Jill Brook: [00:00:00] Hello, fellow POTS patients, and marvelous people who care about POTS patients. I'm Jill Brook, your horizontal host, and today we are interviewing Dr. Kendal Stewart from Austin, Texas, and I am very excited to hear his thoughts on POTS and related conditions because he's a really smart doctor coming from a unique perspective.

He started his medical career as a neurosurgeon, specializing in surgeries at the base of the skull, and then pursuing functional medicine, genetic testing, nutrigenomics. I think he founded some companies in the biomedical space. For example, he founded Neurosensory Centers of America, which offers innovative tools for neurologic sensory dysfunction.

He has a lot of experience with complex neuro immune disorders and looking for root causes of illness. And he's using some somewhat novel approaches such as genetic testing and exosome therapy, just to name a couple. And he also has his own [00:01:00] podcast, Coffee with Dr. Stewart, where he explains a lot of his thinking about these complex disorders and his testing and treatment approaches and so much more.

So I am all ears today and I'm excited to hear what he has to say. Thank you for being here, Dr. Stewart.

Dr. Kendal Stewart: Oh, you're so welcome. Thank you for having me.

Jill Brook: So I'm not sure I did justice to your introduction because you've done so many different things. Do you want to fill it in or say more about your background?

Dr. Kendal Stewart: Well, you know, I will tell you that basically I, I would call myself probably a neuro immune specialist. So basically we, we know that the immune system and the nervous system are intimately linked and in most processes, which we really label as mostly syndromes. We don't have true diseases in a lot of these spaces.

They're mostly just syndromes, kind of like POTS. And the problem is with these syndromes, a lot of times the immune system is one of the underlying causative problems because it'll get turned on and turned on and [00:02:00] stuck and in a role of, chronic inflammation. And then the nervous system tends to, to get into trouble because of that, because it becomes the target.

And so in many, many of these diseases, you have to get back to understanding not only neurologic problems, but you also have to understand the immune system. You have to understand how to modify the system. You have to understand biochemistry and cell biology and all these other complexities in order to treat these patients. And you can't,

in that method fit into the classic western medicine model where I only take care of one organ system. So I like to say that it's kinda like having a car and you go to the garage and you take it and they say, well, we checked your carburetor, but we're only carburetor people, so we don't know. Your carburetor's fine, so go down the hall and find some, or go down the road and find somebody else that that can help you because we can't. And that's just not the way you, you have to deal with these types of patients because it has so many multi-system and complex symptomatology that a [00:03:00] lot of doctors don't have the time or the interest in hearing.

And so, we've been doing it about 25 years. Started on with complex the complexity of autism and autism recovery. And because my background is in skull base and ear, nose and throat, and I'm a vestibular specialist, so the vestibular system. And all the multi system integration kind of came from autism.

And if you start treating people or kids with autism, you wind up treating their parents with all these other neuro immune syndromes and their siblings who maybe were lucky enough not to get autism, but wind up with POTS and all types of other ADD, ADHD, you can just keep going down the list. And so you wind up taking care of families because there is genetic predisposition to a lot of these, these situations.

Jill Brook: Okay.

Dr. Kendal Stewart: So that's the best explanation I have for now. I like to just think I'm a doctor who pays attention to a lot of different areas, so...

Jill Brook: Well, I can tell that from your podcast. I love the way [00:04:00] that you talk and you can hop from topic to topic and I can tell that you're so knowledgeable about a lot of different things and you can connect dots. So I noticed though that at least in the podcasts of yours that I listened to, I had not heard you mention POTS yet.

So I am just dying to know how do you think of POTS?

Dr. Kendal Stewart: Well, so I think of it, well first of all it's a syndrome so everybody knows when they have POTS. You know what I mean? And I like to, the nice thing about it, I, I typically only do cash so I don't have to worry about a lot of things with insurance companies and putting people into little boxes because what's really going on with POTS is that you have the, the syndrome of postural orthostatic tachycardic syndrome, but it's always associated with something that's even more problematic. There's always other things going on. So you have the brain fog, you have the microglial activation, you have all this problems with good days and bad days and fluctuations, and you can have GI issues. You can just have all [00:05:00] types of complexities that all tend to fit under this subheading of POTS.

But really it, it depends on the patient who has it and what their unique aspects are. And so in our practice, we actually focus mostly on genetics because I did, I did found and build and sell a, a large nutrigenomics company that's is now known as Fagron Genetics. It was GX Sciences, but Fagron Genetics.

And so we'll always approach the POTS patient with something that tells us what's unique about them. And the nice thing about DNA is it tells us what their problem is. When you go to the doctor, you have to be selfish. You can't be somebody who goes in there and I mean, you can care that other POTS patients get better, but when you're in there, you really want your family or you to get better.

