Oxalate Rich Foods and Adrenal Fatigue with Emily Givler, DSC


Dr. Joel Rosen: Everyone and welcome back to another edition of the less stress life where we teach exhausted and burnt out adults the truth about adrenal fatigue so that they can get their health back quickly. And I’m really excited to join forces on this podcast today with Emily Givler. And she is a functional medicine genetic nutritional consultant researcher lecturer and has a thriving clinical practice at the tree of life in Lancaster County, Pennsylvania. She is also the co-founder of beyond protocols.org a mentorship platform for practitioners who are committed to learning how to more deeply integrate functional genomics into their existing practices.

She holds advanced degrees in certification in nutrition, herbal Ism nutrigenomics from the whole Institute of Medicine, Pan American University of natural health, and functional genomic analysis, where she now serves as an advisor and supplement formulator. In her practice, Miss Givler uses personalized dietary and nutritional protocols based on genetic predispositions, environmental and epigenetic influences, and functional lab testing to help her clients regain health. You so much for being here today.


Emily Givler: Thank you so much for having me, this is going to be so much fun.


Dr. Joel Rosen: Yes, I’m really excited because I have, I have been one of the students of your teachings. And I always you have a great skill in delivering very difficult information in a way that’s understood and mostly a being able to be applied. So one of the very first questions I always start with is, why don’t you give us a little background of your own health history and why you got into what you got into?


Emily Givler: Sure. Like so many people in this field, it really was my own health struggles that pushed me in this direction. So I started struggling with some chronic pain when I was 14. And I got moved around from doctor to doctor different types of physical therapy, all sorts of testing for about five years until I landed in front of a rheumatologist at 19. And she diagnosed me with fibromyalgia and told me that with how early it had started, and how fast had progressed, that I should basically plan on being disabled by the time I was 30. And then she proceeded to give me a really obscene narcotic painkiller prescription with the instructions to double it when I was in a lot of pain, which was really every day at that point.

And the promise to give me stronger drugs when those stopped working. And when I asked to please to have a liver and kidneys, by the time I was 40, she tacked on an anti-psychotic prescription as well. And so I had this label that was basic that felt like medical shorthand for you’re tired, and you hurt all the time. And those were the two things that I knew. And what nobody could tell me was why. So planning on being disabled by 30 seemed like a really bad plan. So I started kind of this health journey of my own, exploring chiropractic, exploring energy medicine, and ultimately landing in nutrition. And I took lots of missteps along the way, in my own health, which Now, fortunately, helps me, my clients avoid those same mistakes. But that ultimately led me to Bob Miller and functional genomic analysis. And that was when really all of the light bulbs started going off.

And I discovered that my own fibromyalgia and chronic fatigue were really rooted in both in influence chronic inflammation, but really driven by high oxalates. And so I started taking steps to mitigate that. So I will be 40 this year, and fully not disabled. I don’t take any anti-psychotics for any painkillers. And I can honestly say that I had almost 40 my pain is about 2% of what it was when I was a teenager and in my 20s. And my energy is about 5000 times what it used to be, even with three small kids running around.


Dr. Joel Rosen: And you still have a liver and kidney.


Emily Givler: I do two kidneys.


Dr. Joel Rosen: Not one just two. Yeah. So that’s, that’s great. So just to kind of go back though, because I do want to talk about oxalates. And I’m really excited to tie that in with fatigue and exhaustion and hormones and the things that you’ve discovered, but just sort of the Friend in Me wants to know, like, Did that really upset you and make you mad? Or feel like a certain, I guess, energy feeling towards those recommendations because they are very aggressive in the medications that they gave you didn’t give you a lot of hope. Didn’t educate you. I mean, what did you learn from that particular experience?


Emily Givler: So it The moment because I had been struggling for five years with no answers. It was empowering to get that label at the time to know that I wasn’t alone. I wasn’t crazy. You know, I was at the point where I was wondering, maybe everybody just feels this way. And I’m just being a baby about it. Because despite test after test, after test, everything looked normal. And I kept being told, everything is fine. But I knew in my body that everything did not feel fine. So I had a tremendous sense of gratitude, to know that I wasn’t alone, and that, that there were enough other people who were dealing with this, that it actually had a label, and I will never forget, I called my best friend. And as soon as I finished the appointment and told her, I have fiber, or that I found out what I had. And her response was they, they labeled it like you have a real thing. Like she was shocked. She was shocked to know other people had it.

Because we were so young. I mean, I was 19. And she had watched me go through this all through high school. So part of me will always be grateful for that moment. And I’m also grateful that the prescription was so obscene. You know, the thought of taking what amounted to 12, to 16, narcotic painkillers every day, felt really excessive. So in hindsight, I definitely feel grateful because that was what threw up the brakes. For me. I feel like if my doctor had given me a reasonable prescription, I probably would have followed her advice. And then I may have gone the route of so many people who got pulled into the opiate epidemic, because of crazy painkiller prescriptions. So I have a lot of gratitude for how things played out. I felt very lost. But my nature is to question why and to dig deeper. So when I got this label that didn’t give me any explanation, it did give me encouragement, and a place to start digging. And it kind of gave me a mission.

