OneMedicine Podcast

Rob Lutz 00:02
Hello and welcome to the OneMedicine Podcast with Today's Practitioner. In each episode, we share the expertise of a respected thought leader, some you'll know and others you'll probably meet for the first time. We cover topics important to you, always with a focus on improving the health outcomes of the patients you treat, while expanding your understanding of the many healing modalities being used today.

Rob Lutz 00:24
Welcome to the OneMedicine Podcast. I'm Rob Lutz, your host, and with me today is Dr Lexi Loch. Dr Lexi is a licensed naturopath, and we'll be talking about inflammation, acute and chronic inflammation, its impact on your patient's health, and pros and cons of different treatment options and a number of other topics that we'll cover over the next 45 minutes or so. Dr Loch, Dr Lexi, thank you so much for joining me today. I really appreciate it. Before we get started, can you just share with me a little bit about how you came to become a naturopath, and maybe a little bit about inflammation, how it, how you've addressed it in your your own practice?

Lexi Loch 01:00
Absolutely. Well, thank you so much for having me, Rob and the OneMedicine Podcast. It's great to be here. I mean, inflammation is quite a buzzword these days, so I think it'll be a really fun discussion. So a little bit about my background. I come from the world, actually, of veterinary medicine. So I got my start, my first kind of medical career, I guess, was on the animal side of things. I'm still a crazy, passionate animal person. I have three dogs, fingers crossed, they stay quiet. But so I worked in veterinary medicine as a certified veterinary technician for several years. Love, love, love what I did, but got burnt out pretty quickly, and I was looking for a big change, and at this point in my life, I was already shopping at the local health food store when I was living in Green Bay, Wisconsin, and I heard that they were looking for a sales associate, and I was like, "look, I'm already spending a lot of time and dollars here, so if I could get a discount, that would be great." I jumped over to the health food store, and just absolutely fell in love with everything that was there, and just, you know, reading every little label, trying to read between the lines. So that was kind of where I like to say I fell down the rabbit hole of natural medicine, and part of my own journey too, also involved... I've been a lifelong athlete. I've played volleyball since, gosh, I was probably like 10 years old. Love, love, love volleyball, played throughout my undergrad in college. Ended up with a lot of chronic low back pain, and I was trying everything. They were even prescribing me Vicodin at one point.

Rob Lutz 02:36
Terrible.

Lexi Loch 02:36
And I went, yeah, I went and met with a specialist who said, you know, we could do a spinal fusion. I mean, I was 20 years old, and yeah, I was like, I don't know if surgery is the right option.

Rob Lutz 02:49
Absolutely not.

Lexi Loch 02:50
Yeah. So I started exploring a lot of other techniques. That was kind of when I got my first introduction to, like acupuncture and body work. So those two paths in my life, you know, dealing with chronic pain, and then also kind of jumping into a health food store, they kind of merged and, just like, created this love of, you know, natural and holistic modalities for me.

Rob Lutz 03:11
Yeah, and I'm sure they worked for you, right? So that's right, you didn't have to have surgery, which I've heard people say, like, you don't get back surgery until you literally can't walk. I mean, because it's, it's not a permanent thing, and there's all sorts of risks involved, and you're just never, your back's ever going to be the same. Yeah.

Rob Lutz 03:28
Yeah.

Lexi Loch 03:28
Exactly. I actually had a teammate who had already had a back surgery on my, my college team, and, you know, she had some relief, but not all. And granted, she was only one person, but still, I was just like, I think there's got to be more that I can do.

Lexi Loch 03:43
So when I was working at the the health food store, you know, I just would go home and research topics that interested me or research questions that people asked that I didn't have the answer to. And then eventually I started working for EuroPharma, which is the parent company to the Terry Naturally brand dietary supplements and EuroMedica, so I work in the education and science department, and now I have been with them for over 10 years.

Rob Lutz 04:09
Wow. Yeah, those guys are great. And, full disclosure, they do some work with Today's Practitioner and, but love their products. And, you know, feel confident that the ingredients they use and the dosages that are in there, that's why they work. You know, one thing that you hear a lot about with the naturopath, and maybe this relates to, kind of your journey a little bit, is root cause medicine. That's why surgery wasn't really probably the answer, because it's not going to fix what caused it in most cases, right?

Lexi Loch 04:34
100%. I was actually doing some research for a different presentation a little while ago, and I was looking just kind of at some of the statistics out there on like, surgery, low back pain, what are the outcomes, what are the risks? And I found out that almost a million people every year undergo back surgery.

Rob Lutz 04:39
Wow.

Lexi Loch 04:40
Which tells us, right? Like, people are in an epidemic of pain and chronic inflammation, and there are some positive outcomes for certain types of procedures, whether it's like alleviating nerve type compression pains, you know, or cancer, infections, things like that. But overall, I think we have a lot of other things that we can try, kind of, before moving to, like the the top of what I consider like the pyramid, you know.

