I was recently invited to an interview to discuss IC Healer and shed light on our practice, philosophy, and the intricate process that culminates in the remarkable results showcased in our testimonial videos. Here’s a comprehensive summary of IC Healer designed to assist patients seeking deeper insights into our approach and methodology.

Firstly, can you tell us a bit about yourself, where you are based and what led you to treating patients with recurrent UTIs?

Hello my name is Dr Mandy and I am a doctor in clinical nutrition, a licensed nutritionist, a certified nutrition specialist and a functional diagnostic nutrition practitioner.  I am also a professor and teach Biology and Nutritional Biochemistry.

A little bit about me.  I founded IC Healer after my 10-year battle with a debilitating bladder condition called Interstitial Cystitis and Bladder Pain Syndrome.

I was diagnosed in 2008 shortly after the birth of my first child.  I was not given many solutions outside of the conventional treatments and decided to not do any of them. My symptoms continued to deteriorate each year to the point of not wanting to live anymore.

This battle is what pushed me to seek on my own what the root cause was by seeking alternative care and self-research. Through my journey, I learned about MY root cause and how the condition started for me.  I also educated myself on the function of the human body, and how everything is connected.   I proceeded with academics and eventually pursued a doctorate in clinical nutrition.

What types of testing do you utilize when investigating recurrent UTIs and in which situations?

Do you investigate a root cause or other factors that could be contributing to LUTS?

Due to the nature of my scope of practice- the tests I do are often revolved around biochemistry and nutritional biochemistry. I think when someone hears the word nutritionist, there are tons of misconceptions around it.  I am a clinical nutritionist with a doctorate, and the level of work I do is very high level, almost equivalent to what a naturopath would do. Most people clump us in with dietitians and health coaches. First, unlike health coaches, we are licensed. We do not create meal plans- that is not what our training is centered around. Our training is centered around how to correct biochemical imbalances that can be contributing to disease. Although we can also provide dietary guidance and coaching is a big part of what I offer, it is a small fraction of what I do.

The central theme of a clinical nutritionist revolves around biochemical pathways in the human body.

If your listeners don’t know- many of the enzymes in your body rely on vitamin and mineral cofactors to functional properly.  Enzymes are everything- they are responsible for how our organs function biochemically. If they don’t work properly, many of the functions in your body will not work properly.  A good example would be enzymes to break down histamine. One of them is DAO- and its cofactors are zinc, copper and riboflavin (B2).  IF these nutrients are not in balance, a person may have DAO deficiency- and this can affect their histamine balance and make them histamine intolerant. 

Now that you understand a bit about enzymes, you can see how a clinical nutrition doctor and the tests we run can really help find the root cause of many conditions.

The #1 thing I want the listeners to know is that mitochondrial dysfunction and oxidative stress are underlying the majority of the root causes of IC and chronic UTI’s.  I say most of the time, because there are certainly outliers. This is where clinical nutrition can be so helpful.

Mitochondria are the powerhouse of your cells, if they don’t function well, neither will your immune system.  And you will be very toxic with sluggish detox pathways. An area that clinical nutrition centers around.

What is oxidative stress?

Oxidative stress is a natural process that occurs in the body when there is an imbalance between the production of free radicals and the body’s ability to neutralize them. To understand oxidative stress, it’s essential to grasp the concepts of free radicals and antioxidants. This is an important focus for all clinical nutrition doctors.

Free radicals are highly reactive molecules that contain an unpaired electron. They’re formed during normal bodily functions such as metabolism, but they can also be generated due to external factors like pollution, UV radiation, unhealthy diets, or smoking. These unstable molecules seek stability by taking electrons from other molecules, causing damage to cells, proteins, lipids, and even DNA.

Antioxidants are the body’s defense system against free radicals. They are molecules that can neutralize free radicals by donating an electron without becoming destabilized themselves. Antioxidants can be produced within the body or obtained from certain foods, like fruits, vegetables, nuts, and some spices.

