864: The Mitochondrial Masterclass: Hyperbaric Oxygen, Methylene Blue, and GABA with Dr. Scott Sherr

0:00Well, hello, hello guys. You're listening to Beauty Bites with Dr. K Secrets of Aplastic Surgeon. And today's podcast, we're going to learn about the mysterious mitochondria. We have one of my favorite people, Dr. Scott Scher. He's a board-certified internal medicine physician. He is a specialist in hyperbaric medical oxygen therapy and a leader at health optimization medicine. He has developed this program and he's chief medical officer and health education officer of transcriptions, his company that makes these amazing supplements and melting trishes. So we're going to talk about that. And I'm really interested to try the methylene blue one and we're going to learn about mitochondrial health. Scott is vice president of health optimization medicine and practice for home and hope.

1:05And chief medical officer of one base health and his work is really about improving patients, energy, resilience and recovery and overall performance. It's an approach that combines the hyperbaric oxygen and advanced lab testing, targeted supplementation and integrative health strategies. So it's kind of, I think, the practice we should all aspire to do in our medical practices. Today, let's talk about breaking down the framework for sympathetic spiral and why energy, redox balance and sequence matters so much in healing and optimization. I think that's kind of a critical conversation these days. Welcome to the podcast, Scott. Thank you, Kate. It's going to be here in person with you. Yeah. It's so good. It was so fun. I heard you on one of my favorite podcasts, the STEM talk podcast. Yes. Yes. So I was nerding out about that. You mentioned that you had an upbringing as a child that used to work at your dad's office, a kind of doctor's office. Talk a little bit about how that influenced how you practiced. Sure. Yes. So my dad's a character now for over 45 years in New York.

2:08And as you can imagine, you know, as a practitioner, like he had a very busy office and I was there. I was there for when I was very young coloring and hanging out. And then when I was in high school, I collected money behind the front desk. I knew that that money was helping me go to college or my spending money with my friends as he was paying me under the table, of course, right? But I got to see clinical care firsthand all the time. And I saw people getting better, improving, and you know, he always had a very, very integrative perspective, always very integrative way of thinking about things. And I didn't really know there was any other way to do this until I decided, well, maybe I'll go to medical school. And I talked to him about it actually a lot. And the idea was, well, there's limitations as a car practice, what you can and cannot do. All these things have changed over the years and is a lot more leeway than there used to be. But at the time, there was a whole lot of leeway, at least that I thought about, you know, from a car practice perspective. I'm like, okay, well, let's get the medical degree and then figure it out kind of thing. And so I decided to go to medical school with this kind of high-minded idea of how you could

3:11integrate the world of alopathic and integrative conventional or a non-conventional medicine. But it was an interesting road, you know, to get through medical school and to have to completely shift my perspective to being more interventional and pathophysiological and things like that. But it was not that difficult. I mean, it's just, in the end, it was just going to school and learning stuff and then being in the hospital, et cetera, et cetera. But over the years, I always kind of knew, even through medical school, that I wanted to become more integrative. And when I was in my third year of medical school, I did a rotation in a place called Shock Trauma in Baltimore, which is this large shock trauma facility on a largest in the world. And in the basement, there was a large type of bioreg chamber. And it was a place they would use for people with severe infections like neck fascia, neck fatiguedis, burns, other, you know, scheming episodes, wounds and things like that. And I saw some amazing things happening there. And I was like, well, what is this technology? And when I realized it was just oxygen and pressure combined, the simplicity of it really

4:13struck me. And seeing these major, major shifts in patients that were very, very sick, get better, much quicker or not lose all of their limbs if they were going to get amputated, for example, it was pretty impactful to me. And that was the time, you know, during residency, which you remember, medical school for me, and then the residency after that. But I was doing Q3 call. Yeah, Q3. So I was, yeah, Q3, so I was on call 30 hours every three nights when I was on that rotation as a medical student. Usually it was Q4 when I was a resident, but in medical school specifically at Chak Trauma, it was Q3. So it was really. It's in surgery, it's Q3. Yeah. Yeah. And so they've changed those rules now. I think I don't think even surgeons can work or surgical resins can work more than 16 hours at a time. Incredibly. So like, I don't know how we had to suffer so much. It was honestly our poor mitochondria never recovered. I mean, the thing about it is when you're young, you do have more resilience, right? You can pretty much wake up feeling, okay, maybe you're a little tired, but you're not like brain foggy or like feeling toxic.

5:15And although that's changing, right? Younger, younger people are having a harder time because of the toxic load that we all are under at much younger ages now. But in general, I felt fine. You know, I slept when I needed to sleep. I ate relatively well, but I wasn't, you know, I was in medical school, right? So I was always eating better than my colleagues and friends because I grew up very healthy. My dad was always only the next, you know, diet or whatever in the 80s and 90s. And I went to medical school and everybody's having pizza for lunch. I'm like, really? Yeah. I think there was McDonald's in our VA. Like, I don't know if you had a VA. Yeah. You trained in, but I had a trained in a VA where they had a McDonald's, you know, and then the patients would be like going down from their hospital beds to McDonald's with their IVs in their arms. And I was like, VA life, yeah. I don't know if you remember what the VA was to let our patients go out on pass. They could leave the hospital because I'm passed for the weekend and come back. Yeah, we had some of those too. Crazy. Yeah. Yeah, we, I mean, the VA is a very interesting place to work. I mean, it was also for people to a room, at least. Yeah.

