll go with this one. And you can circle this one. Shiitake mushrooms are my favorite. They’re awesome. And why is that? I just like, say it’s right there. There it is. I like saying its name.
[01:04:57] Dr. Alex Jimenez DC*: Shiitake.
[01:04:58] Dr. Mario Ruja DC*: I don’t know. It’s cool. I mean, Turmeric. I don’t know. It sounds kind of deadly, man. Like that tomb turmeric. What are you going to do? Shiitake is cool. You got to eat fun foods, Alex.
[01:05:12Dr. Alex Jimenez DC*: Mario, you said right here, clean eating. Clean eating is one of the most important foods.
[01:05:20] Dr. Mario Ruja DC*: Red peppers, blue peppers, green peppers, purple eggplants. I mean, the more color, the better. More the rawer, the better. I mean, keep it simple. And, of course, there are so many things like Golden Seals. You can go into the many herbs like crazy. Yeah, this I’m telling you. Just go to basics. I mean, you may not find my grass-fed meat. I mean, I don’t know if you have a farm or something, where are you going to go after the chickens, but just make it simple. And I would say during this time of quarantine, being at home with your family, spending more time than you ever have maybe wanted to spend with your husband or wife and children, perhaps. But also, there are no more excuses for you not to eat healthily. Yes. Not to cook your meals. OK. There are no more excuses. And, and I would say again in our prior conversations, the blessings of COVID 19. I know people probably like, Whoa, what’s he talking about? Which was Dr. Jimenez, and not talking about this is risky or crazy guys. OK, well, let me tell you. Make put this into your testimony. Yes, utilize this time to come closer together to your family. Start to cook together and eat together. You have no excuse, then you can’t say, well, I have a meeting at seven o’clock. And you know, you have a meeting, maybe you have no meeting. How about that one? You have all day to cook. Look at this video, go on YouTube, go somewhere, and cook your own meal with your wife, daughter, and son. Like, start cutting some stuff. Make sure you don’t cut your fingers because I know that’s new art for you. OK. And fix it in like, eat over it. And I like, you know, hey, how does it taste? I think it needs more salt. Do you know? And you know what? Let’s make it spicier. This is such an unbelievable opportunity to take advantage of it, guys. Yes, you may not see this time ever in your lifetime.
Conclusion
[01:07:46] Dr. Alex Jimenez DC*: You know, I want to say, Mario, I get that. You’re absolutely right. You hit it on point. It is a very important time to retool our bodies, fix them, and replenish them. It almost seems as if the reports are coming in because the world has been different since that first presentation we made. The carbon footprint is a whole lot smaller in the skies, and the seas are clearer than they’ve ever been before. If that pause is good for the Earth, that pours is good for us as humans. So we need to take that moment and appreciate it. We’re going to be coming across with these, you and I, we’re going to be doing these presentations. We will be doing this webinar will stand the next one next week, particularly. We’ll probably do more this week on other subject matters with this particular report on health and wellness and specifically on immunity. We need to hit it’s a four-part series. We will be hitting this in as we have many more components to discuss. We’re going to be going deep into the actual things that we can do because from what we gather, the initial onset was to give us some list of supplements that we could take. We gave those on our prior presentations and our and our YouTube presentations, and they’re there for you to review. But the and it’s under the antiviral strategies that we did. But this will elaborate on the things that we can do to supplement our immune system and make our immune stronger, not just the supplementation but the nutraceuticals. We’re looking at it from a neutral genomics area, a neutral genetics component. We’re going to be talking biochemistry, but we’re going to be dealing more realistically. So today was the beginning of our new presentations that we’re going to be doing here with Eventbrite and through Eventbrite protocols. We’re now going to discuss our topics and present them to the population out there, not just to El Paso. Hopefully, we can help change more than just the clinical components and the biochemistry and people’s lives, but also the spiritual components of their lives because that’s the functional medicine approach. Our whole goal is to prepare the body to heal itself to deal with complex degenerative issues and holistically assist the body. So wellness components and natural medicine are a very important part of what we’re doing. So we look forward to doing that. And Mario, thank you so much for being part of this because you and I will make an impact. Little by little, day by day, hour by hour, we’re going to be making some impact. So it looks very good in terms of our presentation, and we look and see if you can share this out there, and I’ll give it to the people. Anything else, Mario?
[01:10:34] Dr. Mario Ruja DC*: Yeah, I want to reaffirm and enlighten you, Alex, and the vision you started and being so gracious and inviting me to the party, as they say, this is not a conference. It’s fun. Yeah, it’s not about us. This is about. Impactful health, functional medicine. It’s about motivating, inspiring, and supporting life change and legacies. And I am happy and look forward to connecting with as many people as possible, not only in our community but also in the viewers. We are here to share. And we’re here to be authentic. And we’re here to create the simplicity of life function. So please take the time for yourself and your loved ones. Take the time because you have it now to let them know how much you love them, how much you forgive them, how much you care for them. And then I will say this. Cook a meal together, eat it, and share the love.
[01:11:52] Dr. Alex Jimenez DC*: Amen, brother. We’ll catch it there. We went a few minutes over, but we’ll be ready for next week. Brother, I love you, and we’ll keep on going forward. OK, but so I ended. I’ll call you in the back end. Bye-bye, brother.
In today’s podcast, Dr. Alex Jimenez and Dr. Mario Ruja discuss the importance of the body’s genetic code and how micronutrients provide the necessary functional nutraceuticals that the body needs to promote overall health and wellness.
What Is Personalized Medicine?
[00:00:00] Dr. Alex Jimenez DC*: Welcome, guys. We’re Dr. Mario Ruja and me; we’re going to be discussing some essential topics for those athletes that want the advantage. We’re going to discuss fundamental necessary clinical technologies and information technologies that can make an athlete or even just the average person a little bit more aware of what’s happening in terms of their health. There’s a new word out there, and I have to give you a little heads up where we’re calling. We’re actually coming from the PUSH Fitness Center, and that people still work out late at night after going to church. So they’re working out, and they’re having a good time. So what we want to do is bring in these topics, and today we’re going to be talking about personalized medicine, Mario. Ever heard of that word?
[00:01:05] Dr. Mario Ruja DC*: Yeah, Alex, all the time. I dream about it. There you go, Mario.
[00:01:12] Dr. Alex Jimenez DC*: There you go, Mario. Always giving me a laugh. So we’re going to be talking about is the personalized arena of what we have now. We’ve come to a state where many people tell us, Hey, you know what? It would be best if you had some more proteins, fats, or they come up with some convoluted idea, and you’ll end up with your eyes crossed and, most of the time, more confused than anything else. And you’re pretty much a lab rat to all these different techniques, whether it’s the Mediterranean, low fat, high fat, all these kind of things. So the question is, what is it specific to you? And I think one of the frustrations that many of us have, Mario, is that we don’t know what to eat, what to take and what’s good exactly. What’s good for me doesn’t mean that it’s suitable for my friend. You know, Mario, I’d say it’s different. We come from a whole other type of genre. We live in a place, and we’ve gone through things that are different from two hundred years ago. What do people do? We’re going to be able to figure this out nowadays in today’s DNA dynamics; though we don’t treat with these, it gives us information and allows us to relate to the issues that are affecting us now. Today, we will be talking about personalized medicine, DNA testing, and micronutrient assessments. So we’re going to see what it is that how are our genes, the actual predisposing issues, or they’re the ones that give us the the the workings of our engine. And then also, if it’s good for that, we want to know what our level of nutrients is right now. I know Mario, and you had a very dear and near question the other day with one of your, I think, was your daughter. Yeah, so what was her question?
[00:02:52] Dr. Mario Ruja DC*: So Mia had had a well, excellent question. She was asking me about utilizing creatine, which is very predominant in athletes. You see, it’s the buzzword, you know? Use creatine to build more muscle and such. So the point that I talk to you about, Alex, is that this is something so important that we cannot let in terms of the sports environment and performance environment. It’s like taking a Bugatti, and you’re saying, “Well, you know what? Do you think about just putting synthetic oil in it?” And well, is it the synthetic oil necessary for that Bugatti? Well, it’s good because it’s synthetic. Well, no, there are lots of different synthetic forms, you know, it’s like five-thirty, five-fifteen, whatever it is, the viscosity level it has to match. So same thing for athletes and especially for Mia.
[00:04:06] Dr. Alex Jimenez DC*: Let the audience know who Mia is, what does she do? What kind of things does she do?
[00:04:08] Dr. Mario Ruja DC*: Oh, yeah. Mia plays tennis, so her passion is tennis.
[00:04:13] Dr. Alex Jimenez DC*: And she’s nationally ranked?
[00:04:15] Dr. Mario Ruja DC*: Nationally, and she plays internationally on the international circuit ITF. And she’s right now in Austin with Karen and the rest of the Brady Bunch, as I call them. You know, she’s working hard and through all this COVID kind of disconnect. Now she’s getting back into the fitness mode, so she wants to optimize. She wants to do her very best to catch up and move forward. And the question about nutrition, a question about what she needed. I needed a specific answer, not just general. Well, I think it’s good. You know good is good and better is best. And the way we look at it in that conversation of sports performance and genetic, nutritional, and functional medicine, it’s like, let’s get really functional, let’s be on point instead of buckshot. You know, it’s like you can go in and say, you know, generalities. But in terms of this, there is not a lot of information out there for athletes. And that’s where the conversation is linking the genetic and linking the micronutrients. That is phenomenal because, as you mentioned, Alex, when we look at the markers, genetic markers, we see the strengths, the weaknesses, and what’s at risk and what is not. Is the body adaptive, or is the body weak? So then we have to address the micronutrients to support. Remember, we talked about that to support that weakness in that DNA, that genetic pattern with something that we can strengthen. I mean, you can’t go and change your genetics, but you surely can increase and be specific with your micronutrients to change that platform and strengthen it and decrease the risk factors.
[00:06:24] Dr. Alex Jimenez DC*: It’s fair to say now that the technology is such that we can find the, I wouldn’t say weaknesses, but the variables that allow for us to improve an athlete at the genetic level. Now we can’t alter the genes. That’s not what we’re saying is that there’s a world of what they call SNPs or single nucleotide polymorphisms where we can figure out there’s a specific set of genes that can’t change. We can’t change like eye color. We can’t do those. Those are very coded in, right? But there are genes that we can influence through neutral genomics and neutral genetics. So what I mean by my neutral genomics is nutrition altering and affecting the genome to more adaptive or opportunistic dynamics? Now, wouldn’t you like to know what genes you have that are vulnerable? Wouldn’t she want to know where her vulnerability is as well?
Is My Body Receiving The Right Supplements?
[00:07:18] Dr. Mario Ruja DC*: What do we all want to know? I mean, whether you’re a high-level athlete or you’re a high-level CEO, or you’re just a high-level mom and dad, that’s running around from tournament to tournament. You cannot afford to have low energy that, when we talked about the markers, you know that methylation within the body we want to know, are we processing or how are we doing in terms of the oxidative pattern within ourselves? Do we need that extra boost? Do we need to increase your knowledge of that green intake detoxified pattern? Or are we doing well? And this is where when we look at the patterns of genetic markers, we can see that we are well-prepared or we are not well prepared. Therefore, we have to look at the micronutrients. Again, those markers to say, “Are we meeting our needs, yes or no? Or are we just generalizing?” And I would say 90 percent of athletes and people out there are generalizing. They’re saying, Well, you know, taking vitamin C is good and taking vitamin D is good and selenium, you know, that’s good. But again, are you on point, or are we just guessing right now?
[00:08:36] Dr. Alex Jimenez DC*: Exactly. That’s the thing when we’re in that store, and there’s a lot of great nutritional centers, Mario, that are out there, and we’re looking at a wall of a thousand products. Crazy. We don’t know where we have holes, and we don’t know where we need them. You know, there are certain deficiencies. You’ve got bleeding gums; most likely, you’ve got some scurvy or some kind of issue there. That unit may need a specialist, but let’s assume if we look at things like scurvy, right? Well, we know that gum starts bleeding. Well, it’s sometimes not that obvious, right, that we need certain things. There are hundreds and thousands of nutrients out there. One of the things that we call them, we call them, is cofactors. A cofactor is a thing that allows an enzyme to work right. So we are a machine of enzymes, and what codes those enzymes? Well, the DNA structure. Because it produces the proteins that code those enzymes, those enzymes have code factors like minerals like magnesium, iron, potassium, selenium, as you mentioned, and all different components. As we look at this, this hole that we’re we’re facing a wall. We would love to know exactly where our holes are because Bobby or my best friend says, you know, you should take protein, take whey protein, take iron, take what may be so, and we’re hit or miss. So today’s technology is allowing us to see precisely what it is, where we have the holes.
[00:10:00] Dr. Mario Ruja DC*: And this point that you mentioned about the holes, again, the majority of the factors are not that extreme like scurvy, you know, bleeding gums. We’re not, I mean, we live in a society where we’re gosh, I mean, Alex, we have all the foods that we need. We’ve got too much food. It’s crazy. Again, the issues that we talk about are overeating, not starving, OK? Or we’re overeating and still starving because the nutritional pattern is very low. So that’s a real factor there. But overall, we are looking and addressing the component of what subclinical issues, you know, we don’t have the symptoms. We don’t have those significant marker symptoms. But we do have low energy, but we do have a low recovery pattern. But we do have that problem with sleep, that quality of sleep. So those are not huge things, but those are subclinical that erode our health and performance. For example, little by little, athletes cannot be just good. They need to be the tip of the spear top. They need to recover quickly because they do not have time to guess their performance pattern. And I see that they don’t.
[00:11:21] Dr. Alex Jimenez DC*: You know, as you mentioned that, I mean, most of these athletes, when they want to, they want to assess their bodies. They want to know where every weakness is. They’re like scientists and laboratory rats for themselves. They’re pushing their bodies to the extreme, from mental to physical to psycho-social. Everything is being affected, and put it in at full throttle. But they want to know. They want to see where that extra edge is. You know what? If I could make you a little bit better? If there was a little hole, what would that amount to? Will that amount to a two more second drop over a while, a microsecond drop? The point is that technology is there, and we have the ability to do these things for people, and the information is coming faster than we can even imagine. We have doctors worldwide and scientists around the world looking at the human genome and seeing these issues, specifically at SNPs, which are single nucleotide polymorphisms that can be changed or altered or assisted in dietary ways. Go ahead.
Body Composition
[00:12:21] Dr. Mario Ruja DC*: I’ll give you one: the Inbody. How about that? Yeah, that’s a tool right there that is critical for a conversation with an athlete.
[00:12:31] Dr. Alex Jimenez DC*: The Inbody is the body composition.
[00:12:32] Dr. Mario Ruja DC*: Yeah, the BMI. You’re looking at it in terms of your hydration pattern; you’re looking at in terms of like, yes, body fat, that that whole conversation everyone wants to know, you know, I’m overweight my belly fat again. We had discussions on metabolic syndrome. We talked about risk factors, high triglycerides, very low HDL, high LDL. I mean, those are risk factors that put you in a pattern in that line towards diabetes and that line towards cardiovascular disease in that line of dementia. But when you’re talking about an athlete, they’re not worried about diabetes; they’re concerned about, am I ready for the next tournament? And I’m going to make the cut going to the Olympics. That’s yes, I mean, they’re not what they want to do that Inbody. They’re the micronutrient, the combination of genome nutrition, that genomic nutrition conversation on point allows them to honor their work. Because I’m telling you, Alex, and you know, this here, I mean, everyone’s listening to us, again, the conversation I share with people is this, why are you training like a pro when you don’t want to be one? Why are you trained like a pro when you are not eating and have the data to support that pro-level workout? What you’re doing? If you don’t do that, you are destroying your body. So again, if you’re working as a pro, that means you’re grinding. I mean, you’re pushing your body to little miss neuromuscular. Furthermore, we’re chiropractors. We deal with inflammatory issues. If you’re doing that, you’re redlining that, but you are not turning around to recover through micronutrition-specific chiropractic work. Then you’re going to damn it; you’re not going to make it.
[00:14:26] Dr. Alex Jimenez DC*: We’re going to show that we’ve been able to see in a lot of times cities come together for specific sports, such as like wrestling. Wrestling is one of those notorious sports that puts the body through massive emotional and physical stresses. But a lot of times, what happens is individuals have to lose weight. You’ve got a guy who’s 160 pounds; he’s got a drop-down 130 pounds. So what the city has done to avoid these things is to use body-specific weight and determine the molecular weight of the urine, right? So they can tell, are you too concentrated, right? So what they do is that they have all these kids line up all the way to UTEP, and they do a specific gravity test to determine if they’re able to lose any more weight or what weight they are allowed to lose. So someone who’s about 220 says, You know what? You can drop up to about, you know, x y z pounds based on this test. And if you violate this, then you do that. But that’s not good enough. We want to know what’s going to happen because when the kids are in a load and are fighting another person that is just as good of an athlete, and he’s pushing his body, that’s when the body collapses. The body can handle the load, but the supplementation that the person has had, maybe their calcium, has been so depleted that suddenly you got this kid who was 100 injuries; the injuries, the elbow snapped dislocated. That’s what we see. And we wonder how did he snap his elbow because his body has been depleted from these supplements?
[00:15:59] Dr. Mario Ruja DC*: And Alex, on the same level, you’re talking about one on one like that pugilistic, that intense three minutes of your life on the other level, when it comes to tennis, that’s a three-hour conversation. Exactly. There are no subs there. There’s no coaching, no subs. You are in that gladiator arena. When I see Mia playing OK, I mean, it is intense. I mean, every ball that’s coming to you, it’s coming to you with power. It’s coming in like, can you take this? It’s like someone fighting across a net and looking at it. Are you going to quit? Are you going to chase this ball? Are you going to let it go? And that is where that definitive factor of optimal micronutrition connected with the conversation of what exactly you need in terms of genomic conversation will allow someone to scale up with a decreased risk factor of injuries where they know they can push themselves more and have the confidence. Alex, I’m telling you this is not just nutrition; this is about the confidence to know I got what I need, and I can redline this thing, and it’s going to hold. It’s not going to buckle.
[00:17:23] Dr. Alex Jimenez DC*: You know what? I’ve got little Bobby. He wants to wrestle, and he wants to be the biggest nightmare is the mom. Because you know what? They’re the ones that wish Bobby to thump the other Billy, right? And when their kids are getting thumped on, they want to provide for them. And moms are the best cooks. They’re the ones who take care of them, right? They’re the ones that make sure, and you could see it. The pressure on the child is immense when parents are watching, and sometimes it’s incredible to watch. But what can we give moms? What can we do for the parents to provide them with a better understanding of what’s going on? I got to tell you today with DNA tests. You know, all you have to do is get the kid in the morning, open his mouth, you know, do a swab, drag that stuff off the side of his cheek, put in a vial, and it is done within a couple of days. We can tell if Bobby’s got strong ligaments, if Bobby’s micronutrient levels are different to provide the parent with a better kind of a roadmap or a dashboard to understand the information that’s affecting Bobby, so to speak, correct?