And so you have to be selfish. So we need to know what's wrong with you. And when you try to define POTS, you're gonna have maybe 2, 3, 4, I'm hoping to add another [00:06:00] one to your list of how POTS can occur. So you have different mechanisms that can give you problems. You obviously have the kind of the histamine mast cell model of POTS that you hear about.

You also have the hyper adrenergic model of POTS. I can tell you what we see the most of is actually the hypo adrenergic model of POTS, which you may have never heard of, and we really didn't know about until we started doing genetic testing and started looking at a specific gene called dopamine beta hydroxylase, which is the gene that converts dopamine into norepinephrine.

And we found out that about 70% of our POTS patients possess a mutation in that gene where they, when they make dopamine, they have trouble then making norepinephrine. They don't have enough norepinephrine that when they posturally stand up, they don't have enough sympathetic tone to constrict the blood vessels.

So the problem [00:07:00] is back in, I think it was 2008 when the first hyper adrenergic discussion was going on, those people get hypertension when they stand up, not hypotension. And you'll know that a lot of your POTS, they run around with blood pressures of 60 to 90 on a, on a good day. Do you know what I mean?

So they have this very low blood pressure, and when we started seeing the same gene pop up all the time, dopamine beta hydroxylase, and especially if you have a methylation problem with the methylation pathway and M-T-H-F-R or something of that nature, you don't make enough dopamine anyway because methyl folate's responsible for producing dopamine and serotonin, and if you don't have enough dopamine and can't convert it to norepinephrine, you essentially run around with low dopamine and extra low norepinephrine, and I would call it the hypo adrenergic form of POTS.

Jill Brook: Interesting.

Dr. Kendal Stewart: And so that is something that we see in about 70% of the patients that we, that we [00:08:00] have with POTS.

Now, if it's, if you've got a homozygous mutation, which means you've got two copies of that gene, one from your mom and one from your dad, you really have a lot of difficulty making norepinephrine in enough quantity to essentially maintain sympathetic tone, especially when you're changing positions. We also know it has a lot to do, believe it or not, with imprinting of short-term memory.

So we do know that a lot of these, these patients have difficulty not with, not necessarily focusing and concentrating and organizing, but they have to hear something over and over and over to commit it to memory because that's more of a norepinephrine type of process. So the way I like to do it when a POTS patient's come in I like to talk to 'em, and we gotta get background, we've gotta know, are we dealing with a hyper inflammatory person?

Are we dealing with some potential for mast cell [00:09:00] sensitivity? Are we dealing for something that is giving us too much just inflammatory potential in the system because nothing works good with inflammation. Okay. Whether it's the autonomic nervous system, whether it's the gut, whether it's you in general, you just don't feel good when you've got too many histamines and other chemicals floating around.

But then we'll dive into the genes and we'll figure out are we dealing with a problem with not having enough methylation. What are we doing from a neurotransmitter standpoint that is not allowing us to have this patient function the way they should? So when you take those POTS patients who basically go on a beta blocker and feel horrible, those people are not hyper adrenergic, they're hypo adrenergic, and you just made it worse because the heart rate was the only thing that could really come up to try to maintain that blood pressure and you dysregulated it.

And so I would encourage all of your POTS patients to get a [00:10:00] very simple genetic test because you'll be able to direct the path of how you go about treating it. And we can talk about that in great detail. But in general, I think we, I haven't seen in the literature it mentioned this hypo adrenergic form, although we see it, I mean, every week.

So it's it's a big issue.

Jill Brook: Wow. And if somebody does not have enough adrenaline to get the vasoconstriction, is there's something you can give them to replace that or bring it up.

Dr. Kendal Stewart: So I can tell you I had an absolute flood of high quality national level swimmers. And what happened is, you know how patients follow pipelines. So if one patient comes, it's like the scout, and once they see you, they send everybody else. Well, I had about seven girls in a row over about, oh, a 12 month period, and they were all national level swimmers and they all wound up passing out in the pool. Okay. Meaning they were doing a lot of physical [00:11:00] activity and many of 'em had to be rescued by a coach. Some of 'em were rescued by competitors. It was a, it's a wonderful comradery that we saw, but I mean, these, these, this is very serious stuff.

Some of them, a couple of them really felt like they were gonna drown. And so, what essentially happened is we wound up working up seven of those girls. Okay. Which was really interesting. And we found out six of 'em actually had the DBH mutation of the seven. And that DBH mutation, it depends when you're, when you're dealing with POTS, you've gotta say, what are, what are we trying to return to a normal state for this individual?

So for a national level swimmer, they want to go back to swimming at a national competitive level. And so, what we were very successful if we had a low norepinephrine state in using a medicine, and I don't love a lot of prescription medicines, it's just kind of my nature. If I use medicines, I typically use medicines from the [00:12:00] 1970s 'cause they came more from plant derivatives back then.

But there is a medicine called Sunosi, and Sunosi is an SNRI. Okay. Which means it's a selective neurotransmitter reuptake inhibitor. Not an SSRI. We don't want to just mess with serotonin. We want something that helps both, and Sunosi has the unique ability to help both dopamine and norepinephrine. And it gently blocks the re-uptake of those two agents.

