Fecal Transplants that cure cancer and cause obesity: strange powers of the beings that call your body home.

Fecal transplants are saving cancer patients at MD Anderson? In this episode of Docs Talk Shop, Dr. Gordon and I explore how a major breakthrough in microbiome science could open up new treatment possibilities for cancer patients.

But the news is not all good--fecal transplants can also transfer obesity. We discuss how a patient who received an FMT from an obese donor gained weight, highlighting just how powerful and influential the microbiome is in regulating metabolism.

We discuss the remarkable ability of bariatric surgery ("stomach stapling," for obesity) to resolve type 2 diabetes in just a few days—long before any weight loss occurs, and the mind-boggling reason for this counterintuitive occurrence.

Lifting weights is better than psychotherapy? Believe it or not, resistance training is found to be 1.5 times more effective than medication or talk therapy for treating anxiety and depression. 

And also in the realm of psychiatry, we explore Morgellon's disease. Patients with this condition report colorful fibers growing from their skin. Long considered a psychiatric disorder with delusions, (a misdiagnosis that has confined patients wrongly to inpatient mental health institutions) recent research finds a link between the colorful fibers of Morgellon's and Lyme disease.

Join us as we explore unexpected solutions to the toughest health challenges.

References:

Morgellons disease psychiatric condition or spirochetal infection? National Center for Biotechnology Information. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8647328/. Accessed September 24, 2024.

Morgellons disease linked to infection. Dove Press. https://www.dovepress.com/getfile.php?fileID=69133. Accessed September 24, 2024.

Links between Morgellons and Lyme disease. LymeDisease.org. https://www.lymedisease.org/links-morgellons-lyme-disease/. Accessed September 24, 2024.

NAC alleviates OCD behaviors: Skin-picking, trichotillomania, etc. National Center for Biotechnology Information. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10909310/. Accessed September 24, 2024.

The nucleus accumbens and its role in reward, addiction, and pain. National Center for Biotechnology Information. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6975138/. Accessed September 24, 2024.

Defecation increases athletic performance by increasing brain oxygenation. PubMed. https://pubmed.ncbi.nlm.nih.gov/37102434/. Accessed September 24, 2024.

Bariatric surgery decreases breast cancer risk. MDedge. https://ma1.mdedge.com/obgyn/article/269409/breast-cancer/bariatric-surgery-may-reduce-breast-cancer-risk-some?ecd=WNL_EVE_240603_mdedge. Accessed September 24, 2024.

Infectious agents and cancer. National Center for Biotechnology Information. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10964319/. Accessed September 24, 2024.

Infectious agents including SARS-CoV-2 linked to cancer. Frontiers. https://www.frontiersin.org/articles/10.3389/fcell.2022.8761

Dawn Lemanne, MD
Oregon Integrative Oncology
Leave no stone unturned.

Deborah Gordon, MD
Northwest Wellness and Memory Center
Building Healthy Brains

Chapters

• 1:23 Fecal transplants help treat cancer patients at a major cancer research hospital
• 10:31 Fecal transplants can transfer obesity from donor to recipient
• 19:46 bariatric surgery can normalize blood sugar levels, curing diabetes type 2 within days, due to changes in the microbiome
• 27:31 Weight lifting is more successful than psychotherapy for depression and anxiety treatment
• 35:51 How doctors misdiagnosing a skin disease resulted in patients being sent to psychiatric inpatient care for "delusions."

Transcript

[00:00:00.000] - Dr. Lemanne

Cancer treatment can be enhanced by fecal transplant. So for instance, in cases of melanoma, where patients were treated with immunotherapy, off the shelf immunotherapy drugs like ipilimumab and nivolumab, the checkpoint inhibitor drugs. If patients don't respond at first and their melanoma doesn't get better with that type of treatment, if they're given a fecal transplant from a donor who has had melanoma and who has responded to those treatments, patients. And then they're retreated, they will then respond. So the microbiome from the responding patients is the-Key to implanting, so to speak, immunotherapy sensitivity, responsiveness.

[00:00:44.640] - Dr. Gordon

Yes.

[00:00:46.920] - Dr. Lemanne

You have found your way to the Lemanne-Gordon podcast where Docs Talk Shop. Happy eavesdropping. I'm Dr. Dawn Lemanne. I treat cancer patients.

[00:01:05.720] - Dr. Gordon

I'm Dr. Deborah Gordon. I work with aging patients.

[00:01:09.520] - Dr. Lemanne

We've been in practice a long time.

[00:01:10.690] - Dr. Gordon

A very long time.

[00:01:13.510] - Dr. Lemanne

We learn so much talking to each other.

[00:01:15.280] - Dr. Gordon

We do. What if we let people listen in?

[00:01:23.960] - Dr. Lemanne

In this episode, Dr. Gordon and I share research findings that have surprised or intrigued us. We discuss studies at major cancer centers that show that fecal transplant can save melanoma patients whose immunotherapy has failed. We also discuss how fecal transplants can transmit obesity from the donor to the recipient. We discuss bariatric surgery and how it resolves type 2 diabetes in less than a week without any medication at all and before weight loss has occurred. We talk about how exercise is one and a half times more effective for resolving depression and anxiety than drugs or talk therapy. We discuss something called delusional paracetosis, where patients have been put into psychiatric institutions for complaining that threads are growing out of their skin when actually they had Lyme disease and the Lyme bacterial infection actually was producing colorful filaments within their skin. We then talk about our own experiences with an over-the-counter supplement called NAC, or N-acetylcysteine, which may help with impulse control disorders such as skin picking, cuticle picking, or hair pulling. Dr. Gordon shares her secret way of avoiding $1,000 genetic testing and how she still manages to get the information she needs to help a patient improve mitochondrial health and physical performance for pennies.