So because of, of my nature, my inquisitive nature, it was a good thing for me, it was not there were points of hopelessness, there absolutely, were. But I. And as I said, there were a lot of missteps, like we’re going to talk about oxalates. And one of my first steps was to become vegetarian and eat all of the oxalates. So I made myself much worse and felt myself believing this doctor like, Oh, she was serious, that I’m going to be disabled by the time I’m 30. So but then I started having these small moments of progress. One of the big ones was that when I started working in chiropractic, and got some physical manipulation, and corrected some of the structural issues that had resulted from the high oxalates, that I had systemically destabilizing connective tissue. So that was one of my first aha moments that things could get better.

They didn’t just have to keep getting worse. I started eating meat again. That was a big aha moment. So I kept having these small moments of clarity. And they kept pushing me forward, kept shining a light on things and pulling me out of that darkness that so many people can get sucked down it.


Dr. Joel Rosen: Yeah, well, there’s a lot of wisdom in that in terms of first having something to hold on to her anchor to with a label, even if it was an incorrect label, at least kind of categorized it and gave you something to have a foundational firm sort of grip on to be able to question if it’s true or not. So I think that’s very key, especially with today’s rising epidemic of health challenges. It’s hard to come up with a label per se like if we were to give the mechanisms of everything going on it’s not a label, it’s a physiological pathway with a lot of three-dimensional things going on. The other thing I would say which is very indicative of the people I’m sure you work with that get success in the ones that I get success with our that inherent finding, what’s the good thing that came out of this because a lot of people that are suffering and are exhausted and burnt out.

They are justifiably so in terms of feeling, hey, this isn’t fair, like I’ve been done wrong by, you know, all my friends are going on in their life and they’re living their thing and that that is totally justified, but it doesn’t serve them in terms of getting their health back. And I think that having gratitude For things that you feel, that things that could be interpreted as being a victim is is a huge ingredient for healing. And I’m glad that you were able to harness that. You keep mentioning oxalate, so let’s kind of get into that. But before we do, and I asked if this was okay earlier, is it Adrenal Fatigue is a controversial term. And it is it’s a label as well. But what’s your idea of what Adrenal Fatigue is? And how would you explain that to someone?


Emily Givler: So, you know, this is one of the nice points about being a nutrition consultant, another doctor, so I can’t diagnose so so we can use some of these labels as umbrella terms and descriptors to give people the language to describe what’s going on in their body. But what we think of as adrenal fatigue, when I talk to my clients about it, we talk about hitting this point where we lose our capacity to adapt appropriately to stress. And this can happen for a lot of different reasons. And usually, it’s a multitude of mechanisms coming into play, things affecting the hormone production, excessive levels of stress, environmental insult, because, you know, when we’re talking about stress, it’s not just that emotional stress, physical, mental, emotional, spiritual, all of these stresses prompt a similar physical, the physiological reaction in the body.

So there’s some supply and demand to this, and we live in a very high-stress society. And if we have dietary or metabolic or digestive challenges, or as we’re going to talk about things like oxalates, these can exceed our capacity to adapt in a healthy way to those stresses and systems get run down. And so that’s kind of what we’re talking about that failure to adapt healthily, and the ripple effects that it creates in the body.


Dr. Joel Rosen: Yeah, I love that answer. And I say the same thing as well, I think quite fundamentally and simplistically, you have a demand and supply problem, and you have more demand than you have supplied. And as a result, your body comes up with the most prioritized system or function to use that supply. And then the resultant not having enough supply for other demands are your outward symptoms. And it’s not just a Hey, you got a fuse, that’s out, we got to replace it.

It’s your adrenals and here you go. So, but what I really love to talk about are all of the mechanisms that will impact the HPA axis. And as you know, and as I’m sure you’ve helped us design and then formulate, and so forth is the entire influence influences of epigenetic or environmental triggers that cause that HPA axis to go haywire. And one of the main ones is oxalate, so why don’t you kind of start us with What on earth are oxalates.


Emily Givler: Sure. oxalates are such a massively overlooked problem, especially in chronic health challenges, particularly people dealing with chronic fatigue and chronic pain. So oxalates are a plant poison. They are produced by plants like spinach, beets, Swiss chard, rhubarb, nuts, roots, the parts of the plant that it needs to survive. So the plant produces oxalic acid to deter other organisms, generally insects from eating it. And when we consume the plant we consume that oxalic acid. The level varies and I am not a proponent of not eating vegetables, so I don’t want anyone to think that that’s where we’re going with this. But in certain individuals, the level of oxalic acid in that plant becomes very dangerous to the body because oxalate is also a mineral key later. So when we over absorb it into our system, it will bind very tightly with minerals like calcium, magnesium, iron, and zinc, and form insoluble precipitates. So that means that our body can’t break these compounds down, they’re going to stick around or we have to excrete them intact.