So we raise the dopamine and the norepinephrine levels just enough to where they can function. Okay. And what I mean by function for a swimmer, they can actually go and compete. And of course you then have to tell 'em, you gotta hydrate. Swimmers are notorious for not hydrating well enough, are in water, but why do I need to drink water?

I mean, it's all kinds of excuses. But you, you have to just go about making sure that they understand that and Sunosi, when it's used, it can help them overcome those bad bouts. Because you know, those worst bouts [00:13:00] with the autonomic system always come around something else that's happening, that's inflammatory.

So in girls, it's usually their cycle. Usually they're gonna have the biggest problem a few days before their cycle when their uterus is in massive inflammation. They can be externally sick. We can have chronic viral infections. Epstein Barr, believe it or not, has made a big aggressive return after COVID because of some other genetic mutations that we notice that tend to activate it more.

And so we're always gonna approach it from a foundation of objectivity. I want to know what this person needs. Now, in the swimmer who did not have the dopamine beta hydroxylase mutation, that kind of surprised us. But we wound up finding out that she had an HNMT mutation, which means she basically had a mast cell, a mast cell type of syndrome, however you wanna define that.

Jill Brook: Is that the one where you cannot break down your [00:14:00] histamines?

Dr. Kendal Stewart: Correct. Yeah. And that's the one that really helps us with the, so there's two, two genes in the body that handle histamine. There's the diamine oxidase, and that gene is the AOC1, amino oxidase copper containing one, not the DAO gene.

Jill Brook: Okay.

Dr. Kendal Stewart: So you gotta remember that. We figured that out about 15 years ago.

But some people are looking at the wrong gene. DAO stands for D-amino acid oxidase, which is actually a schizophrenia marker. It's not the diamine oxidase of histamine. And then the HNMT is the histamine in methyl transferase, which actually methylates histamine to degrade it in the cell. And the reason God gives us two of those genes is because getting rid of histamine is really important. Once we release it or we get exposed to it from outside or foods or however we do it, we've gotta degrade it quickly or else we're gonna have this massive inflammatory response. So when those genes are weak, [00:15:00] we really, really do have an excessive type of syndrome that a lot of doctors also don't recognize, which you would know as mast cell syndrome or other things like that.

Jill Brook: Yeah, and I guess, so a lot of the physicians that I've interviewed would absolutely say that MCAS can drive POTS, but is that what you are saying?

Dr. Kendal Stewart: Yeah, because histamine itself is a, is a vasodilator. So the problem is you gotta find out what's important in the patient I'm sitting in front of. You know, we can't, we can't in general medicine, western medicine, we can't take everybody with all these varied, not only just culturally, but genetic backgrounds.

I mean, you're Anglo, I'm Anglo, but our genetics can be massively different. And we can't just throw everybody into a pot and see how things go. We've gotta know what works for you versus what works for me. And so that's why genetics is so unique, because what genetics can tell us is what's really wrong with the patient that we're dealing with, because that's what you're there for.

Jill Brook: [00:16:00] Wow, that's amazing. So how does it work with your genetic testing and how much can you learn about someone?

Dr. Kendal Stewart: So this is nutrigenomics. So the three types of genetic testing, there's what I call doom and gloom genetics, and I, I don't love to call it that, but those are the genetics of disease, which is what we call exome sequencing, which means if you if you don't make a specific protein or something, you essentially have a disease where you're missing a, an enzyme or a protein.

Okay. There's pharmacogenetics where we can actually look at your liver enzymes and tell how well you can break down drugs and hormones, et cetera. And, and that's very, very useful. And then there's nutrigenomics, which tells us about the nutritional elements that your body takes in or is exposed to. How do we handle them, how do we break down

or convert them and how do we then get rid of 'em and, and send them out of the body? So nutrigenomics to me is the most [00:17:00] dynamic of these because if something's missing, I can just put it back into you and I can expect the system to return to normal. I just have to know what state to put it back into you.

So we started doing nutrigenomics very aggressively in about 2015 or so. Kind of a long story, but we were working with a couple of labs and we couldn't get 'em to keep up, so me and another partner went down to the bank and borrowed a bunch of money and went and opened our own. And so that's kind of what happened, and it's kind of taken off.

In fact we sold GX Sciences about three years ago. It's now Fagron Genetics. You should look that up. It's very, very good company. I'm still the medical director there, so they're doing all kinds of wonderful work, but we're actually moving on into more sophisticated genetic testing and a few other companies where we can look at Alzheimer's risk and concussion recovery and all that type of stuff.

So we're doing all kinds of neat things in genetics. But the nice thing about genetics is it tells [00:18:00] us about the individual. Okay, so nutrigenomics, my best analogy for this would probably be what I call the vegetable soup analogy. So, what you really want to know when you're doing supplements or if you're, even if you're doing medications, you want know what you need, and you want to know what you don't need, because nobody wants a guess. Okay? So imagine you're gonna make a vegetable soup. What's the first thing you're gonna do?