When the balance between free radicals and antioxidants is disrupted, excessive free radicals overwhelm the body’s defense mechanisms, leading to oxidative stress. This imbalance triggers a chain reaction of cellular damage and plays a significant role in the development of various diseases and aging processes.

Oxidative stress impacts the body in several ways:

1. Cellular Damage: Free radicals attack cell membranes, proteins, and genetic material, which can impair cellular function and contribute to aging.
2. Inflammation: Oxidative stress can trigger inflammation, a response that aims to repair tissue damage but can become chronic and contribute to various diseases if prolonged.
3. Chronic Diseases: Studies suggest that oxidative stress is linked to numerous chronic conditions like heart disease, diabetes, cancer, neurodegenerative diseases (such as Alzheimer’s and Parkinson’s), and others.
4. Aging: Over time, accumulated damage from oxidative stress may contribute to the aging process and age-related diseases.

It’s important to manage oxidative stress by adopting a healthy lifestyle that includes a balanced diet rich in antioxidants, regular exercise, stress reduction, adequate sleep, and avoiding excessive exposure to environmental toxins.

Understanding oxidative stress helps emphasize the importance of maintaining a balanced lifestyle and consuming a variety of antioxidant-rich foods to support the body’s natural defense mechanisms against free radicals. By reducing oxidative stress, individuals may potentially lower their risk of developing various health issues and promote overall well-being.

Vitamins and minerals play crucial roles in mitigating oxidative stress by acting as antioxidants or supporting the body’s antioxidant defense systems. These micronutrients help neutralize free radicals, reducing the damage caused by oxidative stress.

Here are some examples.

1. Vitamin C (Ascorbic Acid): Vitamin C is a powerful water-soluble antioxidant that scavenges free radicals in both the aqueous environments within cells and in extracellular fluids. It also regenerates other antioxidants like vitamin E, maximizing their effectiveness.
2. Vitamin E (Tocopherols and Tocotrienols): Vitamin E is a fat-soluble antioxidant that protects cell membranes from oxidative damage. It works in lipid-rich areas of the body, such as cell membranes and lipoproteins, intercepting free radicals before they can damage fats.
3. Vitamin A (Beta-Carotene): Beta-carotene, a precursor to vitamin A, acts as an antioxidant, particularly protecting against oxidative stress in the eyes and skin. It also supports the immune system.
4. Selenium: Selenium is a trace mineral that’s a component of various antioxidant enzymes, such as glutathione peroxidase. These enzymes neutralize peroxides and reduce oxidative stress, particularly in cells exposed to high levels of oxygen.
5. Zinc: Zinc is an essential mineral that contributes to the structure of antioxidant enzymes. It plays a role in maintaining the body’s oxidative balance by protecting against damage caused by free radicals.
6. Copper: Copper is a component of superoxide dismutase (SOD), an enzyme that neutralizes the superoxide radical, a highly reactive free radical involved in oxidative stress.
7. Manganese: Manganese is involved in the activity of certain antioxidant enzymes like manganese superoxide dismutase, which scavenges harmful free radicals.
8. Coenzyme Q10 (CoQ10): Although not strictly a vitamin or mineral, CoQ10 acts similarly to an antioxidant, neutralizing free radicals and assisting in energy production within cells.

These nutrients work individually or synergistically to combat oxidative stress.

Vitamins and minerals serve as essential cofactors in antioxidant enzyme reactions, playing pivotal roles in the body’s defense against oxidative stress. Antioxidant enzymes are the first line of defense, working to neutralize harmful free radicals and prevent cellular damage. Here’s how these cofactors are involved in the reactions of major antioxidant enzymes:

• Superoxide Dismutase (SOD)
• Copper, Zinc, Manganese: These minerals are integral components of different forms of SOD. Copper and zinc are essential for the function of cytosolic and extracellular SOD, while manganese is crucial for mitochondrial SOD. SOD catalyzes the dismutation of superoxide radicals into hydrogen peroxide and oxygen, thereby minimizing the damaging effects of superoxide radicals.

