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MODULE fOUr TrANSCrIPT: DAy 2 qUESTIONS | © 2016 fUNCTIONAL NEUrOLOGy SEMINArS LP | PAGE 1

PeriPheral Vestibular and Cerebellum disorders with aPPliCations (module Four)

transcript – module Four day 2 Questions

Presentation by drs. datis Kharrazian and brandon brock

dr. Kharrazian

So, thank you for those that sent questions to us. And let me know when you’re ready. That’s it? Okay.

From late Saturday: “If a person sways to the left… ready? Are we good? Okay.

From late Saturday: “If a person sways to the left while walking, which vestibular system is not firing? Left or right?”

dr. brock

Either. Well, typically you’ll fall toward the side of the weak side. But maybe one side is having spontaneous output throwing you that way, so you’re having lateropulsion. It’s not a simple answer, and it’s not a uni… It’s not a one answer. It is a multi answer.

dr. Kharrazian

And this is how I kind of look at it too, if it helps with some cases. If they’re swaying to the left, and they have no dizziness, it’s probably lack of function. If they have… If they don’t have dizziness, and you’re watching them, and they sway to – let’s say – the left, with no dizziness symptoms, it’s probably lack of vestibular integration. If they have dizziness as they sway to one side, I tend to think those are more overactive canals. It’s not a hundred percent, but it’s one way to narrow it down. That’s how I like to do it.

dr. brock

Or they’re just unstable, so you see them, they look drunk, and they’re going left, and they’re going right, and they’re going left, so it doesn’t really have a particular rhythm to it where one side is really dominant over the other, okay? I mean, if you think the world’s moving, and you think that somebody’s just going to keep falling the same direction, well, they might. Let me ask you this: If somebody has a right unilateral weakness, which way will they not want to turn? If you turn towards the side of dysfunction, and you


turn the other side off, both sides go off, so you drop like a rock. So you’ll see people, they become Derek Zoolanders. They become ambiturners. They don’t want to do it. With unilateral weakness. So, you can stop and make them turn, and see what makes them feel really uncomfortable and start making some decisions on that.

dr. Kharrazian

Ben, if you get a chance, if we could get a timer, that would be great.

“How is modern-day on-screen scrolling – Facebook, Instagram, etcetera – affecting people’s brains, repetitive vertical eye movements, vestibular integration, etcetera? Is this significant enough to create imbalances, and should it be limited during rehab?”

dr. brock

Well, I can tell you this, You don’t mind if I jump in on this one?

dr. Kharrazian

Go ahead. Yeah.

dr. brock

First of all, with dementias, remembering facts, figures, numbers, and location. If you lose all those, what disease is it? Alzheimer’s disease. Do you realize that you learn those things by memorizing them when you’re younger? How many of you know more than five phone numbers off the top of your head? Okay, how many of you don’t even know your own phone number? What I’m telling you is, there’s such a thing that’s especially being researched right now in northern Europe, called digital dementia, where people are not developing parts of their brain that degenerate faster on the average, so they’re worried that technology will create some of these pathologies earlier in life, and they’ve got some pretty good databases that show that they may be right. Now, I don’t know about vertical stuff, and optokinetic stuff, and moving your phone to the left or to the right, or all these things, but I can just tell you this: Whether you are looking at EMFs or whether you’re looking at the fact that the phone does everything for you, it’s always best to use your brain when you can. So if you know how to get to the grocery store, don’t plug it into your damn GPS. A lot of people are like, “I want to know if there’s traffic.” Like, okay.

dr. Kharrazian

Okay.

dr. brock

Try to figure out a way to get there, man. You know, use your brain. Don’t use your phone for everything.

dr. Kharrazian

“Often we learn about hypertension and sympathetic overdrive being coupled together. What would be the mechanism of hypotension with sympathetic overdrive?”