[00:02:57.910] - Dr. Lemanne

Enjoy. You got a criticism?

[00:03:03.600] - Dr. Gordon

So I got an interesting feedback on our podcast from a patient of mine whose opinion I respect, and even more so when she gave me this opinion. So she was saying, Oh, I love your podcast. But she rolled her eyes and, lowered her head and say, but you have to not diss on two and three pound dumbbells. They serve a purpose. So do you remember when we You've been talking about exercise? Oh, I'm guilty. I'm guilty. And I had to concede that she's right on so many levels. She's right on somebody should always have a three pound weight when they're having a range of motion effort that they have, issue that they have to address. You shouldn't try and take a twelve pound dumbbell and lift it up behind your hand to get your back to get posterior range of motion on your shoulder. You should start with a two pound dumbbell. But more than that, if you haven't done weight lifting, it's a great way to start, so long as you take it easy as you ramp up. So we are guilty of dissing that.

[00:04:12.370] - Dr. Lemanne

Absolutely guilty. And you know, Let me get defensive here.

[00:04:17.550] - Dr. Gordon

Okay. Oh, I see your hackles coming up. Yeah.

[00:04:23.900] - Dr. Lemanne

My issue with the three-pound dumbbells, and three pounds is starting to become more respectable. The one and two pound dumbbells, sure, if you're doing range of motion, if you're really, really just at the beginning stage and have been, and I mean, nearly bed bound for years or something like that, sure.

[00:04:44.320] - Dr. Gordon

Which is Some of the people that I would love would be listening to us.

[00:04:49.480] - Dr. Lemanne

And that's great. I mean, there's nothing wrong with light weights. They're essential. They're essential for rehab when something's gone wrong, like an operation or an illness that has caused profound weakness, a situation like that. 

What I object to, what I object to is people using very light weights and doing it with some ease and still thinking they're engaging in resistance training and that they're going to get all the benefits of weight lifting. But it's not resistance training if you're starting with a three pound weight and staying there. You can do that all day long because the weights are so light and so it's easy. And if it's easy, that's a sure sign that you're not getting much in return. It's better than sitting on the couch, but not that much. If you really want to improve your bone density, improve your muscles and your brain, if you want to decrease your risk of cancer, if you want to improve your metabolism, grow muscle, all those great things, you have to move into heavy weights. Not all at once, you do it gradually. You don't do it every day. You do it two or three times a week, maybe four times if you carefully rotate exercises, and that takes some skill and perhaps some coaching.

[00:06:09.830] - Dr. Lemanne

But you have to. You have to push a bit into discomfort. You have to start moving heavy weights to shift the physiological needle because that edge, that, that's where the health improvement happens.

[00:06:23.920] - Dr. Gordon

Actually, that's an important point for no matter what exercise we're talking about, and I can give this back to myself, I go on hikes, and I've been very happy that over the last 6-12 months, I've been able to keep up with some of my faster hikers. I need I can't push beyond that and not be happy with that. I need to, with them or without, try and go up incline faster. I can't just be happy that now I don't need to stop three times on the incline. I need to Keep pushing myself because it's in the edge of pushing that you make new cells or new mitochondrial... There's just so many benefits. I will say those two. You get new mitochondrial pathways and build new muscle cells, and muscle cells are good for longevity and brain health. I'm sure I'm missing something. What else does pushing against your ceiling performance benefit?

[00:07:29.910] - Dr. Lemanne

Well, one of the things that I wanted to talk a little bit about today, maybe we should start here, is depression and anxiety.

[00:07:37.080] - Dr. Gordon

An important...

[00:07:38.330] - Dr. Lemanne

And exercise. Yeah. One of the things that's interesting about that is that exercise is one and a half times more effective than medication for depression and anxiety. This is an article that's synopsized in medical news today. And What's interesting is that resistance training, heavy weights, is one of the most effective versions of exercise for this. So all forms of exercise are important. And certainly we want people to do whatever they're going to do. But avoiding the heavy weights is probably not going to get you to the best condition for brain, bones, and mental health.

[00:08:29.900] - Dr. Gordon

As well. Yes. And if you haven't done heavy weights, it's good to get some coaching. And I have a patient who's got a lumbar disk issue that is long-standing. I say, great. Well, you need to do resistance exercise in some other way than doing squats then. If squats don't work for your limitation, if bench presses don't work for your limitation, yes, you have to do something like that. And resistance exercise with progressively heavier weights, and that's the key, progressively heavier, is good for so many things. But I don't want to leave your topic that you just brought up and go more into the weight lifting. So first of all, being one and a half times better than medication is a pretty low bar.

[00:09:19.580] - Dr. Lemanne

This article says that the analysis found, I'm quoting here, that physical activity produced a median reduction in mental health issues from 42 to 60 %. And it goes on to say that Psychotherapy and pharmacotherapy, so talk therapy and drugs, produced a much smaller improvement between 22 and 37 %.

[00:09:38.120] - Dr. Gordon

Isn't that incredible that the standard of care, the treatment that is most commonly recommended and considered the standard of care, works in a quarter of the patients it's given to? What if an antibiotic only worked in a quarter of the cases of strep throat, they'd go out looking for another antibiotic.

[00:10:00.260] - Dr. Lemanne

That's true. But different specialties have different bars. So in oncology, for instance, if we see a 3% improvement in survival with a particular cancer drug, we will consider that a success and recommend it. So, yeah, but 22% for psychotherapy?

[00:10:21.700] - Dr. Gordon

I'm surprised.

[00:10:22.880] - Dr. Lemanne

And pharmacotherapy is a little better at 37% and exercise much better, 42 to 60%. So at least about around half of the people who exercise get better. Mental health issues, all mental health issues. That is good.