• Glutathione Peroxidase (GPx): Vitamin B6, zinc, selenium, vitamin E and C and B2 are cofactors.
• GPx requires selenium as a cofactor. It is involved in the reduction of hydrogen peroxide and organic hydroperoxides to less harmful substances, using reduced glutathione (GSH) as a substrate.

• Catalase– Iron: Although not a vitamin or mineral, iron is associated with the enzyme catalase. Catalase functions in the breakdown of hydrogen peroxide into water and oxygen, thereby reducing cellular damage from this reactive molecule. Other nutrients involved include copper and manganese.

• Thioredoxin Reductase and Glutaredoxin: Cofactors include selenium, NADPH (from B3), and glutathione which has its own cofactors.

• Vitamin E (Tocopherol): Vitamin E can regenerate itself by interacting with these enzymes. When vitamin E neutralizes free radicals, it becomes a radical itself. These enzymes help restore vitamin E to its antioxidant state.

• Coenzyme Q10 (CoQ10): CoQ10 acts as an electron carrier in the mitochondrial respiratory chain and is involved in reducing free radicals and regenerating other antioxidants, such as vitamin E.

These vitamins and minerals, when present in adequate amounts, facilitate the activities of these antioxidant enzymes. Insufficient intake of these essential nutrients can compromise the body’s ability to combat oxidative stress effectively, potentially leading to increased cellular damage and heightened oxidative stress-related health issues.

This is where my testing becomes very purposeful.

I do testing to not only identify these imbalances, but also toxin testing to identify what may be causing excessive free radicals in the body. 

• Hair tissue mineral analysis testing- Hair Tissue Mineral Analysis (HTMA) is a diagnostic test that assesses mineral levels and heavy metal concentrations in a hair sample. This non-invasive test is used to evaluate nutritional imbalances, mineral deficiencies, and toxic metal exposure within the body.  It is very useful to identify oxidation rate which gives me insight as to how they are functioning.
• Nutreval Testing– Genova Diagnostics offers the Nutreval test, a comprehensive functional nutritional evaluation that provides insights into a person’s nutritional status, metabolic function, and potential underlying imbalances.  Testing components include organic acids, amino acids, oxidative stress markers, nutrient markers, detox indicators and capacity
• Iodine testing-using the 24 hour urinary iodine loading test
• Blood chemistry- a custom panel I created that has copper/zinc investigation, thyroid, inflammation, blood sugar, oxidative stress, etc.
• Mycotoxins and toxin testing- I can do both blood and urine.
• Nutrigenomics testing- see below

What is Nutrigenomics anyway?

Nutrigenomics is a field that explores the relationship between an individual’s genetic makeup, their response to nutrients, and how their diet impacts their health. It delves into how specific nutrients in foods interact with an individual’s genes, influencing gene expression, metabolism, and overall health outcomes.

Here are key aspects of nutrigenomics:

1. Genetic Variations: Nutrigenomics examines how genetic variations among individuals can affect their response to nutrients. Variations in genes can influence how the body absorbs, metabolizes, and utilizes various nutrients.
2. Diet-Gene Interaction: It studies how dietary components interact with genes, affecting gene expression and function. Different nutrients can activate or suppress certain genes, impacting metabolic pathways and physiological processes.
3. Personalized Nutrition: By understanding an individual’s genetic makeup, nutrigenomics aims to tailor dietary recommendations based on their genetic profile. This personalized approach seeks to optimize health and prevent disease by recommending specific diets that align with a person’s genetic predispositions.
4. Health Implications: Nutrigenomics researches how dietary patterns and nutrient intake may contribute to health outcomes and disease prevention. It seeks to identify how specific diets or nutritional interventions can mitigate the risk of certain diseases based on an individual’s genetic predisposition.
5. Preventive Health Strategies: Insights from nutrigenomics can guide the development of personalized dietary strategies and interventions. Understanding how genes respond to nutrients allows for targeted approaches to promote better health and potentially reduce the risk of chronic diseases.