6:15But they all seemed to like it for the most part. But it was, it was, my first primary care clinic was a VA clinic. And that scared the crap out of me because the first patient I had had maybe 25 medications on board. And I was like, what do you do with this? He was the nicest guy ever. He was like, in his old, curmudgeon, you know, veteran. But it was like, what do you do with this guy? Like, and it really got me thinking very quickly. 25 meds, it's a miracle that didn't kill him. Right. You know, like, that's the thing, right? And what it, what it made me realize is that the system is broken, right? And it's, and these guys are doing their best inside the system as a, as a primary care doctor. But you have 15 minutes for this person, right? And they have 25 medications. Like, what do you do in 15 minutes? You go to, yeah, you only can do one thing. Right. Whatever that is, it's one thing and then you're out. And then, so, and then when I finished medical school, I did one year in primary care before I left Baltimore with my wife to go to California. And that was really, really difficult too.

7:17Because again, you have 15 minutes for patients. The system is not set up to really help people. It's really going to keep them kind of put together, bandating them as much as possible. But really no optimizing of their health, no changing their trajectory, you know. Yeah. I got tired of that. You know, patterns that you have to change in people's lives. You have to first make them aware and then really work on the change. Yeah. Yeah. So it's tough. But with hyperbaric oxygen being at the Shocktrum Center, it's now available in every major city like PEPIS and it amazing that you don't have to be in a hospital setting. You can go and get hyperbaric oxygen therapy. But are there some standards you think we should look for as consumers when we're trying to like, there are many different varieties and levels and pressures and things? What should we look for? I think the main thing that you started off with understanding is that not all hyperbaric therapy is the same. Yeah. Even though you might hear from your local clinic, that it is. And what I really mean there is that pressure matters.

8:20In the sense of there's different pressures we use in the chamber. There's milder pressures. There's deeper pressures. Milder pressures are often given in soft shell chambers. Yeah. I don't have a problem necessarily with soft shell chambers, but you have to know what you're going to be potentially having a benefit with a mild chamber compared to a deeper chamber. And so what you'll often hear in the world of hyperbaric therapy is that you need to do more hyperbaric therapy at a milder pressure to get the same benefit than going to a deeper pressure chamber and doing less. That's not true, right? Bees is an oxygen tension that you only can create with a certain amount of oxygen in the body. And so the way hyperbaric therapy works just was a quick primer. I think we mentioned this briefly last time, but this to kind of give it a little bit more depth would be, and up unintended, is a so hyperbaric therapy is really just a combination of increased, inspired oxygen and increased atmospheric pressure. And the inspired oxygen, everybody kind of knows about oxygen already. We breathe it. It's only about 21% in the air. At least at sea level where we are now, where I live in Colorado at 5,000 feet, it's about

9:2418% and 19% oxygen. And so what the body does with that oxygen is it comes into the lungs. It gets bound on your red blood cells and on hemoglobin molecules. You have about 250 million hemoglobin molecules per red blood cell. And there's four sites on each of your red blood cells, on each of your hemoglobin molecules to carry oxygen. So that's 1 billion oxygen molecules per red blood cell. So your oxygen carrying capacity is related to how much, how many red blood cells you have, basically, usually under normal conditions. Because the more red blood cells you have, the more you're going to be able to carry oxygen. This is why doping became such a big thing, right? And cycling and other sports where endurance was a big deal because if you have more red blood cells around, you're going to be able to carry more oxygen. So you're going to have more capacity, right? So even if you increased an inspired oxygen like a mask to 100% on your face, there's not a whole lot more you're going to be able to oxygenate because most of those sites where oxygen binds to the red blood cells are bound under normal conditions, under 21% oxygen in the air. That's why if you put a pulse oxygen in your finger, it measures 97 to 100%.

10:25That's those sites percentage that are bound to two oxygen already. So we have a lot of reserve of oxygen in the body. So like people might think, well, if you have all this oxygen that comes in the red blood cell, you're going to dump all of that into your tissue. The answer is that actually about 50% of it stays unless you have an acute need for more of it, then it will dump more off. And that's why you always have more in reserve. So you can dope. You can take something called epegen, which is a drug that increases the number of red blood cells. You can use yourself a red blood cell transfusion, that's going to do it, but hyperberegoxygen therapy, hyperbereg therapy increases the atmosphere of pressure. So the pressure itself drives more oxygen in circulation via physics laws that say the more pressure you put on the gas, the more that gas is going to go from a gaseous form to a liquid form. In this case, oxygen. So you can give up to 100% oxygen. You pressurize it and it's going to pump oxygen not only onto those red blood cell sites, but actually into the liquid of the bloodstream itself. And so if you're going to like a mild hyperbereg chamber, there's going to be some increase

11:25of pressure. And if you go to a deeper pressure with more oxygen, it's going to be more oxygen in circulation comparatively speaking, right? And so we know that the brain and the central nervous system is more sensitive. So milder pressure somewhere about 1.3 to 1.8, maybe 2.0, which is about 15 to 30 feet of sea water kind of thing. That's good for the brain and for the spinal cord and for the central nervous system. Whereas like 1.8 to 2.4, which is up to about 45 feet of sea water, that's better for the whole body because that's going to get more systemic oxygenation. And so there's crossover here for sure, but it's important that people know that what their goals are. If your goal is to give a systemic wound, like you just had an ACL repair or you just had a plastic surgery, for example, like you want a deeper pressure because the deeper pressure is going to get more oxygen in circulation. The mild ones might help a little bit, but it's not going to be the same kind of increase in oxygen carrying capacity. And so you're not going to get that same kind of oxygen tension in the wounds in this

12:26case. I always, one of my first talks I ever did on hyperbaryctherapy way back in like 2016 or something like that was, that's about 10 years ago, is how hyperbaryctherapy heals wounds from the inside out. And it really does it no matter what that wound was caused by. Was it, you know, a heterogenic from a surgery? Was it, you know, was it something that's from like neurodegenerative wound? Was it infectious? There's always these ways that hyperbaryctherapy could heal the wound from the inside out. And that's because you increase the oxygen tension. And then as a result of that, you have more energy, you have more stem cells released, you have the immune system, you get some more operated and optimized, excuse me. And you also get decreased swelling, decreased inflammation. And all these sort of downstream effects as well, which is why hyperbaryctherapy is so powerful. And so interesting. We've heard of mishaps with hyperbaryctherapy, and I've also seen cases, of course, like in neonates and newborns where too much oxygen can cause damage like proliferation of rental arteries and things that affect vision.

