Adapted from episode 163 of The Perfect Stool podcast and edited for readability with, Scott Sherr, MD, board-certified internal medicine physician and the COO of Troscriptions* and Lindsey Parsons, EdD.
Lindsey Parsons:
So I noticed in emails I’ve gotten that your company, Troscriptions, seems to be under Quicksilver, or joined with Quicksilver since we last spoke. Can you elaborate on that partnership?
Scott Sherr:
Oh, yeah. So we haven’t joined forces from a company-wide perspective, what we’re doing is that the Quicksilver team, they live very close to my house. Actually, their headquarters is here in Colorado. I’ve known Chris Shade for many years, and we have become very friendly as companies. And what Quicksilver has that we do not as a company is a sales force, and so they have a sales team that is available throughout the country to go to practitioners’ offices and to talk about products. And so we are working with their sales force to get the word out about Troscriptions, about our products, and about how they could be integrated in various practitioner protocols, everything from gut optimization and working at bacterial overgrowth to optimizing mitochondrial function in the brain, the heart, everywhere else too. So we’re excited about the partnership, and that’s the story.
Lindsey Parsons:
Oh, okay, so you’re going to be sold through Quicksilver?
Scott Sherr:
No, so we have our own separate portal, like our separate website, so if you’re a practitioner, you would sign up through our own site itself, troscriptions.com*, you’d go set up as a practitioner, but a sales rep from Quicksilver might be coming to your office and talking about our products along with Quicksilver products together, and how you can integrate them in various ways and protocols and things like that. So that’s separate ecosystems, but very much communicating across both when it comes to products and protocols and services and things like that.
Lindsey Parsons:
Oh, okay, interesting. So I know one of the flagship products of Troscriptions is methylene blue, and I’d heard of it before, and know that it’s been around for more than 100 years and used in hospitals for various things. So can you talk first about its historical use before we dig into the more modern uses?
Scott Sherr:
Yeah, I think it’s all very applicable, except maybe the first application, because methylene blue was originally actually developed and synthesized as a textile dye in manufacturing. So back in the 1870s it was used to dye blue jeans blue, for example. So if you were getting a pair of Levi Strauss in 1860, you were getting blue jeans that were dyed with methylene blue as the colorings, because it’s a very, very blue color. But they were doing a lot of work around the late 1800s up into the 20th century, trying to figure out various antimicrobials that might be available. And they looked at this class of what’s called thiazine dyes, which is the type of classification of methylene blue, and they figured out that actually it had a fantastic capacity to be an antimicrobial. And it became the first drug that was registered with the FDA back at the time to treat malaria. And what was cool about methylene blue, and still is today, is that you could give very high doses of methylene blue, and you would kill pathogens, but you wouldn’t harm actually, the normal host. And it was very difficult to find certain types of compounds like that. And that’s why it became a very popular and actually the primary antimicrobial around between about 1897 into the 1950s when antimicrobials came on the scene, like penicillin, etc.
And so if you were in World War II, if you were a soldier, you were going down over to the Pacific, you had to take prophylactic methylene blue to prevent fungal infections. They had songs about going blue in the loo, which is because methylene blue concentrates in the urine. When you urinate and you’ve been taking methylene blue, you’re going to have blue urine as well, to a certain to a certain degree or another. And so we’ve known, now, again, for over 100 years, that methylene blue is a fantastic antimicrobial, and typically at higher doses it can really do that. It’s really great for urinary tract infections. It used to be used a lot for gram negative organisms, specifically parasites, protozoa. And there’s also some antiviral capacity to it as well. It’s been used as an antiviral in all places around the world. If you lived in the Soviet Bloc countries until the 1960s or so, if you were a child and had a sore throat, your mom probably or your dad, but probably your mom would paint the back of your throat with methylene blue, or give you a methylene blue lollipop to suck on, because it would help with the throat infections. And so it’s got really nice, anti-antiviral, antimicrobial capacity at these higher doses. So that’s how it got its start.
That was its first chapter. The first antipsychotics were derived from methylene blue, because methane blue also works as what is called a monoamine oxidase inhibitor. So it increases serotonin, norepinephrine and dopamine in the synapse, and prevents those from being broken down. The first antipsychotics were derived from it, and then it got its next chapter in the world of cellular staining. So if you were in chemistry class, as I was, and you were using methylene blue, it is actually to look at various areas of your cell. The most important one in this case, actually was the mitochondria, because we know methylene blue concentrates in the mitochondria of our cell and functions in various ways, which we can obviously get into if you if you’d like. And it has this really cool capacity, helping both with energy production and detoxification in the mitochondria. So over the last several decades, that’s where a lot of interest has really been focused, is in how methane blue works on mitochondrial function and how it can support energy and detoxification, because the statistics are pretty terrible out there that about 94% of US adults have some element of metabolic dysfunction which really does equate to mitochondrial dysfunction as well.
Lindsey Parsons:
And you didn’t mention the one use that I really heard about it for, which was cyanide poisoning.
Scott Sherr:
So methylene blue still is under the World Health Organization’s list of essential medications because it’s used for cyanide poisoning, which is obviously rare, but it is also used for something called met hemoglobinemia, which is a condition when you can’t carry oxygen in red blood cells. It’s pretty uncommon too, but every emergency room in the country has to have methylene blue available for these particular diagnoses. What happens with cyanide poisoning is that cyanide destroys part of your mitochondria, called complex four, which is a very important protein on the electron transport chain. So without that, you can’t make energy very well at all, but methylene blue can rescue that by various ways of doing this sort of ninja kung fu moves around complex four blockages to prevent you from having the whole system stop working.
Lindsey Parsons:
That’s an official chemistry term, right? Ninja kung fu?
Scott Sherr:
Yeah. I mean, I can go deep down. That’s . . .
Lindsey Parsons:
Okay. I’m just teasing you, yeah, no, you probably don’t need to do that. You’ve probably gone way deeper than most of my listeners can probably follow. But I appreciate that.