[00:18:27] Dr. Mario Ruja DC*: Because and this is what we’ve come a long way. This is 2020, guys, and this is not 1975. That’s the year when Gatorade came over.
[00:18:42] Dr. Alex Jimenez DC*: Come on; I got my tub. It’s got a lot of things on the side of it. I will have everything you look like Buddha when you develop diabetes with so much sugar from those protein shakes.
The Right Supplements For Kids
[00:18:52] Dr. Mario Ruja DC*: We have come a long way, but we cannot just go in and go; oh, you need to hydrate here drink these electrolytes, Pedialyte and all that. That’s not good enough. I mean, that’s good, but it’s 2020, baby. You got to scale up and level up, and we can’t use old data and old instrumentation and diagnostics because the kids now start at three years old, Alex. Three years old. And I’m telling you right now at three, it is unbelievable. By the time they’re five and six, I mean, I’m telling you the kids that I see, they’re already in select teams.
[00:19:33] Dr. Alex Jimenez DC*: Mario…
[00:19:34] Dr. Mario Ruja DC*: Six years old, they’re in a select team.
[00:19:36] Dr. Alex Jimenez DC*: The thing that determines if a child is ready is their attention span. Yeah, I got to tell you, you can watch this. You got to see a kid who’s at three years and six months, and he isn’t paying attention. Three years and eight-month, all of a sudden, he can focus.
[00:19:50] Dr. Mario Ruja DC*: It’s on like a light switch.
[00:19:52] Dr. Alex Jimenez DC*: In front of the coach, right? And you can tell because they wander and they’re not ready. So we’re bringing the kids and exposing them to loads of experiences. Then what we need to do is give moms and dads the ability to understand and athletes of the NCAA and see how I can see what’s happening in my bloodstream? Not a CBC, because the CBC is for basic stuff, like a red blood cell, white blood cell. We can do things. Metabolic panel tells us a generic thing, but now we know more profound information about the susceptibility of the gene markers and see this on the test. And these reports tell us precisely what it is and how it pertains now and progression.
[00:20:37] Dr. Mario Ruja DC*: So this is where I love. This is where I love everything in the world of performance is pre and post. So when you’re a sprinter, they time you. It’s electronic time; when you’re a wrestler, they look at you. Do you know what your winning ratio is? What’s your percentage? Anything, it’s all data. It’s data-driven. As a tennis player, a soccer player, they will track you. Computers will track how strong? How fast is your serve? Is it 100 miles an hour? I mean, it is crazy. So now, if you have that data, Alex, why is it that we do not have the same information for the most critical component, which is that biochemistry, that micro nutritional, the foundation of performance is what happens inside of us, not what happens outside. And this is where people get confused. They think, “Well, my kid works four hours a day, and he has a private trainer. Everything.” My question is that is good, but you’re putting that kid at risk if you are not supplementing on point, say precisely when it comes to the special needs of that child or that athlete, because if we don’t do that, Alex, we are not honoring the journey and the battle, that warrior, we’re not. We’re putting them at risk. And then, all of a sudden, you know what, two-three months before a tournament, BAM! Pulled a hamstring. Oh, you know what? They got fatigued, or all of a sudden, they had to pull out of a tournament. You see, I see tennis players doing all of that. And why? Oh, they’re dehydrated. Well, you should never have that problem. Before you go in exactly where you are, you should already know what you’re doing. And I love the combination and a platform that we have for all of our patients because, within two or three months, we can show pre and post, can we?
[00:22:39] Dr. Alex Jimenez DC*: We can show body composition to the Inbody systems and the incredible systems we use. These DEXAS, we can do bodyweight fat analysis. We can do a lot of things. But when it comes down to predispositions and what’s unique to individuals, we go down to the molecular level, and we can go down to the level of the genes and understand what the susceptibilities are. We can go on once we have the genes. We can also understand the micronutrient level of each individual. So what’s pertaining to me? I may have more magnesium than you, and the other child may have depleted magnesium or calcium or selenium or his proteins or the amino acids or are shot. Maybe he’s got a digestive issue. Perhaps he’s got lactose intolerance. We need to be able to figure out these things that affect us.
[00:23:29] Dr. Mario Ruja DC*: We can’t guess. And the bottom line is there’s no need for that. Everyone has that beautiful conversation, Alex, about, “Oh, you know what? I feel OK.” When I hear that, I cringe, go, and feel OK. So you mean to tell me that you are putting your health the most precious thing you have and your performance based on a feeling like, wow, that means that your urine receptors and turns the pain tolerance are dictating your health. That’s dangerous. That is completely dangerous. And also, so clinically, you’re not able to feel your deficiency in terms of vitamin D, your deficiency in terms of selenium, your deficiency in vitamin A, E. I mean, all of these markers, you can’t feel it.
[00:24:21] Dr. Alex Jimenez DC*: We need to start presenting to the people out there, the information, it’s out there because what we want to let people know is that we’re going deep. We’re going down to these gene susceptibilities, the gene understanding as it is today; what we have learned is so powerful that it allows parents to understand a whole lot more of the issues pertaining to an athlete. Not only that, but the parents want to know what my susceptibility is? Do I have a risk of bone arthritis? Do we have issues with oxidative stress? Why am I always inflamed all the time, right? Well, believe it or not, if you got the genes for, let’s say you got the gene that makes you eat a lot, well, you’re likely going to gain weight. You can raise 10000 people’s hands who have that same gene marker, and you’re going to notice that their BIAs and BMI are way out of there because it’s the susceptibility to that now. Can they change it? Absolutely. That’s what we’re talking about. We’re talking about understanding the ability to adapt and change our lifestyle for the predispositions we may have.
[00:25:26] Dr. Mario Ruja DC*: Yeah, this is wonderful. And I see this quite frequently in terms of the conversation about losing weight, you know, and they go, “Oh, I did this program, and it works great.” And then you have 20 other people doing the same program, and it doesn’t even work, and it’s almost like hit and miss. So people are becoming disillusioned. They’re putting their bodies through this incredible roller coaster ride, which is like the worst thing you could do. You know, they’re doing these unnecessary things, but they cannot sustain it because why? At the end of the day, it’s not who you are. It wasn’t for you.
[00:26:05] Dr. Alex Jimenez DC*: You may need a different type of diet.
[00:26:06] Dr. Mario Ruja DC*: Yes. And so we, again, our conversation today is very general. We’re starting this platform together because we have to educate our community and share the latest in technology and science that addresses the needs.
[00:26:26] Dr. Alex Jimenez DC*: Personalized medicine, Mario. It’s not general; it’s a personalized health and personalized fitness. We understand that we don’t have to guess if a diet is better for us, such as a low calorie, high-fat diet or a Mediterranean style food or a high protein diet. We won’t be able to see that these scientists are putting information together from the information we are continuously gathering and compiling. It’s here, and it’s a swab away, or blood works away. It’s crazy. You know what? And this information, of course, let me be mindful of before this starts. My little disclaimer comes in. This is not for treatment. Please do not take anything; we’re taking this for treatment or diagnosis. You got to talk to your doctors, and your doctors have to tell you exactly what’s up there and what’s appropriate for every individual we integrate.
[00:27:18] Dr. Mario Ruja DC*: The point is that we integrate with all healthcare professionals and physicians. We are here to support and champion functional wellness. OK. And as you mentioned, we’re not here to treat these diseases. We’re here to optimize again when athletes come in and want to be better. They want to get healthier and help the recovery rate.
Can Stress Age You Faster?
[00:27:46] Dr. Alex Jimenez DC*: You know, that’s it. Do you know what the bottom line is? The testing is there. We can see Billy’s not been eating well. OK, Billy has not been eating well. I can tell you, well, he eats everything, but he hasn’t had this level of protein. Look at his protein depletion. So we’re going to present to you some of the studies out here because it’s information, though it’s a bit complex. But we want to make it simple. And one of the things that we were talking about here is the micronutrient test we were providing here. Now I’m going to present you guys to see a little bit here. And what we use in our office when a person comes in and says, I want to learn about my body. We present this micronutrient assessment to figure out what’s going on. Now, this one was, let’s say, just it was in a sample for me, but it tells you where the individual is. We want to be able to level the antioxidant level. Now everyone knows that, well, not everyone. But now we understand that if our genes are optimal and our food is optimal, but we live in an oxidative stress state…
[00:28:45] Dr. Mario Ruja DC*: Exactly
[00:28:46] Dr. Alex Jimenez DC*: Our genes will not function. So it’s important to understand what the problem is.
[00:28:51] Dr. Mario Ruja DC*: It’s rust. I mean, when you’re looking at this, and I see two markers, I see the one for oxidative, and then the other one is the immune system. Yes, right? So again, they correlate together, but they are different. So the oxidative I talk about is like your system is rusting out. Yeah, that’s oxidation. You see apples turning brown. You see metals rusting. So inside, you want to absolutely be at your best, which is in the green in that 75 to 100 percent functional rate. That means you can handle the craziness of the world tomorrow, you know?
[00:29:31] Dr. Alex Jimenez DC*: Yes, we can look at the stress of the human body, Mario. What we can see actually what’s going on, and as I continue with this kind of presentation here, we can see what this individual is and what is his actual immune function age. So a lot of people want to know this stuff. I mean, I want to know where I lie in terms of the dynamics of the body, right? So when I look at that, I can see precisely where I lie, and my age is 52. OK. In this situation, OK, now as we look down, we want to know.
[00:30:02] Dr. Mario Ruja DC*: Hold on. Let’s get real. So you mean to tell me that we can get younger through this incredible system? Is that what you’re telling me?
[00:30:14] Dr. Alex Jimenez DC*: It tells you if you’re aging quicker, OK, how does that sound, Mario? So if you can slow down, if you’re in that top 100, the green, you’re going to be looking like a 47-year-old man when you’re 55. Right? So from the structure, immune function, and oxidative stress in the body, what’s going to happen is that we’re going to be able to see exactly where we are in terms of our body.
[00:30:37] Dr. Mario Ruja DC*: So that is correct? Yes. So we could be our birth certificate could say 65, but our functional metabolic markers can say you’re 50.
[00:30:51] Dr. Alex Jimenez DC*: Yes. Let me make it real simple, OK? People often understand oxidative stress; yes, we hear about antioxidants and reactive oxygen species. Let me make it simple, OK, we’re a cell. You and I, we’re having a family meal right where we’re enjoying ourselves. We are normal cells. We’re happy, and we’re functioning where everything is appropriate. All of a sudden, there’s a wild-looking lady. She’s got blades and knives, and she’s greasy, and she’s slimy, and she comes on. She hits the table, boom, and she kind of walks away. You know, it’s going to unsettle us, right? It’s going to be, let’s call her an oxidant, OK? She’s called a reactive oxygen species. Now, if we got two of those walking around the restaurant, we kind of keep an eye on her, right? All of a sudden, a football player comes and takes her out. Boom knocks her out, right? In that situation, this greasy, slimy weapon-looking lady, correct, that’s scary. That was an antioxidant. That was vitamin C that wiped her out, right? There’s a balance between oxidants and antioxidants in the body. They have different purposes, right? We have to have antioxidants, and we have to have oxidants in order for our body to function. But if you got 800 of those ladies like zombies all of a sudden.
[00:32:02] Dr. Mario Ruja DC*:I could see them as zombies.
[00:32:07] Dr. Alex Jimenez DC*: It is. You know what you’re going to want. Where are the football players? Where are the antioxidants, right? Take them out. The football players come in, but there are just too many of them, right? Anything that you and I do in a conversation could be healthy cells, and we’re having this conversation at the dinner table. We’re disrupted totally. We cannot function in an oxidative stress environment. No. So basically, we may have all the supplements, and we may have all the nutrients, and we may have the proper genetics. But if we’re in an oxidative state, right, an elevated level, we’re not going to be aged. It will not be a comfortable night, and we will not recover.
[00:32:46] Dr. Mario Ruja DC*: We will be at a higher risk factor for injuries. Exactly. And the other thing is we also have the risk factor where we will age faster than we should.
[00:33:04] Dr. Alex Jimenez DC*: That night would be rough is there’s like a hundred of those people around. So we need to know the state of the balance in life, the antioxidants we see, and all the antioxidants foods like A, C, E. That is what this test does. It shows you the level of oxidants in the body.
[00:33:19] Dr. Mario Ruja DC*: Hey, Alex, let me ask you this. Everyone loves to work out. When you work out, does that increase or decrease your oxidative stress? Please tell me, because I want to know.
[00:33:30] Dr. Alex Jimenez DC*: It increases your oxidative state.
[00:33:31] Dr. Mario Ruja DC*: No, stop it.
[00:33:32] Dr. Alex Jimenez DC*: It does because you’re breaking the body down. However, the body responds. And if we are healthy, Mario, right? In that sense, our body first has to break down, and it has to repair. OK? We want to have antioxidants because it helps us go through the process. Part of healing and part of inflammation is oxidative balance. So, in essence, when you’re working out too hard or running hard, you can overburn the bar, and those are the things that you and I have to kind of look at, and this is the balance.
[00:34:08] Dr. Mario Ruja DC*: Now this is like the paradox, right? You know what, if you overwork, you’re going to look fabulous. But you know what? You’re actually breaking down. And if you don’t work out, there goes your cardio. There go other risk factors. So this is where it is so critical that we need to balance and know precisely what each person needs to be at their best. And we can’t guess; you can’t take the same supplements as me and vice versa.
The Right Cofactors For Your Body
[00:34:41] Dr. Alex Jimenez DC*: I can, we can. But it’s to me, I may not be a lot of waste of money, or maybe we’re just missing the whole process. So in this entire dynamics here, just looking at this test, Mario, just using it at this particular assessment, we want to see also what our cofactors are on. We talked about proteins; we talked about genetics. We talked about things that make these enzymes work, our body functions, and pure enzymes in this particular model that you’re seeing what the cofactors are and the metabolites are. Well, you see amino acids levels and where they are in your body. If you’re an extreme athlete, you want to know what those things are.
[00:35:14] Dr. Mario Ruja DC*: Oh yeah, I mean, look at that. Those aminos. Those are critical.
[00:35:20] Dr. Alex Jimenez DC*: You think Mario?
[00:35:21] Dr. Mario Ruja DC*: Yeah, I mean it’s like every athlete I know, they’re like, Hey, I got to take my aminos. My question is, are you taking the right ones at the right level? Or do you even know, and they’re guessing. Ninety percent of the people are assuming you’re looking at antioxidants. Look at that. That’s the beast right there, glutathione. That’s like the granddaddy of antioxidants right there. And you want to know is, is that football players, that linebackers are going to crush those zombies, you know? And again, vitamin E, CoQ10. Everyone talks about CoQ10 and heart health.
[00:36:00] Dr. Alex Jimenez DC*: Coenzyme Q, exactly. A lot of people take cardiac medications specifically to lower their cholesterol.
[00:36:10] Dr. Mario Ruja DC*: What does CoQ10 do, Alex? I want to get you started.
[00:36:15] Dr. Alex Jimenez DC*: Because you know what? Many documentation came out early on when they did many of these medications. Yeah, they knew they had to end it and put coenzyme Q in it. They knew, and they patented it because they knew that they had it. Because if you don’t give coenzyme Q right, you have inflammatory states and neuropathies. But these people have issues, and now they’re starting to understand. That’s why you see all the commercials with the coenzymes. But the point is that we need to know where our present state is right. So when we understand those things, we can look at the tests. And we can look at the dynamics of it. Wouldn’t you like to know which antioxidants? It’s so clear.
[00:36:52] Dr. Mario Ruja DC*: I love this. I mean, look at that. You know what? It’s red, green, black and that’s it. I mean, you can see it right away. This is your board. This is your command center. You know, I love the command center. It’s like, everything’s there.
[00:37:10] Dr. Alex Jimenez DC*: I know Mario, you know, with those athletes, they want to be at the top level. Yes, it looks like this person’s floating somewhere in the middle, but they want to top it at 100 percent, right?
[00:37:19] Dr. Mario Ruja DC*: Alex, they’re on the bench.
[00:37:23] Dr. Alex Jimenez DC*: Yeah. And when they’re under a lot of stress, who knows what? Now, these tests are straightforward to do. They’re not complex to go in. Take a lab test sometimes are these are urine tests, something we can do.
[00:37:33] Dr. Mario Ruja DC*: And we can do those in our offices in a matter of minutes, precisely in a matter of minutes. Crazy.
[00:37:38] Dr. Alex Jimenez DC*: It’s crazy.
[00:37:40] Dr. Mario Ruja DC*: This is why it’s so simple. It’s like my question is, what color is the red bus? I don’t know. It’s a trick question.
What Supplements Are Right For You?
[00:37:50] Dr. Alex Jimenez DC*: Well, going back into our topic today was personalized medicine and personalized wellness and personalized fitness. Doctors around the country are starting to understand that they cannot just say, OK, you’re pregnant. Here’s a folic acid pill. OK, here are some nutrients, though every doctor has to be taking care of their own clients. They’re the ones that are doing this. But people have the ability to understand; where are the other holes? Wouldn’t you want to make sure you have suitable selenium?
[00:38:17] Dr. Mario Ruja DC*: Before you have symptoms. That’s the thing, and this is why we are not treating. We’re not saying that issues, diagnosis issues, what are you doing to optimize and decrease your risk factors?
[00:38:35] Dr. Alex Jimenez DC*: There’s the issue of longevity, too, because I mean, the issue of longevity is if you’re providing your body with the right substrates, the right cofactors, the right nutrition. Your body has a chance to make it to 100 years plus and actually function. And if you have a depleted life, well, you’re burning the engine, so the body starts having issues, you know, so as we look at those kinds of things…
[00:39:00] Dr. Mario Ruja DC*: Can you return to our two markers? Look at that immune system.
[00:39:12] Dr. Alex Jimenez DC*: Yeah, there’s a reason they stop here at 100 because that’s the whole idea. The entire idea is to get you to live 100 Centennial. So if we can do this, if you’re a person who’s, let’s say, 38 years old, and you’re in the midst of your life, and let’s say you’re a business person and you’re a junkie for business. You’re a junkie for entrepreneurship. You want to throttle you against the world. You do not want a kind of Nicholas the worm weakness, so to speak, taking you out of your football run in life. Because otherwise, you can trip up on things. And what we want to be able to provide people through nutritionists who registered dietitians to doctors through the information out there to supplement your lives better. And it’s not just about little Bobby; it’s about me, it’s about you. It’s about our patients. It’s about every single one of them who wants to live a better quality of life. Because if there’s a depletion in certain things, it’s not now. But in the future, you may have a susceptibility that will bring out diseases. And that’s where those susceptibilities are. We can take it to the next level because we can see what’s going on. In terms of this, I’m going to go ahead and bring this back up here so you can just see what we’re looking at. You can see the B-complex is now we have a lot of B-complexes, and we got people texting all over the place here, and I’m getting zapped with messages.