Rob Lutz 05:16
Yeah. Well, we don't talk too much about kind of the physical therapy type of stuff, but same, I'm an athlete, long time athlete, and I've injured myself lots of times and had low back problem. And, you know, really, what I found was muscle imbalances, sitting a lot, you know, caused that. And I read a book called "Becoming a Supple Leopard." I don't know if you've seen that, but it's, it's written by Kelly Starrett. He's a, I guess, a PhD physical therapist, genius guy, right, and very aggressive in how he works with physical therapy, but lots of relief for those types of things, you know. And it's just kind of amazing if you can do some hands on work. And of course, you know, natural pain relievers or anti inflammatories and things like that are key as well. But...

Lexi Loch 05:59
Well, thank you for the book recommendation. I am an avid reader, so I'm always looking for new, new things to peruse. But, you know, I think it brings up a really good point, right? It's like, what are the modalities that we can do to hopefully resolve some of this underlying inflammation? And yeah, I think that kind of clues us right into our topic here, because I don't know about you, but I feel like when the word inflammation is thrown around, it always gets a negative connotation. And I do a lot of education with my patients about inflammation isn't an and/or. It, you know, it's not. It serves a purpose in the body. It is a "yes, and." You know, inflammation can be life threatening. Inflammation can be life saving. I mean, we as a species wouldn't exist without inflammation. I actually saw a statistic from a research article that they found signs of inflammation on dinosaur bones. So it's like inflammation is an ancient process. I mean, millions and millions and millions of years old, and it wouldn't have been conserved across, you know, multiple species if it didn't serve a purpose, right? And I think the big issue is when acute inflammation. So, you know, as a volleyball player, I'll just throw out, you know, I've fallen down and rolled my ankles more times than I could care care to share. But you know, acute inflammation, of course, we're talking about redness, swelling, heat, pain. I mean, those kind of cardinal signs of inflammation, those were documented by the ancient Egyptians on papyrus. So, I mean, these, again, are very well known to us as humans. But I think when we're unable to resolve that acute inflammation, and it moves more into the chronic inflammation, that's where people really get in trouble. One of the big things too, about chronic inflammation is it doesn't always have symptoms. You know, it's not necessarily like you can feel chronic inflammation in your elbow, right? Like it's kind of insidious. There may be some, you know, loss of function. There may be some, I don't know, generalized fatigue or feelings are of unwell. But I think that's one of the tricky things of chronic inflammation, is it can be kind of difficult to pinpoint for people.

Rob Lutz 08:06
So, you know, you mentioned that inflammation isn't all bad. Give me an example. Or, you know, how inflammation is actually a good thing. You know, what would that scenario be?

Lexi Loch 08:15
So let's say, you know, we have some type of viral infection, or some, type of pathogen that's in trying to, you know, set up shop inside of our body. I mean, we are going to use our immune system, which uses various forms of inflammation, or pro inflammatory cytokines, to help clear that pathogen. So it actually helps to protect us against those pathogens. It kind of helps to isolate whatever that area is from the rest of the body. So we're sending, you know, we're having a lot of increases in blood flow. We're sending immune cells to that area. And overall, the inflammatory process, when it is done properly or efficiently, will initiate repair processes after we kind of clear that initial infection, or whatever it is. So, I mean, inflammation is our body's way of, kind of helping us heal, recover, repair, defend, just exist, basically.

Rob Lutz 09:10
Yeah, right. And I guess that's why it's been, you know, continued along the evolutionary process. You know, it's something we've is stuck with us because it has a good feature to it.

Lexi Loch 09:19
Exactly. And I think one of the big things I try to educate patients on, too, is some of the dangers of the non steroidal anti inflammatory drugs. Because if we look at their name, they are anti inflammation, which sounds great, right? You're like, "Okay, I have inflammation. I should take an anti inflammatory and all of my problems will be solved." Well, I think we know that the non steroidal, anti inflammatory drugs carry a host of side effects, whether that's, you know, GI issues, potentially ulcers, changes to liver and kidney function, heart issues.

Rob Lutz 09:42
No free lunch.

Lexi Loch 09:56
Yeah, and I mean, these are, like, some of the most frequently used drugs out there, and they're available.

Rob Lutz 10:04
Absolutely.

Rob Lutz 10:04
Yeah? Same.

Lexi Loch 10:04
Yeah, and they're available over the counter. I am of a philosophy that I honestly think that they should be prescription. Because people, you know, I've done it, I've popped a handful of ibuprofen, you know, before I, before I got introduced to this world.

Lexi Loch 10:05
Yeah. I have aches and pains. This thing takes away aches and pains, so I'm going to use double what it says on the label, because I'm smart, right?

Rob Lutz 10:27
I remember back in the early 90s, and I was friends with some, you know, kind of world class athletes, triathletes. They were taking 20 or 30 of these things in a day, right? And I had a, I had a broken foot from skiing, and I bought a ski pass, and that was in my 20s, so I was going to continue to ski,

Lexi Loch 10:45
Of course.

Rob Lutz 10:45
Of course. So I took a lot of them, and I'm, thank goodness I didn't destroy myself, because it was a lot of ibuprofen I was taking, and I don't really take it now, but yeah, that's, yeah, could have been some problems.

