Dr. Justin Marchegiani interviews Dr. Allan Warshowsky where they discuss everything you need to know about fibroids, their locations and who may need surgery for it including strategies you can do. Dr. Allan shares his wealth of knowledge about hormones likes progesterone and estrogens. In this episode, you'll also learn about angiogenesis.
Discover about the different enzymes you can take to help break down fibroid tissue. Find out what herbs can be used to modulate the receptor sites and learn about the detox and how important proper methylation is when you listen to this interview.
In this episode, topics include:
5:55 Diet and nutritional recommendations
11:14 Treating inflammatory conditions
18:41 All about fibroids and abdominal surgeries
27:18 Hormones
36:55 Herbs used for treatment
41:11 Detox and lab tests
Dr. Justin Marchegiani: Hey, there! It’s Dr. Justin here. We have an awesome show with a great guest here today, Dr. Allan Warshowsky. Dr. Allan is the author of the book, Healing Fibroids Naturally. Great book! I’ve gone through it. I think it provides some extra—excellent solutions where conventional medicine falls short in getting to the root cause a lot—with a lot these—these female issues, that tend to be just used for—with drugs and surgery to address them. So I wanna welcome Dr. Allan to the show. Dr. Allan’s website is Doctor—D-O-C-T-O-R-A-L-L-A-N—dot com. We’ll put links in the show notes. Other than that, Dr. Allan, welcome to the show!
Dr. Allan Warshowsky: Well, thanks a lot, doctor—Dr. Justin. I’m—I’m really pleased to be here. I just love speaking about my passion which is an integrated holistic approach to healthcare. So‑
Dr. Justin Marchegiani: That’s phenomenal.
Dr. Allan Warshowsky: So thank you for inviting me and—and I’m hoping for a great—great conversation here and a great show.
Dr. Justin Marchegiani: I totally agree. Now I’m really interested in your background, because I know you started practice I think in 1977, I’m aware, and you were an ObGyn, meaning you deal with the—the birth of the babies and also women’s health issues, and I think you mentioned recently that you’re only dealing with the women’s health stuff now. And I’m just curious, how the—how you came across this philosophy of functional medicine, integrative medicine, holistic medicine when you know, frankly we know you go through medical school of 4 years. You go through a 5-year ObGyn residency, 1 year internship—that’s 12 years of your life dedicated to a conventional medical approach. How did you evolve and grow into that more holistic, integrative, functional medical approach for women’s health issues?
Dr. Allan Warshowsky: Yeah, I guess I was always kind of a seeker and looking for answers that other people did not have answers for or didn’t really care. I mean, even before getting into medical school, I was interested in the mind-body connection and life after death and near-death experiences. These are things that really interested me and I did a lot of my own research in. I had to put that all aside when I went to medical school because as you said, it’s very conventional and it’s very straight and to get through, which you’ve gotta, you know, you gotta do the work and you gotta get through it but I was, you know, kinda of blessed to be in a residency program where there were a number of attending physicians who were interested in mind-body medicine. I got introduced to the work of Mindfulness Meditation with Jon Kabat-Zinn.
Dr. Justin Marchegiani: Uh-hmm.
Dr. Allan Warshowsky: Who—one of the attending physicians. We—our—our late night chats waiting for babies to be—to be delivered were discussions about how garlic is helpful and the—the role of nutrition and vitamins.
Dr. Justin Marchegiani: Wow!
Dr. Allan Warshowsky: So there were one or two people who were really before their time, people who were doing natural childbirths, like in the 70s, you know, it was a—it was really an amazing residency that allowed me to come into practice as you said in ’77 with a—a different approach to what was going on. So I was doing talk therapy for women with PMS.
Dr. Justin Marchegiani: Wow!
Dr. Allan Warshowsky: In the early 80s. I was using vitamins, you know, to treat, you know, cert—certain PMS symptoms and other conditions related to hormone imbalance and it was hormones that really was—were my major interests along with the connections between mind and body and spirit, because going through medical school I didn’t know what I wanted to do. I—I wanted to be the greatest cardiologist at one point, then the greatest surgeon at another point, and I bounced around until I delivered my first baby–
Dr. Justin Marchegiani: Wow.
Dr. Allan Warshowsky: And then that was kind of an instant, you know, kind of energy hit. It was my, “Aha!” experience.
Dr. Justin Marchegiani: Uh-hmm.
Dr. Allan Warshowsky: You know, just energy of the birth experience is what propelled me into ObGyn, whereas it was just—for other people it was the surgery. It was, you know, some of the endocrinology. But for me, it was the birth experience and—and then wanting to understand that more from a—a conventional perspective led me into, you know, this kind of life-long evaluation of hormones.
Dr. Justin Marchegiani: Got it.
Dr. Allan Warshowsky: And how that’s—how that’s all connected with everything else.
Dr. Justin Marchegiani: And I’m just curious, too, because you were coming out in the late 70s here and it was all the rage was this low-fat kick that was going on starting in the 70s and the early 80s. How much did you see all these low-fat fad diets affecting your women’s hormonal health back then?
Dr. Allan Warshowsky: I can’t say I was aware of that aspect of it at that time–
Dr. Justin Marchegiani: Uh-hmm.
Dr. Allan Warshowsky: You know, at that time we were—I was working more against the conventional hormone, you know, ideas.
Dr. Justin Marchegiani: Right.
Dr. Allan Warshowsky: So the conventional hormones Premarin and Provera.
Dr. Justin Marchegiani: Right, the horse hormones.
Dr. Allan Warshowsky: With the poisons.
Dr. Justin Marchegiani: Right.
Dr. Allan Warshowsky: Which are poisons. Horse hormones and—and synthetics, you know, my battle at that time against conventional medicine was trying to get people to understand the use of bio-identical progesterone and estrogens. So I wasn’t really doing all that much in terms of diet until I got into the Holistic Medical Association in the early 90s and–
Dr. Justin Marchegiani: Got it.
Dr. Allan Warshowsky: People like Bernie Siegel and Norm Shealy and–
Dr. Justin Marchegiani: Uh-hmm.
Dr. Allan Warshowsky: Chris Northrup and you know, some of these 2 pion—8 pioneers, you know, and then, you know, everything chained together for me and, you know, then, you know, showed me the nutrition aspects of health and, you know, more of the spiritual aspect—aspects of health, you know, came with the clear focus and how that all connected with my passion which was evaluating and—and re-balancing hormones.
Dr. Justin Marchegiani: Very good. So you’ve started getting into the more nutritional elements in the—in the early mid-90s. What’s your perspective right now? We know people are individuals but what kind of macronutrients, proteins, fats, and carbs are you recommending? Do you kind of have a Paleo approach where we’re trying to get, you know, good, clean, organic meats; healthy fats, lots of good organic veggies; staying away from pesticides and GMOs. Is that kinda your philosophy? How would you interject the nutritional recommendations to your patients today?
Dr. Allan Warshowsky: You know, for most people, you know, what we wanna do is we wanna reduce inflammation and toxicity–
Dr. Justin Marchegiani: Right.
Dr. Allan Warshowsky: As much as possible. We wanna keep, you know, the chemicals out of our diet as much as we can. You know, so, you know, a—a non-GMO, so I tell people, when you go shopping, the mantra is local, in season, and organic.
Dr. Justin Marchegiani: Uh-hmm.
Dr. Allan Warshowsky: You know? And—and that way you can mostly get healthy foods.
Dr. Justin Marchegiani: Uh-hmm.
Dr. Allan Warshowsky: They should all be non-GMO even though there’s a major push now to show how GMO is not too bad.
Dr. Justin Marchegiani: Right.
Dr. Allan Warshowsky: And I tell them, patients come in and say “I saw this article and they said, GMO is not so bad. And I said, “Well, look if you’re in the Sahara and there’s no food around, and they off—only offer you GMO food–“
Dr. Justin Marchegiani: Alright.
Dr. Allan Warshowsky: “That’s great.” But here we have a choice. And when your food is genetically modified, it could be Roundup or Glyphosate Ready, or now 2,4-D Ready which comes from Agent Orange–
Dr. Justin Marchegiani: Wow. Yup.
