If you have Graves’ disease or Hashimoto’s thyroiditis, and if you want to do more than just manage your thyroid symptoms, then you might be interested in joining our 14-Day Overcoming Graves’ Disease and Hashimoto’s Bootcamp (starts January 9th!):

The 14-day bootcamp will include the following…

Component #1: Daily Overcoming Graves’ Disease and Hashimoto’s Video Lesson

During this daily 20-30 minute recorded lesson I will focus on a different topic that is essential to overcoming your autoimmune thyroid condition. There will be one lesson every day for 14 consecutive days. If you’re interested in the specific topics that will be presented please check out the video where I discuss the 14-day bootcamp calendar (the website link is below).

Component #2: Daily 30-45 minute live group coaching session

The live group coaching calls will take place on Zoom, which is very easy to use on computers, mobile phones, and tablets. And if you are unable to attend live you’ll have the opportunity to email your questions during the separate Q & A sessions (discussed below). For those who choose to join live, the way it works is that I’ll send you a link to join the call, and if you are using a mobile phone or tablet you’ll need to install the free app. I will record every coaching session and post the recordings in a private membership area for those who are unable to attend live. As for the time of the coaching sessions, I will rotate them to accommodate those in different time zones. Most of the live calls will take place either 12pm or 8pm Eastern time (New York time zone).

Component #3: Recording of each coaching call for those who are unable to attend live

I hope most people will be able to attend at least 2 or 3 live sessions per week, although I’ll add that with my previous live events there were participants who didn’t attend the live calls, but simply watched the recordings and emailed their questions for me to answer during the Q and A sessions (discussed below).

Component #4: Daily priority action step

I want people to take action, but I want the action steps to be attainable, which is why there will be a single priority action step each day, although at times there will be one or two additional action steps that aren’t as urgent.

Component #5: Access to a private members-only group

We want you to build relationships with one another and enjoy this bootcamp together. That being said, this definitely isn’t required in order to benefit from the bootcamp, as you will still gain a lot of value if you simply watch the daily lessons, as well as take advantage of some of the live coaching calls and Q & A sessions. The private group will be on Facebook. I realize not everyone is on Facebook, but in the past I did give the option of joining a non-Facebook group and the engagement was very low. In past events we have had people set up a temporary Facebook profile in order to take advantage of this benefit, but once again, if you choose not to participate you still will greatly benefit from the other components. I’ll pop in the Facebook group every now and then, but I plan on having my health coaches moderate the group.

Component #6: Weekly 90 minute live Q & A session

Although I’ll be answering some questions during the daily coaching calls, these will be around 45 minutes, and I will focus on answering live questions. But there will also be two separate live Q & A sessions (one per week) during the 14-day bootcamp. These will be at least 90 minutes long, although with some of my previous events I exceeded two hours with each of the Q & A sessions, as my goal is to answer ALL questions! I’ll once again rotate the day and times to accommodate those in different time zones, and so they will either be at 12pm ET or 8pm ET. However, unlike the daily coaching calls, if you are unable to attend any of the Q & A sessions live you can email your questions ahead of time.

You Get All of This For A Single Payment of $79

If you watch the video on top of the registration page (the link is below) you’ll see dozens of people rave about my live events, and I think it’s safe to say that just about everyone easily got back their investment, and many just couldn’t believe the amount of value they received for what they paid.

Optional Upgrade: 45-minute one-on-one “Find My Food Triggers” diet and lifestyle call with a certified health coach

Both of my health coaches are excellent, and I thought it was important to include an option for affordable one-on-one support, although I’m confident the daily group coaching calls will be sufficient for many people. You have the option of doing this over the phone or through Skype/Zoom. If you listen to some of the video testimonials on this page from members of the past events you’ll hear some rave reviews about the diet and lifestyle call! And so if it’s in your budget I’d highly recommend taking advantage of it for the discounted rate of $50. But if not you still will receive a lot of value from the bootcamp.

For more information on the 14-day bootcamp visit the link below:

Recently I interviewed Dr. Rajka Milanovic Galbraith, as she discussed the genetics of detoxification and how it relates to thyroid health. If you would prefer to listen the interview you can access it by Clicking Here.

With me, I have Dr. Rajka Milanovic Galbraith, and we are going to be chatting about the genetics of detoxification. I am going to dive into Dr. Rajka’s bio. She is a functional medicine MD certified by the Institute for Functional Medicine. She is an international speaker and mentor to practitioners as well as a high-performance coach. She helps high-performing leaders, celebrities, entrepreneurs, and CEOs regain their energy, so they can increase their performance, productivity, and impact. She has expertise in anti-aging medicine, nutrigenetics, bioidentical hormone replacement therapy, and peptides. She sees patients at the clinic she founded, Simply Health Institute, outside Chicago, Illinois, as well as leads group online programs. Thank you so much for joining us, Dr. Rajka.

Dr. Rajka Milanovic Galbraith: Thank you, Dr. Eric. So nice to join you here today.

Dr. Eric: Look forward to chatting with you about genetics, specifically genetics related to detoxification. Before we start with that, would you mind diving a little bit into your background and how you started becoming interested in genetics?

Dr. Rajka: It had to do with my journey partly, and partly others’ journeys. Like many of us in the field, I have had my own journey and health issues. What I wish I would have known was how deep those issues went. Mine did start with thyroid disorder, Hashimoto’s. I know that’s a large portion of your population. I just really wish I had known, and someone would have said, “It’s not your thyroid.” It really was the dysfunctional thyroid, but it was everything leading up to it that wasn’t identified by myself because it took me the better part of half a decade to train in all these things.

It was finding that 80% of the patients I could get better with a usual functional medicine approach, but you had this 20% residual. How do you get those people better that were maybe a little bit sicker and not responding to usual means?

I kept doing the deep dive, and it led me to the road of nutrigenetics. I studied under a variety of people. With the first approach, I got a bigger layer of people better. I ended up with an autism reversal. I say this cautiously; people say, “That’s incredulous. Are you telling the truth?” I’m not the first person, and people need to know that you can get reversal. Of course, it didn’t happen overnight.

It led me into looking more and more. The irony of it is that I looked at everyone else’s genetics but mine. Isn’t that the irony of it? I did a really good job with what we call the epigenetics. That’s having your diet and lifestyle influence whether a mutated gene actually is expressing. We do have the power to turn off defective genes. I didn’t really understand all the ramifications then. I wish I would have.

It would have saved me two decades of intermittently feeling very unwell and ultimately culminating into an issue where my liver enzymes were soaring, and they were entertaining a second autoimmune disease. It really had to do with my underlying detox genetics that I wish I would have known from the get-go that went from Hashimoto’s to infertility to vision-losing migraines to PMS to that weight gain that comes seemingly when you hit perimenopause, to you name it, to ultimately, this near second autoimmune disease. I thought I had autoimmune hepatitis. The statistics on that are if you are not on steroids lifelong, the death rate is 30-50%. It’s very high. I’m happy to say that by taking the approach I did, I never got that formal diagnosis. All the symptoms and numbers, the markers reversed. Never ended up on steroids. That was now over nine years ago.

Dr. Eric: Wow. You said 30-50%, if they don’t take steroids?

Dr. Rajka: Correct.

Dr. Eric: That’s extremely high. Of course, happy to hear that you were able to avoid the formal diagnosis and restore your health. You also said that you were diagnosed with Hashimoto’s?

Dr. Rajka: Yep, that was the first diagnosis. It took about 10 years for me to get that diagnosis. That’s how long I was unwell.

Here is a fear, and I’m sure some of your audience has seen this: You go to your doctor, and you feel unwell. They do the labs. I know because I was one of those doctors. They say, “Your labs are normal. Nothing’s wrong. Perhaps you’re depressed.” The worst outcome is they suggest you’re depressed and offer you an antidepressant. That was my fear. Being a doctor, my labs were suddenly abnormal. I used to check them all the time. They’re not totally normal, but I didn’t know what I know now.

By the time I got the diagnosis, the endocrinologist was a little more savvy. Even though it was more traditionally allopathic, he was switched on to following patterns. He said, “You’ve had this for 10 years. Look at these antibody levels.” It was really shocking, the contrast of how little sleep I needed. I was going from 10-12 hours back to a normal sleep schedule. My energy really soared.

Dr. Eric: A lot of the audience consists of Hashimoto’s as well as Graves’. Can you tie in detoxification with thyroid health? I’m sure some who are listening might not understand how this all relates. I could add my feedback, but I’d like to hear what you have to say here.

Dr. Rajka: I’d love to have the banter. That’s what makes these interviews so much fun. I’d be curious to hear your input.

As you know, thyroid disorders are on the rise. You have to ask why. There is a strong correlation to exposure to environmental toxins. We’ll highlight some of the big ones. Perchlorate is found in contaminated groundwater. That is one of the ones I can measure. Even for people who filter their water, they may feel like they have a good filtration system. I’m talking about more than the filter out of your fridge. That won’t cut it. More than a Brita pitcher, that won’t cut it either. I found high levels in people who are doing everything right. You have to back it down to if these are all water contaminants, we have to figure out a better water filtration system for you.

We classically think that the xenoestrogens, like BPA and phthalates, will affect your hormones. Turns out they can also affect your thyroid. What you put on your skin and clean your house with really does matter. All of these can take out the thyroid with a variety of different means and mechanisms.

I was that nerdy, geeky kid in high school and college. I learned all these pathways in biochemistry, but I didn’t know how any of them applied. I even have all of my notes from the late ‘80s. I am dating myself here. Now that I understand it, it’s so crystal clear to me what needs to happen to support first proper detoxification and things we need to be on the lookout for as clinicians if someone is unwell. You can reverse engineer it, meaning you can assume things based on symptoms and certain findings and labs. Sometimes, I like to look at the genetics.

Dr. Eric: I agree. Obviously, the toxins can directly affect the thyroid. You mentioned perchlorate. Xenoestrogens. As you also mentioned, it’s not just about the thyroid. Especially Hashimoto’s and Graves’, they are more immune system conditions. There is also plenty of evidence in the research that heavy metals, xenoestrogens, and other environmental toxins can also be at least a contributing factor, if not a direct trigger, when it comes to the autoimmune response.

Dr. Rajka: I always say you have to remove all the triggers. I look at about eight of them, and toxins is one of the eight. When I speak about detox, I’d love to segue into the general about detox, what people should know. One of the areas I have found an interest in is oxidative stress. Would that be okay?

Dr. Eric: Yes.

Dr. Rajka: We call general detox two phases, but it looks like there are three phases. Here is my theory on the whole energy thing. The majority of adults, and even children unfortunately- Children are probably worse because their diets are awful these days. If you’re eating a standard American diet, they are protein-malnourished and are not getting the phytonutrients they need. When you measure it, most adults are deficient in 3-5 vitamins and minerals. Top of the list are magnesium and B vitamins.

Phase one takes that chemical, whether it’s an environmental toxin, a medication, etc., and breaks it down into a metabolite. I always learned it was more active, but that requires B vitamins and amino acids. These are the things people are deficient in. B vitamins get depleted when someone is stressed. You start with someone behind the 8 ball, they get stressed, and the last two years put many of us to the test. Everyone had different levels of stress for a variety of reasons. You get further depleted.

The interesting thing is toxins play a role in taking up energy. Our mitochondria are super sensitive to toxins because the DNA in our mitochondria are not protected in histones. You get the environmental toxins taken out, and you produce energy less well. It’s a combination of things. You don’t have the vitamins and minerals to properly detox. Your mitochondria, which make energy, are taken out by these toxins.

The second thing that is high up on the list for phase one is amino acids. That is a breakdown product of protein. Almost everyone who comes to my clinic is protein-malnourished or has an inadequate protein intake for their weight, activity level, age, and disease status. That is pretty profound.

To go from phase two to phase three, this is my hero’s journey. It takes that metabolite and makes it water-loving, so we can pee, poo, or sweat it out. One of the pathways, and there are several, is glutathione. That is where I am lacking two full genes for glutathione recycling. The third remaining major recycling gene is defective. I’m really behind the 8 ball in producing it.

The way not to make glutathione is add stress to the mix or live an unhealthy diet and lifestyle. There are ways to boost it. That’s why I’m careful and look at that. For me personally, I supplement, but I know my genetics, and it’s not the right thing for everyone to do. It depends on the whole story. I caution people when I say that. This is what I determined for me.

One of the things in detox that will take out our body tissues is something called oxidative stress. The way I like to explain this is oxidative stress is very similar to when you cut open an apple, and it starts to brown as a result of exposure to the air. It’s the browning of our tissues, whether it’s our thyroid, and causing thyroid dysfunction; our brain causing some memory loss; our joints causing osteoarthritis. That’s the area I have started to get passionate about: looking at what causes oxidative stress. We usually think of that as free radicals. How do we clear those? What is needed in those pathways and processes?

Dr. Eric: Like you said, the increase in environmental toxicants obviously is a big factor in the increase of oxidative stress. The autoimmune process as well. It’s safe to say that anybody dealing with an autoimmune condition has some degree of oxidative stress. You said you’re missing two of the genes related to glutathione?

Dr. Rajka: Yes, two of them.

Dr. Eric: When supplementing, if someone is missing the genes, I assume they can still take something like NAC that converts into glutathione? Or would they have to take a liposomal glutathione or an acetylated glutathione?

Dr. Rajka: It depends. I saw later some data on how n-acetyl cysteine (NAC) can increase levels of cysteine and further lead to oxidative stress. Anyone who wants to boost production, definitely NAC is the way to go. I am on a very small dose at all times. That is what maintains me. If I ever go through a period where I know I am ill, I will up that dose. I am pretty well versed in turning mine on and off. I’ve used NAC before. I’ll add that when there is an acute illness, too. I do not see benefit, but my patients have. It depends on where they fall on the spectrum.

Am I moderately unwell? I probably just need to boost it with epigenetics, and NAC would be just enough. If you know the genetics and they are depleted, for all of my chronically sick patients, I have started to look at their genetics. I say, “This is what we would need as we are getting you better. This is what you need to maintain and support you to mitigate that relapse.” Of course, with the whole mind/body, diet/lifestyle, comprehensive approach. It’s not just supplementation.

Dr. Eric: Agreed. Diet also plays a big role. You can eat cruciferous vegetables and other sulfur-based foods. If someone is really deficient, diet is still important, but that is where supplementation might be important.

How about IV glutathione? Are there indications where you would ever refer people to get IV glutathione?

Dr. Rajka: It’s interesting. Some of my really sick patients don’t tolerate any glutathione. You have to be really careful to give them an IV. For some people, IV is not the correct route. There are innuendos.

As I was learning the genetics, I was in between jobs. We were moving from Boston to Chicago, where we are now. One of the benefits of the clinic I work at is we have IV therapy. That is one of the perks of the job. I did IV Vitamin C, which I’ve found huge benefit for when I am acutely sick. That has helped me recover quickly. I also did it with glutathione. I didn’t get that boost. What happened? I had my genetics reviewed with another person that was in the field. They said, “This is why. They cancel each other out.” I’m blanking on what that actual process was, but I was intrigued that IV may not be necessary for some people. I underwent six weeks of therapy and didn’t see a benefit. I was trying to supercharge myself but didn’t see a difference.

Dr. Eric: I’m glad you mentioned the IV glutathione, especially some people not doing well because it would be a bummer for someone to get it. It sounds like maybe they should try the liposomal glutathione first. Not to say that everybody should try that and then do IV glutathione, but if someone is considering IV glutathione, maybe try regular glutathione. If they can’t tolerate that then that is an indication they might not be a good fit for the IV glutathione.

Dr. Rajka: Yeah, same thing. If you are sensitive to a lot of inputs coming your way, there is a high chance you will be sensitive to glutathione. Always proceed with caution. I always say sometimes, in those who are chronically ill, to go slow is to go fast. It’s really a hard concept for anyone who has ever been high-performing to accept or follow. There is nothing worse when we’re on the road to recovery, and someone goes through the steps at a rapid pace. They are made to feel worse and worse, but they don’t stop. They push through. Then it throws them under the bus, and that recovery, for me, in a client takes almost twice as long as the original recovery. I really caution people to pay attention to how their body is responding to things, and to have that direct communication with me on how they are feeling. They are given strict provisions on how to increase.

Dr. Eric: You spoke a little bit about nutrients. You also mentioned mitochondria. That is probably a big way this ties into fatigue as well. With the environmental toxins affecting the mitochondria, potentially causing mitochondrial damage. If you have the environmental toxin exposure and/or nutrient depletion, either one of those can have a negative effect on the energy powerhouses of the cell, which can lead to fatigue, correct?

Dr. Rajka: Yes. Just add in the everyday life stressors, which further deplete your nutrients. It’s like this vicious cycle that can be hard to get out of.

Dr. Eric: How about as far as the gut? All of this is important, but if you don’t have a healthy gut, that also could lead to nutrient deficiencies. Even the amino acids, you mentioned protein. People do need to eat sufficient protein. Also, if someone has low stomach acid or other gut issues, they need to address that, or else that could be a big problem when it comes to supporting the detoxification pathways as well, yes?

Dr. Rajka: Yes. You already mentioned the first way. We absorb our vitamins and nutrients less well when you have dysbiosis or low production of stomach acid. That puts people even further less well able to tolerate being exposed to toxic substances.

Ironically, I was re-reviewing things with phase three detox. The dysbiosis will not allow you to do that phase three. Excreting it, transporting those toxins out of the body. I do have a “right order,” my 3D protocol. I do things in the right process. If you go in and detox someone from the get-go as a starting point, you can make someone very sick. It’s never the first thing. I always tell people a diet will detox you.

I’ve had one woman in all these years who ate so terribly that when we put her on a healthy diet, she complained vehemently. She was gently detoxing but really felt the effects of it because she had never provided herself with the right nutrients. She was probably getting a backlog of those metabolites and was not able to clear them as well. We had to back step. That was a rare scenario. It’s the right order, too. I have seen people be made worse if they detox first and not with all the support systems in place.

Dr. Eric: You need to make sure phase three is working, which makes sense. If you’re constipated, you probably don’t want to get aggressive when it comes to detoxification.

Dr. Rajka: Yeah. Having the appropriate nutrients, having amino acids, making sure there is NAC glutathione, making sure someone is sweating and hydrating and having daily bowel movements. Not being constipated. I always laugh when I say the only field we talk about poop as being kind of sexy is our field.

Dr. Eric: Yep, no problems talking about poop here. You said when you were giving your background, you had your gallbladder removed, which unfortunately happens to a lot of people. A couple of questions with that.

One question is if you take any support since you don’t have a gallbladder, whether it’s bile acids or anything similar. Also, if someone is having gallstones, and their doctor is saying they need to remove the gallbladder, not to say there is never a time and place for that, but if it’s maybe in the earlier stages or middle stages, and there is still hope, do you have any tips?

Dr. Rajka: I do. Back story there. We were abroad, and the only American surgeon that was there had left, and we were returning to the same spot. He had said to me when I was pregnant, “I wouldn’t operate on you here non-pregnant let alone pregnant.” He was pretty much, in his mind, the only qualified surgeon. I started to have symptoms right before we moved back. Ironically, I had an appointment with a naturopath and the surgeons. I panicked because I thought, “Oh my god, what if I get into a situation where it’s an acute gallbladder attack that is a do or die? He is telling me he doesn’t trust the system or the process there.” When you have a surgeon saying, “You have a gallbladder full of stones. Get it out,” and I wasn’t trained like I am now, you probably will follow through. Mine is more of a worry about what if? If I had time, I probably would have done what I do now.

Knowing genetics, you first want to make sure there is proper bile formation. You have to make sure you have adequate choline. A good source is the yolks of your eggs. Some people have difficulty absorbing choline. I am in this mix. That is why I developed gallstone symptoms when I was pregnant. I wasn’t absorbing the choline. Pregnancy increases the need for choline. I have a whole pre-pregnancy protocol where we support choline a little more to meet the needs of the pregnancy. That would have been my first port of call: supplement with choline, either liquid or capsule form. I still do that. Your common bile duct, which is what remains, does produce a little bit of bile. I augment and do bile acids or bile salts. Ox bile with every meal, so I absorb properly.

Here is the kicker. Even that took a little while going into functional medicine to understand that I should be on this supplementation. From a genetic standpoint, the gene that governs the choline absorption is PEMT. I do have the mutation. Typically, you will see that those with the mutation experience symptoms when they are pregnant and in menopause. Those are the two time periods. I had a young lady brought to me by her mom and said, “Every woman in our family has had her gallbladder out. I want you to spare my daughter.” The daughter was a teenager. We took a look at her genes, and now she is on gentle supplementation. We have talked about what you can do. I’m on those two.

That was also going on at the time of when I had that whole liver flare. I avoided the foods that would trigger it: caffeine, alcohol, onions, garlic. I backed off on those foods. Things like beets, beet juice, beets themselves were very healing for me at the time. Sadly with the surgery, I had my common bile duct injured, and it closed off. That will make you more sick than anything because it really escalates a backlog of everything. The bile, the liver enzymes shoot up even higher. I’ve had that duct opened twice now before I was in functional medicine.

Now that I am, I rarely get a flare. I know what my triggers are. I had one probably like six months ago. You better bet your bottom dollar stress doesn’t help that at all. I thankfully had a lot of gut healing supplies with me. I travel with a little stash of stuff in case my family gets sick. By taking the ox bile, the PC, I even had some Colostrum, which is your immunoglobulins, and a good solid enzyme, it passed very quickly. Now I’m just super careful. I just try to maintain that, striving for a healthy diet and lifestyle.

For me, if I strive 100% of the time, because I want to hit 80 or 90, I am on board and doing well. I shoot for 80, which means I will hit 60 or 70. I have more resilience to things coming my way. Even asa high performer, overscheduling themselves and being clear on what my mission and goals are personally and professionally and sticking to them. Saying no more than I say yes.

That’s off topic and not genetic. We are genetically wired when you are a high performer and busy to go, go, go, and do, do, do. It’s probably not the best thing for you. I know when I was growing up, it became fashionable to go without sleep. It was like this badge of honor or something. Now I think it’s just not a good health choice to make. It’s fallen out of vogue thankfully. In our circles, sleep is prioritized. So is preserving your most precious asset, which is time. You can never get it back.

Dr. Eric: I’m glad you shared that. I haven’t really looked into the research when it comes to sleep and oxidative stress. I know lack of sleep will cause inflammation in general, like higher CRP levels, I believe. I imagine also oxidative stress plays a role in that, too. I think it all does tie together.

Dr. Rajka: Absolutely. The other thing to know is there is a level of oxidative stress that is going to be okay. We produce free radicals every time we make ATP. A small amount of that is super important because that is how we fight off the pathogens, the bugs we encounter: bacteria, viruses, etc. It needs to be in balance. When it escalates, and you need to appropriately eliminate those free radicals that do damage, that is governed by genetics. I look at the pathways and just love it.

I tell people I had a woman who came in with autoimmune conditions. We did all of these steps without knowing her genetics, and then we reverse engineered it. It was really telling why I chose the steps that I chose, based on her history, symptoms, and labs. That worked. That is how I am able to reverse engineer. You don’t necessarily need it. In fact, I wish we had a better way to affordably measure which gene is expressing. I always tell people you want to combine symptoms with labs along with the suspected action of what the gene might be doing rather than just looking at the genetics, which are worthless alone.

Dr. Eric: Do you look at any tests when it comes to oxidative stress or glutathione? Some organic acids tests look at pyroglutamate. There is some oxidative stress markers as well on the Dutch test. They have the organic acids section that has an oxidative stress marker.

Dr. Rajka: Pyroglutamate looks at your need for glutathione, and it’s presuming that your levels of oxidative stress are high. On the Dutch test, one of the ones that you should pay real close attention to is it looks at damage to our DNA. That marker is called 8 hydroxy deoxyguanosine, 8-OHdG. If you have DNA damage that is present, you better say what is driving that? Is it stress, toxins, lack of sleep, lack of nutrients, inappropriate diet, dysbiosis? You run the list and maximize as much as you can.

The other marker I’ll look at on a NutrEval is a lipid peroxidation, so damage to the lipids on the body. I look at oxidized LDL, which is the bad cholesterol. You not only have to have an elevation of bad cholesterol, but a portion of it has to be on the small particle stick, and a portion of that is the damage. That’s a perfect storm. If you have elevation, a lot of damaged small particles, that is the storm for forming plaque and having that plaque rupture. Think about a heart attack or a stroke. I have had people come back with high levels. I am still looking at what is causing it.

There are ways that I mock that up, so to speak. There are various things I give. If I don’t know their genetics, I will use molecular hydrogen, which will usually lower it nicely. We have to figure out where this is coming from, or we will never be able to stop. “I will protect your tissues by giving you this.” If I know their genetics, I will say, “Hey, is it a breakdown of the super oxide free radical? Do we need to give you an enzyme called SOD, which breaks it down to hydrogen peroxide? Is it broken down into hydrogen peroxide, but you can’t clear it through your glutathione system, through another enzyme called catalase?” I look at the big picture. If I don’t know, molecular hydrogen has worked wonders. I can lower it in about three months. It gives me time to find the source. That is the most important question to ask: What is the source? Why is it happening to begin with?

Dr. Eric: That’s a good point. If you see any of these markers out of range, you want to know why, and not just give the person a supplement. On a short-term, temporary basis, it might be important. You don’t want the person just to take, whether it’s glutathione or molecular oxygen on a permanent basis. Ideally, you want to try to find the cause of the problem.

Again, that ties into the genetics because sometimes, we just have the genetic variations, those polymorphisms, where someone might need to take some support. You mentioned a short while ago that you do take a little bit of glutathione every single day, a small amount, just because of the two genes that you’re missing. Because of this, do you recommend genetic testing to all of your patients?

Dr. Rajka: I recommend it to the chronically sick and those that really want to mitigate any long-term risk. The two varieties now. People aren’t interested, and they have youth on their side, so those in their 20s or 30s may not need it or want to know it. Then we really hit the epigenetics: diet, lifestyle. Just by their markers sometimes, I can tell.

Let me give you a really simple example of genes. When we are trying to get someone’s Vitamin D levels up, so they have proper immune function, the range can be a couple thousand IUs a day to 10,000+. Those people who are needing 10,000+ typically have genetic mutations in either the way they are converting, or they are converting with their Vitamin D transported. There is a whole host of genes that govern that. You don’t need to know the genes; you just titrate their D that they are taking according to what their body is showing you that they need. In the winter, you will need a couple more thousand or more than you would in the summer.

So far to date, I have had one person, and she was another practitioner, have optimal levels without supplementation. She lived in Austin, Texas. She is getting sun.

It was so odd. We were living in the Middle East. We were out in the sun all the time. That was the only activity you could really do when it was so hot was swim in the chilled pools. My kids and I were all deficient despite the sun exposure. We all have those genetic mutations ironically.

I have seen a pattern where some of my patients who have the chronic environmental illnesses are missing the same two genes I am. I am starting to do some research on is that why they are so sick from it? Is that why they succumb quicker?

I talk about how we all have different detox buttons. Some of it is genetic, and some of it is diet and lifestyle. if you are small, you will present being ill earlier in life. If it’s medium, maybe a little bit later. If it’s large, you might be that one lucky person. I’ve had one in a career of over 25 years of medicine where he is the Uncle Harry who smokes three packs a day and dies quietly in their sleep with no adverse outcome. That is the rarity, and I wouldn’t bank on that.

Dr. Eric: I agree. Unfortunately, my mother smoked for 40 years, and she is still with us. She is 80 years old. No bad damage. Don’t know what the next 5-10 years will bring. She stopped smoking 10 years ago, but she did smoke for 40 years. Her genetics were kind to her compared to others, but you never know. Obviously, she didn’t know. She was just lucky with that.