Scott Sherr:
That’s why I said ninja kung fu. But in essence, why actually we know that methylene blue could be so powerful from a mitochondrial perspective, is because of some of the data around cyanide poisoning, and how methylene blue has this ability to recycle various things and then also bypass various things that might be blocked or dysfunctional. And this not only equates or translates to being poisoned with cyanide, it’s also people that have had toxin exposure, medications have caused significant injuries to their mitochondria, and infections that have, insulin resistance. So insulin resistance is actually the number one cause of mitochondrial dysfunction, because if you have too much glucose around, your system tries to make too much energy with all that glucose, and the whole system starts breaking down in the mitochondria. And then, a big category, which is if you’re under chronic stress all the time, chronic stress at work, chronic stress at home, etc., that causes all these fight or flight chemicals like these. It’s called your sympathetic nervous system that gets, stays in, the fight or flight mode. But your epinephrine, your dopamine, your cortisol, which is your stress hormone, these really stress the mitochondria as well. And so the key to understanding all of this is, of course, what’s happening on the meta, the big level that’s causing all of this, and to address that, but right now, to help support mitochondrial function, methylene blue can be a fantastic bridge, as you’re working on really understanding how you can do it over the long term.
Lindsey Parsons:
So obviously, with all these prior historical uses, it must be safe in acute situations. What about the data for long term use of it?
Scott Sherr:
So when it comes down to methylene blue, the safety is very, very good. It’s mostly been used short term in studies. It hasn’t been done over multiple years for the most part. Typically, the studies are done for six to eight weeks at a time, sometimes 12 or 18 weeks, depending on what they’re exactly looking at. But understanding the physiology of it, and understanding the safety in the acute setting, like the safety in the acute setting is actually quite good overall. Even at very high doses, it’s typically quite good. And then if you’re looking at low doses, it seems to be very safe, at least clinically, over long periods of time, if needed. And when I’m talking about high and low, I should define that a little bit, right? And so what I’m talking about, from a low dose perspective, is typically anywhere between four and 25 milligrams or so, as opposed to higher doses for infection, especially acute infection, is anywhere between one and two milligrams per kilogram, which is going to be anywhere between about 70 to 150 milligrams of methylene blue on a daily basis. And that’s typically used for a much shorter period of time, unless you have a very significant need for infection control, like if you have chronic Lyme, chronic mold, chronic viral infection, then you may need to be on these for longer.
But my overall gestalt here, the way I see it in clinical practice, is very rare we need to be on those high doses for long periods of time. Typically, the dose is going to be much lower than that. From a safety profile perspective, we care about a couple different things. You don’t want to take methylene blue if you’re pregnant or breastfeeding, because there might be some interactions there. It also interacts with high blood pressure medications. So if you’re on high anti-hypertensive medications, it may raise your blood pressure. So you have to be aware of it. And it’s dose dependent, though, so typically low doses won’t do it as much as high doses, but it also works and increases that serotonin, norepinephrine and dopamine. So if you’re on medications that increase those medications, like SSRI medications, antidepressants, or some of the newer generations ones, you have to be a little bit more mindful and work with a practitioner if you’re going to be on those meds and taking methylene blue, because there can be an interaction, although the risk of having something severe happen is very low. The risk that it’s talked about in the literature is something called serotonin syndrome, which is very rare, but it’s possible, especially at very high doses of methylene blue. If you’re taking IV methylene blue, especially, I would very much not take IV methylene blue with those medications on board. But if you’re on those medications, and you’re taking methylene blue at the same time, you really need to work with a practitioner just to be sure you’re safe, but also treated in the kidneys. And so you want to make sure that if you have renal dysfunction, that you’re watching very closely with a practitioner, if you’re on dialysis, you should not take methylene blue because it’s not going to get excreted. I don’t even know if it gets out in the dialysate. I don’t think it does. So those would be some reasons to be more wary about taking it. But in essence, these low doses are extremely safe and extremely well tolerated.
Now, can you get detox kinds of symptoms? Sure, if you’re starting something where you’re creating more energy and detoxification capacity and start off at too high of a dose, what can happen is that the system may not be ready for the energy and detox capacity you just gave it, and so you can get some symptoms related to that. Lower doses don’t typically cause that issue, and that’s why I usually recommend slowly titrating the dose over time, not starting off at 50 milligrams, mostly, unless it’s an acute issue starting off at four or eight or 16, and then increasing your dose slowly over time, until you start seeing what’s most beneficial and mitigate some of the potential downsides of going up too fast.
Lindsey Parsons:
Okay, so you mentioned it as an antimicrobial, and I work in gut health, so one of my biggest concerns in helping people heal their gut is not to give them anything that might harm their beneficial bacteria. So how does methylene blue stack up in that area, and can it be used at a dose sufficient to eliminate pathogens without wiping out beneficial microbes?
Scott Sherr:
So there’s always a balance here. But what I usually like to delineate is around the milligram per kilogram dose, around 50 to 70 milligrams; that’s when we get to be more antimicrobial, and that’s when we can use it for pathogens. We can use it for bacterial overgrowth. We can use it for parasites. We can use it for protozoa, etc. When you do this, you’re also going to be affecting normal bacteria and commensals as well. So you have to be aware of that short term, I haven’t seen any major problems. That’s not like using a nuclear bomb like an antibiotic typically, where I haven’t seen significant decimation of all commensals, but I have seen the commensal populations go down while you’re also on these higher amounts of methylene blue. But short term, five to seven, maybe up to 14 days, I have a lot of my colleagues that are using it for bacterial overgrowth and for parasites, and seeing significant benefit without having to do a huge amount of additional cleanup afterwards to rebuild all the commensals as they would have if they’d given them Flagyl or something like an antimicrobial. So I think it’s like one of those.
The way I think about it, Lindsey, it’s one of those things in the middle where it’s not going to be like your berberine, oil of oregano’s and things like that, which are kind of natural antimicrobials that are not going to cause a huge amount of challenges to your commensals, usually, unless you’re using them for long periods of time at high amounts. And it’s not going to be like your antibiotics, where it’s going to decimate everything. It’s sort of in the middle when you’re talking about that kind of dosing. But if you’re keeping the dosing super low, like four to 25 milligrams or so, I haven’t seen any major detrimental effects on microbial commensals and things like that in the gut. I’ve only really seen it happen at higher amounts. So the lower amounts, I’ve only seen, are beneficial from a mitochondrial perspective, energy and detoxification, etc., without causing any major detrimental effects. And I’ve had people on more antimicrobial combinations of things, where they’ve used methylene blue as a way to support energy and detoxification while they’re on those and see significant benefit. I know that you have your own perspective here. I remember you and I talked about how you don’t typically use a lot of the ant-microbials anymore. You don’t use a lot of the oregano and the berberines of the world. Or do you use those as well?