With hypotension with sympathetic overdrive, it’s basically what you have is, you have hypertension… hypotension that can be caused by people that have sodium depletion. So you see a lot of people that have chronic hypoglycemia – low blood sugars – they have adrenal exhaustion, they have abnormal mineralo-corticoids, when you look at blood tests, and they’re driven sympathetically, but they have hypotension. So their heart rate could be up, but the blood pressure’s low, because it’s not a catecholamine-based mechanism; it’s an aldosterone sodium retention mechanism. And for those types of patients, one of the best things to use is glycyrrhiza. So, glycyrrhiza has flavonoids in there that impact the enzyme called 11-beta-hydroxysteroid-dehydrogenase, which then then allows for more sodium retention, so when people have those patterns, I like to put them on glycyrrhiza and have them some sea salt, and their chronically low blood sugar is what’s causing the sympathetic drive. So as we get their sodium retention up, give them some sea salt, give them some glycyrrhiza, stabilize their blood sugar levels, we usually see the sympathetic response come down, and their hypotension improve. Okay?

dr. brock

That’s actually a good question.

dr. Kharrazian

Okay.

“Regarding microvascular disease causing white matter lesions, I have had multiple patients with brain MRIs showing multiple diffuse white matter lesions based on radiologist reports, but medical neurologists consistently ignore it or say that it’s normal and to not worry about it.”

It’s true.

“Why? Should we assume there is an early inflammatory process occurring that needs attention and there is microvascular disease?”

So, I had this discussion with a friend of mine who is a neuroradiologist. I go, “What is your deal? Why don’t you just list what’s there? There’s atrophy in this region. There’s white matter lesions. Why are you calling it trivial, or headache, potentially headache, and all these things?” I go, “That’s an inflammatory response.” You know what his answer was? He goes, “Well, you know, most of the MRIs that we do are for hospitals and looking for acute red flag tumors, strokes. When we start writing all this stuff in reports, it upsets them.”

dr. brock

It’s the truth. Because then they… If you write it, they’re forced to deal with it. And if they don’t know how to deal with it, it makes their day bad. It’s the truth.

dr. Kharrazian

So, people have white matter lesions. That’s an inflammatory reaction against myelin. It’s just that simple. Now, people have it with headaches, people can have it with neurological symptoms, people can have it with MS, people have it with autoimmunity of various types. But the thing is, it’s an inflammatory response. So you always have to also find a good neuroradiologist to work with, or radiology center, and go, “Listen, we do preventative work. We’re looking at signs of neurodegeneration. That’s what I need your reports to


say. We’re not really as concerned with, you know, complete severe pathology. So can you write reports for that?” If they say yes, great. You have a [radiologist] that says no, you find another one.

dr. brock

Ask for patchy white matter disease, and ask for volume loss.

dr. Kharrazian

Yeah.

dr. brock

And then say, “I want you do comment on the cerebellum, and if there’s any volume loss in the anterior lobe, or the posterior lobe, please… and I need you to talk about ventricular shifting and…” You just want them to talk about everything that they can. And that patchy white matter disease, it’s just… They look at it as – a lot of times – osteoarthritis. “At a certain age, everybody has it.” Well, that’s just not true.

dr. Kharrazian

Just because there’s frequency of that doesn’t mean it’s normal. So it’s just like heart disease. It’s frequent, but it doesn’t make it normal. So, white matter inflammatory lesions are common, but doesn’t make it normal just because lots of people have it.

Okay.

“When we discuss how low oxygen and low glucose can cause neurons to get close to threshold and therefore fire easily, does this relate to the CNS only? Does it also include peripheral nervous system?”

dr. brock

Well, you know, when you’re talking about the peripheral nervous sytem, you’re talking about an exten-sion of a neuron. So when you start talking about how an extension of a neuron, which is called an axon, fires, it’s called sodium potassium equilibrium potentials and stuff like that. So, you know, if you damage a peripheral nerve because of glucose – because of hyperglycation – well, that’s one thing. But when we’re talking about low glucose and low oxygen, and low fuel for delivery, and we’re talking about a Krebs cycle component, we’re talking about – you know – the ability to have cellular respiration. That’s in the cell. The axon will suffer from it. So a lot of times the peripheral nervous system will suffer as a result of cell body damage. I don’t know if I’m answering the question.

dr. Kharrazian

Well listen, at the end of the day, peripheral nervous system entrapments are compression. What does com-pression do to neurons past the point of compression? They cause lack of blood flow, oxygen, the neurons spontaneously fire, they feel paresthesia, they feel numbness. I mean, it’s virtually the same mechanism.