[00:40:42] Dr. Mario Ruja DC*: Your oxidative stress is going up, Alex.
[00:40:45] Dr. Alex Jimenez DC*: Well, it’s crazy that we’ve been here an hour, so we want to be able to bring information out for you guys as time goes on. I want to go through this and talk about the individual antioxidants now; those are your football players, man, those are the ones taking those people out. Making your whole life a lot better, right, Mario. This is the kind of stuff that we look at. You know your glutathione on your knees. Your coenzyme Q selenium is your vitamin E’s carbohydrate metabolism.
[00:41:10] Dr. Mario Ruja DC*: Look at that, I mean, glucose and insulin interaction called energy. The last time I checked, it was called turbo.
[00:41:21] Dr. Alex Jimenez DC*: We got to listen; we got a lot of good doctors. We got like Dr. Castro out there. We got all the great doctors out there that are running over.
[00:41:30] Dr. Mario Ruja DC*: I mean, we’re going to get in trouble.
[00:41:32] Dr. Alex Jimenez DC*: All right. Facebook is going to knock us out.
[00:41:41] Dr. Mario Ruja DC*: It will put a time limit on this.
[00:41:43] Dr. Alex Jimenez DC*: I think it’s our views. But the bottom line is to stay tuned. We’re coming. This can’t cover everything. Hey, Mario, when I went to school, we were terrorized by this machine called the psycho cycle.
[00:41:58] Dr. Mario Ruja DC*:How many ATP’s, Alex?
[00:42:00] Dr. Alex Jimenez DC*: I mean, how many miles? Is it glycolysis or aerobic or anaerobic, right? So when we start looking at that, we start seeing how those coenzymes and those vitamins play a role in our energy metabolism, right? So in this individual, there were certain depletions. You can see where the yellow comes in. It affects the whole metabolic process, energy production. So the person is always tired. Well, we kind of understand the dynamics of what’s going on. So this is critical information as you and I kind of look at this, right? We can see what is it that we can offer? Can we provide information to change how the body works better dynamically? So this is crazy. So, in terms of it, we can go on and on, guys. So what we’re going to be doing is we’re probably going to be coming back because this is just fun. Do you think so? Yeah, I think we’re going to come back to what we’ve got to change the way that all El Paso is and not only for our community but also for those moms who want to know what is the best for their family members. What can we offer? The technology is not. We’re not going to allow ourselves in El Paso to be ever called the fattest sweaty town in the United States. We do have unbelievable talent out here that really can teach us about what’s going on. So I know that you’ve seen that, correct? Yeah.
[00:43:18] Dr. Mario Ruja DC*: Absolutely. And what I can say is this Alex? It’s about peak performance and peak ability. And also, getting the correct specific customized genomic nutrition pattern for each individual is the game-changer. That’s the game-changer from longevity to performance and just being happy and living the life that you were meant to live.
Conclusion
[00:43:51] Dr. Alex Jimenez DC*: Mario, I can say that when we look at this stuff, we get excited about it, as you can tell, but it affects all our patients. People come in all depleted, tired, in pain, inflamed, and sometimes we need to find out what it is. And in our scope, we are mandated to be responsible and figure out where this relies upon and where this lies in our patients’ problems. Because what we’re doing, if we help their structure, the musculoskeletal, neurological system, their mind system through a proper diet and understanding through exercise, we can change people’s lives, and they want to be able to fulfill their lives and enjoy their lives the way it should be. So there’s a lot to be said. So we will come back sometime next week or this week. We’re going to continue this topic on personalized medicine, personalized wellness, and personalized fitness because working with many doctors through integrative health and integrative medicine allows us to be a part of a team. We have GI doctors, you know, cardiologists. There’s a reason we work as a team together because we all bring a different science level. No team is complete without a nephrologist, and that person will figure out precisely the implications of all the things we do. So that person is very important in the dynamics of integrative wellness. So for us to be able to be the best kind of providers, we have to expose and tell people about what’s out there because a lot of people don’t know. And what we need to do is bring it to them and let the cards lie and teach them that they had to tell their doctors, “Hey, Doc, I need you to talk to me about my health and sit down. Explain to me my labs.” And if they don’t, well, you know what? Say you need to do that. And if you don’t, well, time to find a new doctor. OK, it’s that simple because today’s information technology is such that our doctors cannot neglect nutrition. They cannot neglect wellness. They cannot overlook the integration of all the sciences put together to make people healthy. This is one of the most important things that we got to do. It’s a mandate. It’s our responsibility, and we’re going to do it, and we’re going to knock it out of the ballpark. So, Mario, it’s been a blessing today, and we’ll continue to do this in the next couple of days, and we’ll keep on hammering and giving people the insights as to what they can do in terms of their science. This is a Health Voice 360 channel, so we’re going to talk about many different things and bring a lot of other talents. Thanks, guys. And you got anything else, Mario?
[00:46:11] Dr. Mario Ruja DC*: I’m all in.
[00:46:12] Dr. Alex Jimenez DC*:All right, brother, talk to you soon. Love you, man. Bye.
In today’s podcast, Dr. Alex Jimenez DC, Health Coach Kenna Vaughn, Truide Torres, Alexander Jimenez, and Astrid Ornelas discuss and focus on a deeper look at understanding metabolic syndrome.
Dr. Alex Jimenez DC*: It is a special day, guys. Today we’re going to be talking about metabolic syndrome. We’re going to be focusing on the sciences and the understanding of what metabolic syndrome is. Today, we’re going to be bringing out some specialists and people from all over the globe in different directions to discuss the topics of metabolic disorders and how it affects people in our local communities. The particular issue that we’re going to be talking about today is metabolic syndrome. Metabolic syndrome affects a whole lot of people now in terms of it to be diagnosed with metabolic syndrome; we have to have a couple of disorders situations that present them that are things such as blood sugar issues, high blood pressure, the ability to have triglycerides off high-density lipoproteins and also the measurements of belly fat in our diet. So today, one of the remarkable things that we’re going to be doing is bringing a panel to us to you guys to see what metabolic syndrome is now. Today is a special day because we’re going live on Facebook Live, and we’re presenting the information for the first time. So this is our first go at it, guys. So give us a thumbs up if you feel we did well. If not, let us also know because we’re learning and going through a process to get to our communities and teach them about metabolic disorders. Today, we have Astrid Ornelas, who will be talking about metabolic syndrome and specific dietary nutritional dynamics to help improve it. We also have Kenna Vaughn, which is our coach, that’s going to be discussing how we interact with patients. We also have our patient here, Trudy, a live individual who has had metabolic syndrome. And in the distance, we also have Alexander Jimenez, who’s out at the National Unity, Health Science, and Medical School, to discuss the associated and linked to metabolic disorders to give us detailed information. Detailed insights as to what metabolic syndrome is and how it affects our communities. Now what to be critical about it is, is this is a severe subject matter. It seems kind of that we chose this particular topic because that it’s affecting so many people. So many of my patients that we see today, even though I have a musculoskeletal practice, are directly related to inflammatory disorders. And when we’re dealing with inflammatory issues, we’re going to be dealing with insulin and how it affects the body. Now, as insulin goes in this process, every one of these particular dynamics that we’re going to be discussing and our future podcasts when we deal with metabolic syndrome is directly related to insulin and its effects on the body. So as we go through these dynamics, what we want to do is we want to bring out each point. I can present today Kenna Vaughn; who will be talking about what happens when we offer a patient and what we do when a patient has metabolic disorders? So we’re going to present it to Kenna. Kenna, can you tell us a bit about what happens when a patient presents with metabolic syndrome, what they look for, what we look for, how we assess it, and how we treat the issues?
Kenna Vaughn: I’d love to. So when the patient first comes in, and we see those signs of metabolic syndrome, the patient isn’t always aware because, on their own, these symptoms that make up metabolic syndrome are not necessarily a red flag. However, when we start to see them getting combined, we realize that we need to take control of this right now. So when that patient first comes in, and they’re telling us about the symptoms that they’re having, we start tracking it, and we make a detailed history on them to see if it’s something that has been going on for a long time, if it’s more recent, things like that. And then we’re going to take it from there. And we do more detailed lab work, and then we look at the kind of even their genetics. Genetics is a huge part of it. And we see what diet would best work for them and just make those realistic goals. But we also really want to make sure we give them that education they need to be successful. Education is tremendous, especially when it comes to something that can be as confusing as metabolic syndrome.
Dr. Alex Jimenez DC*: We discuss how we can give our patients take home dynamics and things of value to change the metabolic syndrome once we determine that someone has metabolic issues. Now the whole idea is to create a direct path from the kitchen to genetics. And somehow someway we have to bring science to the kitchen to understand what we can eat and what we can do and how we can avoid certain foods to change the dynamics expressed at our genetic code level. So we’re going to try to give a little bit of broad, you know, expansive understanding of the processes that can take on each of these five particular issues. One at a time. So in terms of, let’s say, the kitchen, how do we help people help themselves in the kitchen, Kenna?
Kenna Vaughn: One thing that we love to do in the kitchen is smoothies. Smoothies are so beneficial because not only are you feeding your body the proper nutrients you need. You can also provide the right nutrients to your cells, which will make the difference inside your body. And you’ll still feel satisfied and full, not going to be something that’s, you know, you’re left hungry like you just ate a little bit of birdseed. So it’s something that I recommend everybody starts with. One great thing to add to those smoothies is going to be flax seeds. So flax seeds are very high in fiber, a good fiber. So if you put those flax seeds into the blender first and blend them up, opening them up, you start adding in your healthy fats like avocados to make your smoothie nice and smooth. And the almond milk, low calorie, and low carb fruits, things like that. It’s going to just unleash a powerhouse inside that gut. So one main thing that it’s going to do is the fiber is going to stick around. So it’s going to feed your prebiotics and your probiotics every single bug in that gut. And it’s also going to help take things out of your body system that usually gets reabsorbed, such as salt, and let it be able to get excreted the way that it should be, rather than sticking around, like I said, getting reabsorbed and just causing these underlying issues.
Dr. Alex Jimenez DC*: So these dynamics and mainly when dealing with flaxseed, I know Alexander knows a bit of the flax seed dynamics in terms of how it works with cholesterol. And that’s one of the issues, the HDL component. Tell me a bit of what you’re what you’ve seen in terms of the flaxseed, Alex, in terms of our experiences with flaxseed and diminishment of cholesterol and helping out with metabolic syndrome.
Alexander Isaiah: So, flaxseeds are suitable not only for nutrients but like Kenna said, they’re outstanding in dietary fiber. So we have to ask ourselves, why is dietary fiber essential? We can’t digest it, but it can bind to other things that are within our gut. And one of the main things that it does to lower cholesterol is it binds to bile. Now, bile from our gallbladder is around ninety-five percent cholesterol. And I’m sorry, 80 percent cholesterol and ninety-five percent of it gets recycled and reused most of the time. So why have a large amount of fiber within the gut? The fiber binds to the cholesterol. The body’s mechanism to compensate for that is to pull cholesterol from other parts of the body, specifically from the serum of the blood, and pull it back in to rejuvenate those levels of bile. So not only are you forcing your gut to work properly that it is meant to, but you’re also lowering your cholesterol within the inner side of the body.
Dr. Alex Jimenez DC*: So the component of cholesterol can be assisted by fiber. Now, I know that Astrid got some ideas about lowering the blood pressure and bringing a little bit of control in nutraceuticals. And in that respect, she’s been going over some particular topics, and she’s the resident scientist that helps us see the NCBI, which is the national research center that provides daily information about what’s happening with metabolic syndrome out there. So she will be presenting a little bit of some nutraceutical topics that we can touch upon at this present time. Astrid, hello.
Astrid Ornelas: Hello. So, first of all, for those people who are barely coming into the podcast who are barely coming in to listen to us. I want to bring up again what metabolic syndrome is. So metabolic syndrome, as many of you might know, it’s not a condition or disease in itself. It’s more so a cluster of a collection of, I guess, other health issues that can increase the risk of things like heart disease, stroke, and even diabetes. So with that being said, the metabolic syndrome doesn’t have any apparent symptoms, but probably one of the most visible, I guess. You know health issues that are obvious in people with metabolic syndrome is waist fat. So with that being said, some of the nutraceuticals I want to talk about today, as you can see, I’ve listed several nutraceuticals that I discussed the last time. And these nutraceuticals can help with metabolic syndrome in a variety of ways. But I added several on here that specifically target weight loss. Since, as I mentioned, one of the apparent signs of metabolic syndrome is excess waist fat. So I want to bring in one of the nutraceuticals that is that several research studies and I’ve written articles on it that can help promote weight loss in people with metabolic syndrome is niacin. Now niacin, it’s a vitamin B3, and you can usually find it when you buy those supplements that have a kind of B-complex. It has a collection of various of the different B vitamins. So niacin, several research studies have found that it can help reduce inflammation associated with obesity people that have excess weight, of course. Usually, these people have increased blood sugar and blood sugar levels, leading to inflammation. So taking B vitamins, specifically vitamin B3, or as it’s well known for niacin, can help reduce inflammation. It can also help promote metabolism, our body’s capacity to convert carbohydrates, proteins, and fats into energy. So when we take vitamin B and specifically niacin vitamin B3, I want to emphasize that research studies have found that it can help burn calories much more efficiently.
Dr. Alex Jimenez DC*: When we’re dealing with niacin and the nutraceuticals, we are going. I know Alexander’s got some issues. Are you still with us, Alexander? Yeah, I’m here. It’s OK. It’s all good. I can see that we deal with and we’re learning about our technical issues as we go through them. I’m going to go back to Astrid, specifically about belly fat. Now she had mentioned the belly fat. Let’s be very specific when we’re dealing with belly fat. We’re dealing with issues where a male has a greater than 40-inch waist. OK. And for females, they have a greater than 35. Is that correct? Yes. So when we do the measurements, that’s one of the components. So as we discuss these particular issues, we want to make sure that when we’re talking about the belly fat and the weight gains and the BMI issues and the BIA issues, it’s the basal metabolic rate and impedance assessments that we do. We’re looking for those particular aspects. So she’s mentioning in the niacin and terms of niacin, what’s your experience with niacin, Alex with your dynamics that you have put in place?
Alexander Isiah: Niacin, or vitamin B3, is an excellent vitamin B because it is a free product. It reacts to a specific response precisely where it takes hold during glycolysis and the citric acid cycle. It plays a significant role in the citric acid cycle because it is used as the pre-product to synthesize NADH. Now, if someone has metabolic syndrome, this can upregulate that citric acid cycle. So if they’re trying to burn fat or use their carbohydrates at a more efficient rate, it will help upregulate that cycle and allow them to use their mitochondrial metabolism a lot better.
Dr. Alex Jimenez DC*: That’s awesome. Now, going back to Astrid, tell me a bit about what supplements we have here. We may not get through all of them, but little by little. We’ll break this thing down, so we’ll give you guys tidbits. So that useful information so that we can take on metabolic syndrome and change people’s lives. Go ahead.
Astrid Ornelas: OK, so the next nutraceuticals I’m going to talk about, I’m going to talk about these two together vitamin D and calcium, specifically vitamin D3. I want to emphasize that. But both of these nutraceuticals can also help promote fat mass loss. And several research studies have also found that this one, just like B vitamins, just like niacin, vitamin B3, could also help improve metabolism to make the body more efficiently burn calories. And then the next nutraceuticals I want to talk about is DHEA. Now I want to, I guess, one of the things that I want to highlight about the DHEA is that, first of all, this is a hormone. This is a hormone that is naturally produced in the body. But then, of course, you know, some people can supplement it if you talk to your health care professional. And they determined that you need more DHEA in your body because your body’s not naturally producing enough of it, then they can supplement that as well. So specifically about the DHEA, according to the Washington University School of Medicine, DHEA can also help metabolize fat much more efficiently. I guess one of the things that I wanted to discuss goes together with the DHEA. So when we consume excess calories, you know, the daily caloric intake on average, according to researchers, we need to take 2000 calories. But so what happens to the body when we eat excess calories now? These calories are stored in the body as fat. So when the body naturally produces, I guess, sufficient amounts of DHEA, our body can metabolize DHEA. I mean, metabolize fat. I’m sorry, much more efficiently so that our body gets rid of excess fat rather than storing it.
Dr. Alex Jimenez DC*: Got it! So let me ask you, DHEA is a hormone, and one of the things that I notice is that it is a hormone found over the counter. And one of the unique things with some passages of recent laws is that DHEA made it through the FDA to be used over the counter. So you’ll see the product is dispersed through all the stores and depending on the quality, you can see it more every day. And the reason you see it more common over the last couple of years is that the FDA found it, and then through a loophole, it was allowed to remain in the markets. Go ahead. Kenna wants to mention something regarding this particular component in the assessment of those specific issues.
Kenna Vaughn: I was going to add something when it comes to talking about body fat and how Astrid was saying that body fat gets stored. So what happens is when you have those excess calories, you create these things in your body called triglycerides. And triglycerides are composed of glycerol and fatty acids; and however, those in general triglycerides are too big to enter that cell membrane. So what happens is another hormone that controls almost everything, and it’s called insulin, and the insulin gets called in. And from here, we have the lipo…
Dr. Alex Jimenez DC*: Lipoprotein lipase?
Kenna Vaughn: Yes, that one. It’s a tongue twister, so that gets called in and then kind of breaks those apart. The insulin is coming in again and activating something called the glut4transporter, which will open up that cell membrane. And now we’re going to see that fat cells get stored full of glucose, triglycerides, and fat. So that’s how those fat cells go from not having anything to then having those excess calories. Now they’re being converted through this process. Now they’re getting nice and full, and they’re hanging around your belly.
Dr. Alex Jimenez DC*: I’ve noticed that certain people have more efficient LPLs, which is lipoprotein lipase. Some people may say that you know what? I gain weight by just looking at food, and it may happen more as you get older. A whole different control system controls this particular issue. What kind of control systems are the ones that control lipoprotein lips and the glut4, along with hormone-sensitive lipase, that you have there?
Kenna Vaughn: Insulin controls everything else. And it’s like I said, it’s that hormone, and it’s going to come in. And also, on top of that, we have PH that affects enzymes, temperature, and things along that line.
Dr. Alex Jimenez DC*: You know, a lot of things that when we look at enzymes, we realize that the thing that determines the enzyme’s activity or sensitivity or ability to function is encoded in the genetics in terms of lipoprotein lipase and the breakdown of the fatty acids. I know, Alex, you have some points there in terms of the fat breakdown information. What do you have there that you can help the public understand a little bit more?