Lindsey Parsons:
I use them after everything else has failed but, but I try to avoid them. I try to use things like SBI powder or butyrate, pomegranate husk, things that are more selective.
Scott Sherr:
Yeah, yeah, that’s what I anticipated. And so what I’ve seen with methylene blue, it’s a little bit stronger than your berberine and olive/oregano combination, so it’s going to work faster. So in certain people that I used to have three or six months to see their gut get better, using that kind of combination, instead, I’m using the methylene blue for a shorter period of time, seven to 14 days, and at a higher amount, 50 to 70 milligrams in one dose or divided doses in a day, and then seeing significant benefit much faster, where I’ve been actually quite shocked, where three or four days into a higher dose of methylene blue, their brain function gets completely better. They’re feeling significant amounts of more energy, so much energy, so much that we have to be actually careful.
And so that’s actually been very interesting to me to see whether berberine or oregano combinations, which I still use, doesn’t typically happen that fast for people; it’s much of a slower process. And that’s not necessarily a bad thing either, when you’re trying to also repopulate the gut at the same time. So it’s a bit of a balance as to when to use it and when not to but overall, the majority of people that I’m thinking about using methylene blue, it’s not going to be directly for their gut. It’s typically going to be more for mitochondrial function, energy detoxification and detox protocols when they’re on them for the gut as well. A good example is a lady I was just talking to a couple weeks ago was on a gut protocol, using binders, using antioxidants, and doing the sauna, and she was feeling pretty good, but when she did the sauna, she’d feel kind of depleted and tired and a little washed out afterwards, but she added in the methylene blue, just low dose, just 12 milligrams, before she went into the sauna, and afterwards, she felt like a different person, her energy was great. She felt a lot of focus. She could do the whole day without crashing, and that’s because the methylene blue, what it was doing at that low dose, was just supporting energy and detoxification, but not just the detox side.
The thing about most of our protocols, is they still focus on detox, detox, detox, detox, but they don’t focus on the energy side of things, and that’s when people feel washed out. That’s when they feel tired and they just feel kind of crappy. But if you can focus more on the energy side along with the detox, that’s when you can actually have people that don’t feel as washed out and fatigued when they’re doing these kinds of protocols, because that’s a big problem that I found, at least in clinical practice, is that there’s a lot of detox that’s required, both in the gut, otherwise in the cells and that can be hard, and it may not feel very good. And then you have binders and you have antioxidants, and making sure people are pooping every day, those are really important. But if you’re just working on detox, but you’re not helping on the energy side, that’s when people don’t feel very good. So adding the energy side to it has been transformative for many people that I’ve worked with.
Lindsey Parsons:
So are you talking about offsetting a Herxheimer reaction, or are you talking about detox with regard to liver protocols, or mycotoxins or heavy metals?
Scott Sherr:
All the above, right? Because what’s happening on the methylene blue side is that it’s working as a detoxifier, really, in the mitochondria itself. So if your mitochondria are stressed, there’s a lot of reactive oxygen species, whether it’s from heavy metal exposure in the liver, or if it’s in your gut cells because of toxicity as well, and your gut lining, it’s going to work in the mitochondria, in the cells, and also in the cytosol of the cell as well. It’s going to bind up free radicals, it’s going to bind up toxins, bind up heavy metals, bind up reactive oxygen species. It’s going to do it all. And so that’s why it has such significant potential across multiple different things, right? So it’s not like it’s just doing one very specific reactive oxygen species neutralization reaction. It’s really there as something that can be comprehensively supportive.
Lindsey Parsons:
Okay, so what is its half-life? Like you mentioned the 50-70, milligram dose. You said that’s the full day’s dose, but could be divided. What’s the best way of doing it?
Scott Sherr:
The half-life is about four to six hours. So for people that need it for more energy, detoxification, mitochondrial support, I’m giving it maybe once or twice a day, depending on the person. Typically it would be dosed at seven o’clock, eight o’clock in the morning, and then another dose about 12 or one o’clock in the afternoon. It’s not usually stimulating but, in some people, they will feel a lot of energy from it, and so that’s why I typically dose it at those times. There are some exceptions to that rule where actually they’ll take it before they go to bed and sleep better when they take it because they’re getting more mitochondrial support during glymphatic cleaning and also, and obviously, REM sleep is very metabolically heavy as well. So this could be a reason why some people feel better when they sleep with it, but that’s kind of a rare occurrence. What I sometimes will do, though, if they start, some people don’t need it twice a day, some people sometimes, they just need it in the morning. But it usually is depending on how they feel from a mitochondrial perspective, when it comes to anti-infective I typically like to dose it twice daily, just to give it more time to do its work, where, instead of one dose in the morning, it’s typically if it’s a 50 milligram goal dose, or then it’s 25 milligrams in the morning and 25 milligrams at noon, as just an example, that’s what I typically would prefer, instead of one larger dose in the morning to that same dose divided into two doses as an anti-infective.
The way it works is an anti-infective, which might be interesting as well, at least for you Lindsey, is that it increases hydrogen peroxide production, so methylene blue, what it does at higher amounts is to increase the amount of hydrogen peroxide the cells make. So we know that we can buy hydrogen peroxide at the store, but our cells actually make hydrogen peroxide as a primary way to be an anti-infective. It also makes other free radicals, like hydroxyl radicals and other kinds of things to make more capacity to kill bugs, and you can actually combine methylene blue with red light, specifically at high intensities, high intensity red light, high amounts of methylene blue to create more reactive oxygen species at higher amounts to be more anti-infective. Lower amounts of methylene blue with red light are actually supportive for the mitochondria. So it’s just depending on the dose and the frequency and the power of the light and the methylene blue together, but from an anti-infective capacity, methylene blue makes these hydrogen peroxide amounts higher in the body, also some of these other free radicals, especially if you add red light. But what that does is it kills bugs. It kills cancer cells as well. That’s how our body does that, but it also stimulates the body’s own mechanisms to produce this antioxidant in the body called glutathione, right? And so that sounds good, except if you don’t have the capacity to make glutathione, and that’s why it’s important that these higher amounts of methylene blue to be giving antioxidant support, typically at the same time, to be giving the binders if we’re trying to get people to get rid of toxins at the same time.