[00:10:37.300] - Dr. Gordon

But my real question about that is if somebody is depressed or anxious, does Did they also include some magic tricks about how to enable them to adopt a program of exercise?

[00:10:52.520] - Dr. Lemanne

No, this was just a meta-analysis looking at various studies and looking at the numbers. So this was not about implementation operationalization of exercise. But that's a good point. And I think that I don't know how much you believe in self-efficacy versus Everything is neurotransmitters. You've just got to get the neurotransmitters in there or nothing's going to happen. I'm somewhere in between, although I think I probably lean more on the neurotransmitter side of our behavioral abilities, meaning that we do have to change our brain chemistry. But most people would agree that they might be willing to try exercise if they're depressed or anxious. If they're not, then they might try to go for medication, but understand that the medication is less likely to be effective.

[00:11:50.370] - Dr. Gordon

I think the two explanations or the two theories of mechanism of action dovetail. If you look at what actually contributes to the generation or receptor sensitivity for neurotransmitters. So if your mitochondria, the fuel factories in your cells are defective, you won't make the neurotransmitters that you need and trying to replace them by blocking the uptake of your poultry production, which is the current model of most psych meds. So if you don't make very much, okay, it's good to block their reuptake, but it would be good to fuel your making more, which I think is a whole interesting dovetail in and of itself.

[00:12:45.820] - Dr. Lemanne

That's really interesting. I like that. Yeah.

[00:12:47.260] - Dr. Gordon

So the whole metabolic approach to mental health, which I think we will be talking about in-depth in an upcoming episode. I think you're having Dr..

[00:12:58.290] - Dr. Lemanne

Georgia Eid. Yeah. You invited her, didn't you?

[00:13:01.230] - Dr. Gordon

I did.

[00:13:01.960] - Dr. Lemanne

For a couple of months down the line.

[00:13:03.980] - Dr. Gordon

A couple of months down the line. But I want to give a specific exercise tip. Because I think I do some in-depth genetics, particularly with my APOE4 patients, Because APOE4, if you read the common newspapers these days, they would say, if you have two copies, you might as well just buy a plot in the local cemetery, you're on your way downhill and going to die. Frankly, it's not uncommon for a patient with one a copy of the APOE4 and a little cognitive impairment. Their doctor tells them, get your affairs in order. There's no relief for this, and I beg to differ. But I do in-depth genetics because how come one person with one copy of APOE4 does great, and another person does terribly. They develop dementia at an early age. So there are a couple pathways of mitochondria efficiency that can be impaired or not. And there's all sorts of supplements you can take. But there's one in particular that helps, particularly with exercise performance. It's cheap as dirt, easy. It tastes sweet. You put it in water if you want to or your coffee. And it was made famous some decade or so ago by that cardiologist, Dr. Sinatra, not Frank Sinatra, but Steve, I think, Sinatra.

[00:14:31.170] - Dr. Gordon

But D-ribose. Have you ever tried D-ribose?

[00:14:33.800] - Dr. Lemanne

I have. Yes. So there are certain genetic characteristics that you can find on tests that tell you whether someone is going to respond well to D-ribose because of their mitochondria, various It's idiosyncratic mitochondrial functioning.

[00:14:48.520] - Dr. Gordon

Yes. But in that sense, since the genetic test costs about $1,000 and D-ribose costs about $1.99..

[00:14:55.530] - Dr. Lemanne

Let's get the test.

[00:14:56.840] - Dr. Gordon

Let's get the test and try it.

[00:14:59.700] - Dr. Lemanne

So someone can take this and they'll know pretty quickly whether they have a good response.

[00:15:04.210] - Dr. Gordon

Yeah, and the dose is 5 to 10 grams. And 5 grams works fine for getting yourself going over that first hub of the hill, first hill of the hike, so to speak. That was where I started using it. And 10 grams might endure better for persistence in the exercise. But you can put it in your water that you're drinking during your exercise with some electrolytes, something like that. Make a tasty little drink.

[00:15:29.740] - Dr. Lemanne

D-ribose is a sugar, so it's sweet.

[00:15:33.180] - Dr. Gordon

Mildly sweet. Mildly sweet.

[00:15:34.350] - Dr. Lemanne

Oh, interesting.

[00:15:34.980] - Dr. Gordon

Yeah. And so D-ribose might help the energy, but the emotional barriers to exercise for people with psychiatric or depression your anxiety. It's a challenge. And probably, don't you think the exercise solutions you and I have both gravitated towards largely involve other people, right? Either a class class or a walking date or something like that? Sure.

[00:16:03.680] - Dr. Lemanne

I'm more solo. If I had my own gym, one of my fantasies, if I won the lottery, I'd have my own personal private gym and it would have a lock on the door. But I'll let my friends in. They can come as long as I'm not there. You're welcome. But no, I do go to a gym, and I actually go to a CrossFit type program where there are a lot of other people. But still, CrossFit is, it's you against yourself. We're not doing a team effort, usually. Occasionally, there's some partner work. So I prefer, I'm a loner when it comes to exercise. I prefer loner activities like walking, running, swimming.

[00:16:51.840] - Dr. Gordon

So if the gym, question about this gym, if your CrossFit gym were open 24/7 and you could just go anytime, time, you'd be more likely to go when you could have the gym to yourself rather than go when you'd have a trainer who could... Yes. Oh, okay.

[00:17:08.560] - Dr. Lemanne

Yes, yes. I have had trainers and I have trainers from time to time, so I do use that. But yes, for my everyday exercise, I guess I like. But people are different. So you're much more social and outgoing, aren't you? You like to go out and walk with other people.