I agree. You don’t want to take the chance. The good news is there is genetic testing for those who want to find out the information. Like you, I can’t say I recommend it to most of my patients. At this point, I won’t say I’m new at it because six or seven years ago, I did 23andMe, which they have since changed. I have recommended some genetic testing. I’m not at the point where I am recommending it to most patients.

If someone is dealing with a lot of chronic health issues, that might be something to dive into and see, especially if they can’t tolerate- You mentioned that you have people who can’t tolerate glutathione, but there are also people who seem like they can’t tolerate anything. in that case, maybe it would be helpful to take a deeper dive into the genetics.

Dr. Rajka: Like I said, the two varieties, the person who wants to mitigate any long-term risk. I am a firm believer that your thoughts form your words, and your words can change your life. I shudder to think what would have happened had I not discovered this. The genes were ominous. We’ll have to do that another time, maybe over a nice dinner or something when we’re out socializing. I like it for a variety of reasons. You’re right. It’s not necessary in every single person.

To speak to your mom, if I may for a minute. She must have excellent genes. We started running an epigenetic test for aging. It gives you your age based not on your biological age, if someone is 50, but it measures what your diet and lifestyle have done to you. How old are you based on the markers in your body? Smoking is one of the ways that will age you quicker than anything else since it is creating oxidative stress. That speaks mountains. Maybe you have some really good genes if they were inherited. That is one of the eight things we would do to mitigate.We just ran that test on me and my husband to see where we are at.

The other thing that plays into it is sleep and stress. As you know, the past two and a half years have been a very interesting time for a lot of us. I know I’ve pulled out all the stops. I laugh when I tell people, “When I’m stressed, I double down on the meditation.” It goes from 15-30 minutes to an hour when I can. It really does help me stay out of trouble, is how I feel and how I recover.

Dr. Eric: I am a big believer in mind/body medicine. What I tell people, if someone is not in the routine, just start with five minutes per day. Just get in that routine. I don’t want people to think they have to do 30 minutes or an hour every single time. If you can do five minutes a day, get in that routine, and once you are in the routine, you can gradually increase. Maybe some days during the week, you will do it for 30 minutes or an hour, and the other days, you do it for 5-10 minutes. It’s getting into the routine, like just with anything.

Dr. Rajka: I like your five minutes a day.

Dr. Eric: Everybody can do it. Everybody can find five minutes. I know some people find the excuse that they can’t do five minutes a day, but those are the people who need it the most. They need to do 30 minutes a day probably, but at least start with five.

Dr. Rajka: I have started saying: What is my bare minimum of the things that fuel me? I have a bare minimum for breath work and exercise. It’s interesting that when you set that lower limit, and you’re successful, then you’re able to increase it over time. I have found that sweet spot.

Another thing I will challenge people on is when you wake up and get out of bed, hopefully you’re refreshed. Say you don’t have the time even to do five minutes. Do 10 breaths before you even get out of bed. I have trained so long on heart math, which is one of my favorite things we teach every single person because the data is sound. I have seen people say they have meditated for 20 years. You look at their stress response, and it’s either in the gutter or through the roof. It’s not getting you out of fight or flight.

This is a tangible way to test. After a while, you learn what breath pattern gets you out of fight or flight. I can do those 10 breaths and know those 10 breaths are working. Think about when you are answering emails. Do a breath hold. That’s good not only for supplying oxygen and fueling your brain, but getting you out of fight or flight.

Dr. Eric: If you can’t find five minutes in the morning or at any time during the day, but I agree that in the morning it’s nice to start out with meditation or any type of mind/body medicine. 10 deep breaths is an option.

I chatted with another practitioner recently about heartmath. She is a certified heart math teacher. I’ve used Inner Balance for many years, too. Definitely supportive of heart math.

You have shared so much great information. Is there anything else I should have asked you that I didn’t ask you, or anything else you want to share?

Dr. Rajka: I am going to share three things that keep coming up when I talk to people who are thinking about investing in their health. A lot of people say, “I will DIY it.” Set a time frame. Maybe that will work in a portion.

Find that guide. It doesn’t have to be me or you. Find a guide you trust. It will take you from Point A to Z much quicker. My original guide led me on the diet/lifestyle path, but he didn’t really know all the rest of it. If someone had told me, “I am going to give you exactly what you want and get you better from this acute illness. I will also give you everything you need,” I would have said, “I’m all in. What is it that I need that I’m not aware of?” Sometimes, what you don’t know can hurt you. Find that guide, especially if you have tried to DIY this.

If you’re having such significant symptoms, and I view that as any level of fatigue because most people are fatigued and have acclimated to a lower level of energy, and they don’t realize it. I’ll say that again: Most people have acclimated to a lower level of energy and are already fatigued. By the time you actually feel it, you are behind the 8 ball. There is some kind of dysfunction going on with the detox that is affecting you, whether it’s your thyroid, brain, or joints.

If you walk in a room and don’t remember things, those are serious signs. Pain of any sort that seems not to respond to usual measures. That says there is mitochondrial dysfunction. That means there is a lot of oxidative stress going on. You need to figure that out before it gets into a serious state.

It’s mind-blowing to me because I know I can afford help and reversal for people. When they say, “No, that’s okay. I’ll deal with it in two years,” if you’re at that point, you don’t have two years to wait. I only say that kindly and lovingly because I see people on the other end of the spectrum, where they are so far gone, and it’s a real challenge to recover what little you can and maintain them there. Even that six months prior or one year prior. Just to take some of those symptoms that people tend to write off as more serious because they are.

Dr. Eric: Where can people find out more about you?

Dr. Rajka: The main source right now is DrRajka.com. That gives a wide variety of info. We have an energy quiz on there that people can take and other resources. I do have a professional Facebook page and Instagram that is @DrRajka. We are getting more up there with Reels and Lives. When we are busy clinicians, that goes in waves. I like speaking on podcasts like yours because it’s empowering to be able to convey the information so that I can open people’s minds to the possibility of how well they can feel.

Dr. Eric: Thank you for doing this interview, Dr. Rajka. I appreciate you sharing your expertise, not only on the genetics of detoxification, but so much more, like oxidative stress, which I know ties into that, and sharing your story about your gallbladder removal and how you support it. A wealth of knowledge.

Dr. Rajka: You’re welcome. Thank you for having me.

 

With me, I have Dr. Alexandra Swenson-Ridley, who is a thought leader in outside the box and natural approaches to women’s health and hormones, focusing on what she has termed “selfless syndrome.” After suffering her own health challenges that resulted from focusing on everyone and everything but herself, her work turned toward helping other driven women navigate the world of fatigue, thyroid issues, anxiety, depression, difficulty losing weight, gut health, and more without the use of medications. Thank you so much for joining us today, Dr. Alex.

Dr. Alexandra Swenson-Ridley:

Thanks for having me. I’m excited to be here.

Dr. Eric:

Excited to have this conversation. I usually start off by asking people to share their background. How did you get started in doing what you’re doing? I know you have a wonderful podcast. Let’s share your background.

Dr. Alexandra:

I got started, a lot of us do, by my own health struggles and challenges in my earlier to mid-30s. I’m originally a chiropractor. I built a big practice and hit this point where it was not the dream, and my health was really suffering.

In terms of thyroid, I developed some anxiety. I was having panic attacks. My hair was falling out. I was going hoarse at the end of every day. I was exhausted. It was all I could do to feed my kid before I fell on the couch. I learned more, educated more, did continuing ed stuff that was related to women’s hormones. I understood stress and how that all interacted.

I ultimately took myself on a journey, where I knew I did not want to take medication. A) I don’t think I would have been diagnosed as having a thyroid issue because of lab ranges and how they look at that. They wouldn’t have looked at enough things. B) I wouldn’t have taken medication anyway. I was left with how to figure this out on my own.

I am happy to say that today, I have gotten there. Now I help other women do the same, whether it’s thyroid or something else. I really get to the root of why our bodies aren’t functioning the way they should and how we can get them back.

Dr. Eric:

I really want to address the cause of the problem. We will talk about your decision not to take medication as far as how that translates to others you work with. Before we talk about that, can you dive into selfless syndrome and maybe tie that into thyroid health?

Dr. Alexandra:

Selfless syndrome, most people have an idea of what it is by the label, but it applies to both men and women. I don’t know if your show is predominantly women.

Dr. Eric:

Mostly women, yeah.

Dr. Alexandra:

It’s that innate desire we have to take care of everyone and everything except ourselves. We are constantly putting ourselves last. We are the last thing on our schedule, the first thing to go. Before this, I was teaching a workshop around brain health related to this as well. Over time, the more we don’t make time for ourselves, the less capable we are of showing up for the people and the things that we really love and care about. That’s in a nutshell what selfless syndrome is.

I really talk about, especially in our modern world and society, where as women, we have taken on more roles. Some of it is self-perpetuated, and some of it is societal and generational. We have added to the plate but not had anything taken off. We have this very high level of stress that we’re always running through. We can get into the nuances of how that affects the thyroid, but it’s going to impact your thyroid function, your gut health, which has a lot to do with thyroid, and a bunch of other things.

Dr. Eric:

Essentially, doing too much. It’s something I ask when I have patients fill out their case history. Most of my patients are women just because, as you know, it’s mostly women who have thyroid conditions even though I was one of the lucky men who was diagnosed with Graves’. It’s obviously very common. Let’s talk about how selfless syndrome relates to the adrenals. Stress has a great impact on adrenals. We can perhaps tie this into thyroid health as well.

Dr. Alexandra:

We all have stress. We all know there is bad stress. The truth is we need some level of stress. Our body does need to produce some level of cortisol, and it’s supposed to rise and fall in a certain way throughout the day. When we’re living under constant stress or toxic stress-

For example, I had one woman who came in early on when I started doing this work. She said, “I’m not stressed.” As we kept talking, we got into how she actually has a daughter who is severely autistic and lots of appointments and PT and fighting for her at school. All of that is stress. Because it’s just her life, she doesn’t relate to it that way.

The first thing I would say is just be aware that just because you don’t feel it doesn’t mean that you’re not actually experiencing stress. Most of us are functioning in a way where we don’t know anything else. That’s just normal. If your body starts to break down, that’s a good sign we have some stress happening.

As that’s happening, your adrenals get more taxed. We have what’s known as the HPA and HPT axes in the body. They run parallel to each other. The hypothalamus tells the pituitary to do something with our hormones. It either talks to adrenals to produce cortisol, or it’s telling the body to produce sex hormones. It also talks to the thyroid. The pituitary then tells the thyroid, “Hey, make some thyroid stimulating hormone.” It’s released. All of that chain starts.

When you have stress, it’s taking away from that happening. That’s where we start to see a lot of breakdown, especially with hypothyroidism or even developing into Hashimoto’s or Graves’. Hypo seems to be more common from what I’ve seen.

Then you start having the symptoms. You can’t lose weight. You’re tired and cold all the time. Your hair is falling out. All of the fun that can come along with thyroid stuff. Going hoarse. That was my big one. I kept losing my voice by the end of the day. I couldn’t talk. We start to see those. But it starts somewhere. It’s not like you just wake up one day and have these issues, unless you have some genetic thing that has led to that after developing over time.

Dr. Eric:

You had a thyroid condition. Was it Hashimoto’s that you dealt with, or not autoimmune?

Dr. Alexandra:

On the scale of looking at it from a more functional standpoint, I did have antibodies toward Hashimoto’s. It wasn’t at the level where Western medicine is going to diagnose it as such. I look at it as if your body is producing any antibodies that is affecting an organ, that’s generally not a good sign.

My diagnosis on myself was subclinical hypothyroidism, meaning my levels looked more or less normal, going beyond looking at TSH, but TSH and free T3, free T4, reverse T3, and antibodies. My reverse T3 was high, which is another indicator of hypothyroidism. I had symptoms.

My rule of thumb, in all the research and reading and learning I have done and working with other clients, is if you have symptoms, it doesn’t really matter what your labs say. If your thyroid isn’t working, it needs to be for your body to feel good. That’s how I look at that.

Subclinical is everything is normal, but you still have symptoms. I don’t know how much you’ve talked on the show about the ranges they use for defining what normal thyroid is. They have bene arguing about it for about 50 years. It’s way too broad, and nobody ever changes it. By the time you hit a point where in Western medicine, they will say, “Your thyroid is off,” you are really not doing well. This is what I’ve seen.

Dr. Eric:

I’m glad you bring it up because a lot of doctors blow off subclinical hypothyroidism. The TSH, in your case, maybe it was well within the reference range or on the higher side, but either way, it was outside of the optimal range. With the conventional medicine, it’s a waiting game. They will say, “Let’s just keep an eye on it.” Maybe sometimes, if the person is experiencing symptoms, they might put them on thyroid hormone. Most of the time, they usually won’t do anything unless the TSH is overtly outside of that reference range.

Dr. Alexandra:

Mine as well. They very rarely look at anything beyond TSH. That’s the other thing. TSH is only one part of the picture. That’s what’s happening with your brain and the pituitary. You also have to look at the thyroid itself, which mostly releases T4. That goes to your gut, which is converted into T3, which is what your body can actually use.

My subclinical hypothyroidism, my T3 levels are what was hypo. Even though my brain looked normal, my body itself was experiencing being hypo because there wasn’t enough usable thyroid hormone available. That’s what’s going to help our metabolism and help regulate a bunch of stuff in our body.

Dr. Eric:

You said you also had an elevated reverse T3. Correct?

Dr. Alexandra:

Yes. That’s the one thing I haven’t totally impacted yet. I ran labs on myself recently. The other thing I experienced was I put on 50 pounds overnight and couldn’t get it off. That was a combination of I had some stuff that happened with my estrogen. I was estrogen dominant. The thyroid was also being impacted and causing part of that, too.

That’s something I see with a lot of my clients: It’s more common for women, especially in their 40s and 50s, to be in that place where,“ All the things I used to do to get weight off aren’t helping anymore.” There is a breakdown at the hormone level. Until you deal with it-

Dr. Eric:

Speak about weight gain and weight loss. Obviously, you need to get the thyroid hormone levels in balance. That free T3 is very important. Is there any specific diet that you recommend? Does it depend on the person?

Dr. Alexandra:

It depends to an extent. I’ll be honest: Food is something I love. Designing nutrition stuff isn’t my wheelhouse. I’ll leave that to the nutritionists. From my own experience, last year, I lost about 30 pounds all through eating. I didn’t exercise at all. I was exercising, but that’s not how I lost the weight.

Just recently, I found a book by Haylie Pomroy, The Fast Metabolism Diet. I will reach out to her to see if I can get her on my show. If you’re looking for something and are tired of doing Weight Watchers and all that stuff, I love her book. Her definition of “diet” is Did I Eat Today? This is a common thing I see, especially because with thyroid, if our thyroid is off, our metabolism will be off as well. If you are hyper, which is much less common, you’re eating a ton, but you’re losing weight. If you’re hypo, you probably don’t have much appetite, and you keep packing on the pounds. Those things go hand in hand.

Her approach resets all of that and is one of the first things I found that resets the thyroid as well. I guinea pig myself on everything. I think in a week, I lost about five pounds just following her plan, which has more variety than most of your diets out there. You’re eating, which is very important. It’s counterintuitive to think you need to eat in order to lose weight because we have been so trained to eat less and work out more. We have taken that way too extreme. That stuff impacts the thyroid as well. If you’re dealing with hypo, you have to train your body to eat again so that your metabolism turns back on, and it starts producing like it’s supposed to.

Dr. Eric:

I need to check out that book as well. Getting back to selfless syndrome, what do you do to help people with that? Do you tell them to slow down, block out time for stress management, incorporate mind/body medicine techniques? How do you handle that?

Dr. Alexandra:

I have come up with a proprietary combination of a whole bunch of stuff that I have done recently, grounded in a lot of neuroscience, and the concept of neuroplasticity, which is our ability to rewire our brain, what we think about all the time. Our habits are wired into our subconscious.

To really impact what I have defined as selfless syndrome, we have to go deeper than just trying to convince ourselves to do something differently. There is actually something that needs to shift in recognizing our own value. For a lot of women, there is a self-worth conversation that runs underneath all of that: we don’t value ourselves enough to take care of ourselves.

I do a lot of work there actually. I’m less in the nutritional and hormonal world. In terms of doctor hat wearing these days, I’m more in the how do we really rewire our foundation, so that it’s not such a challenge to show up for ourselves, and not in a selfish way, but to do it in a way where we are just the best version of ourselves because we are making time for ourselves?

I got there by looking at every woman who had a huge amount of success working with me. Came off medication, lost weight, balanced the hormones. It didn’t stop there. Their relationships were better. They made shifts in their career. They did a lot of the hard, challenging work. We do have to slow down some to take those steps. There is a level of having to foster some courage and confidence and clarity in yourself and where you’re going and what your values are to make those moves and make those choices.

That is a lot of what I did to heal as well. I made the choice to retire from chiropractic. I got divorced and remarried. I’m not saying you have to do those things to heal, but we have to be willing to look at what has been going on in our lives to get us to this point? Where can we start to make shifts and changes so that we have the life we love and the body to enjoy it with? That’s really what I’m about.

Dr. Eric:

It sounds like you go beyond the diet and stress management. I’m guessing you probably get people from other health care practitioners, not to minimize and say that’s all they did. Some people, that’s all they do. Maybe even on their own, they just read some books or listen to some podcasts like this one, but they just try to do things on their own from a diet perspective or stress management. It sounds like you go way beyond that.

Dr. Alexandra:

Yeah. Honestly, I’ve learned we really have to. If you’re constantly just in information accumulation, you’re missing- I’m a classic high performer who lives in my head, so this has been part of my journey recently that I’m doing with the women I work with, who are driven and in leadership roles but are struggling with their health: getting out of your head, tuning into your body, and asking it what does it actually need? As we start to do that, a lot of how you’re eating and sleeping might shift, as will exercise, in the way that they need to. We have to get out of analysis paralysis and take some action. Our bodies know a lot. If we just tune in and listen, it will tell us things that we need.

Dr. Eric:

Very true. Let’s talk about the medication. It was your personal decision not to take medication. When I dealt with Graves’, I chose not to take medication either. With hyperthyroidism, many people take antithyroid medication, but I chose to take an herbal approach while addressing the cause of the problem. Fortunately, that worked, and it’s worked for a lot of people that I have worked with over the years.

I do think there is a time and place for antithyroid medication, just like with thyroid hormone replacement. I’d like to know your thoughts on not necessarily your personal experience, but how you approach other people with thyroid conditions, more specifically hypothyroidism since it sounds like that’s who you mainly work with when it comes to those with thyroid conditions.

Dr. Alexandra:

Yeah, hypothyroidism and Hashimoto’s is more of what I see. My stance on this, with the caveat that I cannot give you any advice around medication legally under the umbrella of my licensing.

However, what I do like people to know is first recognizing you do have a choice. There is more than one way to handle it. As a society, once you’re on thyroid meds, you’re on them for the rest of your life. All of that is a myth. None of that is true. Realizing it is a choice.

Like you, there is a time and place for medication. It’s not like all medication is bad. If you are really struggling and can’t even start doing the things that are going to help start turning you around, that is a time where I might say, “Hey, let’s talk to your Western medical doctor and get some help for your body, so you start feeling better” with the understanding that it doesn’t mean you’re on it for the rest of your life.

Finding someone who will work with not just looking at- They normally give more T4 combined with T3 if we need to. The gut is left out a lot of managing thyroid. Most of your usable thyroid hormone is made in your gut. While you heal that, because that’s not a quick process by any means, could you benefit from some support if you’re really struggling?

It’s a choice. It’s absolutely one that I think every woman should feel empowered to make or not. Man, too. Recognizing who you are. Are you someone who can make lifestyle changes? With selfless syndrome, you have to show up and make time for yourself to journal, meditate, and ask yourself the hard questions. Have someone go on that journey with you. I provide a road map for that experience. Just getting clear on yourself. Are you willing to slow down? Are you someone who just needs the medication to keep going? In choosing that, you’re recognizing that you’re not heading in a good direction, we’ll just say that.

Those are my thoughts. It’s there. It’s a tool. You don’t have to be chained to it forever. There are other options out there.

Dr. Eric:

Can you dive into the core pillars? You might have already touched upon them a bit, but if you could dive deeper.

Dr. Alexandra:

I keep changing what they are, but they’re all similar. The ones I’m operating with right now, there are seven of them. Most of us tend to think of how I eat, how I move, how I sleep. That’s true to being healthy. I look at them as perspectives. What is your general outlook in life?

Nourishment doesn’t just have to do with what you’re feeding yourself, feeding yourself well, but also how nourished you are by your job, your environment, your relationships, your spiritual practice. It’s that kind of stuff.

Connection is a big one these days. Especially with thyroid, I see both in nourishment and connection, if you feel you are not expressing yourself fully, there is a lot of energy that is stored in your throat. I don’t want to get woo woo on people. I talk about energy centers, not chakras. There is a connection between not being self-expressive and hypothyroidism in particular. Connection is one of the places where we get that. Especially as women, we need to sit down and talk. We haven’t had a lot of that recently.

Rest is not just sleep, but also rejuvenating activities, like not killing yourself in the gym, but when you come down from deescalating.

Attention is how you are able to focus. This is another thing I see a lot of, brain fog. We focus on somebody else or something else or allow someone to focus on you. That can be a bit confronting for people.

Your purpose and contribution. How connected are you to your passion and purpose in life? Are you doing things that light you up, and you feel you are put here to do? Or are you going through the motions?

I look at that whole picture in how we define health and how healthy we really are. A lot of those are access points to having your hormones balanced, your thyroid working right, your gut happy.

Dr. Eric:

Wonderful. What are some of the steps people with thyroid and autoimmune thyroid conditions can take to get their life back? If someone is listening to this, they’re like, “Yeah, this is me. I have been dealing with selfless syndrome. Everything you said sounds great.” Maybe it’s not an order, but could you give some guidance about what some of the next steps could be?

Dr. Alexandra:

With every woman, the journey is a little different. Sometimes, when we help a lot with the physical side, there is an emotional side to healing. That’s the other piece I work a lot in: trauma stuff and other things that most of us have underlying. Either we feel better physically, and they are ready to let go of all of this stuff. Or they are ready to let all of this go, and the physical heals as a result of releasing that. It’s finding an avenue to work on that within.

If that’s super overwhelming, my first two things for anybody is to learn how to breathe again and drink water. Those are the two steps; we can keep it really simple. Twice a day, you take five deep breaths, breathing in five count, holding it five count, breathing out five count, doing this five times. I think we overcomplicate it often.

Water, our bodies are mostly water, so if you’re not drinking half your body weight in ounces of water, and I do mean water, not coffee or soda, etc. If you can start there, you will start to feel better.

From there, there is work we have to do, both emotionally and physically, like working through healing the gut and other things we are storing in the body. Thoughts are the power of the brain. Emotions are the language of the body. All of our experiences and emotions are stored there. Until we let them out, things don’t usually work right.

A little broad. Breathing and water are the easy places for everybody.

Dr. Eric:

I think that’s great. Everybody can start with that. Everybody can start with doing a little bit of breathing each day. Obviously, we breathe all day, but doing some focused breathing exercises, even five deep breaths to start out with.

Dr. Alexandra:

You don’t even have to count. You need to slow down your breathing and breathe a little more slowly and deeply than normal.

I was just certified in heart math. Bringing focus to the heart is another way to push reset on your nervous system and state. That will allow a lot of function to start to come back in your body.

Dr. Eric:

Can you quickly talk about heart math? I don’t think I’ve mentioned that yet. I’m familiar with it. Can you talk about heart rate variability and how you incorporate that into your practice?

Dr. Alexandra:

This is newer stuff I have been doing, but I really love it. Heart math brings a lot to the idea of coherence in our body. We are both chiropractors, so we have lots of background in the nervous system. When we are in a hyperaroused state or stressed, generally, there is a lot of chatter going on. We’re not connected between our head and our body. Heart math is a tool that allows you to start to build coherence. They have biofeedback devices that help you measure how often you’re in coherence.

I have an Oura ring that I use. I don’t get anything if anyone buys one. I happen to like the product. It measures my heart rate variability and gives me a score for the day. It will measure things like how much restorative time you got. With thyroid and a lot of the more hormonal imbalances, if we try to push too much, it’s going to make it worse. I have been someone who has needed that information to be like, “Hey, so your heart rate variability kind of sucks, and you haven’t had more than five minutes of restorative time a day the whole week. Why don’t you chill?” The Oura ring will tell me that, and it’s helpful for those who need that kind of input.

The bigger point behind it is you give your brain a chance to slow down with heart math and find that coherence. The more you can learn how to shift out of a hyperaroused state into a coherent state, coherence is where our intuition lives, energy lives, creativity lies. There is a lot of health benefits, like heart rate variability will increase. We want it to be higher. Heart rate variability is not just measuring your resting heart rate but measuring how much it changes in time. A good healthy heart is able to flux a lot. If you are on the lower end of that, which I tend to be at times still, I am experimenting with how I make this better. And you learn. Maybe I shouldn’t have worked out like that on that day. Maybe this kind of exercise helps.

Heart math has techniques to bring that in. One is heart-focused breathing, where you focus on your heart. I like to touch my heart. Some people don’t like to touch. I bring awareness by touching my heart, the area over my heart on the left side of the chest. Either focusing on something or closing my eyes for a little bit, and just breathing, a little more slowly and a little more deeply. That’s something that will start to train that coherence.

We can talk about heart math, too. Whatever you want to bring up. I think it’s really cool and a great tool for people.

Dr. Eric:

I agree. I have been using the Inner Balance for a number of years. I know others who have an Oura ring. You use the Oura ring as part of measuring the heart rate variability, keeping track of that.

Dr. Alexandra:

Mostly because I haven’t gotten an Inner Balance yet. I really like the Oura ring for that. They keep adding stuff. Now it measures blood oxygen when you sleep. It’s pretty good at measuring sleep. I find it cool when I do a great job of meditating, it will register a nap, which is awesome.

Dr. Eric:

Yeah, that is cool.

Dr. Alexandra:

We have lots of tools available to us to start to tune into how my body is actually doing. How many of us pay attention to them is another story. Those are two that I like. I don’t like the Apple Watch because it just yells at me to move every day even if my body is not ready for that.

Dr. Eric:

I haven’t thought about getting an Apple Watch. I have thought about getting an Oura ring, but I haven’t done it yet. I use the Inner Balance. Everybody is different when it comes to stress management, and I find myself not doing meditation. I’m not a big yoga person. Honestly, I haven’t tried getting into the routine of yoga. I have been in the routine of the Inner Balance and using it to measure heart rate variability for years. It works for me. I’m sure there are some listeners who have been doing yoga or meditation for years. You can continue doing what works.

As you said, there are so many tools. If there are those listening who said, “I tried getting into yoga and meditation, and it wasn’t for me,” it’s just another tool, whether it’s the Inner Balance, or the Oura ring is another option. I know there are others, too. There is a newer device that came out that someone was talking about on another podcast recently. I’m sure there will be many others in the future.

Dr. Alexandra:

There is lots out there. You also don’t really need a device if you’re capable of just checking in with yourself. One of the most challenging things I had a business coach ask me recently was I was ramped up about something. She was like, “Where do you feel this in your body?” It really stumped me, both because I am a high achiever, and I like to have answers, and I didn’t know. And thinking about it, where am I feeling it in my body? What is that telling me? It allows you to tap into that intuition. There are a lot of ways to do it. It’s just figuring out what works for you.

Dr. Eric:

Anything else that I should have asked you that you wanted me to ask you that I didn’t? Anything else you’d like to share?

