Methylene Blue for POTS with Dr. Scott Sherr

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Jill Brook: Hello fellow POTS patients and beautiful people who care about POTS patients. I'm Jill Brook and today we are interviewing Dr. Scott Sherr about an alternative treatment gaining popularity called Methylene Blue. Dr. Jill Carnahan and Dr. Tania Dempsey briefly mentioned they were using Methylene Blue in their episode of Mast Cell Matters and many of you listeners wrote in saying, Hey, what is that?

We need to learn about that. So Dr. Scott Sherr is the perfect person to educate us on Methylene Blue because he uses it with his patients, but he also believes in it so much that he is part of a company that is making it and selling Methylene Blue as part of their product line of science backed supplements.

Dr. Scott Sherr is a board certified internal medicine physician, certified to practice health optimization medicine. He's also a specialist in hyperbaric oxygen therapy, which I know a lot of you are interested in, and which he'll educate us about next [00:01:00] week. And he's COO of Troscriptions, a company creating novel products such as their Methylene Blue product.

So Dr. Scott, thank you so much for being here today. And what else should listeners know about you and your medical approach? Like how did you come to work with POTS patients?

Dr. Scott Sherr: Oh, well, so, well, Jill, first, thanks for having me. I'm so amazed that there's something that's dedicated to this. And when I found out about you and what you were doing, I just, it's such a challenging, challenging set of symptoms for people. And there's so few resources out there, at least there used to be, but now there's so many more over the last several years.

And people actually think it's a real diagnosis after long COVID and everything else, finally, so a lot of people that have finally been having these symptoms forever can say to their family doctor, like, look, this is real, like, this is happening, and like, and so I really do, I'm so grateful that you do what you do.

My approach really, I guess, began as the son of a chiropractor. So I grew up very much out of the box, very much not understanding what conventional medicine really was for, because I didn't have any [00:02:00] reason for using it until I was much older. But I ended up going to medical school thinking that the, that there would be a at some point in my

trajectory where I could bridge the chasm between these worlds, bridge the chasm between the conventional world and the alternative world. Functional medicine didn't exist at that time. Integrative medicine didn't exist. So, it was just alternative medicine. And so, my approach is really colored from that background.

And I went to a conventional medical school. I did a conventional residency at the University of Maryland in Baltimore. I am a board certified internal medicine physician. But I truly think about things in an integrative way now. Over the last decade or so, and I know we'll talk about hyperbaric medicine on our next podcast, but I I really started a practice back in like 2012 2013 focusing on hyperbaric medicine and then I created an integrative approach over the last decade or so that includes hyperbaric medicine, but that creates more of a framework for people to think about when hyperbaric therapy would be appropriate as a modality, and that sort of led me on this train of, [00:03:00] like, well, what is that foundational framework required?

And that really for me, it is related to this non profit that that we now operate called Health Optimization Medicine in Practice, or HomeHope for short. HomeHope. org is the website. This is a non profit organization that was created because of the brilliant work of a friend, mentor, and colleague named Dr.

Ted Achacoso. And Dr. Ted is a, he's a physician, he's a polymath, he's, he's extremely, extremely smart. He's done amazing things in his life and he was originally born in Manila in the Philippines. And so in Manila, he created this framework that he called Health Optimization Medicine. And then in 2017, we became, we started to operationalize it as a nonprofit organization with a, now a seven module certification course for practitioners to how to optimize health rather than treat disease and focusing on cellular health, gut health, neurotransmitter, hormones, et cetera, and really working on foundational principles, not just trying to figure out [00:04:00] the root causes of a disease,

but actually the root causes of health, which is a little bit different than your functional medicine framework. I have a lot of friends that are functional medicine doctors, and I still use that framework, you know, as a referral base, but as a result of creating that nonprofit, we also knew that a lot of people need help right now, right?

Because when we're looking to optimize health, looking to fix our health, to get better, we want this to happen tomorrow. But oftentimes it can take six months, a year, longer to get to where we hope we want to go, sometimes even longer than that. So what can we do in the process? What can we do now to help people?

And so this is why we created a company called Troscriptions. This company is a for profit entity of our non profit and we wanted to create products that could help people right now while they're on the longer path to optimizing their health. And the first products that we came out with were in the realm of this amazing molecule or compound called Methylene Blue.

And we can [00:05:00] talk all about it in any direction you like, but Methylene Blue has been around a long time, but not, but only in the last several decades have we really truly been able to kind of now kind of be able to see the nuances in dosing, the nuances in indications, and how we can implement this in, in a practice that can help people right now while they're on that longer path.

Jill Brook: Okay. Wow. Well, that's exciting. And I know that, you know, given your background and your orientation, you probably look at a lot of different things that can help somebody's health. So I'm also, I'm super curious to start with why Methylene Blue? And I know you're quite into it because you have it as a product.

I know you've written about it a lot in your blog. So what's Methylene Blue and why is it so special?

Dr. Scott Sherr: It's a special compound because it does something that very few other compounds do. It's able to help us make energy in our mitochondria, which are part of the cells that our bodies, you know, that's where we make most of our energy, is our mitochondria.

But at the same time it's helping us make [00:06:00] energy, it also helps us detoxify, or to balance out the stress that happens when we make energy. So most people don't realize that when you make energy, you also, this is called ATP. Not only do you make ATP, but you also make water and carbon dioxide. People know that we breathe off carbon dioxide.