Alexander Isaiah: So, without going too much into the biochemical pathways, this is just showing the mitochondria’s inner mitochondrial matrix. So after I guess you’ve been well-fed and all your cells are satisfied with energy production through ATP synthesis, if you have overconsumption of caloric intake, specifically through glucose, you end up having a large amount of acetyl-CoA being produced or hanging around in the end here. So what the body does is buy high levels of insulin. This enzyme, called citrate synthase, is induced. So what citrate synthase does is use oxygen acetate and acetyl-CoA to make citrate. Now, citrate can then exit the mitochondrial matrix, and then significant accumulations of citrate will start accumulating in the sidewall of the cell. As that happens, ATP citrate lies will break them apart again and bring acetyl-CoA and auxtyl-acetate. Because auxtyl-acetate and acetyl-CoA don’t have specific membrane transporters, they can’t cross that mitochondrial membrane. Only specific ones like citrate do so as acetyl-CoA gets taken out into the cell; taking a look over here, we have acetyl-CoA, which gets turned into methylmalonyl-CoA. And it’s actually this enzyme acetyl-CoA carboxylic is induced by insulin. So usually, acetyl-CoA carboxylic has a phosphate group on it, which inhibits its activity. But when it interacts with insulin, insulin turns on a protein phosphatase. So phosphatase are enzymes that take phosphates off, and then it becomes acetyl-CoA carboxylic. So now acetyl-CoA carboxylic is active to make methylmalonyl-CoA. Now, why is this important? So methylmalonyl-CoA is like putting the boulder on top of the hill; you’re going to start a different chemical process. So methylmalonyl-CoA inhibits fatty acid breakdown and begins fatty acid synthesis. So when you start making methylmalonyl-CoA, you’re going to, without going too much into fatty acid synthesis. The end goal is palmitate, which is the type of fatty acid. Now, palmitate chains will combine with glucose to form triglycerides. So here, we can see how a large dietary intake of carbohydrates, glucose levels, proteins, and insulin activates triglycerides. And if you have diabetes, you pretty much get halted in specific pathways. And that’s why you end up with too much acetyl-CoA. You have too many ketone bodies floating around in the blood, so you are going through without going too much in-depth; we can see that having a large number of dietary triglycerides, large amounts of glucose will force more triglycerides or try sealed glycerol within these kinds of microns within the lumen of the blood vessels. And this is going to cause a chain of reactions. So without breaking down too much here, we’re showing where it’s all going, so we have acetyl-CoA going to methylmalonyl-CoA, going to palmitate, and then we have palmitate forming these triglycerides. So like Kenna said, these triglycerides can’t enter the adipocytes. The adipocytes are fat cells without lipoprotein lipase. So with the combination of lipoprotein lipids allows these cells to get in there. You allow for the storage of the fat, so the cool part to notice is that by doing so, the first one will use fatty acids to be your heart. The heart relies on around 80 percent of its energy from fatty acids. Then it’s going to be your muscle cells. But this is in conjunction if you’re exercising regularly. If you’re not doing that, the adipose cells will favor storing the triglycerides or triglycerol more often. And then you’re also going to use more LDL, which means you have the potential to have more oxidized LDL, causing a higher event of atherosclerosis formation.
Dr. Alex Jimenez DC*: You know, as you go through this process, it seems natural, but for a lot of us, it’s a deep, deep story, and it’s far, and it’s dynamic. And what I want to do is to bring the people back to Kenna as to the diets. In terms of getting this basic understanding. How is it that we assess an individual where these particular issues? I can assure you that when we first evaluate a metabolic syndrome patient. We do a lot of blood work, blood assessment, a lot of enzyme testing. We can even do DNA testing. So we got to go back to a patient and describe precisely how we can better improve their lives by our assessments. So, Kenna, you got some cool stuff in there for us. What do you have in front of you?
Kenna Vaughn: Yes, in front of me, I have a sample report from one of our patients on who we ran the DNA blood test. And one of those things that we can see is a gene pulled up right here, and it’s called TAS1R2. And what this gene does is it’s a tissue that can be found in the gastrointestinal tract, the hypothalamus, and the pancreas. And it’s known for regulating your metabolism and energy, and homeostasis. Also affects that food intake beyond the detection of your sweet taste on the tongue. What does that mean? So what that means is it is nicknamed the sweet gene. So, somebody with this gene is more likely to be drawn to sweet foods because it’s almost like their sweetness is enhanced. So when they taste ice cream, it’s a 10 out of 10, no matter the flavor, versus someone who doesn’t have this gene. Maybe it’s more of a seven out of 10. It hits them differently.
Dr. Alex Jimenez DC*: That makes perfect sense. Or some people that, you know, they love that ice cream and that dynamics, I know that I want to take a little bit of a detour because a lot of patients will wonder, Well, what are we going to do to get into being assessed and what kind of things we can? How does someone get? Where do they go? And for that, we have our clinical liaison here, Trudy, who walks patients in and first determines that the patient is qualified because we do have questionnaires that assess the determination of if someone is a talented individual or does have presentations that are predisposing to metabolic syndrome that require further assessment. And once we do in the situation that a person does have it, they want to understand what to do. So actually, Trudy, you do us help people and guide them through the process. What do we do in the office to help guide an individual through the beginnings of metabolic assessment?
Trudy Torres: OK, well, basically, you know, when people call in, we go ahead and email them a questionnaire. It does take about 45 minutes because it’s a very in-depth questionnaire. We want to pinpoint and get to the bottom of their main concerns. The main issues that we’re going to target for the process to be successful. Once we get that questionnaire back, we set up an appointment with Dr. Jimenez and our health coach Kenna, and they will go in-depth as far as the target areas that we need to address for the process to be successful. And that’s one of the things that I wanted to ask Kenna because I know it can be a bit overwhelming as far as what is it that they get? And as far as what is the following process? So once we get the questionnaire, I know that’s when they’re going to go ahead and do the different types of lab work to determine what will be successful in the kitchen.
Dr. Alex Jimenez DC*: I know you see the patients when they walk in; how do they feel in terms of that Trudy? What is it that they typically will tell you before being further assessed?
Trudy Torres: Well, they’re tired of, you know, all the different changes that you go through as, unfortunately, as we age. You know, some of the DNA genes that we have, that they’re dormant, you know, they become active. And that’s when you start to experience a different type of bad syndromes, you know, like metabolic syndrome. And that’s one of the things that we address. You know that we go ahead and do the DNA testing and see what different genes are dormant that are not dormant.
Dr. Alex Jimenez DC*: I think that also, you know, whether you’ve noticed too and you’ve mentioned this to me, they’re just tired of feeling bad. They’re just tired of feeling like; I guess crap is a good word, right? So they’re tired of just they don’t recover. They don’t sleep well. They feel stressed. They feel like they’re being choked with high blood pressure. It’s not. Their lives are different. They’re in distress. They don’t sleep. So these are issues that the patients present to you, and I know you help them guide them. And then, Kenna, tell me a bit of the assessment you do to qualify an individual on the metabolic syndrome programs we have?
Kenna Vaughn: Like we were saying before, we go through that detailed history to look at that family history. And then we also decide, like Miss Trudy noted, the lab work gives us a lot of these underlying answers because the lab work we do is more detailed than the basic. So we get more numbers, more genetic codes, and more of all of these things. And from there, we’re able to take it and see what will be the most successful path for this patient. What supplements are they going to be able to intake better? What diet is best for them, whether it be the ketogenic diet or the Mediterranean diet? Everybody’s body is different because everybody’s insulin sensitivity is different, and everyone’s hormones change, especially for females. It’s different than male patients, and we create that individualized package for them because we want them to leave at the end of everything, not just that first visit. Still, we want them to leave feeling empowered and healthy and strong and not just they’re alive, but that they’re living. And that makes a massive difference to their families and their friends. And just everything gets impacted, all from the start of these questionnaires.
Dr. Alex Jimenez DC*: You touched on a subject matter there about being left alone. We go through a process, and we do keep connectivity with our patients. With today’s technology, there’s no reason we can’t have a person or an individual connected to our office and give us information such as BMI BIA information, which is basal metabolic stuff, the scale weight, the fat densities. We can have this information today. We have Fitbits that connect to us, and we can understand that that data is now available in a private way, and someone on the other side is reading that tell us what you do with individuals in terms of the coaching that we offer people; for specific metabolic syndrome?
Kenna Vaughn: Of course. For coaching, we have a scale. And like Dr. Jimenez was saying, this scale not only tells you your weight, but it also sends your weight, your water intake, how much of your weight is water weight, how much of your weight is lean muscle? And it also can track it and see the percentages of where you’re changing. So we can follow that maybe the number on the scale hasn’t moved. And some people might start to feel discouraged. But when we look at the numbers of what that scale tells us, we can see that you are losing body fat and being replaced by muscle. So even though that number is the same, your body inside is chemically changing. You’re making those differences you need to make to keep up with it and not to quit because, as I said, it can be discouraging for certain people.
Dr. Alex Jimenez DC*: So there’s a Mind-Body connection here. A mental component, teamwork dynamics, is essential when we’re working through metabolic syndrome. We can’t leave people here, here, take the football and run 80 plays. No, you have to huddle in each time to discuss and change the adaptive processes. Regarding the other areas with fat analysis, I know Alex has some additional areas and Astrid that will be discussing in a few minutes. But I’m going to focus on Alex right now to tell us a bit of what people can do with exercise or fitness that could stimulate or dynamically change their metabolic processes at the biochemical level.
Alexander Isaiah: Well, I would first, in all honesty, be honest with yourself; you will probably be the best observer of your situation. We all know what foods we do well with. We all know what foods we don’t do well with. We’ve always had some intuition as we’ve grown into the people we are today, knowing what foods work well for us and what foods don’t work well for us. For example, I know that if I consume a large carbohydrate consumption, I tend to put on weight pretty quickly. But I am pretty active. So the days that I have strenuous activity, I make sure that I have a balanced meal with proteins, fats, and a decent amount of carbohydrates. But the days that I’m not very active or haven’t gone to the gym. I make sure that most of my caloric intake sometimes comes from good fats or proteins. And that’s going to be the best thing is just be honest with yourself. See how you’re doing, find your BMI, find your basal metabolic rate, and then put numbers on paper. Because if you keep track of things. Odds are you’re going to do better and control the way your body’s responding. The next thing is I would find a health coach like Kenna, to stay on track and find any recommendations. The good part is that we have the internet out there and sources like yourself, Dr. Jimenez, that can provide information to the public on a new level and be able to understand and grasp the concept from a different perspective and give people more information that they didn’t know that they had at their fingertips.
Dr. Alex Jimenez DC*: I’m going to take it back to Astrid. Thank you, Alex. But one of the things is I want people to understand we’re going to assault. We’re going to assault on metabolic syndrome because this is a big problem and affects many in all communities around the United States. And we have to have an open forum to be able to open up. And sometimes, we don’t have 10 seconds, and this is not a 10 second, two-minute thing. We must understand that there needs to be a teamwork integrative medicine approach that helps the patients. So I know we’re going to go with a couple, I don’t think we make it through all of them, but we’re going to get through as best as we can because this is all recorded and can be dynamic and time purposes used later. Tell us a bit of the omega, berberine, and all the other supplements you had planned to talk about.
Astrid Ornelas: OK. Well, first of all, for those of you who are barely coming into the podcast right now, the nutraceuticals that are currently listed up there can all help improve metabolic syndrome in one way or another. The majority of these specifically target they specifically lower help lower the risk factors that can cause that could increase the risk of developing issues like heart disease, stroke, and diabetes. But I want to emphasize several of these because they do they’re more efficient at promoting weight loss associated with metabolic syndrome. You know, if you’re going to improve metabolic syndrome, you want to promote weight loss, so that the last nutraceutical we talked about that’s up there was DHEA. The next nutraceutical I want to talk about is NRF2. So just like DHEA, it is a naturally produced hormone in our body. Well, NRF2 is also found in our body naturally. But unlike DHEA, which is a hormone, NRF2’s actual name, I guess the full name is the NRF2 pathway. It’s what’s known as a transcription factor, or it’s an element that regulates several cell processes if you will. And so I’ve done quite a few articles on this myself, and there are several research studies out there, quite a few to be exact, but NFR2 can also help improve metabolism. So if you improve your metabolism, especially in people who have metabolic syndrome, your metabolism can make it much more efficient for you to burn calories and therefore burn fat more efficiently.
Dr. Alex Jimenez DC*: The Omegas and NRF2, what we’re dealing with here, along with berberine, is inflammatory issues, OK? So what we want to deal with is when someone has metabolic syndrome, we suffer from inflammation, and inflammation is rampant. And that’s what’s causing the discomfort, the joint pain, the overall swelling, the bloating. Those are the kind of things that help, and they affect the blood pressure in insulin does happen, and we haven’t talked about that yet. But we’re going to be discussing that. I know Alex has got some ideas about Nrf2 factors and Omegas and berberine, and tell me a bit of what you’ve seen in terms of the nutraceuticals, and you read in terms of its effect on metabolic syndrome.
Alexander Isaiah: So the way we need to look at the different types of fatty acids is that most of the surface of each cell is composed of a fatty acid. It depends on what type gets incorporated based on the consumption or dietary intake that you have daily. So the main two components that your body’s going to use is cholesterol. That’s why we still need cholesterol and healthy fats that we get. But at the same time, if you’re taking in a lot of red meats, you’re also going to use arachidonic acid, which makes different types of fatty acids. And it also makes a transcription factor called PGE two, which is known for its very informative process or aspects. So what fish oils do, specifically EPA and DHEA, are by incorporating these into the cell membrane. You upregulate NRF2 and downregulate NF Kappa B, which is the inflammatory response. And not only by doing that, but as we talked about before with green tea extract and turmeric, otherwise known as curcumin. These also inhibit the pathways for inflammation. Now there could be the argument Well, do these pathways inhibit the inflammation? So let’s say I get sick or something, right? Well, the cool part is that two different pathways are stimulating the same response. By doing the dietary regimen of curcumin, fish oils, or even green tea, you’re inhibiting it from the body overexpressing these genes. Now, suppose you still get sick in a sense, right. In that case, you could still allow these cells to proliferate, specifically your macrophages, to do their job correctly, so you’re not inhibiting them by overstimulating them. You’re allowing them to be more proficient in their job. And suppose you are virally infected or with some unknown pathogen or let’s say. In that case, a cell decides to go rogue and start producing cancer cells, allowing the body to be more proficient in extracting these pathogens.
Dr. Alex Jimenez DC*: In essence, we’ve learned that if we try to suppress inflammation, we create a huge problem. The question is, let’s stop inflammation from progressing to be too extreme. So, in essence, to keep it at a workable dynamics, and that’s what these curcumins and the green teas do. I know Astrid has something to mention in terms of this particular concept. Tell me a bit about what you’re thinking.
Astrid Ornelas: Yeah. So as Alex mentioned, green tea is a fantastic drink. It’s actually in my nutraceutical list that’s up there, and I wanted to talk about green tea because it’s a very easily accessible drink, you know, for those of you who like tea. Green tea is delicious as well. And green tea has a variety of research studies demonstrated to be super beneficial for people with metabolic syndrome. So as many of you know, green tea contains caffeine. Of course, it has much less caffeine than a cup of coffee, for example, but it still does have caffeine, and green tea is also a powerful antioxidant. That’s another of the things that it’s very well known for. But just like NF2, you know that the interruptive pathway, green tea, has been demonstrated to help improve metabolism tremendously. You see, it promotes the body’s ability to burn calories, to burn fat. And because of its caffeine, I guess amount because even though it is less than a cup of coffee, but it’s just enough, it can help improve exercise performance. And you know, for those people who are looking to lose weight because of the, you know, the issues that they have associated with metabolic syndrome. Drinking green tea can help promote and improve their exercise performance so that they’re more able to engage and participate more efficiently in their exercise and physical activity to burn fat.
Dr. Alex Jimenez DC*: So basically, you’re indicating that as a good option instead of, let’s say, a whatever kind of drink or a juicy drink, it’s wise to keep sort of in the background green tea throughout the day. Is that correct? Or how much the water is good? The green tea’s good; a little bit of coffee and a little bit of this fluid is essential to keep our bodies hydrated through the process. Since it’s already available, green tea is a great option not only for metabolic processes to stop inflammation but also to help with the burning of the fat too?
Astrid Ornelas: Yeah, definitely. Green tea is a great drink. You can pretty much have it throughout your day. You know it has less caffeine than, say, you know, coffee, as I mentioned. And it will, you know, for those who have green tea, I love green tea, and I will have it. And you do get that little, that extra amount of energy. You feel it when you have green tea. But, yeah, you can have it throughout your day. And you know, it’s essential to stay hydrated, drink plenty of water. And you just want to make sure that if you do exercise enough, you don’t want to lose your electrolytes. So, you know, drink plenty of water and just stay hydrated.
Dr. Alex Jimenez DC*: I know that we’re going over there. I know that Kenna wants to speak something, and we’re going to go in that direction right now because Kenna wants to talk about specific dietary changes and things that we can do from a health coach’s point of view.
Kenna Vaughn: I just wanted to say that green tea is super beneficial from Astrid’s point. But I don’t particularly appreciate drinking green tea, which means that all hope is lost. They do have green tea and capsules as well, so you can still get all of those great benefits without actually drinking it because, for some people, it’s, you know, their coffee over tea. So you don’t have to drink the tea. You can still get all those great benefits that attitude was talking about but through capsules.
Dr. Alex Jimenez DC*: yeah, we got exciting, sneaky ways to help people. To help people understand and to come into our office. What can they do, Trudy, in terms of being facilitated in the office if they want to make, if they’re going to have questions or for any doctor, they have out wherever they may be because this is reaching far.
Trudy Torres: I know this can be very overwhelming to just the regular population. You see, we went in too deep, you know, as far as all the physiology behind it and everything else. One of the things that I can tell you is that when you call our office, we’re going to walk you step by step. You’re not going to be alone. You’re going to walk out with a lot of information and know what works for you. Like Kenna was saying, everybody’s different. This is not a cookie-cutter program. We take the time and talk one on one with everybody who walks in and make sure that when they walk out and have a lot of information with them, they also walk out with just the lab work; they will walk out with recipes. Kenna is going to be constantly following up with you. It’s a highly successful approach when you have accountability from a health coach. So you’re not going to be by yourself.