And so hydrogen products are really important. That’s how it works, but it’s also something that has to be understood, that’s why they’ve done some really interesting studies where they’ve looked at methylene blue for Alzheimer’s, for example, and they’ve done something like the placebo group was eight milligrams twice a day, and they did two treatment groups. One was 75 milligrams twice a day. One was 150 milligrams twice a day. And so what they found in this particular study is that the placebo group, the sham group, the ones that got eight milligrams twice daily (they gave everybody some methylene blue by the way, in the study, because if they didn’t give them methylene blue, their urine would not be blue). They wanted everybody’s urine to be blue. So the placebo group, the sham, was eight milligrams twice daily. That group did the best by far. And I think the reason why is that because at these higher amounts of methylene blue, the brain, the body, was producing a lot of hydrogen peroxide. The body, the brain and in patients with Alzheimer’s, probably antioxidant deficient, probably messed up gut as well, right? To not check those many studies for many things, right? And so you have these patients that with the higher amounts, that didn’t do very well with the methylene blue. And so my estimation here, looking at the research and the data, is it’s because they were giving too high of a dose. And so these lower doses can be very supportive, but these higher doses can be great as an anti-infective, but you’ve got to give support along the way, otherwise you might get into some trouble with some Herxheimer, detoxification kinds of symptoms.
The one point I want to mention on detox too is that mitochondria per cell – like most people don’t realize that we have some cells in our body that have 1000s of mitochondria per cell, the liver being one of those places. And we have some cells in our body that have zero or very few mitochondria per cell; and we have zero mitochondria in our red blood cells actually. Red blood cells carry oxygen. They’ve lost their mitochondria. They did have them, but they lost it so they can carry more oxygen. The number one place in our body that has the most mitochondria per cell, in a female, is eggs; in male, sperm. Right after that, it’s the brain, and then it’s the heart and the liver. So huge amounts of mitochondria per cell are required in these areas to maintain energy demands, and this is why fertility rates are going down. Right brain function, cognitive issues, attention, focus, Alzheimer’s, neurodegenerative disorders, these are mitochondrial issues at their base. And so there’s a lot that we need to do, especially heal the gut. That’s probably number one, because if you’re not healing your gut, you have a leaky gut. You also have a leaky brain. And that’s when things also go sideways in the brain, too, as you very well know, Lindsey, and so I always like to give the big picture here that, I don’t think that using methylene blue is the only thing that people need to do, by any means, but it’s a great way to start supporting mitochondria now, improving mitochondrial function, energy detoxification, and so that everything else gets a little bit easier along the way. While you’re doing your gut cleanup, optimizing your vitamins and minerals and your hormones and things like that. I mean, it all goes together. But what’s nice about methylene blue is that it’s an immediate thing that can help with mitochondrial function, and also, if needed, be supportive on the anti-infective side, in the gut itself.
Lindsey Parsons:
Yeah, so you’re describing it almost like a multivitamin, something that everyone should just have going in the background. And I’m sure that people are getting overwhelmed by all these new supplements that are must-haves. Now it wasn’t good enough that we have our omega 3s. Now we’re supposed to have our Fatty 15* and it just keeps adding up. So I’m wondering, is there something that methylene blue replaces in the pile of supplements that people have to take who are chronically ill and trying to get better?
Scott Sherr:
Think about it as your bridge, because taking something like an Omega 3 or maybe Fatty 15 -even I know that’s a newer, fancier one that everybody didn’t know that they needed to have. What I always say is this Lindsey, is that the best way to understand what you need is to test what you need, right? If you need B vitamins, you need to take B vitamins, but you’re not going to feel better on your B vitamins immediately. It’s going to take three or six months to rebuild your cellular stores of these kinds of things. If you have low Omega 3 or Omega 6 levels, you need to be taking those right, even if your Omega 6 levels are low, you need to be taking Omega 6, because Omega 6 is important too. Even though we all get crazy about seed oils, I’m going to talk about the right type of Omega 6s as well.
So the key is to understand is that all of us, in an ideal world, should be measuring our metabolic data and understanding what we need and then taking things that are related to that. Okay, that’s your base. That’s your foundation. In my closet behind me, I have a base level of supplements that I take every day, depending on what my labs show me every three or six months. That is what my deficiencies are. This is what my toxicities are. This is what my gut’s doing. This is what my guts are not doing. Why is my gut doing this? This is the nature of being human. There’s no end of the road, except when we’re no longer breathing. Because we live and we go here, we go there, and we have kids, and then your daughter makes apple cake for Thanksgiving, and then you have too much of it and whatever, right? And so I’m not speaking from personal experience or anything. Of course, my daughter loves to bake, and so for holidays, I’m forced to eat gluten, which I don’t typically eat. But anyway, all good.
And so that’s your foundation. Now, most of those things that are in your foundation are not typically there to make you feel better tomorrow, they should be the things that are going to help you with your foundation the next three to six months. Okay, now there are things, though, that we can use to support that, that can help you right now while you’re on that longer path. Okay? And that’s where things get a little bit more confusing, right? Because you could take this supplement for this, and that supplement, and like, Oh, what about this? And, I also get on these trains, sometimes trialing various things that don’t necessarily directly point to a specific biomarker, for example, right? So that’s where you have a little more I call it fun, but also in that same category, are things that can help you make that bridge to get you from where you are now to where you hopefully want to be in three or six months, and that’s where methylene blue really does shine. I don’t think it’s something that people need to take all the time for the rest of their life. I think it’s one of those things where you can take it maybe a decent amount in the beginning, when you’re working on a mitochondrial function, you’re coming in from a place where you have chronic, complex medical illness, you’ve had mold, you’ve had Lyme, you’ve had chronic stress. That’s where methylene blue can really come in, I think, whereas it gives this beautiful synergy with mitochondrial support while you’re doing the harder work of optimizing your diet, your lifestyle, your supplementation, your stress, getting out of a toxic relationship, getting out of a toxic job, and doing something else that you love, a death in the family, bad stuff that can really be difficult initially, like, get yourself out of those patterns now, or help you and then in really working on the long term. So that’s how I see methylene blue being used even in the gut, as a way to help with gut dysbiosis and parasites and things like that.