[00:17:29.460] - Dr. Gordon

I like I like both. I like both. There's some people I like to check in with, so I do walk with them. But I also schedule a couple of times a week where I'm just walking with the dog who's a terrible conversationalist, and I really do get lots of good alone time hiking with her. So I get a little bit of both. And I have a tiny little mini gym at home with a bench press and a TRX and a deadlift bar. And so I can do some stuff at home. And I do like staying home. To do some... You know what I like to do on a regular basis that I think also has impact on depression and anxiety? Do you know what I get to do? And you get to do it in your home, too. I do it a little more. You can do it across the street, which is forest bathing.

[00:18:16.890] - Dr. Lemanne

Oh, yes, yes, yes. And that's right. You live in the middle of the forest. You've scraped out a homestead there and put a fence around it with some animals in there. It's just amazing. It's just It's a gorgeous place that you live.

[00:18:31.560] - Dr. Gordon

I will credit somebody else scraped it out. We just bought it from them. So somebody did that hard work.

[00:18:38.040] - Dr. Lemanne

Being in nature is really, really important and important to me. And I do enjoy that. And yes, I live across the street from a park.

[00:18:47.910] - Dr. Gordon

Exactly. A very luscious park.

[00:18:49.700] - Dr. Lemanne

Any time. That's really nice.

[00:18:51.360] - Dr. Gordon

And I think what I was referring to is I think the reputation is that in Japan, perhaps, or some other country that is really not this one unless you're seeing a cutting edge doctor. Forest bathing is a prescription.

[00:19:06.410] - Dr. Lemanne

I think it's a thing. Yeah. Yeah.

[00:19:08.530] - Dr. Gordon

Get out there in nature a little bit.

[00:19:10.210] - Dr. Lemanne

I don't think I'm going to write any prescriptions forest bathing. But I think People understand everybody gets that being out in nature in a beautiful spot, something that touches you is healthy. And there are studies that show that hospital rooms that face greenery, the patients are discharged a day or two sooner than patients in the same hospital whose windows face a wall or something like that. So it's really important to be in touch with nature. Yeah. Well, I have another thought about mental health versus physical health. You've heard of Morgelen's disease?

[00:19:53.780] - Dr. Gordon

Yes, I've seen one case of it.

[00:19:56.950] - Dr. Lemanne

I'm going to read you the The current definition. This is from, I think 2022, really recently. And it says, Morgelen's disease, categorized in the psychiatry literature as a type of delusional paracetosis and characterized by the belief that one's skin is infested with an undetectable parasite, toxin, fiber, or other foreign material. Patients typically present with nonhealing wounds that were, and this is in this, I'm quoting this now, that were self-inflicted in an attempt to rid themselves of what they believe to be the responsible agent. Consistent with other delusional disorders, a hallmark of Morgelen's disease is a firm conviction of the validity of the self diagnosis and hostility to alternative explanations.

[00:20:52.580] - Dr. Gordon

Wow.

[00:20:53.440] - Dr. Lemanne

I will put the reference from which this comes in our show notes.

[00:20:59.330] - Dr. Gordon

That should be enshrined in shame rather than celebrated as a reference, right?

[00:21:06.870] - Dr. Lemanne

I get this. If you're the doctor, these patients come in with these big ulcers that they apparently have scratched. It's called the match box sign. They'll bring in little match boxes with fibers, blue, red threads, green, black, white threads that they say, these came out of this wound. I've got to get these out of there. There's something going on with me. There's something wrong. These threads are growing out of my body. You've got to help me. And they're pretty fixed on this.

[00:21:37.370] - Dr. Gordon

Oh, I've seen that patient and I saw that patient long enough ago that I deserve a little cloud of shame over my I had, too, because I... So I have a different... I think you probably do, too. No, there's an alternate explanation. But I thought she was totally, can I say this on the air, batshit crazy. You know that there's nothing there. Those are fibers from the shirt you're wearing. I did the whole thing of seeing that she had some underlying anxiety, and now it was all fixated on her skin.

[00:22:12.700] - Dr. Lemanne

Well, I believe that patients have been sent to institutions, psychiatric institutions, with these kinds of delusions for treatment of delusional paracetosis. And here is an article that I think is really... It shocked me when I learned about this, and it says, this is in a prestigious dermatology journal, and I'll put the link to this reference in our show notes as well. But those doctors say, The key diagnostic criterion of this skin condition is the presence of unusual and often colorful filaments that lie under, are embedded in, or project from the skin. These thread-like cutaneous filaments may be white, black, or brightly colored in hues such as red, green, or blue. In addition to the curious dermopathy, these patients may also exhibit a variety of systemic symptoms consistent with Lyme disease. Exactly. Including fatigue, joint pain, and neurological problems. Studies have established that Morgelen's disease is associated with Borelia burgdorfia and relapsing fever infection. So these are bacteria, they're in the spyroquiet family, meaning they're spiral-shaped bacteria, that are contracted, generally from tick bites, etc. I'll keep reading. Now I'm going to resume the quote. Histologic studies have revealed that Morgelen's disease lesions demonstrate hyperplasia and parakeratotic hyperkeratosis.

[00:24:04.530] - Dr. Lemanne

That's medical ease for filaments production. And that the characteristic cutaneous fibers are composed of keratin and collagen. Those are proteins made by human beings.

[00:24:16.340] - Dr. Gordon

Not the threads from the shirt they're wearing, Deborah.

[00:24:19.460] - Dr. Lemanne

Keratin and collagen originating from, and then they go on to talk about the various layers of the skin, the keratinocytes within the stratum basale. Then The main sentence in this whole paper is, Thus, Morgelen disease fibers are of undeniable human cellular origin and are not manufactured artifacts. And that's the end of the quote. And they should have said, These patients are not batshit crazy. They have filaments growing out of their skin that are produced by their body's response to these germs. They are infected. And when you treat the infection, indeed, the Morgelen's disease and the the formation and the delusional paracetosis all resolve.

