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STORY AT-A-GLANCE
Dr. Ahvie Herskowitz, a former UCSF professor, treats complex health issues by addressing root causes. He believes microbiome problems and leaky gut are fundamental to many diseases, including cancer and autoimmune disorders
Chronic diseases often result from accumulated toxicities and nutritional deficiencies. Herskowitz estimates 80%-90% of Americans have metabolic syndrome, largely due to processed foods and environmental toxins
"Nuisance symptoms" like toenail fungus or indigestion may indicate underlying health issues. Herskowitz found Alzheimer's patients had 2.5 times more such symptoms compared to healthy individuals
To measure biological age, Herskowitz uses tests for oxidative stress, chronic immune function, mitochondrial function, and senescent cells. He also emphasizes the importance of monitoring serum ferritin levels
Herskowitz describes an innovative cancer test that analyzes tumor genomics to guide chemotherapy decisions. He believes this approach could revolutionize cancer treatment in the United States
I recently interviewed Dr. Ahvie Herskowitz, former clinical professor of medicine at the University of California, San Francisco, and founder of Anatara Medicine, a multidisciplinary integrative center in San Francisco.1 Herskowitz, an internist, has a deep foundational knowledge and science background that’s ideal for treating complicated health care cases.
We may be collaborating on a project in the future, but in the meantime at his center, they’re using advanced techniques to help people restore their health, including strategies for longevity and treatments for very ill patients, including those with autoimmunity, gut problems, cancer and more.
Microbiome Issues, Leaky Gut Causing Failure to Thrive
Herskowitz treats illness by looking at the foundational causes of disease. We discussed that a leading cause of death is, in my view, endotoxemia resulting in septic shock. This occurs when you secrete endotoxin from facultative anaerobes, otherwise called oxygen-tolerant bacteria, which shouldn't be in your gut.
These pathogenic bacteria secrete a very virulent form of endotoxin, also known as lipopolysaccharides (LPS), which can cause inflammation if they translocate across the compromised gut barrier into the systemic circulation. Leaky gut, or a disturbed microbiome, is therefore one of the foundational causes of all disease.
Herskowitz explains, “I think that everyone that's doing poorly and failing to thrive has a biome issue and a leaky gut issue, almost 100% … And in the standard allopathic intensive care units, it's not considered a foundational issue.” When Herskowitz treats cancer patients, he says, they’re often in a state of failure to thrive.
“They've gotten so burdened by so many different layers of toxicity, that their system cannot keep up anymore enough,” he says. “And … that's eventually due to mitochondrial failure throughout the body.”
Patients Overwhelmed by Toxicity and Nutritionally Depleted
Chronic diseases often result due to a buildup of toxicities and a lack nutrition and healing in the body to compensate for them. “All these toxicities affect every cell of the body simultaneously,” Herskowitz says.
“So, we all have relative strengths and weaknesses. And that comes up as to what organ is going to be the most involved. But we all have to almost decide whether we're going to release these toxins on a day-to-day basis, otherwise our concept of longevity is going to be badly estimated.”
Herskowitz estimates that 80% to 90% of the U.S. population has metabolic syndrome, which increases the risk of heart disease, stroke and Type 2 diabetes. Obesity is another epidemic. Both are due to several factors, including toxicity that started more than 50 years ago as the food supply became increasingly processed. Herskowitz explains:
“This is where you get to the concept of an infinite number of toxicities, feeding a system that only has a finite way of cellular responses … it's the seed oils [containing] linoleic acid, it's the ultraprocessed foods and snacks. So, when you go to a general store today …
The overwhelming majority of the food that's sold there is not to be for human consumption … and then the concept of our farming system has evolved toward efficiency … listen, industry is not our friend. It's not our partner … their job is to sell more stuff, and to do so in an efficient way.
… I watched it over 45 years, I mean, ‘70s, ‘80s, 90s, this stuff is getting worse. Now the most difficult group to get an appointment with in the hospital is not the cardiology department, because it's usually the largest department, but it's endocrine and rheumatology, neurology.”
In other words, exposure to ultraprocessed foods and other toxicities is wreaking havoc in the body, leading to widespread chronic disease. “It causes havoc within the communications network, so that hormones go awry, inflammation goes awry and the detoxification system is overwhelmed,” Herskowitz explains.
“This leads to all the different disorders … it's a straightforward thing … you have this nutrient depletion, which obviously … you're more susceptible to everything. And then each of us is reaching our limit, so to speak.”
Why You Should Pay Attention to ‘Nuisance Symptoms’
Herskowitz often sees patients when they’re very ill — but they don’t start out this way. He often looks back into their medical records over 25 years to see their past medical history. People who end up with serious diseases like Alzheimer’s disease often have far more “nuisance symptoms” over the years. This includes symptoms such as toenail fungus, indigestion, occasional diarrhea, hyperactivity or even high blood pressure.
In Herskowitz’s experience, his Alzheimer’s patients had 2.5 times more nuisance symptoms compared to a control group that didn’t have Alzheimer’s. “It's consistent with this toxicity type of concept,” he says. “When you're toxic, you have all these little things going on, and you don't pay attention to them, because they're not severe.”
