Transcription
Hey, this is Dr. Scott. Today I'm going to be doing a video on Methylene Blue, specifically as it relates to a video that came out by Dr. Paul Saladino discussing why you shouldn't take methylene blue. In this rebuttal, as it is, I'm going to show why it may be important for you to try it in some cases and actually some places where we agree a lot as well. Let's get going.
Your methylene blue is a petroleum derivative. So, methylene blue was originally derived from petroleum based products. And at this point, many of you are thinking, well, should I be taking a synthetic ingredient or should I not? Think about it this way. Should you be always taking something that's natural versus synthetic? Not everything natural is good for us. Some things that are natural for us are actually things that can kill us. So, when I was in medical school, for example, I saw people that died of liver failure, secondary to eating the wrong mushrooms. So, not everything naturally coming from the ground is good for us.
Now, is everything synthetic bad for us? We live in a synthetic world. Paul is very lucky. He lives in Costa Rica. He does the ancestral thing and that's great for him. But most of us cannot do that. Most of us live under bad lighting, water, food, environmental toxins. And so sometimes we need synthetic things to help us.
One of the more important things that it does in your body is inhibit an enzyme called monoamine oxidase A and it also inhibits monoamine oxidase B, but to a lesser extent. Methylene Blue is a monoamine oxidase inhibitor, but what Paul forgets to talk about here is it's all dose response related. Meaning very low doses of methylene blue do not do this a whole lot and very high doses will. So the monomine oxidase A and monomine oxidase B. For sure monomine oxidase B does not happen until very high doses. But the monomine A doesn't even happen very much until you start ramping up the dose as well. Sure, that is a part of what's going on here. So you got you are getting more norepinephrine, serotonin, and dopamine when you do take methylene blue, but it's dose responsive, meaning that it is dose dependent. The lower the dose of methane blue you're taking, the less monomine oxidase inhibition you're getting. And I disagree with Paul that the reason why people feel better taking methylene blue is because of the monomine oxidase inhibition.
So it's really important to understand that when you take methylene blue, you're at an increased risk of serotonin syndrome, something that is very unpleasant. So serotonin syndrome, this is extremely extremely rare. It's only been described using IV methylene blue and other serotonin medications like SSRIs, SNRIs. It's never been shown to be actually something that happens with oral methylene blue use even no matter even at high doses. Now if you are taking an SSRI, an SNRI, a medication that increases dopamine or serotonin in another way, I do recommend you work with a healthcare provider. And if you're thinking about using methylene blue, use it very small doses to start off with and increase slowly. But clinically, this is not an issue. If you're working closely with a provider, you shouldn't have any problems. Just go very slow with your dosing. Overall, what Paul's saying here is just not something that we see clinically in medical practice. Ask 25 doctors if they've ever seen serotonin syndrome before. One of them may say yes, but that even one may not even be sure.
Now, the other really important thing that methylene blue does in your body is that it acts as a redux reactive compound, meaning it moves electrons around. One thing about redux cycling is that methylene blue is one of the only compounds available or out there that redux cycles means meaning that it increases the amount of electrons it can donate typically to the electron transport chain and also can pick up free electrons like an antioxidant. So it has the ability to energy enhance and to detox at the same time. And there are very few compounds that are like that in the world overall.
If you're taking large doses of methylene blue it actually turns your brain blue. Okay, we're going to stop him there with the brain blue. So, he's going to go on to talk about how methane blue can turn your brain blue. And he will quote you the right amounts. 300 to 500 milligrams of methylene blue in the IV may do this. Nobody should be taking this kind of a dose of methylene blue. The study that he quotes here as well and shows pictures of which are quite shocking. I definitely agree with that. We're giving people upwards of those doses IV for acute septic shock for cardiopulmonary arrest and severe presentations where these patients were going to die. And in fact, many of them did die even despite them trying to use these high doses of methylene blue. So clinically, again, in practice, we do not use these high doses of methylene blue unless it's in an emergency room and there's an emergency. Otherwise, the doses that we typically use 4 milligrams, 8 milligrams, 16, 25, maybe up to 50 milligrams, maybe slightly higher that for for shorter periods of time. But in general, you will not be using these higher doses. Your brain and your heart and other organs are not going to turn blue.
Historically, methylene blue was added to psychiatric medications by psychiatrists to monitor patient compliance. This is true. Methylene blue was added to psychiatric medications to ensure compliance. So if your psychiatric patient was urinating blue, they were then taking their psychiatric medications. True.
