Dr. Victoria Maizes: Hi, Andy.

Dr. Andrew Weil:  Hi Victoria.

Dr. Victoria Maizes: So today we will have a special episode dedicated to answering our listeners’ questions. We have had hundreds of questions, and of course, as you all know, this cannot be medical advice as we haven't seen you or examined you and we really don't know the particulars of your situation.

Also, we received a lot of rheumatology questions and we're about to have an episode in which we will have one of our rheumatology graduates joining us on the podcast. So we're going to put those off to that episode, Andy, quite a few of the questions were focused on diets so let's begin there.

Dr. Andrew Weil:  Alright.

Intro Music

Dr. Victoria Maizes:  Alana from Perth, Australia says I'm really confused about what is ultimately the best diet for our bodies. On the one hand, I hear Dave Asprey telling me to go keto for longevity. And on the other hand, I hear that veganism is the way to go for anti-inflammatory. I have two kids and I'd love to know what you would suggest for the whole family. And then she throws in that a couple of us have anxiety and gluten intolerances.

Dr. Andrew Weil: Well, I'm not surprised that she's confused. I think alarmed and dismayed by the perfusion of what I think are really nutty diets out there a lot that are extremely restrictive and throw whole macronutrients under the bus or exclude foods like beans that I think are extremely good foods for people.

I don't know that there's one right answer to that, I think I would start by saying what it's best not to eat. And I think what's most clear is that we want to avoid refined, processed, and manufactured foods. I think that's what's causing most of the harm. And Victoria, you just sent me an article that looked at the, some of the dangers of ultra-processed foods, which looked even more significant than diets that were having an animal products.

Do you want to say something about that?

Dr. Victoria Maizes: Sure. It was really interesting follow up to the Adventist study, which we have been following for years. People who follow the religious practice seventh day Adventists are often vegetarians and, you know, they've notably been very healthy with less of the chronic diseases that plague Americans at large, but this study looked at, was it the restriction of not eating animal products that made the difference. And actually it appeared that ultra-processed food may have explained the vast majority of the health difference with meat in particular being the one other factor.

So red meat, not pork, but red meat in particular that was associated with increased mortality. But, but the biggest risk factor, as you said, was the ultra-processed.

Dr. Andrew Weil: So I would say the, the main generalization that I would make is to try to avoid refined process and manufactured foods. To eat foods as, as much as you can, that are as close to the way nature produces them as possible.

Dr. Victoria Maizes: I wanted to push you a little bit about the keto diet, because as you know keto, paleo, they've been so popular and why. I would not think about them as a broad public health recommendation. In some cases they could be a therapeutic diet

Dr. Andrew Weil: Yeah. So I think those are very special applications, but I don't think that they are wise as a general diets for most people.

I would also say, you know, I don't tell people to become vegans or complete vegetarians, but I think it is good to eat what some people call a plant forward diet. That is, I think we should be eating a lot of high-quality produce, especially vegetables. I think it is good to reduce the percentage of animal foods in the diet and of the animal foods out there beef is probably the worst in terms both of its effects on health and effects on the environment. I think it's good to lower on the food chain. So that means eating fish may be shellfish even better. You know, there's a push now to look at foods made from insects, which might have a much better impact on environmental health.

We'll see. I think it is good to eat a variety of herbs and spices and beverages. I think all of these things have a unique, protective compounds in them that are good for us. It's probably good to avoid sweetened liquids as much as possible, you know, not just soda, but also fruit juice and energy drinks and putting sugar in coffee and tea.

You know, those are some, some broad generalizations that I feel good about making, I think it's good to include fermented foods in the diet and we know how good they are for the, for the microbiome.

Dr. Victoria Maizes: Yeah. So I'm going to ask you a few follow-up questions about some of that, because some of our listeners have asked, but I'm going to push you a little bit more on the vegan diet, which Allana had asked about, because another listener said, do you think that a vegan diet is healthy?