Lexi Loch 10:56
They're so widely accessible, but you know, they can increase the relative risk of GI bleeding by like threefold. Some studies even up to tenfold. And I think somewhere around like 15,000 to 20,000 people die every year from the use of these things. Now that alone is a very scary statistic, but on the other side, the anti inflammatory drugs work by shutting down the production of compounds like prostaglandins, which we make in like an acute inflammatory situation, but when they shut down the production of those pro inflammatory compounds, it also shuts off the signal to the body to then make anti inflammatory compounds or resolve the inflammation. So yes, you're getting kind of a short term payoff by decreasing the production of things like prostaglandins, prostacyclin, thromboxanes, et cetera. But those are also cues to the body that, hey, we're producing these. But then we also need to shift over into like the resolution side of things. So there's a big difference actually, between like, anti inflammatory and pro resolution. And so the NSAIDs are anti inflammatory, but they don't help the body resolve what actually caused the inflammation in the first place.

Rob Lutz 12:14
So you get some symptom relief, but you're not really healing the body as well as you would otherwise?

Lexi Loch 12:20
Exactly, exactly. It's like, yes, you're kind of putting a band aid over the problem. But again, we're not really addressing, like, you were talking about that, that root cause. We're using these to get some temporary, temporary relief, which I understand. Like, it's, of course, it's a bummer to be to have an acute, inflammatory issue, but again, like we're kind of overriding the body's natural processes, which would shift us from inflammation to then coming into resolution.

Rob Lutz 12:48
Okay, thanks for that explanation. That does make a lot of sense. Yeah. And I think these over the counter medications, you know, for inflammation and pain, Tylenol, ibuprofen, those types of things, they do have a long list of issues that go along with them, right? You know. So let's say you have a patient who comes in and, and I think we've said, or we spoke maybe, before the podcast started, is there's really no one test you can take to evaluate your inflammation level. So as a practitioner, what, what do you do?

Lexi Loch 13:16
You know, there are some labs that can be done, but unfortunately, there's not really, like one size fits all answer, as far as, like, if you were to run like, CRP, or even high sensitivity CRP or ESR, erythrocyte sedimentation rates. So a lot of times, I'm just kind of going off of what the person tells me. And you know, as naturopathic practitioners, we're also digging into some of the nutrition and lifestyle, and I'm trying to kind of build a picture in my head of what might their kind of chronic inflammation picture look like? Like what is their chronic inflammation burden? Because, I mean, at least one in three people in the US have some type of chronic inflammatory disease, so there's a good chance that whoever we're working with is carrying a higher level of chronic inflammation overall. I mean, we all are right, like, whether it's the environmental chemicals we cannot see, or sometimes those that we can see, or it's the pesticides in the foods, it's the... Oh my gosh. I just read an article about the microplastics and tea bags. I'm like, I love tea and I'm like, Oh my gosh. I'm like, where does it end, you know? So, you know, I just am kind of operating under the premise for most people, that, yes, we are dealing with some type of chronic inflammation picture, and then we kind of shift over to, what are the things that that person can do, from like, a stress management standpoint, from a nutrition standpoint, hydration, sleep, I mean all of these kind of foundational elements,

Rob Lutz 14:45
Foundational, yeah

Lexi Loch 14:46
and when we when we are working with those, that those changes sometimes take a little bit longer. So then I'm also using natural medicines like curcumin, boswellia, omega-3s,to also kind of help palliate and, and get them into more of that, like pro resolution phase.

Rob Lutz 15:04
And how do those particular, you know, botanicals or the Omega-3s, how, how does that even work? What? What is the process there in the body that's healthy inflammation.

Lexi Loch 15:13
What I love, I am like a crazy plant person. I love a lot of plant medicines. I also love, you know, all of the other nutrients as well, but I self identify as a crazy plant person, so I'm going to start out with curcumin and Boswellia. I mean, most folks out there have heard of turmeric, right? Turmeric is a fantastic spice. I have stained a lot of surfaces in my kitchen yellow because it is a very vibrant pigment, and turmeric contains a compound called curcumin. Curcumin is probably one of the most well researched natural compounds out there. Last time I checked it, had over 25,000 published research studies. And we know that research is expensive, so they keep doing research on curcumin, because there continues to be wonderful and wonderful results. So curcumin has the ability to kind of down regulate some of our major pro inflammatory cytokines, so things like IL-1, IL-6, 2, TNF or tumor necrosis factor alpha. I mean, curcumin kind of has these multiple mechanisms by which it can kind of reduce the overall inflammation burden in the body. But on the flip side, it also helps with pro resolution. It increases anti inflammatory mediators, it increases our overall antioxidant status. So again, it's kind of working on both sides of the equation, and that's where I kind of think of these more as like inflammation mediators versus like an actual anti inflammatory, right? But for general purposes, I will just refer to curcumin as an anti inflammatory, even though it's working, you know, on on more levels than that. So there's...

Rob Lutz 16:55
So it's not going to have the same side effects as an ibuprofen, then, right? Because it's more balanced than what it's doing.