13:28So is there too much of a good thing? Yeah, so I mean, you overdue it or? So the thing about like you and I when we trained and we were in like in the ICU, we see people that are on high flow oxygen for days upon days. Yeah. Like that's a different type of exposure compared to somebody that's getting intermittent hyperbaryctherapy, exposure once a day, for example, for a six to 90 minutes. So the risk of having the proliferative kinds of symptoms that you would see in a neonator is very, very small. You do have to think about oxygen exposure though. And the deeper you go, the more risk that you have for oxygen toxicity of the brain or the lungs, for example, oxygen toxicity of the brain can present as a seizure. It's very, very rare. But at the deeper pressures, we typically use what are called air breaks. And so you breathe maybe around 100% oxygen for about 20 minutes and then you take a break and do five minutes of medical, great air, regular air and then you go back and forth like that. It decreases your risk. There is some changes to the eye though that can happen over long periods of time. Your vision might change at least briefly while you're having a hyperbaryctherapy because

14:31the lens of your eye is sensitive to oxygen. And so your close vision will get better. Your far vision will get worse. But that will go back to what it was before. It does have a potential growth effect on cataracts. And so if you have cataracts already, you get into a hyperbaryc chamber, those cataracts might grow faster. They won't make cataracts suddenly appear. But they will make them grow faster. How about if you have a cancer or you have some kind of lesion that has proliferative ac polarity? Good question. Is this a problem for angiogenesis? It's a good question. So they've done a number of different reviews looking at hyperbaryctherapy and cancer. There's no evidence that hyperbaryctherapy makes cancer grow. And that's because the proliferative aspects of cancer are very different than the normal proliferative ways that we make blood vessels and things. Most of cancer is related to proliferation and hypoxic tissue, in low oxygen tissue. And so as a result, the blood vessels that are created are disorganized and they're kind of all over the place.

15:32What hyperbaryctherapy seems to be able to do is have potentially have a suppressive effect on that. So you'll find that in the studies, there usually isn't a major effect of regression just with hyperbarycoxone therapy. But there's no progressive effect that they've been able to tease out. What they have done is combined hyperbaryctherapy with something like the ketogenic diet, for example, and seeing significant proliferative decline and regressive aspects with certain types of cancers, for example. Nice. So I think one of the best feelings after hyperbaryc treatments is the feeling of mental clarity and increased energy and just like the world looks brighter and better. It's so interesting. What is that doing to mitochondria and all of us? And your stem cells actually are getting more marginalized into circulation too. They are. Yeah, there's a couple of different mechanisms to play here. So when you have the body flooded with oxygen, say about 1,200 percent more at two atmospheres, which again, 33 feet of sea water is the equivalent.

16:33And all that oxygen is going to go into the body, what's going to happen? Well, that oxygen is the final electron acceptor in the mitochondria, the part of your cell that makes energy. So you're going to get more energy for sure. But you're going to get also some direct stress of all that oxygen, because this is going to make what are called reactive oxygen species. And so people feel good getting out of a chamber because they're getting more energy, typically and making more energy. They also can feel not so good because they have more reactive oxygen species around. And that is a signaling, significant signaling of the body to shift in its expression of various genes that are responsible for growth, inflammation, and overall blood vessel creation, et cetera. So you'll find that the machinery in your body, your engines that mitochondria specifically are very much what are going to tell how you feel good after getting out, or maybe not feel as good. And also the pressure matters too, because the deeper you go, the more reactive oxygen

17:35stress you're going to have. And do you have enough capacity to neutralize that reactive oxygen stress? And what do we neutralize with but antioxidants? So our body needs to mount a response to this oxidative load that's coming in with hyperbaric therapy. And when we mount that response, we neutralize that oxidative stress. But it takes about three days, typically, to do that if you have the capacity to do this. And so over the years of getting involved in hyperbaric medicine, it became very, very, very obvious to me that you needed to have optimized machinery to be able to use hyperbaric therapy most efficiently. If there's an acute issue, it didn't matter as much. If there's a cutrama, acute infection, acute injury, et cetera, hyperbaric therapy, do not pass go. As long as you go to the hospital, it's stabilized. It's going to help you heal faster. If you had a chronic condition, a long-term optimization goal, and you didn't have the cellular machinery available to you to truly optimize the capacity of leveraging all that oxygen, you wouldn't see the benefits that we would anticipate.

18:35And this is everything from the vitamins, minerals, nutrients, and cofactors responsible from making energy. So everything from, you know, in your cells itself to specifically in the mitochondria and in the mitochondrial membranes and everything else. But there's also the aspect of, you know, making energy is not free. When we make energy, we also make waste products like carbon dioxide, water, and we make reactive oxygen species directly as well. And so the body has to be able to neutralize that. And if you don't have the capacity to neutralize reactive oxygen stress, as I mentioned, you know the capacity of the machinery to make the energy effectively, then you're not going to see the benefits as much. And I saw people crash. I saw people go into the chamber and do very, very poorly. And I was initially trying to figure out why. And I realized it was because their system couldn't handle being under that significant amount of oxygen load because their machinery wasn't capable of really leveraging it. Can you diagnose that? I had a time. I carry you assessing a person to know. I see the same thing when I do treatments on patients. Some patients respond really well. Collagen stimulation and other patients, same medicine, same dose, no response.