Dr. Alex Jimenez DC*: You know again where our goal is to make the kitchen to the genes and from the genes to the kitchen, we got to give the understanding maybe not of the deep biochemistry as Alex has taken us into or the nutraceutical dynamics, just know that there are ways that we can monitor. We can assess; we can periodically evaluate. We have diagnostic tools to determine blood assessments that are way beyond what was done ten years ago. We have dynamic metabolic testing in our office to determine fundamental critical aspects of weight density, the limb way to the body, and how much water you have. We use things like phase angle to assess the health of the cells and how they’re functioning. So there’s a lot that goes on in this process. So I want to take the opportunity to thank my guests today because from Alexander, all the way far on the north side of the United States, to Astrid, who assesses things at the NCBI because we need to have our finger right on the research that has been done. To our clinical liaison, which is Trudy, and one of our dynamic health coaches. I can be a health coach, but sometimes I’m with a patient, but she’s really with you all the time, and she can connect with you via email, which is Kenna. So together, we have come with an intention, and our purpose is to understand what the process is. A metabolic syndrome to break it down to deep levels will get down to them as you can see, to the genes, to the kitchen. And that’s what our goal is to educate people on how to feed our children. We intuitively know how to feed our families. Moms know what to do. However, today’s technology and research offer us the ability to break it down and specific to the sciences. And sometimes, when we get a little older, we realize that our bodies change and our genetics change, and that’s preordained based on our past, our peoples, our ontogeny, which is the generations in the past. But we have to realize that we can make a change and we can stimulate. We can activate genetic codes. We can suppress genes that want to get active if you improperly diet or do a proper diet. So our goal today is to bring this awareness, and I want to thank you guys for allowing us to listen in. We look forward to getting different subjects, maybe not as intense or dynamic, but this was our first run at the process. And we’re going to learn, and please ask questions so that we can kind of make it better for you and give you the information you need. So we thank you very much, and I want to tell you from all of us out here in El Paso that we look forward to offering the world information into metabolic syndrome that affects so many people. So thank you, guys. Thank you for everything.
In today’s podcast, Dr. Alex Jimenez, health coach Kenna Vaughn, Astrid Ornelas, Truide Torres, and biochemist Alexander Isaiah Jimenez discuss what is metabolic syndrome and the steps to fix it.
Dr. Alex Jimenez DC*: All right, guys, we’ve come to another podcast, and welcome to Dr. Jimenez and Crew podcast. Welcome, and you have a family here. We’re going to go over metabolic syndrome today. Metabolic syndrome is a disorder that ultimately affects a whole lot of people. And what happens is, is it affects one of the largest populations in affecting El Paso, pretty much in this region. And what we have is it’s not a disease, OK? First of all, it’s a combination of presentations that medical doctors and the World Health Organization have determined high-risk factors to have a stroke, kidney disorders, and even problems with dementia. But overall, it’s pretty much if you have metabolic syndrome, you feel crummy. So today, what are we going to do is we’re going to discuss the issues, and we’d like to at least present it to you so that it becomes useful for you and the information provided by us is going to be helpful for you or a family member. So if you have the opportunity and something that you enjoy, please go ahead and at the bottom area. There’s a little bell to subscribe to. And a little belt in markets so that you could be the very first person to get information in the future when we ever posted. And also allows you to present or ask us for things that are important to you in the health-related realm. Now, what are we going to do today? My name is Dr. Alex Jimenez. I have my entire staff here. We’re going to go, and we’re going to present each one of them in different moments. And we’re going to do some fascinating dynamics. We will also have our resident biochemist at the National University of Health Science, who’s going to chime in and give us a little bit of foundational biochemistry. This information is going to be helpful. We’re going to try to make it as simple but as useful as possible. Now, bear in mind everything that we’re going to be talking about in and today revolves around the metabolic syndrome. Metabolic syndrome is what the health care organizations have determined, and the cardiac departments have five major symptoms. Now you have to have three of them, at least to be classified as metabolic syndrome. OK, now the first thing is to ask… What do you feel? Pretty much you feel like crap, OK? And it’s not a good feeling to feel this way, but you’ll see that if you have of these presentations, you’re going to notice that your doctor may give you a diagnosis of metabolic syndrome. Now, the first thing that happens is you usually have a bit about belly fat. Now, the belly fat that people have, people measure it. For men, it’s a belly kind of like the lonja, the belly that hangs over, and it’s about a good, I’d say, about 40 inches or greater in the male. In women is 35 inches or more. Now that’s one of the first presentations. Now the other presentation is high blood pressure. Now that high blood pressure that they use is 135 milligrams over deciliter. Sorry, yeah. Miller Mercury’s millimeters of mercury over these leaders to determine exactly on the diastolic and the systolic. So the diastolic is going to the systolic is going to be 135, the diastolic is going to be over 85. Now that doesn’t happen again; you’re going to notice something. These aren’t extreme ranges from OK. Metabolic syndrome has high triglycerides. Now the high triglycerides are going to be noted in the blood. OK, now one of the things that can be determined early on is high blood pressure, which is also so associated with metabolic syndrome. So the other final one is the elevation of or decrease actually of HDL. HDL or the good fragments of cholesterol. Alexander will be a resident biochemist and talk to us more about that in the latter part of the show. Now, bear in mind, I’ve given five things a. the fat, b. the high blood pressure, c. the blood glucose levels, and also the triglycerides, along with the lowering of the HDLs. The question is, how are we going to be able to control this now? I’m going to give you some real good basic ways that you can control metabolic syndrome. And by the time we’re done today, we’re going to be able to assess the situation. And even if you have it, you basically will be able to control it. There are rare diseases that you can be disordered. And again, this is not a disease; it’s a combination of syndromes or symptoms to be called a syndrome collectively. So metabolic syndrome can be construed. Now you’ll notice that the blood glucose level will be elevated, usually over 100; these are relatively average numbers people have. But if they’re higher than that, they do create issues now. Also, when you have the belly fat 40, and it’s not that much, many people have it. People also have blood glucose levels that are higher than 5.6 on their blood glucose A1C. These numbers and the 150 mg per deciliter of triglycerides are all normal but in combination. Together, they do ultimately create a scenario that is not favorable to cardiac issues. Cardiovascular issues do present as a result. So what we’re going to try to do is try to bring down and control these issues. Now, what are the things that cause metabolic syndrome? One of the things is stress, smoking, a sedentary lifestyle, and even sleep problems and disturbances. We can be elaborating on each of these we can we’re going to be elaborating on in the future podcasts. Still, we’re going to be able to tell exactly what’s going on in a better way. We also have issues with inflammation and processed foods. At the core metabolic syndrome, the main issue is insulin sensitivity issues and high blood pressure issues, and inflammation. So what are we going to do to control that? I want you to know that every single one of these five issues, whether it’s blood glucose, high triglycerides, low HDL counts, or blood glucose, they’re all relatable to one disorder. It’s insulin sensitivity. Insulin sensitivity controls every one of these factors from raising high blood pressure. The kidneys are controlled by insulin, causing an increase in blood pressure, and we’ll discuss that issue and its correlation. So if we can control the blood glucose, we ultimately have the fastest and the surest way to provide the fastest route to heal and fix an individual with metabolic syndrome. So let’s go ahead about the issues that are going to result from that. Now, as I’ve got this, we’re going to notice that if over some time you continue to have a lifestyle that has high levels of these particular five factors, you’re going to notice that you’re going to tend to have high cardiac risks. Now we have a team here, and I want to introduce each one. We have Kenna Vaughn, who is our health coach. Our health coach is the one that’s going to be the one that explains to our patients what is going on. I’ll bring her in. We also have the clinical liaison, which is Trudy. Trudy is the individual who will be able to bring out the questions and determine what kind of issues are appropriate for you. So we’ll be discussing those. And we have our resident chief editor, Astrid Ornelas, who will be the one that explains the studies on it. From Illinois, we also have Alexander, which we have right in the back where you can’t see him, but he’s presenting and say, Hello, Alex, can you get them there? Hello. All right. So he’s out there, and he’s going to discuss the issues and the biochemistry side of things, and we’re looking forward to explaining those issues. Now, one of the things we have to do is go back to the issue of insulin sensitivity. Insulin sensitivity is at the root of all these issues. So what we’re going to do is discuss exactly how insulin can be controlled. But what we’ve learned through these studies, and I’m going to bring in Mrs. Ornelas, is here to discuss the studies on how to control blood glucose and blood sensitivity. Astrid, what did you find out recently that shows the proof and presents the easiest way to control blood insulin and elevate HDL?
Astrid Ornelas: OK, well, first of all, just as you know, as you mentioned, metabolic syndrome, it’s a collection of health issues that can increase the risk of developing heart disease, stroke, and diabetes. It’s basically like, you know, it can affect our overall health and wellness. And I’ve done quite some research, and I’ve found them through the National Center of Biotechnology Information, the NCBI. A variety of research states that metabolic syndrome or people with metabolic syndrome, one of the easiest, you know, quote-unquote easiest or one of the best ways out there that can be used to help… Restore? Yeah, to help restore or reverse all metabolic syndrome would be through the ketogenic diet. So the ketogenic diet or the keto diet is a low carbohydrate, high-fat diet, which, according to research studies, offers many benefits towards people with metabolic syndrome. It can help improve or promote weight loss, and it can help reduce diabetes.
Dr. Alex Jimenez DC*: You know, I want to mention right there, I have found nothing faster to lower the blood glucose and reverse triglycerides issues and HDL issues than the ketogenic diet. So, in essence, if you want to do it fast, it’s incredible the speed at which it restores the body to what it is. What else is there?
Astrid Ornelas: Yeah. So, like the human body, usually, we use glucose or sugar. It is supposed to be our primary source of fuel, our main source of energy. But of course, for people who have metabolic syndrome, people who have obesity, insulin resistance, diabetes, or the increased risk of diabetes. The ketogenic diet can be very beneficial because it is a low carbohydrate diet, carbohydrates essentially turn into sugar or glucose, and we don’t want that. Like if people have metabolic syndrome, they have, you know, diabetes and insulin resistance. You don’t want sugar in your body because they produce too much of it. They have too much blood sugar. And but by increasing your height, by increasing the number of fats that you eat, and decreasing the number of carbohydrates, you keep a low amount. You keep insulin low, and you, by eating more fats, basically what you would do is make the body go into a state of ketosis.
Dr. Alex Jimenez DC*: You know what? Let me ask you something. I’m going to feed this over right now to Kenna, and I’m going to ask Kenna in your experiences with the blood sugar issues. How is it that we contain and we learn to be able to manage someone’s blood sugar? The quick is the fastest. What is it that you do in terms of coaching individuals, helping them back?
Kenna Vaughn: For coaching individuals. I always evaluate their diet, and the main thing I like to focus on is education because so many people are not educated about, as Astrid was saying, carbs and how they fuel your body. A Big Mac might have 54 carbs, and a sweet potato might have 30 carbs, and people don’t realize that they’re that different, and they only see 20 points or something like that. But the way that the carbohydrate breaks down in the body is enormous. And that’s why the ketogenic diet works so well because you’re using those good whole carbs that are going actually to contain protein as well. And so it’s going to help to break it down slower versus a Big Mac, which is just going to spike your insulin way up.
Dr. Alex Jimenez DC*: And what part of the Big Mac is the thing that spikes the sugar? I mean, in terms of that?
Kenna Vaughn: Right. So the bread, the carbs in the bread, actually breaks down differently in your body than a sweet potato would. And so that’s what’s going to give you that high glucose level. And then after that, you’re going to have the fall of the glucose level, which is your blood sugar going up and down does not feel great. So it’s something you want to avoid.
Dr. Alex Jimenez DC*: I have a question for you. For the sugars. When you asked the types of sugars you have, you just mentioned that the variety of carbohydrates matters. Yes. Tell me a bit of that.
Kenna Vaughn: The quality, like I was saying, sweet potatoes, avocados, things like that. They’re going to have the carbohydrates that are better for you, meaning you break them down differently than you would. Faster sugars like sucrose and things like that.
Dr. Alex Jimenez DC*: So simple sugars are out, basically, which is why, first of all, metabolic syndrome did not even exist before the advent of refined foods. So refined sugars have caused this problem. So what we want to do is sugar leads to inflammation. Sugar leads to triglyceride issues. Sugar or insulin sensitivity issues are the things that are the basis of this process. All roads lead to insulin sensitivity in this process. And the organ that provides us with insulin, the most significant amount is is the pancreas. The pancreas is nonstop. And depending on how the pancreas responds to this blood sugar drama, it determines the fate of the individual. It will alter the triglycerides. It will transform the blood pressure by directly holding sodium in the kidneys, the kidneys the body prepares. It retains the sodium, and by the nature of sodium, the blood pressure soars. So the fastest way to lower your blood pressure is a ketogenic diet. And this is amazing because it is simple. It’s not that complex. We can go extreme. And I know that Astrid had an excellent research document on that. Tell me a bit of what you noticed.
Astrid Ornelas: Yeah, basically, like, what Kenna was saying. Before, many people didn’t know the difference between what type of carbohydrates they want to eat, like, for example, as you said, you know, a lot of people will eat a Big Mac, and they’ll eat that sweet potato, and they don’t know the difference between a good carbohydrate; basically, we want to eat what you call complex carbohydrates, which is it’s more like we want to eat like whole wheat or we want to eat like like good starches because those there break in the body breaks them down into glucose, into sugar. But they’re used much more slowly to where it won’t. The body won’t directly use them. And then you’ll get that crash, that sugar crash.
Dr. Alex Jimenez DC*: Because of the insulin spike, right? It controls the insulin spike. You know what? I want to bring in our resident biochemist here. OK, so our brilliant biochemist is Alexander. He’s got a presentation here, actually, if I can see it there and see if I pop up here. And there he is. Alex, can you tell us a bit about what you’re trying to explain here on the biochemistry side of things?
Alexander Isaiah: As you guys mentioned, just in general, glucose is the primary energy source in the way that we use it for the breakdown. Its breakdown on energy consumption is called glycolysis. So without getting too much into it, our end goal here is pyruvate, which then goes into the citric acid cycle to be turned into acetylcholine. In normal conditions, this is good to have a carbohydrate meal, but when in excess, do you produce too much acetylcholine? When is too much acetylcholine used? You end up inducing fatty acid synthesis, which is induced by significant levels of insulin. So by doing so, you have acetylcholine, which ends up turning into palmitate. And one thing that Kenna mentioned is that not all foods are of equal quality. So here, we can see all the different types of fatty acids. So without going too much into biochemistry, but just giving you an idea of what’s going on here? These numbers on the left side represent the number of carbons in a row, and then the numbers to the right of the semicolon are the number of double bonds. And usually, double bonds don’t play a significant role until you get into digestion and the way the body uses these. So by having more double bonds, it’s more fluid. So you notice the difference between a piece of lard and olive oil. What’s the difference? The only difference is the number of carbons and the number of double bonds. So here we have oleic acid, olive oil, and then we have some saturated fat. We can see that the difference is prominent in the number of carbons and double bonds. Double bonds allow for a lower melting point. That’s why olive oil is a liquid at room temperature versus fatty acids, and this plays a significant role in how the body uses these types of things.
Dr. Alex Jimenez DC*: Alex, are you saying that? We all know that the excellent work of olive oil, avocado oil, and coconut oil is the best thing is, this is why this happens.
Alexander Isaiah: Exactly. So the more double bonds they have, the more fluid it will be within the body and allow the body to use those fats on time versus clogging up artery arteries and creating plaques within those arteries.
Dr. Alex Jimenez DC*: Excellent. You know what? One of the things that insulin does, it pack away carbohydrates in energy in the cell. If you do that, what happens with this blood sugar? Eventually, insulin spikes it and puts it in the cells. Finally, the cell grows, hence the belly fat. Ultimately, The belly starts green and gains the fat cells, and they start getting bigger, bigger, bigger because they get injected in there. That stuff starts seeping out, and once it can’t go in anymore, it ends up in the places like the pancreas. It ends up in the places like the liver. It ends up in the intramuscular into the muscular tissue. And that’s why we have the accumulation. And when you have a big belly, that’s what tips off the doctor, not only with the triglycerides in the blood glucose levels but also the belly fat. And that’s one of the things we have to kind of assess. So are these now these fatty acids? What are fatty acids used for, typically, Alexander?
Alexander Isaiah: Fatty acids are used almost for everything within the body, especially for energy consumption. It’s like saying, would you rather be able to go five miles or 10 miles? You always want to go 10 miles, right? So gram for gram fat as an energy source is much more fuel-efficient than glucose or carbs. So carbs provide our four grams of four calories per gram and fats are around nine. So it’s almost it’s more than double the amount of energy that you’re producing from these fatty acids. The tricky part is just knowing which ones are good. So going into the good fatty acids, which will be the ones with the double bonds. So I mean, any plant oils, animal fats, depending on which ones, we tend to want to stay away from large amounts of wretched ionic acid, as they tend to cause inflammation responses through the inflammation pathway. But the rest of these are good, especially EPA and DHEA. So DHEA is used within the nervous system. It’s turned into neurotic acid and EPA as well. So getting these marine oils is going to be suitable for your system just in general.
Dr. Alex Jimenez DC*: You know what, as I understand these processes and start realizing the biochemistry behind it, bringing it home to this process down to the cellular component it honors. It shows appreciation in terms of what creates the fatty acid excess. Now again, what happens due to too much of these fatty acids or carbohydrates in the bloodstream? The body tries to store it. It tries to store in the form of fat, and it’s shoved into the pancreas. So you get this fat inside the pancreas. If it can’t do it there, it eventually puts it in the liver. And like we mentioned, it gets it in the stomach, or that’s when we see it as a final thing. So then I like to take the explanation and break apart one other point, the high blood pressure component. Insulin has a direct effect on the kidneys. Insulin tells the kidneys, Look, we need to pack this stuff into the fat. And without getting beyond too much of the chemistry dynamics, you can see that what’s going to occur is that the kidneys will be commanded to hold more sodium. In chemistry, biochemistry, and clinical science, we learned that the more sodium you retain, the blood pressure rises. In essence, that’s how quick the blood pressure goes. So you do that for some time, and then you force the collection of atherosclerotic plaques because that fat is in there, and it can’t go anywhere. You’re going to have a problem in the long term, in the long term future. So speaking about the oils, as Alexander just did, one of the things we ask is, Well, what oils cannot we should know? We use canola oil, corn oil, sesame seed oil. I love sesame seeds. But the problem is that sesame seed oil causes inflammation, as Alex said, with arachidonic acids. So what we have to do is figure out precisely what types of oils we can do and avocados, as Kenna had mentioned, are a great source of fats that we can use and make things more processed. Our bodies and the old pyramid of diet are really bad because it’s heavy on carbohydrates. So one of the things that we look at is maintaining all those components. So we talked about triglycerides, the belly fat, how it’s put together. And each one of these, I want to point this out again. The high blood pressure, which is 135 high blood pressure, is not considered at 135. Usually, it’s at 140. OK. So if so, why are we using triglycerides at 150 are not regarded as excessive. You know, HDL is lower than 50 is not considered horrible, but in combination together, if you have one at all, these three of these components are the five. That’s what leads to a pre-position of of of being sick and feeling crummy, let alone any prolonged period of this will end up leading to metabolic disorders, heart problems, stroke problems, dementias that occur as a result of protracted metabolic syndrome states that are within the individual. I want to ask Alexander. He’s got some fascinating dynamics, as I want to present right now, and we’re going to show his screen right here because he’s got some exciting components on what also affects metabolic syndrome. Alexander.