Is it sustainable in the longterm? And to what extent does it require supplementation? In other words, what nutrients are just hard to get from plants?

Dr. Andrew Weil: I think a vegan diet can be healthy, but it takes some care and attention on, especially if you're trying to raise vegan kids. I think you have to be careful it is possible to have nutritional deficiencies on the vegan diet. I think especially for omega three fatty acids for vitamin B12. For iron, for calcium. What else, Victoria, would you say?

Dr. Victoria Maizes: Well, I think I'd also worried about Vitamin D3 maybe creatine, you know, some of these nutrients, I think we're still learning how supplementation may be important.

Dr. Andrew Weil: So, you know, there are a lot of vegans out there and, and some of them are healthy, I also meet vegans whose idea or vegetarians there's idea of. You know, doing that as eating macaroni and cheese three times a day, or, you know, something like that, which is not a healthy diet.

Dr. Victoria Maizes: Yeah, definitely not. You mentioned insects and Robert asked about eating insects as a necessary strategy for global food sustainability. He actually mentioned that he had come to one of our nutrition conferences and tasted them for the first time. So I was just wondering, where are you in incorporating insects into your diet?

Dr. Andrew Weil: Well, I may do so unconsciously, but knowingly, I have not been very good about that. Now I'm less inclined to go for things like chocolate covered grasshoppers. Then I would be for products made from flour, for example made from crickets or mealworms. That may be good protein sources. You know, we have a have a cultural aversion to eating insects factor, the yuck factor, although, you know, anatomically insects are not all that different from crustaceans that we crabs and lobsters and prawns. So you know, it is, it is an interesting psychological barrier, but there are many populations that consider insects, delicacies, even in Mexico where grasshoppers you know, are, are relished and eaten in in talk tacos and fry.

Of course in Africa where insects or, you know, greatly enjoyed. I think it's coming.I think that it's going to be forced on us by environmental economic necessity. And I think they're probably going to be palatable foods made from insect derived products that will

Dr. Victoria Maizes: You know, you mentioned crustaceans.

There was a very interesting New York Times article some months ago about how lobster was considered to be a completely unacceptable food. And it was fed to indentured servants who fought a battle and one that they only be forced accept that as their food, three meals a week.

So things change. Yeah. Another question is about the microbiome, which you mentioned. And one of our listeners asked what are simple methods to make fermented foods at home? How do they work and how much fermented food should a person consume daily?

Dr. Andrew Weil: Well, first of all, it is very easy to make fermented foods at home.

And the basic process is simply either putting vegetables into a brine, a salt water solution and sealing them away from air or putting them in, in, in, just in salt. There's a lot of recipe books out there. A lot of recipes on Google. I make my own sauerkraut. I make pickles. I make kimchi.

I've made kvass from beets, which is a very easy thing to make. I think it is good to, I used to make yogurt a lot. I don't, haven't done that recently, but it is easy and cheap to make fermented foods at home. And they're delicious. And just look up recipes, get books on it and start doing it now in terms of how much I think this is a matter of individual.

Taste and one concern is that a lot of these foods are high in sodium. So you might want to be cautious about the intake if you're salt sensitive, you can also rinse fermented foods off to reduce the sodium content. But other than that, I think you know, including them on a daily basis is a very good thing to do.

I think it's good for general health and certainly good for the gut microbiome.

Dr. Victoria Maizes: And is variety important? In other words, like say you eat yogurt every day. Do you get benefit from adding kimchi or sauerkraut?

Dr. Andrew Weil: Yeah, I think there are different cultures in all of these and that, that there are probably benefits from different groups of organisms.

So I think the greater, the variety of organisms the better.

Dr. Victoria Maizes: And lots of them are vegetables. So it's another way of getting more vegetables into your diet. I experimented with making kombucha during the pandemic and it was delicious and kind of fun. And I know you've made pickles I just want to remind our listeners that not all pickles are alike.