Jill Brook: Chop a bunch of vegetables.

Dr. Kendal Stewart: No, you missed it. You missed it. The answer is if you're smart, you look in the fridge and see what you got. Okay? Now, why you look in the fridge is if you've already got some things, you go to the store and you buy what you need. Okay? If you miss the fridge, you go to the store and you buy everything, and you come home and you get really disappointed when you go to look in the fridge and you already had some carrots and potatoes and you just wasted your money.

You really didn't need it. So that's what nutrigenomics is about. Nutrigenomics tells us, [00:19:00] what do you do well, what do you convert well, what do you deliver well, and what do you not? So we only have to put back in what's necessary. Now, what that really involves is a lot of complexities and in fact, the test that I'm describing, we have about 120 genes that we look at that has to do with basically I kind of parsed through about 10,000 genes and came up with about 120 that were scientifically validated and really allowed us to help people recover, because that's what doctors are here for. We're not here for telling you your diagnosis. We're here for telling you how to get out of your problem.

And so we've got to, we've got to have some methodology that's objective and scientific where we can know what to do, what to do in you as an individual. And so we look at that and we replace what, what we see as necessary. And some of the, there's some elegance to it, you know, there's some art to it because you can't just throw everything you want into it.

You [00:20:00] have to, you have to kind of sometimes know when to put things in, when to put other things in. And then what you do is you essentially make the body a whole organism again, where it's functioning with all its parts, and it tends to wanna function better. The only caveat is we're really looking at a lot of people, especially in the POTS world, who have basically very aggressive on switches of inflammation and very poor off switches of inflammation.

Jill Brook: That's me.

Dr. Kendal Stewart: Yeah. And so in order for us to use something long term to shut off that inflammation, which is the first step of all healing, I like to tell people if I hurt my knee and it swelled up and I'm a man, what do you think the chance is I'm gonna sit in a chair for a couple of weeks and waiting, waiting for that swelling to go down. It's just not gonna happen. So if I get up and I keep walking on that knee and it stays swollen, how well will it heal? It won't. And nobody's [00:21:00] ever missed that question. But when we're talking about the microglia in the nervous system, we're talking about intestinal inflammation from leaky gut, other things. If we're talking about chronic autoimmune type of phenomenon, these people have inflammation that they turn on all the time, but what's really happened is one of their off switches or one of their systems that is not, is supposed to regulate the control of that inflammation, is not working well.

So we're able to look through the JAK-STAT system. We're able to look at the tumor necrosis factor system. We're able to look at the Toll-like receptor system. We're able to tell which system is really problematic or are all of them problematic, and we're able to determine which things that we use to turn off that inflammation are assist them in doing it that are safe long term.

So we will use things like as simple as vitamin D, bioidentical hormones like progesterone, testosterone in men because they're steroids. Vitamin D is a [00:22:00] steroid too. Most people don't know that. But we also will use low-dose naltrexone. We'll use, we'll use certain types of peptides. Thymosin alpha-1, thymosin beta-4 is really popular for us right now.

We have BPC-157. We have all kinds of new techniques, and these are safe therapeutics that you can be on for long periods of time to help buffer your immune system down so that you can get rid of that primary problem, which is that inflammatory potential. So the problem is you can't just go about life and try to avoid every trigger for inflammation because that's how God built it.

So what we have to do is we have to take and buffer, buffer the system down so that we can get past even the first step of healing.

Jill Brook: Wow, that's interesting. And, and you had said that you don't love making drugs your first stop.

Dr. Kendal Stewart: Well, if I use drugs, if I use drugs, I love them from the 1970s. Do you know why?

Jill Brook: [00:23:00] No. Tell me more.

Dr. Kendal Stewart: Okay, so they were made from plant derivatives. Yeah. Most of the studies that were done in the sixties or seventies, they would grow all these exotic plants in greenhouses. In fact, my dad was a pharmacist before he became a physician.

And at the University of Texas in 1959, his job, because he he was poor, was to water all the exotic plants in the, in the greenhouses during pharmacy school so he could afford to go. And so it was kind of interesting growing up with him because we'd be walking across the field and he'd stop and pick up a plant and say, here, smell this and feel it and taste it. And, and he would tell me about medicinal properties, you know. So that's kind of how we did it. But then around the early eighties we started well the patent office basically made a decision to not let us patent things that are naturally occurring.

And so that created a whole new problem because you couldn't study something from a plant and extract it and then patent it, so we then had to change it [00:24:00] biochemically into something that was patentable as an artificial chemical. So I tend to love things from the seventies just because I can tell where the source, where the source was from.