You’re not using it long-term – that’s more directed for what you need really – it’s that you’re using it short-term to help move the needle faster for you. So if you want to move the needle faster and more supported, that’s where methylene blue comes in. And then when you’re more optimized and you’re feeling better, then you don’t need it as often. And then you can use it sort of as needed when you have more stress, when you have more challenges or cognitive load, or you’re traveling, for example, like traveling is a big stress on the body. When you’re on an airplane, your low oxygen levels on a plane compared to sea level, and sea level has 21% oxygen. On a plane you’re pressurized at about 8000 feet, that’s about 17% oxygen. And so that’s a significant hypoxic stress for most people. For me, not as much. I live in Colorado, so 5500 feet, where I live, and when I go on a plane – 8000 feet, not that big of a deal. But for somebody at sea level, that’s a big hypoxic stress. And what methylene blue can do is it actually can compensate for that low oxygen level. It can decrease the inflammation that happens being at that high altitude. It can improve the capacity for you to make energy, even if there’s less oxygen around and makes things more efficient. So it’s really cool to use methylene blue when you travel, for example.
So I use it a lot in that capacity for my patients and anybody that’s coming to visit me here in Colorado. I try to get them to take some methylene blue before they start coming on the airplane, and at least when they arrive and that kind of thing. So, my long answer to your question is that all of us should have a base level of things that we take that are directed to what we need most. That’s going to be more of a long-term play. Some of it will be short term. If it’s acute like if it’s a dysbiotic gut, if it’s things like that you’re working on, that might be more short term, you’re not taking for three or six months. And then we have an additional layer of things that can help us now, like methylene blue. And I have other things that I work on, down regulating the stress response, I work with a lot of patients, because you’re not going to hit your gut if you’re always in fight or flight and always clamp down. And so we’ve got to calm down the nervous system. And I have a lot of things that I use there that can be very helpful, as well as lifestyle things that can be helpful too. And then there’s a bucket of the fun supplements you can try, if you’re like me and you like to try these things, like try something for two or four weeks, and something that’s on top of what you would take as a baseline. So that’s how I think about it, and the structure.
Lindsey Parsons:
Okay, so do you think a healthy person who has good amounts of energy would even notice the difference if they were taking, I don’t know, four, 8, 12, milligrams of methylene blue?
Scott Sherr:
They may or they may not. It may be one of the things where, if you’re already well optimized, you’re 6% of the US population that you feel good on a regular basis without any issues with energy, focus, detoxification, brain fog, you sleep well, it’s probably unlikely you need to take methylene blue very often. You can probably take it when you’re feeling like you’re going to have a bigger, stressful day, or, doing more endurance or going on an airplane. When you take it, you may feel a little bit better from a mood perspective, because methylene blue does increase serotonin, norepinephrine and dopamine. That is mild though. It’s not something that’s at four milligrams or eight milligrams. Or eight milligrams, it’s not going to be a huge bump for most people. Some people will be more sensitive to that than others, but most people, if you’re relatively well optimized, you’re probably not going to have a huge effect. At the higher doses, you will feel something because you’re going to have those neurotransmitters floating around. You’re going to have more energy capacity. So my estimation is that if you’re pretty healthy overall, you’re not going to need it all that often and starting off at a lower dose is almost always a good idea.
Lindsey Parsons:
So then the kinds of conditions where doing something to improve mitochondrial function would be a game changer. Are we thinking like chronic fatigue?
Scott Sherr:
So chronic fatigue, fibromyalgia, long covid, chronic viral infections, chronic mold, chronic Lyme, autoimmune diseases, even if you’re directing the treatment not at the virus and the bacteria or the bug itself, but the mitochondrial support, it can go a long way in making you feel better. So anyway, any place where you’ve had a chronic condition for a while, especially, you’re depleting antioxidants. You’re depleting your capacity to make energy effectively over time. And so that’s where methylene blue can really shine in there. Of course, you can use it at higher amounts as an anti-infective, as we said, but that’s really the minority of cases in general.
Lindsey Parsons:
So you described it when you were talking about the anti-infective properties as creating more reactive oxygen species and hydrogen peroxide and peroxyl radicals. So I’m wondering why that’s beneficial?
Scott Sherr:
Because that’s how you kill bugs. That’s how you kill infections.
Lindsey Parsons:
But what’s pulling those out then? Are you needing a supply of antioxidants from extra vitamins?
Scott Sherr:
So if you’re using it as an anti-infective, you’re also going to be bumping up your antioxidant support at the same time.
Lindsey Parsons:
And you’re not just canceling each other out?
Scott Sherr:
Well, you want to do them at separate times. If you’re doing an anti-infective protocol, you want to do it in succession, where you’re doing your high dose methylene blue, and then two hours later, you’re giving your glutathione support, right? And your binders so that you’re getting the oxidative load that’s required to kill infection. That’s how we kill most infections. We kill most infections by creating stress on the bug itself, and that stress is typically either starving the bug of its fuel, which you can do, or you’re actually directly pounding it with something that it can’t tolerate, and that’s usually reactive oxygen species, hydrogen peroxide, hydroxyl radicals, O3 ozone, right? O3 is an anti-infective because it’s killing bugs, because it’s reactive. And these all have immunomodulatory effects, meaning that it increases your immune system function. It creates the stimulus to have you make more antioxidants, and that’s what’s supposed to happen. But if you’re already depleted in those things, that’s why it’s so important to support them at the same time with exogenous or external supplies of glutathione and alpha lipoic acid and vitamin C, etc., which are very important when you’re using higher doses of anything that’s going to be anti-infective.
Lindsey Parsons:
Hydroxyl radicals are OH, and then hydrogen peroxide is?
Scott Sherr: H2O2
Lindsey Parsons:
Okay. And reactive oxygen species are just . . .
Scott Sherr:
OH is a reactive oxygen species and also oxygen that’s either a singlet oxygen or a triplet oxygen is a reactive oxygen species as well.
Lindsey Parsons:
So I know that Troscriptions products use a bit of an unusual form of delivery, and troches – is that how you say it – I believe those are meant to be dissolved in the mouth, like under the tongue or in your cheek. Is that right?
Scott Sherr:
So we develop troches as a company, because they’re a great way to suspend an ingredient so it keeps it so that it’s always the same amount every single time. The major challenge with a lot of different deliveries, especially liquids, is that it is very difficult to know exactly how much you’re getting. And then with methylene blue, specifically methylene blue liquids, we tested a whole bunch out in the market, and none of them met their label claims for potency. So if it says it’s 10 milligrams per dropper, it’s probably five milligrams; it’s about 50% on average potency compared to what it says. And the other thing about methylene blue is that it can be contaminated with heavy metals, so you have to be super careful about the quality you get. And so it can be contaminated with lead, mercury, arsenic or cadmium, which are not things that most people want to have in their body, especially at any reasonable amount or any big amount. And so we’ve done a lot of quality control over the years to make sure that we have the best stuff that we can out there, and troches really make it easy for us to be able to do that.