[9:49]


dr. brock

Yeah, and I want to say this: When you compress a – you know – the epineurium of a nerve, which is the covering of everything in that bundle, the thing inside the bundle, which has all of the axons, the peri-neurium, the connective tissue, and the vasculature… The thing with the least amount of total peripheral resistance is the vasculature. So when you barely press a nerve, what happens is, it gets ischemia, and it typically spontaneously depolarized. You get enough ischemia, you lose elasticity in the nerve. So now you stretch your arm, and you end up tearing or damaging a nerve, where it should have elasticity to it. So, compression of that nerve, and it becoming ischemic, is different than the cell body becoming ischemic and not having any fuel. One loses its structural capacity; the other one loses its functional capacity. Well actually, they kind of lose both, but, I mean, they’re different mechanisms.

dr. Kharrazian

“How do we know the difference between good, bad, and made-up research?”

Well, let me add a couple things here. First of all, if it’s in a journal, and it’s a reputable journal, it’s usually pretty good, because there’s a peer-review process. Okay? And there’s definitely flawed papers in journals, and there’s grading criteria you can use. But the point is, is that you have to learn your research skills. Like, it’s a whole different skills. You can’t just be a clinician and understand research. Like, if you don’t know what a P-value is, you don’t know what a confidence interval is, you don’t know what prospective versus retrospective, or a clinical trial, or – you know – survival analysis is, you don’t understand research. So you have to actually learn research. And we both have been starting a second career trying to learn how to do research. It’s an entirely new thing. So I think you have to spend the time and learn the skills. There’s no other way. It’s not like you just learn three things and then you go, “That’s how you do research.”

dr. brock

Yeah, and I’ll say this: Systematic reviews are cool, because they put everything together, but it doesn’t prove anything. It’s just like, “Hey look, there’s a bunch of random information out here; let’s put it all together into one piece of paper, and this kind of gives a consolidation of the material.” And then there’s studies that are just considered a publication of a case study. Now, there’s some people that have published a one-page case study, and they’re turned in eight hundred of them, and they’re like, “I’ve been published eight hundred times.” And you’re like…

dr. Kharrazian

And real researchers just laugh at that.

dr. brock

And that’s fine. I really think there’s some validity for case studies. But you can’t say it’s research. You can say this: It’s a published case study. And some people can look at it and say, “Well, that’s interesting.” Does it mean anything? It means absolutely nothing. Okay? Now, there’s research with controls and without controls. You probably need controls. There’s research with shams and randomization, and those are not always the best. There’s some research that has so many variables you can’t power it up enough to make it statistically significant. So when it comes to research, let me tell you something. To get real research that has real results, that is powered up enough, that is really reliable, and it starts to mean something and prove


something, not just something that we think is cool clinically... and by the way, we say things that we think are cool clinically, okay? But that’s different than saying, “This is a known, absolute, researched fact based upon everything that we’ve looked at.” That is totally different than publishing a case study. So, there’s all different kinds of papers that are published. Research is different than publishing a paper.

dr. Kharrazian

Well, let me also share something. The New England Journal of Medicine is the highest-impact factor journal of medicine in the world. Okay? So, they get papers all the time. They get them and put it through the review process; pretty extensive review process. And when they go through the review process, like most journals do, you know, it gets approved or not. But then they go through and have two rounds of statisticians looking at the research. Once it goes through the peer review with all the experts, the statisticians reject almost one-third of them. And this is in the top journal in the world. So it’s not easy, to be honest. And these are the best researchers and scientists in the world looking at these. So, I mean, it’s its own skill, and it’s not easy.

dr. brock

New England Journal has about an impact factor of fifty-four. The impact journal that I’m going to put my doctoral project in, which is one of the higher ones in my field, is about a six. And if I get into that, I’m going to be doing cartwheels, flips, kung-fu kicks, everything else you can imagine. And they’re not playing around. Now, there’s also predatorial journals out there, and they don’t even review the stuff, they just publish it, and it’s published with flaws, all kinds of crazy stuff. And…

dr. Kharrazian

You pay for it.

dr. brock

My doctoral committee said this: “If you try to submit to this journal, this journal, or this journal, we will kill you.” That’s basically what they said. And they’re like, “These are all predatorial journals.” There’s even predatorial seminars now. There’s even calling themselves faculty of predatorial seminars now. I mean, it’s getting so out of control, it’s crazy. But you know what? If you’re going to publish research, do it in a journal where they actually want your paper. You’re not paying them to put it in there.