19:39And like, how do you assess the person who's depleted or in a stress state or in a, you know, it's a problem. Good question. Yeah. I think that you and I have been in practice long enough to know probably who that person is coming in. Because there's just some ways of just getting a sense of how well or how not well they are, right? And how they react to things and how they're sensitive to things and things like that. So there's a subjective thing there that I find that I can tease out pretty quickly. There's also the sympathetic activation aspect of things like how stressed are they on a regular basis? You can kind of get a sense. I wonder if they're going to be able to heal very well because if you're in stress model at time, excuse me, you don't heal very well as we know. But I think objectively, that's kind of what made me graduate my whole practice because I was involved in hyperburet therapy when I finished my medical school, my residency, moved to California, became a medical director of a hyperburet facility out there in San Francisco. And I started noticing that I was having to refer people out a lot. I was like, I don't think this person's right for a hyperburet therapy. They're too sick.

20:39They need other optimization strategies. And so in 2017, I met a physician named Dr. Ted Ochocho. So Dr. Ted had created this framework that he called health optimization medicine. And it's a good practice or a home hope for short. And it's this foundational framework that looks to optimize health rather than focusing on disease. And the optimization strategies are really grounded in something called metabolomics, which is the study of small molecules that are involved in making your cells work well. It's a real-time assessment of what's happening now, what just happened. And I realized that this metabolomic assessment was exactly what I was missing because it was assessment of multiple things, vitamins, minerals, nutrients, cofactors. But in essence, it was checking energy metabolism. So I could see if somebody was going to have the potential to do really well in a chamber or the potential that they're not going to feel very good. Because if their machinery to make energy is not optimized, it can be difficult to make energy. And you're just flooded the body with a whole bunch more oxygen, right? And then if they had antioxidant deficiencies, you wouldn't see the benefits that you would

21:39imagine because people would feel bad. They wouldn't feel good. And then I was starting to do all these strategies to try to figure out, okay, maybe need some detox strategies and antioxidant strategies and kind of doing a piecemeal that I met Ted and I was like, oh, this is what I need to do. And so what I started doing was assessing patients and understanding whether they needed treatment right now in the chamber or could we wait three or six months, do some optimization strategies, and then revisit it. That did not make me very popular in the hyperbaric world because I was going to give a lecture to a hyperbaric community that I was a part of. My lecture title was going to be, please do not put them in the chamber. Oh my gosh, not yet. It's like me telling plastic surgeons, please don't do plastic surgery, right? And so it wasn't very well received. In fact, I was disinvited from speaking after they found out what my title was going to be. And it's okay, right? Because it is a difficult concept. If you have a facility and you need people to be in there so you can make money, somebody

22:39comes in and they say they want a hyperbaric therapy, you know, you do it, right? You know, it's what's interesting to me is that it's kind of funny. Like my first patient, as I mentioned, the VA patient, 25 medications, like ridiculously complicated. My first patient ever in this hyperbaric clinic in San Francisco was a lady that came in that was desperate to get in the chamber. She's like, I've tried everything. Nothing's worked for me. I need hyperbaric therapy. I know it's going to help me. I looked at her. I was like, I don't think this is, I'm not sure this is going to work, but we can give it a try. And what happened? She got worse, right? She got like an asthma attack and I was like, okay, so it was my first patient, you know? And I was like, okay, there's something else going on here. And then over the years that kind of built up to me, giving more of like an integrative approach. My first website was integrativehbot.com, integrative hyperbaric oxygen therapy. And that's how I positioned my work. And I still do, but it's now a huge framework that I've created. The foundation of it is health optimization medicine. That's the base foundation that I try to encourage all of my patients to consider.

23:42If they're not going to do that, working with another provider, at least looking at, you know, getting the basic labs, at least is like the number one. I've seen people not get better from like a traumatic brain injury, only to find out later that they were all year-end deficient or something like that. You don't want to do that. So that's bad form. So you want to have at least basic labs, but foundational metabolomics labs can go a long way. And this is looking at really what's happening with your vitamins, your minerals, like your nutrients, your gut, your heavy metal exposure, your fatty acid levels, and your mitochondria. And then we learned about the mitochondria in medical school, but we didn't learn you could measure all the pieces and the intermediates and things like that. What's the best way to do that right now, like checking mitochondrial health? There are some tests that measure mitochondrial function. Are you doing any of those? And what are they? They are coming out. They've been out for the last couple of years. What I typically use is organic acid testing. And that's done. It's been around for a long time. Organic acid is urine testing, basically.

24:43And the urine testing is pretty well validated as a proxy for mitochondrial function. Now there are newer tests that have come out over the last couple of years that are looking at supposedly direct function of mitochondria. Looking at the complexes that help you make energy, your detoxification pathways that are associated with the mitochondria. I've talked to my colleagues about this, including one of our fellow colleagues, Dr. Yerth, who you know. I know she's been to your office before. I think I saw a picture of her getting a sand and skin facial or something. Sand and sprung. But before a wedding or something like that. But she and I have been talking about this for a while and it's not clear that these tests are accurate yet. But it's funny, because you do the test. I've called my patients. I've gotten them done. And when they get them done, they give you 100 things you could do to fix this. It's like, okay, great, but what you actually do. That's where organic acid testing is really helpful, because you kind of know exactly what they need, what B vitamins, what minerals, what antioxidants they need.