But we also make these things called reactive oxygen species, or oxidative stress, or free radicals. So our body has to be able to compensate for these free radicals that are made with the energy by having enough detoxification capacity, or having enough antioxidants in the system. So Methylene Blue has this amazing capacity to not only help enhance energy production in the mitochondria by helping you make more ATP, but at the same time, it can help you with that detoxification part, part of things.

There's very few things in this world that are able to do both. And so, with Methylene Blue, it's really functioning in the mitochondria. That's what we're going to talk about today. So at lower doses, it's a mitochondrial optimizer, and at higher doses, it's an anti infective. But what's really interesting, [00:07:00] and what to really kind of hammer in, I think, today, is that 94 percent of the United States population has metabolic dysfunction, which means that they cannot make energy effectively.

Either they can't make energy well, or they can't detox from energy that they make, okay? And so, why is this the case? You know, because there are so many things in our environment that are affecting us. Anything from being insulin resistant, to toxins in our environment, to infections, to medications, and this is all disturbing our metabolic function.

And if you have disturbed metabolic function, you have disturbed mitochondrial function, okay? So if you're metabolically challenged, you're also mitochondrially challenged, okay? And so what we want to do is work on that mitochondria, right? Because where are the most of mitochondria in our body? This is actually a good question.

Trivia. So most people would say the brain, and they would be correct. Except they're [00:08:00] not. There's one other place that has more mitochondria per cell. So mitochondria, like again, these powerhouses in our cell. When we learned about it in biology class, like in seventh grade, we like, we saw the cell and we saw that there's like, there's one little organelle in there called the mitochondria, right?

But most cells have many more mitochondria than just one. Okay. And so the ovaries and the testicles, the sperm itself have the most mitochondria per cell. We're talking about thousands of mitochondria per cell, okay? Your brain has a lot of mitochondria per cell, your heart, your liver, and your skeletal muscle, because you have to be able to make lots of energy when you're going to be running, right?

And classically, if running from an animal that was trying to kill you back, you know, during paleolithic times, that kind of thing. So, If we have mitochondrial dysfunction, where is that going to manifest? It's going to manifest in the areas where you have the most need for mitochondria on a regular basis.

So, if you have brain fog, if you have concentration problems [00:09:00] these are often related to mitochondrial dysfunction. It may, again, it doesn't mean that there aren't any other things going on that need to be addressed, but in the, in the end, what's happening is the mitochondria aren't working well and you're not able to kind of power yourself up to maintain energy production, to maintain your cognitive capacity, et cetera, et cetera.

If you have brain fog and concentration issues, if you have chronic, if you have fatigue all the time, if you have exercise induced fatigue where you walk around and like a two for two days, two days you can't move, that's mitochondrial dysfunction. If you have cardiac issues, oftentimes detoxification issues in the liver, if you can't get pregnant, if you're, if you're having a difficult time with, with fertility and we've seen amazing things actually in all these capacities when it comes to bringing in Methylene Blue.

So, as a compound, it's been around. since the 1870s, actually. It's been around a long, long time. The first medical indication for Methylene Blue was at very high doses and this was for malaria back in 1897. And so it was the first [00:10:00] drug registered with the FDA back in 1897. And so it's, it has a long history.

And at the time it was called the Magic Bullet, Jill. And the reason why it was called the Magic Bullet is that you could give relatively high doses of Methylene Blue. It would kill bugs in the human organism that weren't supposed to be there, but it would Leave the human cells intact, vital, doing fine.

So that was why they called it a Magic Bullet. They were looking for drugs at the time. This is where chemotherapy kind of came in as well later, where the idea was like, can you kill, you know, cancer cells or and without killing host cells? The same thing was, can you kill bugs in the system with some sort of compound that would not also kill off human cells?

So Methylene Blue was used at higher doses, like around a milligram to two milligrams per kilogram through the 1940s and 50s because it was really the only antimicrobial around before penicillin was developed in the 1940s and 50s. [00:11:00] And so it's used for urinary tract infections, used for fungal infections, used for viral infections.

If you lived In a developing country, even until the 1970s or 80s, you would get Methylene Blue lollipops and they would paint your mouth with Methylene Blue because of how profound it is as an antiviral as well, especially at higher doses. So it's got a very significant history. It's after the 50s,

it was also transitioned to be used in other different ways. The first antipsychotic drugs were actually derived from Methylene Blue because Methylene Blue increases some neurotransmitters in the brain, dopamine, norepinephrine, and serotonin. So it actually is a mood boosting agent on its own. And so the first drug chlorpromazine, the first antipsychotic, was derived from it back in the 1950s.

It's used as a laboratory stain. So you can, if you went to medical school or if you worked in chemistry class, at some point, and you were dyeing things blue, you were dyeing blue with Methylene Blue, typically and but where did it concentrate when you were dyeing everything? It concentrated in dyeing it with [00:12:00] color, not, you know, killing, just to be sure.

Dyeing with color you were dyeing the Methylene Blue, blue, because Methylene Blue is concentrating in the mitochondira.

Jill Brook: Wow. Okay, why did we stop using it? It sounds like it was like around until the 50s or the 70s and then it was gone. I've never heard of it until the last few months and now it's like making this big comeback.