dr. Kharrazian

Something with impact factor, too. The reason New England Journal of Medicine impact factor is so high is because they only take in general medicine topics. But when you’re looking, for example, for the number one diabetes journal in the world, its impact factor is six. When you look at the top thyroid journal in the world, thyroid, the impact factor is around five, six. So as you narrow down specialties, the impact factor gets less, because not as many people are reading it. So every time someone reads it an references it, the impact factor goes up. So, if you’re looking at a specialty journal, if it’s in the… Listen, if it’s in the specialty journal, like a topic, like neurology or toxicology or diabetes, and you’re in the four or higher, it’s pretty… a pretty good journal.


dr. brock

Yeah, you’ve done something that most people… There’s PhDs, they spent their whole career, and never got in there. And if you get in, you’re like, “I can’t believe we got in!” You know, you’re…

dr. Kharrazian

Okay.

“Any opinion on the Foster technique for BPPV?”

dr. brock

No.

dr. Kharrazian

Okay.

“Would there be any enlightenment… enlightening use of multi-axis rotational device in relation to the perception of sway and the actual sway direction with chronic vertiginous complaints?”

dr. brock

Eventually, yeah. There’s going to be. I’ll tell you a whole lot about multi-axis rotational devices. Pitch, yaw, and even roll. We’ll talk about those things. But here’s the deal: Very few people in here have a two hundred thousand dollar rotational device, and don’t care about it. And I’ve got to tell you, we do an enormous amount of work with one sitting there, and the person never gets in it, and they just do some simple fixation exercises that I showed you, and they get great and feel awesome. So I’ll talk about some things, and some things that you can do, but I’m not going to make that the impetus of the class, and I don’t think Dr. Kharrazian is either, because it’s not… it’s like saying this: “You know what? We’re going to spend three hours talking about the most expensive gamma knife in the world.” Everybody’s like, “Why?” Well, nobody has one. Well, it’s the same thing with this. Yeah, I’ll talk about it some, and I’ll do it because I know some people are into it, but I’m not going to put a lot of information on it. If you want to do that, we may have some grand rounds coming up and doing some other things, maybe. I don’t even know. But if you want to see it in action, that’s cool. Other than that, this is neurology, learning basics. We may go there on some occasions.

Do you have anything to say on that?

dr. Kharrazian

No. I agree.

dr. brock

Okay.


dr. Kharrazian

But I have a gamma knife. No, I…

dr. brock

It’s actually a knife that says “gamma” on it. That’s what it is.

dr. Kharrazian

I’ll bring it for you.

dr. brock

It’s a short knife. It’s really little. It’s like…

dr. Kharrazian

“What recovery strategies and nutritional and neurochemical applications would you recommend fol-lowing a subarachnoid hemorrhage?”

None. Like, get it out.

dr. brock

Go to the hospital.

dr. Kharrazian

Don’t be that crazy person. Get it out. They’re unstable. Let them recover for a long time, and then do something.

dr. brock

You guys do realize, when you have this type of hemorrhage, you may live a while, and then you may die abruptly. I’m telling you, if this person dies abruptly, and you’re the person that’s trying to give them a vitamin C injection, you’re the turd in the punchbowl for a long time.

dr. Kharrazian

Yeah.

dr. brock

So please, don’t do that. Send them to the… If I’m your patient, send me to the hospital. If I’m walking around disoriented with a subarachnoid, please, don’t bring me into your office and start giving me, like, some sort of strange something. It’s not good. Just let me go to the hospital.

dr. Kharrazian

Just don’t do it. There’s some things that require medical acute management, and there’s some stability involved that is important.


“How do you administer galantamine? Is it common to cause extreme nausea for the first few days or even weeks?”