25:45So that's what I like about that kind of testing. So you do it and then you repeat it about six months later, because when you're really looking at mitochondrial function, it takes a while for that to start improving. It's not going to happen overnight. And that's where I started using methylene blue. Because methylene blue is one of those compounds out there that will work in the mitochondria immediately and start revving up the capacity to make energy and also detoxification. And so I started using that a lot in clinical practice. And realizing, especially before hyperburetotherapy, it was a great way to support mitochondrial function, especially if we had a longer way to go to getting them really optimized from a metabolomics perspective. Can you overdo methylene blue? Can you exhaust your mitochondria? Well, think about methylene blue is that it's very dose dependent. Lower doses are a supporter for the mitochondria. Higher doses become more anti-infective and also create more oxidative stress. They may come more hydrogen peroxide. That's good if you're looking to treat an infection, for example. So I use higher doses of methylene blue around a milligram to two milligrams per kilogram,

26:45which would be around 50 to 150 milligrams of methylene blue depending on the weight of the person, ideal body weight, for infection. But once you get to above that dose, then it becomes almost potentially purely oxidative. So then it becomes more stressful to the system. It can actually cause some of the things that it treats. Something called, what is it called, methemoglominemia, which is a state where the red blood cells can't carry oxygen very effectively. Mouthlene blue actually treats that. But at higher doses can actually cause it. So that's kind of one example there. But I mostly use doses around 8 to 25 milligrams. That's the dosing. And it doesn't seem to have a detrimental effect on the mitochondria. But what you'll find, K, is that as you optimize somebody's health over the long term, they need less of it because they have enough now support without the methylene blue around to not have to use it all the time. So I'll use it now personally when I'm traveling, big days at work.

27:46When I feel I have more stress, you didn't sleep that well the night before. That kind of thing. But I don't use it every day. But in some of my patients, I am using it every day until they start getting their system to be able to kind of self perpetuate. Yeah. Well, we're in this world where we have chronic stress. We have sleep deprivation. We have blood sugar and stability and toxin and inflammation. How does all that attack the mitochondria? Literally the only good things we can do are exercise, hyperbaric and maybe some methylene blue. Like those good diet. So that's on the good side, but we have so much attack on the back side. Is there how are these things impacting our mitochondria? I mean, they're dramatic, right? I think the number one reason people have that have mitochondrial dysfunction is insulin resistance. So if your blood sugars are elevated all the time, you're bringing too much glucose to yourselves. Your cells think you need to make a lot of energy because all that glucose is coming around. And then over time, they're not going to be efficient at making it. They're going to stop being efficient. You need more oxidative stress, more inflammation. That's the kind of stuff working as well.

28:47So that's number one. Number two is probably sympathetic overdrive. If somebody is in sympathetic all the time, if they're in fight or flight all the time, they're pumping out cortisol. They're pumping out neurotransmitters like epinephrine and noropinephrine. And these all stimulate the mitochondria to try to keep up with the stress. But eventually, it's not going to be able to do it either. And they're going to have to stop being as efficient. And they go and shift over into something called glycolysis, which is when they don't make energies efficiently. They're doing that to try to protect the mitochondria from getting any more damage. And so, some of that activation can come from any number of things, from stress of work, life, kids, relationships, even deep-seated things like trauma as a kid or as an adult, or terrible things that happen to people as we all know. There's also medications that cause direct mitochondrial dysfunction, things like proton pump inhibitors, which people use. These do use more when I was younger in practice, but still very, very commonly used. And these have a significant effect on mitochondrial function, metformin. Metformin, the drug that's for diabetes and sometimes touted to be a longevity drug,

29:51which I don't believe it is for the most part, unless you have diabetes or high blood sugars. It actually, does it make the first complex in the mitochondria not work very well? Statins do the same thing. Statins affect both complex one and complex two in the mitochondria. Even birth control pills, birth control pills, what, deplete nutrients that help the mitochondria work better, including some of your minerals and things like that. So there's tons of medications that are causing mitochondrial dysfunction. And there's also infections. Infections that we get all the time and cause mild dysfunction or significant. Like COVID, for example, caused dramatic mitochondrial dysfunction. And that's one of the reasons why long COVID is such a problem is it caused dramatic mitochondrial dysfunction. And so you have all these things that are happening as a result of society, right? And you talked about toxins as well. Toxins in our environment, pollutants, these are big, big deals. Everything from our water, our food, our air, our cosmetics and things like that. I mean, these all can really increase our toxic load. And in the end, they're all affecting mitochondrial function. And so the goal really is to figure out what those inputs are and try to remediate them

30:56as much as you can. But at the same time, that can take a while. It can take time. And that's why working with a compound like Methane Blue can be very, very helpful because it does start, it does really kind of come in and start working and giving capacity back relatively quickly within about three to five days of the right dose. Where if I optimize somebody from a vitamin, mineral nutrient detoxification, gut hormones, it takes me three or six months to do all that, right? And that's good. And you want to do that because that's what's sustainable. Well, can you talk a little bit about GABA? We were talking earlier offline, you and I about GABA regulation and how it intersects with mitochondrial health and just necessary to regulate your GABA levels. Yeah, so GABA is your primary inhibitory neurotransmitter. It's the one that is your breaks of your brain. The primary excitatory neurotransmitter in the brain is one called glutamate. Glutamate is actually converted into GABA in the brain. And so glutamate is primary excitatory. GABA is your primary inhibitory. So those two neurotransmitters, those two neurotransmitters GABA and glutamate make up about 80% of your

32:01brains neurotransmission. And so the other ones like serotonin, or epinephrine, dopamine, just 20% in total compared to these two. So these two kind of run your brain, okay? And GABA itself, when it's depleted, your breaks do not work anymore. So you have more anxiety, you have more insomnia, more depression, more tremors. This is what we'd also kind of correlate to what sometimes is called glutamate toxicity, or glutamate overload. The classic example of this K, you probably know, which is the MSG syndrome, like you go to a Chinese restaurant, you have monosodium glutamate in the food, which gives it like a sweet taste. But that gives you instant headaches, instant irritability. That's glutamate overload. But that is what's manifesting people with GABA deficiency as well. And so the problem with GABA deficiency is that it's not something that clinicians, like you and I, are really thinking about. We're thinking about other things. We're not thinking about GABA deficiency. So somebody comes in with depression. We're not thinking about GABA deficiency. But GABA deficiency is much more associated with depression than serotonin deficiency, right?