Dr. Scott Sherr: Yeah, so a couple different reasons. Number one is that when you take Methylene Blue, it has a side effect. It concentrates in your urine and will make your urine blue. If you take very, very high doses of it, over two milligrams to three milligrams per kilogram, which I don't recommend under most circumstances, it will dye other secretions blue as well, like your tears or your poop.

So people didn't like that. And also, the ideas of capitalism is that drugs come out, and that the old drugs become out of favor because they're old, and nobody can make money off of them.

So you, [00:13:00] the Methylene Blue is much less expensive than the medications that they were creating in the 1950s and 60s until today, right? And so, it became out of favor for those reasons, mostly. It's a very safe drug. It's been around a long time, as I mentioned. You do have to worry about certain things at higher doses

as well, which we can talk about. But at the low doses from like mitochondrial function that's where a lot of the new research has been happening over the last couple decades. There's a researcher down at University of Texas in Austin. His name is Dr. Francisco Gonzalez Lima, and he's done a lot of work on Methylene Blue in neurocognitive optimization, neurocognitive repair, traumatic brain injury, stroke pairing things with red light as well, because we know that Methylene Blue plus near infrared light is synergistic because it both enhances the mitochondria to work better.

So, in essence, what we're doing here at these low doses, like 4 mg, 8 mg, 16 mg, a really low dose, is working on that mitochondria to help it work better. [00:14:00] And that's really important because when we have chronic inflammatory issues, you know, our mitochondria are disrupted like we talked about and we want to be able to find ways to support our mitochondria and to help them work better so that you can make energy better and you can detox better, right?

Jill Brook: I always feel guilty asking a question about myself, but I'm going to. So I have played around with Methylene Blue a little bit, and I do not have problems with cognitive issues or energy. I'm one of those POTS patients who has too much energy,

but my doctor thought it might help with healing some things.

And my experience with it, was that it, didn't do the stuff I expected, like it didn't change anything neurologically, but it ended up helping me with GI symptoms, which I did not expect. And does that make sense to you in any ways?

Dr. Scott Sherr: Yeah, so this is the other piece that we haven't spoken about yet, which is sort of the, has been the elephant in our podcast so far, which is, well, how does it help POTS patients, right? [00:15:00] And we haven't talked about one particular type of molecule called nitric oxide. And so some POTS patients have probably heard about nitric oxide, some of them haven't, but the way I actually was introduced to this was in sort of two ways.

So you talked about Dr. Jill Carnahan, for example, right? So Jill and I, we live in the same town. She, her office is just down the street from me and she's a big fan of Methylene Blue as well. And we were talking about it specifically in POTS and you know, there's a couple different things that I thought about, right?

So we've talked a little bit about how what Methylene Blue does is increase some of these neurotransmitters, right? So if it's increasing a little bit of norepinephrine and dopamine and serotonin, you are going to have some vasoconstriction just because of that, right? So you're going to have some, you're, it's not going to be a huge amount, but it's going to be some so that the dilation of those blood vessels may not be as dramatic when you change positions, for example, right?

So if you have Methylene Blue on board, you might find that your positional hypotension, your positional tachycardia may not be as [00:16:00] dramatic as a result of just having that neurotransmitter release on board. Okay? So that's number one. But the nitric oxide piece is the more is interesting as well. So so just to give a quick primer on nitric oxide. Okay, nitric oxide has lots of different roles in our body. One of the main things it does is dilate blood vessels.

Okay, it dilates them up and so that you can get more blood flow to that area. Okay, so we know that nitric oxide is very important for cardiovascular health. We know it's very important for for, for mitochondrial health too. Nitric oxide is an important feedback mechanism for our mitochondria to tell the area around that cell to dilate blood vessel so we can get more oxygen to that area. But, and this is the distinction, nitric oxide is not always a good thing, because nitric oxide is also released into the system. This is called inducible nitric oxide. So there's endogenous, which is in the blood vessels, in the mitochondria, and there's inducible. [00:17:00] The inducible is what gets released when there is stress, when there's infection, when there's trauma, when there's inflammation.

And this is not the nitric oxide that's in your blood vessels, in your mitochondria. This is nitric oxide that's circulating in your system, okay? Causing you causing POTS patients, at least in some, at least it's not everybody, but at least in many, this positional hypotension, this vasodilatory issue that makes it very difficult for them to constrict down their blood vessels when they are changing position, okay?

So if you can do something about this nitric oxide, you could potentially see a mitigation of the symptoms that you're seeing, you know, with positional changes in blood pressure and tachycardia and things like that. So, what Methylene Blue can do is that it can actually, at these low doses even, it can neutralize the capacity for you to make this inducible nitric oxide.

So you can make less of it. So as a result of making [00:18:00] less of it, you are causing less capacity for the system to dilate those blood vessels or to continue to have them dilated than it would have, versus what it would have been done before. So it's this vasoconstriction related to the neurotransmitters, along with the the other aspect of things, which is the vasoconstriction related to the less having of that inducible nitric oxide around to play with.

And so I was talking to Jill, Dr. Carnahan, about this, and she was finding that even at like four or eight milligrams, which is just like a quarter or half of one of our troches she was seeing like profound changes in her POTS patients. Now, of course, you know, Dr. Carnahan is a functional medicine provider. She's not just doing Methylene Blue with her patients.