Lexi Loch 17:01
What I love about Curcumin is it actually can protect against some of the things that, like the NSAIDs, can harm. So it promotes liver health, it promotes GISO health. It's been shown to actually protect against non steroidal, anti inflammatory drug induced ulcers when it was given simultaneously. I believe this was an animal model, but yeah, so it kind of helps to protect against some of those negative effects that can come from like the NSAIDs.

Rob Lutz 17:27
Are there any medications that you're aware of that there'd be could be some kind of an interaction between that substance and a medication a patient might be taking?

Lexi Loch 17:36
So one of the biggest classes of medications that I'm always super, super, super cautious with are going to be like your older types of blood thinners, so like your Coumadin, Warfarin. So what I've done in the past with people who are interested or who I think would be a good candidate for taking Curcumin is I have them talk to whoever their prescriber is for like the Coumadin, Warfarin, and ask if they can do a one week trial. So can I take this curcumin for a week and then see or evaluate if there are any changes to like the INR, like the bleeding times? And I've had a lot of patients do this, and they've been able to stay on the curcumin. One of the things that sometimes people get a little bit confused is they think that curcumin is a blood thinner, which what it does is it more acts on the platelets themselves. So we know that the platelets help create things like blood clots. If you know we have a cut on our arm, something like that, but when our platelets become inappropriately activated, that's when they can start to clump together and like the bloodstream, and lead to some type of blood clot. So curcumin kind of makes sure that the platelets stay kind of like smooth appearance. They don't get overly attached to each other. They don't become overly sticky, if you will. So that's kind of on the, the side that curcumin acts on.

Rob Lutz 18:53
Okay, you know, it just my own curiosity. But what about a, you know, you have a patient who might have high cholesterol, or, you know, some other markers that indicate some issues with their cardiovascular health. Is this a good supplement for them to be thinking about? What, is it a go to for you, in some ways?

Lexi Loch 19:12
I hesitate to think of almost any patient that couldn't benefit from, you know, a good curcumin, because curcumin has research for cardiovascular issues, whether it's atherosclerosis, hypertension, it can really help again, kind of lower that overall inflammation burden in the body, which is going to kind of take the pressure off some of the end organs, or, you know, systems that are impacted by that higher level of inflammation. So I have almost all of my patients on curcumin, and I honestly think that just about almost everyone out there, with just the assault that we're under for all the things that are causing inflammation in the body, I think we need to, you know, have a lot of tools in our toolkit, and curcumin is one of my favorite tools.

Rob Lutz 19:56
Yeah, just it sounds like a go to for you, for just about everybody. Anything else on curcumin that you want to mention, or...?

Lexi Loch 20:03
I will just point out, there are, like, a couple studies that I sometimes will talk about with patients. First and foremost, there are a ton of different curcumin preparations out there. You know, there are some that are using synthetic curcumin, which you're like, oh my gosh, I didn't even think that you could make synthetic curcumin. Unfortunately, they're using, like petroleum based derivatives to make curcumin. So it's always, always, always going to be like a buyer beware type of situation, which is where I think us as integrative practitioners can help kind of direct customers and patients to the right product. So I personally have the most experience using Curcumin with turmeric essential oil. So turmeric essential oil itself helps with anti inflammatory, antioxidant, pain relieving properties, and helps to boost the absorption of curcumin. Because on its own, curcumin can be quite difficult to absorb.

Rob Lutz 20:56
That's what I heard, yeah.

Lexi Loch 20:57
But when it's combined with turmeric essential oil, it's up to 700% better absorbed than just like your, your standard curcumin. And this type of curcumin has 90 published research studies, and almost half of those are human clinical trials. So I think 41 or 42 of them have been done in humans. So I always like to follow the research. It's, you can't always research every exact mechanism for every natural substance out there, but I think the breadth of research on curcumin at this point gives us a lot of good clues as to what it can be used for.

Rob Lutz 21:30
We have a few great articles on this exact topic and the essential oil on the site, and I'll include those in the show notes if anyone wants to go a little bit deeper on that. But I think it's really fascinating, because I had never heard of that before, the essential oil, you know, it's for me, it's fairly new.

Lexi Loch 21:44
I actually saw that it came in as one of the top 10 articles for Natural Practitioner in 2024, and I was like, Oh, yes, see, there's still so much interest. And I think, you know, for a lot of people, it's like, curcumin reduces inflammation, it can reduce pain, it can improve liver function. I mean, there are just so many uses. Like there was one study looking at curcumin compared to acetaminophen and looking at its impacts on C reactive protein and TNF alpha and probably not surprisingly, curcumin outperformed the acetaminophen. This was like a six week study. There's also studies on curcumin for folks with osteoarthritis compared to ibuprofen, where it outperformed the ibuprofen. So again, it's like we have tools. I think we just need to, you know, kind of help educate folks how they can be used, and kind of best practices with them.

Rob Lutz 22:35
Yeah. So what? What kind of a dosage would you recommend? Of course, any practitioner or anyone who's listening to this, this is not medical advice, just to be clear on that, but just, I'm just curious for my own information, what are some dosage ranges that you look at for an average patient, or any specifics as well?