33:01We used to think that people with depression had a serotonin deficiency. They do not. Their serotonin levels are no lower than somebody that does not have depression. And so that whole hypothesis is wrong. Not to say that you can't artificially increase somebody's serotonin and help their depression. We do that all the time. But it takes four weeks or eight weeks to do this. And that's probably because it's not the serotonin that's doing it. It's probably because it might have conjurally focused care, because serotonin actually works on the mitochondria as well. So we used to think, well, it just takes, why does it take six weeks to work? If you're instantly increasing the amount of serotonin around, it's not the serotonin that's doing the thing. It's the mitochondrial optimization that's happening with the serotonin. That happens actually interestingly enough. But in respect, GABA deficiency is more associated with depression than serotonin deficiency. And so in my patients, when I think about GABA deficiency, I talked to them about thoughts, their brain, how many thoughts they're having on a regular basis. On average, there's lots of different metrics here. But the one that seems the most pertinent or I think the one that I believe is on averaging

34:06about 70,000 thoughts every single day. Most of those thoughts are repetitive. Most of those thoughts are the same ones over and over again. And so like the corollary to this is we shouldn't believe everything we think, right? If you're saying, if your mind is making up 70,000 thoughts per day. But if you're anxious, you're stressed, you're GABA deficient, up to 120,000 thoughts every single day. And I can't feel like their mind is just going and going, going, they're perseverating, perseverating, perseverating. They can never stop. And as a result of this, it's difficult to fall asleep. It's difficult to feel like you can calm down, right? An exciting. Yeah, so the GABA deficiency is related to overarching sympathetic activation for long periods of time. It's also related to the gut issues, if your gut's inflamed, if your leaky gut causes GABA to GABA deficiency or issues making GABA, because if there's a lot of inflammation in the body. And convert that glutamate over to GABA very easily. If you don't have enough B6 or magnesium, those are also co-factors that are responsible for that glutamate to GABA transition as well. And so if you don't have enough of those, you're not going to feel good.

35:07And so as a result, you're not going to be able to make that GABA, right? So there's lots of different things that kind of play into this. But for me, when I think about the GABA system, I'm usually thinking about in the context of sympathetic activation. And short term, well, let's give GABA supplements, right? The problem with that is that GABA is too big of a molecule to get into the brain. If GABA supplements work for you, it typically means that the blood brain barrier is not doing its job. It's leaking things in that shouldn't get in there. That almost always correlates with a leaky gut, specifically. If you have a leaky gut, you almost always have a leaky brain. And then that means things are getting inside the brain. So if you've heard people reactivations of Lyme, mold, of EBV, and things like that. Yeah. Post COVID was a really big thing. This is all because they're brain barrier got leaky and all of a sudden let those things in where it was not an issue before that. So in essence, you don't want to take a GABA supplement. Or if you do and you feel good with it, usually you need to get that checked out. You know, go to a doc and see what's going on with your gut and things like that.

36:08So I use other compounds that work on the GABA system that are not GABA itself. And that's in some of our products. We have something like we use something called agron, agron from a mushroom called the Aminita Muscarium Mushroom. It's the psychedelic mushroom, actually. But this mushroom ingredient called agron is not psychedelic, it's low doses. And it's long acting. It works on the GABA receptor. And we use something like Honokial from Magnolia bark, which binds to the GABA receptor as well. So we have something called Trozzi, which has those two. It has agron and Honokial. And then it has other things that are responsible for sleep. It has CBD and CBG, they're work, so excuse me, CBD and CBN, which are working on the endocannabinoid system in the brain. That also works on GABA and serotonin, interestingly enough. And we have 5HTP melatonin. So working on GABA system, excuse me, working on the melatonin system, working on the serotonin system. And also we have adenosine and something called corticepin in there, which are working on the adenosine system specifically. So it's a very comprehensive formula. But in essence, we're looking at the GABA system as being the primary lever because GABA

37:09is hugely important for sleep, as well as regulating your mood and anxiety. That's interesting. I don't know very much about that. I got to study some more. But it makes a lot of sense for all these people out there tired and wired, and they can't seem to get their balance back. Something like that would be really good supplement. Yeah, it can be. And I think that it's always in the context of what's going to be best because sleep is such a big thing for all of us. So if you can get sleep pretty well optimized, almost everybody's going to feel better with better sleep. So oftentimes getting sleep dialed in can be like the number one thing for people. If you can just get them asleep at the same time every night, it gets them supplementation to help. You know, use something like Troz, or something called Troplosomna, as well, which is another product that has GABA-ergic compounds in there as well, some melatonin optionally as well. Maybe not forever, but at least get you on a more regular schedule so that you're getting to sleep, you're getting better rest. That's usually a great way to start feeling better because that's also going to really help

38:09your mitochondria work better too. Any thoughts on NAD precursors? And then I'm also curious about your thoughts on menopause and like how the mitochondria impacted how we support menopausal mitochondria. Sure. So when it comes to looking at, what was your first question? I'm sorry. Oh, thoughts about NAD. Fine, NAD, I'm sorry. NNN and Mar are all the precursors for nicotine-right. So when it comes to the precursors for NAD, I think it's reasonable to think about them. In clinical practice, I don't think taking NAD directly is probably a great idea. It's not really a lot of evidence that it really works in the cell and there's also a potential risk of taking too much NAD as well because it also runs potentially malignant cells as well. I had a long conversation with Dr. Liz Buthier with actually about some of the potential dangers of taking NAD directly. I think some of the precursors make sense because then your body can kind of do what it's required and make the NAD that you need. I use easily found vitamin B3, you know, Naisin, right?