And the problem here is that these precipitates are like tiny little razor blades or shards of glass in the body. They’re the same thing that formed kidney stones and that’s how that is. All most medical doctors know about when you say oxalate, they immediately think of kidney stones. And for anyone who’s had kidney stones, they’re no joke. This is one of the most painful things that you can go through and somewhere between 60 and 80% of all kidney stones are calcium oxalate that calcium bound up with the oxalic acid and the reason they’re so painful to excrete is because it’s basically like a little cluster of razor blades that you have to filter through your kidneys through your bladder tremendously painful however only 0.5% of people with high oxalates are actually kidney stone formers the other 99.5% of people have these oxalates trapped in various tissue so imagine having tiny little kidney stones spread throughout your body and this is the point where i think anyone listening who has fibromyalgia is going yep that is what my life feels like that is what my body feels like so these precipitates can aggregate in the brain in the eyes and the connective tissue in the muscles in the bone and the thyroid in the lungs and the gastrointestinal tract and the kidneys i mean it they can become ubiquitous and they mechanically shred the surrounding tissue.

Because again they are like little razor blades so they create a massive amount of pain and inflammation and they knock out all of the sulfate from your body because oxalate has been shown to outcompete sulfate in the body and for those of your listeners who don’t know sulfate is one of our most critical nutrients it’s the fourth most abundant nutrient in the body it’s needed for things like cholesterol sulfation da ga sulfate you know all of these critical processes in the body for the connective tissue things like can dryden sulfate for healthy cartilage so all of those things get messed up when oxalates are high in the body and i mentioned that they come from plants i should also mention that we make a very small amount of oxalic acid and dodge honestly as part of our metabolism there are some people who have genetic predispositions who end up making too much these are our primary hyperoxaluria people it’s a very small percentage of the people with high oxalates most people fall into the secondary category where it’s coming from either overconsumption and food or some type of gut dysfunction or from organisms like yeast fungus and mold in our systems which can create too many oxalates as well.


Dr. Joel Rosen: yeah and it’s amazing that you just to reiterate the point 5% of the oxalates are resulting in kidney stones where 95.5 are not and doctors only recognize oxalates as a fundamental problem and there’s a problem there Emily


Emily Givler: right but so if you think about what’s happening kidney stones are an excretion of oxalates so if you’re getting a lot of pain and then you pee and it goes away and your doctor has you filter your urine and then picks up that little particulate and puts it on a microscope it’s really easy to say i figured out why you had all that pain but if those same particulates are trapped within tissue and it’s worth noting the size of some of these are micron and nano particle size so you can get several of these particulates across the width of a piece of hair like they’re super tiny we don’t see them on traditional imaging until they have a mast into large stones so they’re not necessarily going to show up on things like x rays or ultrasounds.

Because they are too tiny so they’re invisible to most traditional imaging so we are not seeing them in traditional techniques unless you’re actually exceeding it and then sending that particulate off to a lab for them to analyze and come back and say oh calcium oxalate so that’s the easily recognizable presentation it’s all of these other pathologies due to the trapped oxalates that have historically been missed and honestly most of us as practitioners are continuing to miss them so hopefully after today we’ll get a few more people clued into what may be happening in their bodies.


Dr. Joel Rosen: right I was gonna say like it is invisible or very difficult to pick up based on the techniques that we have but what’s not invisible is the knowledge and the information which isn’t being taught at the academic level which is a shame because you have I wouldn’t even say an epidemic but a tidal wave of incidents of people that have these challenges and I think the key learning of minerals is is not only I mean obviously as you know not just that sulfation component but also just in terms of we need these minerals to drive energy production.

So why don’t you give us some insights in terms of some of the impact that oxalates have like, especially if with our people that are listening to this are considering themselves, adoringly fatigued or their inability to adapt, or the most common thing is I just don’t have energy. I don’t handle stress, my circadian rhythm is off, and I’m exhausted. So why, how would oxalates impact energy production,


Emily Givler: Actually, in multiple ways, and this is part of why we see such strong ties between chronic fatigue and fibromyalgia and adrenal fatigue when people get stuck in those labels. So the first is physical mechanisms. So I’m going to keep mentioning that oxalates are like little razor blades in the body. And for anyone who’s questioning that, I would encourage you to just do a google image search of calcium oxalate, and you will see exactly what I mean. So we’ve got these little razor blades, they shred not only things like the connective tissue, the fascia, but they can also get into the cells through things called soul, you carriers have kind of like a little bridge into the cell. And within the cell, they shred things like mitochondria, which are the engines of ourselves, this is our primary energy generation mechanism, and oxalates will destroy them. So there’s that physical destruction, you know, fewer mitochondria or mitochondrial function. So that’s number one.

