Welcome to the Evolution of Medicine podcast! In this episode, James talks with Michael Twyman, MD, a cardiologist from the St. Louis area, and dives deep into mitochondrial medicine. It’s a topic we’ve explored on the podcast before, but as more research is published highlighting the role of mitochondria in chronic illness, we want to continue providing up-to-date, valuable information to our practitioners. Dr. Twyman shares his knowledge of the latest research and how he is putting it into practice in his functional, integrative cardiology practice. A ton of wisdom shared in this episode—enjoy! Highlights include:

  • The basics of mitochondrial medicine that practitioners need to know, plus more advanced research findings
  • Educational resources for practitioners who want to dive deeper into this topic
  • The symptoms and patient types that point to mitochondrial dysfunction
  • And so much more!

Resources mentioned in this podcast:

James Maskell: Hello, and welcome to the podcast. This week, we are going deep into mitochondrial medicine. It’s a topic that we talked about last year, but it’s a topic that’s very popular amongst practitioners, and there’s more and more research coming out about the role of mitochondria in chronic illness and what we, as practitioners, can do to get people better. This week, we have got Dr. Michael Twyman. He is a cardiologist from the St. Louis area, and he’s up to date with all of the latest research and is putting it into practice in his cardiology functional, integrated medicine practice. There was a lot of wisdom that was shared, enjoy.

So a warm welcome to the podcast, Dr. Michael Twyman. Welcome, Doc.

Michael Twyman: Well, thank you for having me.

James Maskell: Great to have you here on the Evolution of Medicine Podcast for the first time. Last year we took our first dive into mitochondrial medicine and some of the concepts, Dr. Andrew Heyman was on the podcast. And I actually had the chance to go down to a whole conference on mitochondrial medicine with Bob Naviaux and a bunch of other people. And it was super fascinating and kind of new for me. So I know that you’ve been at this awhile, what was it that sort of triggered you to think that this was the next frontier that a cardiologist should start to think about?

Michael Twyman: So about three years ago, I was going to take a trip over to Bhutan and Thailand, and it’s a 14-hour flight, and I was trying to figure out how to mitigate jet lag, so it came up on the article about wearing blue [light] blocking glasses on the plane might help, and earthing and grounding on other side might help. Didn’t really understand the science behind it, but did it anyway, get to Thailand and the jet lag really wasn’t that bad. So once I got back to the States, I really went into a deep dive of why did that light modulation really affect the jet lag? And then realize it all came down to how the mitochondria were functioning was the key.

James Maskell: Yeah, I know it’s become kind of a buzzword in the last couple of years here in the functional medicine space and so, maybe let’s just do a little bit of a dive into sort of what practitioners who are listening to this kind of need to know about the mitochondria sort of from the basic level and then some of the advanced stuff that you’ve learned along the way. So give us a sort of a baseline.

Michael Twyman: So when you’re in medical school or biology in college, you find out that the mitochondria are these organelles in the cells that are the “powerhouses” of the cells. They’re the things that make ATP, which is one of the energy currencies to run the energy requirements of the cell. So millions of years ago, the mitochondria actually were bacteria that the eukaryotic cells kind of usurped up into them to become their energy producers. They actually deleted a bunch of genes in the mitochondrial DNA so that the mitochondria’s main job is to make energy and then the host cell takes care of everything that the mitochondria needs. So I usually talk with patients at the mitochondria are the things that make energy for you, but they’re basically reversing photosynthesis. So you have sunlight, you have oxygen, there’s water, that combines with photosynthesis to make glucose in the plants. Then you eat the plant or you eat the animal that ate the plant, you take those substances, you break it back down into essentially electrons that go into the mitochondria. The mitochondria’s output is water, CO2 and ATP, you’re essentially reversing photosynthesis in the mitochondria.

James Maskell: Wow. Yeah, that’s really interesting. I’d heard a little bit about sort of the evolution of mitochondria and so where they came from and how we ended up with these little powerhouses in the cell. In your research, is there anything that you’ve learned along that way that is interesting to our community?

Michael Twyman: So the guy who’s probably going to have the most data behind him is Dr. Doug Wallace out of the Children’s Hospital of Philadelphia, he’s a pediatrician by training. He’s actually the researcher that discovered that the mitochondria come down through the maternal line, so you get your mitochondria from your mom, she gets it from her mom. So I’d usually tell patients that’s where you want to start to know your family history is how healthy your mom was because that’s your building block. For every 10 years that you age your mitochondria degrade, it’s called heteroplasmy. So 10% of mitochondria become less productive at making energy. So if you had healthy mitochondria at the beginning, this is tends to be the reason why, once you get to be 60, 70 years old, that all sorts of diseases are popping up, it’s essentially the mitochondria are browning out, they’re not able to make enough energy for the cells to keep functioning. So according to Dr. Wallace, it might be up to 80, 85% of diseases are truly driven by the mitochondria and not necessarily the nuclear DNA.