39:12And Naisin is going to make NAD. And it spills over into everything. Over time, right? And so you want to let the body to kind of regulate itself as about how much it needs because if you kind of overdo it, there's always sort of downstream effects that might not be optimal. So I use, I use sometimes I use NMN or NMR or NR, but I often just use vitamin B3. Okay, good. And then in terms of menopause, is there a best way to support our mitochondria during that? Yeah. So when it comes down to menopause and paramanopause, estrogen is one of the best mitochondrial enhancers on the planet. And when estrogen starts going down, things that were easy for you may not be as easy as a result because if you don't have that mitochondrial support and you're already stressed and you're already toxic and you already had a lot of things going on, but then the floor was taken out from underneath you. This is where you see women crash and they're in midlife because they don't have that energetic support anymore. This is why during ovulation, women feel the best because that's where their estrogen

40:16levels, usually they feel the best. Their estrogen levels are the highest during ovulation. And this is where they feel like more powerful and strong and you know, and that's because they're ovulating, right? And so taking that estrogen out from underneath, women is a big deal. And then of course, progesterone, progesterone is a huge regulator of sleep in the GABA system. Pogestrone works on the GABA system. And so if you're not enough progesterone around, your sleep is going to be affected as well. And so in my world, you know, looking at foundational biomarkers, looking at metabolomic testing, looking at optimizing the gutter and hormones are important. But it's usually not the only things that are needed, right? Usually what I find is that if you want to help somebody now, then you want to think about how you're going to support progesterone, how you're going to support, or the GABA system, or how you're going to support mitochondria. And this is where something like methylene blue can come in and be dramatically helpful for women. I know I've seen it where I've talked to docs that are doing a lot of HRT and things. They're seeing their patients benefit, but they're not getting entirely there. And they start adding some methylene blue, just low doses.

41:17It's like night and day. Yeah. Yeah, because immediately you get that mitochondrial support. The problem with a lot of HRT out there, as you know, probably K, is that people just going for their hormones. What about optimizing their cells, their gut, their, you know, et cetera? If you're not doing that, you're going to only see some benefit of doing HRT. And you might need higher and higher and escalating doses to see the benefit. Whereas if you're optimizing cellular health, gut health, stress, of course, right? Looking at those stress aspects and saying, okay, what can you actually start managing a little bit better? Then you don't need as much hormone replacement therapy. And also you're going to see benefits from things like methylene blue and some GABA urgent support very, very quickly. So in women that I work with, almost all of them that come in in paramedicaws, methylene blue gets started and something for sleep, you know, something that's going to work on the GABA system that doesn't take the place of taking HRT. It just supports it and makes it work better. It's just like peptides. Everybody loves peptides, right? Yeah. And everybody's like, well, Dr. Scott, I want to start taking peptides.

42:19I'm like, that's great. But peptides are signaling molecules, right? They are not going to shift your biology more than a certain probability, depending on how optimized that foundational state is. And so if you're just thinking that peptides are going to do the trick, they're often not going to do it without having a foundation to let the land done and to be on. And so in my work, I use peptides, but I use peptides in context of optimizing cellular health, gut health, neurotransmitters, hormones, adding things on like methylene blue, which is a great way to make those peptides actually land. I have a whole lecture that I give. I call it peptides need power. And that power is an engine that's working. Your cells need the capacity and bringing them more capacity with methylene blue can go a long way and making all these interventions work better. I work with surgeons that doing regenerative therapies, for example, stem cells and PRP and other things. And they have found. You probably know this as well. If you optimize mitochondrial function before these regenerative procedures, the patients

43:21do better. Yeah. And it's difficult for them to do this. These are coming into a facility and they're maybe coming out of town and being here for a week or something like that. But adding on methylene blue has been transformative to them because now they have that mitochondrial support while they're doing the regenerative procedures and they land better. They work longer and they work better because you have more of that mitochondrial support. People don't realize that for stem cells, for PRP, for exosomes, all those things to work better. If you're already super inflamed, if you're already having significant amounts of incapacity, the amount of benefit you're going to get is significantly lower compared to somebody that's worked on it even for just a little while. Yeah. That's very true. I think that needs to be part of our pre-op process. Not just pre-op collapse, but pre-op functional medicine approach of looking at what is the metabolomics of this person and how they come through. Even if you don't have two or three months, you can even just do a couple things. You can even just, okay, let's get you some basic antioxidant support. Let's get you on some like lotus methylene blue.

44:21Let's try to work on your stress a little bit. Just like some, I mean, because I know you don't have, like in a perfect world, yes, you have two or three months to work with everybody to get them more optimized and then get them into surgery, right? Yeah, at least a month, I would say realistically, six weeks a month. That's a lot of time. Yeah, if you can get some basic stuff done, the basic labs done, or foundational labs and maybe even some metabolomic testing, like organic acids, and you get a sense, okay, this is really what we can do to support this person. And then you know that if you have that on board, every intervention that you do is going to work better. Are you doing some peptides yourself? Yeah, yeah, for sure. I mean, I've worked them personally. I work with them in practice as well. I have a huge respect for what they can do in the context of foundational approaching first, right? Which is what are we doing here to support everything from the cellular level? But mitochondrial peptides can be helpful, but you have to kind of know which ones to use. Some of them can be more stimulating in a not a beneficial way if you don't have enough machinery to make the cells work or the mitochondria work.