Alexander Isaiah: So kind of going into what it is, I guess ketosis, because everyone wonders what goes on. So I kind of got this diagram here that I drew out for you guys. We’re ignoring the ephedrine pathway over here, but just in general. So what’s going to happen first is you’re going to deplete any glucose that you have. So the body typically stores around 100 grams of glucose in the liver and around 400 grams within the muscle components of the entire body. So if you times 500 times for, that’s about 2000 calories, which is your daily limit, so you’ve got almost a day’s worth of glucose always stored within your body. But once you deplete that, your body’s going to start looking for other things. In the meantime, it takes a few days for your body to switch over from burning sugar, which is glucose, to burning ketone bodies from fat. So what’s going to happen? Your, first of all, your adrenals are going to start releasing epinephrine, its precursors, norepinephrine. And this is because of a couple of different things. You’re going to get a bit jittery first, and you’re going to feel bad for the first couple of days, but then your body and starts switching over as your brain starts to begin using these ketone bodies as an energy source. So as you’re producing norepinephrine, these are just like, this is the cell surface here. These are just different precursor markers. So we have B1, B2, B3, and A2. Doing these will mark and signal to the gas protein, which will allow aminoglycosides to activate ATP into cyclic AMP. Now, cyclic AMP is an essential component of the degradation of fatty acids. The cool part is it’s inhibited by phosphodiesterase. So when people come in and say, why is caffeine a good fat burner? The main reason why is because caffeine inhibits phosphodiesterase to a certain extent. You don’t want to go too crazy with the caffeine and start doing lots of cups of coffee.
Dr. Alex Jimenez DC*: Should I have eight glasses of coffee, or how many cups?
Alexander Isaiah: I think one glass of coffee is more than enough. So by having cyclic amp be more active, you activate the thing called protein kinase A, which activates ATP, and then it starts a hormone-sensitive life base. Once hormone-sensitive lipase is activated, it begins to degrade. It begins to break down fatty acids. Once these fatty acids enter and are broken down, they then enter into the mitochondria, and the mitochondria will then produce heat from this. So that’s why people who are ketosis are always really warm. So what do I recommend when people are starting to do a ketosis diet? Water? Keto diet, definitely water and as well as, I would say, L-carnitine. So as we’re looking at L-carnitine here, we could see that during fatty acid degradation, you use L-carnitine as the primary transporter between the outer mitochondrial membrane and the inner mitochondrial membrane. So by using fatty acids, here’s fatty asceloca; after we’ve broken down these fatty acids, it’s going to enter CPT one, which is carnitine, a seal translocated want or poly transferase one. It’s going to enter and interact with carnitine, and then it’s going to turn into seal carnitine. Once seal carnitine turns into it, it can enter the inner mitochondrial membrane through these two enzymes translocation and CPT two to be broken down back into a seal code, which does the same byproduct as glucose eventually. Also, then, your mitochondria can use these in beta-oxidation. One thing to know is you have to drink a lot of water because people going through ketosis will be upregulating the urea cycle. So you need to make sure that you pull a lot of water or drink a lot of water throughout the day. Anyone doing a keto diet today has a minimum of a gallon of water throughout the day, not all at once, but throughout the day.
Dr. Alex Jimenez DC*: It’s incredible, Alex, that you put that together because that makes perfect sense to me and also explains why people do say when we put them on the ketogenic diet, that they do increase body temperature and the water helps you kind of keep the whole system pumping because that’s what we’re pretty much made of. And also, the pathways that you indicated the hydrogen in the water are necessary for the process to occur.
Alexander Isaiah: Yes. Certain aspects within each of these fuel each other; it’s all an interconnected pathway. But you will upregulate the urea cycle during ketosis much more than when you’re not. For example, everyone’s notorious or cats are notoriously known for having a rotten urine smell. And we have to take a look at that from the reason why right? So general in humans there, urea content in the urine is three percent. In cats, on the other hand, it’s anywhere between six to nine percent. So you have to think about it. What is the only mammal on the planet that is a carnivorous animal that only eats meat? Since they only eat meat, the feline family upregulates their urea cycled, thus having more urea in their urine. So if you’re only a meat-eater, you’re going to have more urea. Therefore you need to drink more water to flush it out through your kidneys.
Dr. Alex Jimenez DC*: That’s amazing because it explains why we make sure that everybody drinks a lot of water, and then they feel better. And I guess if we don’t monitor it correctly, if we don’t do it right, we get that thing called the ketogenic flu, right? And then the body feels kind of crummy until it restores and it stabilizes the blood glucose through ketones. Now, the body can use ketones for sugar, as it’s known. So one of the things that we do is teach the people exactly how to go through the process. And I know we got some research articles here, and Astrid wants to discuss a bit of that.
Astrid Ornelas: So basically, like, as Alex mentioned, when people start going, they start following the ketogenic diet, we do want to, you know, as he said, we want to make sure that they stay hydrated, but more so than that. I guess another thing that we want to educate people on is that not many people know, you know, we need to store up the body with good fats so that as the body adjusts, it starts burning fat as a fuel than sugar or glucose. So we want to teach people, what are the good fats that we want them to like to eat, you know, because like, we need to store up in these fats of that the body can go into ketosis and we can go through the whole process that Alex just explains.
Dr. Alex Jimenez DC*: You know what? I would like to bring Trudy here because she’s the one that connects with the patients at the moment. We do assess someone to have metabolic syndrome. In terms of the resources, how do you go through the process of presenting? Hello, Trudy. Trudy, what are we going to do there? I’m going to ask you, how do you bring that? Because she’s our clinical liaison, our wellness liaison, and she’s the one that basically will give us the information that helps the patient in the right direction.
Trudy Torres: Well, hello. And I, you know, this is all excellent information, which is fantastic that we can provide this to the public. And I know this can be very overwhelming for people that are not don’t have this information. So that’s where I come in when people come, you know, either call us or come in inquiring about their different symptoms. They don’t necessarily know that they’re experiencing the metabolic syndrome. But you know, one of their main concerns is they’re waking. Based on their concerns, I connect them to our primary is with Kenna, and they go ahead and say, OK, well, what are the steps that we have to take and Kenna certainly educate them as far as, OK, this is the lab work that you’re going to have to take. We connect them with Dr. Jimenez after we know exactly their primary concern, and we’re going to start peeling things apart like an onion to get to the bottom of things and get them feeling better. They’re not only going to walk away with the specific results, but they’re also going to walk away with, like Astrid said, what are the good fats to have? What should I be eating? So they’re going to be walking away with a lot of information, but also structure. Another thing that we’re offering is that Kenna is always going to be there, you know, to answer any questions and also Dr. Jimenez, so they don’t have to feel overwhelmed with the process as they’re going through a better, healthy lifestyle.
Dr. Alex Jimenez DC*: You know, that one of the things is there’s a lot of confusion out there, and I’ve got to be honest with you. There’s a lot of misinformation out there. This misinformation can be categorized as intentional or old, or it’s just not up to date, with these five elements and an individual having three of them. It’s essential to repeat precisely how to fix this issue with the individual and change their lives because there’s nothing quicker to change the body than the ketogenic diet. We also have to monitor the individuals and monitor them through the process. Now we have Kenna Vaughn that she’s got some methods that we employ in the office and are helpful to her. Doctors do this around the country, but it’s beneficial in helping guide and allow for interaction and communication between us, the providers, and the patient. What kind of things do we offer, Kenna?
Kenna Vaughn: We have one-on-one coaching, which is great for when you’re just starting something out. Like they were talking about the ketogenic diet. You might be confused, and there is misinformation. So with this one-on-one coaching, it’s great because we can connect through an app that we have, and you pull out your phone. You can send a quick text message; hey, I saw one website said that I could eat this, but another said, this, can I have this? Things like that. We can clear up that confusion fast, which can keep you on track rather than doing that guessing game. We also have scales that connect to this app, which allows us to monitor the water weight they have and the fat that they have. And we can also monitor their activity through a wristband to constantly track the steps they’re taking. Ensure that they’re doing exercise because exercise is also great to help lower that blood glucose level.
Dr. Alex Jimenez DC*: You know, you mentioned that about the monitoring. We do that in the office along where we send the patients home with actual scales that are the mini BIAs and their hands and wrist. We can do pretty much for patients who want to connect with our office. We can directly get the information downloaded, and we can see their BIAs changing. We also use the in-body system, in which we do a deep analysis of the baseline basal metabolic rate, along with other factors that we’ve discussed prior podcast. This allows us to put together a quantifiable method to assess how the body is changing and rapidly restoring the body to or away from a metabolic syndrome episode. It’s a very uncomfortable feeling it really can. There’s nothing that destroys the body in these combinations of issues at one time. However, it’s easy to see that the body does everything quickly. It fixes a ketogenic diet, removes body weight, decreases the fat in the liver, decreases the intramuscular fat, restores blood sugar. It gets the mind working better. It helps the HDLs through some studies, and I know that Astrid knows there’s a study out there that pulls the information upon how the HDL are elevated with and with a ketogenic diet. We have a study here. You can put it on the screen right there that I think you found that shows the HDLs. Am I correct? And the apolipoprotein, the lipid part of the HDL, also is raised and activates the genetic component. Tell me about that.
Astrid Ornelas: So basically something that a lot of researchers, many health care professionals out there, doctors, they often say, is that when people have high cholesterol, you know, and we’re usually talking about the bad cholesterol. According to several research articles, it’s generally associated with a genetic predisposition when they have bad high cholesterol or the LDL fragment. If your parents, if your grandparents had high cholesterol, there is also an increased risk of you having a genetic predisposition to already having high cholesterol plus like add that like your diet. And if you follow a sedentary lifestyle and you know you don’t do enough exercise or physical activity, you have an increased risk of having higher bad cholesterol.
Dr. Alex Jimenez DC*: You know, I’m going to pull the information from I’ve noticed that Alexander’s pulling something information up here on the screen. He’s presenting the monitor where you can see his blood glucose and the screens that he’s going ahead and putting that up there for him. There you go. Alex, tell me what you’re talking about right there because I see that you’re talking about the apolipoprotein, the lipoproteins, and the HDL fragments there.
Alexander Isaiah: So kind of going into a little bit of everything here. So what happens when you eat something that is going to cause an increase in cholesterol? So first of all, you have these genes called Callum microns within the intestinal lumen or your GI tract, and they have apolipoprotein B 48. They have a B 48 because it’s 48 percent of apolipoprotein B 100, so it’s just a little different variation. These microns will bring these through the body and transfer them into the capillaries using apolipoprotein C and apolipoprotein E. Once they enter the capillaries, they’re going to degrade and allow for different aspects of the body to use them. So I have three tissues. We have adipose tissue, cardiac tissue, and skeletal muscle. So cardiac tissue has the lowest KM, and adipose tissue has the highest KM. So what is KM? KM is just a measurement of the way that the enzymes are used. So a low KM means a high specificity for binding to these fatty acids, and a high Km means low specificity for them. So what are the three parts of the body? They use the most energy. It’s the brain, the heart, and the kidneys. Those are the most caloric consumption parts of the body to stay alive. So, first of all, the heart relies large amounts on these fatty acids here, and transferring them to the heart uses mostly fatty acids. I think it’s about 80 percent; 70 to 80 percent of its fuel comes from fatty acids. And to deliver these, your body uses these Callum microns. So once the Callum microns exit the capillaries, it’s already an LDL. It has two choices: the LDL, It can be taken back to the liver or can switch its contents with HDL, and the seals can deliver them correctly to the proper places. So that’s why HDL is so important because they deliver them to the appropriate places if these Callum microns or these LDLs aren’t transferred correctly back to the liver. So why is LDL so detrimental to the system of our body? So here’s a couple of reasons why. So as LDL scavenges throughout the body, they are seen as a foreign object by our macrophages, and our macrophages are our cells used for immune response. So the macrophages end up engulfing these LDLs, and they turn into these things called foam cells. Foam cells become atherosclerotic plaque eventually. But what they do is they embed themselves within or under the surface of the epithelial lining, causing a buildup of these foam cells here and eventually blocking the pathways, causing a plaque. So by eating better fats, having a higher amount of HDL, you can avoid these plaques and avoid atherosclerotic plaques, which clog up your arteries.
Dr. Alex Jimenez DC*: You know what, actually, the link between atherosclerotic plaques and metabolic syndrome you’ve made very, very clear at this point, and that is the reason why prolonged states of the metabolic syndrome do create these disorders. I want to take a moment to thank the entire crew here because what we’re doing is we’re bringing in a lot of information and a lot of teams. And if someone has an issue, I want them to meet the face they’re going to see when they walk into the office. So, Trudy, tell them how we greet them and what we do with them when they walk in if they feel they may be a victim of metabolic syndrome.
Trudy Torres: Well, we’re very blessed to have a very exciting and energized office. You’re always going to feel at home. If we don’t have the correct answer at that moment, we’re certainly going to research. We’re not going to toss your side. We’re always going to get back to you. Everybody gets treated as an individual. You know, each vessel that we have, it’s unique in its way. So we certainly don’t create a cookie-cutter approach. We’re always going to make sure that, as I said, you walk away with the most and valuable, informed option for yourself. We’re just a phone call away. We’re just a click away. And, you know, don’t ever feel that there’s not a reasonable question. We always want to make sure that all the questions and concerns you have always get the best answer possible.
Dr. Alex Jimenez DC*: Guys, I want to tell you, thank you. And I want to also share with you that we happen to be in the fantastic facilities when we do; there’s exercise involved with returning the body to a normal state. We function out of the PUSH Fitness Center. We’re doing the podcast from the fitness center. And you can see the information herewith Danny Alvarado. And he’s the one that or Daniel Alvarado, the director of Push Fitness who we work with a bunch of therapies and physical therapists to help you restore your body to where it should be. We look forward to coming back, and as I said, if you appreciate, are you like what we have here, reach down on the little bottom, hit the little button, and hit subscribe. And then make sure you hit the bell so you can be the first to hear what we got to go on. OK, thank you, guys, and we welcome you again. And God bless. Have a good one.
In today’s podcast, Dr. Alex Jimenez, health coach Kenna Vaughn, Truide Torres, biochemist Alexander Jimenez, and Astrid Ornelas, discuss how chiropractic care can ultimately help treat sciatica or sciatic nerve pain.
Dr. Alex Jimenez DC*: Hey, guys, we’re live today. We’re going to be discussing the scourge of the back, the scourge of the back for myself. I’m a chiropractor practicing out here in El Paso, Texas. We usually have a disorder that’s typically there isn’t a day that we don’t see it, and it affects so many people. But there’s a lot of confusion with, and I call it, the scourge of the low back. It’s called sciatica. Sciatica is a disorder that has many, many reasons and many, many causes. One of the most important things is first to assess the reason and cause of sciatica. But most importantly, when it first hits an individual, it strikes them, usually with a shocking misunderstanding as to what’s going on in their legs. They feel pain in the low back. They sometimes feel pain in the leg. Different areas depend on where the issue lies, so a little bit of its anatomy breakdown and explanation of what it is. First of all, it’s a syndrome. It’s a syndrome that has many reasons and many causes. The issues that come about and are that that make sciatica arise are vast. I would venture to say that there are a million people that come in with sciatica. There are a million reasons that have presented each one of those patients. There is a majority of problems in and a subset of issues. We’re going to go over that. Today, our goal is to bring out the awareness that it is a problem, just like the present anemia. And there are many reasons why a person would have anemia. Many people are familiar with anemia, and they say that’s low blood, but you’re going to find out where the blood issue is to determine exactly what the causes of anemia are. Well, the same thing with sciatica. There’s a lot of reasons why the sciatic presentation occurs. So we’re here to kind of begin the process of explaining that. So we’re going to get real deep and down and nasty with the science of it. We’re going to try to give you some tools that you can look at and assess. So your provider can give you a better explanation, or you can ask better questions in terms of where your sciatica originates. So the first thing is to understand the anatomy, and I’ll go through the anatomy in a very visual way. But I want to first kind of take you to a visual, and my visuals are very three-dimensional and offered through complete anatomy. Complete anatomy has given us the ability to use this and show, and it is something that many medical students use. So in today’s modern-day, we don’t have to use some visceral or some sort of human anatomy. We can use these tools to help us present to the patients and to teach. So it’s probably one of the most used anatomical structured systems, and we use it to teach people in our patients every day, given the dynamics of sciatica. Here we have a picture of a sciatica HDMI, so we can see a presentation of what the sciatica nerve looks like when we can see it. The interesting dynamics here is that when you look at the interesting presentation, you can see as I go away how vast and how large it is. Now the first thing is I rotate this individual. You got to see that it comes from a large glute plexus in the lumbar spine to the sacral nerve roots. So anywhere down the line that anything is touching this thing, this beautiful, powerful nerve, you’re going to find that there is pain radiating down. So we’re going to discuss those issues. And as we kind of go over that, we want to understand that so away from HDMI. So what we’re looking at are the issues that present with us when we discuss it. So what are the causes, and what is sciatica? Sciatica is inflammation of the sciatic nerve, and as it presents what happens many times, it is the largest nerve in the body, and it’s how most people know it, and it travels from the lumbar plexus to the leg. So, anywhere that that thing is touched, it’s going to radiate pain. Now, what are the causes? Well, they could be from vascular. They could be compressive. They could be lymphatic. There could be a space-occupying lesion, such as a tumor causing the issues. Now, a good clinician will do a lot of different tests and a lot of different assessments to determine where it is having the problem. So when I have a patient, they come in when the first thing we have to do is a history we have to assess and find out what’s going on. So finding the history of something that suddenly someone starts sitting or they become active, or they get hit in the back, and they start having sciatica, it boats to a well, dynamics. So what happens is, what we need to do is we need to discuss the dynamics of where it begins and what goes on. So in terms of our direction, I would like first to take you to the physical assessment. When you explain to your doctor what’s going on, you need to tell him exactly when you started having it. That’s very important. The history is very like when these issues are? Do you have a sedentary life? So these are the types of issues that present most of the time a person comes into the office with having a severe presentation that they’re shocked? They didn’t expect this and what occurs in this particular area is that you can see where the nerve root comes in. So over here, you’ve got to figure out where it came from. As you notice, a lot of the reasons that many of these individuals have is because it’s a little bit of atrophy and muscular issues that arise. As you can see right here, there’s a lot of areas where the nerve can keep becoming trapped, and this is the main reason that most people have this issue now as they go through this and they present a symptom. I got to figure out, and we have to figure out where the problem originated with our team. So as I go through that, I want to give you a different dynamics here in what I’m going to explain. I’m going to present my team to you so that they’re all going to. Each one of them is going to explain a little different aspect of what goes on. Today, we will discuss how a coach, such as an individual helping the doctor, can assess the situation. We are going to talk to our coach Kenna. We’re going to talk to Astrid, who’s going to bring some science knowledge here. We will bring a patient in, discuss the experience with her, and bring in our top guy from the university at the biochemical level. He will teach us a little bit about some nutraceuticals and some applicational processes that we can do to help an individual with sciatica. So at first light to tell, I like to ask a question to Kenna. So Kenna, what I want to do is I want to ask you exactly what it is that you notice when a patient presents with sciatica and what kind of things we can do in the office and what’s our approach specifically more like the metabolic issues and the disorders that present that way? So when we’re looking at here, let me go ahead and head into this area, tell me a little bit about how we present a patient and what we deal with when we’re talking to an assessment or doing an assessment.