Well, if it causes nausea, then it’s diagnostic. Because also, when you look at pathways involved with the vagal nuclei, in addition histamine, acetylcholine has some effect, and if you guys remember that neural storage pathway, acetylcholine has some response there. Most people that take galantamine, for the most part, don’t get nausea, but a lot of dementia and Alzheimer’s patients that end up on galantamine have that as one of the initial symptoms. So you could try to taper down, but for the most part, it just lets you know that you have some instability. Now, how a person responds to a supplement lets you know what’s going on. So let me give you some examples. I had a person – was at a seminar – person took a supplement that had acetylcholine response stuff, like at that time was galantamine, and huperzine, and so forth. So they took it, and all of a sudden had fasciculations all over their face and arms and hands. It’s not normal. Patient ended up having myasthenia gravis. Another person had it and they started to spin in one direction. What does that tell you? You just brought out and activated a vestibulopathy, and where it is can tell you where it is. So responses adversely can be helpful, but anything you have to kind of taper off and see what works.

Anything you want to add?

dr. brock

No. Great answer.

dr. Kharrazian

Okay.

“What is the difference in absorption, bioavailability, and effectiveness of oral acetylcysteine, glutathione, and oral liposomal glutathione? If you are supplementing with glutathione, is there a concern for down regulation of endogenous glutathione production?”

[20.02]

Okay. Can I answer this?

dr. brock

Yes, please do. You’re glutathione.

dr. Kharrazian

There’s no concern for depleting the most common antioxidant tissue of you take some glutathione. That does not happen. Okay? And then, as far as which is more effective, we don’t really know. It hasn’t been investigated enough for us to know. They’re just theories out there.

dr. brock

That’s research. It could be an opinion. In other words, you see the difference between opinion and research? We don’t have a huge database saying that one’s better than the other. That I know of. Do you?


dr. Kharrazian

No.

dr. brock

Okay. I mean, there’s good clinical results with both.

dr. Kharrazian

Some patients respond to one variation, and some don’t and that happens all the time. We don’t know why. There’s lots of factors and variables we don’t know. Okay.

“When using turmeric or resveratrol for management of TH17, are you concerned with stimulation of TH1 or TH2?”

No. Because we used to think, first of all, turmeric is an NF-kappaB blocker. It doesn’t have a polarity. We used to think resveratrol does, but it actually doesn’t. So those are pretty neutral substances to use with any type of TH1, TH2 dominance.

One for me.

“I’d like Datis’s opinion on low-dose interleukin therapy for autoimmune patients. I know one company particularly that seems reputable that is promoting it.”

I don’t know anything about it, but I would say, “Holy Moly!” Watch out, be careful, and that is crazy to some degree. Now, I used to know a person who used to treat prostate cancer, and he would actually inject cytokines into tumor cells, and he would have some response. He lost his license, and – you know – he was claiming to have effects. So I don’t really know about this. And I don’t have any experience.

dr. brock

I will say this. There will, in the future of medicine, be specific cytokine blockers and modulators. There already is. But it’s going to get more and more and more. Other than, like, the shotgun approach of prednisone or anti-inflammatories. There will be specific manipulators of…

dr. Kharrazian

They’re trying, but they’re failing on most of them, because most cytokines have pluripotentiality, which means if a cytokine’s exposed to other signaling agents at the same time, it has a different effect. So, NF-kappB with IL-6 has a different effect than NF-kappB with TGF-beta.

dr. brock

Yeah, and there’s a company – I don’t want to say the name – but they are trying like hell to make NF-kappaB blockers, and NMDA receptor modulators. Like hard. Hard, hard, hard trying. Because they’re thinking, “Man, if we can block NF-kappaB with a medication, then we can stop – you know – inflammation at its source, and if we can modulate NMDA receptors, we pretty much solved the psychoses component of schizophrenia or mania. So, I don’t know what they’ll end up doing. Once medicine start monkeying around


with some of those things, it leads to another problem that sometimes is worse than the problem that the person had. So I don’t know how that’s going to turn out.

dr. Kharrazian

“Are there any lab tests to determine a patient’s serum acetylcysteine or glutathione levels?”