So in general, a troche, it’s called a dissolvable lozenge that usually would go between your upper cheek and gum and dissolve over about 15 to 30 minutes. Now good news is that methylene blue is highly bioavailable, which means that most of what you take in orally, no matter if it’s a buccal troche or if you swallow it, is going to get into circulation at about 90% bioavailability, which is quite high. Most supplements, for example, are much lower than that. An example that I like to give is one called NAC. NAC that’s about 10% bioavailable. So if you take 100 milligrams of NAC, you’re only getting 10 milligrams in the body, as opposed if you take whatever methylene blue dose you take, you get about 90% of that into the body, which is great, which is really nice.
And so as a result of its bioavailability, you don’t have to dissolve in your mouth. You can swallow it and get the same effects. And this is good, because methylene blue is very, very blue. So if you dissolve methylene blue in your mouth. Your mouth is going to be very blue. The only difference, really, is that buccal absorption, and cheek absorption is faster. So people like cheek absorption because it’s faster, and they’ll feel the effects faster, but they have the downside of having a blue mouth in the process. So for most people, what we do recommend is just swallowing it on an empty stomach, and then you can eat about 20 to 30 minutes later to kind of push it through a little bit faster, and so that you metabolize a little bit faster, you’re going to feel the effects faster. That’s the ideal, although I do have some patients and some colleagues actually that swear by using it in their mouth, because they like how it makes them cognitively feel better faster. I have a friend. She’s a practitioner in California. She has bartonella, which is one of the chronic co-infections with Lyme, and when her bartonella acts up, she gets brain fog. And so she knows that the fastest thing to do is to put eight milligrams of methylene blue in her mouth, and then the brain fog is going to go away in about 15 to 30 minutes. So that’s an exception. I think for most people, they can take methylene blue orally and swallow an empty stomach and get the same mitochondrial benefits, the same brain benefits. But just the minority of people will do better dissolving in their mouth.
And we make the troches too, and they have a score, so it’s got a line across in the middle. So you could take a quarter, a half, or three quarters or full. So you can really titrate your dose and find the right one for you. And that’s what I typically recommend, is that you start off at a low dose. Start off at a quarter, try it for about three days, and then if you don’t feel much, then go to a half, don’t try and don’t feel much, then go to then go to three quarters and go to a full. We also have a practitioner strength version called Tro + Blue, which is 50 milligrams. We have a lower strength, which is 16. So a quarter of a 16 is going to be four milligrams. So you have a spectrum of dosing, the Tro +s for practitioners only. So you have to work with a practitioner if you want to be at the higher doses. But I like having a spectrum of dosing capacity, because that’s the best way I found to figure out where people are going to land and kind of go slowly up there.
And the key with methylene blue to understand also is that it’s not something that’s building up in your body over 30 days or longer to see if you have an effect. Usually, when you find the right dose, it’s pretty obvious that you found the right dose. So you found the dose, you’re like, oh, my brain fog is better. My pain is better. My inflammation feels better. My sleep scores are better. So we have people that take methylene blue in the morning, but then their sleep scores at night are dramatically better. Their HRV is better. Their sleep is better. And so you can have an effect even much later, because you’re supporting mitochondrial function, right? So I think that the key to understanding is that the dosing is very personalized, and we allow that in the troche form, which I appreciate as a clinician, because, you know, even as a user of things, like having a capsule that’s one dose, and you’re too sensitive to that dose, what are you going to do with the capsule? You can break it open. You can try, like, pour half out. It’s a mess. And then with tablets, trying to break them could be hard sometimes, too. But as clinicians that run my company, myself and his name is Dr. Ted, we’re very much supervising all of the manufacturing, all the R&D, making sure that we’re making the best stuff possible, as we use it in our patients, we use it personally with our family members, etc.
Lindsey Parsons:
And so the beginning titration would start at four milligrams and then work up from there?
Scott Sherr:
Usually like either four or eight milligrams, sometimes up to 12 and a half milligrams as a starting dose, depending on the person. But usually eight milligrams is my starting dose. If somebody is super sensitive, four milligrams and then try it in the morning for about three days. If you feel great, you’re sold. And then maybe you add a second dose if you need it at the end of the early afternoon. If you don’t feel much, then that’s when you increase it. But what some people will feel, what’s common to feel, if you’re relatively well optimized, is that you should just feel this sort of energy rise. You just feel that your energy is better throughout the day. It shouldn’t hit you over the head like a stimulant. It should be like, oh, I just feel like I can just go for longer. And then you look back at your day and you feel like you didn’t get an energy dip in the middle of day like I usually would, or like my kids came into my room and yelled at me. I didn’t yell back. That’s interesting. You know what? What kept me from being so reactive, for example. So like you often say, it can be a little bit in the rear-view mirror when you find the right dose, if you’re relatively well optimized. But if you’re coming from a place where you’ve been having challenges for a while, it shouldn’t be subtle. You should pain better, mood better, brain performance, cognition better, brain fog better, attention better. You should notice these things. for somebody as well optimized, it may not be as obvious, because you’re already starting at a different level.
Lindsey Parsons:
So I have mostly not dabbled in energy-related supplements because I have really good energy. That’s never been an issue for me. Actually, that’s not quite true. Sometimes, if you take me on a hike up a hill, I don’t have good energy. But for what I do, for day-to-day operations, going to the gym and exercising, whatever. So I started taking NMN a week ago, because I got a free bottle. So anyway, I went to the gym yesterday, and I’ve been working over the course of multiple years to be able to do pull ups, because my whole family made fun of me, because most women can’t do pull ups. Anyway, so I went in there, I did two pull ups. I’ve done that before, but anyway, then I went and did the pull-up machine. And I’m pulling 100. Normally I’m topping out at around five of each set. But I’m doing six, no problem, both directions, essentially six sets. So I’m just curious about NMN versus methylene blue, side by side.