In the medical world, the main use of methylene blue right now is for met hemoglobinia. This condition occurs when the iron atom at the center of your hemoglobin molecule is oxidized from the Fe2+ state to the Fe3+ state. So here Paul is correct. One of the main uses of methylene blue in the emergency rooms is something called met hemoglobinia. And he does a really good job here describing the physiology of the iron molecule and the redox state and how methylene blue can actually fix that. And every emergency room in the United States has to have methylene blue there for this emergency. And in fact, methane blue is still on the World Health Organization's list of essential medications for met hemoglobinia along with something called cyanide poisoning. Now, cyanide poisoning destroys complex 4 in your mitochondria on the electron transport chain and methyl can compensate for that and redirect electrons so that you can maintain energy production. We'll talk about that more later when Paul goes into more electron transport chain physiology. It's not a very common thing, but that is the main use of methylene blue. It's what I learned about in medical school. It's what most people know as the use of methylene blue.
Some of the other uses of methylene blue, not only from that perspective, is actually a medical merking. So if you are an OB/GYN surgeon, you're taking out a uterus, so you're doing a hysterctomy, you'll actually inject methylene blue into the bladder to make sure you didn't cause any harm to the bladder or any breaks in it so that you have to fix those potentially before you close up somebody after a surgery. I have a friend that's a transplant surgeon that uses methylene blue for the same reason. And so it's used for medical marking very commonly along with met hemoglobinia and very rarely cyanide poisoning but every ER in the country in the US has to carry it.
The idea that methylene blue improves the function of your mitochondria is really totally false. I think most people are feeling a little bit better maybe a little bit brighter or a different psychological state because of the ma inhibition. So if you are a generally healthy human ah that's it. Okay. So what Paul is saying here is that most people are feeling better taking methylene blue because of the MAI quality and he then says that most people are generally healthy. The answer is that that's not the case. Most people are not generally healthy. 94% of US adults are metabolically unhealthy and that means that 94% of US adults also have some element of mitochondrial dysfunction. And later in the video, Paul actually talks about this in detail about how people that are metabolically unhealthy have broken mitochondria. He says that actually and I agree with him. And I also agree that we need to be doing things to optimize mitochondrial function. Not just of course taking methylene blue, which can help, but also optimizing our vitamins, our minerals, our nutrients, our diet, our lifestyle. Many of the things that Paul says I agree with 100%. But what I think he's making, I think a fallacy in judgment here is saying that people are just feeling better because they're taking something that increases serotonin. Again, that is dose dependent. It's very mild at the low doses that we're talking about, mostly for that are clinically relevant. And methample boo has a fantastic capacity to compensate for mitochondrial dysfunction at any complex in the mitochondria. And Paul does a really good job in a couple minutes talking about all that. So I think the challenge here and I think the the sort of break in understanding is the clinical relevance of mitochondrial dysfunction and how methane blue can compensate for that in so many different ways that we see in patients all the time with autoimmune issues with chronic inflammatory issues with with mold and COVID and things like that. Lots of different things that are happening on the mitochondria causing severe issues insulin resistance toxins in our environment stress in our environment. It could be bad sleep. It could be stressful people. It could be medications. Paul at the video in the end talks about medications that can cause mitochondrial stress like like mito like metformin and bourberine for example. All of which I agree with. Method what it's doing here is compensating for all of those things. Compensating for mitochondrial dysfunction optimizing and allowing you to bypass various areas that aren't working.
If you don't have clear blocks in your mitochondrial electron transport chain, methylene blue actually is hurting you. It is decreasing the amount of ATP produced in your mitochondria by moving electrons further down the electron transport chain. Let's talk about this study that he's quoting here. It's methane blue induced O2 consumption is not dependent on mitochondrial oxidative force fllororilation implications for salvage pathways during acute mitochondrial poisoning. So the challenge with this study is that it's not at all clinically relevant. Zero. In fact, I've responded to his Instagram video specifically because this is the only study that he quotes in the entire article. I know there's lots of other great studies that he could have quoted that may have been helpful, you know, from my perspective, of course, and I'm I'm going to link all those in the notes below, so you have an understanding of what where the information that I'm telling you all today is coming from. Okay? But nothing but concentrations in in his study that he quoted here far exceed typical therapeutic plasma levels in humans by 5 to 100 times. These levels are super physiologic and not relevant to clinical doses. Low doses have been shown to be very safe to improve mitochondrial support, cognitive enhancement, and all the kinds of things that I mentioned before. So, the only study that he's showing here in the entire video is one that's completely not relevant for humans at all because the doses far exceed what we would use in clinical practice. That's what it comes down to.