Dr. Andrew Weil: Well, first of all some pickles are alive and have you know, are, have organisms growing in them. And those are the ones you find in refrigerated sections of supermarkets. But they're also what are called quick pickles, which are made with vinegar. And are not cultured products and do not require refrigeration and probably most experienced people's experience of pickles is with vinegar pickles.

Vinegar is acidic acid, which has a different flavor also from lactic acid. That's made by the organisms that grow in fermented foods. To me, the taste of lactic acid is much more appealing.

Dr. Victoria Maizes: Do you ever worry about too much bacteria or one of these cultures going bad?

Dr. Andrew Weil: I think if a culture goes bad, it's pretty obvious.

You know, often there'll be a slime that develops on it. It's foul smelling. You know, it's pretty obvious. I think that that's really not a concern with the common things that you make.

Dr. Victoria Maizes: All right. Another diet question, which I know you get asked a lot, but here it is again. I was wondering if you could discuss wheat / gluten. It's all the hype right now. And as a lay person, I have a hard time discerning scientific fact from fiction. It seems to me that if you include 100%, whole grains as part of a balanced diet, and you don't have a gluten intolerance, Celiac disease. That would be okay. But I'm continuously told not to eat wheat or gluten as it causes inflammation in everybody, as it is a good source of dietary fiber, it would be nice to know how to utilize it or not.

Dr. Andrew Weil: Well, that's a complex question. I personally think that we is a, a good food. It has sustained life in many parts of the world for millennia. It is possible that we have changed wheat in recent times to make it less healthy or more allergenic. But I don't think there's anything wrong with wheat or grains in general.

I think it's what, we've the way we prepare wheat. That's a problem for many people, I think when you mill any grain into flour do you turn the starch into a quick digesting product that raises blood sugar and that can promote inflammation in people? So I think, but eating whole grains or crack grains is fine.

Some people find that they can tolerate ancient forms of wheat, like farro, for example, a better than they can, modern forms of wheat. Other people who think they're have problems with we'd find if they go to Italy or France, that they don't have problems with wheat products, which suggests that maybe something in the way in the types of wheat or the way we do as grown or contaminants of wheat that may be causing people problems.

I mean, obviously people with celiac disease are in one category. There are people that have wheat allergies, but the large majority of people who are gluten sensitive, this is an often a subjective diagnosis. And it may not have an objective correlation. I think the only way you can tell is by systematically leaving wheat out, adding it back, see if you make a correlation with symptoms.

What do you think about that?

Dr. Victoria Maizes: Well, I want to say two things. One is that you mentioned there could be a contaminant. And the one I'm most worried about is an herbicide called glyphosate, which is in the product Roundup ready. And it's often sprayed on conventionally grown wheat because it's a desiccant.

And so it makes it easier for the farmers to get the wheat in before a storm happens. And the wheat crop is ruined. That means it's on the food. As you know, the wheat is milled and turned into flour.So two ways to avoid that are either organic or GMO because GMO doesn't allow the use of Roundup ready.

So. You know, that's really an

Dr. Andrew Weil: You mean GMO or non-GMO

Dr. Victoria Maizes: Thank you. non-GMO that really does then lend itself to the anecdotes you hear about why people do better when they're in Europe, because Europe doesn't allow this product to be spreadable.

Dr. Andrew Weil: Do we know what glyphosate does to us? Isn't there, it has some bad effect on our gut microbiome.

Dr. Victoria Maizes: Exactly. So they basically say glyphosate doesn't harm humans at all. And that seems to be true, but it does have a direct effect on the bacteria yeast, fungi that are in our colons. And so it, it is a hit to the microbiome and that may be why so many people are having trouble tolerating it, you know, on top of a microbiome that already is getting a lot of processed food, not enough fiber, maybe antibiotics that have changed the microbiome.

So it could be just as one more thing that tips us over the balance. It's interesting to consider a second thing, which is gluten is obviously a much larger category and includes not just wheat, but also barley and hops. And some people do find just eliminating wheat and not the whole larger category. All right, one more diet question. And maybe this isn't really a diet question per se, but a how we eat.