Dr. Alexandra:

No, I think we hit a lot for people to think about. Bringing it full circle, it’s looking beyond your symptoms. The answers to whatever you’re dealing with, thyroid or anything else, is you have to go beyond the symptoms and be willing to get to know yourself in a new way. On the other side of that is a lot of freedom: freedom from medication, symptoms, and feeling crummy. It is possible. It takes time, and it takes a willingness to do the work.

Dr. Eric:

Definitely agree. Dr. Alex, where can people find out more about you?

Dr. Alexandra:

I’m on all the social places. I hang out more on Facebook and LinkedIn. I’m @EmergentWomanCoaching on Facebook and Dr. Alex Ridley on LinkedIn. I’m also on Instagram.

I also have a podcast, which I’m currently rebranding to The Selfless Syndrome Show. We are getting into some of the nuances of how you really overcome that. Not that there is something wrong with you, but to transform it to live and exist in the fast-paced world we have and be healthy. You can check that out on all the podcast platforms.

In this episode, I interviewed Berris Burgoyne about herbal quality. This was a great interview, as Berris discussed the herbs she uses in both her Graves’ and Hashimoto’s patients. Just to be upfront, the goal during this episode was not to promote any brands of herbs, but one of the main reasons I decided to do this episode was because for years, I had been recommending the MediHerb brand of bugleweed to my patients with hyperthyroidism. Due to the supply chain issues, it’s been on backorder for quite a while. I have noticed that other brands of bugleweed haven’t been as effective. I reached out to Berris because she is an expert in this area and has a lot of experience with MediHerb products.

***

With me, I have Berris Burgoyne, who is a renowned naturopathic clinician with 33 years of experience. She owns and runs a naturopathic practice in Brisbane, Australia. She is a well-known international speaker. She has lectured in Australia, New Zealand, the United States, Canada, the United Kingdom, and South Africa. What sets Berris apart as a speaker and educator is her ability to take complex technical data and transform it into practical, clinical information that is easy to understand and apply. This, coupled with her extensive clinical experience, makes her an authoritative and dynamic presenter. Thank you so much for agreeing to do this interview, Berris.

Berris Burgoyne:

Thank you very much. It’s a pleasure to be here with you.

Dr. Eric:

I’ve looked forward to this. Berris and I are going to discuss the importance of herbal quality and get into talking about bugleweed and other herbs that could benefit thyroid health. Can you start out by discussing the importance of the quality of the herbs?

Berris:

Certainly. I have been a naturopath, and my main modality in doing that for the last 33 years is herbal medicine. That’s where my real passion lies. I have always been very careful about the quality of the herbs I use. There is a brand in Australia that I use called MediHerb, which is also available in the United States. I have always used that brand of herbal medicine because I’m really confident in the testing procedures they use to make sure that they are giving the practitioners the very best quality herbs.

When we’re talking about herbal quality, it’s very complex. We have to start thinking about how the herb is grown. The reason we use herbal medicine is if they are full of phytochemicals, these magical ingredients, that have the activity in the body we are using them for. We have to think about how they grow and how they are harvested, how they are dried and how they are processed after that.

There is a lot of testing that has to go in when a company gets an herbal medicine in to make sure first of all, that it’s the correct species, that it’s the correct herb. They do a lot of different testing for that to make sure it’s not adulterated with anything because that’s not that uncommon.

Also, to make sure it’s the correct herb part that is used. Plants have lots of different parts. People don’t always differentiate between the different parts that are actually used. They will talk about the herb per se. Sometimes, you don’t know what part is used when doing research on an herb. A good example of the importance of this is something like nettle root or nettle. Most people would know of nettle, stinging nettle. We use the leaf in herbal medicine as a really good depurative herb, which is very good for the skin and internal cleansing. Then we use the root for prostate problems. We have to know what part of the plant we’re using. If we’re using the wrong part of the plant, then we’re not going to get the benefits we’re after. In many cases, we won’t get any benefits at all. That’s very important.

You have to test the herb when you get it in and make sure it’s the correct herb. You have to test during the procedure of making that liquid herbal extract or tablet. You have to test the finished product to make sure it still has the level of active phytochemical we need. It’s very complex. I feel very confident that the brand that I use really goes through all those steps to make sure we have good quality medicines. That’s what I want to give my patients. Ultimately, if I’m not giving them good quality medicine, we won’t see good clinical outcomes. That’s what I want for my patients, as we all do.

Dr. Eric:

That’s true. That’s definitely important. We want people to get better. Is it true, at least I’ve heard, that Australia has much higher standards when it comes to herbs compared to some other countries?

Berris:

Yes, we do have very high standards. We have the TGA, the Therapeutic Goods Association, that oversees the manufacturing of all medicines. Unlike the United States, in Australia, herbal medicines are classed as medicines. They are not food supplements or dietary supplements; they are medicines. Anybody manufacturing herbal products for sale to practitioners, etc., have to do it under what’s called GMP, Good Pharmaceutical Practice. That covers all medicines whether you are producing pharmaceutical drugs or nutritional supplements or herbal medicines. Any company that has that GMP/TGA license, they are set up in exactly the same way as a pharmaceutical company with the same stringent guidelines in place. They get audited. Auditors from the TGA can turn up and do an audit.

Dr. Eric:

You also mentioned different parts of the herb are important. This goes for all the herbs, like echinacea or ashwagandha. That is something that most consumers aren’t aware of. Do you see where, not to knock other companies, but some companies might use the wrong part of the herb? Maybe it’s because they don’t know any better, or it’s less expensive to use different parts of the herb.

Berris:

Mostly herbal medicine people will be using the right part because they know. Tribulus is a good example of this. In Western herbal medicine, we tend to use the aerial part of the tribulus plant, the leaves. Most people have heard of tribulus. It’s been used in other traditions of medicine. The fruits have been used. That’s a very valid medicine in that system of medicine for what they use it for. But when we’re talking about using tribulus to improve male and female reproductive health, for example, we need the aerial parts, the leaves, because that’s where all the research on that topic has been done. You do see in health food shops and over the counter sales tribulus, which is sometimes the fruit. That’s very valid, but you can’t think it’s going to help with these other things where the research has been done on the leaf.

I personally think if you’re going to a naturopathic physician or someone who is specializing in using herbs and nutrients, whether they are chiropractors, naturopaths, acupuncturists. Doctors sometimes go to a professional to get what you need because I’ve seen patients who have wasted a lot of money just going into health food shops and buying products that they have read about on the internet, or their neighbors told them about it or something. It’s not often actually what they need. You can easily waste a lot of money.

Dr. Eric:

That’s true. A lot of people read about something or watch a video and get it on their own. They might ask the person working at a health food store, who might just have very basic knowledge. It is a good idea to work with a qualified health care practitioner who has knowledge when it comes to the quality of the herbs.

Berris:

When you go into a health food store, those people have very limited time. They are giving you advice the best they can under the circumstances. But when you go to a practitioner, practitioners will be gathering all the information they need to prescribe very appropriately for you. That is extremely important.

Dr. Eric:

I also wanted to ask you the difference between using alcohol, specifically ethanol, versus glycerin. There are some people who are cautious about using herbs that have ethanol. Can you talk about some of the advantages and disadvantages of each?

Berris:

This is a really interesting topic. I can totally understand people thinking, “There is alcohol in this herbal medicine. I don’t know that I want to be using that. I’ll get the glycerin-based ones or glycetracts, as they’re called.” We’d probably all do that if it was viable to do that, but it’s not. The reason that alcohol/ethanol is used to make herbal extracts is that the ethanol is a fantastic solvent. It draws out the chemicals from that herb. Glycerin doesn’t do that. It doesn’t draw out phytochemicals of very many herbs at all.

The other thing is that ethanol is a very good preservative, whereas glycerin is not. You can get herbal extracts that have a shelf life of a few years depending on the level of ethanol in them. Even though glycerol is a nice idea, it doesn’t work for most herbs. One herb that it works very well for is marshmallow root. I use that in a glycetract in my clinic because it works well with marshmallow root. But for most herbs, it doesn’t work well.

You can buy liquid herb medicine that is a glycetract, but it’s not going to have the level of phytochemicals that you need to do the job that you’re using it for. Sometimes, companies will make ethanol water extract of the herb, and then they will take the ethanol off and add glycerin to it. That sounds like a good idea, too, except the problem with that is those constituents that are soluble in ethanol or alcohol are not soluble in the glycerin, so they drop to the bottom and don’t mix through properly.

I think most companies would be making glycetracts if it was viable, and you could make very good quality herbal medicines doing that, but you can’t. When you think about the amount of ethanol, if you were to get an herbal formula from your health care practitioner, maybe in that whole formula, there would be an average of maybe 40-45% ethanol. That sounds like an awful lot. You’re only taking a 5ml or 7.5ml dose in most cases. If you think about the level of ethanol in that, it’s not very much. It’s maybe a third or quarter of what you would get in 100ml glass of wine. I’m not sure what that is in ounces; I should have looked that up. I know you have wine in six and nine ounces, is that correct?

Dr. Eric:

I’m not much of a wine drinker, so I can’t tell you from experience.

Berris:

It’s much less than what you would get in a standard drink. Your standard drinks in the USA are much smaller than ours. I think they’re 150ml. If anyone wants to look that up in ounces, it gives you an idea. Very little alcohol in there. Our body is actually designed to metabolize small amounts of alcohol because we produce alcohol in our normal day to day metabolism. The liver is designed to metabolize small amounts at any one time.

When I think about this and get asked things like this, I have been in clinical practice for 33 years. I use a lot of liquid herbs in my practice along with herbal tablets. I have never seen an issue; I only have seen good results. Probably for the first 10 years of my clinical practice, I used only liquid herbs because we didn’t have any good quality herbal tablets in Australia. I used only liquid herbs. Every single one of my patients got maybe one or two different formulations to take.

Dr. Eric:

A small amount of alcohol, which I realize, but then also, it’s a better preservative, so it lasts longer on the shelf. Perhaps most importantly, it has a higher amount of phytochemicals, so it will have a greater therapeutic effect with the ethanol compared to the glycerin.

Berris:

Absolutely. Some herbs will work well with making them in alcoholic water extract and taking the alcohol off. Most herbs don’t. You’re not going to get good therapeutic activity if you’re not using good quality medicines. That’s the bottom line. Basically, you’re absolutely wasting your money.

Dr. Eric:

Before we started this interview, I briefly told you about my experience with Graves’ and how I took bugleweed, specifically the MediHerb bugleweed. Can you talk about bugleweed, some of the indications for those who are unfamiliar with it?

Berris:

Bugleweed is an herb that we use for hyperthyroidism, high thyroid function. The species of the one we use is lycopus virginicus. In Europe, they use a different species called lycopus europaeus. But they are exactly the same; they are interchangeable basically. The research is often done on the European one because that is where a lot of the research has been done.

There is definitely research to show that bugleweed, or lycopus species, is very good for reducing thyroid hormone in patients with hyperthyroidism, whatever the cause. Most times, when people have Graves’, for example, that is an autoimmune disease, and it is the most common cause of hyperthyroidism. There are other causes as well. Whatever the cause, lycopus is the key herb that you’ll use. For us, it would be bugleweed. In Europe, it’s called gypsywort.

That is the only use for it. You don’t use bugleweed for anything else because it will reduce thyroid. We want to do that if we have overactive thyroid, but not if we have poor or underactive thyroid. It’s an excellent herb. That is my key herb that I use in my practice to support patients with hyperthyroidism. It works extremely well.

Dr. Eric:

Same here. That is the main herb I recommend for those with hyperthyroidism because I had a lot of success with it. I don’t know if you have an answer, but I’d like to pick your brain on this. I find that bugleweed works for a lot of people, but there are some people where it doesn’t seem to work, and maybe they need to take antithyroid medication while trying to address the cause of the problem. I’m sure it’s not just bugleweed; I’m sure it’s other herbs as well. Can you talk about why bugleweed or other herbs might work wonderfully in some people but not in others?

Berris:

That’s a really good point. I treated a lot of thyroid conditions in my clinic. It’s one of the areas where I specialized as well. Partly because you said you had Graves’. I have a history of Hashimoto’s, which is an autoimmune thyroid disease causing hypothyroidism. When we have a condition, we know a lot about it. Mostly in my clinical practice, I have seen patients with hypothyroidism, and I have also seen a lot with hyperthyroidism, too.

My experience with hyperthyroidism is exactly the same as yours. Most patients will respond well to the herbal medications, but some, you just cannot get on top of it. They have to go on the antithyroid pharmaceuticals. That is something I think as practitioners, we have to face: Sometimes, what we do works, and sometimes, it doesn’t. Quite often, when we see these patients, they’re also under the care of a physician or endocrinologist. Often, we’re working in conjunction with them. You wouldn’t give bugleweed to someone who is already taking those antithyroid medications though. Don’t do that.

For me, my experience is that the hyperthyroidism is a little bit harder to treat than hypothyroidism. It depends how far advanced it is when you see the person. It depends on their underlying health of the patient, their lifestyle, a range of things. Sometimes, it comes down to genetics and how susceptible they are.

Dr. Eric:

Good point. I mentioned that I took the MediHerb bugleweed. One question I had is what differentiates the Mediherb bugleweed from other brands? I think you mentioned it. You said it uses the lycopus virginicus. For some reason, I thought it had a couple of different types of bugleweed.

Berris:

Mostly it would be lycopus. It might just say “lycopus species.” Lycopus species generally reduces thyroid function. Certainly the MediHerb is the one I use in my clinic as well. You can guarantee a good quality. It is what it’s supposed to be. There is no “Somebody has made a mistake when they harvested it or something;” that doesn’t happen here. It’s not adulterated with anything else. As I said, I’ve only ever used MediHerb in my clinic, so I don’t have experience with others. I do sometimes have patients come in and say, “Look, I have been using this, and it doesn’t work.” I say, “Try what I use, and I think it will probably work.”

Dr. Eric:

That’s why I wanted to bring it up. As of this recording, hopefully this won’t be the case too much longer, but the MediHerb bugleweed has been on backorder, so I haven’t been able to recommend it. Since then, I’ve had a number of people say that other herbs that they have been taking haven’t been as effective as the bugleweed. They were taking bugleweed, and once it was on back order, they had no choice but to switch to something else. Not to say the other herbs didn’t work at all, but I’m realizing how good of an herb bugleweed is because I do get people who mention that this brand is just not working as well. When we do a follow-up thyroid panel, it’s not having the same effect. That’s why I wanted to bring it up.

It’s a unique situation with it being on back order for so long. Seeing the effects of other herbs. To be fair, bugleweed is not like ashwagandha or milk thistle or other herbs where you can find those herbs in every single health food store or many places online. There is only a handful of companies that have bugleweed.

Berris:

Yes, that’s correct. For many herbs that we use in clinical practice, there might be “That’s out of stock,” or “I’m out of stock in my dispensary at the moment, so I can use this other herb instead.” When we are treating nervous system problems, for example, there is a whole range of herbs we can use. But when we are talking about bugleweed, there is no substitute. It’s bugleweed. It’s the herb for hyperthyroidism, to directly deal with the thyroid and reduce the production of the hormones. There is no substitute for that.

With things being out of stock, as a practitioner, since 2020 with the beginning of the COVID pandemic, supply chain issues. Everything that we deal with, including the medicines that we use. Manufacturers can’t get the raw materials because of supply chain issues. 100 ships are sitting off the coast of different countries waiting to dock and unload. Then of course, it’s getting things from the manufacturer to my clinic sometimes. It’s very difficult. As a practitioner, it’s been very frustrating, but it’s one of those things that we can’t do anything about. It’s happening around the world; it’s a thing of daily life really.

Dr. Eric:

Can we discuss some of the other herbs that can benefit thyroid conditions?

Berris:

For hyperthyroidism, if it’s an autoimmune disease, then as a practitioner, I would also treat the immune system to deal with that autoimmunity. If you can have an impact there, then of course, you can deal with the hyperthyroidism through that route as well.

What’s happening in Graves’ Disease, for example, is you have antibodies that sit on the receptors, thyroid stimulating hormone receptors (TSH). When those antibodies are reproduced, they sit on those receptors and keep telling the thyroid gland to keep producing more thyroxine, even when we don’t need it. That’s why our thyroxine goes high. If we can modulate the immune system so that we can maybe reduce the production of those antibodies, then we are also solving the problem, particularly when we do that along with the bugleweed.

For me, echinacea. Everyone has heard of echinacea. It is a great herb for immune modulation. There is some research showing that it can be beneficial in autoimmunity. That’s one herb I use a lot in my autoimmune patients, whatever the autoimmune disease is.

There are also other herbs, like an herb that comes from the Indian tradition of medicine called hemidesmus that I use a lot in my clinic. That is a very mild immunosuppressant herb. In my clinical experience, it tends to bring down the production of those auto antibodies. I might bind them with anti-inflammatory herbs, for example. I often give that in a tablet formulation, but sometimes in liquid. Echinacea, I use in tablet form. I use echinacea root. I use a combination of echinacea angustifolia roots because that is what I found works much better.

Dr. Eric:

It’s interesting that you mentioned echinacea because a lot of people are familiar with it when someone has a cold but not so much with autoimmunity. Some people are concerned about taking echinacea with autoimmunity. The concern is it might possibly exacerbate the autoimmune response, but in your experience, that hasn’t been the case.

Berris:

No, just the opposite in fact. Very early on, when we started using echinacea as a common herbal medicine, of course, the First Nations people in the United States have been using it as long as they have been there. That’s where we have gotten our traditional information about echinacea from.

In the early days of research with echinacea, it stimulates your immune system; therefore, it probably can make the immune system overactive, so it will worsen autoimmune disease. It was a lack of really good understanding about how echinacea works. There is evidence to show that echinacea primarily works on the innate immune system, and then we have the adaptive immune system, which has the antibodies. There is research to show that many people with autoimmune diseases have a deficient innate immune system. They think the origination of the autoimmune disease is a problem in the innate immune system. If we can use anything that can support the health of the innate immune system, then we are going to benefit from that. Not only in coping with the autoimmune disease, but also keeping the general immunity up to fight infection efficiently.

Echinacea can be taken long-term. We also read sometimes that it should only be taken short-term because it can wear the immune system out, and that is not great either. It does work better if it’s taken long-term. You don’t need a high dose to do that.

Dr. Eric:

When you say long-term, do you mean many months or even years?

Berris:

Years. I take it every day and have done so for many years. My college mentor has taken it every day of his life as well.

Dr. Eric:

I have heard that, too. I just want you to share your experience. It’s great you are letting people know not to be afraid of echinacea when it comes to autoimmunity.

Berris:

All of my patients who come to me with, say, Graves’ or hyperthyroidism, I would give bugleweed. I also give echinacea, and I also give that combination of hemidesmus and angustifolia. That is dealing with the autoimmunity and the hyperthyroidism very well. I will often also give them another herb called motherwort.

Dr. Eric:

I took motherwort as well when I dealt with Graves’.

Berris:

Motherwort, as far as I know, doesn’t have any direct effect on the thyroid, but it’s very good for some of the symptoms of hyperthyroidism, like the fast heart rate and that sort of thing. It’s a very nice for the nervous system to help keep people calm. That’s my approach for Graves’.

If we’re looking at Hashimoto’s, which is the most common cause of hypothyroidism, another autoimmune disease, then I use herbs like ashwagandha. It’s been shown mostly in animal research. A lot of the herbs that we have, due to funding issues primarily, we don’t always have clinical trials. For many of them, we do.

For ashwagandha, animal studies have shown that you can improve thyroid function and thyroid hormone output. It’s another one that I have used a lot. I use it in combination with bacopa. It’s an herb that we use for cognition, memory, etc. It’s another nice nervous system herb. That’s been shown in animal studies to improve thyroid hormone output as well.

I also use bladderwrack, which contains iodine. That is the main reason I use it. Iodine is a key constituent for thyroid hormone production. If you don’t have enough iodine, you can’t produce thyroid hormone in the body. That’s a really nice combination that I use to support improving thyroid function.

Dr. Eric:

For Hashimoto’s, you recommend ashwagandha, bacopa, bladderwrack. For Graves’, bugleweed, motherwort, hemidesmus, and echinacea. Correct?

Berris:

The hemidesmus and echinacea for Hashimoto’s as well.

Dr. Eric:

Hemidesmus and echinacea for both.

Berris:

For any autoimmune disease in fact. I sometimes use coleus for Hashimoto’s or low thyroid function. It does also improve thyroid output. It can also reduce body fat, which is sometimes an issue when you have low thyroid function. There have been a few clinical trials showing that coleus can do that.

Dr. Eric:

Interesting. I didn’t know that. Coleus can reduce body fat in some cases?

Berris:

Yes. You need a good dose of coleus to do that. I use coleus in my clinic as a tablet for that purpose and for low thyroid. The active constituent in coleus is called forskolin. In the clinical studies, they’ve used doses of forskolin per day that I can get, 50mg of forskolin per day in coleus in clinical studies. I can get that in using three of the coleus tablets in my clinic every day. That is what I use in my thyroid patients because it helps thyroid, but it also helps them to lose body fat as well.

Dr. Eric:

A couple of quick questions I know people are going to have. One is going to be the iodine in the bladderwrack. No question, iodine is necessary for thyroid hormone production. But there is some concern with iodine exacerbating some thyroid conditions, like hypothyroidism or hyperthyroidism, but also the autoimmune component. Same with Hashimoto’s. Some say to stay away from iodine completely, even from a food perspective. What are your thoughts on that? Obviously, you’ve had a good experience with the bladderwrack over the years with your Hashimoto’s patients. You yourself have it as well.

Berris:

Iodine can increase the level of the auto antibodies we find in Hashimoto’s. You probably need higher levels in order to do that. You can’t avoid iodine. You just can’t avoid it. Low thyroid function and goiter, which we don’t see so much now because we have an understanding of what causes it, and it’s iodine deficiency. There are certain areas in the world where the stores are very iodine deficient, including places in Australia. Before we realized what was happening, we would see a lot of people in those areas with goiter. You can’t avoid iodine. It’s not good for your thyroid, but it’s also not good for a lot of other tissues in the body. It’s not just thyroid that requires iodine.

The amount of iodine in the tablet I use with bladderwrack in my clinic is not very high. I have never seen an issue. However, sometimes, to be quite honest, most of this I have seen from out of the United States, where some people will advocate hugely high doses of iodine. Iodine is usually prescribed in the mcg dose, but you see them prescribing huge doses of iodine. I have never been a fan of that; I have never done that in my clinic. I have actually never prescribed iodine as a separate supplement in my clinic. When I give it to patients, it’s always in the bladderwrack. You have a complete herb there. It’s not just straight iodine. That is very important when we are talking about herbal medicine in particular.

If you have too much iodine, you can see Hashimoto’s occur as well. I have seen this in some areas of Japan, particularly on the west coast, where they eat huge amounts of seafood and seaweed, and they get huge amounts of iodine. They see a lot of goiter and Hashimoto’s there because of too much iodine. If you are taking some bladderwrack prescribed by your health care practitioner at the correct dose for you, you aren’t going to see those issues at all. It’s very important.

If we’re thinking, Well, should I be giving this patient something with iodine in it? We can prescribe iodine level testing for patients. I do a 24-hour sample collection, where I get patients to have that tested. That gives us an indication. Is the iodine already high? Obviously, I wouldn’t use it. But often, it’s low. It’s very rare that most people are supplementing with high doses of iodine or eating huge amounts of seafood, which we don’t see in most of our patients. Otherwise, they won’t have high iodine. It’s more likely to be low. When in doubt, as practitioners, we test.

Dr. Eric:

Good points. Ashwagandha. Some people are concerned about ashwagandha being a member of the nightshade family. Some people don’t do well with nightshades. I wanted you to mention that.

Also, with ashwagandha, since it can help in some cases with lower thyroid hormone levels to increase it, should those with hyperthyroidism avoid ashwagandha?

Berris:

People with hyperthyroidism should avoid ashwagandha. It’s a fabulous herb. It’s one of my favorite herbs, one of my most prescribed in my clinic. But it’s not the adaptogenic nervous system herb for hyperthyroid patients.

In fact, I have read some research, case reports, where a patient developed hyperthyroidism or was diagnosed with hyperthyroidism after taking reasonable doses of ashwagandha. It may well be that that patient already had borderline or undiagnosed hyperthyroidism, and the ashwagandha just made it worse so that the symptoms were much more obvious.

If you have normal thyroid function, and your thyroid is healthy, ashwagandha is not going to suddenly make it hyperactive. I don’t think I have a single patient in my clinic who hasn’t had ashwagandha at some time. Not for hyperthyroid patients.

As for being a nightshade plant, it is indeed. I have used it in patients who have a nightshade sensitivity without problems. One patient I had once, she said, “I absolutely cannot have anything in the nightshade family. Do not give me anything.” I never gave her ashwagandha. Sometimes, you don’t even know. Patients may not even think to mention they have a nightshade sensitivity when you see them at first consultation. It might be something they mention down the line later. They have been taking ashwagandha with no issue. It’s one thing in practice: we never get all the information in the first consultation.

Dr. Eric:

It sounds like most of the time, you don’t see a problem with your Hashimoto’s patients when it comes to ashwagandha. It is something you give pretty much to everybody, it sounds like. Just like with any herb, besides the nightshade, anybody could have a negative reaction to any herb. If it’s not agreeing with them, you will tell them to stop that herb.

Berris:

Absolutely. That happens in clinical practice. It’s what we call idiosyncratic reactions. Their reaction is very uncommon and totally unpredictable. It’s the same as how people can suddenly develop an allergy to nuts in mid-life that they never had before.

In my practice, if somebody comes back and says, “This herb doesn’t suit me. This is what’s happening,” then I will take them off of it. Most herbs, we can bring other herbs that will have similar effects.

Ashwagandha is excellent for the thyroid not only because of its seemingly direct action on improving thyroid hormone, but also, it helps to improve energy, and it keeps people calm. You would think with low thyroid, because it’s low metabolism, energy is low, but you can sometimes have thyroid patients who are very low energy but also feel quite anxious. They are not sleeping well, etc. Ashwagandha is very good for that.

Bacopa is also good for concentration and memory, which is lacking when you have low thyroid. It also gives you that nice nervous system support.

The beauty of herbal medicine is that all herbs have multiple activities, actions, not just one. If you give an herb to someone, we are not just doing one thing, we are doing multiple things.

Dr. Eric:

Ashwagandha is also great for the adrenals, which can also cause low energy. From what I understand, it can be taken whether someone has high cortisol or low cortisol, correct?

Berris:

Yes, it can. It supports the adrenals. The adrenal gland produces cortisol. If it’s producing too much cortisol, we need to support the adrenal gland, so it doesn’t wear out from doing that, which happens. Then we get very low cortisol. But if there is low cortisol, we need to support the adrenal gland to balance in producing the correct amount of cortisol.

What we are talking about here is not just the adrenal gland; we are talking about the HPA axis, the hypothalamus pituitary adrenal axis, which controls our response to stress. Herbs like ashwagandha support that whole HPA axis, not just the adrenals.

It’s called an adaptogen because they help us to adapt the effects of stress. When we are talking about the adaptogen’s effects on the adrenals, they don’t have a direct effect per se on the adrenals, but what they do is they spare the adrenals from the effects of the stress we’re experiencing. They are improving the activity of the whole HPA axis.

I think these adaptogenic herbs that we have, nature has been amazingly generous. I think these are the real key herbs for our modern lifestyles because they help us adapt to the stress that we experience. Most of them help to improve immunity in one way or another. Most of them will help to improve energy and sense of wellbeing. They are all things that are fundamentally essential in our modern lives.

Dr. Eric:

You’re right. One other herb I wanted to ask you about, if you have any experience with it, is lemon balm. That is also commonly given to those who have hyperthyroidism.

