In this episode, I’m joined by Dr. Scott Sherr to explain why energy dysfunction is so common in chronic illness, and how methylene blue is being used clinically to support mitochondrial function, oxidative stress balance, and detoxification. I also explain why this topic is especially relevant for people with thyroid and autoimmune conditions, based on what I see regularly in practice. If you would prefer to listen to the interview you can access it by Clicking Here [1].
Dr. Eric Osansky:
I am super excited to chat with Dr. Scott Sherr. We are going to be talking about a few different things, probably more of an emphasis on methylene blue, but also talking about GABA, maybe a little bit about hyperbaric oxygen. He has a great deal of knowledge. Really excited for this.
Let me dive into his impressive bio here: Dr. Scott Sherr is a board-certified internal medicine physician, certified to practice health optimization medicine and hyperbaric oxygen therapy (HBOT) specialist. His clinical practice is built on health optimization medicine as its foundation, complemented by an integrative approach to HBOT that incorporates cutting-edge and dynamic HBOT protocols, comprehensive laboratory testing, targeted supplementation, personalized practices, synergistic technologies, and more. He is the COO of Troscriptions, VP of Health Optimization Medicine and Practice, Chief Medical Officer of OneBase Health. Thank you so much for joining us, Dr. Scott.
Dr. Scott Sherr:
It’s great to be here. Thanks so much for having me, Eric.
Dr. Eric:
You’re welcome. Like I said at the top, excited about this conversation. How did you get started? You do have a lot of knowledge, like we said. Methylene blue, the hyperbaric oxygen. How did you really start going in this direction and end up where you are right now?
Dr. Scott: I
’ll try to give you the short story here. The short story is I grew up pretty alternatively in New York, not in Queens like you, Eric, but on Long Island, until I was 18 years old. My father was a chiropractor, so I grew up out of the box. I decided to go to medical school. This high-minded idea that I could find a way to bridge the gap between conventional or allopathic medicine and alternative medicine. There weren’t defining aspects of alternative medicine at that time. There was integrative medicine or functional medicine or those kinds of things.
I went to medical school and really fell in love with a field called hyperbaric oxygen therapy because it had the capacity to have both the conventional side of treating people in hospitals with acute trauma and infections, but it also had the amazing capacity to help people heal from a systemic way, from things we didn’t have a lot of options for inside the medical system. Things like stroke, traumatic brain injury, and other things that were interesting to me.
About a decade after finishing my internal medicine residency, so I am an internal medicine doc. My fastest way out to figure out what I wanted to do. I developed what I would call an integrative practice around initially hyperbaric oxygen therapy. It’s still a big part of what I do.
Over a decade, I realized it was very important that we had a much bigger idea of what would be optimal when someone is thinking about using hyperbaric therapy. It wasn’t that everybody should go into the chamber right away. Oftentimes, if you were sick or had a more complex illness or had more long-term goals, it was better to focus on foundational biology first rather than go directly into the chamber.
This got me in trouble over the years in the hyperbaric community. I would give lectures like, “Please don’t put them in a hyperbaric chamber right now. Let’s wait 3-5 months and optimize them beforehand.”
I trained in something called health optimization medicine in 2017-2018. This became the foundation for what I do in clinical practice. I realized if you want to make energy effectively, you have to have all the machinery to be able to do that. If I am flooding the body with more oxygen, which is what happens in a chamber, then you’re basically requiring the body to have a huge amount of capacity to make energy and to deal with the waste products or end result of a lot of energy made. You don’t just get energy for free in our body. We have waste products like reactive oxygen species or ROS and free radicals and other things.
My framework foundation became this thing called health optimization medicine. I learned it from a colleague and mentor named Dr. Ted Achacoso who had decided on this framework in his own clinical practice and was in the process of creating a nonprofit organization and asked for help. I became the COO of Health Optimization Medicine and Practice (HOMe/HOPe), where we train practitioners on this framework. That became a huge part of what I do as a foundation.
As a result of that nonprofit, we also knew that along the path to optimizing your health, you need help along the way. You need people to help you most of the time. Also, it’s sometimes really important to help with energy, with focus, with sleep, with stress, as you are trying to optimize your health, which can take a while. It’s not something that happens overnight. It happens over 3-6 months or longer. If it took you 50-60 years to get to where you feel now, you can’t expect to feel tomorrow back like you did when you were in your 20s.
Troscriptions, the company, came around, initially as an offshoot of the nonprofit, but then as its own company, to develop products that could help people right now along the path.
This is where methylene blue came around. This is where optimizing the GABA system came around. And much more than that.
My clinical practice right now, the foundational framework is health optimization medicine, which I do with clients all over the world. Optimizing vitamins, minerals, nutrients, cofactors, etc. a little bit differently than most functional medicine looks at the root causes for illness. We are more the root cause of health perspective and looking at optimized markers when you are about 21-30 years of age. It’s a different framework. We can go into it if you have questions.
In essence, that’s a big part of what I do foundationally. I do it by telemedicine. I have the Troscriptions company that I help run that works on the product side of things. I am also still very involved in helping people on the hyperbaric oxygen therapy side, but within the confine of maybe it’s not right for you to do right now. Let’s optimize you before we start considering the chamber.
Dr. Eric:
You don’t recommend HBOT for everybody. When someone does get HBOT, it’s usually down the road.
Dr. Scott:
It really depends on the person. If there is more of an acute issue, more of an acute trauma, inflammation, low oxygen state, then HBOT may be beneficial to somebody right now, even if they are not as well optimized as they could be.
What I often say is it’s not if hyperbaric oxygen therapy will be helpful, it’s when. When will it be the most optimal for you? It might not be now; it might be later. Or it might be now depending on what’s going on. It’s very individual.
In general, if it’s more of an acute issue, with an acute inflammatory cascade, HBOT could be great for that. It might be something you want to use now, even if you don’t have all your ducks in a row, all your foundational biology figured out, or at least in the process of doing that.