Lexi Loch 22:51
Absolutely. So generally, I'm recommending 750 milligrams of the Curcumin with turmeric essential oil that yields 500 milligrams of the curcuminoids total. And one of my primary reasons for that is the majority of those clinical studies done on the curcumin used two per day of that 750 milligrams.

Rob Lutz 23:12
Got it. Okay.

Lexi Loch 23:12
And they had super impressive results. So I was like, You know what? I like to follow the research. There were a few studies that used higher dosages. One study used, I believe, six per day. And the most recent clinical trial actually used 16 per day, so eight grams of curcuminoids. But it was an interesting study on folks with multiple myeloma who were ineligible for a bone marrow transplant. And so every one of the participants took, like chemo, some type of chemo and prednisone, and then half of them were also given the Curcumin with turmeric essential oil. And the folks that received kind of that adjunctive curcumin, 70, gosh, I think it was something like 75% of them went into remission, whereas only 21% of the people who were on the two drugs only went into remission. So, I mean, it was a much higher dose of what I've personally experienced, or have experienced with. But you know, if I had multiple myeloma and I couldn't get a bone marrow transplant, I would also probably be trying as many things as I could. So it's, it's pretty incredible. You know, what it can really do?

Rob Lutz 24:22
Yeah, that is amazing. Just amazing, also, to think about different topic for another time. But these plant medicines, you know, how they were discovered, initially, the trial and error, figuring things out, and then just kind of the the knowledge base that was passed down, and now it's being verified with, you know, real clinical studies. That's pretty amazing.

Lexi Loch 24:40
Yeah, I love that kind of, like the the ethno botanical uses, and it's like, yeah, I, I'm growing some turmeric. You know, it's overwintering in my "she shed" in the backyard. Fingers crossed, it survives the winter. But you know what I would I have known prehistoric times to just like, chew on this tuber and see what happens, or this rhizome, I guess. Yes, but yeah, it is quite fascinating, though.

Rob Lutz 25:02
I mean, I wonder. I mean, I'm sure they're much more connected to the land and the the environment back then, and there's they're probably more aware of things than we are today. But it is interesting to think how, how that all came about. But that would be another, another topic. So what other botanicals or supplements do you think about and recommend to patients for inflammation?

Lexi Loch 25:23
So I kind of think of curcumin as touching just about every single inflammatory pathway in the body. And again, it's more of a modulator versus like a pushing all of those pathways down. But what I love to combine Curcumin with is another botanical called Boswellia. So Boswellia is a tree medicine. There's about 20 distinct Boswellia species. They grow in places of the world, like India and Northern Africa. And they're really interesting because the the way that you derive medicine from them is by scraping the bark. When you scrape the Boswellia bark, it kind of exudes these like resins, or what they call Boswellia tears. Now I think about this, you know, I live in the Pacific Northwest, so it's like, if you see a big evergreen tree lose a branch, it's like the that sap that it produces, right? Like, that's kind of analogous to what the Boswellia resin is. Now, the reason that I like Boswellia so much is because it helps to reduce a specific type of inflammatory pathway in the body, called 5-LOX. So curcumin acts more on like the cyclooxygenase or the COX side of things, whereas Boswellia acts on this 5-LOX pathway. When we have high levels of activity in this 5-LOX pathway, we're producing a lot more leukotrienes. And leukotrienes are inflammatory compounds that play a big role in like lung issues, gastrointestinal issues, joint issues, even certain types of cancer. So if we can reduce that 5-LOX inflammation, that also translates to generally like a big reduction in symptoms and, and more comfort for people. And it's tricky, because that 5-LOX pathway really isn't touched by a lot of substances, whether they're naturalor pharmaceutical. One of the biggest pharmaceutical medications used to address 5-LOX inflammation is steroids, so there's a lot of five blocks activity in asthma. So that's why the doctor doesn't say, you know, pop an ibuprofen and call me tomorrow. They're like, use, you use your asthma inhaler, which is going to act on that 5-LOX pathway. So Boswellia combines really well with curcumin, because when you have the combination of them, you know, again, you're covering pretty much every single inflammatory pathway in the body.

Rob Lutz 27:36
Amazing explanation. I love it. Any other, I think you mentioned omega-3s as another?

Lexi Loch 27:42
Yes. So omega-3s are probably, you know, most people think of them maybe for like, heart disease or things like that. Omega-3s are, you know, omega-3 fatty acids. The two that we are probably most familiar with are EPA or eicosapentaenoic acid, DHA, docosahexaenoic acid. But basically, the reason they're so important is omega-3s are essential, meaning that our body cannot produce them, so we have to obtain them from either diet or supplemental sources. What's really cool about omega-3s is, I think just like 20 ish years ago, there was a doctor, Dr Charles Sirhan, him and his team were doing research on omega-3s, and they actually found that omega-3s are precursors to these really important compounds in the body that they named "specialized pro resolving mediators." It's a mouthful, but they're called SPMs, but if we kind of look at the name specialized pro resolving again. So they are pro resolution of inflammation. So if we are deficient in omega-3s, it's kind of easy to theorize that we would be deficient in our body's ability to go in and resolve inflammation. So some of these specialized pro resolving mediators have names like resolvents, protectants, maresins, I don't really know why maresins got that name, but the other you know resolvents And protectants, it's intuitive to be like, Oh, he's resolved and protect so we also know that a lot of folks out there are having much higher intakes of omega-6 fatty acids, which aren't all bad, but it's all about that ratio, right? It's all about the balance between omega-3s and Omega-6s, and we just are so skewed at this point, you know, with the Omega-6 fatty acids that it can actually interfere with our body's ability to use omega-3s and create some of these, you know, pro resolution compounds.