Now with that being said, like low-dose Naltrexone, many of your patients probably know about that, many of your, your listeners. You know that Naltrexone was created in 1972, I believe. And I can tell you that what we're looking for is just opportunities to take the immune system and just dial down the buffering because what's really happened in most of these patients and COVID is particularly bad at showing this, is we have T cells, which are basically cells that kill viruses, bacteria, fungus, yeast, and cancer. They're called thymic cells. Okay? And then we have B cells, which are bone marrow cells, and those make antibodies and control inflammation from our adaptive immune system. Well, they're supposed to be in a perfect balance.

The problem [00:25:00] is that balance is a lot of times thrown off. So in COVID we had so much stress on the T cells. They were so stressed by this chronic spike protein infection, et cetera, that they started depleting, and in fact, some major institutions, which I won't mention have actually mentioned that it's almost the new AIDS. In fact, they're, they're calling it COVID, and COVID acquired AIDS in some people where their T cells are so depleted, they really cannot fight infection very well. Well, what happens in that scenario is God has a fail safe, and that's to take these B cells that make antibodies and and create a lot of inflammation and make them hyperactive.

So everybody comes in in this skewed fashion where they're very off kilter in their ability to kill versus inflame. And the only option they have is really to inflame. So what we're doing over time, we'll get hold of the inflammation by buffering it, but we're, what we're [00:26:00] really up to is rebalancing that immune system and reestablishing the normal balance of the T cells.

And that's why in our hands, the thymosin peptides, which come from the thymus gland, are so effective at assisting us at recovering those T cells.

Jill Brook: Oh, wow. Nobody else is talking about this, in the world of POTS. Are you educating people?

Dr. Kendal Stewart: Sure. We educate it because we're, we're not just, we don't want to, when you come in with POTS, I'm not gonna ask and only take care of your POTS. I'm gonna take care of your body. POTS is one of the things you came in with. It's like coming in with a headache. Okay, but I've gotta get your body healthy too.

You know what I mean? So ultimately we can help you deal with your POTS in the short term, meaning we can make you feel better. But what we really want to do is get it to go away. And there's always something underneath that's driving, driving the factor to make you symptomatic enough to get to the doctor, because the problem is [00:27:00] chronic inflammation. And dysautonomia, for instance, inflammation in the autonomic system just sets POTS on fire.

So you just, you know, we gotta get to the underlying dysautonomia. How can we keep that autonomic system calm, calm and, and relaxed? So even if you do have a little bit of lightheadedness, when you get up out of that chair, it's not so bad that you're passing out in school or can't go to work or, you know what I mean, we've, we've gotta have it at a manageable state.

Jill Brook: Right. Right. And so are there any other tests or treatments that you are finding helpful on POTS patients? Like I know in your podcast you've talked a lot about using exosomes. Is that something that you use on POTS patients very often?

Dr. Kendal Stewart: The answer is yes. A lot of this has to do with economics, to be honest with you. There are lots of therapeutics that work great, but they're very proud of them. Okay. And I wish they weren't. Exosomes work very, very [00:28:00] well in doing several things. Exosomes, basically the, the ones that we typically use, we use 'em in an IV fashion.

They, they do come from amniotic fluid, so ours come from amniotic derived. So what we do is we take the amniotic fluid that we harvest at the time of C-section. We then filter it with 140 nanometer filter, which takes off all the DNA, all the tissues. We're not transferring DNA from any person to any other person.

Okay? But remember a stem cell, and the reason we like the amniotic fluid is that's mom's stem cells and also the fetus's or the, the newborn's stem cells. And so we, there's advantages to both, adult stem cells versus neonatal stem cells have some advantages that are unique to, to each other that are just a little bit different.

But what those essentially do is every stem cell thinks it can grow a whole new baby. And so that stem cell is secreting billions of [00:29:00] little vesicles that we call exosomes, and those exosomes are giving information to the cells around it and communicating. And what's really unique, most people don't quite realize how much communication is going on from cell to cell in different organs, in particular in the nervous system and other aspects of that.

I think we're, we really underestimate it a lot, okay. Now those exosomes will contain three things. One of 'em is messenger RNA, which means it can go from one cell to the next and tell you to make a protein that can repair anything in the body. And so that's the healing factor that you see with exosomes.

The second one is called micro RNA. Micro RNA is able to shut off inflammation. In fact, what I like to say is God will not allow inflammation to occur in a uterus when a baby's growing because if there was inflammation there that would screw up the baby's development. So he has this special [00:30:00] exosomic micro RNA, that will shut off inflammation very effectively.

So when we give an exosome, if you feel better the next week, that is not messenger RNA repairing you. That is us turning off the inflammation in your body with the micro RNA. Whereas what you will see a couple of months from then when your nails are growing like crazy, your hair's growing and all that, that's the messenger RNA repairing you.

And then the third thing is tumor suppressors. A lot of exosomes have tumor suppressors in them because the baby's cells are growing so fast that if we didn't have a tumor suppressor, most babies would be born with a benign tumor. So imagine how common birthmarks are, for instance. Well, imagine if those were benign tumors coming out of kids.