The other bucket is the bigger bucket, which is the chronic medical illness and/or health optimization performance/longevity world. I even argue that in the world of longevity, which is so popular these days, we are still chasing things. HBOT is one of those things. You are chasing a tool where you are not getting your foundation in order first, so you will not benefit from using that tool, either short or long-term. If you don’t have that foundation in order primarily, or at least ongoing while you’re thinking about doing some of those other things.
Dr. Eric:
Makes sense. You always want to incorporate those foundations. I’m glad you mentioned that.
Definitely want to talk about methylene blue, but I want to stay on HBOT for a minute. When I dealt with chronic Lyme in 2018, I was doing a lot of foundational stuff, but I decided to look into other methods, like I ended up doing UV light IV ozone, but the clinic I went to, which focused on Lyme and other chronic health conditions similar to Lyme, HBOT was an option given to me.
At that point, I did more research on the IV ozone. I’m not super claustrophobic, but looking at the chamber, I was like, I don’t know if I could be in there for an hour and a half.
For conditions like Lyme, bartonella, chronic health conditions, how does HBOT help? How would that potentially have helped with my Lyme condition, or someone else who is listening to this who might be dealing with chronic Lyme or some other chronic infection?
Dr. Scott:
I first learned about HBOT and how to practice it from a nurse in my clinic in San Francisco, where I was at the time, who had chronic Lyme. A lot of chronic Lyme and chronic coinfection patients would come in.
What I found out very early, and this is alluding to what I said so far, is if you used HBOT in somebody who was very sick, they would not often do well in a hyperbaric chamber. Their system was so inflamed, so toxic already, and had so much infection. If they didn’t have the machinery to support them throughout the process.
Over the years, I had gotten to a point where people need to be about 50-70% better already before even considering HBOT. That is so they have a more foundational biology that can tolerate and leverage going into a hyperbaric chamber.
With Lyme as an example, what happens is that Lyme, which is called a facultative anaerobe bug, which means that it does not like high oxygen conditions. If you flood the body with a lot more oxygen, especially deeper pressures in the chamber, you will flood the body with more stress on the Lyme bugs, which will kill them off. You will get more Lyme inflammation when the Lyme dies. There is all the inflammation associated with that. Can you actually get rid of the Lyme? Do you have the detox pathway capacity? Are you pooping every day? All these things.
I found that almost all the Lyme patients I’ve worked with over the years, I will highly recommend they work with a Lyme-literate physician at the same time. If they don’t, and they just use HBOT on its own with Lyme, I don’t typically recommend that.
There is an anti-infective capacity for HBOT, which we can use it for. I have in the past. You have to be mindful of what’s going on physiologically, that it will either tolerate killing a whole bunch of bugs, or it won’t.
When you have a chronic complex medical illness, like chronic Lyme, EBV, or mold, you have long COVID, etc., if there is an infection component, HBOT might be able to address that, even from a viral perspective, there is some evidence that HBOT can improve immune system function as well. There is a capacity there as well to potentially have anti-inflammatory, immune system activation, antimicrobial aspect.
It also has to be thought about in the ecosystem of how well the body and the person is going to be able to tolerate these kinds of exposures. Typically, you have to go to deeper pressures to see that kind of benefit. A lot of Lyme patients, chronically inflamed patients don’t typically tolerate very deep pressures, at least initially, because they don’t have the capacity to use that oxygen and detox from the energy they make and also use that oxygen to kill bugs and detox from the bugs they are killing. That’s why over the years I have gotten to the point where being 60-70% better is likely a better starting point for HBOT.
The other thing I would see is people maybe slightly getting better over time using a hyperbaric program for Lyme, even if they were super sick. I remember even the nurse I worked with, she told me about the first time she did a hyperbaric program. She was going in every day in a wheelchair. They had to wheel her out because she couldn’t even walk. She did better for a little while after finishing her program, but then she got worse again.
This is common if you don’t have enough support throughout the process if you are not 60-70% better already. This is why having a foundation is so important, and having the right doctors to work with who really know how to help you in a foundational way, whether you’re coming from a health perspective or complex medical perspective.
Dr. Eric:
Makes sense. Methylene blue also has antimicrobial properties from what I understand. Let’s transition to methylene blue. For those who are unfamiliar with it, what is it?
Dr. Scott:
We got interested in methylene blue because we were looking for ways to support mitochondrial function very quickly in people who had significant mitochondrial dysfunction. The spectrum is wide. We have about 94% of adults who have some element of mitochondrial dysfunction.
The mitochondria, for those who don’t know that part, is the part of our cells that make energy. We used to think that if you took biology class in 7th and 8th grade, like my kids just did, you actually see a cell that has one mitochondria in it. We have some cells that have thousands of mitochondria, and we have some cells that have very few. The cells that have the most mitochondria are ovaries and sperm. Fertility is a big lever that mitochondria either will help with or not. Brain, heart, liver, musculoskeletal tissue as well.
Keeping that all in mind, as I start talking about methylene blue here.
The thing about methylene blue, to give a little bit of a history, is it’s been around for over 120 years now as a compound. It started as a textile dye back in the 1870s. There are very few antimicrobials around at that time. If you got an infection, there was very little you could do, except hopefully the body walls it off, and you survive. This is one of the reasons why mortality rates and the age we live is much lower compared to now.
The first indication of methylene blue was it treated malaria. That’s why it got a lot of interest in 1897 and became the first drug registered with our nascent FDA at that time. It got a name called the Magic Bullet as well, which was interesting. The reason why they called it that is you could give very high doses of methylene blue, around 3mg/kg or higher. You would be able to see significant killing of microorganisms or bacteria, fungi, and viruses because you wouldn’t see the killing or harming of the human host. That was something that was very difficult to find. It still is now actually. It was very unusual at the time.