Rob Lutz 29:43
That makes sense. You've got a patient that comes in, are you going to prescribe all three of these? Typically?

Lexi Loch 29:49
Generally, when someone comes in and they have inflammation and pain, I'm usually going for a combination of curcumin, boswellia, black sesame seed oil, or curcumin, boswellia, dlpa, nattokinase. That's kind of like my first line for pain, specifically, but generally, I'm putting most folks on, you know, Curcumin with turmeric essential oil, at least as a standalone initially, if they have lung issues, GI issues, various forms of arthritis, etc. Then I might throw in the Boswellia as well. Okay, pretty much everyone out there could benefit from higher levels of omega-3s. So I'm usually doing some education around why omega-3s are important, what they can do in the body, especially for folks who aren't eating, you know, a lot of seafood, or they're vegan, they're vegetarian, they have specific dietary, you know, restrictions, whatever that looks like. So I think the Omega-3s are crucial point as well for most people.

Rob Lutz 30:50
And what kind of a dosage are you looking for daily?

Lexi Loch 30:53
So when it comes to omega-3s, a lot of people equate omega-3s with fish oil, and they are not the same thing. So fish oil is kind of like a carrier for the Omega-3s, but it's not necessarily like the most optimal carrier. So I'm usually recommending Omega-3 is attached to phospholipids, which is how you would find them, like in fish, because the phospholipids help to protect those sensitive omega-3s. Omega-3s don't really like a lot of light or oxygen or extreme temperatures, so they are quite delicate. So the phospholipids kind of help to shield those omega-3s so they don't go rancid.

Rob Lutz 31:30
Okay.

Lexi Loch 31:31
So I'm, you recommending omega-3s with phospholipids and peptides. So sometimes it looks like it's a lower dosage, somewhere around like 270 to 290 milligrams. But when you use omega-3s with phospholipids, they're absorbed a lot easier because they're more easily recognized by the body, so you don't need to take, like, tablespoons of fish oil to get people level of omega-3s on board.

Rob Lutz 31:55
Okay, that makes sense. Yeah. It's really about how much gets into your system, rather than how much you put in your mouth, I guess.

Lexi Loch 32:01
Exactly, and, and because it's not in an oil base people tend to tolerate it a lot better, and they don't always get some of those fishy like burps or regurgitation, which, from a treatment plan adherence standpoint, that's going to impact, like, if I'm burping up, you know, fishy taste stuff, I'm like, Yeah, I'm done with this supplement.

Rob Lutz 32:19
It's very unpleasant when you you've tried it and you're like, wow, that's doesn't taste so good.

Lexi Loch 32:24
Yeah, exactly. So always trying to find ways to help people stick with treatment plan recommendations and have it not be a source of stress in their life.

Rob Lutz 32:33
And that's always got to be a challenge for a practitioner, is adherence to your plan. You know, are they going to stick with what you're telling them to do? Probably easier with a few supplements. We haven't yet quite talked about the, you know, lifestyle and dietary stuff, but I'd love to chat on that a little bit, because that is foundational in a lot of ways, and probably makes a big difference in a lot of other areas in their life as well. So what? How do you talk to a patient about some of those changes that might be necessary if you are trying to reduce inflammation?

Lexi Loch 33:02
So I think one of the biggest things we can do for reducing inflammation is getting our bodies moving. I mean, we, we are designed to be moving, and whether that, you know, was foraging or hunting or, you know, exploring, like our bodies are designed to move. And unfortunately, a lot of us are just sitting so much more than what historically, we would be able to do. So I'm coaching folks on how to get even, you know, an extra five to 10 minutes of movement per day. You know, I'm not saying I need you to get 150 minutes of activity, you know, per week, which, which is the goal to work up towards. But when folks have, you know, high levels of inflammation and they're feeling fatigued and they're feeling unwell, you know, they're not going to be able to go straight into, you know, two and a half hours of activity every week. So I'm trying to find ways that we can incorporate more movement throughout their day. And I try to sometimes stay away from the word exercise, just because I feel like exercise gets a negative connotation. So, you know, park a little further away, or, you know, take the stairs when you can do some chair yoga, do some gentle stretching, tai chi and qi gong, like some of these gentle moving breathing activities, I think can be really profound for a lot of people. And again, we're moving our lymph so we're kind of using the body's like waste disposal system more efficiently, which is going to help kick some of these inflammatory compounds out of the body or remove them in other ways. So I think that movement is probably one of my biggest treatment recommendations.