James Maskell: Yeah, that’s super interesting and the more I understand about it, the more I see that it’s such an important role. So I know that you’ve sort of going deep into understanding how to reinvigorate the mitochondria and sort of the structures on mitochondrial medicine, as sort of like this…I guess, it’s kind of like almost another phase beyond functional medicine in a certain way.

Michael Twyman: In a way it is. I mean, it’s also just getting back to the way mother nature intended things to be. Modern medicine is outstanding at saving people for acute issues and functional medicine is doing a good job trying to help people with chronic disease, get them back to health, but I think the next step might even be just reconnecting with the way that mitochondria actually work because the body has an amazing ability to repair itself, if you get out of its way. Humans started living indoors 90% of the time once they invented artificial lights and could do things that were outside the way mother nature intended to do. And those mitochondria, they’re basically light sensors that are sensing the environment at all times, when the mitochondria get sensed from artificial light, they send signals to the body to make hormones off-kilter. So I’ve been doing a lot of mentorship and training with Dr. Jack Kruse, who is probably the number-one clinician that does mitochondrial medicine and he’s always big into talking about something called, “light, water magnetism,” because those are the three forces in nature that are required to have life on a planet. And so if you can control your light environment, control your water, and control your magnetism, which is basically a surrogate for cold, or if you’re out doing earthing and grounding, that’s basically magnetism, you make the mitochondria work appropriately.

James Maskell: Yeah. That’s super interesting. So for clinicians who are sort of really interested in this topic, what are some of the educational resources that you’ve taken on that you found the most sort of beneficial or useful for developing your skills as a clinician?

Michael Twyman: So the light one probably is twofold, the easy book is John Ott’s book, it’s called Health and Light. John Ott was the time-lapse photographer for Walt Disney, those old movies where there’s like pumpkin’s growing and he’s doing stop-lapse photography, he basically figured out that different wavelengths of light made the plants do different things. And he had a good plausible idea that if this is happening in plants, it probably happens in animals and humans as well. That’s a fairly straightforward book, it’s 150 pages, you can get through it in a day. The hardest book to go through, and I’m only about halfway through it right now, it’s Roeland van Wijk’s book, it’s called Light in Shaping Life. That really goes into the science of biophotons, how cells talk to each other with light wavelengths? It’s a deep dive into the lighted pathway. As for the water, the greatest book is probably a Gerald Pollack’s book called The Fourth Phase of Water, really explains how water is a battery and how it stores energy. And so your mitochondria, one of their main jobs, is it’s making water and it’s that is a battery inside the mitochondria. So ATP is an energy source, but the water that the mitochondria make and they store energy from sunlight, is another source of energy for the cell.

James Maskell: Interesting. So is there a certain like patient type or a certain patient category that now that you’re educated in this, when you see a patient presenting with “X” certain symptoms, your mind is going towards, “Okay, let’s really do a deep dive into, say, the mother’s health or the mother’s health timeline,” because you suspect mitochondrial dysfunction?

Michael Twyman: So I’m a classically trained cardiologist and got interested in integrative functional medicine six, seven years ago, so I’m still focused mainly on cardiac patients reducing the risk of heart attack and stroke, but the mitochondria there’s approximately 3,500 mitochondria per cell in the heart cells and also in the brain cells, those are the kind of two biggest areas that the mitochondria are located. So if the patient comes in with signs and symptoms of heart failure or coronary artery disease, they have Alzheimer’s, Parkinson’s, those are, for the most part, a mitochondrial disorder, but for people who aren’t that down the rabbit hole, I mean, autoimmune conditions and even malignancies, have a strong tendency towards, “There’s something going wrong in the mitochondria.”

James Maskell: Okay. And so, in your regular intake, what are some triggers to make you sort of think in that direction?

Michael Twyman: I mean, that’s the mitochondria energy, essentially. So people coming in with chronic fatigue, fibromyalgia, all these things are basically brownouts for them because their mitochondria aren’t pumping out enough energy.

James Maskell: Great. Okay, cool. So you’re doing integrative and functional cardiology in your practice, and now you are, obviously, doing like dietary changes, reducing stress, try to get people sleeping, those kinds of things. What are some tools that you’ve added to your toolkit that other practitioners would be able to use? And what are some of the sort of ways you’ve seen that some of those new strategies have had the biggest impact on individual patients or cohorts of patients?