She's doing the whole thing, right? The whole kit and caboodle, the whole shebang, whatever analogy you want to use. But she was finding that just adding this on here was a dramatic shift [00:19:00] in how our patients were doing and symptomatically feeling better while she was doing the work to try to figure out how could you quelch that actual production of nitric oxide in the first place, right?

So the Methylene Blue is not going to change, at least, but we'll talk about this with your gut in a second, it hypothetically will not, you know, change the, sort of, the whole path of the reason why you're getting this nitric oxide released. Because there's something that's happening in your system to cause that, right?

So you want to have, you know, get to your root cause of what that is. But what it can do, at least at these lower doses, is affect this nitric oxide production and affect the, you know, the neurotransmitters related to vasoconstriction. But to get to your question, which is also important on the, on your gut, is that Methylene Blue is also, there's other things that are happening in your gut,

your gut is not sterile, right? Your gut has lots of different types of microbes in there. It has fungus, it has bacteria, it has virus, and some, depending on where you are in the world, it might have, you know, protozoa as well. And [00:20:00] what Methylene Blue tends to be able to do is, in the gut, it actually can break up and and it can help optimize the gut by getting rid of certain bacteria that may not like various types of stimuli, including Methylene Blue.

So Methylene Blue can help get rid of some of the bad bacteria in there overall and fungus and virus as well. And then it also can break up the what's called the biofilms. The films that, you know, we have, everybody knows you have film on your teeth, right? That's what you, you kind of see, you kind of, when you brush off, you have, you have biofilm in your gut as well.

And biofilms are, can be positive, but they, but oftentimes in people with POTS or with other sort of infectious kinds of conditions, autoimmune conditions, like sometimes those, those biofilms can hide things. They can hide bacteria, fungus, and virus that don't want to be found by your immune system and be eliminated.

I would be interested in what GI symptoms have improved for you. But, but in essence, you can break up biofilms, you can get rid of, you know, bacteria, fungus, and virus that aren't supposed to be there.

Jill Brook: Okay. [00:21:00] Yeah. I think that's, that's probably relevant to my situation. And I think maybe the vasoconstriction too, which is really huge for me. So that's super fascinating to me that this one compound can do so many different things. It's not a natural compound, right? It was originally like a dye.

Dr. Scott Sherr: Originally a dye, originally a textile dye, so used to dye blue jeans blue back in the 1870s. So if you had blue jeans back in 1870s, you were on a cattle ranch or something, you were, the blue on those blue jeans was probably from Methylene Blue, actually. So, it was, it's a fully synthetic ingredient, and that is a challenge for some people.

I know that everybody out there has a different feel for this, but what I always like to say is that we don't live in the Paleolithic times. We don't live in a fully natural world, and oftentimes as a result of that, we're going to need not fully natural remedies to help us recover and help us feel better, you know.

And so, and that's, and on the other side of things, it's not like every natural thing is good for us. That's for sure. We know that and I [00:22:00] unfortunately took care of some patients that went foraging for the wrong type of mushroom and end up getting liver failure and dying, right? So we know that. You know, natural things are not always healthy.

Synthetic things aren't always bad for us as well. There's a spectrum here, and I, and I, I mentioned in the beginning that I grew up the son of a chiropractor, right? So, like, I, I, in the beginning, like, my dad, my father was truly like, no. Nature is everything. Like, don't do anything that's not natural. Like, no fever medications.

No anesthesia when you go to the doctor, to the dentist. I have bad experiences. I have, trauma from that. But you know, as a kid, I had like 10 cavities at a time. I had to, anyway, that's a different story for different, but, but in general, he's even come around to the fact that you do need modern, you know, modern remedies or synthetic remedies in a modern world, right?

So, but yeah, Methylene Blue is not something you can find in the ground. It comes from a lab, and that's a big piece of things, actually, because of that, Jill, you have to be very careful with the quality of the Methylene Blue you're taking, because Methylene Blue during its manufacturing process can be contaminated with heavy [00:23:00] metals like mercury, lead, arsenic, and cadmium.

You don't want any of that stuff in your body, right? And so, you know, our company, you know, went to the ends of the earth and still does with every batch to make sure it's, it's safe and it doesn't have any of that stuff in there. We've had to throw out thousands of dollars worth of material in the past just because it didn't meet our standards.

So, and that's why you have to be very careful when you buy this stuff. You want to make sure, like, you don't just buy it on Amazon. Please don't buy any supplements on Amazon ever. It's you can buy your clothes, DVDs, computers, it's all, but just don't buy supplements because you just don't know if you're actually getting it from the company that you think you're getting it from.

There's been crazy stories of some of my colleagues and other companies where counterfeit supplements were being sold and like they were getting, you know, trash and it's just, it's terrible. So, just don't buy supplements on Amazon and especially Methylene Blue. There's a, there's a it's called the USP grade, which is like pharmaceutical grade.

That's what you should be looking for, but even if it's pharmaceutical grade, you should be asking for the testing [00:24:00] because even pharmaceutical grade can have contamination with heavy metals if you're not careful. So, so the quality is really, really important. You can find Methylene Blue in a lot of different types of quality now.

Like there's a lot of people that some people may be listening might be into Aquarium Aquaria or something like that. I don't remember, like, there's a name for this kind of person but Methylene Blue is used in fish tanks all the time. It's a great antiseptic. And so you were asking what happened in the 1950s after antibiotics came around.