In essence, nutrigenomics aims to unravel the intricate relationship between genetics, diet, and health to provide personalized nutritional recommendations tailored to an individual’s genetic profile, promoting overall well-being and disease prevention.

Is there something about your approach that is different to the typical approach to UTIs

With my testing, I have found some very interesting similarities to all my patients.  First, many of them have oxalate issues- either from dietary intake or endogenous production.  Second, many have low antioxidant status- such as taurine and glutathione.

  And finally, genetically, a very high % of my UTI patients have polymorphisms in Nrf2. 

Think of Nrf2 as a protective superhero inside our body. Its main job is to defend our cells from damage caused by harmful substances and stress. When our cells are stressed due to things like pollution, UV rays, or even the food we eat, Nrf2 springs into action.

It works like a switch that turns on the production of special proteins that act like shields

Nrf2, short for nuclear factor erythroid 2–related factor 2, is a crucial protein that functions as a cellular defender in our body. It acts as a master regulator, orchestrating a complex network of genes responsible for protecting cells from damage caused by oxidative stress and harmful environmental factors.

When our body encounters stressors like pollution, toxins, UV radiation, or inflammation, it triggers oxidative stress—a condition where free radicals overpower the body’s ability to neutralize them. Nrf2 plays a pivotal role in combating this stress by activating a series of protective genes. These genes produce antioxidants and detoxification enzymes, fortifying cells against damage and supporting their repair processes.

Under normal conditions, Nrf2 is kept in check by a protein called Keap1, which confines Nrf2 to the cell’s cytoplasm. However, when the body encounters stress, Nrf2 separates from Keap1 and moves into the cell’s nucleus. In the nucleus, Nrf2 binds to specific DNA sequences known as antioxidant response elements (AREs), initiating the transcription of genes involved in antioxidant defense, detoxification, and cell survival.

Through its actions, Nrf2 helps maintain cellular health, supports the body’s defense against oxidative damage, and promotes resilience against various diseases. Enhancing Nrf2 activity through lifestyle changes, such as consuming a diet rich in antioxidants and engaging in regular exercise, can potentially optimize its protective effects and contribute to overall health and well-being.

There was an interesting article published in 2021.

The journal article titled “NRF2 promotes urothelial cell response to bacterial infection by regulating reactive oxygen species and RAB27B expression” explores the role of NRF2, a transcription factor known for its involvement in cellular responses to oxidative stress, in urothelial cell defense against bacterial infection.

The study investigates how NRF2 influences the urothelial cell response to bacterial infections, specifically focusing on its impact on reactive oxygen species (ROS) levels and the expression of RAB27B, a protein associated with antibacterial functions.

The research conducted experiments using urothelial cells and observed that NRF2 activation, induced by a bacterial infection, led to an increase in ROS production within the cells. This rise in ROS was found to be essential for the effective clearance of bacteria from the cells. Additionally, NRF2 activation was linked to an upregulation of RAB27B expression, which played a crucial role in the secretion of antimicrobial molecules to combat bacterial invasion.

The findings highlight the significance of NRF2 in the urothelial cell response to bacterial infections. NRF2 activation triggers ROS production, facilitating the cells’ ability to combat bacterial invasion, while also promoting RAB27B expression, which aids in the secretion of antimicrobial substances. Understanding these mechanisms could offer insights into potential therapeutic strategies for enhancing the urothelial cell’s defense mechanisms against bacterial infections.

Patients with these polymorphisms are showing an upregulation of KEAP1. 75% of my patients have at least 1 copy of this mutation! This is a huge finding.

The primary function of KEAP1 is to regulate NRF2 by acting as a sensor for cellular oxidative stress. Under normal conditions, KEAP1 binds to NRF2, leading to the degradation of NRF2 by the proteasome, thereby maintaining low levels of NRF2 activity within the cell.