Dr. Allan Warshowsky: Which means that the seed are genetically modified so they could spray these poisons on them that kill the bugs ostensibly but we still have servicemen that are suffering from exposure to Agent Orange in Vietnam.
Dr. Justin Marchegiani: Right.
Dr. Allan Warshowsky: And that’s where Dow Chemical is producing 2,4-D comes from.
Dr. Justin Marchegiani: Uh-hmm.
Dr. Allan Warshowsky: So we want you to—the stuffs out of our diet, you know, so that’s the basic. And then, you know, I—I eat myself a Paleo type diet.
Dr. Justin Marchegiani: It’s great.
Dr. Allan Warshowsky: And that works for a lot of people. It doesn’t work for everybody.
Dr. Justin Marchegiani: Uh-hmm.
Dr. Allan Warshowsky: But a Mediterranean style diet–
Dr. Justin Marchegiani: Uh-hmm.
Dr. Allan Warshowsky: You know, we do 4 of the above ground vegetables and we, you know, the leafy greens, the deep sea coldwater Mediterranean fishes, and you know, maybe some grass-fed red meat can be added to that. A lot of good oils, the olive oils; certainly big on—on coconut oil and avocado, and you know, so that’s the diet that we promote to most people. I think that the—the low-fat high, carb diet—the low-fat, you know, the American Diet—Diabetes Association is still saying 5-7 servings of whole grains a day. I think that’s crazy.
Dr. Justin Marchegiani: Oh, absolutely. I think it’s even more. It’s 9-11 a lot of times.
Dr. Allan Warshowsky: Yeah, I—I think that’s, you know, that—that should be malpractice. You know?
Dr. Justin Marchegiani: Oh, my gosh! Absolutely. Now I see a lot of–
Dr. Allan Warshowsky: That–
Dr. Justin Marchegiani: Go ahead. Yup?
Dr. Allan Warshowsky: No, go ahead.
Dr. Justin Marchegiani: I see so many patients come in, right? The diet isn’t right, like you already mentioned. And then they have either endometriosis or they have some type of fibroid or some type of ovarian cyst, and you know, the conventional medical cookbook, ObGyn approach is predictable. If you have PCOS, it’s metformin. If you have endometriosis, let’s go in there and—and burn it out. If you have a fibroid, let’s cut it out. If you got PMS, we’ll throw you on a birth control pill, maybe an antidepressant. It’s kinda like this cookbook shop in the ObGyn world and I’m just fascinated on some of the things that you went above and beyond the conventional standard of care. What kind of things were you doing early on in your career to start fixing let’s say endometriosis, fibroids, PMS, just to start there.
Dr. Allan Warshowsky: It—it all really started with me with one of these, “Aha!” experiences in the operating room because I mean, for many years I was doing all the surgeries–
Dr. Justin Marchegiani: Uh-hmm.
Dr. Allan Warshowsky: That I’m now trying to keep women from having.
Dr. Justin Marchegiani: Uh-hmm.
Dr. Allan Warshowsky: You know, so I was walking through the OR and watching a—a colleague take out a totally normal uterus from a young woman. So, you know, we—we have a very collegial kind of group and I went–
Dr. Justin Marchegiani: Right.
Dr. Allan Warshowsky: Over them and I said, “Well, what’s your indications of taking out this normal uterus in this 40-year-old woman?” And he said, “She just had heavy bleeding and I couldn’t stop it.”
Dr. Justin Marchegiani: Oh, my gosh!
Dr. Allan Warshowsky: So, you know, for, you know, for menorrhagia which right now we–
Dr. Justin Marchegiani: Right.
Dr. Allan Warshowsky: There’s an FDA-approved medication for it even called Lysteda. Lysteda is the—the prescription form of Tranexamic acid–
Dr. Justin Marchegiani: Uh-hmm.
Dr. Allan Warshowsky: Which is antifibrinolytics, so it prevents the breakdown of clots in the uterus. So this was just approved about 2 years—2 to 3 years ago by the FDA but I’ve been using Tranexamic acid to 20 years. For all the time I’ve been working on my fibroid protocol which basically happened after that episode in the OR. So we—I looked for ways of—I looked for, first of all, you need to find the reasons for these things going on. So the conventional approach, all the things you mentioned are just taking away the problem.
Dr. Justin Marchegiani: Uh-hmm.
Dr. Allan Warshowsky: It’s either putting on blinders, putting on a Band-Aid, taking out the tumor, but it doesn’t take away the underlying issue. The underlying issue is all about a chronic inflammation. So I became an inflammation doctor. So I went from a hormone doctor to both a hormone and inflammation doctor so the—from my perspective, you know, what we could see, you know, the tip of the iceberg at least—what we could see conventionally even if you do the labs, is that all of these chronic conditions—fibroid tumors, endometriosis, they’re all based on some underlying inflammation, inflammatory cytokines–
Dr. Justin Marchegiani: Uh-hmm.
Dr. Allan Warshowsky: And some kind of hormone imbalance, and you could identify those issues. You can, you know, correct the imbalances once you find them and if you certainly bring in the—this—the mind-body connection which is what we do, so for fibroids, endometriosis, we always have patients doing the meditation, visualization exercises while they’re using castor oil packs. So each patient gets their own individualized exercise that’s done–
Dr. Justin Marchegiani: Uh-hmm.
Dr. Allan Warshowsky: in conjunction with the castor oil packs. They meditate by doing—teach them to do belly breathing, diaphragmatic breathing. So if they’re in calm, relaxed state while they’re doing it, and so in addition to the physical anti-inflammatory aspects of this treatment and bringing in the mind issue, you know, getting rid of the feelings of frustration and anger–
Dr. Justin Marchegiani: Uh-hmm.
Dr. Allan Warshowsky: And this feeling that women have when they have to deal with these difficult issues and bring in instead feelings of gratitude, thankfulness that the fibroid, the endometriosis is bringing up and what’s out of balance in their lives, that’s what helps bring on the healing.
Dr. Justin Marchegiani: Got it and you’re recommending–
Dr. Allan Warshowsky: You can–
Dr. Justin Marchegiani: Go ahead, yup.
Dr. Allan Warshowsky: You don’t heal the fibroid by–
Dr. Justin Marchegiani: Uh-hmm.
Dr. Allan Warshowsky: Taking it out, because I—I work with women who’ve had 3 and 4 myomectomies. They’ve had their fibroids removed 3 or 4 different major surgical times, and they just keep coming back.
Dr. Justin Marchegiani: I‘ve seen that, too.
Dr. Allan Warshowsky: Because no one’s looking at the under—the underlying issues.
Dr. Justin Marchegiani: I agree. And you’re recommending a lot of the castor oil packs to help with the lymphatic circulation to kinda clean out the—the lymph. Is that what I’m hearing?
Dr. Allan Warshowsky: Right. It’s been shown to be an anti-inflammatory.
Dr. Justin Marchegiani: Got it.
Dr. Allan Warshowsky: I—I also bring in things like dry skin brushing for lymphatic drainage.
Dr. Justin Marchegiani: Uh-hmm.
Dr. Allan Warshowsky: There are some herbal compounds that can be helpful with lymphatic drainage. So we’re—we’re concerned about that because if we’re breaking down toxins, if we’re helping to eliminate toxins, we wanna support the body’s way of doing that, and that’s certainly part of the lymph system.
Dr. Justin Marchegiani: So we’re gonna make that pack, we’re gonna put it right over the—the uterus, ovary area? Is that where we’re putting it on the body?
Dr. Allan Warshowsky: Right, so the pack is made with generally wool flannel and–
Dr. Justin Marchegiani: Uh-hmm.
Dr. Allan Warshowsky: We use hec—hexane-free castor oil, so you don’t wanna use anything that’s toxic. Sometimes we use Phytolacca or poke oil first. Poke oil has been used, I believe, for like decades as a—as an essential oil to break down breasts cysts and fibroadenomas in the breast.
Dr. Justin Marchegiani: Uh-hmm.