So, there are indirect mechanism tests that measure oxidized versus reduced, and free radicals that glutathione quenches, but here’s the thing. You can’t determine from levels how much someone needs. The amount of glutathione in the blood is different than the amount of glutathione in the frontal lobe, which is different than the amount of glutathione in different tissues, and just because you do a serum test isn’t a reflection of what’s happening throughout the body. If someone’s inflamed, you should just after it, and you go after it, and support it. So I think most of the serum glutathione levels don’t really have a reflection of tissue patterns, so I don’t really think it’s that effective, so I don’t do it. But it can be done. You can order them. They’re available with functional medicine labs, and they just are indirect measurements, and I don’t think they’re accurate for tissues because they’re different throughout the tissues.

dr. brock

Yeah, I agree too. There’s only so much money in the pot. I don’t want to spend any money in the pot on that test. Personally.

dr. Kharrazian

Yeah.

dr. brock

And that’s without naming a company. Just, in general, that concept. I don’t want to really go down that road.

dr. Kharrazian

“What are the benefits of taking potassium bicarbonate?”

There’s a lot of good benefits of taking potassium bicarbonate, especially if you have abnormal anion gaps on lab work, and that’s your sodium, potassium, against your chloride and CO2. If those levels are above, let’s say, 15, you can really look at this buffering system. So when you look at the pH buffering system, when you look at hydrogen, potassium bicarbonate is one of the things that helps quench that. So you take something that has an acidic component and helps make it alkaline. But when you look at potassium levels, the RDA has left levels for potassium at, I think it’s like two hundred or four hundred milligrams, because of a history of some people that have renal disease, for them to take it. Well, the actual dosages that have benefits are around two thousand, three thousand milligrams. And it’s not contraindicated unless someone has renal disease. So a lot of people don’t use enough potassium bicarbonate. One of the key things that lets you know if someone has a need for bicarbonate buffering is just to have the person hold their breath.

dr. brock

Yep. Or hyper… they’re just… when they’re singing in the shower, they pass out.


dr. Kharrazian

And they can’t… Because when you hold your breath you increase your hydrogen, and you impact… because you’re not pulling out CO2, you get a shift, you increase hydrogen levels. And if you don’t have enough bicarbonate buffering, you can’t hold your breath, and you have to immediately breathe.

dr. brock

I’ve got an interesting data set right now of about twelve hundred labs, the whole thing, all the way across. And Dr. Kharrazian and I are learning how to program some statistical software. And I ran an anion gap thing, and I realized this kind of incidentally, that all my TBI patients that don’t do so well, their anion gaps are not coming down. They’re staying acidic, which changes the action potentials, which means they don’t fire the same way that they probably should, in my opinion. I don’t know yet. I haven’t worked up the whole mechanism. But I can tell you right now, it’s interesting enough for me to look at a little bit more.

dr. Kharrazian

Yeah, and increases in urinary… urinalysis, specific gravity that are elevated could be clues to support bicarbonate systems. Alright?

Alright, let’s move on.

“Can you please comment on the antioxidant content versus chelation properties of spirulina? Is this useful as a supplement? Do you recommend it? Why or why not?”

dr. brock

Spirulina.

dr. Kharrazian

Should I go?

dr. brock

Yeah. Spirulina’s interesting. They’re growing it all over the world. People are eating it as food sources. You know? They’re learning how to grow it.

dr. Kharrazian

It’s actually a good source of protein and antioxidant nutrients, but it’s not really a very strong chelator, and I know a lot of people use it that way. But it’s something that has benefits on red blood cells, has some antioxidant, anti-inflammatory properties, but I wouldn’t consider it something you would use as a very powerful chelator.

dr. brock

Yeah, I would use it as a lot of things before I would use it as that. There’s some good chelators out. This is not even in the top ten of my list as chelators, so I don’t know.


dr. Kharrazian

Yeah. Yeah. Okay.

“Dr. Kharrazian, what kind of estrogen replacement at menopause do you recommend? Estradiol or estriol? How can estrogen replacement therapy be taken safely to avoid blood clotting in high blood pressure patients?”

So, when you look at the world of hormones, there’s all these different opinions of what type of estrogen replacement therapy to take. So, there’s estradiol, estriol, and estrone. And in the conventional model, when they use things like Premarin, it’s estradiol. And they like that because it’s the most powerful type of estrogen, has effects cellularly, and estradiol can convert to estriol and estrone. The issue though is that compounds like estradiol are not as aggressive, and they don’t cause much tissue proliferation, so then you have all these people that theorize you should only take estriol. Then you have another group of people that think you should take estriol, estradiol, estrone all together in a mixture in ratios the body makes, and they have those. So you have a whole list of different opinions. I don’t know if anyone is really right. But the key thing is this: The key this is, probably if you’re really serious about… at the point you made a decision to take estradiol or that your patient has, it wouldn’t hurt to do some different variations and see what works best. Okay, there is some individual uniqueness to combinations. Secondly, if it’s safe, run your serum fibrinogen, and your plasminogen activator, your inhibitor one lab marker, and if those are abnormal, then you have risk, and you should probably run it before and after. And if your clotting markers go up, then don’t take it. You can also look at platelets, just on a routine CBC. A lot of times when people take too much estradiol, their platelets go up. If you see platelets go up over four hundred fifty thousand, or five hundred thousand, it could be a strong indication of fibrinogen levels. The patient’s fibrinogen levels are up, and clotting is a risk.