So in general, those three things, when we give 'em, we get the advantage of all of 'em. So as far as inflammation control and repair of especially the autonomic nervous system, because the problem is what you're dealing with in the nervous system [00:31:00] is you're dealing with the support cells that we call the microglia.

So the microglia, and in fact we like to label autism, some of these psychiatric diseases, things like POTS where there's a lot of inflammation, we like to label 'em microglial activation syndromes. Something turned on the inflammation of that nervous system, and they can't turn it back off.

So microglia do two things. One is they create inflammation, but they also release glutamate. And glutamate stimulates the nervous system. And so that's why a lot of these POTS patients are not just hypotensive and don't feel good, but they're wound up. They're, they're distractible, they're, they're hyper-focused on everything around them.

They run around with anxiety that's through the roof. And that's, that's essentially to some degree a glutamate storm, but to some degree just a hyper glutamate type of protection mechanism. Meaning if I had POTS and I was in the woods and my friends didn't have POTS, and [00:32:00] a bear came into camp, who's the bear gonna get?

It's gonna get the person with POTS. And so God knows that. So he's dialed up all this hyperawareness, and we call it the magnocellular system of the brain. It's the protection system, so it heightens your peripheral vision, heightens your hearing sensitivity, heightens your smell sensitivity, and makes you hyper aware of your surroundings and it protects you from danger because we are supposed to live in the woods.

And so in, in that facet, by using exosomes, we can dial down a lot of that fairly quickly if we're in trouble. The problem is, I mean, in our clinic we charge about $3,000 for a very high concentration of 'em. And I know doctors clinics that charge way higher than that, but it's just, they're wonderful to use, but they're economically more expensive than I would've liked.

Jill Brook: And is that something that you do a number of times for a treatment?

Dr. Kendal Stewart: So here's the way I do it. I never wanna be a [00:33:00] doctor who's caught trying to sell high dollar items to people. It's just not my nature. So I can typically recommend or explain the first one to you. And I have patients get it, and then I tell 'em I'll never, I'll never tell you to get another one, but if you ask me for one and you want another one, I'll be glad to give it to you.

So that's kind of how I handle it because I want you to experience, does it, did it work for you? And if it, if it worked for you and you want another one, you can come back and I have 'em all the time sitting in the freezer, you know, in our IV room. But you're gonna have to ask me for one 'cause I don't want to be sitting there pushing you for what you would consider as some kind of economic benefit to me.

Jill Brook: Right, right. So another tool that I think you've mentioned in some of your podcasts that maybe is less expensive, and I don't know if you use it for the same thing, is CBD. Do you use that to fight inflammation?

Dr. Kendal Stewart: When you're dealing with the T cell or the microglia or whatever immune cell you're dealing with, there are certain [00:34:00] receptors on those cells that can give us control. Okay. The most effective one is the steroid receptor. That steroid receptor responds to cortisol, responds to progesterone, mostly in women, and testosterone in men.

When a man's 20 years old and his testosterone's through the roof, he can tear his body down as much as he wants, and the next day he can get up and do it again because he didn't get so much inflammation. Now with women, you have, unfortunately, you have the PMS period and your cycle where your progesterone tends to be lower.

So we do see more inflammatory potential and more symptomatology around that premenstrual period. And then basically we have the steroid receptor effective, but the problem is long-term steroids don't work very well unless they're bioidentical. So we can boost a man's testosterone either by, you know, outside sources.

We like to use a peptide [00:35:00] for young men to tell, it's called gonadorelin. It tells the testicles to make more testosterone if they need it. In women, we like a little bit of low dose bioidentical progesterone in some situations for many different reasons. The next thing we typically will use is we have the opiate receptor. And the opiate receptor is a, is a on switch, which means that when you make endorphins and you are trying to help deal with stress and neurological stress and everything you'll make, you'll do something to make endorphins and they do calm your brain, but they tell the immune system to rev up because they think it's a crisis.

So by using low-dose Naltrexone, we go in and we gently block that so that we're not, we're not getting an upregulation in somebody who needs a lot of endorphin help. Because when you have POTS, you're stressed. I mean, and, and chronic stress can kill people. [00:36:00] It is very aggressive at that. So the reason we use that low dose Naltrexone is to go in there and hopefully gently block the immune upregulation from the anxiety you're suffering from.

We then have the CB-2 receptor, which responds very well to CBD oil. Okay. Now we know there's some unique facets to it, meaning it works fantastic for some people and it doesn't work worth a flip for other people. So unfortunately the people who it works for, it is great, and you can't talk 'em out of it.

And then some people try it and they go, I mean, they take an enormous amount and they don't feel anything. Okay. And I know that because I'm one of them. It doesn't do squat for me. Okay. But when I put my young seizure patients on low dose Naltrexone and CBD oil, we control about 80% of 'em without having to use any anti-seizure medicine because we're able to shut the inflammation down.