[00:25:06.930] - Dr. Gordon

Yes. And if we could all develop as doctors some real degree of humility that there's so many things in medicine that we are absolutely sure of that we later find out to be completely wrong. One of the simple tools, who's going to pull apart filaments in their office? But one of of the simple tools that I read about for distinguishing, and I read about this because I was totally guilty of really suspecting this patient 20 years ago. But one of the differences is if you go to a derm doctor They have a little handheld magnifying glass, and it magnifies a certain degree of power. I think it's four times or five times, something like that. And all you have to do is double the intensity of the magnification, and you can tell it looks completely different. Oh, my goodness. It could be that simple. But what you're talking about is they've looked into and, gee, why if this is a psych condition, do antibiotics work better than antipsychotics?

[00:26:24.430] - Dr. Lemanne

Hearing what patients are saying and believing patients, sometimes that's the wrong thing Sometimes it is. But I made a mistake in the other direction. I walked into a patient's room, and unfortunately, this patient was very, very ill and in pain from a malignancy. And I had the patient on a high dose of morphine. And I walked in one morning and the patient said to me, Dr. Le Monde, you just missed it. And I said, missed what? And she said, there was a llama in my room. I said, a llama? And I was thinking, like a Buddhist priest. And she says, No, no, no, no, no, a llama, like a llama in Spanish, with two L's, an animal. I thought, well, typically we don't allow farm animals, livestock in the hospital ward. But she went on, she said, yes, and it had a big red bow around its neck. I went back to the nurse's station and I lowered the morphine dose and I went about my rounds and I got to the ICU.

[00:27:32.110] - Dr. Gordon

Oh, no.

[00:27:33.300] - Dr. Lemanne

And there was a llama in the ICU with two Ls and a red bow around its neck. And it was some type of charity emotional support for the patient. I think the llama did eventually get kicked out of the hospital. But that was eye-opening for me. So I went back downstairs and turned up the morphine again for my patient.

[00:27:54.750] - Dr. Gordon

When do you believe a patient?

[00:27:58.450] - Dr. Lemanne

And that's a hard question. It's not straightforward. You try to always believe them. And you have to- What is it trust, but in trust, but verify?

[00:28:10.500] - Dr. Gordon

Verify. Verify there.

[00:28:12.620] - Dr. Lemanne

Or trust, but tie up your camel. Or your llama.

[00:28:17.560] - Dr. Gordon

The thing is going down this Morgelen's rabbit hole a little bit. In general, these skin picking disorders that are... So Morgelen What my patient 20 years ago did not have ulcers, but she was constantly plagued by little itching, tingling, burning parts of her skin, and she was always picking at things. And that is actually a skin disorder. It's called something like skin picking disorder or something like that. And that does respond... Excoriation disorder, I just found it. I have a link to an article about that. And they have used some pretty the heavy duty psych medicines for that to calm people down. But there is an interesting supplement that works for excoriation disorder that I can see how it also would work for Lyme disease. And that could be confounding the evidence that you see.

[00:29:19.230] - Dr. Lemanne

Oh, interesting. Well, have you ever bitten your nails?

[00:29:23.280] - Dr. Gordon

Yes, I prefer my hangnails. Me too.

[00:29:27.690] - Dr. Lemanne

I pick my head and my cuticles. I pick my cuticles I have picked them to the point of bleeding, and I have found that n-acetylcysteine, which is the supplement I think you're getting at. It is. Will take that right away from me. There are studies, there are literature and case reports showing that that's the case for a lot of impulse control disorders. They're called in psychiatric parlance. Oh, I like that. It makes us all psychiatric patients if you want to go down that route. But Do you think it helps? Skin picking, hair pulling, cuticle picking.

[00:30:05.140] - Dr. Gordon

Yeah. Do you think it helps with compulsive eating disorders?

[00:30:08.880] - Dr. Lemanne

That's a really interesting question.

[00:30:11.110] - Dr. Gordon

I have to look into that. And it's dose dependent.

[00:30:15.590] - Dr. Lemanne

So what's your dose? My dose is 1,800 milligrams. So that's a high-ish dose. Most of the NAC pills come in 600 milligrams. That's a common dose. And I also take it with a lot of vitamin C. And don't do this at home, children. You want to make sure that your health care professional agrees with anything that you decide to take. But they are relatively safe. They're over the counter. And I do find that it has helped me. And there are case reports of even higher doses being used. A 13-year-old boy who picked a skin, skin excoriation disorder, had to go up to 2,400 milligrams a day to take care of that. And then the The symptoms subsided.

[00:31:03.050] - Dr. Gordon

The interesting question in my mind is why and how that works. And if you look into NAC, it has efficacy in other neurological disorders. And I must say I have been guilty of thinking of it just as a precursor to glutathione. Glutathione is good for all the neurological disorders. Just take glutathione. And what I realized looking into this, plagued by this wonder about why it helps with excoriation disorder, NAC has, first of all, it's able to cross the blood-brain barrier. So what we're talking about can happen in the brain. But it has a great ease in crossing the cell wall membrane and going into the cell and helping to promote glutathione synthesis in the cell. So in each of our cells, we have this little enzyme that is just dying to make glutathione, and it has glutamate, and it has sulfur, and what it's mostly lacking is cysteine. So when cysteine crosses over the cell wall, because NAC adheres to the cell wall, and cysteine shows up, that little enzyme goes to town, and we It's going to have an antioxidant effect within the cell itself, which taking all the glutathione you want by mouth or by IV or any way like that, isn't going to get glutathione in the cell.