However, they’re clues that something is off balance in your body, which can likely be addressed in the early stages. Unfortunately, most physicians aren’t looking for these types of systemic problems.
Tests to Measure How Old You Really Are
One of the challenges facing longevity medicine is figuring out what to measure in order to get an idea of how old you really are — meaning your biological age, which is how well your body is functioning compared to your chronological age, the actual number of years you've been alive. Biological age can be younger or older than your chronological age depending on your lifestyle, environmental factors and genetics.
Herskowitz believes oxidative stress is one useful measure to show where you are in a given moment in time over time. At his center, they use a urine test called 8-hydroxy-2-deoxyguanosine (8-OHdG) as a biomarker for oxidative damage and they use the lipid peroxides as a marker. He also uses tests to measure chronic immune function, mitochondrial function and senescent cells.
Senescent cells are cells that have stopped dividing and entered a state of permanent growth arrest without undergoing cell death. These cells can no longer replicate, but they remain metabolically active.
Senescence is a natural part of the cellular lifecycle and serves as a mechanism to prevent the proliferation of damaged cells, which can lead to cancer. However, the accumulation of senescent cells over time can contribute to aging and various age-related diseases. According to Herskowitz:
“[We look for] concepts of the subtlety of how the immune system is being suppressed. And it's not the current CBC [complete blood count]. It's more on the chronic side. So how does it deal with biological toxins? And that's more a journey into the complement immune cascade, which deals with chronic infection, chronic biological toxins and how to deal with it.
So, measures of complement cascades for autoimmunity as well. And then probably the biggest one, other than mitochondrial function and oxidative stress, to me is if we can measure the number of senescent cells we have in our body at any time. The higher it is, the worse you're doing.”
Herskowitz also uses markers of metabolic pathways that measure glucose metabolism. “It's not as simple as glucose,” he says. “It's more inflammatory/metabolic/hormonal,” or the fact that patients are so nutrient deficient that their system isn’t generating sufficient energy. Further, on a day-to-day basis, Herskowitz uses serum ferritin level as an important marker of health.
I have also long stated that serum ferritin, which measures stored iron, is one of the most important tests that everyone should have done on a regular basis as part of a preventive, proactive health screen.
Innovative Test for Cancer Treatment
Meanwhile, Herskowitz described an innovative test for tumors that can improve treatment decisions. Many people with cancer capitulate to taking chemotherapy, either because of fear, their own choice or direction from loved ones or their oncologist.
Many alternative practitioners treating cancer patients say their biggest challenge is the fact that virtually no one comes to see them before they take chemotherapy, which often destroys their body’s healing abilities.
Herskowitz, who uses antioxidants, nutrition, photobiomodulation, intravenous therapies and other strategies for cancer, details a test he believes may change the way chemotherapy is given in the U.S.:
“There's a new innovation you should be aware of. And that's taking a slice of the tumor itself on the biopsy side, articulating the various genomic mutations, and looking for the same genomic mutations in the peripheral blood. Now, it's not a new generation of circulating tumor cell counts, and this is all different generation. So, the goal here is, say, I'm on chemo.
I don't want to be on it, unless it's working. Whether it's high dose chemo, or even low dose chemo, I want it to be working on my behalf. And unless these markers are going down, I'm going to switch. I can tell my oncologist to switch because the genomic data are universally accepted by any oncologist in any university setting.
And I think that's going to change the way chemotherapy is given in the United States over time. These are approved tests for advanced cancers, and now they're moving to get approvals for all cancers of any kind.”
Cellular Function Is Becoming Less Efficient
In his decades of clinical experience, Herskowitz says he’s seen our overall capacity for cellular function becoming less efficient. “Practicing now is just different,” he says. For instance, less than 2% of the population used to have autoimmunity, but now he believes it’s somewhere between 10% and 20% — and we may be reaching a tipping point.
“I don't know where we're going to be in 10 years … people are still functioning, which is remarkable … [but] I think that we've lost most of our reserves. Our reserve function is relatively gone So, maybe more than 50% of our reserve function has now gone over the last four decades,” he says, referring to not only biological resiliency but also metabolic and mitochondrial function. Fortunately, there’s still hope to turn health around.
“Mitochondrial biogenesis is possible, at some point, so I think we still have a lot of hope that right now we can reverse by going clean. And the cleaner you go, the better you'll feel anyway,” Herskowitz explains. The fact is, your body has unbelievable resiliency provided you identify what’s causing your problems and address it, including by eliminating ultraprocessed foods from your diet and reducing your exposure to other toxicities.
You can find out more about Herskowitz’s strategies for longevity and chronic disease at his website Anataramedicine.com. As mentioned, we're going to be working together in the future so Herskowitz can further direct his knowledge and insights into correcting the faults in the system. He adds:
“I can tell you one thing. I'll end it like this. There's a lot of secrets going on, there's a lot of mystery. There's a lot of things we don't know very much about. And the worst thing a doctor can do is have an arrogant attitude. They understand everything. And I think that as long as we remain open and honest now, and remain lifelong learners, we will all be in better shape.”
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