It became something used in fish tanks and still is now. So if you're a big fish tank person, you know about Methylene Blue because you use Methylene Blue. It doesn't, so it's classically thought of as it cleans the tank, but no, it actually cleans the fish. It actually, you know, treats the fish for, you know, fungal infections that happen after being in tanks for long periods of time.

But you don't want to drink fish tank cleaner, of course, like, because that's going to be contaminated. You can win a Darwin Award for that. That's one of my favorites. But yeah. But it's the same thing as like, you know, Ivermectin story back in the day. Right. Like, you don't want to have a horse version.

You want to have a human version. Right. But, but you [00:25:00] were, if you're having a human version, you're not having a horse. You know what I mean? So like, it's you want to have really good quality of the stuff that you're getting.

Jill Brook: So can you talk more about dosing? Like how do people take this? How much, I know you mentioned lower doses and higher doses. And is this something people take orally only. Can you just kind of talk about that?

Dr. Scott Sherr: So, Methylene Blue comes in a bunch of different varieties, right? The classic way of using Methylene Blue in hospitals that's still used now is in the IV. IV Methylene Blue can be a rescue for something called methemoglobinemia, which is when your red blood cells can't carry oxygen. And so, this is actually, it's, it's a, it's an antidote for that.

It's also an antidote for cyanide poisoning, which I don't recommend anybody get anytime soon. So, but IV is also used for infection sometimes. But it's not often required, it's not usually, because the thing about Methylene Blue is that it's very highly bioavailable, which means that most of what you take in, IV, orally as a buccal troche [00:26:00] which we can talk about too, almost all of that's going to get into the system, no matter how you take it, going to be different is how fast it gets into the system. So IV is obviously going to be your fastest. And then at Troscriptions, we created something called a buccal troche that dissolves between your upper cheek and gum. So you can put it up there. That's going to dissolve fast because it bypasses digestion, or you can swallow your Methylene Blue as well.

And that's going to take a little bit longer. But again, the bioavailability is about the same, but the how fast it's going to work is going to change. So if you dissolve it in your mouth, your mouth is going to be blue, and not everybody wants a blue mouth, and I completely understand that. But for how fast it works, if you have POTS and you're thinking about using it, you may want to try it that way.

Because if it works faster that way, you may feel the effects faster. For the most part, like, I use Methylene Blue on a regular basis, just as a kind of a mitochondrial optimizer. I swallow it most at this point in my life. I did it in the mouth for a little while because, you know, that when we first started the company, but so you have, you have to really, you have a choice, you know, in, in most cases, it's going to be an oral delivery.

It's going to be either a buccal troche or you're going to swallow [00:27:00] it. You just have to know that it's going to be slower if you swallow it, but the bioavailability is going to be higher is going to be the same, excuse me, whether you put it up here or if you swallow it. So, what I found in a lot of patients with like, with brain issues, like, cognitive issues with concentration, fatigue, memory problems they do better if they dissolve it in the mouth because it just works faster that way.

Yeah.

Jill Brook: And can you just say what a troche is for people who don't know?

Dr. Scott Sherr: Yeah, so at Troscriptions, we developed something called the buccal troche, and I can show one here. It's not the Methylene Blue ones, but it's another. So a troche is a dissolvable lozenge. It goes between your upper cheek and gum.

Jill Brook: So this is like a candy.

Dr. Scott Sherr: It looks like a little candy, yeah, but it's, you see, it's like there's a little bit of a line in the middle right there on the sides, across, so it's, it's scored, which means you can break it up and you can titrate your dose.

So you can start off with a quarter of it, you can do it with like a half or a full, depending on what you need. And we love troches for a couple different reasons. One was because, as I mentioned, you can break up the dose. You can start off with a quarter, which is really important, actually, in really sensitive people you know, like POTS patients, for [00:28:00] example.

If you go too high, too fast, it might cause too much energy, too much detox right away, and you might get, you can get some headaches, or you can get like detoxification kinds of symptoms. But if you start off at like a lower dose, and you can increase the dose slowly, that's when you see the most benefit overall.

But the, but the, the buccal troche, so it's, it's titratable, so you can start off with a quarter half or full. It goes between your upper cheek and gum, and the mucosa up here allows it to dissolve over about 15 to 30 minutes. And by bringing it up here, you're getting it into the bloodstream directly.

Okay, so it's faster. Okay, and then it's bypassing the whole process of going through your stomach, and then your small intestine, and your liver, into the circulation from there. That's called first pass metabolism. Now, many products, many compounds, will be inactivated to some degree. That's called the bioavailability.

Now the nice thing about Methylene Blue is that it's not inactivated, actually. So you can take it and swallow it and still get the same mitochondrial benefits. [00:29:00] But again, it's going to be faster here. So the buccal troche is faster, it's titratable, and then for some of our other products where we have different ingredients, it's going to be, ingredients have a higher bioavailability in the system so that they're going to be more active as opposed to swallowing it overall.

Jill Brook: And for POTS patients who have difficulty standing around or who might have shaky hands, I think, at least the way that I was introduced to Methylene Blue, it was a powder that you had to mix and oh boy, if you spill that, look out, they're not joking about it being a dye. I mean, it's a nice shade of blue, but oh boy.