Between 1897-1950, it was one of the major antimicrobials around. It was used for UTIs. It was used for fungal infections. If you were a WWII soldier, and you were getting shipped off to the Pacific part of the war, you were taking methylene blue prophylactically as something that would prevent you from getting fungal infections from the jungles and islands in the Pacific. There were songs about taking methylene blue at the time because it concentrates in the urine. The higher the dose you take, the more blue your urine would be. They talked about “being blue in the loo,” the loo being the bathroom.
That was the original chapter of methylene blue being an antimicrobial. When penicillin and other antimicrobials came around in the 1950s, methylene blue became less in favor. They were using more of the antibiotics, as many of you know now, like penicillin and derived drugs.
Fast forward 80 years. A lot of the drugs we use are now resistant because the bugs have created resistant patterns to antibiotics over the years. Methylene blue is coming back a little bit because of this mechanism of action, which we can talk about if you have interest.
The next chapter of methylene blue was the first antipsychotics were derived from it back in the 1950s and 1960s because it has a capacity of what’s called the monoamine oxidase inhibition, which just means it increases norepinephrine, serotonin, and dopamine in a dose-dependent way. The first antipsychotics were derived from methylene blue.
If you were in chemistry class, methylene blue has been used for a long time as a chemical stain of cells. Interestingly, it concentrates in the mitochondria of the cell. That’s where things get interesting.
There are two medical indications for using methylene blue. If you have a condition called methemoglobinemia, which is when your red blood cells cannot carry oxygen very well, what methylene blue can do is facilitate the carrying of oxygen by those red blood cells.
If you get poisoned by cyanide, which I don’t recommend, cyanide destroys your mitochondria. Methylene blue can rescue in that case and prevent you from dying if you get poisoned with cyanide if you get it soon enough.
It’s also used in medical marking as well because of the fantastically blue color it is.
In essence, that’s a long way of saying it has a lot of history. It’s been around a long time. Where we’re really focused on using it primarily now is with mitochondrial function. Over the last several decades, there have been a number of researchers who have looked at methylene blue as a mitochondrial support because it has this capacity to compensate for mitochondrial dysfunction, which I said earlier.
94% of US adults have, from insulin resistance or toxins in our environment or stress in our lives, stressful relationships, stress partners, stressful jobs, even stress from trauma in our childhood we haven’t dealt with, along with medications and infections and things like COVID, medications like metformin or PPIs, we have a lot of insults going on in our mitochondria all the time.
What’s really interesting about methylene blue is it works both on helping you make more energy in the mitochondria as well as the detoxification side. It’s called a redox cycler, which means it has the capacity to do both, energy production and detoxification. That’s extremely rare. Most compounds either help you make more energy or detox, like antioxidants. There are very few that do both.
Dr. Eric:
Go a little bit deeper in how it’s supporting detoxification?
Dr. Scott:
Methylene blue can work directly as an antioxidant. When you make ATP, which is our energy currency, which by the way we make just about 150 pounds of ATP every single day, making energy is not free. It’s like gasoline fumes or burning gasoline in your car. You obviously can run your engine with gas, but there is exhaust.
We have exhaust in our cells. One of the reasons why we age is mitochondria are making so much energy for such a long period of time, and there are these exhaust products that are being made at all times when we have energy production. We make carbon dioxide and water every time we make energy.
We also make reactive oxygen species. These are free radicals, unpaired electrons that are in our mitochondria and are important. They give the mitochondria a sense of their capacity, their need to make more energy, slow down, speed up, etc.
What’s required actually is you need to have a balanced neutralization of that reactive oxygen stress with antioxidants. These are things like Vitamin C or glutathione or melatonin, which is a very powerful antioxidant in the mitochondria. The body is always trying to balance this energy production with this capacity to neutralize the stress that is happening from energy production.
What methylene blue can do at low doses, even 4, 8, 12mg, is work directly like an antioxidant in the mitochondria, picking up these free radicals and neutralizing them.
Fun fact: When methylene blue does this, it turns its color from blue to colorless.
In addition to working directly as a free radical scavenger in the mitochondria as well as the cytosol as well, at higher doses, around 1mg/kg or so, you start getting the upregulation of the pathway called the Nrf2 pathway. This particular pathway increases your production of an antioxidant called glutathione, which is also known as our master antioxidant.
It does this in a very interesting way actually. It creates the production of hydrogen peroxide at these higher doses. People know you can buy HPO, but our cells make HPO. This is how they kill bugs. This is how they kill errant cells that are potentially precancerous. HPO is a very important mechanism as to how our body and cells specifically regulate themselves.
What methylene blue does at these high doses, around 1mg/kg, which is around 50-70mg for most humans, although maybe that’s slightly increasing now because of obesity. In essence, that dosing is antimicrobial. It also is antioxidant-producing if you have the capacity to actually make antioxidants in the first place. That’s what it comes down to with methylene blue.
Often, you want to start off at low doses and make sure someone tolerates it before going too high. If you do go higher, you might get more of a need for antioxidants, and you potentially don’t have the capacity to make them.
Dr. Eric:
Thanks for the comprehensive explanation. I know in phase one detoxification, you get those reactive intermediates. It sounds like methylene blue can be helpful acting as an antioxidant to reduce those reactive intermediates and possibly also play a role in phase two detox as well.
As far as the antimicrobial properties, maybe you could confirm or clarify. It’s not really killing. Its antimicrobial properties are through its antioxidant properties?
Dr. Scott:
It’s through its production of hydrogen peroxide. Higher doses of methylene blue create stress on bugs. One of the major antimicrobial mechanisms that we use in a cell is by releasing hydrogen peroxide to kill organisms that shouldn’t be there. Methylene blue enhances that process. It doesn’t have a direct killing effect itself.