Michael Twyman: Sure. Great question. So I, typically, always start with circadian rhythm management, so your 24-hour cycle. The two main things that control that circadian rhythm are the light that enters your eye and hits your skin surfaces and then also the time of day that you’re getting your meals. So the light, now we’re supposed to be an outside being, you should be ideally living outside 80, 90% of the time. Most humans have it reversed, and they’re living inside 80 to 90% of the time. So the sun, the wavelengths of light program your cells throughout the day, the sounds basically like your GPS clock, tells you how to make your hormones throughout the day. And if you live inside, you get different signals, you make hormones off-balance. So the number one sign of illness is having low melatonin levels, high cortisol levels because they’re yoked.

So I usually tell patients, do your best to get outside and see the sunrise, that morning light set your pituitary up to make your testosterone, make your other sex hormones appropriately for the day, you raise your cortisol levels in the morning appropriately. But once you’re inside, and especially when you’re talking on screens and such, you want to mitigate your blue light hazard, so get a pair of blue blocking glasses that filter out that blue light that goes into your eyes and can destroy the melanopsin receptor. The melanopsin receptor is a blue light receptor in your eye and if you destroy that too much, your melatonin levels will drop. You’re not going to sleep well, melatonin is the hormone not only for helping you stay in a deep sleep, but melatonin is the hormone that causes the mitochondria to do autophagy and apoptosis. So it recycles damaged mitochondria, and it kills off the ones that are not functioning appropriately. So control your light environments.

And then the second thing that the basis of Dr. Panda’s book, The Circadian Code, was time-restricted eating. So the liver and the gut have clocks, anything that comes into your system that isn’t water in the morning, time sets those clocks off and ideally 12 hours after that point, nothing else should go in your system so that you have three to four hours of nothing going in before bedtime. Those gut clocks and the liver clocks will shut off, you’re able to get deeper sleep, you’re likely to improve your body composition, and also likely to improve your glucose regulation if you just change up the time of day that you eat. So focusing on circadian rhythm management first, and once those things are dialed in, then we go deeper into the weeds.

James Maskell: Yeah. So that’s cool. So I love a lot of that and I’ve been in the last year, obviously, the PLMI Conference that I think we were both at the beginning of last year, went deep into all those circadian rhythms and that’s really just affected the way that I’ve thought throughout the whole of the rest of this year. When you say deeper dive, what are some of that? Like you’ve done a baseline, you’ve got people doing that. Obviously, the majority of cases will probably have significant improvement with those kinds of inputs. If you get stubborn cases where that doesn’t happen and still the symptoms are still around, even with those kinds of changes, what are some things that you look to for a deeper dive?

Michael Twyman: That’s a great question. So sometimes you need to go back a little bit in to the family history and know what the maternal mitochondrial haplotype is. That’s something you can obtain on your 23andMe, you can pull it off the report and it’ll tell you where your maternal mitochondria haplotype comes from. So most North Americans, if they’re Caucasian, they’re going to have a Northern European haplotype. And there’s essentially two types of mitochondria, there’s tightly coupled mitochondria, which are generally people who come from the equator and then there’s uncoupled mitochondria, generally the Northern Europeans, which most Americans are. Typically, the people who are tightly coupled, dark-skinned, Africans living on the equator, their body is more programmed on light, they’re used to being in 12 hours of UV light daily. And the mitochondria will basically spend the ATPase, the thing that makes energy faster when red light and UV light are going through it.

People who moved away from the equator and went North, so the Scandinavians, this is the reason that they’re blonde, blue eyed, light skin, is because their body has to try to assimilate as much light as it can when they can, because there’s 20 hours of darkness in the winter time. So their bodies lightened up, but also their mitochondria are uncoupled, meaning that the respiratory proteins are further spread apart. They’re not nearly as energy efficient, so what happens is, as the electrons are passed off through the cytochromes, there’s heat exchanged. That heat does a couple of things, it shrinks the water around the mitochondria proteins so they get closer together, so the energy can go faster again, but heat is also liberated, so basically you don’t freeze to death if you’re living up in Estonia, Scandinavia in the winter time.

So if somebody is Northern European and they’re living and in a Northern European latitude, they’ll probably do okay. But the reverse is that if somebody is equatorial, African in their haplotype, and they’re supposed to get 12 hours of sun almost every day of the year, but they’re living in Detroit and they get no sunlight, those people are going to tend to break down faster because their mitochondria aren’t optimized to their local environment. So, typically, one of the things Dr. Kruse always says is it’s very challenging. He always says impossible, “it is impossible to get well in the environment that broke you.” If 80% of diseases are epigenetic, you have to figured out what is in your environment that’s breaking and change it. So sometimes one of the best answers is do what I just did, go down to Mexico for a week, live outside for the most part and see how well you feel. If you feel much better in a high light environment and you’re drinking the appropriate water, getting seafood, and out there earth and grounding on the beach, then you know how your mitochondria are set up. You’re more light-based, or you’re more kind of cold-based. So sometimes you have to kind of do the deep dive with the mitochondria haplotype, and then put the person in the environment that their mitochondria are supposed to be optimized to.