And that is one of our listeners asked about how often is it recommended to do intermittent fasting?

Dr. Andrew Weil: Well, I'm going to let you answer that, Victoria. I think there was so many different recommendations out there. There's so many different schedules that people propose for doing intermittent fasting.

And I don't know if there's one right way to do it. I think it, it, this is a very individual.

Dr. Victoria Maizes: Well, I, I agree with you on some of them are really restrictive, for example, where you only eat in a six hour, an eight hour window each day, and those are truly restrictive. And of course they're interfere with the social aspects of eating because you can't share meals with people because you're during your fasting time.

Again, I, I see a difference between using this as a therapeutic approach. So someone who has diabetes, it may really be useful to the body to have a long window where the body doesn't have to deal with any incoming food. It helps therefore with blood sugar regulation and

it similarly appears to be useful for women who've had breast cancer, a 13 hour overnight fast appears to reduce the risk of recurrence, but those are therapeutic uses as opposed to a more, everyone should eat this way recommendations.

Dr. Andrew Weil: So I think you have to experiment and find out what works for you.

Dr. Victoria Maizes: I will say some people love this as an approach to keep their weight on target.

It doesn't work for everyone, but for some people, this feels really easy to eat in a narrow window and it seems to have that effect. And I think the other thing that is intriguing is the potential effect on our immune system.

Dr. Andrew Weil: Say more about that?

Dr. Victoria Maizes: Well, the gut has the largest number of immune cells in the body, so again, this concept of putting the gut to rest for 10, 11, 16 hours in a day may really lead to a reset of the immune system and be beneficial, especially perhaps for people with autoimmune disease.

Dr. Andrew Weil: Yeah. Well, we certainly see that, like that correlation with long-term fasting and the autoimmune diseases like rheumatoid arthritis, asthma ulcerative colitis, which may go into complete remission on long fast

Body of Wonder General Ad

Dr. Victoria Maizes: All right. I'm going to move from diet and ask you some other questions this is a beginner's question about the mind body connection and our listener says I am new to your podcast and not. As some people on understanding the mind, body connection. I'd love to hear more about the basics of how the mind affects the body and how it can generate physical symptoms for people in the absence of disease.

I'd also like to understand the current medical model and treating symptoms, and what's been missing in this mind body model with the traditional approach. It would also be helpful for us newbies to understand how to start integrating the whole body together. In other words, what's steps does one take, just connect mind and body.

Dr. Andrew Weil: All right. My view is that mind and body can only be separated verbally. They are two poles of the same reality. You can't separate them. And anything that happens in one sphere happens in the other. So there is a constant interaction between the mind and the body. And it's not just that the mind can generate diseases.

You know, that is one category of things. And whenever there's an event in the body, it's having an impact on the mental sphere and, and vice versa. And you, and I think medicine should be taking advantage of that connection. I think conventional medicine is greatly limited in its effectiveness by the materialistic paradigm that now dominates Western science and medicine and in materialist philosophy, all that is real is that which can be seen measured, touched that non-physical reality doesn't exist and non-physical causation of physical events is not allowed for. And that's why medicine has never been able to make sense of more cures by suggestion and placebo responses and why mind- body methods are so underutilized in conventional medicine. You know, you look at at we, you mentioned autoimmune diseases a little while ago in that general category of disease the more mind body interaction hits you in the face.

You know, a typical onset of rheumatoid arthritis and a young woman is. A flare up of all joints within 24 hours of a severe emotional trauma. I mean, that's just obvious. And yet in room in conventional rheumatology mind, body methods are rarely used. We bring out immunosuppressive drugs you know, we go to those methods and we don't explore that the possibility of changing the situation by using mind-body methods.

There's a whole array of what we call mind, body therapies hypnosis. Guided imagery, visualization, biofeedback, and these therapies are time effective, cost-effective, they're even fun often for both patient and practitioner and we don't use them that much. So this is an integrative medicine, and this is one of our major philosophical planks.