However, when cells encounter oxidative stress or electrophilic insults, these events modify specific cysteine residues in KEAP1. This modification alters the configuration of KEAP1, inhibiting its ability to target NRF2 for degradation. Consequently, NRF2 is stabilized and accumulates within the cell. The accumulated NRF2 can then translocate into the nucleus and bind to antioxidant response elements (AREs) in the DNA, promoting the transcription of genes involved in antioxidant defenses, detoxification enzymes, and other cytoprotective proteins.

Therefore, KEAP1 functions as a key modulator of NRF2 expression and activity by regulating its degradation in response to cellular redox status. The interplay between KEAP1 and NRF2 serves as a vital mechanism for cells to adapt and mount a defense against oxidative stress and maintain cellular homeostasis.

Other Common Polymorphisms

• HFE– many patients are dealing with iron imbalances, which can contribute to the Fenton reaction
• iNOS/eNOS– an upregulation of iNOS can activate platelets, and increase the risk for blood clots and biofilms
• PON1- mutations in PON1 can negatively impact detoxification of endocrine disrupting chemicals such as glyphosate
• ABP1– disruptions in the DAO enzyme or lack of key cofactors can affect how the body degrades histamine
• B6 transport – a critical nutrient in many biological processes, but most importantly, to help the body safely degrade and remove oxalate. B6 is also important for the body’s production of glutathione
• MTHFR– plays a dual role depending on the variation. MTHFR A1298C is involved in the production of BH4- which important for healthy nitric oxide levels. MTHFR C677T is involved in homocysteine metabolism- which is yet another risk factor for increased blood clots and biofilms.

My basic approach

  My philosophy is a bit different than most. I take the offensive rather than the defensive approach. I like to increase the FUNCTION of the body rather than chase infections like many doctors do.  The antibiotics are often detrimental to the gut- and many of these patients already have dysbiosis. So giving them even more antibiotics seems to create additional problems, so I like to avoid it if we can.

 I like to spend the first 4-6 months working on foundations to bring back balance/homeostasis, because for many of my patients, their symptoms resolve when they increase function.  This is because the body is more efficient at producing ATP- the energy currency of the cell.  We also do some gentle detox protocols and I help them follow an anti-inflammatory, antioxidant rich diet that helps reduce inflammation while supporting a healthy immune system.

What is your typical treatment approach when infection is identified?

First test we always do is the HTMA.  I start all my patients on a customized mineral formula that is base on the results. We also do diet makeovers, and gut support.  I also start them on a micronized zeolite binder to help charge the minerals while supporting the body’s detox of harmful chemicals.  This is actually called my HTMA Supercharged

After they get the other test results back, we tweak protocols depending on what is found.  If mold is found, we discuss additional testing.  I often have to have patients do additional blood work , so there is often follow up testing.

The personalized supplement is tweaked when the Nutreval testing comes back.  And then it is highly recommended to repeat HTMA testing in 4-6 months to make appropriate changes.

If after a few months, we have not made progress, then we move to Level 2 testing, where I do a Microgen test and Ruth’s Kriz’s hypercoagulation panel.  I then consult with Ruth and with my nurse practitioner we will pursue a protocol of prescriptions.  I often pair this with herbals or natural antibiotics, probiotics and supporting the immune system.

What advice would you give to someone who suspects they have a UTI but is testing negative?

Identify your root cause. 

Is it biochemical?

Structural? 

Physical? 

Dietary? 

Could your partner be passing it back and forth to you?

All of the above?

Stay consistent and committed for the long haul.  Be open to other treatments such as ozone or instillations.

Typically, how long can a patient expect to be in treatment?

Most patients get 80% symptoms resolution in 6-9 months- if they are under 50.  Over 50, the timeline is 9-12 months. The timeline is longer, the longer they had the condition unfortunately.

How can recurrent and chronic UTI patients reach out to your practice?

Visit my website- ICHealer.com- book a Discovery call. We are highly selective on our patients due to the nature of the commitment required to get well