What you can do is make it more anti-infective by adding in red light therapy. High intensity red light at around 680nm or so combined with high amounts of methylene blue, 15mg or above typically, becomes even more anti-infective. Not only do you make hydrogen peroxide, but you actually make what are called free electron O1s. You actually make OH radicals, too. Those are much more oxidative stressful than just hydrogen peroxide.
When you’re making more oxidative molecules, you’re putting more stress on the system. What the body does there as a result is it tries to upregulate pathways that increase antioxidant production. Unfortunately, if you have a chronic complex medical illness, you may not be able to do that easily.
There are some interesting studies looking at high intensity red light laser along with methylene blue. Really significant studies looking at COVID for example and how you can create more stress on the COVID virus as a result of combining these things together. I use that in clinical practice definitely as an antimicrobial.
You can use it from an acute perspective. You have an acute infection. You can use higher doses of methylene blue, sometimes up to 2mg/kg, for 5-7 days, depending on the person, and wean them down, along with red light. Methylene blue in these cases can act as a photosynthesizer. You can use that red light in combination.
What’s also interesting is low doses of methylene blue, around 25 or 37.5mg or so, combined with lower intensity red light, the combination is really supportive for mitochondrial function. It can both help enhance energy production, cycle in mitochondria electron transport chain, specifically complex 4, which is also called cytochrome oxidase. Methylene blue can donate electrons directly to that. So can red light. You have that combination be very effective. You obviously can do this with red light panels or by doing it out in the sun. The sun has red light in it as well as other spectrums.
I combine methylene blue with red light a lot. Typically, it’s lower doses of methylene blue and lower intensity red light. The combination is more supportive for mitochondrial function. The higher doses of methylene blue plus more intense lasers of red light are fantastically anti-infective.
If you want to get fancy, I have done all three. Using methylene blue, then having some red light exposure, then getting into a hyperbaric oxygen chamber. We were using that early in COVID, people going from positive to negative tests in three days and feeling fantastic compared to how they did three days earlier.
To bring that together from an anti-infective perspective, you can have a combination of things. In my world, that became a very important way of looking at how we can help people during the pandemic.
Dr. Eric:
For acute infections, you said 2mg/kg of body weight?
Dr. Scott:
Typically for an acute infection, I would use higher doses, up to 2mg/kg, for 3-5 days, and then wean them down from there.
If it’s a more chronic infection, like chronic Lyme, mold, long COVID with potential protein spike replication, they typically respond to 1mg/kg. What you want to do with the chronic people is start them at a lower dose. Every 3-5 days, increase the dose.
I start the dose at 4, 8, 12.5mg, and increase it every 3-5 days until they get a response. The first response will probably be more of a mitochondrial response. From there, do you want to keep going up? What other therapies are you doing alongside using methylene blue?
For bartonella, for example, a lot of colleagues use around 15mg twice daily for a period of time. Bartonella also has biofilms that tend to build up. Methylene blue can break up biofilms at these higher doses in the gut, the bladder. There is some evidence clinically that it can help with this condition called intestinal interstices, which is a pretty painful condition of the bladder. Most people are told this is just all in their head. Often, there is a biofilm that is protecting various sets of bacteria and maybe fungi as well from being treated by antimicrobials. Nothing can be used in conjunction for a treatment program for those kinds of things.
Dosing ranges from 1-2mg for infection. On the higher level, it’s given for a shorter period of time. The lower end of that range, 1mg/kg, you can use that for a relatively long period of time if needed while trying to optimize the infection and get rid of it in other ways, too.
Dr. Eric:
A regular UTI, what typically is the recommendation for dosing and duration?
Dr. Scott:
At this point, we can’t recommend you take methylene blue instead of an antimicrobial for a UTI. In my clinical practice, what we’ll typically do is if someone has a UTI, which are gram negative bacteria usually, they are more sensitive to being killed by methylene blue, which is good.
For compliant patients, I’ll give them 2mg/kg of methylene blue for about three days. From there, if their symptoms are resolving at that point, we will potentially continue for another 2-3 days. We may start weaning it down the third day. I will usually recommend it being used in conjunction with antimicrobials as a way to support the process and maybe shorten the course you need from an antimicrobial perspective.
Most of the regimens for acute illness are about 5-7 days. Between 1-2mg per kg. If they are more severe, higher end of the range. If they are less severe, lower end of the range. An acute viral infection that you get coming off an airplane or something like that, that would be more like 1mg/kg for 5-7 days. If you have a UTI or COVID or a more significant infection.
Dr. Eric:
Sticking with the UTI, have you tried combining that with the D-mannose, or do you still need an antimicrobial along with that as well?
Dr. Scott:
I found in my compliant patients, they can get away with just using methylene blue. We are using D-mannose, a common one. Cranberry and hydration and other things.
Where I have found it shine as well is you can use lower doses of methylene blue prophylactically to prevent recurrent UTIs in those who are more subject or have more of a predilection for those potentially.
Typically, I have seen 4-8mg every other day in patients with chronic UTIs. I have had some good clinical success using it that way as a preventative.
It’s not the only thing I’m doing. We talked about D-mannose. We talked about cranberry. Vagina estrogen, if it’s a female who is peri or menopausal. There are other things we can do. I have seen a significant lever and something very easy to do three days a week as a way to help with prevention as well.
Dr. Eric:
Some expressed concern with it affecting the good microbes, kind of like oregano oil. Everything comes down to risks versus benefits. I also assume the dosage matters, too, when it comes to potentially- Or maybe it doesn’t.
Dr. Scott:
No, it does. You’re right. It’s a dose dependent kind of thing. Once you get around to that mg/kg, it becomes more anti-infective. If you’re at a lower dose, 4-8-12-16mg of methylene blue, no major indication from the last five years I have been working with it that it has any detrimental effect on the gut microbiome itself.