Rob Lutz 34:28
You touched a little bit on how to get your patient to adopt some of these new habits. Those were the exact words you used, but that's what came to mind, and that's got to be a challenge, right? Is to get a patient to really integrate these things into their day and any words of wisdom for other practitioners on how any tricks of the trade?

Lexi Loch 34:47
One of my patients actually showed me this journal that she found on social media that's about like gentle stretching or movement. And I think sometimes having having some like tangible data for people can be really helpful. Where it's like, okay, if you have five minutes, here's, you know, three activities you could do in that five minute span, rather than just, you know, maybe doom scrolling or so I, I think, like, there, there are a lot of tools now, like, you know, you can go on YouTube and, you know, 10 minute gentle yoga flow. And so I'll try to, like, give patients some of those ideas initially, and then sometimes they come back to me and they're like, "Look what I found." Or, you know, and they're, they're teaching me new things, like this movement journal. I was like, gosh, maybe I'll get one of these for myself. And then I also have been a really big fan of, I don't know if you've seen them before, but they're like, the wiggle boards, so you stand on it, and they kind of like, go back and forth a little bit. So I, I have a couple patients that are using those and finding them really helpful.

Rob Lutz 35:44
Is that, like your standing desk, or is that an actual it's got like a cylinder and then a board that you balance on?

Lexi Loch 35:50
It's more like a standing it almost looks like a scale, but like, you know, maybe eight inches high. And basically the whole premise is you can kind of adjust the settings from, like, low, which is going to be more of like you're moving your limp all the way up to, like, more of a intense workout, which is designed to help more with, like muscle strengthening and even bone building. So sometimes for people who, again, are having trouble getting into a regular, you know, exercise or movement routine, I think one of these boards which, you know, they're a couple $100 so they're definitely an investment. But I've had some patients really, really enjoy standing on them. I have one myself. Sometimes I'll even do some strength training on it, just to kind of, you know, build some different muscles or whatever. So, yeah, I think that we have, we have a lot of tools. We just, you know, need to find the right tool for the right patient.

Rob Lutz 36:36
Yeah? So you want them to move more, which, you know, is good advice for anybody? Yeah, right. Everybody. What about their diet? What do you look for? Or what do you try to, just tell me how what your approach is there?

Lexi Loch 36:48
So I'm generally of the impression of kind of recommending more of the Mediterranean like diet. Only because I think it can be really challenging for people when they go on some of these more restrictive diets. I think it almost acts as a little bit more of like a stressor in their life then So, and it's not just always about what we're eating, but it's also how we're eating. You know, can you take a few deep breaths before you eat? You know, really engage that parasympathetic nervous system preparing the body for food so we can actually break it down. So again, you know, taking a few deep breaths, really focusing on chewing. You know, there's a lot of people, they are eating in their cars. You've seen it, you know, we're driving, and people are, you know, taking bites of a burger. And it's like, okay, so you're driving, which is already stressful, at least for me, and now you're trying to eat as well. So, you know, it's kind of, I think, a little bit about, like, food hygiene, you know, giving gratitude for the food that we're eating, trying to slow down a little bit when we're eating, you know, eating with friends and family, because then you get some conversation. So, you know, it kind of slows down the actual food eating part. And then again, really trying to focus on more of, like the Mediterranean style of eating, so a lot of vegetables and some healthy grains, clean and lean proteins, healthy fats. I do think a lot of folks out there are not consuming enough protein, especially as you know, maybe they're getting a little bit older, so sometimes, if people maybe aren't like huge breakfast folks, I'll say, at least have a protein drink. Whatever your protein of choice is egg white, whey, you know, pea protein, other plant based proteins, because when we don't consume enough protein, then we're going to perhaps, over consume some of the carbs and things like that.

Rob Lutz 38:30
Yeah. And for me, you know, as soon as I eat something sugary, I'm going to want something sugary all day long.

Lexi Loch 38:35
Uh, yeah.

Rob Lutz 38:36
So I try to have all my willpower when I'm at the grocery store and I don't bring it home. And I've also, you know, shifted over the last few weeks to having a very but I think it's a much higher protein breakfast. So it's a couple of eggs, black beans, I saute up some spinach and some other veggies. And I feel like I don't need to eat for a while. It's very filling and sustaining. I would say.

Lexi Loch 38:57
Yeah, it kind of reminds me when I was in school and, you know, as like a kid, and it's like, you know, I could eat probably two or three bowls of Cinnamon Toast Crunch because there's really, like, no actual nutrients. You're like, I'm like, how am I still hungry? And now I think about how my thought process has changed around breakfast and really trying to focus on protein and getting vegetables in the morning. You know, I think we need to kind of re reclassify what a breakfast food is, and I think that's part of the education process, because most of us grew up with, you know, toast and orange juice and sugary cereals and all of these things. So again, that, that piece of education also comes in into the conversation. And then another one that I haven't quite touched on is also stress management. I mean, stress is a cause of inflammation. You know, our stress molecules promote inflammatory changes in the body. Prolonged periods of stress can even damage or shrink parts of our brain. So I'm really focusing on the stress management piece as well, whether that's, you know, helping find cognitive behavioral therapy for someone, or trying to find, you know, a couple minutes outside every day, or again, some deep breathing practices. I think, I think stresses is an often overlooked piece that also contributes to, you know, tangible inflammation in the body.