Dr. Allan Warshowsky: We use it, the fact that I just brought it down to use for fibroid tumors as well, so that’s applied first to the fibroid when you can feel it. So a woman who has a—a uterus that’s larger than a 3-month size pregnancy, that uterus already to be felt abdominally, so you know, we—we explore the uterus, the fibroids together, myself and the patient, through an ultrasound so they see where their fibroids are. They apply the poke oil with visualization that is getting into the fibroid and then they put the pack on top of that. They continue with the visualization exercise.
Dr. Justin Marchegiani: So the castor oil packs–
Dr. Allan Warshowsky: So–
Dr. Justin Marchegiani: Go on right over that fibroid, how long is that there? For half hour?
Dr. Allan Warshowsky: I—I look—you know, you know, a major piece of this, Dr. J, is the stress piece.
Dr. Justin Marchegiani: Yeah.
Dr. Allan Warshowsky: So these patients are coming in in major stress already. Their lives are being totally disrupted whether it’s severe PMS or fibroid tumors, or endometriosis, it’s—it’s all, you know, the same. Their lives are being totally disrupted. So you don’t wanna give them more things that are–
Dr. Justin Marchegiani: Yeah.
Dr. Allan Warshowsky: Gonna be stressful. So I tell them, this is what, you know, this is how you do it. The frequency is up to you. You know, so I—I explain to them the importance of carving out some time for themselves, because self-nurturing is an extremely important piece of any kind of healing process.
Dr. Justin Marchegiani: Uh-hmm.
Dr. Allan Warshowsky: You—you know, if you don’t do the self-nurturing, you’re back to the conventional way or taking a pill or cutting it out or burning it out.
Dr. Justin Marchegiani: Uh-hmm.
Dr. Allan Warshowsky: You know, I don’t wanna do any work, just give me something and get rid of it.
Dr. Justin Marchegiani: Right.
Dr. Allan Warshowsky: So that’s the conventional approach, we wanna—we wanna avoid that. So you know, the—the patient, the client needs to be a—a partner in the healing process.
Dr. Justin Marchegiani: I understand.
Dr. Allan Warshowsky: And then—yeah.
Dr. Justin Marchegiani: And you also said poke oil. Tell me about that. Are you applying that topically when you’re—when you’re inside the–
Dr. Allan Warshowsky: Right.
Dr. Justin Marchegiani: The vaginal area there? How are you—how does that work?
Dr. Allan Warshowsky: No. I use the poke oil to—to massage, to have the patient massage it into the fibroids that they can feel abdominally–
Dr. Justin Marchegiani: Okay, got it.
Dr. Allan Warshowsky: So before they’re—before they’re applying the pack, they’re massaging a little bit, a few drops of the poke oil in maybe an ounce or so of the castor oil and just massaging that into the fibroids that they can feel abdominally.
Dr. Justin Marchegiani: Uh-hmm.
Dr. Allan Warshowsky: And then they can pack on top of that.
Dr. Justin Marchegiani: Got it.
Dr. Allan Warshowsky: So it’s kind of a ritualistic session, you know, that self-nurturing and then the other major piece of it that I haven’t addressed yet is working with the emotional issues that come up.
Dr. Justin Marchegiani: Uh-hmm.
Dr. Allan Warshowsky: So here we’re talking about in the Eastern traditions we call it the energy on the pelvis, the second chakra.
Dr. Justin Marchegiani: Uh-hmm.
Dr. Allan Warshowsky: The second chakra has associations with your relationships. The relationships not only to people but to your work, to your finances, to you and the entire outside world. Certainly in women, it’s associated with creativity.
Dr. Justin Marchegiani: Uh-hmm.
Dr. Allan Warshowsky: So what’s in your life that you don’t want or what’s not in your life that you do want? And all kinds of abuse. These are the issues that sit right in that second chakra in the pelvis and when these emotional issues are there, you know, we could say, you know, because we—we understand these issue, we understand that we’re all energy beings, we could say that these stored emotional issues are blocking the flow of energy in our meridians.
Dr. Justin Marchegiani: Uhmm.
Dr. Allan Warshowsky: And these are the meridians that acupuncturists are needling to get that flow going again. And my—my opinion is that this stored emotional energy is blocking the flow and when Einstein said, “When energy doesn’t move, it turns into mass.”
Dr. Justin Marchegiani: Uh-hmm.
Dr. Allan Warshowsky: So e=mc² says, “Energy that’s not moving is gonna turn into mass.”
Dr. Justin Marchegiani: Uh-hmm.
Dr. Allan Warshowsky: So what—what I feel is that these fibroids are the physical manifestation of blocked bandaging in the second chakra and we need to get that out. So we need to be aware of what comes up during these castor oil pack sessions and then journaling has been shown to be an extremely effective way–
Dr. Justin Marchegiani: Uh-hmm.
Dr. Allan Warshowsky: Of releasing the stored emotional issues.
Dr. Justin Marchegiani: Got it, so we were dealing with the emotions through meditation, through—through journaling. Do you do any type of other work, like for the deeper emotional trauma, maybe like EMDR or EFT? Any other energetic psychology techniques?
Dr. Allan Warshowsky: I—I refer out to that–
Dr. Justin Marchegiani: Uh-hmm.
Dr. Allan Warshowsky: You know there are good business in my area. I, you know, it would be great if I could do everything, but–
Dr. Justin Marchegiani: Yeah.
Dr. Allan Warshowsky: You know, they’re going to be on my scope–
Dr. Justin Marchegiani: Got it.
Dr. Allan Warshowsky: So we have—we have, you know, the—the kind of partnership without walls, you know–
Dr. Justin Marchegiani: Uh-hmm.
Dr. Allan Warshowsky: So there are a number of practitioners that, you know, I could refer patients to for these more sophisticated mind-body techniques.
Dr. Justin Marchegiani: Got it. And I’ve had a lot of patients come to me recently that do have fibroids and I wanna just kinda break down, you know, the fibroids, what they are—they’re the most common tumor out there. They are leiomyoma, benign tumor, I think about 20% of females will get one in their lifetime, and for the most part they happen in 3 different places. They happen in the uterine lining, submucosal. It’s kinda like, imagine you’re wearing—for people listening at home—imagine you’re wearing a t-shirt and a jacket on, so a fibroid in between the skin and the t-shirt is like a submucosal fibroid. A fibroid between the t-shirt and the jacket, it’s like an intramural fibroid, and the fibroid on the outside of the jacket is like a—subserosal fibroid. You get the endometrium, the first layer; the myometrium, the middle; and the perimetrium on the outer layer. So just giving people a visualization of where these fibroids are and just kinda, so you get your mind around that, and then I want Dr. Allan here to talk about women that may have to get the surgical option. Some people they’re in that biological clock time where they may only have a few more years left to get pregnant, tell me about the surgical options if someone is gonna go the surgical route. How does that work with you?
Dr. Allan Warshowsky: Well, the—the fibroid that causes the most problems with any kind of a pregnancy would be the submucous one–
Dr. Justin Marchegiani: Right.
Dr. Allan Warshowsky: Because that one—that one is growing where the baby needs to grow.
Dr. Justin Marchegiani: Uh-hmm.
Dr. Allan Warshowsky: You know, and if the fibroid grows in that area it could interfere with the baby’s growth. It could interfere with where the placenta develops. So that fibroid would need to be removed before pregnancy–
Dr. Justin Marchegiani: Uh-hmm.
Dr. Allan Warshowsky: If you know it’s there.
Dr. Justin Marchegiani: Right.
Dr. Allan Warshowsky: So many pregnancies have probably gone one without knowing that there’s a small submucous fibroid and have been fine, and others are probably miscarried and we didn’t realize it was because of a small submucous fibroid. Those are generally removed fairly easily through a—a vaginal operation that goes through the cervix, and that’s called a hysteroscopic resess—resection. So a hysteroscope, the uterus is the hystero part of it, that’s why we call it a hysterectomy, but the hysteroscope would go into the uterus through the cervix like doing a D&C–
Dr. Justin Marchegiani: Uh-hmm.