Kenna Vaughn: So one thing that many patients with sciatica have is the pain they’re feeling, of course and that low back. But another thing is they don’t have a lot of movement due to that pain, and movement is essential. It’s what life revolves around. So we take that movement, and we look at how we can help this patient decompress that sciatic nerve with the adjustments that Dr. Jimenez does, but also how can I benefit from my side of things for this patient? So we do have a lot of great resources available to us. We send our patients to Push, which is a gym here that helps them get that calibration in their muscles that they need to build up those stronger muscles all around that sciatic nerve so that this nerve doesn’t get pinched frequently or as often. And another thing we have available to us is an app called Dr. J. Today. And what that does is it syncs with the bracelet that our patients wear, which allows us to track their movement. So we want to focus on that movement as part of it. And another thing we can do is nutraceuticals in supplements. So what are nutraceuticals and supplements? One of the main ones we focus on that almost every individual should be taking is vitamin D3, and we like it coupled with vitamin K. This will help your bones and circulation. And it’s going to help to decrease that glucose by increasing your insulin sensitivity. And this is where it comes into play with sciatica.
Dr. Alex Jimenez DC*: I had a question for you in terms of that. When you’re discussing that we’re dealing with and sciatica as a pain in the hips, we’re correlating, and we’re tying together, I guess, a disorder that many people have as metabolic syndrome and many times are overweight. And that was one of the presentations that many of the patients with sciatica, not that everyone is overweight, with sciatica. Still, many people who become sedentary and don’t move as much do suffer from metabolic syndrome. So to get that under order, one of the things is to bring the insulin under control. And once we do that, we start losing weight and getting more active with the exercise protocols. She mentioned Push because we began to calibrate the hips. Now, as you can tell from our picture here, there’s a whole lot of muscles in this region, OK? So as I kind of use the application, you can see a little bit more of the muscle tissue that is involved. So as we look at the muscle tissue, we can see that calibrating and these muscles that control the hip actually propel the creature, so propel humans, so to speak, right? So what happens is as this happens, if this becomes deconditioned through a sedentary lifestyle. Well, the thing that’s lying underneath also stops working, and the muscles stop working as effectively. So one of the ways that we treat people is through a coach to assess their body mechanics and put them through the Push Fitness protocols that can help them get a calibration of the structures. One of the things that we also do in this process is we look at the sitting issues and tell me a bit of what you do, Kenna, in terms of helping people adjust their lifestyle or modify their mobility issues.
Kenna Vaughn: So what their mobility, as I said, we use the app, and we also use Push Fitness, and the supplements have a lot that comes into play because like I said, with that increasing the insulin sensitivity, what we’re going to want to do it, that is it’s going to help to control the blood sugars. And you might not necessarily relate blood sugars to sciatica just yet, but as I said, everything is connected. So when we put our patients on a protocol and have them control these blood sugars, it also helps maintain their inflammation because sugars and chemicals cause that inflammation in the blood. And that’s also it’s going then to cause nerve damage to our body and our system. And then, once we have that nerve damage going, we’ll see many more patients sitting down, which relates to that lack of motion. And then we see a lot of patients coming in with sciatica.
Dr. Alex Jimenez DC*: Sciatica. So basically, we’re going back to the same monster, which is called inflammation. Right. So inflammation is the deal. People that have sciatica will often tell the story of how it kind of looms with them. It’s like having this untrustworthy nerve back there that if they have stress or go through emotional dynamics, it affects sciatica. So this threshold that activates the sciatica presentation could have even an emotional component to it. So we want to bring that to light, too, because many people have normal lives, but they don’t have the presentation under normal situations. Suddenly, bam, they get an emotional, financial issue, family things, and sciatica just flares. Where is that even logical, right? The key is inflammation, inflammatory response, stress responses. And those issues do create an almost perfect storm to create a predisposition for inflammation. So that’s why we bring in the dietary components and the food to start eating better to prevent inflammation again. Those are some of the things. So she also mentioned the issue of Push. Push is our fitness center, where we actually put people through exercise protocols, and when we start putting people through exercise protocols, it’s there to calibrate. Now, what’s the biggest muscle in the body? Well, not too far from the anatomy to an anatomical structure. You can see the muscles in this particular area, and everybody knows that the glutes are the big muscles. So when you see this powerful muscle, if this muscle becomes decalibrated from a sedentary lifestyle, you’re going to notice that you’re going to have a lot of predisposition. So it’s like a car with flat tires. So if the car has flat tires, it starts swaying and moving to the wrong side. Well, if it’s swing, you can imagine that it affects the axis and the axles, and all that kind of stuff starts happening. Things like these happen, but in our human structure, there’s a finely calibrated system here. One of the things that many people don’t know and don’t think about is the lymphatic structure. Now, if you can see here, you can see the lymphatic. Now those guys ride directly next to the venous and arterial structures, and you can see it here. So as you can see that for progressing, you also look at the arteries. So if someone doesn’t have an arterial system that is working well and sitting on this, you can see congestion occurring around the structures, around the nerves. Now there’s a lot of nerves in here. So when you start looking at these dynamics, you start seeing that a person who is not using their muscles has an increased congestion level. So as I remove these muscles here, you can see this picture, and I’m going to remove every one of them. You start seeing the noticeable dynamics of how complex their nervous system is. So over here, you can see the complexity of how those nerves function. It’s amazing to see all the structures in here. So when you look at this, you can see the amount of influence that lack of movement would cause. It’s almost like a traffic jam. Imagine sitting on this thing all day long, OK, let alone be inactive. So one of the things we want to do is to assess exactly what it is. And one of the things that we do is to calibrate the system. So going back to removing these picked areas, you want to go ahead and work on the big systems. OK, well, as you can see, these muscles bring a huge component into helping sciatica. Now, where are the sciatic issues coming from? Now let’s go ahead and start discussing those particular issues as we can kind of go through this. And I want to take you through a little anatomy lesson here because it does require a little bit. As I remove these things, we’re going to see all of the structures that come in, and actually, but you can see if I can get the nervous system only out to the minimal component of it, the big ones. And as you can see here, you can look over this way and see anywhere down the line right here by where the nerves are. Them out where the disk comes out in this particular area as it penetrates forward, it goes this what we call the sacral notch, which is this guy right here. This hole is a sacral notch where it comes out, and you can see that it can be bumped into the bone and the actual femur here. So there’s a lot of areas that we can see that directly affect the sciatica regions. But having gone through that, I’m going to go into that in a little bit deeper. But I want to go ahead and get a little personal story right now. I want to ask an individual now what sits in here, and most women, you know, this is where they contain babies, right? So in a situation where you have an individual that is going through a lot of changes, such as an individual who’s having a child, you can see where the hips actually change and right down there, if you can see down there, this is where the sacrum has to open up to allow for the birthing canal. You see that big hole right there. A baby’s got to go through there, and if it can’t go through there, which it probably won’t until probably the ninth month where this area starts expanding, guess who’s going to go by, then kick in on the way down? OK, that would be a child. OK, so let’s talk about that. I’d like to present Trudy here because she has a story of how it affected her.
Trudy Torres: Well, I guess, you know, as a woman, you know, it’s an extremely joyful situation when you find out that you’re going to be a mom. If it’s your first-time baby, you’re in for a roller coaster. You know, like you guys were mentioning, there’s a lot of different scenarios that you go through emotionally, physically. So when you’re pregnant, you’re the perfect storm for something like this to come up. You know, you are just balanced from you’re so, so tired the first trimester. I’ve always worked out. So for me, I have never experienced sciatic pain before, and for me being so active, I went from being 100 percent active to just being so tired. I had to be super careful about spending my energy, especially in the first trimester. So on top of that, if you add, you know, everything else that’s going on physiologically with me and then my life became so sedentary. On top of that, you know, I have a desk job. So sitting at a desk and then not compensating, moving all of a sudden, that pain is so excruciating. I did not experience this with my first baby. I experienced this with my second child. And, of course, I gained more weight with my second child. So once again, you know, you’re adding problem over the problem. And just because you’re pregnant, that doesn’t mean you’re eating for two, because unfortunately, some of us, you know, have that misconception, and that’s when your weight tends to get a little bit out of control. So you’re adding a lot of different factors that create the perfect storm and are just super, super hard. One of the things that Kenna mentioned that helped me was becoming active and being exposed to Push. I had someone here that was able to work out specifically with me being pregnant. Obviously, my limitations as you start gaining more weight, it’s not the same thing that you can do when you’re not having a baby. So I was able to continue to work out later on in and, you know, after I was exposed to chiropractic and implementing exercise.
Kenna Vaughn: So the main symptoms you had when you had sciatica, and you were pregnant, was it mainly just pain, or did you also get that tingling feeling because there is more than one symptom of sciatica?
Trudy Torres: No. Unfortunately, it was just not pain. It was pain. It was burning all down my leg. I did not know what was going on. As I said, this was not with my first pregnancy, and every pregnancy is different with my first child. I watched more what I ate. I was still active, so I believe it was a combination of things, you know, that I felt like I was eating for two. I gained more weight than I should have.
Dr. Alex Jimenez DC*: I got a question: Was it when you rapidly gained weight during the final trimester?
Trudy Torres: I think everything kind of started happening a little at a time. I wasn’t that active in the first trimester, so I began having flare-ups not as bad as once I gained the weight. But, you know, once I gained more weight, that’s when I started having more severe symptoms, as I said, the burning, the lower pain. It was just excruciating, and it’s something that I don’t wish upon my worst enemy.
Dr. Alex Jimenez DC*: Now, did you ever have a recurrence after you had your baby?
Trudy Torres: Yes, I did. I did, and unfortunately, I did, but one of the things has helped me keep that under control. It’s been being active, continue to watch my weight. My supplements were one thing that I would ask Coach or Dr. Jiménez when you’re pregnant. I know we were talking about the different supplements. What do you still recommend for pregnant women to get on the different vitamin D and K supplements?
Dr. Alex Jimenez DC*: That’s an excellent question, and one that I’ll answer very clearly as a wide disclaimer; you need to make sure that your doctor knows what you’re experiencing. Obstetricians, which are OB-GYN doctors. They’re very well astute as to what type of supplements. So in the world of supplementation, it is wise to have a doctor assess that, and many of them will make sure that you have good supplementation. The area where it’s the accurate assessment is you have to have supplementation. Your body’s trying to produce an enormous amount of cellular activity as it creates life. It draws upon a particular area that inflammation goes crazy, the body goes into dynamic changes. So nutrition becomes an essential thing from intestinal nutrition through metabolic nutrition. So one of the things is that you have to have a doctor, typically today’s individual who is in there as young childbearing age, they have a doctor evaluating. So yes, one of the essential things is from folic acid to vitamin E, D. These are a whole, complete gamut of vitamins that are assessed and given by their doctors. So most women will know that if they take some medication, they have to put it clearly by their doctor. That’s the most important thing. And the second thing is on the supplementation side; once your doctor knows, he’s probably going to give you something of a basic level of supplementation and nutritional assessment. So in terms of that, a dietitian can evaluate you and assess you and determine what’s going on in terms of the aggressive approaches where an individual is not pregnant; there’s a lot of things that can be done. But let me ask you this. I know that you do a little bit of a CrossFit, and you do that kind of stuff. And you mentioned that you had sciatica after. I want to go to the point that many people who have sciatica lead a predisposed life to sciatica now, meaning that once you get it, it’s not that your terminal is that you always have the potential of having it, so whether your body dynamics have changed. Typically, you’re not 18, and now you’re 40. What happens is your body is warning you that it’s not working as it should be. And suddenly, the nerve starts becoming flared up, either the compression through atrophy of muscle or imbalance of muscles. So all those things are essential; I notice that you mentioned something that you did. It also affected you after. Did you do some competitions later, and did it affect you?
Trudy Torres: I did do competitions after. What helped me keep it under control was that its different factors to keep it under control. You know that keeping moving makes sure that you’re taking the right supplements in chiropractic care. I’m a firm believer, you know, of a holistic approach, and I believe that a combination of all it has helped me keep it under control. I have not had flare-ups, but I believe it’s because I’ve had all these different combinations. As I said, you know, I kept active. I have, you know, been in average weight. I have also implemented chiropractic, you know, as maintenance.
Dr. Alex Jimenez DC*: You know, I would like to give people a kind of insight as to what happens when you first go to a doctor, and they assess you; there are many ways to figure it out. One of the ways that it’s an easy way if there’s degenerative and there are bone changes is an x-ray. And that’s what we typically look at, and we first start all assessments. But the definitive assessor who gives the vast amount of information is looking for some compression. And at that point, sometimes we have to look at the arterial-venous circulation. But the number one way to determine if someone has sciatica due to a disc injury or some compression or space-occupying lesions like a tumor or some arthritis or some sort of imbalance in the muscle is genuinely the MRI. The MRI is an excellent tool. Now, if there is bone involved, a CAT scan is used. The EMG is used to determine the muscular tone and the muscle’s ability to react and see which tone levels. But you don’t need to be a rocket scientist and put someone through that. They already know that their muscles are tight, and there is an issue. The ability to determine how the nerve functions is a nerve conduction velocity test that tells you how fast and slow the nerves could work. Now in the situation where we do a bone scan, we’re trying to look for any metabolic issues outside, and there could be a tumor or some problem. But that’s rare, and that’s not typical, but the number one way to assess an issue is through an MRI and an X-ray. Those will give you the most significant, broadest areas. Now I want to go ahead and talk a bit about nutraceuticals and specifically nutraceuticals. We’re going to go ahead in this about the treatments for it. And as we go through that, I’d like to go ahead and discuss certain areas and specific supplements. Now Astrid is our resident nutraceutical information gathering. We also have a biochemist in the background who will bring some insight to a different level. But what kind of things do we typically offer patients when they need it as a metabolic, a leaving protocol?
Astrid Ornelas: OK, well, first of all, I want to bring in an interesting statistic. According to researchers, approximately 80 percent of the population suffer from some type of back pain. Included in that are low back pain and sciatica. So with that being said, of course, it becomes a priority to know what is it and what can we do to assess this common problem? And like, Kenna and Dr. Jimenez, like you and Trudy have said, exercise is essential. And together with exercise, we want to bring in a diet. We want to eat foods and supplements. And because obesity or excess weight is one of the problems is one of the leading causes or one of the most common, commonly well-known causes of sciatica. We want to, you know, all together with exercise and following like a good, a good diet. We want to follow these things so that we can. If we lose weight, it can help improve sciatica. So with that in mind, there are several of them. I guess natural remedies, natural nutraceuticals, if you will, can help reduce or improve sciatica symptoms and, therefore, lose weight. So one of the ones that I want to talk about is that we have it here: turmeric or curcumin. So turmeric is a plant, it’s a flowering plant, and it’s related to ginger. And we eat the root. That’s what we know it. This yellow kind of orange-looking root is very commonly used in Asian foods and most commonly in curry and curcumin. You’ll hear turmeric and curcumin used a lot interchangeably together, and curcumin is the active ingredient that’s found in turmeric. So one of the things that I wanted to bring up with turmeric and curcumin is the benefits that many people can take, and they can either eat turmeric or take turmeric supplements. It can help to reduce sciatica or sciatic nerve pain. So turmeric has a lot of anti-inflammatory properties, which can help reduce pain and swelling, which is probably one of the most common symptoms of sciatica. There’s a lot of research studies that have found that turmeric or curcumin can reduce neural inflammation, which is inflammation in the nerves, which, as some of us here, know if your sciatica is caused by a disc herniation or a herniated disc, sometimes the substances or the chemicals that are inside of your disc, they can irritate the nerves. So taking turmeric and curcumin can help reduce the inflammation caused by these irritating compounds. It is also a powerful antioxidant that can help reduce oxidative stress, which can cause inflammation. And probably one of the highlights of taking turmeric or curcumin is that it can improve metabolic syndrome, as we previously discussed in a past podcast. Research studies have found that turmeric can help regulate body fat by reducing inflammation. It can also help lower bad cholesterol. It can lower triglycerides. It can improve blood sugar levels. And it has antibacterial properties as well.
Dr. Alex Jimenez DC*: Let me ask you. We’re talking about the potential of someone having sciatica; since some people have sciatica, that kind of looms on them. Well, we’re trying to do with turmeric, and we’re trying to prevent it from kicking off. So it’s basically like prophylactic prevention. I like to go a little deeper, and we have our resident scientist here, Alexander, and he is right with us right now, and he’s got some points of view on some of those supplementations. Tell us a bit of what you learned in terms of supplementation and your point of view on how we can assist sciatica from a biochemical point of view.
Alexander Isaiah: Well, there are a couple of different ways of taking different perspectives and avoiding the whole. An inflammation response is a good way of saying it. Let me see. Can you guys see my screen here?
Dr. Alex Jimenez DC*: Yes, we see you, we see you right now. So I saw your screen. Yes, I do. We see the screen entirely.