dr. brock

And hematocrit and concentration. I – you know – there’s E1, E2, E3. I don’t use a lot of E1. It’s not really all that great. We use some E2 and E3, and we – you know – we sometimes ration it, or we make one ratio versus the other, but we also do some genetic tests that look at does the person have susceptibility to estrogen-sensitive breast tumors? I don’t really feel like giving breast cancer to somebody. So, you know, sometimes we look at things like that. But, you know, we don’t do a ton of hormone replacement. We try to do as much as we can to get away from it, but some people need it. Like, you know, their post-menopausal, they don’t make any estrogen. And estrogen’s neuroprotective. So…

dr. Kharrazian

“Based on your clinical experience, how long can it take on average for onset of vestibular damage, if it happens, after taking short-term ototoxic drugs like antibiotics? Hours? Days? Weeks? Can it be unilateral or bilateral? After onset, do symptoms such as tinnitus and hearing loss ever resolve?”

dr. brock

Before they finish pushing the drug in the IV.


dr. Kharrazian

What?

dr. brock

In other words, while their driving the drug in, you can literally… the changes will start to take effect.

dr. Kharrazian

Now remember, all the medications don’t… like, gentamicin is one of the most common ones that does. Some of the drugs like some of the loop diuretics are terrible, but they don’t always cause permanent ototoxicity. Aspirin, Tylenol toxicity, they don’t always cause permanent ototoxicity.

dr. brock

Amino glycosides. They are dangerous.

dr. Kharrazian

But listen. It could be unilateral in early presentation, because you have someone who’s already got a vestibular discrepancy, so one side’s already not working so well, and then they get inflamed, and that side fails first, so they have unilateral-based symptoms. Right? Or it could be bilateral. How long it lasts and how severe it is, is probably due to the glutathione reserves, like we showed you in some of the studies. Okay?

“Can HHV-6 cause neuronitis? If so, would it be unilateral, bilateral, or possible either one?”

Any virus has potential to get into any tissue, the nerve, and HHV-6 is one of them, and for the most part, a lot of these are usually unilateral.

dr. brock

Yep. I would say probably.

dr. Kharrazian

Yeah, they’re usually unilateral, and it’s usually horizontal nystagmus, and it’s not usually bilateral.

dr. brock

But it would be a good PubMed search.

dr. Kharrazian

Yep.

“I did not hear Dr. Kharrazian mention any recreational drugs like cocaine as being ototoxic. Are there any that cause end organ damage? Can recreational drug use cause central structure damage that can result in vestibular [complaints] or symptoms?”

So, let me answer this.


dr. brock

I’m glad they asked you this.

dr. Kharrazian

Yeah. I don’t know. I’ve looked at ototoxicity with the literature a lot the past few weeks to make sure it’s updated research in your material. I didn’t find anything on cocaine. So I don’t know, but I would say, “Hey, stop doing it.”

dr. brock

There’s probably not much ototoxicity unless you’re doing this: having strokes or vascular ischemia from the cocaine.

dr. Kharrazian

Yeah.

dr. brock

Because it can drive your sympathetic nervous system. So…

dr. Kharrazian

And it can totally disrupt your dopamine pathways permanently and have major effects there.

dr. brock

And it’s illegal, so you could go to jail. So be careful.

dr. Kharrazian

Okay. So we’re all done. Thank you guys all for coming. Hope you got something out of this weekend. We really appreciate you being here, and we’ll see you in the workshops, and we’ll see you in future seminars. Thank you so much.

dr. brock

Be here next time.

dr. Kharrazian

Thank you.

[32.05]

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