Rob Lutz 40:14
Yeah, I mean, you mentioned the parasympathetic nervous system. So I, you know, I've been variation the vagus nerve and kind of goes in hand with deep breathing and some of those things. Any thoughts about how vagus nerve tone or stimulation can impact inflammation?

Lexi Loch 40:30
Absolutely. I mean the vagus nerve,I think there are, like, some devices now, some like Vagus Nerve Stimulation devices, even some that, like clip onto the ear. I think it's really impactful, because the vagus nerve absolutely will help to reduce inflammation by putting us more into that parasympathetic state, which is the state we need to be in for healing and repair. Yeah, you know whether it's singing, singing is actually a really good exercise for the vagus nerve. So if you're a little shy about your voice, you know, do some showers singing, whatever it is, or, like some of the yawning or deep breathing exercises are also going to activate that vagus nerve and really just kind of improving what we call, like vagal tone, like, how tonified is your vagus nerve? Like we actually, at the clinic that I do some part time work at, we have a tool that can kind of look at your sympathetic versus parasympathetic balance. So it's really interesting, because most people, of course, are going to be very sympathetic dominant, but then when you find that, it's like, now, what are some tools we can give people to kind of help balance the scales a little bit more?

Rob Lutz 41:32
So is that heart rate variability that you guys are...?

Lexi Loch 41:34
Yes, yeah. And I know that, like a lot of the kind of smart tech, like wearable technologies, will look at some of the heart rate variability as well. This, the, the heart rate variability we have does, I think, give a little bit more kind of information versus, like, maybe what like a wearable might. But again, it, working on that heart rate variability, trying to increase it, you know, is super, super important, because we want our bodies to be able to adapt to changes, whether it's big or small, and not be a major stressor to our body.

Rob Lutz 42:04
Yeah, no, I find that really interesting. I do have a smart, smart watch, and so my heart rate variability when I'm, you know, feeling good or whatever, it goes very high at night, you know, when I'm sleeping, might be over 100 sometimes, if I'm sitting there watching TV, watching the news, it's gotten as low as, like, six. I think I'm almost dead at that point, you know. So I'm probably not even breathing, you know, just sitting there. But if I meditate, and, you know, the watch has this mindfulness setting that you can do it, I don't, I don't look at I just do my regular breathing stuff, but my heart rate variability while I'm doing that goes up over 100 so your breathing is just so incredibly important to to all this stuff. It sounds like, you know, so...

Lexi Loch 42:44
That's, that's amazing. I love getting some of that kind of real time data. I personally don't have one of the wearables. I'm considering getting one, just because I am curious of, you know, my own, like, how my heart of variability may shift, you know, in my day to day, like what I'm doing, but it's so interesting that you saw that it dropped so much when, like, watching TV versus, you know, meditating. So there are big shifts that we can make in our health by making, you know, some of these, these changes.

Rob Lutz 43:10
Like, if I could be more mindful with my breathing all the time, I'm sure my heart rate variability would remain high. But I'm not very good at that.

Lexi Loch 43:17
Yeah, it's easy to get stuck in kind of that more superficial type of breathing pattern, you know?

Rob Lutz 43:22
Exactly well. That was a really interesting tangent. Thank you for humoring me on that. Anything else you want to say about inflammation or treatments or anything like any other pearls words of wisdom for other practitioners that you'd like to share?

Lexi Loch 43:35
So kind of, if we're just thinking about where to start with someone, I'm generally going to start with the curcumin with turmeric essential oil, 750 milligrams, once or twice per day, most of the time. I'm also adding in, you know, the omega-3s with phospholipids and peptides, just because so many folks out there we know are, are deficient. And then again, if someone is also dealing with lung inflammation, GI inflammation, joint issues I may layer in Boswellia as part of more of a protocol. And there are some specific ingredients I like to combine when it comes to pain, because we know one of the feeling signs of high inflammation can be pain. So I think that there's a lot that we can do, and I'm generally, again, recommending these in combination with, you know, extra movement, focusing on nutrition, because, you know, as NDs, we are looking for that root cause and helping people establish those, those healthy foundations.

Rob Lutz 44:28
That's great. Well, thank you so much for coming on the show. This was very fun to talk with you, and very informative. I'm probably gonna ask you to come on again for something else, because this was great. I really do appreciate it. And thank you so much.

Lexi Loch 44:40
Yeah, thank you to everyone who's listening. Always, always, always, love to share, you know, information and learn from the podcast that I'm not on. You know, it's like I love to listen to to see what's going on out there. So thank you for having me.

Rob Lutz 44:52
Yeah, you're welcome.

Rob Lutz 44:55
Thanks for listening to the OneMedicine Podcast. I hope you found today's episode interesting and came away with a few insights you can apply to your practice. If you're looking for the show notes, they can be found in the link below. If you want to go deeper on this topic or anything else, please visit todayspractitioner.com and consider registering for our weekly newsletter as well. Thanks again, and I hope you'll join us next time.