[00:32:42.220] - Dr. Gordon

It's only NAC that's going to get glutathione in the cells. So then that cell can do things wisely. It can produce neurotransmitters. It can receive neurotransmitters and act upon them. And it can help with to reduce the inflammation or oxidation that might be generated by your case of Lyme disease. So you can see what I can see. And for me, this is an aha moment. Maybe everybody else already knew this. But how NAC can help with any neuropsychiatric, neurodegenerative, or neuroinfectious problem like Lyme.

[00:33:22.700] - Dr. Lemanne

That's really fascinating and really helpful. That was a very helpful rundown of how the mechanism probably works.

[00:33:35.010] - Dr. Gordon

Probably is a good point. Good caveat.

[00:33:39.000] - Dr. Lemanne

I'm looking here at this article that I was the case report. It says, There's growing evidence for NAC's use as a treatment for psychiatric disorders related to impulse control, such as skin picking, tricotylia, which is pulling out your hair, OCD, obsessive compulsive disorder, autism, and substance abuse. And an OCD, especially in adolescents, has been associated with infections, for instance, strep infections, particularly. Oh, I didn't know. Oh, yes. And so this all makes a lot of sense.

[00:34:12.850] - Dr. Gordon

Did you use it with your patient who chewed on her hair?

[00:34:16.410] - Dr. Lemanne

No, this was a long time ago, and that patient was in a nursing home with other issues. So that went back to the nursing home and I wasn't involved in their care.

[00:34:25.440] - Dr. Gordon

I've recently thought of- You're talking about the patient who had the supposed A tumor that turned out to be a hairball. A bisouar.

[00:34:32.620] - Dr. Lemanne

A bisouar, yes.

[00:34:34.420] - Dr. Gordon

I've recently suggested anacetylcysteine for a young gentleman I know with autism, which is a...

[00:34:43.850] - Dr. Lemanne

Boy, I wish we That's on this list.

[00:34:46.220] - Dr. Gordon

Yes. Yeah, it's on that list. But I don't... It's something that it's infrequent enough that it's... I bet there still has been plenty of research on autism, and I'm not sure We've moved much past square one or square two. I guess we don't lock them up and put them in strait jackets anymore. But it's difficult to raise a child with autism or to walk a path through life if you're very far on that spectrum. Yeah.

[00:35:20.510] - Dr. Lemanne

Yeah. Well, you asked if NAC, if it helps with impulse control, might it be helpful in and appetite control and obesity. And I think that's a good question. I don't know if we have the answer to that, but obesity increases the risk for cancer and bariatric surgery, which is a type of surgery, stomach stapling, it's typically called, that results in weight loss can reduce the breast cancer, the risk of breast cancer. So losing weight via surgery, bariatric surgery, It can be helpful to patients who are at higher risk of breast cancer.

[00:36:06.110] - Dr. Gordon

So correct me if I'm wrong, but I think when people have bariatric surgery and these people are obese and they have type 2 diabetes, disease. And so their blood sugar and their A1c and their insulin are all really high. I think there's something like when you staple their stomach within 24, 48 hours, which does not happen if you've knocked them out for 2 hours to fix their knee and they haven't eaten for 2 days. They look metabolic. That those people look metabolically the same after 2 days. But if you've had a stomach stapling, I think all your metabolic markers change within a day or two.

[00:36:48.500] - Dr. Lemanne

Yes, I have seen that. It's amazing. And what I've seen, and I'm going to have to look into this, but what I recall about that is that it has to do with a change in the microbiome. So yes, operating on the knee. It doesn't really change the gastric juices and things that come out of the stomach and then go downstream through the small intestine and the large intestine and to change who's living in there. But one of the things that was found, you're absolutely right, that type 2 diabetes in these overweight patients will resolve. I mean, their numbers go to normal without medications within a few days. It's unbelievable.

[00:37:28.890] - Dr. Gordon

And it's all those numbers, I think, not though, because they haven't lost the pounds yet. But don't you think it's changing those numbers and reducing the insulin and the IGF1?

[00:37:40.510] - Dr. Lemanne

In this study, the baseline insulin levels were high. They were 15.8, the fasting insulin levels. And so that was one of the things that was measured. And it was the people who had those higher baseline insulin levels that had the best lowering of their breast cancer risk. And this was mostly... This was all in... It happened, this risk reduction happened in, get this, in pre Menopausal women, not postmenopausal women. So the premenopausal high insulin levels are particularly potent risk factor for breast cancer, I think, is what we can extrapolate from this study. So if you're As a premenopausal woman, you really want to make sure that your insulin levels are nice and low and your fasting insulin levels. I like fasting insulin levels around five.

[00:38:40.000] - Dr. Gordon

Right. And so when you say nice and low, I think it's important because a lot of the people that I'm talking to are postmenopausal or men of postmenopausal age. I'm not happy with an insulin level less than two or two and a half. That's too low. That's too low. Those people, I actually say, well, I've got some good news and bad news. The bad news is your insulin levels are too low. The good news is you need to eat more carbs, which is not what I usually say to people. Sure. So here the thing about breast cancer risk reduction by gastric stapling or gastric resection. Are there any studies with cancer risk reduction and fecal microbial transplant that also can have some profound metabolic effects? Isn't that right?

[00:39:31.020] - Dr. Lemanne

So that's really interesting. I don't know about cancer risk reduction, but certainly cancer treatment can be enhanced by fecal transplant. So for instance, in cases of melanoma, where patients were treated with immunotherapy, off the shelf immunotherapy drugs like imumab and nivolumab.

[00:39:52.100] - Dr. Gordon

You can say that.