In terms of how they affect hormones, stress adaptation. This is an ongoing stressor in the body when you have this physical precipitate trapped within your body. And this is not some abstract mechanism of inflammation. We have these nanoparticle razor blades, mechanically shredding surrounding tissue, that is a stressor on the body. So if you are always under this physical stress, it’s very difficult to keep up with that adaptive mechanism, because it’s rarely The only stress that’s going on in your life or your body at the same time. And then when we think about some of the mechanisms by which we get high oxalates, some of them exacerbate hormonal disruption. So I mentioned that genetics is a pretty rare reason to get high oxalates.

The most common reason that people get hyperoxaluria is actually due to fat maldigestion. So if we are not emulsifying, our dietary fats with adequate bile, then that undigested non emulsified fats will bind with our dietary minerals like calcium, magnesium, and we will end up excluding the fat and the mineral bound together, it forms almost like soap and we lose it in-store, so you lose the benefit of the minerals and you lose the benefit of the fat. And at the same time, one of the benefits of the minerals that you lose is their ability to bind with dietary oxalate, allowing for its harmless excretion soul. So we end up absorbing more oxalic acid in the intestinal lumen and then ending up with hyperoxaluria.

So at this, we get the oxalates, we lose the minerals, and we lose the fats. And fat is the building block for our stress and reproductive hormones. So we end up with too many oxalates and the physical stress that they create, and too little of the building blocks for these hormones. And fat is also one of our major energy sources. So like when we think about calories, just in straightforward, like energy in energy out, that’s really concentrated energy. And it’s ending up in the toilet bowl, rather than being actually used metabolically. So we see just a tremendous amount of challenges towards the adrenals towards cortisol production. I mean, we can throw in a couple more mechanisms there too. For some people, oxalates become a trigger for my activation.

They up-regulate an enzyme called NADPH oxidase, which triggers muscle activation syndrome, which drives up more inflammation in the body. And we need compounds like cortisol to stabilize the mast cells. So if you’re not able to make enough cortisol because you’re pooping out all your fat, and your body is chronically in pain and stressed out because it’s full of oxalates and you’ve got this inflammatory immune dysregulation happening with mast cell activation, you can bet That you are going to be exhausted. And this is where these things create ripple effects. And we have these symptoms building on one another. And it’s so critical that we do our best to find that upstream root cause. That’s how we can stop symptom management.

And so often, fatigue is a symptom. And it’s a horrible symptom. But it’s resulting from all of these other things. And so if one, dealing with one of those branches doesn’t give you full resolution, don’t give up, it may be multifaceted, we’ve got to keep working towards what that upstream trigger can be in a kind of fixing some of the damage that may have been done along the way. But I really believe that when we can figure out what’s upstream for us, then we can compensate and correct for it and really take major steps to get our quality of life back.


Dr. Joel Rosen: Yeah, and I think that for the listeners, and for even the host to go back and listen to that, again, because there are so many beautiful, eloquent things that you said, that needs to be repeated and listened to because it’s banging on in terms of why you would take an adaptogen or, you know, fossil title Serien, or licorice root, and it’s not moving the needle whatsoever.

And that’s kind of what I want to teach people is it just not reductionistic in that way. So you mentioned getting upstream. So I want to get there in one second. But one of the things I want to mention is is that with the fat metabolism and the absorption and the being able to flow bile and remove chemicals and toxins, and not even just hormone cycles, but nerve function, brain function, all of those things. Could you not say though, and I guess you’re going to get this in your answer for upstream mechanisms, that even though a very small percentage of having high oxalates are from a genetic challenge from oxalic gene snips, the fat malabsorption, or the bio flow is a genetic predisposition that may have a lot more susceptibility for bio.

And that’s part one, part two, because I know I will forget it is when you were saying that when I look on an organic acid test now from Great Plains that has the oxalates if I’m seeing on the fatty acid metabolism thing, a lot of fatty acids and ketones coming out in the urine, would I also potentially think about having high oxalates because of what you just said.


Emily Givler: And my gosh, those are such great questions. So when we look at what genes are oxalate genes, typically we’re thinking about what would cause us to produce more endogenously. So these are genes like a Gx t, which is our alanine, glyoxylate transferase. When that’s not working, we make more oxalates instead of making glycine, when or other genes like gr HPR, so they would be the endogenous oxalate producers. So there’s a lot of other things that can contribute to the over absorption of oxalates.