45:24I've used the growth hormone peptides a lot. I like those. I've used BPC and some of the other immune system peptides with some success over the years. So I do like them. Do you have any favorites? I tried BPC and they could maybe it helped my plantar fasciitis, but then I also wasn't sure if I was having a placebo effect. So I'm kind of I'm with you in terms of growth hormone in the lungs. I think that the FDA approved and tried and true and tested things that have human studies. So I'm very up for that. I think that immune peptides are really beneficial. I think a lot of aging is immune change and senescence of the thymus gland and all things. Yeah, back in the beginning this year, I had like three or four conversations all in a row about immunosensin essence and immunosensin essence and aging. I mean, that's a huge topic that's going to change, I think, how we age. Yeah, but what it comes down to is mitochondrial function. And that's because if you're a mitochondria, don't work well, your cells don't produce what's required. So if you have mitochondria that don't work well in your brain that's in your GABA producing neurons, you're not going to make enough GABA, right? If it's in your immune system, it's not going to mount an immune response, right?

46:28Or at least not as optimally. So you have to I always think about these things now from mitochondrial perspective, but the immune system and immunosensin essence is a big deal. As we get older, we get more of these senescent zombie cells. They don't work as well. So working on the immune system is like the number one that I think about outside of purely working on the mitochondrial level is the immune system optimization. And a lot of that has to do with looking at what people need. And most people are antioxidant deficient. So almost all of my patients are on a number of antioxidants. They're usually on the fat soluble vitamin A, D, E and K2. They're usually on glutathione or a knack as a precursor. Usually an alpha-lipopocacid, vitamin C. Almost all of my patients are on those. Because it's very rare that I find somebody that's not in their 20s that doesn't need these things. And what I find is that when you get somebody on a nice regimen, they're so much more resilient over time. And they don't get as sick as often, even when they're under significant stress load. And then I have all my tools and tricks that I use across the board to help people when

47:31they are at higher risk. They have one product called Tromunet, a troscriptions, which is high strength extract of the cortisol's mushroom. It's called Cortisepin. And it's a very, very powerful antioxidant anti-inflammatory. It increases deep sleep so you take it at night. And then it's also antimicrobial. It blocks fast RNA replication. They're actually even studying it in cancer. And you take that prophylactically when you're traveling or you take it immediately in the signs if you feel like you're coming down with something. And it is gold. It is green colored. It's gold. It's like, and even my wife listens to zero of what I say. She's a physician as well. She's an allergy immunologist. She will take, we call it the green stuff in my house. My kids will call it, my kids eat it. I have a bowl of the green stuff in the house. And so, you know, it's very difficult to get good sleep if you don't feel well. And so deep sleep, increasing when you don't feel well is like night and day. Amazing. Well, guys, I don't know about you, but I have learned a lot.

48:31About mitochondria and metabolic optimization. And like, it's kind of a new way of thinking that I think we have to adopt. I am definitely a fan of all these strategies. I'm going to check out your new products, your transcriptions, and then I'm lecturing with you. We're doing a webinar. Yes, we are. We're going to do it on GLP1 face, right? Yeah, exactly. GLPs and how they're the most amazing thing for longevity, but they're also very savage for facial. We can talk about that as peptides, but that's the biggest peptide right now. Yeah, that's the best thing to feel very good about. Yeah, but there are challenges with it, right? And I think that's what we'll talk about. We'll talk it from a skin health optimization perspective. We'll talk about it from a mitochondrial perspective, because I've seen people who start methylene blue alongside their GLP1s and do much better. Yeah. Because they're dropping a bunch of weight. And they have a whole lot of inflammation when they're doing it. And so, yeah, we'll send out some links so that your audience and mine, we can all share and have a nice conversation. Well, amazing. Where can people find you on the gram and otherwise? Yes, so you can find me at Dr. Scotchur, DR, SCOTT, SHER on Instagram.

49:34You can also find me, I think, at the same handle on YouTube. And my website is my name, DrSkotcher.com. We also have our company's choice descriptions that make our products, things with methylene blue and the GABA system, as I mentioned. Also, the cornicep and the tromeon for deep sleep and immune system optimization, the green stuff, as I called it, green gold in my house. Where else? The nonprofit. So that we have a nonprofit organization called Health Automization Medicine and Practice. The nonprofit is how everything started in the sense of our company's choice descriptions emerged out of the nonprofit as a way to help people right now along the path of optimizing health, which takes time. And so you can check it out at homehope.org. If you're a clinician, don't have to be licensed, but if you see patients or clients, you can actually check out, we have a seven module certification. The first module is metabolomics. About three times a year, we do a cohort style where you can learn with us over 10, 12 weeks with weekly lessons with our faculty via Zoom. And so it's a great way to learn metabolomics if you're interested in KW.

50:36We're happy to have you. And it's a really great way. And then we also have a conference every year. This year we'll have our conference, a troper second and third in Chicago, Illinois. We have an annual conference last year, it was in Boulder. This year is in Chicago. So if you're interested, you can check that out at homehope.org as well. That's incredible. He's such a busy guy. I'm going to visit you in Colorado. And then we are looking forward to doing a good webinar together. That's it for now guys. Don't forget to find me on my Instagram. It's Beauty by Dr. K, DRKAY. And our website is the same. Beauty by DrKAY.com. You can find our new peptides. Can Karen launch there? It's doing really well with GHK Copper. Glitter. Nice. Yes. I guess I'm too much. You did send me. Yeah, I've been using it. I find us here on Tuesdays for a longer podcast. And every Friday, there's a five minute Friday. We love you. Rank and rate the podcast. Join us in learning more about beauty. Longevity, wellness. That's it for now guys. Stay beautiful.