Alexander Isaiah: Awesome. So I’m going to go into a little bit of the biomechanics of what’s going on with sciatica. Then we’re going to break down a little bit of the muscles, and then we’ll go into the supplementation aspect of what we can do to have either prevention or active treatment during treating sciatica. So here we could see we have three individuals from left to right. The first one is an individual who has a neutral spine. And you can see that as we draw a line down the middle there. External auditory Matis, the ear, is in line with their deltoid and is in line with the median part of the sacrum. In the second person, we can see that they have a little bit of dysfunction in terms of their physical aspect. So here we have an individual whose sacral promontory, which is the anterior side of the sacrum, is tilted superior, and their posterior area is tilted, posterior, inferior. I’m sorry. And what this is called, this is called a counter mutation. So by having that sacrum pointed up, you’re putting more stress on the thoracic region and causing the areas to be more inclined to different stresses. And most of the time, this is caused by tight hamstrings. So these hamstrings are pulling down, forcing the anterior side to come up and stretching these quadriceps. So it can either be done from an imbalance of over-powerful hamstrings or tight hamstrings and weak quads. In the third individual as we draw the same line down the middle. We can see that they are almost in line, but on an individual like this, we could see that their sacral promontory, the front side of the sacrum, is tilted anteriorly, which is called mutations. So we have a counter mutation over here. It’s going to go counter. And then mutation over here on the right side, so an easy way to remember this. They’ll stick forever is that this is pretty much if you think plumber’s butt, this is what it looks like. This is what J-Lo looks like. Oh, so you’ll never forget it that way. But the difference is here is that here the pressure is on the thoracic spine. But in an individual with notated hips, the pressure is in the lower back. So let’s say someone is pregnant and developing another child in this area. They’re going to be putting more pressure on the lower back versus someone who has pressure on their thoracic area. They’re going to be more pressure there. So going into a little bit more of the anatomy. We can see that we have all the different muscles here, and we could see the piriformis, which is this muscle right here. I’m going to give you different colors for you guys, so that you can see better. It is muscle right here. And then we could see the superior gemellus is right under that. So sandwiched between the two is the sciatic nerve. And if we have someone who is mutated, they’re going to be stretching these muscles more and putting more compression on that sciatic nerve, causing that area to be more inflamed. More of those neuropathies are occurring, shooting down the leg. And then in other instances, when we have the piriformis, which is split in half and the sciatic nerve is running between them, and that’s 10 percent of the population that that usually happens. And so and these people have always had sciatic problems. So by strengthening and working on those conditions and going over those nutraceuticals, we’re about to go into, we can treat and alleviate some of those symptoms. So the first one I kind of want to go into is a little bit of niacin. So niacin, we all see it as the store brand as something popping up like that. And most of the time, it’s either in 250 mg or 500 mg of capsules or tablets. I always recommend getting the tablets just because you can take half of the tablets. And I tell people this is because most of the time, nicotinic acid is the main thing is, vitamin B3 causes a little bit of a flush effect, but that’s just the way it works. So we’re going into it here. We can see that nicotinic acid, as it’s going through its chemical pathway, actually produces lots of NAD+, and NAD+ is essential in the cellular metabolism of many tissues. So going into brief biology, we all know that the mitochondria are the powerhouse of the cells we were all beaten to death growing up in basic biology. But as we take a look more in-depth at the structure of the mitochondria, we could see that it has an outer membrane, an inner membrane, and then an interim membrane space. So we’re going to look mainly at this little section here that’s folded in between, which are called the cristae. And we could see that the first complex, known as complex one or all the known as any dehydrogenase, is responsible for using NADH, converting it and using its protons, and moving it across the gradient to make ATP. But we could see that more NAD+ is produced here, right? So that’s where niacin comes into effect. We supplement more with NAD+ to cause a reduction reaction between NADH and some other electrons, forcing it into NADH. So what does this all mean? Pretty much what we’re doing is we’re creating a boulder downhill effect, so we’re making more NAD, and we’re forcing it to go to product. And how does this happen? Just easy thermodynamics is you put a lot of it up the hill. The enzymes are going to force the work to go down the hill and make more energy. In doing so, and you have a more healthy metabolism of cells. And this does not only correlate to neuropathies, but it also helps with circulatory function, cardiovascular health; the main multi nucleotide muscle in the body is the heart, so you’re not only making sure that you’re neuropathies are covered, but as well as you’re making sure that you’re keeping a healthy heart just by supplementing with vitamin B3. Another great one, saying that you have more ATP produced and more functioning and healthy tissues, is green tea. I chose to use green tea because it has a very similar pathway to curcumin in the sense of anti-inflammatory effects. So the main ingredient in green tea in case you either have green tea in your house or curcumin available, whichever one’s easiest for you, they mostly have the same chemical pathways in that they inhibit either inflammation or cell proliferation neural damage. So the main chemical in green teas is called catechins, and catechins are similar to catecholamines, like epinephrine and norepinephrine, which is just adrenaline. And the main one is EGCG. The cool part about EGCG is that it inhibited NF Kappa B and ROS. ROS is just a reactive oxygen species, which is just free radicals, which can cause havoc and wreak havoc throughout your body, which is why it’s an antioxidant. So in doing so, it prevents NF Kappa B from producing any proliferating effects from cells or inflammation or neural damage. Now, if we go more into biochemistry, I can just break it down a little bit here. So EGCG will upregulate AMP. High levels of AMP will down-regulate this enzyme, called glycolysis, and allow for ATP to be converted to CATP. This is important because not only does the CATP break down things, but it mainly breaks down any adipose tissue and helps kill any cells that are proliferating too quickly, such as cancer cells. And it also keeps cells functioning properly, such as neural cells. So as we’re coming here, another cool part about green tea is it has small amounts of caffeine. If you are pregnant, we don’t recommend that you do any caffeine or stimulatory effects. Always consult with your doctor before taking any of these things. Specifically, something that does have caffeine and that we just doesn’t want to mix anything, especially during pregnancy. But if you are trying to make sure that you help your sciatica or your metabolic syndrome. Green tea has another effect. Using caffeine, which inhibits phosphodiesterase and phosphodiesterase diseases, is responsible for turning off CATP, so it’s a double whammy effect. Not only are you burning fat and shutting down glucose storage, but you’re also allowing for this catabolic or this structure that breaks down things to keep going. Here’s a little bit of an overview of the different things that green tea does and how it helps. And just kind of going into another cool part about green tea is that it binds to other very toxic things, such as iron. We know that we have iron in every red blood cell, but people who have hemochromatosis have too much iron in their blood, and they have to give blood about once a week. Someone who has hemochromatosis can take supplementation of green tea and reduce their iron levels, preventing any toxicity from those iron.
Dr. Alex Jimenez DC*: You know, when you’re talking about those pathway patterns, you remind me very clearly that many of the times, the whole idea behind our show is to try to give you natural ways. However, there are potent medications that work with these pathways, one of which is gabapentin, used for neuropathic pain. Many people don’t want to do that because of the side effects and the critical issues that it causes. We were looking at this in a natural format in a natural way. Going back to the metabolic, what are the things that we notice in the metabolic areas you have seen? What are the other supplements? Do you notice that I have been able to assist people in recovering from because Astrid mentioned turmeric, and that’s the line we’re using. We’re using the anti-inflammatory. They’re limiting, limiting the reactive oxygen species or the ROSs to prevent the inflammation from occurring. Is that correct?
Alexander Isaiah: Yes. OK. The main thing is to inhibit the production of NF kappaB, which both curcumin, other known as turmeric, both have the same name. They’re interchangeable and green tea, and both inhibit these inflammatory pathways and cancer pathways.
Dr. Alex Jimenez DC*: Yes. So let me ask you, Astrid, in terms of those inflammatory comments. Tell me a few of your thoughts on this particular matter.
Astrid Ornelas: Well, I wanted to add another compound that can benefit sciatica or sciatic nerve pain. And that is called alpha-lipoic acid or ALA. And so ALA is an organic compound, and it is produced naturally in the body, but of course, in smaller amounts. Or it can be found in foods such as red meat or organic meats or in plant foods such as broccoli, spinach, Brussel sprouts, and tomatoes. Or it can also be taken as a dietary supplement. And I wanted to discuss the effects or the benefits of alpha-lipoic acid. Because just like green tea and turmeric or curcumin, ALA is also a powerful antioxidant, and it helps reduce inflammation, according to several research studies. And it can also have a lot of benefits for people with metabolic syndrome because it can help lower blood sugar or blood glucose levels. It can improve insulin resistance, which is, you know, an effect, or it’s something that they can that can ultimately cause diabetes. And several research studies have also found that alpha-lipoic acid can also improve nerve function, which, you know, people with sciatica or sciatic nerve pain, especially caused by neuroinflammation. ALA can also help improve nerve function in these people.
Dr. Alex Jimenez DC*: OK. That’s an essential point of view. As you can see here on our list, we have quite a few different presentations and areas such as vitamin C, vitamin D, calcium, fish oils, omega 3s with EPA, berberine, glucosamine, chondroitin, alpha-lipoic acid, acetyl-l-carnitine, ashwagandha, soluble fibers, vitamin E, green tea, and turmeric. As you can tell, there’s a lot of things that we can do to stop the inflammatory cascade. We’re going to be going into all those because sciatica is so complex and diverse that we have to find the best for the patient from the millions of presentations that it has. So throughout the anatomy, as we discussed, and I’ll show you back the anatomy in a second here, you can see that there’s a lot of physiological and as Alex presented biomechanical imbalances that, if not taken into consideration, we will end up with issues in the future as a result of these predisposing dynamics. Now, as we recover these dynamics, we’re going to discuss many different topics. So I wanted to at least give a little more on the side of the things that we do now in terms of differential diagnosis. Many other issues can cause these presentations and from, you know, the dynamics of just a compressive nerve through space-occupying dynamics. We have other areas that come in and affect the patients. So what we’re going to do is in the following seminars, we’re going to go over specific types of things we can do, but let’s give you some guided ideas in terms of the treatment protocols that are out there. We have chiropractic care, which is a form of chiropractic. Chiropractic means mobilizing joints and moving the body, and there are thousands of ways we can do it. A lot of people think that it’s just manipulation or adjusting the spinal. We have to take a lot of things into consideration. We work on the bones; we work in the muscles; we work on the counter muscles. We have to formulate many dynamics to figure out what’s best in line to assist each patient. Once we find out the cause and find out what we call etiology or the pathology and the problem. We can go and use different methods. We use acupuncture, nutraceuticals. We work hand in hand with different providers to provide medications. We also do the goal ultimately in sciatica is to eliminate any chance of surgery if there is a surgical need or that needs to be done. But that’s such a small dynamic that we don’t want to go there unless we have to. We have different other protocols in different methods of treatment, like dry needling. We do aggressive rehabilitation. Now, why are we doing rehabilitation? Because as you saw in the picture earlier, the muscles we have were extremely involved in calibrating the hips. We want to make sure that we, we determine now over here, we got some basic care. We also got some aggressive care. Now, as you know, some basic care will be like ice-cold ultrasound, tens units, spinal adjustments, lifestyle changes, which is pretty much the biggest one because most people end up in a chiropractic office because their lifetime lifestyles change. Now, what do I have? I have a person who was an athlete at one point that suddenly got a desk job and now doesn’t move as much. Well, that’s easy. We can start getting that person back into yoga, pilates, tai chi, getting their bodies to align pelvically, and their whole body structure to get back to where it should be. Here’s the deal as soon as you can get past the inflammation and prevent that, and we can get you to move your body in a way that you did when you were a child, kind of like moving, dancing, and walking. That’s the way to calibrate the glutes. This is a powerful muscle, and as we’ve learned through technology and science, immediate atrophy occurs with the muscles not used. So imagine what happens when you start getting a job, and you used to be an athlete, and now you sit down eight hours a day, that’s going to give some great dynamic. So one of the crazy components is that as I look at this, I give you an idea of the types of exercises we can do. We can go into the extreme kind of CrossFit environment. And if we look at that, you just don’t look at the crazy structures, but you see people moving dynamically. A lot is going on here, and you can see that we can come up with our rehab centers. We have extreme athletes, too, even the people that are, you know, able to move just a little bit. But the point is that as we do this process, we can help someone with the treatments and protocols occurring, as you can see in this particular area. We can see Trudy and me. This is one of the things that the reason I was alluding to. But we can see when you were doing some self-treatment here. Tell me a little bit about what you were doing and what you were experiencing at that point.
Trudy Torres: That was, I believe, if I recall correctly, that was after my competition. I did compete for CrossFit. And, you know, it’s hard, after for a couple of hours. It takes a toll on your body. So I was kind of stretching my hip and stretching, you know, the rest of my glute area to avoid that flare up again. That’s something that once you experience it once and you have to go through the treatment, it stays in the back of your head because you certainly don’t experience pain again. That’s why you have to pay attention to all the different preventive areas and approaches to avoid ever having a flare-up.
Dr. Alex Jimenez DC*: Well, I got to tell you that I led you there because I know you had a lot of experience with sciatica. Alex, let me ask you this. You know, you were an aggressive competitor in the world that you did things. Tell me a bit of the thing that you did that you noticed when you were working. Let’s say an as a collegiate athlete, did you ever have hip issues?
Alexander Isaiah: Only when I didn’t stretch or when I didn’t work on my core muscles, or when I wasn’t making sure that I was anatomically in line, I did have some issues either with joint pain or just lower back problems or even upper back problems that all just tied into either flexibility or I just wasn’t paying attention to either my diet as strictly as I should, especially at that level. So, yes, I did.
Dr. Alex Jimenez DC*: Yeah. You know what? There’s a lot to be covered here, and we’re going to be discussing a lot of issues. Did anyone want to add something else before we kind of closeout? I want to thank my crew for what we’ve done here. We are going to continue with this. Because we’re going to go real deep, this story of sciatica is going to get nasty with information. This is the beginning of touching on the subject matter. Thank you, Alex, for bringing the information because extremely, very deep in terms. I want to thank Astrid for giving us insights into biochemistry. My true patient, Trudy, and my coach over here, Kenna, and the supporting staff. So I want also to go if you guys want to find us. We’re here, and we’re here in this area where we are available. If we can help you and you can contact us at any given time. I want to thank you all, and I appreciate it. We’re going to be hitting sciatica relentlessly because it was relentlessly the scourge. It is ripping apart a lot of people at their works. They just quietly suffer. They don’t sleep, they stress out, and it causes a disruption. And it happens in mommy’s world, and it disrupts the whole family directly because a happy mommy is a happy family. So the entire thing is what we want to do is to assess what’s going on here. Find out the treatment protocols and give you the best options possible. Thank you guys very much, and God bless.
Antioxidants like resveratrol, lycopene, vitamin C, and vitamin E can be found in many foods. However, one of the most powerful antioxidants is naturally produced by the body.�Glutathione is known as the �master antioxidant�. Many foods have some glutathione but it is ultimately broken down by digestion before it can be properly used. Research studies have found that dietary glutathione isn�t associated with glutathione in the blood. As previously mentioned, glutathione is naturally produced by the body. But, if your capacity to do so is affected, it can cause a variety of health issues.
Glutathione is essential for liver detox or detoxification. Unlike other ways in which we can detox the body, scientists have demonstrated the benefits of glutathione for detoxification. It�s also necessary for healthy immune function and antioxidant defenses against free radicals. Glutathione deficiency is associated with health problems from overtraining to HIV/AIDS. In the following article, we will look at the role of this well-known amino acid in detox or detoxification. Glutathione is made up of three essential amino acids, including L-cysteine, L-glutamic acid, and glycine. It is responsible for:
Promoting liver detox or detoxification before bile is released
Reducing harmful components and toxins, such as peroxides
Neutralizing free radicals and other chemicals or substances
Cleaning out the body and supporting the immune and nervous system
What is Glutathione Responsible for in Detox?
Glutathione is essential for liver detox or detoxification. Glutathione binds to harmful components and toxins before they�re eliminated which is an important step in getting them out of your body.�Glutathione may also be very essential for helping your body eliminate harmful components and toxins found in the food you eat and the environment. By way of instance, one research study found that in people who eat a lot of fish, the total amount of mercury in their bodies was associated with genes that regulate glutathione levels in the blood. The more glutathione people made, the less amount of mercury they had.
Glutathione is found in every cell and tissue of the body. However, concentrations are seven to 10 times higher in the liver than anywhere else in the body. That�s because the well-known tripeptide plays a fundamental role in the Phase II liver detoxification pathway. The Phase II liver detoxification pathway is the process of metabolizing molecules that need to be eliminated from the body. Glutathione commonly binds to these molecules to eliminate them from the body. Glutathione ultimately has the capacity to bind to harmful compounds and toxins, flagging them as hazardous.
This helps eliminate chemicals and substances, scientifically known as xenobiotics, which weren�t produced in the body. And it can identify drugs, environmental pollutants, or any number of chemicals and substances. It�s important that glutathione binds to these harmful compounds and toxins before they can bind to important cells and tissues.�But the detox process isn�t complete. The next step is to turn the harmful compounds and toxins into a form that can be further metabolized and/or eliminated. Glutathione plays a role in turning fat-soluble toxins into water-soluble toxins so you can eliminate them from your body. The Phase II liver detoxification pathway involving glutathione plays physiologically essential roles in detox or detoxification. Without it, you�d probably be filled with hazardous material.
In conclusion, glutathione is essential for liver detox or detoxification. Glutathione is made up of three essential amino acids, including L-cysteine, L-glutamic acid, and glycine. Unlike other ways in which we can detox the body, scientists have demonstrated the benefits of glutathione for detoxification. As previously mentioned, it�s also necessary for healthy immune function and antioxidant defenses against free radicals. Glutathione deficiency is associated with a variety of health problems. In the article above, we looked at the role of this well-known amino acid in detox or detoxification.
Glutathione is an essential antioxidant for liver detox or detoxification, regulating inflammation, and supporting healthy immune function. But it�s not like other nutrients where you can eat more of it to take advantage of its health benefits. Instead, the important part about glutathione is supporting your body�s natural ability to produce it on its own. Think less �glutathione supplement� and more �eating your broccoli and moderate exercise� to help your body cleanse and protect itself against harmful components and toxins as well as bacteria and viruses. – Dr. Alex Jimenez D.C., C.C.S.T. Insight
Protein Power Smoothie
Serving: 1 Cook time: 5 minutes
� 1 scoop protein powder
� 1 tablespoon ground flaxseed
� 1/2 banana
� 1 kiwi, peeled
� 1/2 teaspoon cinnamon
� Pinch of cardamom
� Non-dairy milk or water, enough to achieve desired consistency
Blend all ingredients in a high-powered blender until completely smooth. Best served immediately.
Cucumber is 96.5% Water
Because they’re so naturally high in water, cucumber is also very low in calories. It only has 14 calories per 100g (3.5oz). That means you can nibble on it all day without worrying about your waistline.
The scope of our information is limited to chiropractic, musculoskeletal, physical medicines, wellness, and sensitive health issues and/or functional medicine articles, topics, and discussions. We use functional health & wellness protocols to treat and support care for injuries or disorders of the musculoskeletal system. Our posts, topics, subjects, and insights cover clinical matters, issues, and topics that relate and support directly or indirectly our clinical scope of practice.* Our office has made a reasonable attempt to provide supportive citations and has identified the relevant research study or studies supporting our posts. We also make copies of supporting research studies available to the board and or the public upon request. We understand that we cover matters that require an additional explanation as to how it may assist in a particular care plan or treatment protocol; therefore, to further discuss the subject matter above, please feel free to ask Dr. Alex Jimenez or contact us at 915-850-0900. The provider(s) Licensed in Texas*& New Mexico*�
Ask The Scientists Staff. �Glutathione – The Amazing Detoxification Molecule You Might Not Know.� Ask The Scientists, 19 Dec. 2019, askthescientists.com/qa/glutathione/.
Dr. Judy. �Glutathione: The Detox Boss.� Vitality Natural Health Care, 14 Apr. 2018, vitalitywellnessclinic.com/detox-immune-system/glutathione-the-detox-boss/.
Dowden, Angela. �Coffee Is a Fruit and Other Unbelievably True Food Facts.� MSN Lifestyle, 4 June 2020, www.msn.com/en-us/foodanddrink/did-you-know/coffee-is-a-fruit-and-other-unbelievably-true-food-facts/ss-BB152Q5q?li=BBnb7Kz&ocid=mailsignout#image=24.
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