Berris:

Thank you for reminding me. Lemon balm can improve hyperthyroidism as well. It’s also a really nice calming herb. It does help digestion in some people if stress affects their digestion. That’s another one I often use in my hyperthyroid patients.

Dr. Eric:

Wonderful. I personally did not take lemon balm when I dealt with Graves’, but I do have some hyperthyroid patients take it. Bugleweed is my main go-to, as it is with you. Motherwort is #2 probably as far as the herbs that I give for those with hyperthyroidism. Lemon balm is on the list, too, for some people.

I want to respect your time, but is there anything else that you’d like to share? You shared so much, so if not, that’s fine. I appreciate the time you spent so far going over all these herbs.

Berris:

No. Thank you for the opportunity. As a practitioner, things that I think are really important, if you are going to feel better in taking herbal medicine or any medicines, is to see a health care practitioner in order to have the correct medicines prescribed at the correct doses and to be sure that you are getting good quality medicines. I personally would never go online and purchase an herbal medicine where I didn’t know it was made, how it was made, how it was overseen in the manufacturer.

When I went into naturopathy in college, I am still very altruistic, but I was under the assumption that the whole herbal medicine industry would be altruistic. It’s actually not. There is a lot of deliberate adulterations and substitutions, and there are a lot of accidental ones. You have to make sure you are using a product where all that testing has been done, so you are guaranteed you’re going to get good quality, safe herbal medicines.

Dr. Eric:

Well said. Thank you so much, Berris. Appreciate you sharing your knowledge. I learned a lot, and I’m sure the listeners did as well.

Berris:

Thank you very much.

 

Recently I interviewed Kevin Ellis, known as “the Bone Coach”, as he discusses how to increase bone density, how osteoporosis and osteopenia are diagnosed, risk factors for bone loss, risks vs. benefits of osteoporosis medications, natural sources and supplements to consider adding to your diet, the most beneficial types of exercise for your bone health, and more.. If you would prefer to listen the interview you can access it by Clicking Here.

Dr. Eric Osansky:

With me, I have Kevin Ellis, who is also known as The Bone Coach. Kevin is a certified integrative nutrition health coach, podcaster, YouTuber, bone health advocate, and the founder of BoneCoach.com.

After an osteoporosis diagnosis in his early 30s, Kevin realized just how challenging it can be for the average person to make sense of what needs to be done to improve and how to move forward confidently with a stronger bones plan. Today, not only has he transformed his own health and made continued progress on his own journey, but he has now dedicated his life to helping women with osteopenia and osteoporosis gain clarity and confidence that improving is possible. Through a unique three-step process and world-class coaching programs, Kevin and his team of credentialed experts have helped people in over 1,500 cities around the world get confident in their stronger bones plan. His mission is not just to help one million people around the globe build stronger bones, but it’s also to help our children and grandchildren have the education, resources, and nourishment needed to prevent osteoporosis and other diseases in the future so they can lead a long, active life. That’s what we’re all here for.

Kevin, It’s a pleasure having you here.

Kevin Ellis:

Thanks so much for having me here. It’s great to be here.

Dr. Eric:

It’s great to chat with you. Why don’t we dive in with your background? If you could please let us know how you got started on this journey helping women with osteopenia and osteoporosis.

Kevin:

Absolutely. A lot of times, when you hear about osteopenia or osteoporosis, you’re not talking about a 30-year-old male. You’re talking about women, 50s-70s, or maybe the grandma who had fractures, hunched over, or was walking with a cane. You’re not thinking about the 30-year-old male.

For me, I was shocked when I was told I had osteoporosis. The great majority of my younger years, I was really active. I went into the Marine Corps and spent five years there. I got out of there and had these health issues that came to fruition and the surface. I had high stress, poor sleep, really poor energy. I could barely get out of bed some days. I had all these other health issues that started taking place.

Then I found out I had Celiac Disease, which is an autoimmune condition where the villi, these nutrient absorption centers in your small intestine, become damaged when you consume gluten. For me, my villi were becoming damaged and blunted to the point where they couldn’t do their job. They couldn’t absorb those nutrients that I needed that were so important. My body still needed those minerals and nutrients to execute its daily functions. It went to the bones, which are our greatest source of mineral reserves, and pulled from the bones. Then it only makes sense that I was subsequently diagnosed with osteoporosis right around 30 years old.

It was actually a physician’s assistant. It wasn’t even a doctor I was working with at the time. None of my doctors said, “Let’s do a bone density exam. You have Celiac.” It was actually a physician’s assistant who asked me, “Have you done this?” I said, “No.” They told me to do this. We both thought it was going to come back as normal.

When I got the results back, they sent me a letter in the mail. They didn’t call me or anything else. The letter said, “You have osteoporosis. Go on a gluten-free diet.” That was it. I remember reading that letter, and the blood drained from my face. I had tingles. What does this mean for my future, especially after I started Googling what osteoporosis was? All I saw was fractures and medication dependency for the rest of my life. It was scary.

At that point in time, I didn’t mention this before, but my father passed away at a really young age, when he was 35 years old. At the time he passed away, I was two months old. My entire life, I had this fear that I was going to follow in his footsteps to an early grave and not be there to be a father for my own kids. That was my biggest fear in life. I had a young daughter and a son on the way. I thought I was headed down that path. It was a living nightmare.

I realized at that point, I had to do something. I started doing a lot of reading and research and consulting with people. I spent a lot of money on food and supplements. I have an osteoporosis atlas. It was the most expensive book I ever bought on the topic. I have just about every book on the topic. I don’t recommend this to anybody. This is the level of research I was going to do to figure this out.

I started getting the right plan in place. I improved my health and my bones. I realized it’s not the average 30-year-old male who needs help. It’s the women in their 50s, 60s, 70s who is told they have osteoporosis and are presented with calcium, Vitamin D, go for a walk, take a bone medication, we’ll see you in one year for your next bone density exam. I’ll tell you that’s not enough.

That’s the reason why I became the Bone Coach, a certified health coach, built out a team of credentialed experts, now have launched a program called The Stronger Bones Solution that has helped people in 1,500 cities around the world, and launched BoneCoach.com. That is my journey of getting into and becoming the Bone Coach.

Dr. Eric:

That is some story. Obviously, cutting out gluten was important for someone with Celiac, so it was a piece of the puzzle. You did a lot more when it comes to, not just in the past, but currently, to maintain healthy bones now.

Kevin:

It is so much more than just going gluten-free. If you are Celiac, gluten-free is a must. It’s not a negotiable thing. It’s not like eating a little bit of gluten from time to time, and you’ll be okay. No, you have to remove it from your diet completely.

Dr. Eric:

When it comes to osteopenia versus osteoporosis, I’m sure some listening know the difference, but some people have heard of osteoporosis and may not be familiar with osteopenia. Can you differentiate between the two?

Kevin:

Let’s talk about what osteoporosis is. Osteoporosis means literally “porous bone.” It’s a condition characterized either by not enough bone formation, excessive bone loss, or a combination of those two things. In osteoporosis, both your bone density and your bone quality are reduced, which is going to increase the risk of fracture.

The way you find out you have osteoporosis is through a bone density scan, also called the DEXA scan. This is dual energy X-ray absorptiometry. It’s a painless test. Kind of like an X-ray, but low levels of radiation. You lay down on the machine, the machine does the scan, and it tells you your bone mineral density, the actual mineral content of your bone. Then it generates a score, which is called the T score.

The T score is telling you how much your bone mass differs from the bone mass of an average, healthy, approximately 30-year-old adult. If you have a score of +1 or -1, that is considered normal and healthy. If you have -1 to -2.5, that is considered osteopenia, also called low bone mass. That is a precursor to osteoporosis. If you have -2.5 or lower, that is considered osteoporosis. The greater that negative number becomes, the more severe the osteoporosis.

Most people are getting a DEXA scan, most women especially, in their 50s, 60s, 70s as a check in the box. Their doctor will order it, or they may not order them. You may be listening to this and thinking you haven’t had one yet. That is not uncommon either. If you have not had one, get one. You want to get this objective information, and you want to get a baseline from which you can monitor future changes.

If you had a parent or someone you know who had osteoporosis or a lot of fractures, and you are avoiding getting that information because you don’t want to know, that is not a good strategy. We don’t want to avoid doing something because we don’t want to know what the answer could be.

Dr. Eric:

What age do you recommend starting as far as getting a DEXA scan? 30s or earlier than that even?

Kevin:

Especially the women I am talking to in their 50s, 60s, and 70s who have daughters, I’m telling their daughters to go get a bone density scan. You’re reaching peak bone mass right around 30 years old. If you get a bone density scan in your 30s, that is a great baseline to have. You can monitor future changes in your 40s, 50s, and so on and so forth.

Especially when you get to a point where you hit menopause, you will have a reduction in hormones, which will impact your bones. You can lose up to 20% of your bone mass in a five-year period after you go through menopause. Really important to know that. A lot of people don’t understand that.

Dr. Eric:

Obviously, more common in women, which is why you focus on women. You’re a guy. You got diagnosed with osteoporosis. I will quickly ask: Should men also consider getting a bone density scan? I’m going on 52 this year, and I have never gotten a bone density scan. This chat makes me think, maybe I should get one.

Kevin:

Men should absolutely get their bone density scan, too. It’s not just women who are affected. We know primary osteoporosis is related to a decrease in estrogen in post-menopausal women. Estrogen has a reductive effect on bones. When estrogen levels decrease, as they do during menopause, that causes an increase in the activity level of cells that break down bone.

There is another cause of osteoporosis called secondary osteoporosis. This is where osteoporosis occurs as a result of behaviors, disorders, diseases, medications, and other factors. Men will fall into those other factors. Especially if you have overt digestive issues, Celiac, Crohn’s, ulcerative colitis, even thyroid conditions, or maybe you were taking specific medications for a long period of time. I can talk specifically about what some of these things are. Your bones could have been impacted.

For me, 30-year-old male, former Marine with a background in weightlifting, you would never think that I would be told I had osteoporosis, but I was. It was a total shock. It’s always good to get that information, know where you stand, and then the younger you are, the more things you have in your favor. It’s not saying the older you get, it becomes impossible. That’s absolutely not the case. You can build bone strength at any age. It just becomes more challenging the older you get and the more bone you lose. There are fewer cells involved in that process. That process becomes less efficient. We want people to be on the side of prevention, not reaction, and to get that objective information as early as possible.

The other thing I’ll mention about men, and this is just an observation that I have made, is that men are more likely to see this as a suck it up condition. I’m tough. I can handle it. Trust me, this is coming from a guy who thought he was pretty darn tough for quite some time. This is not a condition that is one of those you can just suck up. It’s really important to make sure you objectively figure those things out.

Dr. Eric:

Let’s go over some of the causes in greater detail, like the medications. As women, going into menopause. Can you dive deeper?

Kevin:

Absolutely. I know you talk a lot about thyroid. You and I did a podcast on thyroid, too, that we can refer people to also. Let’s talk about thyotoxicosis. That can be a contributor. That refers to having excess circulating thyroid hormones. That can be hyperthyroidism, overactive thyroid. That occurs when your thyroid gland produces too much thyroxine. You could have thyroiditis, inflammation of the thyroid gland. Iodine-induced and drug-induced thyroid dysfunction. Excessive intake of thyroid hormone in patients with hypothyroidism can also be a contributor, too. These can be some of the things that are contributing from a thyroid perspective to bone loss.

Let’s talk about some of the other more common ones as well. There are medications specifically that some people aren’t even aware of that can contribute to bone loss that they have been taking for quite some time. One is glucocorticoids. This would be prednisone, cortisone. Glucocorticoids are steroid medications designed to suppress inflammation. They mimic natural steroid hormones produced by your body and are used to treat conditions like asthma and autoimmune diseases like rheumatoid arthritis.

The reason they contribute to bone loss is they are reducing the gastrointestinal absorption of calcium, which is increasing the urinary excretion of calcium. That is also going to lead to a calcium deficit. You are not absorbing; you are excreting more; you have a calcium deficit, which is the primary mineral of your bones.

The biggest impact is that glucocorticoids act directly on the cells that break down bone, osteoclasts, to increase their life span. It ends up reducing bone density. That is a really big one to be aware of. If you are taking that medication or considering taking it, it will contribute to bone loss.

Another one is SSRIs, selective serotonin reuptake inhibitors. These are a class of drugs typically used as antidepressants. There was a review of 19 studies on the effect of SSRIs on bone that show they have a negative impact on bone density and increase the risk of fracture.

Also, antacids. These are drugs that reduce the production of or increase the suppression of stomach acid. A lot of times, when people are considering taking these medications or are taking them, they have heartburn or reflux. When you have those things, a lot of times, you have too little stomach acid. People take these medications to suppress what little stomach acid they do have. This would be your Omeprazole, Nexium, Prevacid, and H2 receptor antagonist drugs like Pepcid and Zantac.

The reason suppressing stomach acid is a problem is you need stomach acid to break down and extract nutrients from your food, like amino acids, the building blocks of protein. Your bones are 50% protein by volume. You need a constant supply of amino acids, calcium, magnesium, iron, B12. If you have low stomach acid, your body will be starved of these nutrients. You won’t be getting the nutrients you need.

Long-term, there are plenty of studies that show just using these medications will not be good for supporting your bone health and can have a negative impact. That is important to understand.

I already talked about GI conditions. Celiac is a big one. Ulcerative colitis, Crohn’s. Those are also big ones.

In terms of autoimmune conditions, when we are talking about these, Ankylosing spondylitis is one that primarily affects the spine and the vertebrae.

Rheumatoid arthritis is one where the body’s mistakenly attacking the joints. That is creating inflammation inside the tissues and joints that also can lead to bone loss.

Lupus is another big one that can contribute to bone loss as well. Anything that is contributing to inflammation in the body is going to be fueling those osteoclasts and extend their life span and continuing to break down bone, which will contribute to bone loss.

Dr. Eric:

When you interviewed me, I spoke about that, too. The research I did when I was looking at the impact of Graves’ and Hashimoto’s, thyroid autoimmunity, on the bone showed that the inflammatory process from those conditions has a great effect. It’s not just the thyroid hormone imbalance. That translates to other inflammatory conditions, so I’m glad you mentioned that as well.

Medications. Let’s talk about medication that they typically use as treatment for osteoporosis. You spoke before about some of the meds that could increase the risk of osteoporosis. You said if you go to a conventional medical doctor, they will recommend calcium, Vitamin D, walking, and some meds. Can you talk about the risks versus benefits of meds for osteoporosis?

Kevin:

This is a great topic because it will come up. If someone is diagnosed with osteopenia or osteoporosis, they are going to have a bone medication recommended to them most likely at some point. 90-95% of people I talk to, that is the situation they are in. They get diagnosed. In a 15-minute window, they get their bone density results back, are told they have osteoporosis, and are handed medication. There is very little education around the big picture of medication. Let me give you that education right now at a high level.

The first thing I want to point out is these bone medications are not like taking an aspirin. They have a dramatic effect on bone physiology. That is the first thing we have to understand.

There are two different categories of drugs: antiresorptive drugs, which are designed to slow down the resorption or breakdown part of the remodeling process. They are reducing the rate of bone breakdown and reducing bone formation. Then, we have another class called anabolics. I will talk about those in a minute.

Antiresorptives are like bisphosphonates. Fosamax is a common one. Or RANKL inhibitors. Prolia is one you have probably heard of. With bisphosphonates, there are a lot of side effects: bone/joint/muscle pain. One of the biggest ones I hear from people is digestive issues. If you have digestive issues, you are probably going to have issues absorbing your nutrients, too. Some of the side effects that can happen but happen less, like osteoporosis in the jaw. That occurs when the jawbone begins to starve from lack of blood. You have cells in the jawbone that can start to die. That’s rare, but it’s something to be aware of, too.

The biggest concern with these bisphosphonate drugs is the safety and efficacy of the drugs are for patients who took them for less than five years. I have people who come to me who are on these drugs for eight or ten years. That’s a long, long time.

The reason that’s a problem is because, as all of us, we are going about our daily lives, doing our activities. We are starting to get these tiny, little, micro cracks in our bones; it’s normal. Then what happens is we have these cells in the bone that send out a signal; they say, “Hey, we have damage to the bone.” We have these bone-resorbing osteoclasts that come in and scoop out that damage. Right behind them, we have these osteoblasts, building cells, that form new, stronger, healthier bone.

When you are taking antiresorptive medication, if you slow down the activity level of that cell that is scooping out the damaged bone, over time, you start to accumulate that old, worn, damaged, weakened bone. That is one of the most important things that can ultimately lead to loss of structural integrity and strength in that bone. A lot of people don’t know that.

The other point is if you start something like Prolia, which is a RANKL inhibitor, you can’t just come off of it really quickly. It can actually increase your risk of vertebral fractures. You need to understand that if you are starting out on a medication, there are implications later on for you stopping that medication. It could require another medication after that.

Let’s talk about the other class of medication, anabolics. These are drugs that are designed to build bone and build it faster. They are stimulating the formation part of this bone remodeling process. What happens is more bone ends up being formed than is taken away.

Usually, the people who are recommended these drugs are those who have had low or no trauma fragility fractures. They have poor quality bone. They need a medication to help them build good quality bone. These drugs can help build that bone. They can help build better quality bone.

But what you have to understand about these medications is that you can only take them for a certain period of time, about 13 months-2 years. After you finish it, you have to follow it with an antiresorptive. Otherwise, you will lose all that bone that you just spent years of time taking medication for.

I have seen situations where people who had no business being prescribed an anabolic medication were being prescribed an anabolic medication. It’s really important for people to understand that you may be getting to a point where you are going on this endless cycle of medication, not even knowing it, just by starting out with that first doctor’s visit.

Dr. Eric:

It sounds like there might be a time and place for the anabolic medication. If they are on it, typically, they are on it for 13 months-2 years. Then they have to take the other medication to maintain what they built up. Is that correct?

Kevin:

Yes. I would say most of the people coming to us are trying to do everything they possibly can naturally before considering the medication option. There are situations where some people have had 5-10 or more fractures, which is an indicator of really poor quality bone. A lot of times, in those situations, there may have to be a quick intervention, which could be necessary and lifesaving.

I am not pro-medication; I am not saying you should take a medication. I’m saying you need to make an educated and informed decision. Most people don’t need a medication at all when they are prescribed one. That is my personal opinion that I have seen. It’s not necessary. But there are some situations where that may be necessary and lifesaving.

Dr. Eric:

Makes sense. Obviously, you want to try to do things to address the cause of the problem. These people aren’t deficient in any of these medications. There might be some situations where it’s really extreme. Maybe it’s a good idea for them to take it.

Let’s say if someone is listening to this, and they are already on one of those anabolic drugs, I assume they could switch gears if they want to and just take more of a natural approach. You won’t tell them to stop taking the medication, but if they make that decision on their own, they could stop taking it on their own or under the guidance of a prescribing doctor.

Kevin:

For sure. This is not me giving medical advice for any individuals because we are talking about the medications. If you are on an anabolic medication, if you have already started it and been on it for any length of time, you will need to follow it with an antiresorptive medication. Otherwise, the entire reason you’re taking it is going to be washed away. You’re going to lose everything you gained.

What happens is when you take an anabolic, yes, it speeds up the cells that build bone and build it faster. But it also speeds up the cells that break down bone. In order to build new quality bone, you have to speed up the osteoclasts, too. If you don’t slow down that train, that’s what’s going to happen after you come off of that. We have plenty of people who have been on an antiresorptive medication who are like, “You know what? I don’t think this is the right fit.” They decide to stop using it and are just fine. That’s not me telling anyone here specifically in your situation, but I would say most of the people that we encounter, they can do a lot of things naturally to build stronger bones and set themselves up for an active future.

Dr. Eric:

Speaking of doing things naturally, let’s talk about food. Is there any diet or specific foods that can help to improve bone density?

Kevin:

Whenever I talk about food, I always like to start out by saying there is no one single dietary approach for every single person, or one specific set of foods that are only good for every single person. Now, there are some uniform things that I would suggest to most people.

You have probably beat this down, and I am going to put one more nail down in this coffin: sugar. Reduce your sugar intake. It’s key for bone health. Sugar will damage your bone by triggering an inflammatory response. It will lower your Vitamin D levels; deplete bone healthy minerals like magnesium, calcium, copper, and chromium; inhibit intestinal absorption of calcium; and block the absorption of Vitamin C. Vitamin C is key for maintaining a healthy skeleton. I will talk about that in a bit.

Your breads, cakes, cookies, crackers, pizzas, and pastas break down into sugar. That won’t be the best thing for your bones. Make better swaps. Get those things out of your life if you haven’t already. Find better alternatives for some of those things that are your favorites.

The other thing I would say is chemicals. If you can get food that’s organic or from your local farmers, go to your farmers’ market and ask them at the table, “Do you spray?” They will tell you if they do or not. Ask those questions.

You can always go to the Environmental Working Group. They have the Dirty Dozen and the Clean 15. If you are on a budget, they will tell you where you can get the most bang for your buck for organic. Don’t ever eat non-organic berries, especially strawberries. Those will be laced with lots of different chemicals. We want to make sure we look at that list. That’s a good starting point.

In terms of general dietary principles, if you are looking to handle an autoimmune condition, or you have Hashimoto’s or Graves’ or something like that, your dietary approach is probably going to work to put that autoimmune condition into remission. Your dietary approach may be different than somebody who is not working to put an autoimmune condition into remission. Those are just some important things I like to preface when I start talking about food.

Now, there are some foods that I’ve found that are pretty universal for most people that work really well for a lot of people. The first one is fish. Not just any fish. I would talk about fish with the bones in them. This would be canned fish. Non-BPA lining. We don’t want the BPA.

Dr. Eric:

Sardines.

Kevin:

Sardines, mackerel, wild salmon. You can find wild salmon with the bones in. The reason you want the bones in is because these bones are a natural source of not just calcium but all the other minerals that your bones need with the right co-factors and the other nutrients in nature’s perfect form. It is a great source of calcium and other minerals.

The other reason I like these is because they have protein. Protein breaks down to amino acids. Your bones are 50% protein by volume. You need these amino acids. Also, to support muscle building. Muscle and bone have a really important relationship together. You need to be able to support stronger muscles, and that’s why you need additional protein.

The other part of fish I like, especially canned fish, is they are easy to take to go if you are hiking or doing activities or on vacation. Throw them in a pack. Don’t open them up on an airplane. They smell horrible; people will hate you for it. Don’t get fish juice on yourself. I’m not making the case here for mackerel and sardines here, I know that.

But they have Omega-3s. These are fatty acids that can help dampen inflammation. Like Dr. Eric and I were talking about, anything that contributes to inflammation contributes to bone breakdown. That’s a big star for me. I really like that one.

Another one of my favorites is arugula. I have been talking about arugula for years. It’s a leafy green. Same cruciferous family of vegetables as broccoli and kale. It’s rich in potassium, folate, Vitamin C, Vitamin K, and calcium. All of those are important for bone health. You can get a great bioavailable source of calcium from arugula.

This is super interesting. There was a recent study that found a bioactive compound in arugula called erucin that helps turn off osteoclasts, those bone breakdown cells, which is awesome. It’s amazing. I didn’t even know this when I first started consuming arugula. Now, it’s just confirmed: Arugula is a great food for bone healthy diet.

There are two other reasons I really like arugula. One is it’s a bitter food. Our diets nowadays don’t have a lot of bitter foods in them for the most part. The reason we want bitter foods in our diet is they stimulate bile production and bile flow. Bile is produced by the liver and stored in the gallbladder. When you are consuming foods, it will help break down your foods, so it’s important to have.

The last reason is arugula, unlike spinach, a common green a lot of people use, is low in oxalates. I don’t ever like to vilify foods, other than candy, usually. Spinach has some great nutrients in it, but it’s high in oxalates. Oxalates are an antinutrient that bind up bone healthy minerals like calcium. They will prevent you from absorbing them. If you’ve got digestive issues or kidney stones, arthritis, or joint pain, those can be some indicators that you have a hard time breaking down and degrading that oxalate. You might not have the intestinal bacteria, oxalobacter formigenes, to break them down. You can swap spinach for arugula. If you need any other reasons to why arugula should be added in your diet, give it a shot.

One of my other favorite foods is Vitamin C-rich foods. You heard me talk earlier about why we shouldn’t consume sugar because it will block the absorption of Vitamin C. Vitamin C is super important for general health. We all know that. If you remember, our bones are made up of this collagen protein matrix upon which minerals are laid. Vitamin C stimulates pro-collagen, enhances collagen synthesis, and stimulates something called alkaline phosphatase activity, which is a marker for osteoblast, bone building cell, formation. That’s pretty cool.

Some of the best fruits, berries, citrus like lemons and limes, plums, cherries are all great ones. In terms of Vitamin C-rich vegetables, for those with autoimmune conditions who are putting those in remission, you don’t want to eat red and yellow bell peppers, but those are great sources of Vitamin C. They are also a nightshade, so if you are on an autoimmune protocol, you won’t be consuming those. You can get dino kale or lacinato kale, lightly steamed broccoli, Brussels sprouts. You can incorporate those. Those are some other good options to start incorporating into your plan.

Dr. Eric:

A number of years ago, I used to stuff my smoothie with spinach. Then I did a test from Great Plains Lab, their organic acids test, that looks at oxalates. Mine were definitely high. There were other high oxalate foods I was eating, but that definitely was the top oxalate food. That was the main change I made. I cut out the spinach and did add arugula. I can’t say I have eaten that as regularly as I should have because I didn’t realize how much calcium it has. I try to diversify when it comes to the greens and other vegetables. I did a retest of the Great Plains Lab. Sure enough, the oxalates decreased just with that change alone.

I was eating more nuts than I should have been eating, which are higher in oxalates. I can’t say I completely avoided the nuts. Berries, raspberries, higher. Anyway, you can’t completely avoid the oxalates, but the spinach is a big culprit. You’re right. It doesn’t mean that people can’t have spinach every now and then, but there are people who are doing what I was doing years ago, either stuffing their smoothies with spinach or having a lot of spinach in other ways. It has a lot of calcium, but not the bioavailable type of calcium that is found in other foods. I do need to incorporate more arugula into my diet.

Kevin:

I want to touch on one other thing here. You highlighted something that’s really important. I was also trying to talk about how I don’t like to vilify specific foods that could have healthy nutrients or could be in a dish you’re going to consume infrequently. What I don’t want people to do is develop a fear around some healthy paleo spinach casserole that somebody made for Thanksgiving, and they are completely avoiding something that they would possibly enjoy because it has this one food in it.

Same thing with beets. Beets are high oxalate. Cacao and dark chocolate, high oxalate. You can still enjoy those things from time to time. If you have issues with oxalate, you won’t be eating those every single day.

Dr. Eric:

Some are higher than others. I attended some of the Great Plains Lab workshops. They said spinach is by far the highest oxalate food. Even if you cook it, it might decrease the oxalates a little bit, but it won’t lower it from being a high oxalate food to a lower one. It’s still going to be a high oxalate food. I agree. Even with spinach, every now and then, or beets and sweet potatoes, you could drive yourself crazy trying to completely eliminate oxalates. A) You won’t be able to do it. B) You don’t need to do it.

You mentioned the importance of muscle when it comes to bone density. Can you talk about exercise and what types of exercise? I’m guessing resistance training based on what you just said.

Kevin:

Exercise is super important for your bone health. If you have younger kids, this is also important for them. By the time you turn 18, you have put on 90% of your bone mass. As you’re younger, you’re in these years that you’ve got a great chance to build a solid foundation for the rest of your life with your bone health. Get your kids in gymnastics. Get them playing sports. Soccer players do a lot of running in multi-directional ways. They have stronger bones in their legs.