Dr. Allan Warshowsky: Scraping and then this is attached to a video camera and then through direct visualization, the submucous fibroid could be basically shaved off by an instrument that goes along with the hysteroscope. Any other fibroids in the wall of the uterus and on the outside if the uterus or the—the one that kind of connects via stalk called the pedunculated fibroid–
Dr. Justin Marchegiani: Right.
Dr. Allan Warshowsky: Those would be removed through an abdominal incision in the old days—the old days being the 70s, the 80s, and probably early 90s. This was all done through a large abdominal incision, either a vertical or horizontal abdominal incision, big enough to take out these large fibroids, some of which could be the size of a newborn baby’s head, about 10cm or 8 or so inches. And fibroids, you know, 20% is really a short number, it’s a small number. I would say more like up to 70% of women have some devel—some development of fibroids, they may be very small but they’re there.
Dr. Justin Marchegiani: Got it.
Dr. Allan Warshowsky: So, you know, all you need is the inflammation and the hormone imbalance to drive that growth. Because inflammation wherever it’s coming from, could be coming from gingivitis, mouth inflammation—we know the association with mouth inflammation and cardiovascular disease and even Alzheimer’s disease. So certainly inflammation could affect the uterus and we know that the leiomyoma cells, the fibroid cells, they support their own existence by developing a blood supply.
Dr. Justin Marchegiani: Right.
Dr. Allan Warshowsky: Bringing in nutrients, getting rid of toxins by virtue of these inflammatory chemicals–
Dr. Justin Marchegiani: Interesting and then–
Dr. Allan Warshowsky: But–
Dr. Justin Marchegiani: Uh-hmm. Go ahead.
Dr. Allan Warshowsky: You know, just the surgical aspect changed when—when many surgery became the vogue–
Dr. Justin Marchegiani: Uh-hmm.
Dr. Allan Warshowsky: And laparoscopic attempts at removing these fibroids became the way to do it and that went on. It was very successful. People became very good at it until very recently the mainstay of the removal of these large fibroids which is called morcellation–
Dr. Justin Marchegiani: Yeah.
Dr. Allan Warshowsky: Basically means breaking up these large fibroids into tiny little pieces in the abdominal cavity so you could take out small pieces of the fibroid through these tiny incisions in the abdomen.
Dr. Justin Marchegiani: Right.
Dr. Allan Warshowsky: But because of the 1 in 300 risk of a fibroid being malignant, there were several cases of these women having a morcellation procedure which then seeded the entire abdominal cavity with tumor and–
Dr. Justin Marchegiani: Uh-hmm.
Dr. Allan Warshowsky: You know, unfortunately these women had a—a quick demise and morcellation is now, you know, not done. It could only be done if the—if the operator can take the fibroid out of the uterus, and put it in a bag, so this is now taking an overcoat on top of the outer coat–
Dr. Justin Marchegiani: Right.
Dr. Allan Warshowsky: Putting a bag inside the abdomen and breaking up the fibroid in the bag so it doesn’t seed the entire cavity. But very few laparoscopic surgeons are capable of doing that. It’s a very—the learning curve on that is extremely steep.
Dr. Justin Marchegiani: Interesting. And I know Dr. Pritz, she a researcher, I think she did a study or it was in the Cochrane database where she was actually finding that the intramural, the in-between fibroids between the—the t-shirt or the shirt and the coat so to speak with my analogy—were even having an effect on reducing fertility, and the—the mechanism is best—is suggested as decreased blood flow or decreased angiogenesis. Do you have any thoughts on the in-between fibroids, the intramural ones affecting fertility at all?
Dr. Allan Warshowsky: Yeah, the—the reproductive endocrinologist believes that any fibroid in the uterus, anywhere can affect fertility.
Dr. Justin Marchegiani: Uh-hmm.
Dr. Allan Warshowsky: And if go into—if a woman gets to the point where she’s seeing a specialist, they—they generally would recommend removal of that fibroid. My—my concern, you know, with the intramural fibroids is, you know, more about the potential of damaging the—the endometrial cavity itself.
Dr. Justin Marchegiani: Uh-hmm.
Dr. Allan Warshowsky: And then once that happens, the, you know what, the cesarean delivery is essential because of the risk of rupturing of the uterus.
Dr. Justin Marchegiani: Right.
Dr. Allan Warshowsky: So, you know, that—that certainly would be a more of a risk with the intramural fibroids weakening the uterus, and then the other issue about the weakening the uterus which you know, they’re still studying is that can you put the uterus back together again, you know, using a—a mini surgical approach which is not using your hands really, you’re using instruments or robotics, to tie knots and to bring the, you know, incised portions of the uterus back together again. Can you do that as well robotically as you could do with your hands feeling the tightness of your—of your closure?
Dr. Justin Marchegiani: Uh-hmm.
Dr. Allan Warshowsky: So that’s still being looked at and they still do studies, you know, is—is an abdominal myomectomy with the hand closure as secure as the laparoscopic one and does the laparoscopic one increase the risk of rupture of the uterus. You know, so we don’t have answers on that yet, but it’s still I would say, a concern.
Dr. Justin Marchegiani: So ideally–
Dr. Allan Warshowsky: Research–
Dr. Justin Marchegiani: Go ahead, yup.
Dr. Allan Warshowsky: That’s because recently there’s been some studies looking at another aspect of this cutting into the uterus and then future pregnancies and that’s the issue of just doing a hysterectomy for whatever reason and leaving the ovaries, so in taking the hyster—taking out the uterus and leaving the ovaries ostensibly as because you don’t want to disrupt the hormones being produced by the ovaries but we—what we see very often is that the ovaries go into shock. When you do pelvic surgery, the ovaries go into shock and for a portion of time don’t produce any hormones and depending upon the underlying status of the woman if they’re—if she’s older or if she’s got some underlying physiologic problems, her ovaries may not come back at all. So there may be and we don’t know exactly why, it could be this ovarian shock issue or it could be related to something that the uterus is being—is producing, some hormone–
Dr. Justin Marchegiani: Uh-hmm.
Dr. Allan Warshowsky: That we have not yet identified that the uterus is producing that also affects ovarian hormone production.
Dr. Justin Marchegiani: Got it.
Dr. Allan Warshowsky: And in that—in cutting into the uterus at any point, you know, could be affecting that.
Dr. Justin Marchegiani: That makes sense. And can you talk about some of the hormonal factors that are driving this. We know we have lots xenoestrogens from estrogens in the water supply, such as you know, fluoride even could be an estrogen mimicker. We have all the pesticides and the GMOs, which are estrogen mimickers. Plus we also have the birth control pills which have a significant amount of synthetic estradiol in there. So I wanna get your take on the estrogen dominance and also do birth control pills increase your chance of growing a fibroid?
Dr. Allan Warshowsky: In my opinion, it does. I don’t think that–
Dr. Justin Marchegiani: Uh-hmm.
Dr. Allan Warshowsky: There’s been a study that shows that, you know, but we certainly see, you know, patients that are put on birth control pills extensively. There are reduced role for the thyroids and they just grow.
Dr. Justin Marchegiani: Right.
Dr. Allan Warshowsky: Now these things are being done, you know, these kinds of treatment are being done in the dark. You know, doctors are just throwing these drugs at patients. I had a patient come in just the other week. You know her fibroids are under control. She had seen me years and years ago when things were under control, and then she started having some bleeding problems and her doctor put her on—you know, examined her. The fibroid was growing, so gave her injection of Depo-Provera.
Dr. Justin Marchegiani: Mmm.
Dr. Allan Warshowsky: To—so stop the growth of the fibroids. And you know, it’s just unbelievable that what we know about regular Provera that doctor—you know, Provera has been shown to cause malignant breast tumors in dogs–
Dr. Justin Marchegiani: Right.
Dr. Allan Warshowsky: And then in the PDR, the Physi—Physician’s Desk Reference—for years and years, they took it out now. I, you know—somebody took it out, but for years and years, Provera had as a quack doc’s warning, this drug increases breast cancer in dogs but yet they give it to women and now they give a Depo-Provera which is like a 3 month’s shot that doesn’t even go away, you know, which is even worse and sure enough this woman’s fibroid came and it twice the size that it was–
Dr. Justin Marchegiani: Wow.