Now, the higher doses, as you mentioned, it’s a risk versus benefit ratio. What I would typically do is use it for a short period of time at these higher doses, if at all possible. If you have a chronic infection, where it might be helpful to be on it for a longer period of time, you have to consider that and have that, as a practitioner, be something you’re considering, that you may be decreasing commensal organisms, like the normal bacteria in your gut, over time. That may be okay if you are trying to address the biofilm that has been difficult to address in other ways.
I’m not a big fan of ever using antimicrobials, even methylene blue, at higher doses although I feel like it’s less of a nuclear bomb than using penicillin or sipro or urimax or whatever. Those are much more nuclear bombs, at least in clinical practice, that I have seen.
The reason for that is it also has some mitochondrial support aspects and antioxidant upregulation. It’s not like just giving an antibiotic and calling it Hiroshima and having to completely rebuild the gut from there. Sometimes, that’s necessary. That’s totally okay. We now know there are various strategies that can be helpful in that capacity.
What it comes down to is a risk versus benefit ratio for using higher doses in a shorter period of time in practice. Most of my colleagues who use methylene blue regularly are mostly using it for mitochondrial support. 94% of adults have a need for this in the U.S. This is energy deficit, brain fog, concentration problems, mental health disorders, exercise-induced fatigue, infertility. So many things that the common denominator is mitochondrial dysfunction.
Start out at 4, 8, 12.5mg, a low dose of methylene blue, and slowly titrate that dose until you start feeling better. Every 3-5 days, increasing the dose.
A good example is a lady I spoke to a couple of years ago. She always rings very true in my mind. A physical therapist who had mold exposure. She’d done a lot of great work getting the mold remediated both internally and externally in her home. The mold was gone in her house. The mold wasn’t showing any issues in her blood or urine, but she still felt terrible. Why did she feel so terrible? She had mitochondrial dysfunction, trashed mitochondria from all the years of having those exposures. Even if the mold was gone.
All she did was 4mg of methylene blue. In five or seven days, she thinks she felt pretty good. She increased it to 8mg, and she felt amazing. She was back to work a week after that. She just needed to have that mitochondrial support along the way, especially now that everything else had been resolved.
I’ve seen this time and time again. They are really doing the hard work of dealing with the Lyme, mold, or infections. They still feel terrible. Often, this is because they have significant mitochondrial dysfunction because of those infections, toxins, and stress.
If you could start at these lower doses and then increase the dose, the good thing about methylene blue is you don’t need to wait for it to build up in your system for 30 days or two months to see a difference. Once you find the right dose, you know you’ve found the right dose, and you stay on that dose. It depends on why you’re taking it as to how long you take it and how frequently you take it from there.
Coming from a pretty sick place, you might need to take methylene blue seven days a week for a period of a month or two months or longer until you can start weaning it down. Hopefully, you can optimize it in other areas of your life. Hopefully, methylene blue has helped you do that because you now have more energy and detox capacity. You can take that walk around the block. You can do that dietary shift you have been trying to do for a while.
In other nations’ populations, you’re just using methylene blue even shorter than that for a small amount of support as they do something more stressful or because they have something ongoing that is requiring more support, like they are traveling more for example.
The cool thing about methylene blue is it can work just like oxygen in your cells. If you have less oxygen around, it can work like the oxygen that isn’t there to help you maintain energy capacity for longer as well.
That’s why it’s great for flying on airplanes for example. Everyone who flies is going to be hypoxic. You’re instantly from sea level, where you are probably at in the moment, then going on an airplane and being pressurized at 8,000 feet, which is 16% oxygen compared to 21%. Another example of how you can use methylene blue more short-term in those examples.
Dr. Eric:
Because my audience consists of those with thyroid and autoimmune thyroid conditions, could you tie it into thyroid health? Some of the things you mentioned like oxidative stress is a factor when it comes to all autoimmune conditions. Methylene blue can help in that respect. Of course, infections can be a factor with certain autoimmune conditions. Is there anything else showing direct correlation or relationship between methylene blue and thyroid autoimmunity? Any other way methylene blue can potentially help?
Dr. Scott:
You’re correct. There are no direct studies looking at methylene blue and thyroid function. However, we have had a good amount of experience over the past five years talking to people who have been having the challenges of thyroid issues for many years, Hashimoto’s and otherwise.
What it seems to be is the inflammatory component is a big one. If you can decrease inflammation in the system by helping the thyroid and mitochondria neutralize oxidative stress and decrease inflammation, that’s a big deal. That goes across the board for a lot of thyroid conditions at this point.
In addition, what I hear a lot from patients who have thyroid conditions is they feel like they get more energy. That is seeming to correlate with a need for potentially less thyroid medication and also potentially even thyroid antibodies that are going down associated with taking methylene blue.
I’m not making any claims here specifically. Don’t want anybody to stop their medications or change anything without talking to their practitioner. It’s happened enough where people have reached out and said, “I started methylene blue, and I need less of what I was using before because I feel better, and my numbers look better.” It’s a metabolic support in the sense that it’s helping with energy production.
We didn’t get into the major details here. There are some cool ones. When your mitochondria aren’t working very well, you have these complex mitochondria called protein complexes. Typically, the first two are the ones that are dysfunctional. Those are the two that are most important to help you take energy from the food we eat and bring it to the mitochondria, so we can make our energy currency called ATP.
What methylene blue can do is it can compensate for dysfunction in any of those complexes, especially 1 and 2. It’s almost like a switch for a lot of people. Especially with autoimmune/inflammatory conditions, once you get enough of that methylene support and play, you can bypass those complexes if you need to and make the electron flow go further down the chain into a place where you can still make energy more effectively.
You’ve taken those off the table for now. They’re not as involved in the cascade of making energy or the inflammatory result of not being able to make energy effectively.