And we train practitioners to be aware of and use mind body methods. My personal experience is that there is no condition, which is off limits to mind-body methods. And we should always be trying these out. Now there's some art to using these because patients are very set to interpret suggestions of this sort as meaning that their diseases are not real or not important, or that they're making them all up.

And you have to be delicate in how you present this to patients. You're not saying that their diseases are all caused by the mine. It's just that there's a connection there and you can take advantage of it to promote healing.

Dr. Victoria Maizes: So one of the messages I get from what you're saying is that the mind, body connection fundamentally trusts that the body is capable of healing and doesn't necessarily need some outside intervention that there is an inner intervention that could happen.

Dr. Andrew Weil: And that is what the placebo response is. You know, it's a pure healing response from within that is mediated by that mind body connection. And rather than trying to rule that out, we should be trying to make it happen more at the time.

Dr. Victoria Maizes: One of the strategies I've sometimes used in my integrative medicine practice.

When someone seems especially sensitive to that notion that this isn't real, you know, if you suggest my body interventions is to actually send someone to a practitioner of a Tradition Chinese medicine because they never did that split, you know, these folks treat the body and those folks treat the mind.

But rather there is this more, a whole person approach.

Dr. Andrew Weil: Yes. Good idea.

Dr. Victoria Maizes: Okay. I want to ask you a few of our listeners questions about medicines. The first one is another one is another one I know you get a lot. Is there any hope for people who are trying to taper off benzodiazepines without the debilitating and terrifying withdrawal that happens to many of us who are prescribed benzos

Dr. Andrew Weil: Absolutely possible.

It is a very tough. Withdrawal is a difficult problem. It is a more difficult withdrawal than then coming off of opioids. But it is certainly doable. I've known many people who have done it. I don't think there's any one right way of doing. I think, first of all, you, you have to have a schedule of tapering off the medication and not hesitate to go back up.

If, if problems persist, you want to be putting in place methods. If, if the problem is anxiety that they've been meant to deal with to controlling anxiety. And as you know, my main recommendation is the 4 7, 8 breathing exercise. And in terms of, of supplements, I think kava is by far our best ally.

There it is the most powerful, natural anti-anxiety agent. And you want to remove things that may be contributing to the problems such as caffeine making sure that people are trying to get regular sleep and not getting too much stimulation of one sort or another. There are all sorts of methods, hypnosis acupuncture that can be used to help.

But it is absolutely important to know that it's possible and doable and just take some time and patience and, and people should not start them in the first place because you know, these are not great drugs and they're handed out like candy without any warnings to people of the problems of this kind of addiction.

Dr. Victoria Maizes: Yes. I completely agree. Prevention is key here. One thing that I have sometimes recommended is that people actually get a liquid form because it's some moment. Too hard to cut it into 18th. And I'm sorry to eighth and 16th. And it's surprising as you lower the dose sometimes by how small the change has to be in order to effectively taper off.

Another question about a medication. How can I get off blood pressure medicines, even though I live an extremely healthy lifestyle?

Dr. Andrew Weil: Well, I'm not sure that it's that important to get off blood pressure medications, you know, unlike benzodiazepines, which have horrible effects on cognition and, and you know, all sorts of other problems.

Blood pressure medications are very effective. It may be possible to reduce the number of them that you're taking or to reduce dosages. But I don't know that it's such a bad idea to be on blood pressure medication. You know, it is certainly worth seeing if you can control blood pressure just through lifestyle changes.

You know, exercise autonomic, relaxation, cutting, sodium, and so forth.] But if you can't keep it in the normal range, I think it's okay to use a blood pressure medication starting with the lowest dose of the least potent agent. Then you add more if necessary. So I would say, you know, maybe it's worth trying to reduce the number of medications or the dosages, but I wouldn't be obsessed with trying to get over.