The reason for this is that your bones need two different types of stimuli. They need muscle pulling on bone, and you need impact. The most effective interventions are using one or both of these in combination. You need muscle pulling on bone to become stronger, so you have this mechanical signal sending a chemical signal to tell those bones to become stronger.

Usually, what you’re going to be told to do, if you’re in the doctor’s office, and you have osteoporosis, they will tell you to do weight-bearing exercises and walking. You know what? Walking is great for your health. If you’re doing it now, keep doing it. But do not count on that as your only form of exercise. You need to do more than that. It could help you maintain your bone density in certain areas of your body, but it’s not going to help you build bone density. You need to incorporate other weight-bearing exercise.

When I say weight-bearing exercise, that’s where your muscles and your bones are working against gravity to keep you upright. They are exercises you’re doing on your feet. Doing that on your feet, where you are working against gravity, you are placing stress on your bones. That’s a good kind of stress that we want. This would be your running, hiking, jogging, gardening, playing tennis, aerobics, jumping rope, climbing stairs, playing soccer with the kids or grandkids. All of those things are included in weight-bearing exercise. It also includes things like tai chi, yoga, Pilates, dancing. Those kinds of things can also be weight-bearing. If you’re doing those, keep doing them. That’s great.

Now, there are also some things called non-weight-bearing exercise. This is where your body is not working against gravity to keep you upright; you’re not placing that stress on your bones. This is the same situation that astronauts go up to space. Working against us to place that stress on our bones. They end up losing bone density over certain periods of time. We have to actively work against that. The exercise that we could be doing, non-weight-bearing, would be cycling, kayaking, seated stretching, seated exercises, or the biggest one is swimming. Swimming is a big one.

What I’m not saying is that if you’re doing these things now, if you’re riding your bike, you’re swimming, and you’re putting in some laps in the pool, or doing some kayaking, that’s great. If it makes you happy, if it reduces your stress, do it. But don’t overdo it. Don’t count it as your only form of exercise. It’s not going to be enough to stimulate what your muscles and bones need.

What is the other type of exercise we have to incorporate to give our bones what they need? Resistance training. This is where you’re using dumbbells, resistance bands. Could be even your own body weight if it gives you that level of intensity. You may be thinking, “Oh my gosh. Muscle strengthening. I have to be a body builder.” No, you don’t. You don’t have to be in that position. You just have to be able to do these exercises at an intensity that stimulates your muscle and your bone.

What intensity level is that at? The studies show the greatest effect on bone is in the 5-10 repetition range. There has been a lot of work done by Dr. Belinda Beck and some other research. They looked at things like overhead presses, deadlifts, squats, chin-ups with drop landings. Those were all effective.

If you are listening to this and are like, “I have never done a squat or a deadlift before. That’s so intimidating.” Don’t just YouTube it and knock out some sets. Understand it’s okay to expand what you may not be familiar with. Just do it safely. Find somebody who can help guide you through that. Get your proper body mechanics down. Make sure you’re doing the right things. Let’s slowly progress you to the point where you’re actually building muscle and bone strength.

This is not a quick fix. Bone health is not a quick fix. It’s not like you can get two good workouts in every other week, and your bones will be noticeably stronger. This is a long game. Play the long game with your bone health.

Dr. Eric:

You spoke about certain foods and just covered exercise. Do you have time to go over supplements a little bit? I’m sure people are wondering about calcium. I know you don’t recommend high dose calcium supplements. If you could talk about that, Vitamin D, and some other ones you might recommend.

Kevin:

Vitamin D is super important, not just for your overall health, but for your bone health. It’s not just a vitamin; it’s a hormone. It induces the transcription of more than 50 genes. It increases the intestinal absorption of calcium. It promotes higher bone mineral density. It will help lower fracture risks. It’s super important for our bone health.

Your best source of Vitamin D is going to be the sunlight. Midday sunlight, UV ray radiation. Bare skin, no sunscreen. 5-30 minutes a day in those warm months. Just enough not to burn. If you can go longer, that’s great. That’s the bare minimum for your best source of Vitamin D.

But most people aren’t even getting that in the warm months. We’re covered up. We cover up in our hats, our sleeves, our chemical-laden sunscreens. For sunscreens, when you get to the point where you have already gotten your sun, just enough to the point where you won’t burn, use a mineral-based sunscreen.

In terms of dietary sources, you can also get Vitamin D from salmon, herring, sardines, anchovies, oysters, and egg yolks.

With supplementation, you never want to supplement blindly with Vitamin D. You always want to test your levels. Test your 25 hydroxy Vitamin D levels. If you’re going into fall or winter wherever you are, there is a likelihood you will increase the level of supplementation you’d be using to maintain a healthy level of Vitamin D. It’s an important one to incorporate into your plan.

Vitamin K2. This is one that not everyone is too familiar with, but let’s talk about it because it’s super important for your bone health. You probably know about Vitamin K, and maybe K1. K2 is important because it aids in bone mineralization formation by activating something called osteocalcin. This is going to ensure that calcium is deposited in our bone and not our soft tissues like the arteries and kidneys.

There are different forms of K2. There is an MK4 form and an MK7 form. The MK4 form will be found in beef liver, grass-fed ghee and butter, dark meat chicken, pastured egg yolks, emu oil. MK7 is going to be found in things like hard cheeses, fermented foods, sauerkraut, kimchi, natto (which is the greatest source, but most people won’t be eating a lot of natto). This is a really interesting one. Bacterial fermentation in our guts can actually help produce Vitamin K2 as well. If you’re not getting enough K2, which most people aren’t, consider supplementation there as well.

Vitamin C. I talked about how important that was. Obviously, we want to try to get as much Vitamin C from our diet and nutrition. Sometimes that’s not possible. Incorporating that into your plan could be helpful.

When it comes to calcium, I am a big fan of get as much as you can through your diet first. Get it in those forms where it has all the other nutrients that you need. I do find a lot of times though that people are still falling short, or they’re having a hard time making sure they are getting calcium into their diets.

In those situations, usually the maximum I would want to see somebody incorporate is 500mg a day. Not all at one time. Maybe spread out in two different meals. Use an absorbable form of calcium. Any of the ones bound to an organic acid or amino acid can be helpful. Malates. Citrate is a highly absorbable form. MCHC calcium, which is like bone meal basically. That can be helpful, too.

If we are talking about a controversial topic, dairy. Let’s talk about that one. If we have an autoimmune condition, dairy is most likely not going to be a part of your plan, especially initially. If you or someone in your family has that as part of their plan, for bone health specifically, cultured dairy, fermented dairy would be the way to go. If you’re going to incorporate it, make sure you are getting some additional benefits from it.

The benefits of fermented and cultured dairy is you have probiotics, beneficial bacteria and yeast that come in large quantities, which can help your gut health. They could also lead to better nutrient absorption. Those are my thoughts on calcium.

Another big one I will touch on is magnesium. You have to have magnesium. It has 300 functions in the body. You need it to build proteins back inside your body. I talked about how important proteins were. In order to rebuild anything inside our bodies, you need magnesium to do that. If you want to rebuild stronger bones, magnesium has to be part of your plan. As you’re increasing your calcium and Vitamin D, your need for magnesium increases as well.

And Omega-3s. I touched on that before. If you’re not eating healthy, fatty fish, get some Omega-3s in your diet. Get them in their bioavailable form. Those are all good things to incorporate.

Dr. Eric:

You mentioned healthier forms of dairy like fermented dairy. If someone is going to eat dairy, it’s optional, you would say. If someone is eating plenty of arugula and other vegetables higher in calcium, and maybe the fish with the bones, there is no need for dairy. Would that be correct?

Kevin:

Especially if you’re adding in some supplementation, that can help you. If you’re eating a can of mackerel, for example, you may be getting 250mg of calcium from those bones, maybe a little bit more, like 300mg. How many cans of mackerel are you going to eat in a day? I can tell you: I eat quite a bit of mackerel and sardines. I’m at my limit at about two a day. That is 600mg.

Let’s say I add in three ounces or 85g of arugula. That is one of those big plastic clam shells full of arugula. That is 200mg of calcium. That is a pretty significant volume if you are eating a raw salad. If you sauté that down in some good quality olive oil, that can make it a little bit smaller to consume. You have 200mg of bioavailable calcium there. Now we’re at 800mg.

Now we’re starting to try to figure out some of the other sources for we can bring in calcium to our diet. Cruciferous vegetables. Those have a pretty good absorption rate for the calcium. There has to be some supplementation that takes place usually for most people because they have a hard time from a practicality standpoint and from a convenience standpoint, figuring out how they are going to get enough into their diets.

Dr. Eric:

You shared so much great information. I’m sure there are people who want to know more. Can you let us know where can people find out more about you, Kevin?

Kevin:

You can always find me at BoneCoach.com. That’s where we have Stronger Bone Solution coaching programs. We help a lot of people; the program was featured in Forbes and other places. Even medical doctors, physicians, registered nurses, nurse practitioners, and orthopedic surgeons come through our programs and refer their patients to us after. We have physiciansspending their own money to learn about bone health outside of the pharmaceutical treatments and then referring their patients to us. I am proud of that and happy to see that because I think we have a long way to go in our conventional system. If you want to learn how to build stronger bones naturally, and you want to do it the right way, head to BoneCoach.com.

For your audience, Eric, I have a free Stronger Bones master class. This is where I would encourage every single person who is listening to this right now, if you are worried about your bones, fractures, or if you have someone you know who has osteoporosis, forward this onto them. Help them out. Make them listen to this podcast. Get them to sign up for that free master class.

If you sign up for that master class, not only will you get the awesome information that comes with it, but I will send you the replay, so you can watch at your own convenience, and I will send you a bone healthy recipes guide, too. Those are the best ways to get a hold of me.

Dr. Eric:

I need that free bone recipes guide.

Kevin:

I’ll send it to you.

Dr. Eric:

It was great chatting with you, Kevin. Thank you so much for sharing your expertise related to bone health. Really do appreciate it.

Kevin:

Happy to help.

 

Recently I interviewed Cynthia Thurlow, as she discussed the benefits of intermittent fasting, and of course she discussed whether or not it can benefit those with thyroid and autoimmune thyroid conditions. If you would prefer to listen the interview you can access it by Clicking Here.

I am thrilled to chat with Cynthia Thurlow, who is a nurse practitioner and author of the best-selling book Intermittent Fasting Transformation: The IF45 Plan. She is a two-time TedX speaker, with her second talk having more than 10 million views. She is also the host of the Everyday Wellness podcast. With over 20 years of experience in health and wellness, Cynthia is a globally recognized expert in intermittent fasting and women’s health. She has been featured on ABC, FOX 5, KLTA, CW, Medium, Entrepreneur, and The Megan Kelly Show. Her mission is to educate women on the benefits of intermittent fasting and overall holistic health and wellness, so they feel empowered to live their most optimal lives. Thank you so much for joining us, Cynthia.

Cynthia Thurlow:

Thank you for having me. I have been looking forward to our conversation.

Dr. Eric:                            

Same here. If you could start off by sharing your background and why you are so passionate about intermittent fasting.

Cynthia:

I am a traditionally trained allopathic nurse practitioner. My background as a nurse was in ER medicine. I am a bit of an adrenaline junkie. I trained in inner city Baltimore, so I got to see a lot of amazing things. It was a natural extension to then go into cardiology as a nurse practitioner. I did 16 years of clinical cardiology, both in-patient and out-patient management. I love everything about the heart.

After becoming a parent, I had a child that developed life-threatening food allergies. He had really terrible eczema. Having never really dealt with eczema as an ER nurse, it was really baffling. I kept saying to the pediatrician, because at the time he was exclusively breast-fed, “Do you think it’s something I am eating?” “No, not at all.” His eczema got worse and persisted. We used all the conventional allopathic treatments, like topical steroids, etc. I kept asking, “Is it something that he is eating?”

I finally got a referral to the allergist. Boy, was I surprised to find out that my beautiful, otherwise very healthy two-year-old had life-threatening food allergies. That set me down a proverbial rabbit hole. All of a sudden, I went from thinking of food as being a safe thing to all of a sudden we had to be very careful where we ate. We didn’t eat out much at all to begin with. I got very careful about where we ate in restaurants, ensuring he wasn’t getting cross contamination or exposure of these allergens. It really shifted my focus.

I always say it’s a blessing I had that experience with my son. Thankfully, he is nearly 17 years old and is otherwise very healthy. Only 30% of kids will outgrow their food allergies. He is one of the many children that has not outgrown their food allergy.

I really started looking more deeply. I read a book called The Unhealthy Truth by Robin O’Brien. Then I actually considered doing a doctoral program. I took one class and decided that wasn’t it. I went down another rabbit hole and did a wellness coaching program, which was interesting, but did not light me up. Then I read another book, and I reached out to that author and asked where they got their training.

I think nutrition is what I am most interested in because I was seeing patterns with my patients. Despite the best evidence-based medicine you can imagine, we weren’t curing their cardiovascular disease or diabetes. We were stabilizing symptoms. It was very disheartening. I did this functional nutrition program, and that lit me up. That was the beginning of the end of my traditional path.

Within about a year, even though I was going to work and following those evidence-based guidelines, I became acutely disconnected/frustrated, feeling like we were missing opportunities with our patients. I left clinical cardiology without a business plan. I wouldn’t necessarily recommend anyone do that. Almost instantaneously, I had a large following of women who started coming to me because they felt like their needs weren’t being met. For me personally, during that time period, for a lot of women, as they enter perimenopause, which is the 10-15 years preceding menopause, all the things that used to work no longer work.

For me, the value of the N of 1 was this is someone who had always done everything right. Nutrition, exercise. I thought I was sleeping enough. I thought I was managing my stress. In perimenopause, the game changes. I started having some weight loss resistance. Intermittent fasting to me was something I came to out of an interest to see if I would lose weight. That is how most people are.

What I found was that I didn’t lose weight initially. What I did find is I had more energy. I started sleeping better. I started to feel like I had a very different relationship with food. I could recognize true intrinsic hunger as opposed to “It’s X time. It’s time to eat.” I started with intermittent fasting. Then I started talking to everyone who was willing to listen to me about the strategy, not realizing it would be something I would be known for several years later.

From my perspective, it was traditional allopathic medicine, cardiology, ER medicine. Then pivoting and taking this opportunity.

The other thing that is probably worth sharing is that in 2018, as an introvert, I decided I was going to challenge myself. I was going to do a TED Talk. My husband thought I was nuts. “No, I’m an introvert. This will be a scary challenge.” I didn’t realize I would get multiple offers. I did one talk on perimenopause, that super sexy topic. Around the same time I did my first talk, I was offered a second. That changed everything. Obviously, now I am known for intermittent fasting in women because that talk went viral and really changed a lot of things for me.

Bringing greater awareness to a strategy that is not new or novel, and certainly one that thyroid patients appropriately can integrate into their lifestyle is something that I take as a great honor. I am able to impact more people than I ever would have or could have being just in a hospital or in clinic.

Dr. Eric:

Speaking of thyroid, you have been diagnosed with Hashimoto’s, correct?

Cynthia:

Yes, I have. That is why I like women in particular to understand that you can successfully utilize intermittent fasting and have thyroid disease. As we were talking before we started recording, there is always exceptions. If we really understand that intermittent fasting is not just about weight loss, it actually improves the health of our mitochondria, which are the powerhouses of our cells. From substantive to less substantive, there are lots of benefits. Thyroid patients in particular can benefit from this mitophagy, autophagy, getting rid of these diseased, disordered cells that are no longer serving us.

Dr. Eric:

Can you talk a little bit about metabolic flexibility, what it is? How does it improve when practicing intermittent fasting?

Cynthia:

This is something I have gotten very outspoken about. As you can imagine, in cardiology, I saw a lot of metabolic inflexibility, metabolic syndrome. When we are talking about metabolic flexibility, it is specific to our body’s being able to use both fats and carbohydrates as fuel sources. We don’t want to just be using one over the other. Most individuals, we know based on recent data, it’s 92% of the population here in the United States, is not metabolically flexible or healthy. That is most of us.

How do we actually define what metabolic syndrome is? I look at a couple of variances. We look at waist circumference. This is very important. If people have a waist circumference greater than 35 inches or men greater than 45 inches, that is one.

Another is triglycerides greater than 150. I would advocate it should really be under 75. It’s really a reflection of the quality of carbohydrates someone is consuming.

Looking at HDL. HDL is considered to be “heart healthy cholesterol.” There is more to it than that. In men, we want to see that number greater than 45, and in women, greater than 55.

You also think about fasting glucose. To give you a sense of how long I’ve been practicing, when I graduated from my nurse practitioner program in the early 2000s, you wanted to see blood sugar under 140, which makes me cringe. Now we are saying we want it under 100. I would argue your fasting blood sugar should be under 90, or at least under 95.

When we are looking at these metrics, there are more, like fasting insulin or uric acid. These are all metabolic markers of health. It’s important for you to know these numbers. Some of these things, you can measure at home, like waist circumference. Every year, you should be getting fasting blood sugar, triglycerides, HDL. You should know those numbers, so you can trend and track them.

When we are looking at metabolic inflexibility, these are the people who struggle with weight loss resistance, energy. They will probably get sleepy after meals. They may in fact have poor quality sleep. They won’t have the energy to get up and play with their children or go for a run or engage in sustained exercise. These are individuals who will get hangry. They get this hungry grumpiness that you see in little children because they don’t have the ability to articulate that they are hungry, or they just get grumpy. They also generally tend to gravitate toward foods that are carbohydrate-dense as opposed to protein and healthy fats. These are obviously generalizations.

When we are looking at someone who is metabolically healthy, they won’t deal with weight loss resistance. They are going to be able to go for longer stretches without eating. They will put their meals together differently. They will use protein and carbs or protein and healthy fats.

This is really important for people to understand. I am not anti-carb, but if you are insulin resistant or diabetic, you should absolutely be on some degree of carbohydrate restriction. We can talk more about that.

When I am looking at someone who is metabolically flexible, they sleep well, have plenty of energy, have lots of cognition so they can power through tasks. They don’t think about when their next meal is.

The person who is less metabolically flexible is going to be focused on watching their watch. When is my next meal? I’m hungry. I am running out of gas. I need that candy bar, energy drink, soda in the middle of the afternoon because I get a slump. Those things shouldn’t be happening.

What I think people have forgotten about is that metabolic flexibility is our birthright. It is the way that our bodies are designed to thrive. We have just forgotten. The processed food industry has convinced us as a nation, as a society that we need to eat snacks and mini meals to stoke our metabolism and to have energy. I am here to tell people that eating less often with very few exceptions is the way our bodies are designed to thrive. It is definitely a way to support metabolic flexibility.

Unfortunately, the lay press and magazines like to focus in on this hot new diet system. I remind them that this is our birthright. Intermittent fasting has been incorporated in all major religions. We wouldn’t be here as a species if our bodies had not been able to go through periods of time with food scarcity or even periods of feasting and famine. Metabolic flexibility is something that every single person that is listening should be focused on because our health care system and our nation can no longer support this kind of sick care system that is potentiating and exacerbating metabolic inflexibility.

I will give you an example. Obviously in cardiology, we are dealing with people with disease. They have cardiovascular disease, whether it’s their heart, their brain with strokes, peripherals vascular disease. More often than not, almost all of them have diabetes. Unfortunately, we go about addressing inflammation, oxidative stress, insulin resistance. We wait until someone has disease. We don’t go proactively and say, “Your fasting insulin is abnormal. Your fasting blood sugar and hemoglobin A1C look great. Let’s wait until they look abnormal.” Being more proactive and being truly preventative.

I technically am trained in primary care medicine. I never worked in primary care because at the time, there wasn’t as much of a desire to educate nurse practitioners in acute care medicine. Of course, that makes me laugh because that’s all I did as an NP. The reason why I’m sharing this with your community is that we have to start taking accountability as individuals and as clinicians to be more proactive and not wait until someone is diagnosed with disease. Diabetes takes 10-15 years to be diagnosed.

There is lots of things that start to happen in our bodies, and especially for andropause and menopause and perimenopause. These times we are all going through reverse puberty, there are things we have to be more proactive about in terms of the hormonal changes that are happening in our bodies. It doesn’t mean that you will develop diabetes, but you could become insulin resistant. We want to do everything we can to shift that happening.

We want to be as proactive as possible. This is where the hard work comes in. There is no magic pill. I don’t know if this has been your experience, but I have patients who say, “Give me the pill. I’m not going to change. I’m not going to stop smoking or change my diet or exercise.” I always tell them that’s so disheartening. Yes, lifestyle changes are hard, but the long-term yield is pretty significant.

Dr. Eric:

You mentioned carbohydrates. If someone has insulin resistance, they definitely need to restrict their carbohydrates. If you could talk about if someone has insulin resistance, on average, how many grams of carbohydrates they should be eating? Also, if someone doesn’t have insulin resistance. Like you said, we want to prevent someone from developing insulin resistance. If someone doesn’t have it on a wellness basis, how many grams of carbohydrates should they be consuming?

Cynthia:

Unfortunately, I am sometimes labeled as anti-carb. That couldn’t be further from the truth. I eat lots of carbohydrates: lots of non-starchy vegetables, low glycemic berries. When we are approaching this topic, the first question is are you insulin-sensitive? If you are part of the 8% of the population that is, you probably get a bit more leeway than the rest of the population. What does that look like? On days I earn my carbohydrates, and by that, I mean lift heavy things, I lift at least three days a week.

Every person listening should be doing and incorporating strength training because you have to think of your muscles. Dr. Gabrielle Lyon says they are the organ of longevity. After I started leaning into her work, I started to fully understand and appreciate that she is absolutely correct. Muscles help with insulin sensitivity. We want to maintain lean muscle mass for as long as we can.

Why is this relevant to this discussion about carbohydrates? The more muscle mass you have, the more high quality carbs you can consume. That may look like sweet potatoes, rice (if you tolerate grains). That is the unprocessed stuff. I am not a fan of people eating lots of bread and pasta. I’m sorry to say that. Cookies, candy, that is not the quality carbohydrates I am referring to. But if you are working out hard, and you go to the gym and lift, and you are lean, and you’re insulin sensitive, you can utilize carbohydrates.

I typically recommend that people consume no more than 30-40g in a meal. You have to understand that a candy bar could be 60g of carbohydrates. Just to give you an idea. Really understanding that if you are insulin sensitive, you can very likely get away with 30-40g in a meal. For me, that might be half a sweet potato. We are not talking about a starchy carbohydrate.

When you are insulin-resistant or diabetic, you have to be very mindful. You already have a sugar handling problem. This is where I would say to get your carbohydrates from green, leafy vegetables, low glycemic berries. That doesn’t mean one cup of berries. That means a quarter cup of berries. That means you can have lots of broccoli and cauliflower. Those are good things for your body. That does not mean you sit down with a massive bowl of pasta and have a miniscule amount of protein.

When you have carbs, you never want to have them naked. You should have your carbohydrates with your protein. There is a very interesting book I’m about halfway through by a biochemist called Glucose Revolution. She has some very interesting ways to buffer the net impact of carbohydrate intake. You start with vegetables, then protein, then the carbohydrates. I am very much a fan of pairing your carbohydrates with protein. Never carbohydrates and fat. They generally don’t occur that way in nature, and they are very easy to overeat. Think about chips and guacamole. Let’s be honest. Guacamole is delicious, and salted chips are fantastic, but you won’t trigger the same satiety cues in the body.

To get back to your original question, if you’re insulin-sensitive, you can probably handle 30-40g of carbs in a meal. Always with protein, not by itself.

Another thing people can do irrespective of where they fall on the insulin sensitivity spectrum, and this is well-researched. This is not just me telling you to do this because it’s good exercise. Walking for 5-10 minutes after a meal helps with insulin sensitivity. The organs of longevity are muscles. Your muscles will help with the glucose disposal and insulin sensitivity.

I always encourage people, especially if you have eaten a larger meal than normal that had more carbs than normal, to get out there and take a walk as a way to disperse some of the carbohydrate load that you consumed. A lot of people are thinking, “I eat way more carbohydrates than that in a meal.” You need to examine if you are metabolically healthy, if you are insulin sensitive. Everyone should know what their fasting insulin levels are; they should be between 2-5. If they are higher than that, you have work to do. It may take a bit of time. We don’t become insulin-resistant overnight. I don’t expect that people will become insulin-sensitive overnight. I do think adjusting your carbohydrate intake, lifting weights, taking walks after meals.

Checking your blood sugar. I am a fan of continuous glucose monitors. If that is not in your budget, glucometers can be very beneficial. You can track what your blood sugar response to your meal is. If it’s more than 20-25 points, you probably had too much carbohydrates. Hopefully I’m not busting people’s minds about how we navigate carbohydrate loads. I think a lot of it is dependent on where you are in your life stage, how insulin-sensitive you are, and getting nuance.

I know for myself, I’m 51 years old. I just had a birthday. I am very conscientious about how I time my carbohydrates, when I time my carbohydrates. Always earlier in the day we are more insulin sensitive. I think very thoughtfully about carbohydrates. I probably didn’t when I was younger. Now I definitely am very strategic about when I eat them and how much of them I eat.

Dr. Eric:

I’m glad you mentioned that because a lot of people do the exact opposite. When they have dessert, not that they should be having any bad dessert, but even if they are having a cup of fruit, it sounds like maybe have it early in the day and not after dinner.

Cynthia:

Yes. The other thing to think about is right now, it’s summer. It stays light until 9pm at night where I live. I remind people that in summertime, you can actually get away with a little bit more carbohydrate intake. When I say a little bit, I mean a little bit. I’m not talking about having a brownie sundae at 9pm; that’s a disaster. Maybe you can get away with a little more discretionary- We just got through stone fruit season. I love apricots. It’s one of my favorite things to eat during the summer. They’re not very sweet.

Being mindful of when you eat and what you’re eating. I remind people you really want to be done with eating within 2-3 hours of bedtime. I actually like an earlier stop to my feeding window personally. That is one thing the pandemic showed me. I actually don’t do well eating dinner at 7:30 or 8pm. I do better finishing my meals earlier.

The other thing is this is aligned with current biology, meaning it’s better for us to eat earlier in the day than later. We have these melatonin clocks. We have a centralized clock in our brain called the super chiasmatic nucleus. We also have peripheral clocks in the gut, the pancreas, the liver, and elsewhere. When we eat late at night, it disrupts these clocks. It disrupts melatonin secretion, which impacts our sleep quality, our blood sugar, our cravings the next day.

Getting attuned to your body might be that you have that watermelon or fun summer food that has some fiber in it, the digestion of which will be slowed. Have them earlier in the day. Don’t eat the brownie sundae at 9pm and think you’re doing yourself any favors. My teenagers can get away with that, but my husband and I can’t. Just be mindful of where you are in time and space.

Dr. Eric:

Let’s switch gears and talk about protein. I’m sure just in general there are people who are not getting enough protein. I know some people who do intermittent fasting definitely aren’t getting enough protein. Can we talk more about how people can get enough protein when doing intermittent fasting?

Cynthia:

This is a very important concept. I say this because I inherited co-hosting another podcast. I have one of my own, and I have Intermittent Fasting that I co-host with Melanie Avalon. My predecessor was a big fan of OMAD. OMAD is one meal a day. My biggest criticism, and this is irrespective of gender, is you cannot get enough protein in in one meal a day. I don’t know of anyone that can.

What is enough protein? I say at a minimum 100g a day. For most women, that’s going to blow their minds because they probably are getting 40-50g a day. You heard me mention earlier that muscle is this very important organ. We start to lose muscle mass at a fairly exponential rate after the age of 40. The less muscle mass you have, the less insulin-sensitive you are, the less calories you will actually burn. One of the ways that we circumvent the development of sarcopenia, which is muscle loss with aging, is we have to lift heavy things, eat enough protein, and sleep, amongst a myriad of other things. But those are the three big ones.