You have this really cool combination with methylene blue, this energy enhancement capacity and the detox capacity. That’s the other reason why it’s supportive in a lot of complex medical conditions. It’s not just making more energy. If I can bypass a couple complexes and give you more energy, but you still don’t have the capacity to address the detoxification that is required for making more energy, you will feel worse.
When you drink caffeine, you get a headache or crash afterwards. You have some nicotine, which is becoming more interesting in the world of thyroid as an anti-inflammatory, something that can help with autoimmune conditions, maybe as a cognitive enhancer as well. Even nicotine is increasing energy production without the additional support of detoxification.
Methylene blue has that redox side, which is energy and detox at the same time. That’s also why I’ve seen it so clinically effective for patients who have fatigue related to autoimmune inflammatory conditions. We’re not just giving more energy; we’re giving the detox at the same time.
Dr. Eric:
Are there any contraindications for methylene blue? Anyone who shouldn’t take it? Second question is what differentiates Troscription’s methylene blue from others out there?
Dr. Scott:
When it comes to contraindications or reasons why you should not take methylene blue, the first two are unfortunately common across lots of different pharmaceuticals or supplements, which is if you’re pregnant or breastfeeding, please don’t take methylene blue. There is some indication, especially in later trimesters, that there may be a problem. Earlier, there doesn’t seem to be an issue. If you’re pregnant or breastfeeding, just be careful.
The other thing to talk about here is something called serotonin syndrome and another thing called G6PD deficiency. Serotonin is a neurotransmitter. Many of you know that, I’m sure.
Serotonin is something that is thought to help us regulate our mood. For many years, we used to think people with depression had serotonin deficiency. Doctors were told that your patients with serotonin deficient, give them serotonergic reuptake inhibitors, so these are antidepressants, to make them feel better.
We now know that serotonin deficiency is not any more common in depressed people as it is in non-depressed people. Fun fact. Many people are on these drugs, SSRIs, SNRIs, and they can be very helpful. I don’t want to say they can’t be helpful because they can.
These drugs increase the amount of serotonin in the synapse in the brain. Methylene blue also increases metaserotonin along with norepinephrine and dopamine. If you’re combining methylene blue with SSRIs and SNRIs, there could potentially be an interaction here. The potential interaction for very low doses of methylene blue, 4, 8, 16mg, the only study that showed the potential interaction could be very severe is using IV methylene blue with SNRIs, causing something called serotonin syndrome. This is where you can get what’s called hemodynamic instability, where your blood pressure can go up and down, and your heart rate, too. It has never been described with oral methylene blue and SSRIs.
That being said, if you are on any of those medications, you should not take methylene blue without practitioner supervision.
The most common symptom we see is GI distress. You make more serotonin in your gut than your brain. 95% of those hormones are made in your gut.
The other thing is G6PD deficiency. G6PD is an inherited disorder of red blood cells, where they have a higher risk of breaking under stress. IV methylene blue combined with this particular genetic condition can cause what’s called a hemolytic anemia, where your red blood cells start breaking up. It’s never been described with oral methylene blue. If you’re worried about this, you can always get a genetic test.
In general, low doses of methylene blue, especially the ones at our company, are extremely safe. We do have a practitioner-only version that is slightly higher dosed. If you are taking that for a longer period of time, consider getting the test done.
Those are two major things that people talk about. The other one to discuss is hypertension. If you have high blood pressure, methylene blue can potentially increase your blood pressure. If you are pre-hypertensive, so you’re not taking meds, but your blood pressure runs kind of high, you can do it as well. That’s because of the norepinephrine that is in there. You have to be aware of that.
If you are on hypertensive medications, or really any medications, you should be working with a provider closely before starting anything new, supplement or otherwise. Sometimes, people have interactions that you don’t know about. Certainly, high blood pressure medications would be a red flag to take methylene blue without practitioner supervision.
There is also blue urine. Methylene blue concentrates in the bladder itself as it’s being excreted. It’s excreted by the kidneys and bladder. You will have blue urine.
If you have CKD, you have to be careful taking methylene blue as well because it can build up in the body.
If you’re on dialysis, you shouldn’t take methylene blue because it won’t get excreted through a dialysis machine.
There is this category I call detox symptoms. It’s not uncommon, especially if you start with a too high dose of methylene blue to get more detox symptoms. Your headaches, muscle pain, abdominal comfort, bone pain, joint pain.
You can get a detox reaction if you start too high of a dose. You’re making that hydrogen peroxide that you talked about before. You may not have enough antioxidants to support that system. Almost always, unless it’s an acute trauma, issue, low oxygen state-
There are some studies in strokes with animals, where methylene blue can be helpful, along with acute infection. That is where you would want to start off with a higher dose immediately.
In general, you want to start off at a lower dose, 4-12.5mg, somewhere around there, and then increase your dose slowly over time until you find the right dose for you. You’re addressing the issue you’re looking to address.
Those are the major things to consider when taking methylene blue.
The other one, which dovetails into your second question, which is quality of methylene blue. That is the biggest additional one. Methylene blue is not made from the ground; it’s made in a lab. One of the naysayers of methylene blue is it’s a synthetic compound. My response to that is that not everything synthetic is bad for us. We live in a synthetic world, under synthetic lights, food, people, like AI bots. We have a lot of synthetic things in our life right now. Sometimes, we need synthetic things to help us, and methylene blue is one of these things.
If it’s dosed appropriately and clean. In the sense that methylene blue made in a lab can be contaminated with lead, mercury, cadmium, and arsenic. You don’t want those.
In 2020, Troscriptions was the first company to come out with a commercial methylene blue product. We came out with two, one in February and one in June. The first year of the pandemic. We took about a year and a half longer to launch the company because it took us that long to find a reliable source that wasn’t contaminated with heavy metals, that had the right purity and potency that we were looking for.
Until 2024, there was about 6-8 companies that were making methylene blue. 2025, it was extremely ramped up in popularity because of a number of things. The zeitgeist, everyone was talking about it. There are now 60 companies.