Dr. Victoria Maizes: So, this is a reminder to our listeners that integrative medicine is not anti-medication or anti pharmaceutical approaches, especially in the case of the blood pressure medicines. There's a really wide range they tend to have, or you usually could find one that has minimal side effect for you, and they are proven to prevent heart attacks and strokes.

Dr. Andrew Weil: Yeah, I would say one of the great advances of conventional medicine over the 50, 60 years has been much better control of blood pressure. And I think that's one of the things that's accounted for the drop and incidents of heart attacks, especially, and, strokes

Dr. Victoria Maizes: I do want to add one thing and that's that one factor that's sometimes not thought about is environmental chemicals. So for example, bisphenol a, which is in plastics, which we're regularly exposed to can raise blood pressure. And so removing plastics and other environmental exposures might actually be something that tips this person or other people into a healthier blood pressure range.

All right. You mentioned in your book Spontaneous Happiness, that there is a link between anti-histamines and depression. My husband has a disposition which tends to lean on the more depressed side than the upbeat joyful side. He takes Benadryl every night for sleep because it helps him sleep and it helps his allergies.

Do you think this could be depressing his mood?

Dr. Andrew Weil: I certainly do. And I also think there's evidence that long-term use. Of Benadryl may actually increase the risk of dementia in later life. So I think this isn't something you want to get off of. There are something much better options for sleep. You know, my first choice would be valerian the herb to see if he can substitute that for the Benadryl.

And in terms of allergy control. I don't know what the allergies are. But I would take a look at the chapter on anti-histamines and my book Mind Over Meds. And there's a lot of suggestions for integrative management of allergies.

Dr. Victoria Maizes: I couldn't agree more. I also would say that in terms of the anti-histamines Benadryl, which is in many of the sleep meds is the worst.

And some of the newer anti-histamines aren't associated with that risk of dementia.

Dr. Andrew Weil: Right. But they may, you know, there were supposed to be non-sedating, but in my experience, they still are. I mean, they still can cause a kind of grogginess and mental fogginess and probably not the best thing for mental health.

Dr. Victoria Maizes: This is a question on the health benefits of singing, and I know that you are super fond of singing.

Dr. Andrew Weil: I love to sing. I love to sing in groups. I think it can be a very joyful experience. And also I had, I have a friend who used to teach, or I have two friends actually that used to teach workshops in singing and encountered many people who think they cannot sing. And often this stems from one experience early in life, when somebody told them they couldn't sing and that stuck with them all their life and these people work from [00:30:00] the premise that everybody can sing. And I, I absolutely agree with that. And I think it's a wonderful thing.

Dr. Victoria Maizes: Yes, I think it's one of the things that we have lost in the pandemic years, because early on, we were told about some spreading events but group singing can be just such a wonderful form of being in community. Okay last question and it's on supplements. Is there a good way to figure out which supplements one should be taking?

I currently take about 15 a day adding as I hear about a supplement that I could feel I could benefit from, I've heard or read the advice that taking unnecessary supplements is a waste of money. So how do you know?

Dr. Andrew Weil: Well, I would say you consult an integrative practitioner. Ideally someone that we've trained at our center because our education includes very good information on this subject.

You can also look at my website, DrWeil.com or my books like Healthy Aging and 8-weeks to Optimal Health, which give advice about recommended supplements. So I think you want a good, good guide to help you.

Dr. Victoria Maizes: That's great advice. I think one other thing people can do is, you know, when you're on 15, you could say, let me try going off of that one for awhile and see if I notice a difference.

So for example, say you're taking a glucosamine and chondroitin for your joints and you go off for three or four weeks and you notice no change at all. Well, maybe you don't need that right at this point.

Dr. Andrew Weil: Good idea.

Dr. Victoria Maizes: Well, Dr. Weil, as always, it's been wonderful to talk with you about all of these really common questions that we get asked, and I appreciate listeners sending them to us.

We will do another episode like this, so if your question did not get answered, or if you want to add a question into the mix, we welcome it.