And the fat malabsorption. And bile flow snips are absolutely huge parts of that. So I would consider them Oxyelite related genes, but not everyone who has that issues there will necessarily present directly with hyperoxaluria. Whereas with the AJAX to the GR HPR, it’s more one-to-one, but it is absolutely an indirect mechanism. Anything that wouldn’t affect the integrity of the mucosal barrier could become a secondary path for hyperoxaluria. And things that disrupt the microbiome are as well, because, you know, we, as humans have eaten plants and nuts roots for a long time without major issues. And a large part of why we can do that is because there are keystone species in our gastrointestinal tract in our microbiome called ox load factor for machines. And this is our primary oxalate degrading organism.

So oxalate can’t be broken down by human cells, but this bacteria can break it down under any physiological conditions, but it’s really sensitive to antibiotics, especially. fluoroquinolones, antibiotics like Cipro or tetracycline, like doxycycline. So we see a lot of people in the Lyme disease community really struggling with oxalates. For them, it’s probably due at least in part to disruptions in the microbiome because of the use of doxycycline for the treat Treatment of Lyme disease. So fostering a healthy microbiome taking steps to correct for fat malabsorption, Whatever the cause may be, definitely can help prevent or reduce the over absorption of dietary oxalates. And the urine organic acid test is such a great tool for figuring out if oxalates are high. And why, because we’ve got a bunch of different mechanisms that can cause them.

And they are not mutually exclusive. So part of the reason I have issues with oxalates is partially genetic, partially mold exposure, and my childhood home, partially dietary, that malabsorption dysbiosis. I mean, I think I had all of the above, it was like the universe really wanted me to work with people with oxalates, I was gonna get this message one way or another. So when we look at the organic acid test, if we are seeing those, like high levels of fatty acid metabolites, we should absolutely be thinking that this is at least one of the mechanisms for high oxalates. If we’re seeing markers for potentially colonized mold or yeast in the gut, that may be something that we need to address. So there are a couple of different patterns on that organic acid test that can point us in the direction, why we might have issues with high oxalates. And it also helps us to determine if it’s actually coming from genetic sources.


Dr. Joel Rosen: Well, yeah, no, that’s awesome. I mean, full disclosure, I didn’t look at the organic acid test with the high fatty acids and think oxalates. But you did mention mutually exclusive, and they’re not mutually exclusive. And that’s that whole 3d chess game played underwater, where, if you asked me to come up with different theories as to how that would have been related, I probably would have had the ability to connect all those dots. And that’s the scary thing about all of this is that whole feed forwarding mechanism where there actually aren’t mutually exclusive.

And indirectly, they actually produce more of the something that caused the something that caused them to cause the something and create major challenges. So So Emily, so now that we’re understanding all of these interventions, you did mention in terms of doing an organic acid test and seeing and it has to be Great Plains because unless I am not aware, there’s not another organic acid test that shows these oxalate markers on there.


Emily Givler: So I, I use the Great Plains test primarily. I believe that Genova just added the oxalate markers to theirs because it’s so important. So we may have a second tool, but historically great, the Great Plains urine organic acid test has been the best tool for this. And it does give us all of those other pieces to cross-reference. So in terms of interventions, our interventions are going to help us the most, if we can figure out the why of the oxalate. So if we have run a urine organic acid test, then we have more clear points of action. But for those people who are just sitting here going, Hmm, this sounds like me, what can I do today.

So we have to take steps to reduce oxalates in our body and our diet very slowly. So this is the number one caution point with oxalates. You have to go slowly if you have trapped oxalates in your body because you can’t break these precipitates down. So like I had a lot of oxalates in places like connective tissue. So I want to get those oxalates from my connective tissue out of my body. Now I’ve got to move these little razor blade-like particulates all the way through my system. We move oxalates out of the body through a few different pathways. They come out in the urine. That’s why some people get kidney stones. They also can be excreted in the stool. They can be excreted in tear ducts, so they can come out through the eyes, and they can come out through the skin. So if you move these little razor blades through your system too quickly, they attract each other so they aggregate and clump together and form larger and larger precipitates that are going to do more damage.

So this is something that we call oxalate dumping when it happens, and it is horrible and painful. I have only gone through one point in my life that I can say 100% no questions was the axe like dumping. I took too many steps to push out oxalates too quickly. It was The worst migraine I’ve ever had in my life is the only time in my life I have ever literally passed out from the pain. It is a very serious thing. Many people get their first kidney stone because of oxalate dumping, it is not something we want to encourage that we’ve got to think tortoise versus the hare, we will cross the finish line much sooner, if we are very deliberate and slow about the so really important. Any of these interventions that you take have to be gone, you have to go slowly with them. And you should not do all of them at the same time, even if you’re doing all of them slowly, one at a time with these things.

So the first is to kind of assess what your dietary oxalate intake is. And there are a lot of different lists that you can find online with the oxalate content of foods, but generally speaking, dark leafy greens, like spinach, beet greens, Swiss chard are your highest oxalate foods followed very closely by nuts, like almonds, and then roots like sweet potatoes and Tumeric. So these are not unhealthy foods. And that’s why, you know, we want to be judicious about how much of them we take away. So if you’re reducing your dietary oxalates, if you’re sitting here going, Oh, my gosh, I have been juicing three cups of spinach every single day and my pain has been through the roof. Well, I used to be you. And we can get that.