I remind women and men that when you are plating your meals, you need at least two food bolus a day. You need to eat at least two good-sized meals a day. I can eat 50-60g of protein in a meal because I have been doing this for a while. In fact, when I was on vacation, I was the person asking for a second portion of protein because I knew I wasn’t going to hit my protein threshold. In Europe, they have small meals. Everything is small, most of which is good, but protein can be a little less than what I’d like.

Maybe you have never tracked your protein intake. Chronometer is a good app. It’s cheap. It’s free in fact. I think it’s very helpful to track your macros for a period of time. Not forever. Not so you feel like you’re being obsessive. But it builds awareness. I find most people are probably doing 25-30g of protein a day. You can’t hit that 100g of protein threshold. Gabrielle Lyon talks about 1g per pound of ideal body weight. I’m 115 pounds. I aim for 115 a day. Sometimes I hit 120. Some days, I hit 90. Over time, it will even itself out.

Protein is not just about maintaining muscle mass. It’s also for satiety. You eat a big enough piece of steak, and you will be full. You won’t be looking at the brownie sundae or more pasta or bread. You’re full. Triggering these satiety cues and switches in our bodies is another really important benefit of protein.

When we are looking at animal-based versus plant-based. I’ll be the first person to tell you that animal-based proteins, the amino acid profiles, are superior to any plant-based protein. For a lot of vegetarians and vegans, they can be very low in protein at the expense of too much carbohydrate. Legumes aren’t a bad thing. Beans aren’t a bad thing.

In order to get the same amount of protein in a plant-based diet, people end up either deficient in protein, or they have completely dysregulated their blood sugar because they are consuming a lot of quinoa, beans, legumes, etc.  It’s a careful dance to ensure that people who are predominantly plant-based are getting enough of protein macros.

Protein is very important. In fact, I will often say it is the most important thing you have on your plate. You can technically make carbohydrates from protein through a process called gluconeogenesis. We cannot make our own protein. We have to consume it. We want to consume high-quality, animal-based protein; that’s what I advocate for and speak openly about.

Dr. Eric:

What are your thoughts on protein powders? Obviously, a plant-based protein powder isn’t going to be as good as a hydrolyzed beef one, let’s say. If someone feels like they can’t eat enough protein, is it okay for them to have a smoothie with protein powder with hydrolyzed beef or collagen or maybe even an amino acid supplement?

Cynthia:

Great question. I am a total realist. I am not sitting here on this mountain saying, “I’ve never had protein powder.” I occasionally have a protein bar while I’m traveling. Plus I have teenage boys. The amount of protein they eat is astronomical. If you’re going to consume protein powders, you want to ensure you’re consuming a high-quality product. Something like Marigold, which is whey-based protein. New Zealand, grass-fed, grass-finished cows that you know aren’t being fed a bunch of chemicals. Less ingredients on the label are going to be better than not. I myself don’t tolerate dairy, so I have that one in my house for my kids. I have a bone broth protein.

I think collagen peptides are fine. It’s not a complete protein, but it’s good for hair, skin, and nails. What person isn’t looking to have better hair, skin, and nails, especially as we are getting older?

In terms of plant based, I have talked to some of the leading experts in the field about this. With regard to pea, because that appears to be a very in vogue plant-based protein, we don’t have any research to know what’s going to happen. Does it have estrogenic effects like soy does? We don’t know.

I would recommend if you are doing plant-based proteins that you source from a really high-quality company. Truvani is one that has been recommended. I have tried every protein powder out there to find one that is palatable. I generally don’t find them to be palatable; they are chalky. Truvani is the one I generally recommend if people are looking for a cleaner option, but we don’t know about long-term effects of pea protein.

There is a lot of rice protein that is out there. I always get a little concerned about making sure you have a high-quality product because rice can be heavily arsenic-laden by virtue of where and how it grows.

I am a complete realist. I am all about meeting people where they are. I do have a problem if people are choosing just to have protein bars and shakes and not eating real food. But if you are traveling, on the go, if it’s a busy morning, I get it. You definitely want to put your body through the mechanism of chewing food, swallowing it, having that food bolus hit your stomach because that is much more satiating than a shake or a bar is.

In fact, the hyperpalatability of some of those products, even cleaner-sourced ones, my concern is always if you finish that bar, and you’re thinking about another one, it’s because the processed food industry does a really good job of creating flavor profiles in a way that keeps us wanting more. That’s always the concern.

There are companies out there like Epic as an example that set a reasonable price point. They have a bar that is more like a meat bar. Or Paleo Valley is a company I definitely buy and enjoy their products. Jokingly, that is my protein bar. I take Paleo Valley beef jerky and some salted macadamia nuts, and that is a small meal if I’m on the go. It’s at least clean, and I can live with myself.

To answer your question, I think you want to find the highest-quality supplement with the least amount of ingredients if you go that direction. Things like Perfect Aminos, there is a company out there that has these amino acids. Three years ago, when I was hospitalized for 13 days, I took that product for a while because I could not get enough protein in my diet. My digestive system had gotten so rerouted that I only tolerated protein. Some days, when I was trying to push my protein intake without upsetting my stomach, I would take the aminos, and that worked really well. Again, no affiliation with that company either. Spending some time to think thoughtfully about how to get to that threshold where you are getting at least 100g of protein in a day.

Dr. Eric:

Let’s dive into some of the different intermittent fasting regimens if that’s okay, including of course your IF45 plan. If you could expand on that as well as comparing it to other popular regimens.

Cynthia:

My bulk intermittent fasting transformation, IF45, is a 45-day program focused on a 16/8. 16-hour fast with an eight-hour feeding window. I feel like that is a very approachable window for most people to work up toward. Obviously, there are lots of varieties.

I mentioned OMAD, one meal a day. There are people who do 24-hour fasts. There are people who do longer fasts. There are people who do alternate day fasting. There are individuals who do a combination like a 30/16, meaning they will fast for 30 hours, have a meal, then do a 16-hour fast. A lot of these variations are for different reasons.

I’m at a healthy goal weight. I’m not looking to lose weight, so I don’t do long fasts. After spending 13 days at a hospital and not being able to eat for almost two weeks, that cured me of any desire to go a long period without eating ever again.

I think if you’re metabolically unhealthy, you’re part of that 92%, doing alternate-day fasting, doing longer variations of fasting can be very helpful. If you are diabetic or someone who has high blood pressure or on chronic medications, you want to be having a conversation with your provider to see if you need to be monitoring your blood pressure or sugar more closely. Let me slide that caveat in there.

Typically, the plateau busting comes from variation. Once someone has mastered the basics, then you want to have some variety. Just like we don’t eat the same food every day, like we don’t do the same type of exercise every day, I think our bodies naturally desire to have some flexibility.

Today is a very good example. I broke my fast at 9am because I have a super busy day. I was up early this morning to get the workout in before my day started. I am going to have a wider feeding window today. I have been fasting for a long time. I was also very hungry when I woke up. That was the clue. I have been doing more lifting. I am more hungry.

I don’t believe nor do I recommend anybody white knuckle fast. Meaning if you have a day you’re hungry, if there is a specific time in your cycle, maybe you are lifting heavier, maybe your body needs more macros, more protein, etc., there is nothing wrong with having some variety to your fasting window. But there are a lot of varieties, both time-restricted eating or intermittent fasting and then those longer fasts. Anything over 24 hours is a longer fast.

Dr. Eric:

It’s funny. I was thinking about asking you if you were in a fasting state. I figured we started after 10am. In the back of my mind, I was thinking you were in a fasting state. I’m glad you mentioned that. It’s not like someone has to every single day start at the exact same time, say at 11am and then end at 7pm, depending on how long of a fast you go. You pretty much listen to your body.

Cynthia:

Yeah. Intuitive eating is great. If you’re metabolically flexible. If you’re not, that’s very hard. You go back to the basics. It may take someone who is insulin-resistant six months to get to a point where they are attuned to the cues in their bodies, and that’s okay. I always tell women, “Put your blinders on, and just pay attention to what you’re doing.”

I don’t care how old you are or young you are. We are all influenced by what we see on social media. It’s the extremes. I’m seeing a lot of women in their 50s who are still very lean. Their rhetoric is very different than what I see in a very young 20-ish woman. What happens is people who are in between those age ranges see that, and they are influenced by that behavior. That is why it’s very important that those of us who are in the public eye and have podcasts and are out in the space are very cognizant of the messages we are sending to people our own age and people younger in us about what’s reasonable and attainable versus some stuff- I question if they naturally got to where they are. There is no judgment. We are all influenced by what other people are doing, whether we are aware of it or not.

Dr. Eric:

You mentioned earlier about fasting is not a perfect fit for everyone. Just a few minutes ago, you mentioned you have high blood pressure. Diabetes, you might want to check with your healthcare practitioner.

Let’s get back to thyroid health. Before we started the interview, I mentioned that a lot of listeners have hyperthyroidism or Hashimoto’s. You mentioned your experience with Hashimoto’s. If someone has a thyroid condition, autoimmune thyroid condition, it doesn’t mean they can’t fast. When I dealt with Graves’, I was losing a lot of weight. I lost 42 pounds. I probably wasn’t a good candidate for intermittent fasting then. Now I do incorporate it into my diet. I have been in remission for many years.

If you could expand a little bit more about when you work with thyroid patients, how do you determine who is a good candidate for intermittent fasting? Who might not be a good candidate? Maybe even tie in adrenal health. If someone has compromised adrenals, should that be an indication that maybe they are not ready to fast either?

Cynthia:

Those are good questions. First and foremost, intermittent fasting is a form of hormesis. Hormesis is a beneficial stress in the right amount at the right time. What I see is a lot of men and women desperately want intermittent fasting to be the thing that is going to change it all for them.

If you are newly diagnosed with Graves’, which is hyperthyroidism, or you are newly diagnosed with hypothyroidism/Hashimoto’s, it is not the right time to add more stress to your body. If you were going through a divorce, you were just in the hospital, you are in the midst of a move, you have a lot of stress going on in your life. Don’t add intermittent fasting. It’s not going anywhere. Wait until there is less stress. Your body can’t adequately distinguish intermittent fasting from the divorce or the hospitalization or this stress of a new autoimmune condition.

My standard refrain is if you are stable on medication, which means you haven’t had to have an adjustment, if you wake up and have energy, if you have energy to get through your day, if you’re sleeping, then it is certainly okay to have a conversation with your health care practitioner about whether or not this is the right strategy for you. Now there is enough awareness about fasting that those practitioners are aware of it. They know how to carefully navigate around the strategy.

I do find that there is still a lot of fearmongering about individuals with thyroid disease. I remind people that intermittent fasting can help improve mitochondrial health. We know that if you have an underactive thyroid as an example, your mitochondria aren’t functioning as optimally as they could be, largely because-There is so many reasons why you can become hypothyroid. Is it a nutrient issue? Is it because you have an autoimmune condition? There are so many reasons why you can be hypothyroid.

I think the bulk, somewhere from 80-85% of us with hypothyroidism have Hashimoto’s, even if you have negative antibodies. I want to publicly share that for many years, I was told I did not have Hashimoto’s because I did not have positive antibodies. That probably has everything to do with the fact that I don’t eat gluten and haven’t for over 10 years. More often than not, you have Hashimoto’s until proven otherwise.

With that being said, I do find that intermittent fasting for those with both thyroid health issues and adrenal health issues—adrenal health issues is really your body’s perception of stress. The hypothalamus and pituitary adrenal axis. A lot of what these individuals need to work on is managing stress. That is not five minutes of meditation once a week. It’s getting out in nature. It’s doing things to tap into the parasympathetic, which is the rest and repose side of your brain. It’s sitting down to digest your food. It’s acknowledging that digestion starts in our brains. It goes on and on. The right types of exercise. Doesn’t mean Orange Theory or Cross Fit five days a week. There are many lifestyle things that have to be adjusted before we add in intermittent fasting.

I speak from personal experience that I absolutely have had significant bouts of HPA axis dysregulation. I obviously am thriving with thyroid health issues. I am very stable on medication. My labs are stable. It’s an n of one. Bioindividuality rules. Getting your health care provider involved in the decision-making process. Is this the right time? The answer may be no, but maybe six months from now, you will be ready.

There is no one listening that can’t go 12 hours without eating. No one. Not one person. It’s not going to hurt you. When I walk women through intermittent fasting around their menstrual cycles, I tell them 12 hours of digestive rest, which is exactly what it is, is not going to harm you. Even my teenagers, who eat voluminous amounts of food and are growing like weeds, they can go 12 hours without eating. So can you. Is that technically intermittent fasting? No, but that’s digestive rest, and we all need that anyway.

If you look at the data on meal frequency here in the United States, it’s horrifying. 12 hours of not eating is not going to hurt your adrenals or your thyroid. You want to make sure that you are hooked in with your health care provider, so you can both detemrine when the right time, if at all, is to intermittent fast.

Dr. Eric:

There are so many more things we can cover, but we are running out of time. We may need to do a part two in the future. Everybody needs to dive into your book, which I have also been reading and find fascinating.

For those who are not intermittent fasting and perhaps are thinking about it, or maybe those who are currently intermittent fasting and may look to incorporate your plan, can you give some action steps they should take?

Cynthia:

The first step is to stop snacking. I know that seems trite, but we have been conditioned to believe we need to have snacks and mini meals and eat all day long. The only way you can get from breakfast to lunch and lunch to dinner and dinner to breakfast is to stop snacking because it will force you to restructure your meals. What does that mean? That means you will prioritize protein. You are either having protein and carbs or protein and healthy fats.

The next step is to do that 12 hours of digestive rest and see how you feel. For some people, it may take weeks to get to a point where they have their meals adjusted enough to go from breakfast to lunch and lunch to dinner and dinner to breakfast. That is a very good first step. Once you have mastered 12 hours, you go to 13 hours. Then you go to 13.5. You go to 14.

If you are not fat-adapted, if you are not metabolically flexible, it could take you 6+ weeks or longer. I remind people that if you are metabolically flexible, intermittent fasting is not going to be as challenging. A lot of it can depend on where you are in your menstrual cycle and what life stage you’re in. Those are some very straightforward logical first steps.

If people follow those—stop snacking, restructuring your meals, and doing 12 hours of digestive rest—they generally end up being pretty successful.

Dr. Eric:

Wonderful. Where can people find out more about you? Your website is CynthiaThurlow.com. I’ll let you take over.

Cynthia:

The website is a great place to start. You can catch Everyday Wellness Podcast, which is my solo podcast. I also have Intermittent Fasting Podcast that I co-host with Melanie Avalon. I am active on Instagram. I am a little snarky on Twitter. Depends on the day. I have a free Facebook group called Intermittent Fasting Lifestyle/Cynthia Thurlow, which you are more than welcome to join.

The easiest way to get a sense for who I am and what I’m about is to listen to the podcast. I get to interview really amazing people in the health and wellness space. I have been humbly surprised at how much I love podcasting. It’s one of my favorite things to do. That is probably a great first step if you want to learn more about me.

Follow my crazy dogs. I have teenagers who don’t like to be on social media at all, so out of an abundance of respect for them, you won’t see them much on social media. But I do feature my dogs quite prominently.

Dr. Eric:

Thank you so much for sharing your knowledge. It truly was a pleasure chatting with you.

Cynthia:

Awesome. Thanks so much for having me.

 

With me, I have Risa Groux, who is a functional nutritionist and certified autoimmune coach in private practice in Newport Beach, California. She has always been passionate about nutrition and good health. Today, she is passionate about cooking and healthy, nutritious food. She works with a wide array of clients from professional athletes, adults, and kids, to The Biggest Loser season 4 winner. Risa works with issues like diabetes, autoimmune disease, cancer, digestion, thyroid conditions, and hormone imbalances, to name a few. She firmly believes the body can heal itself with whole foods we obtain from the earth and sees living proof of that in her office each day. Risa looks at root causes using functional nutrition guidelines as well as blood and stool tests. Thanks so much for joining us, Risa.

Risa Groux:

Thank you so much for having me. It’s great to be here.

Dr. Eric:

Look forward to talking about your wonderful book, FoodFrame… Diet is a 4-Letter Word.

Risa:

Yes!

Dr. Eric:

I was going to ask if you could talk about your background. I know you mentioned in your book you had Hashimoto’s. If you could talk about that and what led you to write your book.

Risa:

I do have Hashimoto’s although I am just about 10 points from reversing it at this point. I want to join the crew in my office that have reversed it already, so I’m getting there. I was diagnosed with Hashimoto’s after I had my second child. I was diagnosed with hypothyroid when I was trying to conceive my second child. No problems with the first. We just started having all these issues getting pregnant for the second child. It took a long time.

I did everything. I looked at everything. Why do I have hypothyroid? The doctor handed me a script and said, “Take this med every day.” I asked, “For how long?” He said, “No, every day.” I asked, “For how long do I take it every day?” He said, “For the rest of your life.” Isn’t that odd? Why would I be taking something synthetic that my body was actually born to produce? That started me on my journey.

I started to put together a little list of why you would become hypothyroid. When I was diagnosed with Hashimoto’s, I realized this is a pretty comprehensive list. I could not find a list anywhere, so I put my own list of root causes together. Why is my body in a state of attack? It’s just landing on my thyroid for me, but autoimmune lands in different tissues and organs and body parts. Let’s see if we can reverse this attack. I have compiled a very comprehensive list of root causes, which is in the book.

I have done extensive research and realized a lot of it is what we eat. I have seen thousands of patients through decades of work that I have been doing. I first started out with putting everybody on this one diet type, usually the diet type of the book I had recently read. It had all these great success stories and science to back up the success. I realized that not every diet type is right for every person. When that new diet book comes out, it says, “This is the great proven science.” Yes, all of those things are probably true. It’s probably going to work for a really good group of people. It’s not going to work for everyone.

I started customizing diet types according to your health status. FoodFrame is the methodology I created that basically says you should be eating according to your current health status. If you have blood sugar dysregulation, you should be either on Paleo or keto, depending on which one you qualify for. If you have IBS or IBD (irritable bowel syndrome or disease) or SIBO (small intestinal bacterial overgrowth), which is very common with thyroid, you should probably be eating on a low FODMAP plan, at least an elimination diet, for a period of time.

I realized that all these different health statuses should be eating according to different diet types. They are all matched up. In my book, I have highlighted six major diet types or eating lifestyles that I usually refer to. It usually hits pretty much everybody on the spectrum regardless of what your health status is. That is the book.

I wrote the subtitle “Diet is a 4-Letter Word.” I struggled with that one for a long time, but I couldn’t find the right words to say that we have this horrible relationship with the word “diet.” The actual real definition of a diet is what we eat throughout the day. It’s not starving and deprivation and restriction. I don’t like that idea, that people feel they should be restricted or starving or depriving themselves. Animals don’t do that. “Oh, I shouldn’t eat those berries on that tree.” They eat when they’re hungry; they don’t when they’re not. That is the premise of which I base my FoodFrame on.

Dr. Eric:

I do love the title and the subtitle. It makes sense that not everybody should follow the same exact diet. I work with a lot of patients who have Graves’ and Hashimoto’s, which are autoimmune thyroid conditions. I commonly recommend an autoimmune protocol as a starting point. I know that’s one of the recommended diets in the book. If someone has SIBO, then they probably shouldn’t follow an autoimmune Paleo diet, unless they have autoimmunity as well. Sometimes it gets complex if there is overlap.

What I’d like you to do is talk about the different FoodFrame diets. I know you also mentioned the book The Four FoodFrame Steps. I don’t know which one you want to talk about first.

Risa:

The four FoodFrame steps are basically find out what your FoodFrame is. Either take the quiz on my website, RisaGrouxNutrition,com, or get your bloodwork and stool test done. That is typically what I do during the first phase.

Find out do we have insulin resistance? Most allopathic conventional medicine doctors don’t typically test for more than just a fasting glucose. Occasionally, they will test you for hemoglobin A1C, especially if you are overweight or have diabetes in the family. But they don’t really ever test for C-peptide and insulin, which is what I test every single person for. I want to see if you’re insulin resistant.

What I do is functional nutrition. Functional nutrition is based on four pillars. We look at root causes. Why is this happening? Why am I having headaches? Why is my cholesterol high? Why, why, why? It’s not because we have a deficiency in statins that brings our cholesterol high. We know that’s not the case.

We also look at prevention. How do you prevent things, unless you have the information? We’re not really good at playing darts in the dark when I cannot see the target. I need all the lights on, and I need to be perfectly in vision with where I’m aiming.

Then we believe the body is one interconnected unit. Everything has to do with each other.

The fourth thing that I base my practice on is data. I have to see what I’m looking at. I order extensive labs. Insulin resistance is a precursor to prediabetes and diabetes, so I order that.

If you have a blood sugar dysregulation issue, fatty liver, congested gallbladder, or autoimmunity or SIBO, you have to find out what your particular health status is, so we can match your FoodFrame to it.

After you do that, then we do the RGN detox, which is super helpful because it cleans out the liver and blood. It optimizes your body, so you are operating much more optimally rather than sluggishly. We take out the trash of the body. Yes, you lose weight. Everybody does. But it’s not a weight loss program. Everybody loves to come in and do the detox to lose weight, which is fine. It’s a side effect of wellness, but we focus on wellness. The detox clears things out. Oftentimes—I see this all the time. Yesterday, I probably saw it three or four times—people’s main complaints already go away within those two weeks. You’re eating real food. You’re having collagen shakes. It’s not about starvation. Eat when you’re hungry; don’t when you’re not.

Then we do the recommended supplements for that health status. If you have blood sugar dysregulation, we do balanced berberine. Vitamin D deficiency, things like that.

Eating healthy food. I have a boatload of recipes on my website. Any food in your FoodFrame category is good to eat. That’s how we stay healthy.

The FoodFrame book highlights the six different diet types. As you mentioned, low FODMAP is for people with SIBO and IBS and IBD. That is meant to be an elimination diet. I would recommend that for 30-90 days. If you’re experiencing any chronic bloating, and you realize that it’s probably not a deficiency in digestive enzymes, then I would definitely recommend low FODMAP, whether you have been diagnosed with any of those things or not. It’s going to help you. It’s not calorie-restrictive, but it’s portion-restrictive for certain types of carbohydrates.

FODMAP is an acronym for fermented oligosaccharides, disaccharides, monosaccharides, and polyols. In plain English, those are certain carbohydrates that absorb water when you eat them. They tend to be a lot of prebiotic foods like onions, garlic, artichokes, and cruciferous vegetables like broccoli, cauliflower, cabbage, Brussels sprouts, and kale. Those things will make some people bloat and with major discomfort. What we’re trying to do is starve the bacteria that has inadvertently parked itself in the small intestines rather than the large intestines. We can do that through food. We see tremendous results from that.

Anybody can do that, but I wouldn’t recommend it for everybody because it’s a little restrictive. It’s those people who are really experiencing chronic bloating. Usually, it’s coupled with either chronic constipation or chronic diarrhea.

Then we have AIP, as you mentioned, the autoimmune protocol. That is what I recommend for anybody with autoimmune. Doesn’t matter if you have been recently diagnosed or at some point down the line. If you have family members who are autoimmune, and you feel like you are going down that road, it would be great for you to do it. It’s an anti-inflammatory eating lifestyle, so it wouldn’t hurt anybody to do it, but I really recommend it for those who have been diagnosed with autoimmune. You can jump on that anytime.

Again, it’s an elimination diet, so 30-90 days. It’s basically Paleo, but a little stricter. Remove nightshades, nuts, seeds, and eggs. A little restrictive, but you will really quell the inflammation that is ongoing that cytokine storm. That is helpful for anybody, but mostly autoimmune people.

Then we have keto. Keto is very popular, and it seems to stay popular for the last few years. Keto was when you switch your body’s fuel source from carbohydrates, which turn into sugar, to fat. You’re needing to eat about 75-85% of your calories every day in fat. Eating less than 20 net carbs. This will get you into ketosis. Ketosis is great because you’re burning that fat for fuel.

This is the diet type for all the bacon and egg lovers. You can eat all the cheese you want and lots of fat. Avocados, nuts. Lots of meat. Hard to get a lot of fiber in this one because carbohydrates are found in vegetables, so it’s very hard to get enough vegetables that you’re getting enough fiber without getting out of ketosis.

This is not a diet type that I would recommend for anybody without a gallbladder or who have a hard time absorbing fat. On a stool test, I test for steatocrit. If GGT on your blood test is high, this is not for you. It’s also very difficult more so for women. Some women thrive with it, but more women have a struggle with it. Men do great with it. Pretty much all men that fit that description. People who are really stressed with a lot of cortisol production, mostly women, not a great fit.

I personally tried to get into ketosis, and it was very difficult for me to get into ketosis no matter what I do. I have to use exogenous ketones to get in there. I recommend people use a urine stick to find out if they are in a state of ketosis because it’s very frustrating. Very easy to get out of ketosis. Hard to get into it. It can be very effective. There is a lot of science that proves it’s very good for heart, cholesterol, all that. But it is really aimed at people who have blood sugar dysregulation. If you have very high diabetes or pre-diabetic, going into ketosis will be effective for you.

Again, I don’t recommend it longer than three months. Some people can go a long time, but I personally see it being more advantageous for people to stop after three months, take a break, and then you can get back on.

Then we have Paleo. Paleo is the one I would say has the broadest appeal. Paleo is eating like our caveman, our carnivores did back in the day. We are eating quality animal protein and quality vegetables. Unlimited vegetables, any way you want them, except deep fried. Sweet potatoes, yams, good fats, nuts, seeds, eggs, olives, avocadoes, good oils, good quality. We are trying to decrease that systemic inflammation and increase that good gut health. That will do it for Paleo. It will help with blood sugar regulation. That is a really good bonus for Paleo.

I find Paleo to be easiest to travel with and maintain. It is a lifestyle. I pretty much follow Paleo myself. I never really go off the grid there. It’s very easy to maintain.

Then we have low lectin. Lectins are under the umbrella of antinutrients. We all have our ability to protect ourselves and cope with any kind of danger. Humans can flee, bite, scream, kick, yell, call 911. Plants don’t have that ability, so they have what I call a hard candy shell around that germ or seed. They protect themselves, so they say, “If you are going to try to destroy me, I will stay as whole as possible, so I can survive and procreate,” our two main goals as living organisms. It can be very difficult to break them down. When they get into the system, they cause some inflammation.

We find lectins in nightshades: tomatoes of all kinds, peppers of all kinds except black pepper, eggplants, and potatoes, except for sweet potatoes and yams. Goji berries as well. These are foods that are high in lectins.

I recommend the low lectin plan for anybody who is just getting off AIP. Go low lectin or go Paleo after that. It’s aimed at being anti-inflammatory and good for gut health and decreasing systemic inflammation. Those two main foundational issues I believe are the definition of health: good gut health and no inflammation.

There is vegetarian or vegan. There are different types of vegetarians and vegans. I break this down in the book in detail. I believe that pretty much 60-80% of our plate should be plants, living things that were pulled from the ground or a tree. With vegetarian, there is different types.

I find too many times, people come into my office as a vegetarian or vegan and are on the carbohydrate diet, or carbivores. They are sustaining on bread, pasta, Oreos, French fries, Diet Coke. These are all vegan, but they are not real food. I recommend eating plants and plant proteins, like beans, legumes, nuts, seeds, grains, and vegetables. Watch blood sugars because a lot of people can increase their blood sugars because they are eating so many grains and legumes and carbs.