We have tested them. The liquids cause the big issues because liquids of methylene blue never meet the potency standards. If it says it’s 1mg/ml or 1mg/drop in your liquid methylene blue, the average that we’ve found is between 60-80% potency of what they say. They are getting much less than you think. Sometimes, they are down to 45-50% potency. Even some of the capsules we tested are down at that level.
Then you have to think about the heavy metal component. The heavy metals being cadmium, mercury, lead, and arsenic. You have to be careful what you’re buying out there.
The bigger issue here, and this is more from a supplement at large issue, is most companies, including us, are getting ingredients from outside the United States. Methylene blue we get is coming from Korea and Japan mostly. Also China.
What these manufacturers do is they are supposed to give you a certificate of analysis with the ingredient. This is supposedly an “independent” review of their ingredients, saying this is exactly what is made in the lab.
The problem is you can’t trust those certificates of analysis. They can be completely forged. There was a recent scandal on creatine gummies with this thing. Or they can be completely wrong. You test it yourself, which is what we do with all our ingredients, including methylene blue. You find it doesn’t meet the same standards as they said it met when it came from their lab. That’s why we retest everything that comes into the United States independently, to make sure it meets our criteria.
You have to be careful what you get. A lot of these companies are trusting those ingredient certificates of analysis. Some of them might be saying they are made in the USA. I had someone reach out to me who said, “I bought liquid methylene blue that says it was made in the USA, but it took three weeks to get through customs.”
What we do at Troscriptions is we have really trusted manufacturers. We do our own independent testing. After we make our Troches, which is the lozenge delivery mechanism, we test them all again to make sure it still meets our purity and potency standards. Only then does it go out to be sold. You will find very few other companies doing that kind of quality control.
Dr. Eric:
Wonderful. Troscriptions also has GABA support supplements. It was a long time ago that I learned from- are you familiar with Dr. Datis Kharrazian? He has a book on Hashimoto’s, and he mentioned the GABA Challenge. If you take a regular GABA supplement, if you notice anything different, you probably have a leaky blood/brain barrier. That is the first time I heard of that. Then I was listening to one of your interviews, and you were talking about something similar as well. If you could talk about what Troscriptions offers as far as GABA support, that would be great.
Dr. Scott:
How long ago was he talking about that? Out of interest.
Dr. Eric:
I think his book was 2016. It might have been before that. I think that’s when his book was published.
Dr. Scott:
It’s interesting because we have this blood-brain barrier that is supposed to keep things out. GABA is too big of a molecule to get across under normal circumstances. However, if you have a leaky brain allowing things in that are not supposed to be in there, GABA can get across and make you feel relaxed.
Typically, what this corresponds to is a leaky gut. Optimizing your gut will optimize the blood-brain barrier and make that less leaky as well.
GABA is a really interesting compound, neurotransmitter. GABA is our primary inhibitory neurotransmitter in our brain. It’s the brakes of your brain. We have a lot of on switches. Our main on switch is glutamate, our primary excitatory neurotransmitter. Your main off switch is your GABA system.
Interestingly enough, glutamate is converted into GABA in the brain. It requires Vitamin B6 and magnesium to do that. These two are always supposed to be in this beautiful balance. You have enough glutamate and GABA working together. They are helping regulate your nervous system, so they go up when you’re up and down when you’re down.
Unfortunately, so many of us are stuck in what I call this sympathetic spiral of doom at all times. This sympathetic activation, our fight or flight system is on all the time. We don’t know how to relax. We are constantly anxious. We have depression. We can’t sleep.
A big part of this is we have become GABA deficient. Our system stops working well, and we don’t have any brakes to press. That truck that has to go down the hill, we don’t have a place to turn off. The brakes are gone. GABA deficiency is associated with anxiety, depression, insomnia.
Our mind is having a hard time calming down because it also regulates our thought patterns. We typically on average have about 70,000 thoughts every single day. That is just average. If you have anxiety or depression, you have upwards of 120,000 thoughts every single day. We’re not saying these are unique thoughts, but these could be perseverating thoughts about something you’re anxious or depressed about.
What you want to do is think about the GABA system in its totality and see how you can optimize it from the ground up. This is what I do in my health optimization medicine practice, looking at gut health, vitamins, minerals, nutrients, and precursors, like glutamine for example, which is an amino acid that is the primary fuel of the small intestine. If you have a leaky gut, you need more of it. It’s also the precursor to glutamate in the brain. You want to think about that.
You also want to think about probiotics. Certain types of bacteria in our gut help signal our GABA system and make it work better.
Your cofactors, things like magnesium and B6.
This is important. That’s a long-term play though. That takes time. The other long-term play is how can you understand why somebody is stuck in this fight or flight mode? Is it because they’re married to someone who they don’t like? Do they have a poor relationship with their kids? Did they have trauma as a child? Are they stressed at work? You have to address this stuff to get the brain to start working again. You can give the experience to someone to what it feels like to have those brakes back and be available again by modulating the GABA in a way that doesn’t require you to give GABA itself.
Fun fact. I have worked with patients over the years where GABA supplements are working for them. We optimize their gut, and their GABA supplements stop working because they no longer can get GABA to the brain. This is clinically very useful for all who are listening to think about this.
What you really want to do is work on all the stuff that takes a harder, longer amount of time. Optimize nutrients, cofactors, gut health, and stress. What we did at Troscriptions is create some products that can help you modulate the GABA system in a much more holistic way without giving GABA itself. Things that modulate the GABA receptor and enhance the GABA receptor.
We combine locations of where things bind on the receptor together. The combination is really great because it helps support the GABA system right now without depleting more GABA. If you are drinking alcohol, taking benzos, using sleep drugs, these are enhancing the amount of GABA to bind the receptor. If you don’t have a lot of GABA around, you will become more GABA deficient than you were before, and this is also why you have a higher risk of tolerance withdrawal and dependence on those drugs.