Dr. Scott Sherr: Yeah, if you get it in drop form, if you get it in powder form, it is super, super messy. Now, there is, like, an antidote for tabletops and things. It's buffered vitamin C. If you, if you have buffered vitamin C, you get it on a tabletop, for example, you scrub a little bit of vitamin C, it'll come out very quickly.

It doesn't work in the mouth like that, though. Like, if you have blue mouth, and you have some vitamin C afterwards, it's not going to work. What actually seems to work for whatever reason, and I don't know why, is actually matcha. So, [00:30:00] matcha green tea. If you take, have some matcha tea after you have a blue mouth, it's going to go away much faster.

That's that's courtesy of Dr. Isabella Wentz, who's a pharmacist, a pharmacist that's very she's very prominent, like the thyroid hypothyroid world, et cetera. But, yes, so the troche is nice because it's not as messy. Now, of course, if you're going to be cutting a troche, like if you're going to make it into like a quarter of one of these things, you're going to probably want to do it on a dark surface or like on a paper towel so that you're not getting your plate

you know, blue so you have to be thinking about that. You can also get, you have to watch out for your toilet getting a little bit blue as well because, again, you're urinating and it can get blue, but if you have a little bit of vitamin C scrub, that'll usually be, do, do fine overall. But but yeah, so you have to think about that's another benefit of having it in troche form, that's for sure.

Jill Brook: So how much would a person work up to taking in a day?

Dr. Scott Sherr: So we have two versions. We have one called Just Blue, which is 16 milligrams of Methylene Blue, and we have one called Troplus Blue. Troplus Blue is our [00:31:00] professional line. So Troplus is our professional line. So this is only available to practitioners right now. So if you're a practitioner and you want to start to think about using Methylene Blue in the office at the higher doses you sign up for a professional account with us and you can get access to that.

If you are a patient or, you know, you have a doctor that you would like to tell them about this, you can absolutely let them know and very easy to sign up on our website at Troscriptions com. Because what I usually do here, Jill, is I think about this as a spectrum, okay? Some people will really, really benefit from the mitochondrial perspective, at very low doses, like 4, 8, 16 milligrams, but some people will need a higher dose as an anti infective, as like getting to like 50, 75, 100 milligrams of Methylene Blue, depending on the situation.

So what I like to have people do, typically, is start off at four or eight milligrams and then increase the dose every three to five days if they're not seeing an impact. When they're seeing an impact, it depends on what that impact is. Is it the impact that they're looking for or is it something like, you know, a beneficial side effect like you're talking [00:32:00] about your GI stuff, right?

Like, oh, this is beneficial, then is that really what I was looking for, right? If it's beneficial but not really what you're looking for, keep going. Keep going with your dosing until you start seeing the benefit that you're looking for. Average for most people is somewhere between about like from a mitochondrial perspective is like 8 to 16 milligrams, somewhere around there, sometimes up to 25 milligrams from an to see a significant mitochondrial benefit.

So energy, seeing detox capacity go up, seeing some of the symptoms of that vasodilation get better. Oftentimes will be in that realm. But not for everybody, so it might be in some people that you need to continue to go up on the dosing to see those benefits. So the spectrum, meaning every three to five days, increasing the dosing until you start seeing the benefits that you are looking for, not just the beneficial side effects of, or the additional benefits you're seeing that you didn't, that are surprising to you as you're kind of going through it.

Jill Brook: So that's interesting. So when you talk about the effects on infection, we have one of our types of [00:33:00] episodes is about Mast Cell Activation Syndrome and we have Dr. Tania Dempsey who leads those episodes and she talks a lot about infections being an underlying cause of Mast Cell Activation Syndrome. Are you talking about the same kind of infections and that this is something that could help manage some of those infections?

Dr. Scott Sherr: Yeah, exactly. Yeah. And then, because if you can manage some of those infections better, you're going to have less cell, less of the, the degranulation that occurs related to the infection itself. So this is like your, your viral syndromes, like your EBVs, your, you know, your HHV6s, your, you know, and then also some of your chronic co infections of Lyme disease, your Bartonella, Babesia, things like that.

So Methylene Blue has been used in those contexts. Typically, the dose to be clear, is very high though. It's like for Bartonella, it's about 50 milligrams twice a day, but, but can go up to about 300 milligrams twice daily in some patients. So oftentimes when it gets to be that high of a dose, taking our troches doesn't make any sense because it's not, the our dosing is much lower.

I, there's other ways to get Methylene Blue. You can get it through compounding [00:34:00] pharmacies. And I often have, you know, these kinds of people, these patients working with providers very closely because you want to be, more diligent about follow up if you're taking like over 100 milligrams of Methylene Blue per day because of some potential downsides, which we can talk about.

But as an aside, we also have another compound or product that we, and I can talk to maybe your co host at some point, we have something called Tromune in our, in our arsenal, and that's high strength cordycepin from the Cordyceps mushroom and cordycepin has been studied as a, as a mast cell stabilizer, and we're, we're starting to use this now as well, and, and at high, at higher doses and seeing significant benefit there from allergies, asthma, and mast cell as well.

Jill Brook: Okay. We might have to get you back to speak with her because that would be an amazing conversation. So you mentioned some potential risks. What are risks at the low or I mean, it sounds like this population isn't really talking about doing a high dose right now. So maybe you could start by talking about risks at low doses.