These are mistakes I have made in my own life. So we wouldn’t want to go cold turkey on that slow down on it, maybe do like about a 10% reduction. So still do about 90% of that spinach and then 10%, some low oxalate greens, something in the cabbage family, lettuce families, something like a cola bring that oxalate down progressively. If you’re using a lot of nuts, maybe switch to seeds, which are slightly lower, and oxalate. So we want to slowly make these transitions if you’re eating sweet potatoes four days a week switch to winter squash with similar taste much lower oxalates. So don’t just take food away, find a safer, healthy alternative for it and they are out there.

So we want to slowly and progressively decrease that overconsumption. And then we want to think about you know why we may have gotten here. So have you done a lot of antibiotics are you sitting here going oh my gosh, I took three months of doxycycline? And I have never felt the same ever since for so for people who are making that clear Association especially with things like the tetra cycling’s at the fluoroquinolones using good probiotics can be a really good step in correcting and reducing the dietary oxalates. So there, you can’t take a probiotic that contains X Factor Formaggi.

It’s too delicate of an organism, no one’s been able to get it in a pill form that you can just swallow and go. So we have to do things like good quality prebiotics, or I see success with the spore-based probiotics, largely because they’re creating a lot of butyrates, which is fuel for some of these other organisms. So when we use those are the prebiotics, we allow whatever remaining oxide backer we have to start growing again, so we can correct for the gut. And in that way, if you’re having digestive issues, if you’re seeing floating stool or pale or clay-colored stools, or like an oily sheen and the toilet bowl, these are really clear signs of some impaired bile flow, fat malabsorption. And things like maybe bitters or phosphatidylcholine Tadka digestive enzymes that contain some lipase and some ox bile, some of those interventions would help prevent that absorption.

So again, if we can figure out maybe why based on some of our bodies, other clues, why we might be getting these oxalates then we can take some corrective steps. In addition to that, if you’re not willing to really cut a lot of dietary oxalates out if these are the foods that you love, or you have other food restrictions, and so you’re forced to eat some of these higher oxalate foods because you don’t have any other options. Using some dietary calcium. At the same time that you’re eating these high oxalate foods can actually bind the oxalates to the calcium in the gut and you can excrete it harmlessly install so they do have to be taken in tandem. If you suspect high oxalate you should not take calcium on an empty stomach it would actually increase the risk of stone formation or increase the pain and the aggregation of oxalates out elsewhere

so calcium with food restricting the dietary oxalates slowly but one of my favorite interventions for getting rid of the oxalates that are already there so all of those other steps are slow what’s coming in but what about the tract oxalates for most of us that’s the issue and we’ve got to get them out so oxalate moves through the body on our sulfate transporters and binds to sulfate receptor sites and there is a gradient in each cell between oxalate and sulfate so they’re kind of like on a seesaw with each other and so when oxalate is high within the cell it pushes sulfate out and we end up excluding all of our sulfate in urine so then that’s where we can use that for things like hormone storage and cholesterol sulfation or healthy cartilage and connective tissue so if you’re someone who gets chiropractic adjustments and is told you don’t hold your adjustment you want to be thinking about this sulphate relationship so one of the best ways easiest least expensive ways to get sulfate is epsom salts which are magnesium sulfate now this is a this is not something to take internally it will be way too laxative for almost everyone so we’re talking about soaking in water with epsom salts dissolved in them so either a full body so or just soaking your feet.

And some warm water with that a quarter cup of Epsom salt dissolved in increasing that sulfate will end up displacing oxalate so just like those other interventions we’ve got to start slowly with it start with about five to 10 minutes make sure you’re feeling okay you can do up to 20 minutes three to five times a week but if you ever feel a little bit worse after those Epsom salt soaks we want to watch out for oxalate dumping so slow down on that but the Epsom salts are really powerful mechanism for getting rid of these existing oxalates we want to tip that Cseh away from high oxalate towards high sulfate so the oxalate can leave the body instead and anytime that just one last key thought there anytime you’re moving out oxalates the number one most important thing to do is to stay hydrated you know we’ve most of these pathways we’re gonna come out through the tears through through the skin especially through the kidneys we don’t want to be dehydrated or we increase the risk of those negative dumping symptoms so hydrate hydrate hydrate.