[00:39:53.420] - Dr. Lemanne

I had to practice.

[00:39:54.750] - Dr. Gordon

I'm impressed.

[00:39:57.430] - Dr. Lemanne

The checkpoint inhibitor If patients don't respond at first and their melanoma doesn't get better with that type of treatment, if they're given a fecal transplant from a donor who has had melanoma and who has responded to those treatments, and then they're retreated, they will then respond. So the microbiome from the responding patients is the key here.

[00:40:26.040] - Dr. Gordon

The key to implanting, so to speak, immunotherapy sensitivity, responsiveness. Yes. Yes. Wow. Change the bugs in your gut. Yes.

[00:40:37.450] - Dr. Lemanne

So that's an emerging field of study. A lot of that work has been done at MD Anderson, which is a large cancer research institution in Houston, Texas. And I'm watching that work with great interest. And so we'll see what new developments come of that. But that's a big new field. It's very, very interesting. But But again, it's not something you'd want to do without real care.

[00:41:05.340] - Dr. Gordon

I do know people are doing DIY fecal transplants, which would certainly make me nervous.

[00:41:16.300] - Dr. Lemanne

Yeah, it makes me really nervous. We do not know what bad things you might be transplanting in there.

[00:41:23.390] - Dr. Gordon

Yeah. And people jump through a lot of... So right now, the only, I think, Is there just... Well, now you're telling me there's a second medical indication, which is resistance to this immunotherapy. And the first one is the first indication for fecal transplant is that colitis that's name is escaping, the antibiotic.

[00:41:46.920] - Dr. Lemanne

Clostridium difficile.

[00:41:48.300] - Dr. Gordon

Clostridium difficile. And that is covered. And gastroenterologist will do that. But the person who's the donor has to jump through all sorts of hoops. It's done in a hospital sterile setting, and it's all very guarded and supervised. I think DIY fecal transplants probably suffer from a lack of careful oversight.

[00:42:14.440] - Dr. Lemanne

Well, one of the first cases of successful fecal transplant treatment was between a daughter and a mother. The mother had a Cdifacil, and the daughter was the donor for the fecal transplant. The daughter had obesity. The mother had never been obese. The mother received the fecal transplant and the colitis was resolved. However, the mother developed obesity and was not able to overcome that. So the transplant seemed to be related to the obesity. And we have been able in animal studies to transfer obesity and insulin resistance via fecal transplant.

[00:43:01.870] - Dr. Gordon

Not a welcome benefit.

[00:43:06.500] - Dr. Lemanne

Just a caveat, things that can be, we consider completely under our control are typically not. And things like obesity and insulin resistance can be transferred from one being to another, mouse and human. And so we should be very careful with that. Do you want to talk about... I have something else about defecation.

[00:43:32.470] - Dr. Gordon

Yeah, that's what I was going to ask you because I think you tickled me with the possibility of another topic related to defecation. So, yeah, go for it. I want to hear more about it.

[00:43:43.870] - Dr. Lemanne

So defecation actually improves exercise performance. I believe these were cyclists. And the reason is that once you defecate, If you release blood that has pooled in the rectum.

[00:44:03.760] - Dr. Gordon

Trying to hold on.

[00:44:05.330] - Dr. Lemanne

Trying to hold on to things there. That blood is pooled, is released, and can go up to the brain and the frontal part of the brain, which has to do with our willpower and agency and exercise performance is thus improved. So I guess the moral of that is just please go to the bathroom before you have your big athletic event.

[00:44:29.200] - Dr. Gordon

And maybe that's so interesting because the lines at the Porta Potty at a rowing competition are lengthy in the morning and not so lengthy at all at any time during a break or the end of the day. But in the morning, everybody's had their coffee and their nerves are up and everybody empties their rectum. And now I can say, yes, you're serving your team well by defecating at that Porta Potty, even if it is disgusting by this time before you compete.

[00:45:03.940] - Dr. Lemanne

Yeah. I think that everybody knows that they feel better if they do that. But now we have the numbers here. So I'll put this study up in our show note is called Defecation Enhances Cerebral Perfusion and Delays Fatigue in Elite Triathletes.

[00:45:25.410] - Dr. Gordon

Oh, I hope it works for the mere mortals among us, too.

[00:45:29.060] - Dr. Lemanne

This was a 2023 article published in the Journal of the International Society of Sports Nutrition.

[00:45:37.040] - Dr. Gordon

This raises in my mind a topic that I think deserves its own whole episode at some point, which is I am more and more... So when I started working with Dr. Brettison and Cognitive Health, and I started working with a number of physicians who are fully, functionally, medicine-trained. And functional medicine, I think most people who are listening to this podcast understand about it. But I think of it, well, it's just a fancy term for applying physiology to medicine. In medical school, we had great classes in physiology that talked in pretty great detail about how every little part of our body works. And what if we actually take that to medicine rather than shortcutting from pathology to pharmacology, which is what conventional medical practice can err on the side of being too pharmacological, right? So Functional medicine is more physiological. Well, all these doctors that are functionally medicine trained really do start out, it seems to me, by doing a stool test on almost everybody. And this isn't just looking for pathogens in adverse GI function, but it's really looking for the physiology, the nuts and bolts details of inflammation and immune function and digestive efficacy evidenced in our stool.

[00:46:59.990] - Dr. Gordon

And we know a little bit about some of the bugs and not so much as some people think we do. And I'm coming around to the point that probably everybody benefits from an in-depth good stool test.

[00:47:11.810] - Dr. Lemanne

What is your favorite stool test these days?