Scott Sherr:
So NMN, what it’s doing is increasing your NAD supply. NAD is one of the main electron carriers in your electron transport chain. The short story is that we need food. We eat food, specifically fat and carbohydrates, to get the electrons from our food and ship them over to our mitochondria to help make energy. And one of these electron carriers is called NAD and when it has electrons, it’s called NADH, when it doesn’t, it’s NAD+. And so as we get older, our ability to carry these electrons from our food gets worse. It just gets more sludgy and there’s a lot of different reasons. This could be inflammation. This is enzymatic issues or lots of different things. What you basically just did is give yourself a bigger supply of that NAD and so as a result of that, you have more capacity to flip those electrons over to the electron transport chain and make more energy.
Okay. Now what methylene blue can do, which is interesting, is it can synergize with that, because it can help maintain electron flow and energy production while you have more capacity. And the other thing it can do is, actually, it recycles that NAD back to its NAD supply so you have more of it that’s available as well, so it’s synergistic. I would say that you could try one or the other and see if one had more of an effect than the other, but I usually use them synergistically, although I’m a little bit more wary of NAD supplements these days, but I think any NMN is probably a better choice than NAD directly. We don’t have a lot of evidence that NAD+ gets directly into the cell for people taking NAD+ IVs and things like that. I think it’s probably misguided, and I think there’s also some worry that some of us out now in the longevity community, that too much NAD supply is also likely potentially dangerous, because also NAD is what runs cancer cells too, and that’s why there’s some controversy around just taking NAD without taking something else that’s going to make sure that NAD doesn’t go to particular pathways. And it gets into biochemistry, but anyway, the short story is that they’re synergistic.
Lindsey Parsons:
Okay, got it. So we talked a bit on the introductory call about SIBO, and you were elaborating on your view of what’s going on underneath the diagnosis related to oxygen. So can you talk a little bit about that?
Scott Sherr:
Yeah. So what we do think is that most of the bugs that are involved in small intestine bacterial overgrowth are anaerobes, which are bugs that do not like high oxygen environments. So there’s some question as to whether, if you can flood the system with more oxygen, if you could potentially have a regressive effect, or decrease the amount of the bugs that are available. So in the world of hyperbaric oxygen therapy that I’ve been in for many, many years, there’s been some case reports of looking at using hyperbaric therapy as an adjunctive treatment for SIBO infections, and seen with some positive benefit. And I’ve seen this also in people with Crohn’s disease, with ulcerative colitis, just inflammatory bowel disease, benefit from using hyperbaric oxygen therapy. And I think one of the reasons why is because it has this effect on anaerobic bugs that tend to be the ones that grow more preferentially in more pathogenic states. There’s also the potential that what hyperbaric therapies do is increase stem cell growth and stem cell mobilization in the gut, which is helpful for regrowth and repopulation and the gut lining itself. So I think that’s also a part of it as well. So I think those are some things that I think about when it comes to SIBO.
I mean, the big thing for me these days, Lindsey, I think you and I talked about this briefly in our intro call, was just sympathetic activation in general, like in the sense, if somebody is in fight or flight all the time, they’re chronically stressed, chronically over activated nervous system. They can’t ever get into the rest, digest, detoxification. There’s no amount of hyperbaric therapy, there’s no amount of methylene blue, really, that I’m going to give them, at least in my experience, that can help them long term, because they’re never really going to be able to fully detoxify, fully recover gastrointestinal function, without being able to be in parasympathetic mode more of the time. And so that’s been a big focus of mine. When I first got into hyperbaric therapy, I put people in the chamber wondering why aren’t they getting better? I’m giving them the right supplements. But if they’re always clamped down and always in that fight or flight, if you’re always in that state, and many of you don’t even know that you’re in that, which is the hard part, because you’ve been compensating for such a long time at this level, and don’t realize that there is a base level that you’ve not been in for a long period of time. But once we can acknowledge that we’re there, bring it down, that’s when we can start healing.
And I think that’s been a big, big push of mine recently. And giving mitochondrial support at the same time is very important, like methylene but could be very helpful here, but it’s not going to be the only lever. And that’s why we’re leveraging the GABA system. Really, really important, looking at various supplements you can use, maybe. But really, the big things are lifestyle: if you’re living in a room with a partner that’s snoring all the time, get out of that room or get them a sleep apnea machine. If you’re in a toxic environment where you’re stressed all day because your boss is yelling at you, find another job, if you can. These are really important, and that’s where I’ve been gravitating towards a lot lately is don’t forget the proverbial elephant in the room.
Lindsey Parsons:
I laugh because I was living with my husband, who was snoring all the time, and he refused to do a sleep apnea test, so I made him get a mouth thing that pushes the jaw out and wear tape across his mouth every night, and that has solved the problem. So if anybody else is in the same situation, that works very well.
Scott Sherr:
That’s good. I’m glad you figured that out.
Lindsey Parsons:
So back to the whole oxygen question. So I actually think of most of the cases of dysbiosis that I see as the opposite of what you describe, where the facultative anaerobes, in particular, the Proteobacteria, are overgrown along with high E. coli and Enterobacter.
Scott Sherr:
The facultative ones. Yeah, yeah. So the facultative anaerobes typically can thrive in oxygen-rich conditions, but they don’t thrive in high-oxygen conditions. So Lyme is also a facultative anaerobe as an example. So this is why it’s important. The dosing of oxygen is important, where a little bit of oxygen might not be a good idea, but a lot of oxygen is doing what we talked about earlier, which is causing reactive oxygen species. It’s causing oxidative stress, and as a result of that, it’s actually stress for those facultative anaerobes as well.
Lindsey Parsons:
Okay, thanks for the clarification.
Scott Sherr:
Yeah, no problem. Yeah, that’s a good question.
Lindsey Parsons:
So you were talking about, obviously, getting out of fight or flight mode. And of course, lifestyle is the biggest piece of the puzzle. I often look at adrenal tests and there is this whole family of the adaptogens. Are you looking beyond something like that, or are there particular things that you’re thinking of within that family that you like?