Dr. Eric:

Thank you for sharing that. I agree with your thoughts about Paleo being more of a wellness diet and lifestyle. That’s also what I follow most of the time.

A few questions. You mentioned that if someone has elevated GGT on the blood test, they probably shouldn’t do a ketogenic diet. Is it the same with if someone has elevated AST, ALT on a comprehensive metabolic panel? Or would that be okay for them to follow?

Risa:

AST and ALT is liver congestion basically. It depends how high it is. If you are confirmed fatty liver, it might be a good idea to do ketogenic. I would follow your labs and make sure that they’re okay. You should start to decrease that fatty liver. Depends what the source is. If it’s alcoholic fatty liver or non-alcoholic. Oftentimes I see it from sugar consumption. In that respect, for sure, keto would be really good for you.

GGT is a measurement of how sticky and gooey your bile is that your gallbladder holds. If your GGT is high, functionally, we like it less than 20. If you’re very elevated there, I wouldn’t recommend doing keto until you get that down. Have some bile salts and some enzymes that will help you break down that bile. You will get sick and not do well on a high fat diet.

Dr. Eric:

What’s the difference between AIP and a low lectin diet? Autoimmune protocol as well as even regular Paleo minimizes the lectin. Is there any difference between them? I imagine there is, or else you wouldn’t have put it in the book.

Risa:

Yes. In low lectin, you can eat eggs. In AIP, you cannot. In low lectin, you can eat specific nuts. In AIP, you cannot. Certain seeds in low lectin. No seeds at all in AIP. In low lectin, it is not recommended that you eat cucumbers, or at least the skin and seeds. In AIP, you are perfectly fine with doing that with cucumbers and squashes. There is a little bit of alcohol and coffee allowed on low lectin, but not on AIP. I sold a bunch of people there, didn’t I? There are certain sugars, like sugar alcohols, that are allowed on low lectin but not on AIP. AIP is really a very strict flushing of any kind of processed foods. The point is to live on plants, animal proteins, good organ meats is encouraged, and a little bit of fruit. In low lectin, it’s really only berries and only in season. Very little fruit. AIP has a little bit of fruit on it.

Dr. Eric:

How long again do you typically have someone follow AIP for?

Risa:

AIP is 30-90 days. If you’re having flare-ups or noticeable symptoms, I would go as long as you can go. If you can get to 90 days, I did that when I first discovered AIP. I had been diagnosed with Hashimoto’s long before that, but I did it. You can see numbers. I work with people all the time who do it, and they see remarkable changes in their flare-ups. I work with somebody who had Tourette’s, and their Tourette’s was dramatically down. The whole point is to decrease that systemic inflammation, just like low lectin. I would do that for 90 days. Then I would either hop on low lectin because it’s going to continue to take out those inflammatory foods, or Paleo.

Dr. Eric:

What advice would you give for someone who has been following a vegetarian diet or is a vegan, and they’re autoimmune? Ideally, they should follow AIP. Would you modify the vegetarian/vegan diet?

Risa:

Great question. This is a tricky situation. I’m working with somebody right now who is vegetarian. I spoke to her yesterday, and she tried eating meat and said, “I just can’t do it.” I got her labs back. Her sugars are just starting to come up. She is now insulin resistant. She has been living on grains and beans and bread. I always urge people to get their bloodwork done, so they can see.

I was vegan myself. Same thing happened. I was just 1/10 of a point shy of being prediabetic. I stopped immediately and brought back in animal protein a little bit. I just think that it’s better for most people to eat that way. I understand that people want to be vegetarian, and I completely support that.

I would say watch the grains. Make sure you’re having millet, which is low lectin, and higher in protein. Quinoa, which is a seed, not a grain, but it’s higher in protein, lower in carbohydrates. A little bit of brown rice, which is higher in protein and fiber. A little bit of legumes. When I was a vegan, there wasn’t a salad or meal that I wasn’t having hummus beans, garbanzo beans, black beans, or lentils. I loved it. It’s a great source of protein. We also get protein from vegetables as well.

It’s important to know where your blood levels are, where your blood sugar is, where your protein levels are. We have to make sure you’re getting the right proteins. Nuts are a great way. Seeds, too. Start to calculate how much protein you’re getting, so you understand.

Dr. Eric:

Makes sense. I briefly brought up a scenario earlier where someone has autoimmunity, like Graves’ or Hashimoto’s, and they have SIBO. In that situation, would you have them follow both diets, AIP and low FODMAP? Would you prioritize one over the other?

Risa:

Another great question. SIBO is something I address immediately. I would do a stool test to make sure there is no H-pylori, which is very common. I would address the SIBO. If you kick that can, it will just get worse. It’s hard for you to heal when you’re in this inflamed state. If you have SIBO, I would do a stool test to determine it. There are SIBO tests we do as well. I treat that.

There are three ways to treat SIBO. One is with an antibiotic, which I don’t know that everybody needs. Severe cases may need that. No matter which way you go, it’s not 100% effective for anything. They are all about 70-80% effective. SIBO is very recurring. You may have to do it again.

I do a supplement protocol with a low FODMAP diet. I keep somebody on that for a good 30-60, maybe even 90 days, depending on how bad they are. The stricter you are at the beginning, the better off you’ll be. You are trying to starve that bacteria. Once you starve it and can kill it with supplements, then you are good to go.

I of course had that because it’s on the list of triggers for autoimmunity. I am always looking for root causes. When I had it, I was pretty one and done. I did it, and it’s never come back. I have tons of patients who will experience recurring SIBO. It depends on how you eat afterwards. It depends on how you live. It’s important to get your stool checked all the time, so you know where you are and where you stand. If you’re bloating, you should absolutely look into that.

Dr. Eric:

I agree. If I am working with someone who has Graves’ and Hashimoto’s, and they have SIBO, I usually tell them to hold off on the AIP and focus on getting rid of the SIBO. I usually try to do the herbs first. There are times when someone will choose the antibiotics. There is that elemental diet, which most people won’t choose to follow, unless they have a severe case. If nothing else works, or if they are just an extreme situation. Even then, they will usually go with the herbs. We take a similar approach.

Risa:

Exactly. No food for 14-21 days is pretty brutal for most.

Dr. Eric:

Agreed. In your book, you mention that you use and recommend reverse osmosis water. You told a story of why you use reverse osmosis water. Can you share that here?

Risa:

People should learn from my mistakes. I moved into this home. We were remodeling it pretty much floor to ceiling. I have this plumber I worked with for a long time, and he was great. I said, “I want the best water filtration system you can find.” I had instant hot because I do tea. When I cook, I always want to drink out of that filter. Then I had my tap water. We did this research, and I was so busy doing all these other things with the house that he said, “I got this great filter.” He put the whole system in and charged me a fortune. I said, “This tastes so good.” I was drinking it. I’m pretty good about tasting chemicals, and it tasted really clean to me. I used this for quite some time.

One day, I thought, Hmm, I wonder if I can just check it and see how many things are in my water. I found a meter on Amazon for like $10 or something. I came home and was so excited. First, I tested the tap water, and it was 498. I said, “Oh, great, good start.” Let’s go to the filtered water. It was 494 or 495. Just shy of that. I went, “What?” I redid it again. Sure enough, it was just a hair below. I was devastated. I couldn’t believe it.

I immediately got on the horn and looked into reverse osmosis. I bought this tank that was not even that expensive. At the time, I probably paid about $200. I had it installed under my sink. It took so much space under that sink, but I said, “Forget it. If it’s good, it’s fine.” It was installed. I tested it, and it was 11 versus 490-something. I was absolutely thrilled. Reverse osmosis is, I think, the best water to drink. That’s what I do. That’s what I recommend.

Filtered water tells us really nothing. It really is just tap water. It just contains a ton of fluoride. 70% of the water that we get in the United States is fluoridated. Fluoride is a halogen that blocks iodine absorption. Not good for a thyroid person. We need our iodine. I wouldn’t recommend chlorine in the water as well, fluoride, bromide. It’s what we get from bread. That was an interesting lesson.

Dr. Eric:

I also use reverse osmosis in my home. Sometimes I actually commonly drink Mountain Valley Springs water. I have a glass bottle as well. Most of the time, it will be the reverse osmosis.

One other thing you mentioned in your book: Sugar is the devil. I’m sure people realize they should avoid sugar. For those who aren’t aware of that, can you talk a little bit about that?

Risa:

First, sugar doesn’t really glean any nutrition. There is no value to it. I have these foods I call food for sport and food for survival. That would be in the food for sport category that we could occasionally have. There is not a bonus. There is no value to it.

Sugar, table sugar or most sugars, even natural sugars, spike our blood sugar levels. We go high, then we go low. This causes a lot of imbalance in the blood sugar. It causes the pancreas to pump out a lot of insulin. It causes the cells to require an influx of a surge of sugar. We want to make sure that those receptors that are on those cells are alive and functioning. We don’t want them impaired, which is what happens when we get insulin resistance.

The other reason I don’t like sugar is it eats up our white blood cells, which are our army, our protector, our immune system. Even a tablespoon of sugar can deplete your white blood cells for about 50% up to five hours. If you’re feeling that tickle in your throat, I wouldn’t recommend sugar at all. You have no way of fighting if you kill your army.

Sugar causes a fatty liver. I was talking about that earlier. Lots of sugar and carbs will cause a fatty liver without a doubt.

Sugar feeds cancer cells. It proliferates cancer cells. It is astonishing to me that in hospitals, when they are giving you chemo, they are giving you Coke, brownies, cookies, chips, bread. They are giving you sugar. There is tons of sugar in hospitals. It should be banned. It makes us unwell.

Sugar makes us fat. Sugar causes that pancreas to pump out insulin and puts it in the cell. If we have excess energy for the cell, then it just parks it in fat cells and fat tissues. This is how we get fat. To lose weight, we want to give the cell less than it needs, so it has no choice but to pull from the storage unit.

Sugar makes us tired. After that spike, we come down, and we are tired. We want a coffee or another cookie or another pick-me-up.

Sugar comes in many forms, not just in a cookie or cake, but it comes in your wine glass, lemonade, big glass of orange juice. Especially if you take the fiber and protein out, you will spike big-time.

I am not a fan of sugar at all. It tastes good. We now have so many other things we can eat that taste sweet and don’t spike our blood sugar levels, cause gastric upset. I am a big fan of allulose. I use that in all my sweeteners and products, like my collagen bars. It really protects your blood sugar levels.

Dr. Eric:

When you speak of blood sugar, some of the testing you mentioned, like insulin, which I also recommend fasting insulin. You also mentioned C-peptide. With insulin, which range do you look for? What would be your optimal range?

Risa:

For fasting insulin?

Dr. Eric:

Yes.

Risa:

Less than 5. 4.9, 4.7. You can even go down to 3.9. Something less than 5.

Dr. Eric:

That’s what I ideally look for as well. What other tests do you recommend in your practice?

Risa:

I do a full comprehensive bio screen for everybody that I work with. I’m looking at all four markers of your blood sugar. I’m looking at all nine markers of your thyroid. I’m looking to see if you have reverse T3, T3 uptake, free totals, antibodies. I’m looking at fatty liver. I’m looking at your GFR, your kidney filtration. I’m looking at GGT, the breakdown of your white blood cells, your eosinophils, your monocytes, your neutrophils, your lymphocytes. I’m looking at your Vitamin D levels of course.

I’m looking at the size of your red blood cell that is your MCB. That will tell me if you are likely to have MTHFR, if you have methylation issues. MTHFR is a gene mutation that I commonly test people for. You should know if you have MTHFR. I have it. Both of my kids have it. 90% of the population has it. It is 100% genetic. It tells us if you are having trouble methylating your B12 and/or your folate. You should know which one you have. Make sure you are taking a methylated B vitamin.

I also look at inflammation markers. How do we know how you are if we don’t look at inflammation markers? I always order a C reactive protein, CRP, cardiovascular inflammation, and general inflammation. I look at homocysteine, which is a methylated marker. If it gets driven high, and it stays high for a long time, we look at dementia, cardiovascular disease, and other things. I am all about looking at systemic inflammation.

Gut health is what I was talking about earlier. I send everybody home with a stool test. I am looking at 84 pathogens. I want to see if there is H-pylori. Are there any pathogens, parasites? Blastocystis hominis is a root cause of Hashimoto’s. If you have these parasites, pathogens in the gut, if you have these autoimmune triggers, let’s kill them. See if we can reverse this autoimmune situation.

Whether it’s fibromyalgia or colitis or anything else, I am looking at gut health. I order a zonulin to see if you have leaky gut. Leaky gut, leaky brain. I am seeing an influx of a lot of Parkinson’s lately. I am seeing a lot of brain deterioration. Leaky gut, I am focusing on big-time.

I look at if you have fat malabsorption, if you are producing your own digestive enzymes, which is your secretory IGA. Your immune system is doing it in your gut. I am looking at all those numbers. How inflamed you are in the intestinal linings. Do you have IBS? Was that just a name your doctor gave because they don’t know what else to say?

I look very comprehensively. When I look at the breakdown of your white blood cells on your blood test, I can see if there is a viral pattern or bacterial pattern. If there is a viral pattern, I will do further testing and see if there is Epstein-Barr virus or Cytomegalovirus. Those are also root causes to immunity. I am always looking at those root causes.

Dr. Eric:

Sounds good. I order a lot of the same tests. I also have the MTHFR polymorphism, the C677T. The way I found out was the elevated homocysteine, which led me to further testing.

Finally, can you discuss some of the supplements you recommend? Maybe expand on the RGN detox. Why you recommend it and how it differs from other detoxes.

Risa:

I love my detox. I have made several. I have tried every one on the market practically. I love this one the best. The reason is because it’s fully doable. You can work, travel, eat. You’re having two shakes a day. They are collagen-based. Collagen is the grout for leaky gut. I am always about protein, fat, and fiber. Then you are eating food. You are eating animal protein, unlimited vegetables, sweet potatoes, yams, good fats. We stay away from a couple of foods. We are not drinking alcohol for 14 days or coffee, hopefully, if you can. If you can’t, bring it down to one cup, and don’t put any cancer-causing chemicals in it. Put full, non-dairy fats. We are taking out dairy. We are removing grains and legumes. You should have plenty to eat, and it’s very good.

People feel amazing. I had two people yesterday on the detox say their body aches went away, just from the detox. It really quells that inflammation. It’s there to support gut health, get the ball rolling, and decrease systemic inflammation. There are a million benefits to it. It’s all good.

That is 14 days. Sometimes I recommend people do it for 28 days if they have fatty liver or just feel good and are thriving on it.

I have a line of supplements that I am picky about. I am picky about what goes into my body, my kids’ bodies, so I make my own. My Vitamin D has Vitamin K in it for absorption. I don’t have any gluten, dairy, soy, sugar, or anything artificial in my supplements at all.

I make these amazing collagen chocolate bars that are sweetened with allulose, so they don’t spike blood sugar levels. They are low carb but packed with protein, fat, and fiber. They are delicious. We all need a little something to eat.

I have a myriad of products to help with gut, blood sugar, inflammation.

I have a Fab 5 that I have everyone who has autoimmune on. That is Vitamin D, my Omega Max, resveratrol quercetin, turmeric max, and glutathione. Glutathione is our master antioxidant. It helps protect us against any oxidative stress. That is anything that wants to come in the body and cause disease. That is the Fab 5 that everybody who is autoimmune should be on.

If there is thyroid, I have some opti-thyroid. I have AI balance for people with general autoimmune. All the products I have are to decrease systemic inflammation, support the body, and increase good gut health.

Dr. Eric:

Wonderful. Thank you so much, Risa. Where can people find out more about you? Of course, your book. I found it on Amazon. What is your website or any other resources?

Risa:

My book FoodFrame is available on Amazon, Barnes & Noble, and Target online. It’s also available on my website, RisaGrouxNutrition.com. You can find me there. You can reach out and set up an appointment. I work with people all over the world. On Instagram, TikTok, Facebook, RisaGrouxNutrition. I have lots of healthy meals and tips. I do lots of videos. Lots about thyroid. You can see all the yummy food I cook and eat and enjoy.

Dr. Eric:

Thank you so much for being here. I appreciate you sharing your wealth of knowledge with us.

Risa:

Thank you so much for having me. It was great to be here.

 

Recently I interviewed Laura Frontiero, as she discussed how to restore mitochondrial health. If you would prefer to listen the interview you can access it by Clicking Here.

Dr. Eric Osansky: With me, I have Laura Frontiero, and we will be chatting about mitochondria. Laura has served thousands of patients as a nurse practitioner over the last 22 years. Her work in the health industry marries both traditional and functional medicine. Laura’s virtual wellness programs help her high-performing clients boost energy, renew mental focus, feel great in their bodies, and be productive again. Her belief is that to create optimal wellness, first, we need to identify and clear the root causes of our health problems, usually toxins, chronic infections, and stress; eliminate inflammation; and restore gut and mitochondrial health. Her signature system helps to reclaim what she calls the energy edge. For each person, it’s a unique journey back to their peak mental, physical, and biological performance. When your body is bio-optimized, and you are operating at your energy edge, you are unstoppable, productive, happy, and fulfilled. Thank you so much for joining us, Laura.

Laura Frontiero: Doesn’t that sound good? Don’t we all want to be happy, fulfilled, and producing at our highest level?

Dr. Eric: It does. I definitely want my body to be bio-optimized.

Laura: Yeah, for sure. Thanks for having me on the show, Eric. It’s fantastic to participate and collaborate with you again.

Dr. Eric: You’re welcome. Again, I look forward to this conversation. Let’s go ahead and start off by sharing your story. Why did you transition from working as a nurse practitioner in the largest HMO in America to specializing in functional medicine?

Laura: That is a story, I’ll tell you. I spent 20 years working in conventional medicine in the clinic setting. A great portion of that time, I actually worked in what we call preventative medicine. It dawned on me many, many years into the process that preventative medicine on the conventional medicine side is not really prevention at all. When you think about what we’re doing in a preventative medicine clinic, we’re doing colon cancer screenings, breast cancer screenings, prostate cancer screenings, and thyroid cancer screenings. We’re screening, but it’s really looking for early disease. One day, it just hit me that this isn’t really prevention. This is early detection. That’s a really huge problem in the Western medicine world. We’re not actually showing people how to prevent early disease.

As I dug in and started learning about functional medicine, I also realized that some of the things we tell people to do in the Western medicine world to prevent disease are actually harming people. For example, we tell people in the Western world to be sure to eat lots of whole grains. We tell people to use artificial sweetener instead of sugar if they’re diabetic. You and I both know, Eric, that lots of whole grains and artificial sweetener are probably not really helping people.

We also tell people to monitor your 10,000 steps. Use a wearable monitor. I have some concerns about that because the level of personal body EMF exposure, there are wearables that you can use that don’t cause problems, but the majority of the people in the Western world don’t know that their wearable could actually be causing problems for their health.

I realized I can better serve people if I just focus on true prevention, true root cause, and truly reducing risk for disease. That is where it came from.

Dr. Eric: How long have you been a nurse practitioner for?

Laura: 22 years.

Dr. Eric: Wow.

Laura: I know. For those watching, you can see I don’t look like I have been a nurse practitioner for 22 years. But there is something to say. I’m going to be 50 this year. Clearly, I know something about preventing aging and taking the best care of your body possible. It’s obvious when you can see my face because I don’t look like I’m old enough to have worked that long in medicine.

Dr. Eric: I never would have guessed you’re about to turn 50. You’re looking great. You are taking awesome care of your mitochondria apparently, which is what we’re about to dive into. Why don’t we talk about mitochondria and explain in simple terms what mitochondria are as well as what they can do to support our health?

Laura: I love this topic. I’d really like to make it easy to understand. Mitochondria are your life force. They are called the powerhouse of your cells because they are responsible for 90% of energy production. We hear that over and over when people talk about mitochondria. I like to break it down even further.

What is this energy production? I like to think of it as we have two types of energy: physical energy and invisible energy. Physical energy is that energy that you experience throughout your day where you hit the mid-afternoon, and you have still got energy to keep going and be productive. Or maybe you don’t have energy, and you feel like you want to take a nap or have a cup of coffee. That is that physical energy, that energy to keep going with. How we notice our brain functioning and how we notice our body feeling.

Then there is something called invisible energy. Your mitochondria are responsible for that, too. That is a higher level of cellular energy. It’s required for everything from gut healing to restoring your immune system. It’s responsible for you being able to digest your food and your liver to be able to detoxify and for your urinary system and kidneys to work. That is the invisible energy that we don’t even know is happening, but we need it. Our mitochondria are supplying that ATP energy.

That is an overview of invisible energy versus the physical energy. This is not scientific; this is my experience of energy and how I help my clients make sense of it. I’m not quoting a research study here or anything. This is a Laura-ism.

The next thing I want to talk about is where mitochondria are at in our body and how they function. The best way I can explain this to you is to really compare mitochondria to houseplants. Let’s have a discussion about houseplants, okay?

Dr. Eric: Sounds good. I wasn’t expecting this, but I like houseplants.

Laura: Let’s talk about a couple of things. Let’s talk about mitochondria and houseplants in terms of location of where they like to live and their living conditions and their function. Those three aspects are really important to mitochondria health. It’s easy to understand it if you think of houseplants.

Before I say that, I should say mitochondria are these tiny, microscopic organelles that live inside of all the cells in our body, excluding red blood cells. They’re even smaller than a cell. In fact, in some cells, you have 10,000 mitochondria. They’re itty bitty and inside the cells. That is a huge concept to understand.

Let’s break it down to houseplants. Location is everything. Houseplants live in a specific spot in your home. Think of them living on a windowsill or sitting on a shelf. They have a spot where they live. That special spot is inside a room. For example, a bathroom or kitchen or bedroom or patio. That room is inside the larger structure of your home. We’ve gone from the most small part where they live to the large structure of the home. Each of those plants that you have in your home, they’re suited for certain rooms. Some plants do better in a moist bathroom. Some plants do better in a bright kitchen. Some do better in a dark bedroom.

Now, let’s explain mitochondria, now that you have that concept in your brain. Similarly, mitochondria live inside the individual cells. Think of that like the windowsill or the shelf in your home. The cells are located in organs, kind of like how the shelf or the windowsill is located in a room in your home. The organs are like the rooms. Think about brain, liver, kidney, heart, all the organs. Those rooms or organs are in the larger structure of your body, which is similar to the home, the house, for the houseplants. Does this make sense, Eric?

Dr. Eric: It makes sense.

Laura: Just like the houseplants that have a certain living condition that they want to be in, like the moist bathroom or the dark bedroom, your mitochondria are the same. They are suited for certain areas of your body. Some mitochondria are specific to brain. Some mitochondria are specific to heart. Others for muscle, others for your digestive tract, and so on. It’s the best analogy I can give you to make sense of these mitochondria.

I said there are three things I was focusing on: location, living conditions, and function. The next thing is living conditions. Given the right living conditions, houseplants will thrive, grow, and even sometimes reproduce. I have these little air plants right now in my kitchen window that are reproducing. They are making baby air plants.

Mitochondria are similar. Given the right conditions, they will thrive, grow, and reproduce. Mitochondria are fragile. If you withhold what they need, they will die, malfunction. That’s no different with houseplants. Some people have a green thumb, and some people kill everything they put in their house because they also need certain things. If you withhold what they need, they will die or look limp and terrible.

The funny thing is that mitochondria and houseplants are so much alike that they both need clean water, they both need sunlight, and they both need nutrition. They are quite similar. We even know through studies that if you speak negatively or talk negatively to your houseplants, it’s more likely to stunt their growth. The same thing goes for mitochondria. If you live in a stressful environment, and you’re stressed all the time, high levels of stress, trauma, that will yield lower mitochondrial function.

That leads us to function, the third point. Houseplants create life-giving oxygen. That’s why we want them in our house in the first place. They help remove toxins from the air. They clean the air. They create oxygen. Mitochondria also create something; it’s called ATP, a unit of energy that is needed for every cellular function in your body. Plus they even assist in the detox pathways. Like houseplants detoxify the air, mitochondria assist in the detox pathways to keep your body flushed of toxins. Then they remove toxins from the body. Very similar. That’s the best, easiest analogy that I can give. I think it’s fun.

Dr. Eric: Mitochondria are not only important for energy, but they are the powerhouses of the cell and important for ATP production. Also, they play a role in reducing one’s toxic load. If you don’t have healthy mitochondria, you could have an increased buildup of toxins. Is that correct?

Laura: It is. People constantly think of mitochondria as being energy producers. There is actually a long list of functions that mitochondria are responsible for in your body. Yes, detoxification and energy production. They’re also really important for calcium homeostasis to promote cell growth and multiplication. They are responsible for cell death, which is really important. Apoptosis is a word you may be familiar with. This is programmed cell death, and this needs to occur to make space for new cells. They are responsible for cleaning out cellular debris. They generate oxidative radicals, or free radicals, and reactive oxygen species. That’s a whole talk, but those reactive oxygen species can be helpful when you have an invader, like a virus or bacteria. Mitochondria support your nervous system function. They help with heat production. They are organs of metabolism. They help the whole body communicate with your immune system as well. Lots of things that your mitochondria do.

Energy production is the one we talk about the most. It’s the one you learn in biology class in high school, the Krebs cycle, when we talk about ATP and the cycle of energy production. That was about the time I tuned out in high school; I found that very boring.

Dr. Eric: Same here. Overall, I like biochemistry, I guess, but the Krebs cycle, I can’t say that it’s something that I’ve kept up with over the years. We had this conversation because I’m in Laura’s upcoming summit, which we’ll chat about later. I was telling her not to ask me about the Krebs cycle because it’s been years since I’ve learned about it. I’m sure some of it will come back to me if I review it, but I try to distance myself from it.

Laura: Totally there with you. I am not a biochemist; I am a nurse practitioner. My superpower is educating people, breaking down complex concepts into easy-to-understand concepts so that you can take action. If I just sit and talk to you about biochemistry, I promise you you’ll tune out.

Dr. Eric: Same with me. I also try to stay away from the biochemistry. Let’s talk about certain health conditions. Mitochondria, as you mentioned, are in pretty much every cell except for red blood cells. Let’s talk about mitochondria and chronic health problems. I know mitochondrial dysfunction can lead to health issues, but I want to hear you discuss this relationship.

Laura: When we have strong mitochondria health, we can avoid chronic health problems. It’s as simple as that. There is a cascade of things that need to occur for mitochondrial damage. There are a few levels. Let’s start at the beginning.

Let’s talk about how we damage mitochondria in the first place. We have to talk about that before we can talk about how we get to chronic disease. Chronic disease is cancer, heart disease, autoimmune conditions. The list is long. There is a lot that goes on between healthy mitochondria to that end point.

The first thing is how we damage our mitochondria. Most of the ways we damage our mitochondria, we have control over. There are a few things we don’t have control over. We don’t have control over the genetics we’re born with. However, we do have control over our epigenetics and whether we turn on or off those genetic switches. We are born with a set of genetics.

We also can’t control aging. Aging is going to occur to us no matter what. Every year, we are a year older. We can influence whether we age in a healthy way or whether we age in a way that is accelerated. Those two things, we really don’t have control over.

Everything else I’m about to list to you, we do have control over. These all affect mitochondrial health. This sets you up for mitochondrial decline: sedentary lifestyle, not eating healthy, poor diet, eating sugar and processed foods, and non-organic food that contains pesticides. Having nutrient deficiencies because you don’t eat a wide range of foods. Having hyperglycemia or high blood sugar levels and blood sugar dysregulation due to the way we eat and types of food we eat.

Chronic stress. Not sleeping. This is a big one. Burning the candle on both ends. Sleep problems and stress kind of go hand in hand.