Dr. Allan Warshowsky: Before she got her shot. So I think this synthetic certainly in—in women who have the right combination of hormonal issues. And it’s not just hormones. We keep just saying hormone imbalance but you know, it’s more complicated than that because it’s the receptor sites for the hormones–
Dr. Justin Marchegiani: Uh-hmm.
Dr. Allan Warshowsky: in your cells. And it’s the—the enzymes that detoxify the hormones.
Dr. Justin Marchegiani: Uh-hmm.
Dr. Allan Warshowsky: So all of these—it’s safe to say that they work altogether, you know, so it’s hormone change, receptor sites change, enzymatic enz—enzymes that metabolize hormones change. These foreign hormones come in and they affect the same receptor sites so it becomes very complicated. I would just say in the last 5 or 6 years, they’ve discovered that there is a second progesterone receptor in our cells and depending upon whether or not you have inflammation, you either stimulate progesterone receptor A or B–
Dr. Justin Marchegiani: Uh-hmm.
Dr. Allan Warshowsky: There’s no doubt to figure out which one it is. If you stimulate A, you get fibroid growth. If you stimulate B, you may not. So it’s that—that, you know much of a—of a blind issue that this point. There’s so much that we don’t know. What we do know is what—that’s—those are the issues that I try to work with. So what we do know–
Dr. Justin Marchegiani: Do you have any thoughts on using progesterone, bio-identical progesterone specifically in the luteal phase or the second half of a female cycle? Would that help—that will help with the PMS but will that grow the fibroid at all without having negative effects of maybe shrinking the fibroid?
Dr. Allan Warshowsky: In some women, it’ll grow it and in some women, it’ll shrink it.
Dr. Justin Marchegiani: Uh-hmm.
Dr. Allan Warshowsky: And that’s been my experience, and you know, at this point in my career, I don’t use progesterone in—with women who are having fibroid problems.
Dr. Justin Marchegiani: Uh-hmm.
Dr. Allan Warshowsky: So fibroid problems would mean—would mean a fibroid that’s growing, causing heavy bleeding, pressure symptoms and pain symptoms, quality-of-life issues. So a fibroid that’s causing quality-of-life issues, I would not treat with progesterone. I would be looking to keeping hormones in balance, you know, the three different estrogens–
Dr. Justin Marchegiani: Uh-hmm.
Dr. Allan Warshowsky: Es—estradiol and estriol, estrone, being the most problematic–
Dr. Justin Marchegiani: Uh-hmm.
Dr. Allan Warshowsky: Because it’s to be the one that support an inflammatory environment, so we—we can do things to modify the—the balance between those 3 estrogens to keep the estradiol and the estriole in a higher level and keep estrone at a lower level by influencing again some of these enzymes. In here, the aromatase enzyme–
Dr. Justin Marchegiani: Uh-hmm.
Dr. Allan Warshowsky: You know, we—from breast cancer treatment, they try to use aroma—aromatase inhibitors–
Dr. Justin Marchegiani: Right.
Dr. Allan Warshowsky: So medications like Arimidex that would inhibit–
Dr. Justin Marchegiani: Arimidex, Uh-hmm.
Dr. Allan Warshowsky: The aromatase enzyme, but we can do them naturally.
Dr. Justin Marchegiani: Uh-hmm.
Dr. Allan Warshowsky: We do that with flaxseed, with melatonin–
Dr. Justin Marchegiani: Uh-hmm.
Dr. Allan Warshowsky: The sleep hormone, very powerful aromatase-inhibitor–
Dr. Justin Marchegiani: Uh-hmm.
Dr. Allan Warshowsky: You know, we could use natural progesterone. Again if there were not quality-of-life issues. I use a lot of natural progesterone cream, a 3% cream for PMS is—issues, you know, certainly for women who’s symptoms go away when their bleeding begins. So to me that’s like a keynote sign–
Dr. Justin Marchegiani: Right.
Dr. Allan Warshowsky: You know, a women who’s had horrible, horrible symptoms and then I bleed and then I’m fine. To me that’s like a curtain comes down on their PMS, that’s an indication for progesterone. When the symptoms linger through the cycle, then I’m more concerned about things like thyroid, yeast issues.
Dr. Justin Marchegiani: Uh-hmm.
Dr. Allan Warshowsky: Other times, issues that progesterone could actually make worse. So women often have an increase in yeast overgrowth in the week or so before a period because that’s when progesterone is the highest. And then obviously the treatment is not getting rid of that progesterone. It’s finding out why they’ve got yeast problems which usually goes back to their Hy—called the Hydra diet. So–
Dr. Justin Marchegiani: Right.
Dr. Allan Warshowsky: You know, we—you can deal with all that. And then progesterone also could be very effective as part of the therapy we use for endometriosis which we really haven’t talked too much about, but I—you know, you could think about endometriosis, kind of in the same vein as—as fibroids and then–
Dr. Justin Marchegiani: Uh-hmm.
Dr. Allan Warshowsky: Throw in autoimmune disease at the same time. So endometriosis has a—a total connection with autoimmune issues. There’s a high incidence of illnesses like lupus‑
Dr. Justin Marchegiani: Right.
Dr. Allan Warshowsky: And when we’re thinking autoimmune, then that brings us right back to the gut, because you know, if you have autoimmune conditions, you probably have what we call leaky gut.
Dr. Justin Marchegiani: Got it.
Dr. Allan Warshowsky: So—so most of our work here, I would, you know, think—I forget who said, “Life and death begins in the gut.” You know, that’s kind of, you know–
Dr. Justin Marchegiani: Yup.
Dr. Allan Warshowsky: How we look at into health.
Dr. Justin Marchegiani: Got it. Yup, that is Dr. Metchnikoff. That’s his quote there. That’s a good one.
Dr. Allan Warshowsky: Thank–
Dr. Justin Marchegiani: And I wanted—
Dr. Allan Warshowsky: Thank you.
Dr. Justin Marchegiani: I wanted to just—yeah, no problem with that. I wanted to just touch upon some of the strategies that you’re using to help reduce fibroids. So if we’re not gonna be progesterone or any hormones, are we gonna be using things like systemic enzymes like serepeptidase or are we gonna be using hormone modulating herbs such as Chaste tree or Dong Quai or Black cohosh or any other herbs like—in a—a Myomin herbal support. Anything like that? DIM, indole-3-carbinol, green tea extract? What’s your take on some of these natural things to help reduce fibroid size?
Dr. Allan Warshowsky: We have a basic protocol that we start women on and that consists of a good curcumin product.
Dr. Justin Marchegiani: Uh-hmm.
Dr. Allan Warshowsky: So curcumin and green—green tea as you mentioned. There are good studies that show that both of these are natural anti-angiogenesis factors.
Dr. Justin Marchegiani: Mmm.
Dr. Allan Warshowsky: And both major anti-inflammatories and there are studies with both of those, you know, that you can pick up on PubMed.
Dr. Justin Marchegiani: Uh-hmm.
Dr. Allan Warshowsky: You know, showing the reduction in growth of leiomyoma cells. So those—those two and then we use resveratrol.
Dr. Justin Marchegiani: Uh-hmm.
Dr. Allan Warshowsky: Resveratrol because it’s been shown to be effective in down—downgrading the—to reducing the activity of the cytochrome P450 enzyme, 1B1. You know, so the detoxification enzymes usually have 2 different or 3 phases. The first phase, these group of 57 enzymes and they have these funny names, 1B1, 1A2, things like that.
Dr. Justin Marchegiani: Uh-hmm.
Dr. Allan Warshowsky: But the 1B1 enzyme, which has been shown to be overexpressed in both tumor cells, cancer cells and fibroid cells can be affected by resveratrol because resveratrol’s–
Dr. Justin Marchegiani: Uh-hmm.
Dr. Allan Warshowsky: Been shown to be the—inhibit the 1B1 enzyme. So we use resveratrol, we use the systemic enzymes as you mentioned, serratiopeptidase.
Dr. Justin Marchegiani: Yup.