Scott Sherr:
Yeah, I mean, I think that those are good, but it’s really leveraging the GABA system. So GABA is our neurotransmitter in our brain that’s supposed to calm down the firing of our neurons, and it’s like the breaks of our brain. Glutamate is our primary excitatory neurotransmitter that’s like your gas pedal and glutamate and GABA are supposed to be in balance. Glutamate gets converted into GABA in the brain. We have your other superstar neurotransmitters, like norepinephrine, dopamine, serotonin, etc. Those are only 20% of the brain’s neurotransmission. Eighty percent of it is glutamate and GABA. So the key to understand is, if you’re GABA deficient, you don’t have enough GABA around, you have more stress, anxiety, or more depression. You can’t sleep, you have more tremors. You feel like you’re just irritable and sort of on edge all the time. And so if you can leverage the GABA system, that’s another really great way to start downregulating that sympathetic nervous system, to go back more parasympathetic. But you can’t take GABA supplements, and I think I’m not sure if we talked about this in the call earlier, but the GABA itself is too big of a molecule to get into the brain. If it does get into the brain, it means your blood brain barrier is not optimized, meaning that you’re allowing things to leak through. And this is a great approximation for a leaky gut. And if you have a leaky gut, you almost always have a leaky brain that goes along with it, not always, but it does happen. And so if you take GABA supplements and they work for you, it’s because your brain is not doing what it’s supposed to do and keeping things out.
Lindsey Parsons:
Yeah, I’ve rarely seen GABA be helpful to anybody, but I’ve offered that for sleep help and such.
Scott Sherr:
So what’s interesting, I’ve had the experience where I’ve had people come to me and GABA supplements are working for them, but then we heal up their gut and then the GABA supplements stop working. And that’s actually quite diagnostic, as you can imagine. So I use things that enhance the GABA receptor in other ways, but before I get to that, what I don’t use is alcohol or benzos, benzodiazepines like Ativan, Valium and Xanax and sleep drugs, because those all work on the GABA receptor, okay, but the problem with all those is that tolerance, dependence, withdrawal, all the things that are not great because they bind very tightly to the GABA receptor. So I use things like kava, CBD, CBG, ashwagandha is a good one. I use another one called agrin, which comes from a psychedelic mushroom, but it’s not psychedelic at low doses, the Amanita mushroom, it’s long acting. You can use it for sleep – honokiol and magnolol from magnolia bark are good. There’s also dihydrohonokiol-B, which is the more active version of honokiol, so I use all those to enhance the GABA system.
The key is that you want to supply the system with GABA if you can. Using things that work just like GABA, such as apigenin, is one of those ways. It works just like GABA and binds to where GABA would bind. Another one is called picamilon (nicotinoyl-GABA or Vitamin B3-GABA). Vitamin B3 has a transporter that gets it across into the brain and takes the GABA with it; then it breaks up into B3 and GABA, giving you the niacin/NAD+ so you don’t feel tired when you take it, which is nice because NAD+ is a bit activating. So I use things that can activate the GABA receptor without causing tolerance, withdrawal, or dependence – hopefully for just a short period of time as people get a sense of, ‘Oh, this is what it feels like to have a nervous system that’s calming down.’ Once you can get that experience, then it becomes a lot easier to get back there with breathwork, yoga, mindfulness training, warm baths at night or a sauna.
Lindsey Parsons:
So are those supplements that are offered through Troscriptions, the ones you were mentioning?
Scott Sherr:
Some of them are, yeah. So we have one called Tro-Calm, which is great for anxiousness and stress. It has kava, CBD, and CBG – which are both non-psychoactive cannabinoids – and something called B3-GABA (picamilon). That’s the one that helps with relaxation and GABAergic tone but doesn’t make you feel tired because it has some B3 in there too. That’s great for taking during the day; you take a quarter, half, or full dose depending on what you need. It’s really great for taking that edge off and quieting your mind. It’s a nice way to relax after a long day at the office or with kids; instead of reaching for that glass of wine when everybody goes to sleep, you take some Tro-Calm.
There’s also something called Tro-ZZZ, which has eight different ingredients that comprehensively support sleep. The ‘one-two combo’ therefore for the GABA side is honokiol and apigenin, which I mentioned earlier, which work on that GABA receptor really well. It also has 5-HTP, melatonin, CBD, and CBN, as well as things that work on the adenosine system, another neurotransmitter system in our brain that helps us feel tired and gives us the sleep drive to get to bed.
It’s very comprehensive: ashwagandha, rhodiola, lemon balm, and other non-psychoactive cannabinoids can also be helpful to bind to the GABA receptor and the endocannabinoid system, which is another balancing system in our brain. I use all those things depending on the person. Valerian root, by the way, is another common one that works on the GABA system. Those are just awesome options for people. In my practice, I do a lot with anxiety and sleep because I think if you can get sleep better, everything else is going to get better. If you can improve anxiety, you’re likely going to have a better-functioning human. And then, of course, it’s important to support mitochondria along the way.
Lindsey Parsons:
Yeah, okay, well, we have run out of time, but I did want to ask if people want to get things through Troscriptions, can we set up an affiliate account for me*?
Scott Sherr:
Yeah, sure. Absolutely easy to do.
Lindsey Parsons:
Okay, great. Well, we’ll put that link in the show notes. Then, okay, awesome. Anything you want to share before we get off, about where to find you and and all that?
Scott Sherr:
Well, thank you for having me, Lindsey, this has been fun. I think that easiest for the company, it’s Troscriptions.com*, so you can check it out. You check us out on the socials and things like that too. Personally, for me, it’s DrScottSherr.com. You can find out more about my companies, my consulting. I have my own health optimization practice where I work with people. We have a nonprofit organization associated actually, that’s where everything started. It’s at homehope.org, health optimization, medicine and practice is the name of the nonprofit. That’s my clinical practice framework as well.
Lindsey Parsons:
Okay, great. Well, thank you so much for sharing all this great information with us.
Scott Sherr:
Well, thank you for having me. It’s been fun.
If you’re dealing with gut health issues of any type (diarrhea, constipation, bloating, SIBO, IMO, H2S SIBO/ISO, IBS, IBD, gastritis, GERD, H pylori, diverticulitis, candida, etc.) or have an autoimmune disease and need some help, I see individual clients to help them resolve their digestive issues or reverse autoimmune disease naturally, You’re welcome to set up a free, 30-minute breakthrough session to see if you’d like to work with me. I also have my own two products, Tributyrin-Max, which is particularly helpful for loose stool and diarrhea as it slows your motility and firms up your stool, and SBI powder, which is an all around gut pathogen binder, which is super safe and won’t harm beneficial bacteria, and is usually the first line of treatment I educate my clients about in order to avoid stronger antimicrobial herbs.
*Product and dispensary links are affiliate links for which I’ll receive a commission. Thanks for your support of the podcast by using these links. As an Amazon Associate, I earn from qualifying purchases.