Dr. Joel Rosen: right that’s those are awesome clues and great steps and thank you so much that again i will be listening to this over and over and over again a question that i have well and of course we’ll have to do part two because mold and oxalates is a whole other category and i don’t want to kind of go down that rabbit hole yet but one small rabbit hole i do want to go down is when you look at the organic acid test and i love that you said that a you can see what you have in way of oxalates and then why and pathways which would then necessitate the nutri genomic test to be able to see potentials to be able to now fill in the blanks like if there’s nadph issues with production and you’re stealing that away or there’s you know detox issues that now because of the nadph is being stolen away or even just not being able to produce cortisol from progesterone to limit the histamines so there’s so many things the question i have to you is what do you think about people or even doctors especially with the doctors that you are grateful for that kind of screwed you over when you were younger what would you say to doctors that say well i don’t think it’s really important that you do an intra genomic test like i don’t see the value in it i mean if you have mthfr all you got to do emily is take full fully you don’t have to worry about folic acid so like why is it so important as part of this entire conversation to have that blueprint as well


Emily Givler: so I just want to correct one thing first I would never say that they were the doctors who screwed me over they were the doctors on this no they’re the doctors who set me on this path and right I am grateful for that grateful that I knew better than to follow their advice but I’m grateful for that every day because I love the work that I do has impacted toward me in my own health and you know I love empowering other people to take control of their own health and to get their quality of life back so that that is just central to who I am so I can’t let that one slide.


Dr. Joel Rosen: oh thank you for correcting me I appreciate it.


Emily Givler: but in terms of do we need the genetics I mean can we recover our health without it yes we can it’s not 100% critical for everyone but we can get there more quickly and with fewer adverse reactions when we have this blueprint it’s our understanding of genomics has evolved so much in the past 10 years we have come so far beyond oh MTHFR just take limitless amounts of five MTHFR forever and you’ll be fine well there are some people who do that and yeah they feel great and I have other clients who were told just take a bunch of foley and they ended up in the emergency room you know this is not the right step for everyone and genetics is not one gene doing just one thing that’s not how we’re made we have all of these complex biochemical pathways and it really is that 3d chess game we played underwater you know there’s a lot of moving pieces the genetics are about maybe 15% of the whole picture but it’s a really critical 15%.

So it’s like our stage dressing you know everything else is going to depend on those predispositions they don’t define who we are we layer on things like proteomics and metabolomics we look at the role of the microbiome in our health but there are so many people who are stuck in the cycle of dysfunction because no one has taken the time to understand you know this setting on which they’re moving pieces around so we get a much more clear understanding of the body especially when we use things like the functional genomic analysis which gives us this much more dynamic pathway based approach to genetics which is much more in line with what’s actually happening in our bodies so I really believe that one we’re able to integrate the predictive piece with the genetics along with the kind of active piece of the urine organic acid test to see what within the genetics is actually expressing and creating issues that’s when we’re able to find these places where we can intervene with kind of surgical precision and really advance health in a positive direction and when we are stuck in that negative feedback loop that we were talking about the genetics is even more important because it helps us to find all of those places where we need to kind of throw in the brakes to stop the negative feedback loop and then actually start it turning in the opposite direction so help can start rebuilding.


Dr. Joel Rosen: yeah awesome and I think the predictive terms you use are very succinct and very just it captures exactly what is what its util utility is for and it is predictive especially when you when there are they’re not independent and you have all of these things these mechanisms that you can only get so far on a real-time test and subjective feedback now I need to know what are the I guess the positive feedback loops that put it in that downhill avalanche that just continues to gather momentum and really precision like the ability to customize a recovery program so I guess that was the intent of the question is it just really does upset me that when doctors I feel it is a violation of the Hippocratic oath when you do say that it has no value whatsoever because I think you’re harming by errors of omission and it’s hugely problematic it’s so helpful and not all doctors work that way I get it.


Emily Givler: no and a lot of it I think is born out of ignorance on their parts they don’t understand that they don’t understand the utility they might only know that what MTHFR is and that maybe it’s going to affect fully but they don’t understand the nuance now that information is also available on like they could learn these things and many many of them are but this is something that your average doctor has to go out of their way to learn it’s not something they’re currently being taught in med school you know Addison 1.0 to kind of use meal Nathan and Robert Navios terms is very much acute care crisis care type of things.

But we’re dealing with when we talk about adrenal fatigue and chronic fatigue and autoimmune conditions, and things like that. Western traditional medicine doesn’t have a lot of great answers, we’ve got to look at it at the body differently, and incorporating things like genetics is a really critical piece of medicine 2.0 and kind of moving into a deeper understanding of how the body works, and how we balance the nervous system, the immune system, these inflammatory responses, to allow our bodies to thrive and heal.


Dr. Joel Rosen: Yeah, no, that’s a great answer. So as far as I could talk to you forever and hopefully I’ll get a part two on this because there’s so much more we can get into I want to get into sulfation a little bit more in terms of what that is and hormones and not so much how it’s related to oxalates and ultimately mold. But I respect your time and as far as one of the questions that I have for you are given what you know now and all the transformations you’ve been through and how you’ve helped people and yourself.