Dr. Allan Warshowsky: There are a number of good ones out there and these are the only things that really need to be taken on an empty stomach.
Dr. Justin Marchegiani: Is there a favorite brand for the enzymes you have?
Dr. Allan Warshowsky: No, I, you know, I’ve used, you know, Wobenzym and Neprinol–
Dr. Justin Marchegiani: Yup.
Dr. Allan Warshowsky: And you know, there was one called Proteo-Zyme that works well–
Dr. Justin Marchegiani: Uh-hmm.
Dr. Allan Warshowsky: Also and you know, so a number of them are—are pretty much equivalent in their effectiveness. It’s just a matter of getting a—you know, usually looking between 9 and 15 of these a day on an empty stomach, splitting it in 3 doses a day. So again, it goes back to are you committed to your own health that you’re gonna take time, pause time out of your busy schedule as you know, a professional, a mom, a partner or whatever to take care of your own health? So it always kind of boils down to that as well. But the, you know, the symptom, the quality-of-life issues are key as well. So then the packs come into play. We use the tranexamic acid for the bleeding. We also use a number of herbs. So I have a protocol using raspberry, yarrow and Shepherd’s purse–
Dr. Justin Marchegiani: Oh, great.
Dr. Allan Warshowsky: In a—in a protocol to reduce bleeding. That works very well. It’s generally 30 drops of the yarrow and the raspberry before the period–
Dr. Justin Marchegiani: Uh-hmm.
Dr. Allan Warshowsky: To tone the uterus and to get the—the—the extra fluid out of the tissue spaces and then the Shepherd’s purse is added when the bleeding starts. Shepherd’s purse being more of a—a contractinger. So that works well and if that’s not doing the job, we add in the tranexamic acid and that—that really helps quite a bit.
Dr. Justin Marchegiani: Did you also use any cramp bark, too?
Dr. Allan Warshowsky: You know, if we need it, I—I find Black cohosh works fairly well–
Dr. Justin Marchegiani: Okay.
Dr. Allan Warshowsky: The—the black haw, the cramp bark, those—those Viburnums they also work. I think a little bit more difficult to find.
Dr. Justin Marchegiani: Uh-hmm.
Dr. Allan Warshowsky: The Black cohosh is, you know, it’s—in addition to being very good for night sweats and hot flashes in menopause, it was originally used for rheumatism.
Dr. Justin Marchegiani: Oh.
Dr. Allan Warshowsky: So it was a nerve—for joint pain.
Dr. Justin Marchegiani: Joints, wow.
Dr. Allan Warshowsky: And also for pelvic pain, so it’s an effective herb for—for that and we, you know, we use some that, you know, if women—you know, some of these women come in and they’re pretty sad about herbs or some other, you know, integrative approach to healthcare and if they’re using things like the Viburnums, black haw, or cramp bark, you know, and they—they’re getting a good response from it, then they can certainly continue it.
Dr. Justin Marchegiani: How about Chaste tree or—or Vitex?
Dr. Allan Warshowsky: I used that quite a bit in the beginning and didn’t really see much benefit from it, so, you know, in, you know, in—in lieu of adding—I always find more—you know, less is more—is—is better.
Dr. Justin Marchegiani: Uh-hmm.
Dr. Allan Warshowsky: You know, when you start adding on supplements to patients, you could break the camel’s back.
Dr. Justin Marchegiani: Uh-hmm.
Dr. Allan Warshowsky: You reach a point of saturation with people, so I try to keep it to, you know, a reasonable number of supplements. I tried it so, you know, I was doing some of these herbs for lymphatic drainage, you know, and I backed off on some of that in lieu of things like dry skin brushing. You know, I’d bring in things like oil pulling for—for oral inflammations. So I try to bring in things that are, you know, not a supplement. You know we try to work with, you know, the mind-body, you know, as often as we can. You know, and—and after our approach, so that would be our initial visit. You know, people walk out, they’re usually kind of blown away. It’s a 2-hour visit, our initial visit. They walk out with a folder of, you know, maybe 20 pages of things that we’ve gone over, and then you know, our next visit which is 2 weeks later when we review the labs that we’ve done, we go over everything again. So, you know, the first visit is really planting seeds. The second visit is not only rehashing the first visit, but looking at what the individual issues are. So we look at estrogen metabolism. We look at the 2:16 hydroxy ratio to see if we wanna bring, you know, indole-3-carbinol or DIM into the picture. So you know, and again I would try to work first, you know, with increasing cruciferous vegetables.
Dr. Justin Marchegiani: Right.
Dr. Allan Warshowsky: And—and bringing in more flaxseed. Down flaxseed into the diet, you know. And you know and certainly working on maybe exercise and fish oils. So you know, wherever I can, I’m gonna try to at least initially to keep the supplements low‑
Dr. Justin Marchegiani: Uh-huh.
Dr. Allan Warshowsky: And to have other, you know, the other lifestyle changes, you know, work to make a difference because ultimately—ultimately these patients are not gonna be on 30 supplements a day. They’re gonna want to have–
Dr. Justin Marchegiani: Right.
Dr. Allan Warshowsky: You wanna instill in them some tools that they can then continue to just incorporate in their lives, whether it would be oil pulling, dry skin brushing, belly breathing when necessary, making sure that they’re exercising appropriately, getting the body weight and fluid ounces every day, you know, flossing nightly. So these are the things that we stress, you know, above everything else. So the patient says I can’t be your program, you know, it’s just too much to do, but I like all your other stuff, to me that’s a win.
Dr. Justin Marchegiani: Okay.
Dr. Allan Warshowsky: You know, but daily they—they’re gonna change their lifestyle and they’re gonna bring all these healing modalities. They’re gonna be—they’re gonna have a commitment to their—to their health. To me, that’s a win.
Dr. Justin Marchegiani: So when you talk about the detox. You mentioned the 2, 4, and the 16 estrogens there, the metabolites, and you also mentioned the detox pathways. Question number 1, part 1 is do you have an objective way of looking at detox or using an organic acid test or hormone metabolite test? Number one. And then number two, give us the story. Which ones are the bad ones and which ones are the good ones in those hormonal metabolites.
Dr. Allan Warshowsky: I—I do organic acid testing–
Dr. Justin Marchegiani: Uh-hmm.
Dr. Allan Warshowsky: On every—for every new patient.
Dr. Justin Marchegiani: Good.
Dr. Allan Warshowsky: So, you know, in addition to a—a lot of the blood tests, so I’ve been accused of going on fishing expeditions with my blood work–
Dr. Justin Marchegiani: Uh-hmm.
Dr. Allan Warshowsky: And I ___41:47___, that’s exactly what we’re doing because I don’t know what’s your underlying issues. You’ve—you’ve seen 3, 4, 6 different professionals already, different doctors. They all tell you that you’re fine. So I’m gonna do a lot of things. I’m throwing out a wide net. When you go fishing, you throw out a wide net, everything you pull in is not edible. You’re gonna throw some stuff back. So I go on this fishing expedition with lab work and we look at all, you know, certainly we look in liver enzymes for detox.
Dr. Justin Marchegiani: Right.
Dr. Allan Warshowsky: You know I do a—a GGT or–
Dr. Justin Marchegiani: Yeah.
Dr. Allan Warshowsky: Gamma glutamyl transpeptidase base–
Dr. Justin Marchegiani: Yeah.
Dr. Allan Warshowsky: Again we’ll keep a toxicity. We do a lot of inflammatory tests as well.
Dr. Justin Marchegiani: Yup.
Dr. Allan Warshowsky: We do oxidized LDL, C-reactive protein, homocysteine–
Dr. Justin Marchegiani: Uh-hmm.
Dr. Allan Warshowsky: Hemoglobin A1c, so all of these tests toxicity and inflammation and then the organic acid test, so those are—those are tests that’s showing us breakdown. You know, so those are the breakdown tests, your—your cells are now spewing out enzymes into the bloodstream, they’re breaking down. So then I turn to the organics test which tells me if you need an oil change before the breakdown.
Dr. Justin Marchegiani: Right.