[00:47:14.870] - Dr. Gordon

Genova Diagnostics. And I follow the work of Lucy Maling, who's a PhD microbiologist who luckily stayed in that field and didn't go to medical school, which was one of her other considerations. And She constantly every year, and I haven't looked at it recently, evaluates stool tests. And the last time I looked at her ratings, doctor's data in Genova Diagnostics were her most highly rated ones. And I use Genova because it's covered by Medicare.

[00:47:49.130] - Dr. Lemanne

Okay, Genova. And Doctors Diagnostics is the other one?

[00:47:52.730] - Dr. Gordon

Those are the two she liked. For a long time, I was using GI Map, and then I heard her talk about The disappointment she had with GI Map. Essentially, she snuck in two or three different stool specimens all from her from the same day. They were completely different in the results. And GI Map had nothing to say about it when she contacted them. And she said, that doesn't mean they're overall a bad stool test, but they just aren't reliable enough for me to work with. So at least the time that I heard her say that she was happy with doctors data and Genova And doctors data is the other one. And if you're cash pay, I would choose either one of those by cost. But I like Genova because it is covered by Medicare So Dr..

[00:48:46.880] - Dr. Lemanne

Maling's test, did she take one stool sample and divide it into three parts and send it in?

[00:48:51.140] - Dr. Gordon

Well, they don't take the whole specimen. Turning in these fancy stool tests, you get to play with your poop like a kindergarten You poop into a container and you spoon some of it into their container with a stabilizing liquid in it and you ship that off. So it was pretty easy for her to take specimens. And she chose them from the different parts of her stool for each of the different specimens that she set off. So she had a dinner-size plate, let's just say, or a dessert-size plate full of size, worth of stool, and she took it from three different areas for each one of the specimens, sent them in all labeled with different patient names, all came back completely different results.

[00:49:37.220] - Dr. Lemanne

Okay. Interesting.

[00:49:39.120] - Dr. Gordon

We could have her on someday, maybe. Talk about what we can and cannot learn from a good stool test.

[00:49:47.560] - Dr. Lemanne

Okay. Well, there's one other thing that we could talk about, and that's tattoos.

[00:49:57.230] - Dr. Gordon

Yeah, I know. You've got a bunch of stuff rolling around in your That's something that's very intriguing to me, and this is very intriguing. So please do tell.

[00:50:04.860] - Dr. Lemanne

Well, tattoos are really popular. Very. And they're the norm in the generation after us, anyway. And so this was a case control study in Sweden, looking at people 20 to 60 years of age. And this was over a period of years. And following them to see if they got lymphoma amongst... And a tattoo prevalence, what they found was that it was 21% among cases and 18% among controls. So a tattooed individual had a higher risk of lymphoma.

[00:50:50.970] - Dr. Gordon

It wasn't huge. About a 20% higher risk, something like that. So one of the previous health concerns heard about tattoos are concerns of heavy metal toxicity from the ink?

[00:51:06.800] - Dr. Lemanne

They looked at the area of the tattoo, and they found no association with a larger area of tattoo. So that suggests that it's not the actual tattoo material. To me, it suggests that that's probably the actual operation and the risk of exposure due to the instrumentation, possibly lack of complete sterilization, those kinds of things. Because lymphomas are notably connected to viruses in many cases.

[00:51:42.750] - Dr. Gordon

So that second part of the sentence is I want to hear more about that. So say more about lymphoma because I don't think of viruses as being transmitted by unsterile minor surgery procedures, but I guess viruses can live on instruments.

[00:52:00.090] - Dr. Lemanne

Yeah. So when we were in medical school, when I was in medical school and HIV was just coming into being, we noticed that a lot of the people who developed HIV were injection drug users. That's true, of course. And Hep C. And Hepisitis C, HIV. You can transmit pretty much anything you want with a needle. And so, yeah, I think.

[00:52:27.230] - Dr. Gordon

And what are the viruses that show an increased association with cancer in general or lymphoma in particular? I guess that's what this is pertinent to.

[00:52:37.760] - Dr. Lemanne

Yeah, that's a really good one. So there are a lot. And Epstein-Barr virus is closely associated with lymphoma risk, hepatitis C lymphoma risk, HIV, of course.

[00:52:56.070] - Dr. Gordon

So question about, let's just take Hep C because we have a wonderful paradigm shift in Hep C in the last couple of decades. If you had Hep C 30 years ago and were never successfully treated for it, you have a certain increased lymphoma risk. What if you get Hep C now and you have it for a couple of years and then somebody tells you, oh, you can get treated for it? And so you have resolved Hep C. Do we have any knowledge of whether treating the virus and eradicating it from your system reduces your lymphoma risk or is it the... Or your... Yeah.

[00:53:34.120] - Dr. Lemanne

Yeah. So I think the answer to your question is in your question. If you develop it now and treat it, we'll have to wait.

[00:53:43.380] - Dr. Gordon

Right.

[00:53:44.760] - Dr. Lemanne

And see what the numbers are in the next coming decades, but that's a really great question.

[00:53:48.910] - Dr. Gordon

Great talking to you today, as usual.

[00:53:50.790] - Dr. Lemanne

As always. Take care. Next time. Bye.

[00:53:55.520] - Dr. Gordon

You have been listening to the Lemanne Gordon podcast, where Docs Talk Shop.

[00:54:01.300] - Dr. Lemanne

For podcast transcripts, episode notes and links, and more, please visit the podcast website at docstalkshop.com

[00:54:10.050] - Dr. Gordon

Happy eavesdropping.

[00:54:20.630] - Dr. Lemanne

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[00:54:37.530] - Dr. Gordon

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[00:54:49.620] - Dr. Lemanne

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[00:55:04.060] - Dr. Gordon

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[00:55:10.910] - Dr. Lemanne

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[00:55:28.600] - Dr. Gordon

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