And I love the gratitude and not feeling like you were screwed over you are in doubt with your purpose and mission in life. And that is really empowering. But what would you tell the younger sort of naive, I say bright-eyed and bushy-tailed Emily on her health journey that you know, now that would have maybe accelerated your healing or any, you know, getting you out of where you were.


Emily Givler: put down the green juice. So, this is truly the number one thing. So for and, and this was very specific to me. So I was diagnosed with fibromyalgia, I left for college, I went to a great school that had a vegetarian and vegan cafe on campus, we had our own organic farm and garden on campus, it was part of the meal plan. So I ate spinach, beets, and shard three meals a day, seven days a week, and boy did I feel terrible, because for me specifically, it was oxalates. So and then I got into green juicing and really wanted to feel good was that’s why I was doing it and just felt worse and worse and worse.

And I was eating and drinking the things that were driving my own dysfunction because they were the things that everybody else told me were healthy. So had I stopped that sooner, I probably would have felt better sooner. But I also would tell my younger self not to give up.


Dr. Joel Rosen: Right? Yeah, no, those are great answers. And so as far as the beyond protocols go and for providers because a lot of providers will listen to this. And I think it’s an awesome thing that you’re doing. Can you tell us a little bit more about that and who’s out for, can just the Joe public take that as well give us a little insight on that.


Emily Givler: So beyond protocols is for practitioners only, but it’s for a wide variety of practitioners. So our members include traditional medical doctors functional and integrative medical doctors, nature of paths, pharmacists, acupuncturists, health coaches, nutritionists. So it’s a very diverse group of practitioners. And it’s a mentoring platform. So it is made up of myself and a few other colleagues with practice management consultants, Aaron Adler, we have our functional mental health expert, Brendan, Brendan vermeil. And then my colleague, McKay Rippy, who’s the co-founder of the platform, he’s a traditional acupuncturist.

So we’re also coming from a diversity of backgrounds. So we are here as your functional team to help practitioners who are trying to expand their knowledge base and help their clients and patients in a deeper and better way. My focus on the platform is helping people understand how to better integrate functional genomics into their existing practice. You know, a lot of us start dipping our toes into genetics, and it can feel overwhelming, especially when we already have tools in our toolbox to like, how do we do both? You know, do we have to give up everything that we knew and we’re trained in to now do this genetic thing?

And I don’t think we have to I think we expand our toolbox and help people better this way. So, McCain, I created beyond protocols to help build that community help empowers More practitioners to move into that medicine 2.0. And we’ve started on beyond protocols, but we’re calling 1000. Practitioners project. And our goal is to educate and empower 1000 practitioners in the next two years to help more people get well, faster with fewer adverse reactions. So for any interested practitioners, they can check us out at beyond protocols.org. And so we really believe that that’s how we can touch the most people, you know, help other practitioners help more of their clients and patients.


Dr. Joel Rosen: Yeah, that’s great. So as far as health coaches, do, they have to have a certain certification.


Emily Givler: Nope, we are very inclusive in our community. A lot of my training has been nontraditional, and it’s been my own drum that has gotten me here. So we don’t want to exclude anyone based on a lack of credentials, if you are someone who is setting out to help people recover their health, we want to help you do that.


Dr. Joel Rosen: Okay, that’s great. Yeah, cuz I find that a lot of the clients that I work with are people that have like yourself, and myself has gone through their own journey. And now they’re empowered to help other people. Because, they had to be their own advocate, and, and they enjoyed, they’re passionate about what they’ve now learned to help themselves. So that’s going to be a great resource that we’ll be able to post the link to.

And then as far as just getting in contact with you, how does what how does that work? And what do you offer for the listener to be able to help them in their own health journey if they’re not looking to go on and do coaching?


Emily Givler: Sure. So most of the work that I do is still one on one with clients. And I do that at the tree of life, health, and effort of Pennsylvania, our website is to. l health calm. I’m so blessed to work there with my mentor, Bob Miller, who’s actually the visionary who created the functional genomic analysis software. So I’ve had the good fortune of working alongside Bob for the past six years that a tree of life, and kind of learning from him how critical looking at genetics is. So we’ve got a team of amazing practitioners at the tree of life.

So people can choose to work with me to work with Bob to work with my wonderful colleague, Jacqueline downs. So we are all there using genomics, the functional labs to try to help people regain their health. So that’s at all, health calm, and we see people both locally, and especially these days, virtually.


Dr. Joel Rosen:  Right, right. Right, no, excellent information. And we appreciate your time. And I hope that we can meet again to discuss the 2.0 version of this podcast. Yes. And I want to just wish you continued success in your own health, your family and your business, and all the people that you help. And I would like to see that beyond protocol, really serve a practitioner so that you can help ultimately more people. So thank you so much for your time today.


Emily Givler: Thank you so much. This has been so much fun. I look forward to part two.


Dr. Joel Rosen: Perfect. Thanks, Emily.


Emily Givler: All right.

To check out beyond protocols for provider training click here

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