Dr. Scott Sherr: Yeah, so the main, you [00:35:00] know, risk, let's call it, is that, you know, you're going to get blue urine, right? So just be aware that your urine will turn blue and that other countertops and things like that may turn blue but it's much, much easier with a troche as opposed to drops or powder. That's for sure. What else you have to think about here is that when you're revving up energy production and revving up antioxidant capacity, you can get symptoms when you're doing this. So, so, you know, your classic sort of detox, excuse me, kind of symptoms are, are not uncommon. But if you go slow with the dosing, you often can see those be relatively tolerable and mitigated.

So these are going to be some examples would be like headaches, a little GI distress, a little bit of joint pain, like a little bit of just mood instability, you know, those kinds of things. So that can happen. What the theoretical risk here is, well, one additional one before I get to the theoretical is that that because you have an increase in some of those neurotransmitters, especially norepinephrine, dopamine, serotonin you can see blood pressure rise a little, a little bit.

Now, this is not necessarily a bad thing for POTS [00:36:00] patients, but it can also, if you're already, if you're a hypertensive patient, and you're on like four, or multiple antihypertensive medications you may see your blood pressure rise, so you have to be careful. If you start Methylene Blue, even at low doses, you can see blood pressure rise a little bit, so you have to be a little bit, you have to be aware of that as well.

Now, theoretically if you are, if you are taking a medication that prevents the block or the reuptake of norepinephrine and serotonin, so like you're taking an SSRI or one of the newer medications, SNRIs, that prevent norepinephrine, there is a theoretical risk of doing the combination of Methylene Blue and those medications.

But in practice, We don't see any issues at low doses, but if you are taking an SSRI or SNRI, I do recommend you work closely with the provider as you're starting, you know, Methylene Blue if you choose to use it. The risks, you know, the risks they always talk about in the literature. Something called Serotonin Syndrome, which is extremely rare.

It's only been described [00:37:00] with IV Methylene Blue at high doses, along with patients that were already on very high doses of antidepressants. So have I seen that? No, I have not ever, even when I was in medical school and residency, never saw Serotonin Syndrome. It just doesn't, it really, it's very rare, even in the, even in the setting where you see, potentially see it, like an acute care setting.

So very, very rare. The other rare thing is something called G6PD deficiency. So if you have an issue with your red blood cells where they are more sensitive to stress this is a genetic disorder. Higher doses of Methylene Blue, especially IV, we have to be watched out for. If you're going to get IV Methylene Blue, you should get a G6PD test just to make sure you don't have this, okay?

But oral Methylene Blue, especially at low doses, the risk is extremely, extremely low. In fact, I know of colleagues of mine with G6PD that take low doses of Methylene Blue and they feel fantastic because their red blood cells don't carry oxygen as well because of this genetic issue that they [00:38:00] have. But again, if you're going to do that, do it under supervision with a clinician, making sure that you're safe, etc.

Right? But in essence, those, those are the main ones. And then when you get to the higher amounts of Methylene Blue it's really the main, the same basic things that I just described. Except you have a higher risk of things like, you know, Serotonin Syndrome if you're using IV Methylene Blue.

Higher risk of G6PD causing an issue if you're using IV or very high doses for long periods of time. You also have a risk of actually shrinking the diversity of your gut. Which you wouldn't be surprised at because it's an also an antifungal and antibacterial so it's going to shrink the diversity of the types of organisms that are in your gut as well over time.

There's also some reports of gastric ulceration with high doses of Methylene Blue over long periods of time, but that's, again, pretty rare overall. And the other thing I worry about is, very high doses. What I mean by high doses here, I'm usually talking about over one milligram per kilogram, but definitely more like 100 milligrams or higher.

I worry that it can build up in the system over time, and if you get at very high doses in the system, it just [00:39:00] becomes a stress on the system.

It doesn't make energy, doesn't detox, it just stresses you out. And so if you take high doses for long periods of time without supervision, let's say over 100 milligrams a day, usually, or higher, you may get yourself into danger in this capacity too. Low doses, extremely safe, extremely extremely safe under multiple, I mean, it's been studied in children, it's been studied in adults.

The other population that shouldn't use Methylene Blue is pregnant women or breastfeeding women. It's a theoretical risk with some really bad studies that show it's risky, but in any respect, I don't recommend using Methylene Blue if pregnant or breastfeeding.

Jill Brook: That's so great and thorough. So what should people expect when they start? Like, does this take a few months to start showing any effects? Or do you notice something in the first week? Or what is the experience typically like for somebody?

Dr. Scott Sherr: So, it's both, it's it's actually sort of both in the sense that you should feel something relatively quickly once you find the right dose for you, okay? So if you take it and you're like, [00:40:00] say you're at 8 milligrams of Methylene Blue, you're taking Just Blue and you're like, you know, I don't feel much, like maybe I feel a little bit better, but like, you're not like waiting for it to build up in your system.

It doesn't work that way, it's at least in this capacity. You want to keep increasing your dose every three to five days until you start feeling like you have a benefit. There's two things. If people tell me that methylene but didn't make their blue their, their urine blue, or if their Methylene Blue didn't work for them, I tell them they need to go to a higher dose until they at least have blue urine to say that Methylene Blue doesn't work for you.