James Maskell: Is everyone going to have to move to Costa Rica? Is that the option?

Michael Twyman: Not everybody. But if somebody is really broken, they probably do need to go down and get more sunlight. I mean it’s clear about vitamin D.

James Maskell: It’s interesting that you mentioned that, I think I had a friend, who I think was at that conference, who was chronically ill and moved to Mexico for a period of time because she realized that was what was needed to happen for her to recover and dealing with similar kind of stuff that, so that doesn’t surprise me in the slightest. Thanks for sharing those ideas, I think there was a lot of gold in there for practitioners who are trying to get people well and bring people out of chronic disease and, especially, these kinds of complex issues that have troubled even functional medicine doctors and it’s certainly like cutting edge work. One of the conferences that we went to last year in October, I went to, was the Mitochondrial Medicine Conferences in Dallas and Bob Naviaux was speaking there about the cell danger response. And I know ,earlier this year, he brought up some research on the effect of toxins to the mitochondria. It seems like, when we’re looking at the way in which toxins affect human health, affecting the mitochondria seems to be a big part of the mechanism.

Michael Twyman: Yeah, for sure. I mean, this is the story of life is the story of electrons being powered by the sun and the electrons running through the mitochondria to spin certain things to make ATP. So the classic toxin that poisons the mitochondria, cyanide. Cyanide stops the electron flow decided to cytochrome IV, instant death. So many of the pesticides and other things that when we’re saying like, “Well, does that cause cancer?” Well, what it does is it just messes up the energy production in the mitochondria and then when the mitochondria don’t make energy, those things wear out. Remember at the beginning, we talked about mitochondria are essentially bacteria, so things that would damage a bacteria are the things that damage your mitochondria. So this is one of the reasons why certain antibiotics, certain medications that have toxic effects to bacteria are going to affect the mitochondria.

James Maskell: Yeah, that’s super interesting. And I mean, in your experience working with this, is there an order by which you would sort of go after toxicity as a cause as compared to, let’s say, light regulation or any of the other sort of other factors that you mentioned earlier?

Michael Twyman: I mean, I tend to favor Dr. Kruse’s protocols where it’s more you redox before you detox, meaning the redox potential is the amount of energy that the mitochondria can potentially make. If you have healthy mitochondria, they can detox anything, so if you just focus on rebuilding the mitochondria by controlling your light environments, getting optimal sleep so that the autophagy and the apoptosis can actually happen and you rebuild the damaged mitochondria at night, the body can get rid of a lot of toxins.

James Maskell: Absolutely. Yeah. Wonderful. Well, look, this has been a wonderful dive into it, and I really appreciate you sharing. And it’s interesting to me that, obviously, that this is a part of general practice and I could see a nutritionist or a dietician or someone taking advantage of this information, but also yourself as a cardiologist can really get a lot of value from it. Are there any other things that you think practitioners need to know on this topic? I mean, I’m sure there’s a whole…there’s so much to learn and we’re, obviously, still only in the beginning phases of understanding everything, but are there any lessons along the way that you learned that have helped you really implement this effectively clinically and get the best results with people?

Michael Twyman: Really I think it just goes back to the basics, reconnect with nature, listen to the way that you were put together, you were supposed to be an outside being, sunlight programs your cells to make hormones the way your body needs them. So if you’re breaking because of your environment, reconnect with nature, get outside, see more sunlight, earth, ground, you get free electrons from the earth if you do that. So if you’ve reconnected with nature and you’re still broken, then maybe it’s time you to go further south and kind of change up your environment. But, typically, always look at your environment, it’s rarely something that is genetic that’s going to predetermine your fate, if you change your environment, you change your health.

James Maskell: Beautiful. Doc, thanks so much for being here and being part of the Evolution of Medicine Podcast. If you’d like to find out more about Dr. Twyman, you can find his website and you can follow him online on the cutting edge of mitochondrial medicine and cardiology at his practice in the St. Louis area. There’s a lot of interesting practitioners that we’re finding in St. Louis over the last little while, I know a big part of that community there with SLIIM, which is one of the longest-running practitioner meetups in the country. And we are going to be hearing a lot more about that during the rest of the year, but Doc, thanks so much for being part of the Evolution of Medicine Podcast. If you’d like to know more about this topic, please feel free to get in touch with us. But in the meantime, I’ve been with Dr. Michael Twyman and I’m your host James Maskell and we’ll see you next time.

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