Dr. Allan Warshowsky: So this is telling me—do we need any—are we running out of gas? Do you need more glutathione? Do you need more NAC? Do you need more lipoic acid, the B vitamins, etc. So we could prevent the breakdown. So we’re looking at this, you know, through the organics, through the routine labs, and then certainly with, you know, what the patient’s story is. Patients come in, they tell you, “I’m fatigued every day. Everything hurts. I can’t think. I can’t remember. My head is just brain fogged.” I mean that’s toxicity. That’s inflammation.
Dr. Justin Marchegiani: Right. Uh-hmm.
Dr. Allan Warshowsky: We do a—a body composition test. We do a bio—bio-impedance analysis on every new patient as well, and we could see what’s going on with the mitochondria. We could see that the mitochondria not making energy or that there’s no permeability through membranes, and we could look at, you know, by virtue of intra and extra—intra and extracellular mass in water, you know, the ramifications of inflammation. So we do that one every patient. So we’re picking up from the gecko, you know, where the issues are. And now if we see significant toxicity, you know, based upon our history, our labs, you know, we’re gonna suggest doing a—a some kind of a detox which is usually, you know, involves eating a very clean diet, getting rid of the foods you’re eating every day, because once you have—show this level of toxicity, and so you wanna heal the gut, you wanna support detoxification and reduce inflammation. So you need a very clean diet, and you need some kind of detox powder which we use, maybe infrared sauna, maybe adding in the—the dry skin brushing and things like that.
Dr. Justin Marchegiani: Got it. So we want—we want more upregulation of the two estrogen pathways, right? Less of the 4 and 16 and more of the 2. Is that correct?
Dr. Allan Warshowsky: Correct and that’s where the crucifers with the indole-3-carbinol and the DIM are gonna come in. That’s where flaxseed is gonna come in. Fish oils—they’re all gonna promote the—the development of the 2 hydroxy estrogen. You know, we don’t have a way of reducing the 16 or the 4. You know, we don’t—we don’t have any studies showing ways of lowering that, but we have ways–
Dr. Justin Marchegiani: Of the 2.
Dr. Allan Warshowsky: Of increasing the—the 2. And the indole-3-carbinol, DIM, the diindolylmethane combination sometimes works better than one or the other. You know, we don’t why but people do respond to one or the other. And then, you know, methylation. You know, so we haven’t spoken about methylation but, you know, then we have need another hour I guess.
Dr. Justin Marchegiani: We’re gonna have to have you back again for a part 2 on this. This is great.
Dr. Allan Warshowsky: 30% of the population do not—do not methylate correctly.
Dr. Justin Marchegiani: Yeah, they have MTHFR issue, right?
Dr. Allan Warshowsky: Absolutely. So and you need methylation, you know, to further promote the detoxification of your estrogens because–
Dr. Justin Marchegiani: Uh-hmm.
Dr. Allan Warshowsky: If you can’t methylate, you can’t make the methyl estrogens–
Dr. Justin Marchegiani: Uh-hmm.
Dr. Allan Warshowsky: The 2, 4 , the 16—methyl estrogens which do the work. So we say the 2 hydroxy is a good one because we can methylate it to 2 methyl estrogen and that’s the one that shows reduction in breast cancer. It shows reduction in other cancers as well, and the 16 hydroxy and the 4 hydroxy which are carcinogenic, you can take the teeth out of those by methylating them. So they’re no longer carcinogenic if you can make them the 16 and the 14 methyl estrogens which is basically estriol. So methylation extremely important and it’s something that you still have to fight the insurance companies–
Dr. Justin Marchegiani: Uh-hmm.
Dr. Allan Warshowsky: Just to even cover the tests in their labs.
Dr. Justin Marchegiani: Right.
Dr. Allan Warshowsky: I write letter almost weekly to explain why I’m checking MTHFR in these patients’ labs when there’s just thousands of studies already on methylation and all the different aspects, everything from ADD, ADHD, and schizophrenia and hormone imbalance. Who would have thought? So–
Dr. Justin Marchegiani: I know. I just wanna give everyone a summary here of everything you said so far because you just dropped some serious knowledge bombs on us. So number one, we talked about kind of the fibroid locations, who may need surgery, and then if we have time, strategies to do. We talked about off the bat leaving out things like progesterone because they may cause some growth, some people may or may not, but we wanna keep it out to be safe. We talked about some things to help with decreased angiogenesis. That means decreased blood flow to the benign tumor, that being the turmeric and the green tea. We also talked about the resveratrol and how that can help modulate the estrogen receptor sites. We also mentioned the different enzymes taken on the empty stomach to break down that fibroid tissue. You also mentioned some herbs to modulate the receptor sites as well such as the black cohosh, the Don Quai, the raspberry root and the Shepherd’s purse, and then you also mentioned some of the detox stuff. You mentioned increase in the cruciferous vegetables, the DIM, the indole-3-carbinol, and you also talked about doing the testing to figure out methylation, to figure out your detox pathways and really improving the 2 hydroxy estrogens while trying to basically push the ratio more in favor of the 2 versus the 4 and 16. Is that a good summary so far, Dr. Al?
Dr. Allan Warshowsky: That’s—that’s excellent, J—Dr. J.
Dr. Justin Marchegiani: Okay, excellent. Do you wanna add a little bit more into this? I wanna have you back on a part 2 in a few months to go into endometriosis. I don’t wanna sell us short on the fibroid part here. Is there anything else you wanna dig in that ‘s clinically relevant and important to any patients that have this issue?
Dr. Allan Warshowsky: Well, you know, I—I think again we need to look at what—what’s going in your lives. You know, what—what is not working in your life because the energy of these fibroids is all about the–
Dr. Justin Marchegiani: Uh-hmm.
Dr. Allan Warshowsky: Really I think investigating what is not working for you because those are the issues that need to be addressed. The fibroid is there as an indicator.
Dr. Justin Marchegiani: Uh-hmm.
Dr. Allan Warshowsky: The fibroid, it’s not a punishment. You know, it’s not something that just happened. It’s there for a reason and generally, the reason is approachable, you know, once you start doing this work and looking into it and then—then the true healing begins. ‘
Dr. Justin Marchegiani: Got it. And do you have your patients avoid phytoestrogens like soy?
Dr. Allan Warshowsky: I more avoid soy these days because of the GMO.
Dr. Justin Marchegiani: Uh-hmm. Uh-hmm.
Dr. Allan Warshowsky: You know, I just don’t—I have a problem with glyphosate or 2,4-D getting into my patients’, you know, physiology. But soy itself has been shown to be in small amounts an estrogen modulator.
Dr. Justin Marchegiani: Uh-hmm.
Dr. Allan Warshowsky: You know, soy and flaxseed, these are just estrogen modulators–
Dr. Justin Marchegiani: Uh-hmm.
Dr. Allan Warshowsky: Just like ginseng as a tonic. You know, if your estrogen levels are low, the isoflavones will raise them a little bit. If you’re too high, they compete for the same receptor sites, so they’ll drop your estrogen by competing for those same receptor sites. So I don’t have a—a major problem with soy other than the GMO issue and—and then other people are just overdoing soy. I mean there are people who could have soy at every meal because they’re vegetarian or vegan–
Dr. Justin Marchegiani: Right.
Dr. Allan Warshowsky: And that could lead to major problems.
Dr. Justin Marchegiani: So would you recommend if you’re gonna do soy, do it in condiment amounts? And maybe do the fermented varieties that have all the trypsin inhibitors pulled out like the—the miso, the nato and the tempe?
Dr. Allan Warshowsky: I—I would go along with that and the only other brand of soy milk, the only one I’ve seen is—is WestSoy which has a non-GMO sticker on it. That—other than that I, you know, I have difficult time with soy. You know, obviously if you’re gonna have a—a serving of tofu once every other week or so and you’re generally healthy, you should be able to tolerate that. You’re probably getting more toxicity just walking out the front door and taking a breath of what we think is fresh air.
Dr. Justin Marchegiani: Got it. But if you’re a male patient, you definitely wouldn’t do the soy, right?