But what I have found, at least working with this, this compound is that once you get to a dose, like, everybody will have a response at a dose. It just depends on what that dose is going to be, right? So, so that's the first thing is that, and it should be relatively short. Like I said, relatively quick for you to notice.

Like, oh, I do feel different. Like, yeah, like there's something happening, right? The other thing that Methylene Blue we think can do is that it looks like it can actually rebuild one of the areas of the mitochondria called Complex IV, and that's the one that that, that red light also, or near infrared light also is working on as well.

So, we think that [00:41:00] over the long term, using Methylene Blue can help rebuild, and it doesn't have to be that long, it'd be like four or six weeks, we think, it doesn't have to be, like, years. We think that in, like, a longer period of time using it, that you can start seeing a rebuilding of that Complex IV and see regeneration of some of that mitochondrial function as a result.

Hopefully, as a result of that, then, Jill, you're able to wean yourself off of the Methylene Blue over time. And this is what I do with my patients, is I'll, I'll have them on two to four weeks, sometimes up to six weeks, and then I'll start trying to wean them down from there, while some of the other things that I'm doing are hopefully taking effect, and hopefully the mitochondria are working a little bit better from those reasons, and also because Methylene Blue might be having an effect as well.

Jill Brook: Okay, fabulous, fabulous information. And I think I'm going to try a little bit higher dose. Maybe I didn't get blue urine, so ...

Dr. Scott Sherr: Gotta keep going. Gotta keep going, yeah. Yeah.

Jill Brook: So is there anything else people should know about this and where can people learn more about you [00:42:00] and all of this stuff online?

Dr. Scott Sherr: Well, I think we were actually pretty comprehensive here, overall.

Jill Brook: I know!

Dr. Scott Sherr: I I mean, I, and so I, I don't know that there's any, anything else we need to add to the story. I think that the key here is to know that titration is the name of the game, and that, you know, start off low, increase your dose every three to five days.

You should feel something. It's not like it builds up in your system in the respect of you feeling something. pretty quickly. It does build up in the sense of helping, hopefully working on your mitochondria over there. The key of course also is that even though they called it a Magic Bullet back in the day, now we don't use it in isolation, right?

What are you doing to help your health otherwise? Behaviors, lifestyles, vitamins, minerals, nutrients, cofactors. I have a whole concierge practice where I work with patients to do all that stuff and consult and try to work on it so that, and we can take them off of Methylene Blue hopefully over time as well, or at least decrease the amount that we're using over time.

So, so where you can find more about what we're doing, our company is called Troscriptions. It's the word troche and the word prescriptions kind of mashed up into one word. So it's [00:43:00] Troscriptions. You can find us on Instagram, as you were alluding to earlier, Jill. We've also done a lot of blogs on this. I've done a lot of, you know, podcast and media around Methylene Blue in the past. This is my first one, as you can imagine, specifically, you know, dialing in on the positional hypertension and tachycardia aspect of things, which I was very excited about when we found you.

And so you can find a lot of information on our blogs. If you go to Troscriptions and you, you type in Methylene Blue, you won't find one on POTS, but you'll find a lot of things on the physiology of what's happening there. And yeah, I think those are the major places. And so, you know, we have Just Blue, which is our lower strength.

We also have a combination, which might be interesting for some of you called blue canatine, which is a combination of Methylene Blue with nicotine, caffeine, and CBD. So, nicotine sounds scary to people, but it's a fantastic mitochondrial optimizer 2, it's a cognitive enhancer, it decreases inflammation, it also vasoconstricts a little bit with the caffeine, so if you're somebody that tolerates caffeine pretty well already and you have POTS, it might be something to think about, you know, because then you can, it might be something that kind [00:44:00] of revs up mitochondrial function, causes a little vasoconstriction, it has the Methylene Blue in there as well, and we've, I've seen a lot of good benefits in people with, you know, cognitive issues like, you know, like with brain fog and, and concentration issues, so something to think about as well.

Jill Brook: And I've seen a group of researchers online who are now kind of promoting nicotine and researching it and they're saying it's not addictive if you...

Dr. Scott Sherr: At low doses, and you don't smoke and you don't vape it. So don't smoke nicotine, don't vape nicotine. Keep it very low doses. Like, a cigarette has 26 milligrams of nicotine in it. Our troches have 1 milligram of it in a full troche of blue canatine. Average dose is a half of a troche, 0.5 milligrams.

And so it's dissolving up here. It's slow release over 15 to 30 minutes. It's not possible to get addicted to the amount of nicotine that we have in our products. As long as you follow directions and don't have like 20 of our products, 20 of our troches a day, which nobody would ever do. So, it's very, very safe and very, very, very effective from an inflammatory perspective, from a [00:45:00] cognitive perspective.

Nicotine's fantastic. It's obviously gone a bad rap for good reason, but it's, if it's used appropriately, it's fantastic.

Jill Brook: Fascinating. Well, we so appreciate all this great thorough information and we're already excited to hear about your take on hyperbaric oxygen therapy next week. And we just thanks a million for doing this and thank you for finding us and for working to help POTS patients.

Dr. Scott Sherr: Thank you so much for having me, Jill. It's been a pleasure. I look forward to our next conversations.

Jill Brook: Awesome. Hey listeners, that's all for today, but we'll be back again next week. And in the meantime, thank you for listening, remember you're not alone, and please join us again soon.