So CBD is a wonderful thing if it works for you. [00:37:00] Okay. And that's what you really want. You're there to find out what works for you, not for everybody else. I mean, you can be, you can be happy for other people, but you really wanna fix yourself. And then we, we then also have, um, some other receptors for things like thymosin and other peptides that can actually help the immune system calm itself down.

And so we focus on those ones that we can hit for long periods of time and give us a layer of control without getting any secondary side effects or long-term effects from any of this. We're not looking to immune suppress. We are looking to immune control. And that's what people don't really understand.

Because if they say, you know, if somebody's in really big trouble, we'll use a special depot steroid called Depo-Medrol, which is a low slow release steroid, and people are like, well, you're gonna immunosuppress the patient. And I'm like, exactly. I am gonna bring their [00:38:00] immune system from up here, down to here. 'Cause I have to bring it back to normal. But I'm not gonna give 'em so much that we're suppressing the immune system into non-existence. So controlling inflammation is probably the hardest part of medical practice and it's the first step, unfortunately, in healing everything.

So it becomes a very difficult thing for doctors to get your hands around because there's not one size fits all .

You have to find out what works for the patient and for you. And so, some of it's a little bit experimentation. We do know that the peptides work. The problem is peptides, we use 'em in a sublingual manner and a lot of 'em are oral. A lot of people use injectables. And so the only two that always work are bioidentical, like peptides, and steroids always seem to work, so that's why we like those.

But the low dose Naltrexone can be his hit or miss. The CBD oil can be hit or miss. But if it works for you, we're, we're very happy. [00:39:00] Trust me.

Jill Brook: Wow. As you had said, a lot of POTS patients have something in addition to their POTS or maybe a few things in addition to their POTS. And you had mentioned Mast Cell Activation Syndrome, and I don't know if you have anything more to say about that, but the other one that comes to mind is the hypermobility.

And a lot of times I think those people feel like, well, it's just genetics, so I'm just outta luck. There's nothing I can do. Is that your understanding as well?

Dr. Kendal Stewart: Well, there's two things about that. So one, if you're EDS for instance or hypermobility, you basically have connected tissue that's a little bit stretchier than other people, which means that from an autonomic standpoint, we have to squeeze it a lot harder with that epinephrine response in order for us to get the blood vessels to not be as compliant.

And that's why when they get older, we have to, we have to image their aorta to make sure we're not getting, uh, you know, an aorta that's blowing up because they're so hypermobile. Now, the problem too, though, is most EDS patients, unfortunately also [00:40:00] most of 'em have an M-T-H-F-R or a methylation deficiency too, which seems to go with EDS very heavily.

So if you don't make methylfolate, so what happens is methylfolate, which is the active form of folic acid, is responsible for helping tetrahydrobiopterin. Tetrahydrobiopterin is the co-factor that helps tyrosine convert to dopamine and helps 5-hydroxytryptophan convert to serotonin.

So the problem is if you don't have enough methylfolate, you're not making enough dopamine and therefore you're not making enough norepinephrine, so you've always gotta look at that M-T-H-F-R and not just M-T-H-F-R 'cause it's just the last step in the pathway. You gotta look at all of them. Does that make sense? So it, a lot of times it, it has to do with which part of it are you dealing with.

So if you help them with methylfolate, a lot of times you can take that Ehlers-Danlos or hypermobility patient and you can really [00:41:00] impact them a whole lot more. Now, they tend to be more symptomatic just because of the EDS, but they certainly aren't completely out of luck. We just have to be much more aggressive.

Jill Brook: Okay. That's great to know. So, in order to do the genetic testing and the other treatments, do people need to come and see you in person or do you do any of these things like virtually?

Dr. Kendal Stewart: So there's two things going on. You can come and see me in person. That's not a problem. We actually have a brand new company launching next month called Helix Revolution.

And Helix Revolution is going to essentially have these genetic panels available direct to the consumer. And basically they're small genetic panels that I'm gonna shoot videos on how to interpret them. I'm gonna shoot videos on how we built the supplements to assist these. Now the only difference is, is that that will only be with supplements and not with medical not with [00:42:00] prescriptions. If you need those, you will have to see a doctor to do that. But, and you know, it was really not built for POTS patients. POTS patients are very complicated. You gotta have a doctor who really knows what's going on.

And so, we, I mean, we would love to see 'em, but we know that we are completely limited in the, in the scalability to get to everybody. Do you see what I'm saying? So what we're really trying to do is just educate people on all these, these options. But I will tell you that the biggest thing I think to add to the POTS community is this hypo adrenergic POTS that we've actually seen so much of. So I usually get people that who have failed other physicians, meaning they've been to the cardiologist, they tried to deal with it, they've been to other specialists, and then they wind up in my office. And then using genetics, we'll see that they have a dopamine beta hydroxylase, and, and then we know their answer.