Dr. Allan Warshowsky: I have problems with, you know, the male patients having their own problems with the phytoestrogens and–
Dr. Justin Marchegiani: Yup,
Dr. Allan Warshowsky: Xenoestrogens, you know.
Dr. Justin Marchegiani: Yup.
Dr. Allan Warshowsky: They’re—they would get more gynecomastia–
Dr. Justin Marchegiani: Yeah, men boobs.
Dr. Allan Warshowsky: You know, and there’s a—you know, an epidemic or male—male cosmetic surgery to remove gynecomastia and then as men age, they look more like pregnant women, you know, with their big bells and the—and their chest hanging down. So men having—having a real hard time, and I would stay away from soy but I would bring flaxseed—I would bring flaxseed into—into the diets of men because it is an estrogen modulator for them. And I check estrogens in all men patients, so I do see men, I do see children these days. I only do office work. I don’t work in hospitals any longer.
Dr. Justin Marchegiani: Uh-hmm.
Dr. Allan Warshowsky: And I do—I—I really I do an integrative holistic approach to healthcare for men, women, and children down to about the—the prepubital years, down to about 12 years old. So I bring this approach that—of what I do now to families.
Dr. Justin Marchegiani: Got it.
Dr. Allan Warshowsky: That changed about 10 years ago.
Dr. Justin Marchegiani: And do you have any thoughts at looking at the free fraction of the hormones like the estradiol free, progesterone free versus just looking at the total serum levels of the hormones?
Dr. Allan Warshowsky: Whenever we do look at free levels, we can—I—I’m not seeing in the labs that I use in New York is a bit restrictive, and maybe other labs–
Dr. Justin Marchegiani: It is.
Dr. Allan Warshowsky: That are doing free estrogen levels. We can do a bio-available testosterone so that’s–
Dr. Justin Marchegiani: Uh-hmm.
Dr. Allan Warshowsky: Giving you your free testosterone but you know, you do free thyroid hormones–
Dr. Justin Marchegiani: Uh-hmm. So you do free T3 or free T4 and wherever I can do free hormones I would, because that’s telling you the—the hormone in your bloodstream that can get into your cells. We have no way of knowing if it is or it isn’t, even if you’re doing saliva testing which is really the next step. Now you got the—the hormone from the bloodstream into the interstitial spaces but still we don’t know what’s getting into the cells.
Dr. Justin Marchegiani: Uh-hmm.
Dr. Allan Warshowsky: So it is important to—to look at, you know, as specific as hormones as you can so I always measure, you know, the estrone, the estradiols–
Dr. Justin Marchegiani: Uh-hmm.
Dr. Allan Warshowsky: Men and in women. Other hormones like androstenedione and certainly dihydrotestosterone in men–
Dr. Justin Marchegiani: Uh-hmm.
Dr. Allan Warshowsky: As you said, check out these pathways. You know, so if you have, you know, variable pre-cursor hormones like androstenedione is very low in a woman or man, then her estrone or his estrone is sky high, you know that their aromatase enzyme is being stimulated and that’s an inflammatory issue. So usually we see that from, you know, things like insulin resistance.
Dr. Justin Marchegiani: Uh-hmm.
Dr. Allan Warshowsky: You know, with the—whether it’s a metabolic insulin resistance or a dia—true diabetic insulin resistance, that’s gonna drive that aromatase enzyme. So–
Dr. Justin Marchegiani: Got it, and if a woman comes in to you with a—a fibroid, let’s say, you know, 6 or 7 or even 9 cm, have you had success in the past, and let’s say time isn’t an option, right? I mean, let’s say the woman’s not at that biological ticking clock where they need to get pregnant. Let’s say they have time. Let’s say they’re already menopausal, or let’s say they’re very young and they’ve—they’re not gonna get pregnant for a while, what’s the biggest fibroid you’ve been able to reduce naturally with some of these holistic medical techniques.
Dr. Allan Warshowsky: I would say, you know, 10-12 cm, you know–
Dr. Justin Marchegiani: Wow.
Dr. Allan Warshowsky: We’ve certainly reduced some to the point of not being an issue. So will they go away completely? Probably not. But when time is not an issue and we can control the quality-of-life issues, those are key. You have to control the quality-of-life issues, I would say that almost 100% of the time these fibroids are gonna get to a point where it’s not gonna be an issue.
Dr. Justin Marchegiani: So let’s say you’ve dropped all these brain candy on everyone so far. Let’s say the average listener is incredibly overwhelmed, they’re listening, and they’re saying, “Alright, what’s the top 3?” If I could do Dr. Allan’s top 3, what would those top 3 be for those women that are just feeling a little bit overwhelmed right now?
Dr. Allan Warshowsky: Yeah, so I go back to, you know, the mainstays, you know, so it’s lifestyle and diet–
Dr. Justin Marchegiani: Uh-hmm.
Dr. Allan Warshowsky: Nutrition, and—and stress—stress modification. So you need this—modify your stress. Everybody has stress, but you need to find ways of getting rid of it, whether it’s meditation or belly breathing or exercise, it’s healthy diet, exercise and stress modification. Those are key. You know, without that and you’re not having ,you know, healthy digestion that comes with it, without having healthy excretion of toxins, that’s what a regular bowel movement every day is necessary for, you’re not gonna heal. So if you’re not gonna do anything else, get started on that, get down to an ideal weight, you know, get stretching or if you’re carrying a lot of extra weight as fat, we know fat cells are not inert, they’re producing hormones and they’re inflammatory hormones–
Dr. Justin Marchegiani: Umh.
Dr. Allan Warshowsky: And they’re producing cytokines and they’re inflammatory cytokines. So these are the basic things that need to get started on. People don’t heal when they’re—you know, you can’t—you can’t fix the roof when the—when their foundation is shattering.
Dr. Justin Marchegiani: Got it, that’s great. That’s great. And doc, you got a book here, Healing Fibroids Naturally, so everyone can go take a look at that on Amazon, we’ll put some links on the show notes. Also doc’s available here over in Rye, New York at 150 Purchase Street is the address. His email—or I should say his website is Doctor, D-O-C-T-O-R-A-L-L-A-N dot com. You can obviously see Dr. Allan over in New York. Doc, do you also do phone consults for people that are outside of the New York area that wanna run through your case—or run through their case with you.
Dr. Allan Warshowsky: I—I don’t—I don’t do phone consults until I’ve had one face-to-face visit and we see people—people almost every state in the country. We have patients that are international from the Middle East, from India, from UK, from all over Eastern Europe and the Middle East. And we do one face-to-face visit and then we work over the phone.
Dr. Justin Marchegiani: That’s great.
Dr. Allan Warshowsky: You know, we do a lot of emails. We do a lot of emails so we stay in touch via email and we stay in touch periodically via phone consultation and many of the patients come back. You know, we’ve had one patient came back from Dubai.
Dr. Justin Marchegiani: Wow.
Dr. Allan Warshowsky: And then—and she actually—she shared another colleague of her, she’s also gonna come in from Dubai for her follow-up, so–
Dr. Justin Marchegiani: Wow. That’s amazing.
Dr. Allan Warshowsky: That is pretty amazing to me. I never—never anticipated this with—after I wrote the book, but I understand the book is in—it’s in a lot of the bookstores in the Middle East and it seems fibroids seem to be a—a large issue. I would suspect because of the environmental toxins.
Dr. Justin Marchegiani: I agree. Are there any other ways my listeners can get a hold of more of your information outside of what I already mentioned?
Dr. Allan Warshowsky: The book and the website are the two best ways and that’ll—that’ll direct you to your next step if you wanna take it.
Dr. Justin Marchegiani: That’s great and I look forward to having you back in the next few months. I really wanna go into endometriosis. You’re such a wealth of knowledge. I felt like we should just focus on the fibroid area and we’ll have you come back for a part 2 and we’ll go over some—some more gems you have to offer them.
Dr. Allan Warshowsky: My pleasure.
Dr. Justin Marchegiani: Dr. Allan, thanks. You were a phenomenal guest. Have a great day!
Dr. Allan Warshowsky: You, too. Take care now. Bye-bye.
Dr. Justin Marchegiani: You, too.
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