So, the movement of electrons down the mitochondrial electron transport chain is what creates the proton gradient necessary for energy in your body. Good stuff. This is relevant to methylene blue. Here we go. Because methylene blue is effective at bypassing blocks in that mitochondrial electron transport chain. Blocks at complex one, blocks potentially at complex 2, three, or four. Now, what causes mitochondrial electron transport chain blocks? Generally, it's toxins. Toxins and metabolic dysfunction will also cause dysfunction in the complexes themselves. Not complete blocks, but blocks enough that you can get symptomatic, especially if a complex one or two when you can't actually get your electrons from your food to help you get over to the ETC and make energy. But even complex three and four, of course, can be even more severe. But in general, complex one and two are the most common complexes that are disturbed by mitochondrial dysfunction from metabolic dysfunction. Methylene blue is actually doing you no favors. It is moving electrons down the electron transport chain, creating less ATP than you would normally have. So there's no evidence that if you have an optimized mitochondria that methylene was going to make it less optimal, meaning that it's going to bypass any of the complexes at all at low doses. At high doses, this may be the case. But at low doses, there's no evidence. 4 milligrams, 8 milligrams, 16, 25, there's no evidence that it bypasses any of the normal complexes. What it's going to do though is if you have abnormal complexes that aren't working well, it can help recycle things like NAD and FAD from your complex one and two, which is very well described in the literature. Less ATP to be produced. And that's what methylene blue does. It moves electrons further down the chain, which can bypass a block in the chain. If you have a pathology, which very few people actually do, but some people do, that makes less bypassing complexes that are blocked or dysfunctional, not working at optimal capacity. There are many people out there that don't have a 100% blockage of a complex, but they have 60 80% maybe 40% and they can't get enough energy production as a result of that. So having methylene blue on board can help bypass the complex while you're doing the harder work of optimizing your vitamins, your minerals, your nutrients, your diet, your lifestyle to help that complex work better. In addition, there's also evidence that methane blue increases the density of complex 4 or cytochrome oxidase in your electron transport chain, making your electron transport chain more efficient over time when you're taking it as well. Makes less ATP in the end because you those electrons are traveling a shorter distance, moving less protons to the intermembrane space and resulting in less ATP as the protons move down their concentration gradient back into the matrix. So, this is a good point though that if you are bypassing complexes, you are making less ATP than you would have if you're using all of your complexes on your electron transport chain. That being said, if you have a complex that's not working well, like a complex one, for example, and you're not allowing the whole electron transport chain to work efficiently because complex one isn't working, all of that upstream isn't going to work very well at all. And or maybe maybe just a little bit or maybe a lot depending on the situation. So, if you can bypass that complex one for a little while with methylene blue, you're going to have the capacity to make more energy from complex 3 and complex 4, and that's going to be helpful in the short term while you're optimizing and hopefully working on why your complex one isn't working very well. I think most people who are taking methylene blue are decreasing the efficiency of ATP production, decreasing the amount of ATP produced in their body because you don't need to bypass those complexes in your mitochondrial electron transport chain.
So, I completely disagree with this. You know, from a clinical perspective, we see people that take methylene blue feel remarkably better. Better energy, better focus, less brain fog, better exercise tolerance. This is not an MAI induced effect. Increasing serotonin will not have any of those effects. I work with people all the time. There are hundreds of my colleagues that are using methylene blue in clinical practice. It is something that works dramatically in so many people because it has the capacity to help increase energy production and bypass some of those complexes, helping the whole downstream electron transport chain work better while you're doing some of the hard work of optimizing some of the things that Paul advocates for and I advocate for too. Optimizing your vitamins, your minerals, your nutrients, your diet, even some of Paul's supplements are fantastic for this. Some of his some of his organ complexes and things. I 100% agree with that. But the problem here is that he's thinking nonclinally. He's thinking from a a mechanistic perspective and it's a misguided mechanistic p perspective because he's not looking at the dose dependence of the studies that he's showing you and the actual clinical evidence that we see day in and day out in practice.
Are there situations where methylene blue may be helpful? Yes, potentially. Methylene blue has been studied in Alzheimer's, but the data have been very underwhelming. So, the study in Alzheimer's he's referring to here was an interesting one. It actually had a placebo group that was getting 8 milligrams twice daily of methylene blue. Then another group getting 75 twice daily. Another group getting 150 milligrams twice daily. The placebo group or the sham group at 8 milligrams twice daily did much better. Why is this the case? This is nuance. But too much methylene blue as we were been kind of alluding to at least you know Paul is talking about somewhat here is that too much can cause stress on the system and in fact cause increase in something called hydrogen peroxide production. Hydrogen peroxide is actually very good as an anti-infective. So higher doses of methane blue around a milligram per kilogram or so orally, sometimes IV, but typically orally is a fantastic anti-infected because it increases hydrogen peroxide production. However, when you have hydrogen peroxide in the system, you're also increasing the need to produce antioxidants to help balance out that antioxidant load, excuse me, that oxidant load of the hydrogen peroxide. As a result of that, if you don't have the capacity to make glutathione with your NRF2 pathway, which gets up upregulated with H2O2 or hydrogen peroxide, you're not going to feel good. And if you have a brain that's already under stress because of Alzheimer's, you likely don't have the capacity to make enough glutathione. So, short story that low doses of methane blue are very compelling. And they're working on a phase three study right now looking at 8 milligrams twice daily in this particular condition.