So, you know, my practice is a little bit skewed. You've seen a lot of doctors before you typically get to me. And [00:43:00] so we wanna make sure that we would love to see 'em. We just wanna make sure that you, you have a good understanding of the physiology and how this can occur. And I'm gonna tell you, no matter what you have in the nervous system, whether you have any neurological disorder, if you've got mast cell activation, you're gonna have to have somebody who really knows what they're doing, deal with that for you.

You just cannot sit there and have your, your immune cells going off all the time and live, live a quality life. It's just not gonna happen. And you can't run around on eggshells, wondering about every little place you go, every little food you eat, can't go out to dinner. You know, you gotta have something that actually somebody who can help you reign that in and, and get you past that, that, uh, that kind of fearful kind of state.

Jill Brook: Yeah, do any of the things that you've talked about for inflammation work for the mast cell type of inflammation?

Dr. Kendal Stewart: So we make a supplement. So I designed for [00:44:00] Neurobiologix. I founded Neurobiologix. I don't know if you know that supplement company.

We made a a basically a supplement that's called GI Hist support, and what we've actually learned, there's actually one organ that cannot tolerate histamine in it, and that is actually the kidney.

So if the histamine hits the kidney, all the micro tubules that filter all your, your urine and, and reabsorb all, all of your electrolytes are, it just becomes a disaster. So it turns out the most effective place you can find diamine oxidase. Which is the, the antihistamine, uh, or the histamine breakdown product is actually in porcine kidneys, in, in pig kidneys.

That product contains porcine kidneys and it it also has other things like bromelain and other things of that nature to help deal with that, but it's all in one. What we do at Neurobiologix is I tend to make a whole recipe of things in a single bottle. So you're not having to try these different bottles.

My thought process behind that is if I put [00:45:00] everything that we know could possibly work, hopefully one of those will work for you. So, so that one is very, very popular. It works very, very well. You take it before you eat. You take it after you eat. You take it if you suspect a histamine type of response.

But it really is made mostly for external histamine sources. So when we get down to internal histamine issues where we really have the mast cell in a hypersensitivity state, we're gonna have to use something that's basically typically peptide based to dial the sensitivity down. And one of the things that does that fairly well is called BPC-157.

It might be something that you've heard about before. But BPC-157 has an excellent response on mast cells that most people don't know. A lot of people think of it as a gut, a gut healing thing or a connective tissue. But remember, the gut has to have a beautiful mucosal lining to keep basically the gut from leaking.

And so when you [00:46:00] have your mast cell syndrome, a lot of those mast cells are sitting there around the gut because it's the number one source of contamination in people. And so BPC-157 does a pretty good job at controlling that, if you are, if you're very consistent with it.

Jill Brook: And my understanding is that you have to be really careful about your source of these peptides. Otherwise they can have some nasties in them.

Dr. Kendal Stewart: Well, we get 'em only at a pharmacy. So I tell my pharmacy to, to buy 'em and I have a compounding pharmacy near my office that does all of our peptides. And the reason I get 'em there is for one reason. Uh, everything that goes into that pharmacy has to be third party assayed for purity. And so we take in all the raw materials we get, it has to be third party assayed. They have to keep that certificate and I can ask for it for any time. And that's why I get it there, as opposed to distributing it in my office. So yes, you have to be very, very, very careful because a lot of it is not what you think it is.

Jill Brook: Right, right. Well, this is so much great information [00:47:00] and a lot of, a lot of alternatives that are not being offered at the average doctor's office right now. And so this is a lot of, a lot of good hopeful stuff. Where can people find you online if they wanna learn more?

Dr. Kendal Stewart: So you can go to Coffee with Dr. Stewart and that'll link you, or you can go to drkendalstewart.com and you can find me, or you can probably find me all over the internet if you just look. I like the lecture, I like to talk. I really like to teach and I like people to understand why they're doing things and so I think, I don't think you'll have too much trouble finding me.

Jill Brook: Okay, perfect. And we'll also put those links in the show notes so that people have it handy.

Dr. Kendal Stewart: Sounds good. I really would appreciate that. So, and then keep an eye out for Helix Revolution. If you have relatives that are looking for that kind of thing, I think you'll be very impressed when that's all launched.

We just got a lot of video and things and education to shoot.

Jill Brook: So this has been tons of wonderful information, Dr. Stewart. Thank you so much for your time. Thank you so much for all thi s thinking that you do and connecting [00:48:00] dots and coming up with solutions for people to try. This is a, a lot, a lot of hopeful things and I'm gonna go make some notes right now selfishly of things I'm excited to try. So, so thanks a million.

Dr. Kendal Stewart: Well listen, you're so welcome. I'll talk to you later.

Jill Brook: Okay, great. Alright everybody, that's all for today. We'll be back soon with another episode, but until then, thank you for listening, remember you're not alone, and please join us again soon.