In Tro Calm, for example, we use a combination of B3 GABA and cava together. B3 GABA gets across the blood-brain barrier because GABA is attached to B3. B3 is mildly activating, whereas GABA is relaxing, binding to where GABA would bind. Cava comes in and binds to a separate site on the GABA receptor, enhancing the amount of GABA to bind.
In addition, we have CBD and CBG, nonpsychoactive cannabinoids. You can take the Tro Calm and get an anxiolytic, relaxing effect without feeling too tired as well. This is a great combination to support the GABA system. If you are just using cava, you deplete GABA over time because it’s not giving something that is supporting where GABA would bind as well. We use that combination effectively.
It’s in a troche form. You dissolve a lozenge. It goes between your upper cheek and gum. They are scored. You can take a quarter, half, or full. These lozenges go directly into circulation. These ingredients are more potent because they don’t go through digestion. You can titrate them, too. You can take the dose that works well for you.
We have another combination in our sleep product called Tro Z, which includes something called agaric, which is from amanita muscaria mushroom derivation. It’s a psychedelic mushroom, but this is not a psychedelic compound. At low doses, it binds directly to where GABA would bind.
We also have something called honokiol, from magnolia bark. That combination is great for working on the GABA system in a holistic way. As I mentioned earlier, like Tro Calm does, Tro Z also has things like melatonin, 5HTP, some CBD, CBN, both nonpsychoactive, something called cordycepin, which is from the cortices mushrooms, also increasing deep sleep. It’s a comprehensive formula.
In essence, we are focused on breaking that sympathetic spiral, getting people that GABA urgent tone now, so they can feel like this is what it feels like when my nervous system is more regulated.
From there, hoping they can get back there over time, using the more physiologic and psychological support that is often required to do it more long term.
Dr. Eric:
If someone is stuck in that fight or flight response, that is one indication to taking GABA support.
Dr. Scott:
If you have a lot of anxiety or depression, we know now there is a new drug that was just released last year, potentially the year before. It was the first antidepressant that works instantly for postpartum depression. It’s a GABA-A agonist. The GABA-A one is the most prominent receptor. It works immediately because it’s working on that GABA system.
Just to be clear, if you have overactivation, depression, issues with sleep, GABA things will likely be helpful for you. Not to say you should stop your medications or do anything you shouldn’t be running by your doctor first. This GABA system is such an underappreciated aspect of why people are having such a hard time now, especially with that sympathetic activation, that synthetic spiral that so many people are going through.
Dr. Eric:
One more quick question with GABA. Do you know if liposomal GABA crosses the blood-brain barrier?
Dr. Scott:
The only company that I’m familiar with that has a liposomal GABA that has been shown to cross into the brain is QuickSilver Scientific. Otherwise, I would be staying away from it. Even if they say it’s liposomal, I wouldn’t believe it with most companies.
I do think a combination of GABA itself, whether it’s GABA directly through liposomal or B3 GABA that we have or agaric that binds to where GABA would bind, plus something like cava, CBD, CBG, that combination is really important. If you are just giving something like cava, or even honokiol, or valerian, L-theanine, lemon balm, these are also working on the GABA receptor, without actually modulating or supporting where GABA would bind, so you’re not causing GABA deficiency over time, you will get into trouble.
You have something like cava that works for somebody. You have to keep increasing the dose for that same reason. With our products, we haven’t noticed any tolerance issue. The same dose works every single time because we’re doing it in this comprehensive way.
We have higher strength products, too. We have a Tro+ Calm. A Tro+ Somnia, which is our practitioner line. You can get access to those by signing up on our website as a practitioner. If you are a patient or client or someone without a practitioner, we have a practitioner map on our website. You can find someone who might help you if you need higher potency kinds of things as well.
In essence, the troche is great as a delivery device. It dissolves directly in the mouth. The natto liposomes, like the small liposomes, may also work from a GABA delivery perspective.
Dr. Eric:
This was awesome. Others have mentioned you’re a wealth of knowledge. I will say that here. So much great information. Where can people find out more about you, Dr. Scott? Your website, social media? Anything else you want to say?
Dr. Scott:
Thanks for having me, Eric. I appreciate it. I tend to take our time, whatever that time is, and use it for a lot of information. Don’t be afraid to wind back down to the beginning and go back over some of this info if you have interest.
I have lots of additional support for you in other locations and resources. Check out my personal website, DrScottSherr.com. You will find my consulting there both on hyperbaric therapy and health optimization medicine, which is the framework we were talking about in the beginning.
It’s also linked to my company. I have a company called Troscriptions. You can find it at Troscriptions.com. You can also find us on socials @Troscriptions. You can find me @DrScottSherr on Instagram.
If you’re interested in the nonprofit, you can check it out at HomeHope.org or @HomeHopeOrg on Instagram.
I have a hyperbaric company that specializes in hyperbaric technology and the connection of systems together, One Base Health. OneBaseHealth.com. @OneBaseHealth on Instagram.
Those are the major places to go. Start with either my website or Troscriptions. You can check out Just Blue, our pure methylene blue troche, at 16mg.
We have another one called Blue Cannatine, which is a combination of methylene blue, nicotine, caffeine, and CBD. That is for focus, flow, giving you that stimulant feel. Pure methylene blue doesn’t give you a stimulant feel as much; it elevates you and makes you feel more awake, more up, your brain is working better, your mood is better. From an inflammatory perspective, downregulating and helping with that inflammatory load, which can be super helpful for many reasons, especially thyroid conditions.
Dr. Eric:
Wonderful. I learned so much about methylene blue. This was awesome. Some things about GABA and HBOT, too. Definitely will need to have you back in the future. Thanks again. Really appreciate it, Dr. Scott.
Dr. Scott:
Thanks for having me.