In Parkinson's, same thing. New data is coming out. very interesting as a way to improve mitochondrial function. Of course, Parkinson's is known as a dopamineergic deficiency as dopamineergic neurons die, but it's also significant mitochondrial dysfunction as well. And remember guys, the benefits of methylene blue at an energy production level are a irreconcilable, unhealable complex block in the electron transport chain. Irreconcilable, unhealable block in the transport chain. This is completely untrue. If you have a dysfunctional complex, you can bypass it for a short period of time, work on optimizing those complexes and see massive benefit. We see this clinically all the time. Again, we see this clinically all the time. So, I completely disagree with this. I think for most of us, methylene blue is a net negative and you should not be taking this. Don't take methylene blue unless you absolutely know that your mitochondrial electron transport chain is badly inhibited. So, again, I disagree here. 94% of US adults have some element of metabolic dysfunction which often correlates to mitochondrial dysfunction and electron transport chain dysfunction is part of that whole ecosystem.
I understand where Paul's coming from. And from a clinical perspective, again, I don't think that methyling blue is the answer for everybody. And I don't think it's the answer long term for almost anybody, especially all of the time, especially if you can optimize your vitamins, your minerals, your nutrients. Work on those things. But not everybody can do that easily. Not everybody has the capacity to live like Paul in Costa Rica and be ancestral all the time. We live under synthetic environments. We live under lights that are bad, toxins, toxic people, etc. And so, we need synthetic things sometimes to help us. And nothing but at very low doses 4 milligs 8 12 16 milligs can be extremely helpful in these capacities and is extremely extremely safe. If you are taking medications that increase serotonin for example work with the provider. If you're taking other medications otherwise and you're not you know not sure especially high blood pressure medications work with a provider and watch very closely. But I disagree with what he's saying there. There's such clinical relevance to this particular compound. That's why it's been so gotten so popular. Even before this year when RFK went viral, we've been using this this particular product, this compound in clinical practice for years and seen massive benefit. And tons of my colleagues in the clinical space have seen the same.
Methylene Blue somehow optimizes mitochondrial function is completely wrong. Methylene blue absolutely does not optimize mitochondrial function. So how does it optimize mitochondrial function? It can bypass complexes and help you work on getting your other complexes working better over time by right diet lifestyle supplementation. It can also increase cytochrome oxidase your complex 4 in your mitochondria. So that is an optimization strategy increasing the density of complex 4 over time. And it's also working as a redux cycl as an antioxidant which he forgets to talk about in this video. But as an antioxidant, it can mop up free electrons. It can mop up free radicals oxidative stress and help decrease the stress on the system. And that can be so powerful for people that are so toxic because of infections and toxins and so many other things that are happening.
If you have metabolic dysfunction, methylene blue is not the answer. That's not the root cause. What should you be doing to fix this? Well, you need to make sure you're getting critical nutrients that your mitochondrial electron transport chain works. NADH is derived from nasin 100%. FADH2 is derived from riboflavin. Co-enzyme Q10 is found in the electron transport chain complex of the electron transport chain. copper and a very high level, you're probably getting enough of those things. Co-enzyme Q10 very rich. Okay, I'll let Paul keep talking here in a bit, but I completely agree with him. I think that we all need to follow a better diet, better lifestyle, and optimize mitochondrial function, but it's not an easy thing for all of us to do. Methylene boo is one of those things that can be used at these low doses to optimize mitochondrial function. Yes, I said optimize. Increase energy production when energy is is deficient in various ways while you're doing the harder work of optimizing it over the long term. and also working as an antioxidant and detoxifying and help decrease the toxic stress that the mitochondria are on so that you can make energy better. So I don't agree with Paul in the sense that I do feel that methane book can be something that help optimize mitochondria, but it's not the only thing that we need to be doing. Over time with my patients, I decrease the amount that they need as their mitochondria are coming better online that they're more optimized. And that's something that I encourage all of you to think about is that don't just think of methylene blue as a cure all. It's not. It's something that can be used in the context of a larger optimization strategy. Okay. Thank you.
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