Then there is this whole category of infections. Everything from viral infections like Epstein-Barr virus, hepatitis, and herpes to bacterial infections, like infections that occur in the gut microbiome or urinary tract—many people have chronic UTIs. Fungus or candida infections. Parasites that are not just in the GI tract, but parasites can be anywhere in your body. They can be anything from visible to the naked eye to protozoa, which you can’t see with the naked eye. They are microscopic and can live anywhere in the body.

There is a category of environmental toxins and industrial toxins. Some of the stuff we get exposed to from industry and things being produced in factories and petroleum and exhaust from planes and cars. Then there is the environmental toxins that we put on ourselves from our body products, our beauty products, our cleaning products for our home. Burning toxic candles in the home and air fresheners.

Another category of problem that I touched on is EMFs, electromagnetic fields. I mentioned it with the wearable devices. Then there is the problem of radiation. Heavy metals. Industrial mold mycotoxins.

All of this leads to chronic inflammation, which is possibly the #1 killer of mitochondria. This chronic inflammatory process in the body. The first step of hurting your mitochondria and going down the chronic disease path is how we damage them.

Once you have damaged mitochondria, the next thing that happens is you start to get into metabolic instability. What that means is you have a lowered energy production. We talked about ATP energy, the Krebs cycle. That’s your energy that your body uses for every cellular function. That starts to decrease. The invisible energy and the physical energy I talked about, we don’t have enough of that for our body processes and to feel good as well.

When we have lower energy production, we also have increased metabolic waste, so the cells are releasing damaging free radicals and waste that needs to be carried away through your detox pathways. You have an increase in oxidative stress. These are concepts you may have talked about with your other guests, and your listeners are probably aware of because you have a high level of highly educated listeners here.

Once you get through that phase of metabolic instability, the downward spiral to chronic disease, you are getting closer to it. You go into what we call metabolic inflexibility. We went from instability to inflexibility. That is the inability to respond to metabolic demand and choose the best fuel source.

Your body uses two types of fuels to make energy: glucose and ketones. Glucose is like using leaded gas in your car. It burns dirty; it makes a lot of exhaust. Ketones are like using super premium unleaded gas in your car, where it burns clean. Like the engine in the car doesn’t suffer, your body doesn’t suffer either. You’re unable when you’re inflexible to choose between what type of fuel to burn, and you just end up burning glucose all the time. You get dysfunctional energy production, poor fatty acid metabolism. This results in chronic protein damage and more increase in oxidative stress. Now, you have created a chronic disease. Those chronic diseases manifest as cardiovascular disease, cancer, Alzheimer’s, Parkinson’s, metabolic syndrome, muscular dystrophy, epilepsy, autoimmune disorders, autism, fibromyalgia, chronic fatigue syndrome, migraines, and on and on. Thyroid disorders, Eric?

Dr. Eric: Most thyroid conditions are autoimmune. Graves’ and Hashimoto’s fall under that category. A lot of what you mention are triggers of Graves’ and Hashimoto’s and autoimmune conditions. You mentioned the impact of certain infections, not only gut infections but stealth infections and environmental toxins, including heavy metals, xenoestrogens. There is a lot of overlap.

Laura: Yes. You see that cascade. It’s really important how we live our life and the choices that we make in our day-to-day. That is going to spiral you and cascade you toward that chronic disease state.

Dr. Eric: Are there tests out there that you recommend to evaluate mitochondria? Or do you go more by symptoms, or just assume everyone has a mitochondrial issue?

Laura: I love not to assume. I love to test. You’ve heard that concept of “test, don’t guess.” Let’s see what’s really happening with your mitochondria. Are they mildly dysfunctional? Are you in full hypermetabolic state, where your mitochondria are lying flat on the ground and not producing energy at all? The way you approach supporting those mitochondria would be different.

The beautiful thing is we can test this through an organic acids test. It’s a simple urine test. It tells us what’s happening in that fancy Krebs cycle, the biochemistry of what’s happening in the body. Eric and I are really good at reading organic acid and Krebs cycle tests but aren’t so great at explaining the biochemistry. This is our superpower, being in this space that we’re in right now.

An organic acids test is incredible. It tells us whether you are efficient at making energy from glucose or fat. It tells us what your metabolism is like and whether those mitochondria are super suffering. An organic acids test is pretty awesome because it also gives us an idea of what nutrient deficiencies you might have and what nutrients you may need to help support mitochondrial function. Everything from B vitamins to magnesium to lipoic acid to CoQ10.

The other test that I really like to do is a toxin test. Look at your toxic burden, mold and mycotoxins, environmental and industrial toxins, everything from pesticides and herbicides to folates and parabens, endocrine-disrupting chemicals. You can also test for heavy metals.

Those are tests that are really supportive in knowing what to do to help you at a foundational level and help you have a starting point so that you’re not willy nilly trying to figure out what to do to help your mitochondria and figure out how severe the problem is. Where are you in that cascade of lifestyle to chronic conditions?

Dr. Eric: Does the testing depend on the person? Maybe not necessarily the organic acids test, but let’s say mycotoxin testing. Do you recommend that to everybody or just if you suspect there might be a mold issue or toxic mold problem?

Laura: Good question. It’s interesting. You would be surprised how many people have mycotoxins affecting their health who don’t think that they have ever been exposed to mycotoxins. If people are resourced and can really afford some investigation into their health, then I do recommend, not right out of the gates, but maybe after we have taken a little bit of binders and opened the internal detox pathways in the body, and your body can start releasing some of those toxins, and we can start seeing them. Then I will often recommend we do a total toxin evaluation that includes everything.

As an example, I didn’t think I had mycotoxins, and I was stunned at what I saw in my own test. If you have any brain fogginess and low energy, that’s a good sign that you should probably include it in your evaluation. Not necessarily right off the bat. It will probably get more bang for your buck if you do it four weeks into taking some binders and doing a little bit of opening those drainage pathways.

Dr. Eric: Makes sense. It’s not just airborne. Of course, that’s probably the major source of mycotoxins, but you can also get them in food, too. If someone is eating grains, corn-

Laura: Grains, corn, coffee. Those are big sources of mycotoxins. I was surprised to see I had those as well. The surprising thing is I also had the type of mold toxins that you get in a wet building. The thing with mycotoxins is once you’re exposed to them, they can be in your body for the next 30-40-50 years. You may not be able to clear them on your own. Probably you won’t. We can’t tell you exactly when you were exposed. Once you start digging into your past, oftentimes you can pinpoint when it happened. I was able to do that. I know exactly when I got exposed once I started thinking about it.

Dr. Eric: Are certain heavy metals more significant than others? Obviously, you want not to have any metals. Do you find that mercury or cadmium or arsenic or lead-

Laura: Heavy metals are a problem. It’s really hard to accurately test for heavy metals in the urine without actually challenging them to come out of the body. If you are going to do heavy metal testing, you want to work with a practitioner who can put you on some supplements to move the metals, or even a prescription medication. It’s a hard thing to do. The beauty is a lot of us who work with detoxing the body, our protocols that remove industrial toxins, mold toxins, the same binders will move metals as well. Even if you don’t see metals on your testing, doesn’t mean they’re not there. Oftentimes, a protocol will also help support removing them. That’s good.

Dr. Eric:Can you discuss how you go about restoring mitochondrial function?

Laura: Yeah. Obviously, you lived into mitochondrial dysfunction. You need to live out of mitochondrial dysfunction. This is not an overnight process; it takes time to restore your health. Definitely give yourself an honor space and time for this.

The first thing you can do is really support your nutrition by eating a nutrient-rich diet and eliminating refined sugar and processed grains and bad fats. By bad fats, we’re talking about vegetable and seed oils. Removing casein, which you find in dairy. Removing gluten. Removing artificial ingredients. Then eating all the things that your body craves and wants, like greens and vegetables and herbs and fruits and nuts, seeds, legumes, and some whole grains. You don’t have to remove all whole grains. If you have autoimmune disorders, you should probably remove all grains. If you are not dealing with autoimmune disorders, you can probably eat some, and you can work with your practitioner to find out what would work best for you.

Incorporating healthy fats like avocadoes, olives, coconut, grass-fed butter and ghee, pasture-raised eggs. Clean proteins, like grass-fed beef, wild-caught fish, wild game, pasture-raised poultry, free of hormones, free of antibiotics. All of that matters when you are choosing your animal proteins. Organ meats by the way are also really healthy for you: liver, kidneys, heart, brain, bones. If that grosses you out, you can always get encapsulated forms of organ meat, which are really nutritious and supportive to mitochondria.

While we are on the topic of food, the way you eat your food, or the timing of eating your food, is also important. If you can tolerate it, some intermittent or extended fasting, you may need to work yourself up to that depending on what your current glucose dysregulation could be. If you are really dysregulated, you may not be able to do intermittent fasting right away.

When you’re fasting, your damaged mitochondria are purged through something called autophagy. Your body removes and gets rid of damaged cells and damaged micro-organelles. This is amazing because damaged debris and accumulated reactive oxygen and nitrogen species are removed from your body. Intermittent fasting, you can start with a short 12-hour window.

The keto diet can be supportive. This is not something I recommend long-term forever, but getting you to become more of a fat burner than a glucose burner could be supported by keto. Work with a practitioner on that.

Moving your body in regular exercise. Studies show that you get a 50-80% increase in mitochondrial capacity when you exercise with interval training. I am not saying it has to be crazy athlete-level training because that would be too much for damaged mitochondria. Work with your practitioner to see what kind of low intensity exercise would work well for you to do in intervals. The high intensity exercise, leave that for the athletes right now. If you have mitochondrial dysfunction, there is no way that high intensity exercise will be helpful to you. It will be more harmful.

Reducing stress. I talked about the link between stress and poor sleep. There is also a huge link with increased inflammation and reducing your immune function. Reducing stress is absolutely critical to healing your body. You’ll hear integrative and functional practitioners talk about this all the time. That was something missing in the Western world when I was working in a Western clinic. We didn’t focus enough on helping people heal from trauma and reduce stressors in their lives.

Sleep is really important. Circadian rhythms. Sleep and sunlight, as I mix these two concepts together. Our sleep cycle is actually dependent on and related to our Circadian rhythm. Sunlight is part of that. It’s really important that we get at least seven hours of sleep a night to support mitochondrial health. Circadian rhythm is supported when you get out into the sun or look at the sun. Get your eyes on the sun first thing in the morning when you wake up. It’s also equally important to see the sun setting at night. Don’t spend your entire waking cycle inside your home. Get outside. It’s really critical to mitochondria function and Circadian rhythm.

Also, in sunlight, you’re making Vitamin D from your skin. You can’t wear sunscreen if you want to go out and make some Vitamin D. It’s important for mitochondrial function. It promotes mitochondrial biogenesis. It increases oxidative capacity. Vitamin D is critical. Sunlight is so healing.

There are a bunch of things we can do, like red light therapy, cold exposure. You have heard of people taking cryotherapy or cold showers or cold baths. That shivering recruits your mitochondria to generate heat. You can do heat exposure. If you go into a sauna, this is a mild stressor signal that triggers cell responses. It creates a beneficial response in the mitochondria.

Then there are nutrients you can use, like supplements. I mentioned a few of them. When we look at the organic acids test, we can tell if you are deficient in CoQ10, L-carnitine, magnesium, alpha lipoic acid. Other things that can help are resveratrol, d-ribose, curcumins, PQQ, a lot of supplements. Work with a practitioner to figure out what supplements would support. I’m sure you have some tricks up your sleeve as well.

Dr. Eric: Did you mention CoQ10? You might have.

Laura: Yes. Absolutely. On the organic acids test, we can see your oxidative stress levels, and that will tell us if you need more CoQ10. We can also see what’s happening in the Krebs cycle. CoQ10 is one of the cofactors there. We can tell if that would support you. It’s probably a simple thing that everyone could do, even without an organic acids test or working with a practitioner. CoQ10 is safe and supportive to your cardiovascular health, mitochondrial health. It’s a good idea.

Dr. Eric: It comes to mind not just because it’s very commonly taken. A lot of people associate CoQ10 with mitochondria, but especially with hyperthyroidism, it’s common for people to take beta blockers. A lot of beta blockers will have a negative effect on CoQ10. Statins as well for those on cholesterol lowering medication. Wanted to bring that up.

Of course, you mentioned food and nutrients. What you mentioned earlier, reducing your toxic load, if you have mycotoxins, clearing those out. Reducing your exposure to EMFs. There are so many things that need to be done. Good news is a lot of things you can do on your own. In some cases, it is a good idea to work with a healthcare practitioner because it could get complex when it comes to things like toxic mold and stealth infections.

Laura: I think it’s really hard for people to go through a true detoxifying process on their own. When I went through my own detox, I actually hired a practitioner to walk me through it, even though I know what I know. You will be held more accountable. You will have somebody to talk to. Your body shifts and changes as you go through detox. If you live on planet Earth in today’s day and age, you have exposure to a level of toxins and chronic low-grade infections. Almost everyone on the planet could benefit from working with a practitioner on some level of detox.

Eric and I are not talking about doing a juice cleanse. That’s not detoxing. You cannot detox your body with food. You can’t. You need to have binders. You need to have support for your organs for phase one and two liver, kidneys, lymphatics, bowels. This is not something you can do with food. It’s a misconception. You can’t actually thoroughly detox. It’s just impossible.

Dr. Eric: Especially in this day and age. Food plays a role, but if you just are relying on food, it’s difficult with the toxic world we live in.

Laura: You know the concept, “Let food be thy medicine?” How many thousands of years ago was that stated? Hippocrates? Did he say it?

Dr. Eric: I believe so.

Laura: This was before the Industrial Revolution. This was before big food, big pharma. This was before the level of stress that we have now. I really like to think of that concept of after you have restored your body to its balanced and healthy level, and after you have learned how to live a clean, healthy life in the 21^st century, once you have accomplished all of that, you remove the chronic smoldering infections, you have reduced inflammation, you have removed the toxins in the body. Once you’re there, let food be thy medicine.

Dr. Eric: Well said. Gut health. The last thing I wanted you to chat about, even if it’s briefly, is why you like to start the process of restoring mitochondria health by first addressing gut health.

Laura: This is a really important concept. In all of my programs, when I work with my clients, we address gut health first and foremost. It is foundational to wellness. If you don’t address gut health, you’re never going to get rid of the smoldering inflammatory fire that is happening in your body. All programs begin in my mind with gut health and detoxification and build from there.

Let’s talk about why gut health is really important. In order for mitochondria to survive and do their job, they need nutrients. We talked about the cofactors and nutrients required to make ATP energy. Primarily, those nutrients come from the food that we eat. It’s simple for people to understand that all food goes to one place first: into your digestive tract, into your gut, where the food is broken down into smaller parts, so your body can utilize the nutrients required to make energy and all body functions.

Here’s the thing: Our body can’t do any of it without the help of your gut microbiome. It’s made up of three main things. You have this community of bacteria that live inside of you. Plus you have the immune and neurological axes that regulate everything and help it communicate with our body. Here is where it all syncs together. Your mitochondria are stimulators of the same immune and neurological systems that interact with your gut microbiome.

Let me give you an example of where things go wrong. If you get food poisoning, you start having communication back and forth between the mitochondria and microbiota, the community of microbes that live in your gut. That regulates the body’s immune system response. Mitochondria, microbiota, are communicating. The body’s immune system is doing its thing. What you have here are two different set of organisms, bacteria and mitochondria, communicating back and forth to keep everything going smooth and healthy.

What goes wrong is you get this infection from food. You get food poisoning. This dysregulates everything, driving inflammation. You have an overgrowth of disease-causing pathogenic bacteria. The cycle of inflammation increases. Inflammation damages the mitochondria, which are supposed to be communicating to the immune system to tell your immune system what to do. Everything goes haywire.

If you don’t start at that really basic level of assessing and supporting gut health, then it’s going to be an uphill battle. It’s kind of like that concept of trying to solve your problem with just food. You’re leaving something big out. You must start with gut health. I know even in your programs, Eric, you focus on gut health when it comes to thyroid. It’s so vital.

Dr. Eric: Agreed. Healthy gut is important for overall health, especially for those with immune system conditions. Graves’, Hashimoto’s, other autoimmune conditions, you need a healthy gut to have a healthy immune system. It’s safe to say that just about every functional medicine practitioner at least pays attention to some extent to the gut. You dive into great detail. You’re definitely a gut expert. I agree. I spend a lot of time as well helping people to optimize their gut microbiome.

Laura: When people come to me and say, “Hey, I’m a high performer. I have a big life to live. I have big goals, big vision, big dream. I want to be present with my family. I want to excel in my business or at work. I want you to fix my energy, Laura. I want energy, and I want brain stamina.” Great. Let’s check your gut. That’s where we start. Let’s look at your gut health. Then we will be successful at building from there.

Way back when I was a nurse practitioner working in the conventional world and working in pseudo prevention, we did not talk about gut health. It did not exist. We did not talk about mitochondria health. We did not talk about toxins in the environment. We did not talk about how to truly nourish your body and solve underlying infections and toxins so that you can restore your health to optimal function. It’s really what it’s all about.

Dr. Eric: Quick question: Do you recommend testing, like a comprehensive stool panel, to your patients as far as evaluating gut health?

Laura: I do. You and I both know that we can do a pretty strong health intake. Really comprehensive. Learn a lot about what people are suffering from based on their symptoms and health history. If you have a gut test, it will tell you a few things about the good bacteria, the bad bacteria, the opportunistic bacteria. It will tell us about inflammatory markers, digestion. The most valuable piece of having a gut test is once the client sees what’s happening in their body in black and white, written out, and they have an explanation of what’s happening, it helps you stay the course. It helps you stay motivated. It helps you with accountability. It’s really nice when six months down the road, a year down the road, if you retest and see that all that effort, all that work you put into it, actually changed something, it really feels good. We want proof that what we’re doing is working.

I could help you heal your gut without ever doing a gut test. There are all kinds of things we can do to support your gut health. It’s knowing what’s happening that can give us little tweaks in your protocol and get you faster results. The most valuable piece is you seeing what’s going on so that you’re motivated, and you keep going.

Dr. Eric: Awesome. I want you to discuss your upcoming summit, the Mitochondrial Matrix Summit.

Laura: Restore your mitochondrial matrix, boost your energy, and fix your health, so you can live the life you love. It all starts from this talk. If we ignore mitochondria, it’s going to be really hard to restore energy levels, fix chronic health problems, and live your most productive and amazing life. When people ask me, “Laura, why did you do a mitochondria summit of all things?” Because it’s so foundational. It’s so critical. We have to support mitochondria health in order for you to reach all those goals.

Dr. Eric: I am one of the speakers, but I am also looking forward to listening to the other speakers. You have a lot of different experts, but this is the first mitochondrial summit I have heard of. Speaking of the gut, you always hear of gut summits and things about environmental toxins, but I think this is going to be a unique summit truly. Check out my talk, but check out as many of the talks as you can. It is a free summit.

Can you discuss other ways people can find out more about you?

Laura: Thank you. I’m really looking forward to your talk. We got deep into thyroid. We talk about hypo and hyperthyroidism and how they relate to mitochondrial health. We talk about simple strategies all coming from the brain of Eric, which is amazing because he is the thyroid guy.

In terms of getting in touch with me, you can find me at LauraFrontiero.com. I’m also on Instagram @Laura.Frontiero. You can find me on Facebook. Occasionally, you can find me on Tik Tok. I gotta get better about being on there. Thanks so much!

Dr. Eric: Thanks, Laura. This was great. I’m sure people will find this to be extremely valuable. Definitely register for Laura’s upcoming summit. Check out her website and social media. Take care!

Laura: You, too.

 

Recently I interviewed Dr. Ritamarie Loscalzo, as she discussed how to address insulin resistance and thyroid hormone resistance. If you would prefer to listen the interview you can access it by Clicking Here.

Dr. Eric:

Although I am always excited to do these interviews, I am especially excited today because I have the honor of interviewing Dr. Ritamarie Loscalzo, as we will be chatting about thyroid and insulin resistance.

Let me give Dr. Ritamarie’s bio: She is the founder of the Institute of Nutritional Endocrinology. She is passionately committed to transforming our current, broken, disease-focused system into a true healthcare system, where every practitioner is skilled at finding the root cause of health challenges, and uses the wisdom of nature combined with modern scientific research to restore balance. Dr. Ritamarie is also a licensed Doctor of Chiropractic with certifications in acupuncture, nutrition, herbal medicine, and HeartMath. She specializes in digestion, thyroid, adrenal, and insulin resistance. I know you didn’t include it in your bio here, but she also has a great deal of knowledge when it comes to genetics.

She is also a master at using palate-pleasing whole fresh food medicine and is a best-selling author, speaker, and internationally recognized nutrition and functional health authority with over 30 years of clinical experience. She also has a podcast called Reinvent Healthcare. This provides health and wellness practitioners around the globe to be part of the movement to provide root cause care to people in need. Thank you so much for joining us, Dr. Ritamarie.

Dr. Ritamarie:                                     

I’m so excited to be here. I love talking about this topic, and I’m honored to be on your podcast.

Dr. Eric:

It’s an honor having you as well. I normally ask my guests to begin by discussing their background. If you could please discuss how you got to where you are today, that’d be great.

Dr. Ritamarie:

Like a lot of people in functional health and wellness, I came through my own journey of illness. In my 20s, my health broke down, and nobody knew what was wrong with me. I went to all kinds of specialists, neurologists, gastroenterologists, ear/nose/throat docs because of the symptoms I was having. I wasn’t getting well.

I asked the fated question one day—I don’t know where it even came from—in the gastroenterologist’s office after they said, “Good news. You don’t have an ulcer.” I asked, “Great. What’s wrong with me? What do I do?” They said, “We don’t know. Just keep taking the ulcer medication.” A little bit of intelligence came up and said, “Huh? What do you mean? I’m 25. I’m supposed to keep taking ulcer medication? I don’t have an ulcer. What am I supposed to do? For the rest of my life?” They said, “Oh, maybe, until you don’t need it anymore.” The question popped up. “Could it be my diet?” They looked at me like I was crazy. They said, “No, of course not. Diet has nothing to do with your health.”

I set out to prove them wrong. This was back in 1984 when we didn’t have summits and podcasts and any of what we have now. People were in the dark about what we just freely talk about, and people get the information now. It wasn’t available then.

Long story short, went and did a lot of research. Discovered toxicity, food allergies, insulin resistance, hypoglycemia, and all kinds of things. Did some things to get myself better, but it took a long time. That’s when I decided to jump ship and leave my computer job, which prepared me eloquently for what I do now because I was a diagnostician. I was helping to fix breakdowns in software on the computer. Now I said, “I just changed the hardware and software,” and now I’m working on the body. That’s where it started. I have been passionate ever since to help people not to have to work so hard to figure it out.

Dr. Eric:

Wonderful. Thanks for sharing that. We’re going to dive into insulin resistance, tie it into thyroid resistance. I don’t know where you want to start. It’s probably best to start with insulin resistance. We can talk about what insulin is. If you want to mention metabolic flexibility as well.

Dr. Ritamarie:

Insulin is a hormone. A lot of people don’t even realize that. The hormones that people think about when we say “hormones” are progesterone, estrogen, testosterone, and a more educated person will say thyroid. Insulin is actually a hormone. Its job is to take the sugar from the food you eat, glucose, and put it into the cells, so the mitochondria in the cells can make energy.

What happens is because of the diet, lifestyle that we live, not me and you, but other people out there, our living is loaded with starches and sugars and processed foods and hydrogenated fats and things that are damaging to the body.

What happens is every cell has receptors, little places that hormones latch onto and get entrance into the cells. The receptors for insulin get damaged and tired and resistant, and they start to want to protect the inside of the cells from that hormone. There is so much of it because we have so much glucose and starch that is converted into glucose coming in. We develop something called insulin resistance. When we develop insulin resistance, all of that sugar stays in the blood. Doesn’t get into the cells. We have hyperglycemia, which eventually can lead to diabetes.

Long, long, long, long, and I emphasize, long, before it becomes diabetes, it’s a problem in the body. It’s a problem because of the damaging effects of insulin. We are going to talk a little bit more about the damaging effects of insulin on thyroid function in a bit.

Getting back to metabolic flexibility and what that is. We’re intended to burn carbohydrates, or we can burn fat as fuel. Most people are eating enough glucose all day long that they just look for glucose. When they are doing that all the time, the body is going, “I can burn glucose. Whoops. There’s no more glucose. I need glucose.” You have food cravings, low energy in between meals, etc.

When somebody is metabolically flexible, it means that they can switch between fat burning and glucose burning. But you can’t be metabolically flexible if you’re eating corn flakes, sugar toast with butter and jelly, that kind of stuff. You just can’t.

Recent research around 2018 was that 88% of the population is metabolically unwell, meaning that whole glucose/insulin/metabolism and the way it’s supposed to work doesn’t work properly. 88%! Think about that. That means 12% of the population is metabolically well and healthy. 12%! That’s tiny. This was pre-pandemic. My guess is it’s a much higher percentage of metabolically unwell people over the last few years.

Metabolic unwellness leads to all sorts of problems: cardiac problems, kidney problems, blood pressure problems, and imbalances in other hormones. Thyroid is a train wreck when insulin is out of balance. We can’t get the thyroid in balance if we continue with the process of too much insulin and insulin resistance. That’s in a nutshell insulin and the whole concept of metabolic health.

Dr. Eric:

It’s more of a cellular problem. Insulin resistance is too much insulin, but it’s not getting into the cell.

Dr. Ritamarie:

This is true of all hormone resistance. People know about insulin resistance.  We have kind of started to hear about leptin resistance. But you can develop resistance to all hormones. The way it manifests is the body shows signs of too little of that hormone, even though in the blood, there is either enough or too much of that hormone. The cells are smart. They know that too much thyroid in a cell causes somebody to be hyperthyroid and all kinds of complications that you talk about a lot.

Same thing with insulin. Too much insulin in the cell can cause lack of elasticity. It actually damages endothelial linings and cells. The body tries to protect itself from it, and it becomes resistant. You can get resistance to hormones by taking too much hormone. We think, Oh, hormones are not like drugs. It’s not like the chemical things that are foreign to the body; it’s natural to the body, so we should be able to take hormones safely. In reality, we have to take just the right amount to fill in what the body isn’t doing. Otherwise, you develop lots of complications of hyper hormone, but you also develop the resistance to that hormone.

Dr. Eric:

What are some of the common causes of insulin resistance? Why do so many people have insulin resistance these days?

Dr. Ritamarie:

Have you looked at what people are eating? That’s one reason. The garbage processed food.

Second is stress. Under stress, we release a lot of another hormone called cortisol. Cortisol is meant to help us run away from hungry animals. A tiger is chasing me, so I need cortisol to run away. One of the mechanisms by which cortisol works is to mobilize stored energy. That could be in the form of fat, protein, or glycogen carbohydrate, and create more sugar in the blood so we can run away from tigers. In that situation, it’s a good mechanism, and we don’t get in trouble unless we slow down and get eaten by the tiger. For the most part, it doesn’t get us in trouble to have that elevated sugar. It actually helps us.

In the day to day, modern life, I don’t know about you, but I haven’t had a tiger chase me recently. I’ve had deadlines chase me. I’ve had lots of anxieties perhaps. I don’t really get anxious, but people have lots of fear and anxiety around our current world: the economics, the crime, all that stuff. That causes that same stress response as if we have a hungry tiger chasing us, except we don’t get to run away from the tiger and burn that energy. It sits in the blood and causes that elevation of the sugar.

What the pancreas does when it sees the sugar so high, and it’s not getting into the cells, is it goes, “We just need more insulin.” It keeps producing more and more insulin. Then the cells become even more insulin resistant.

A lot of it is a modern lifestyle disease. We can change it, and I have seen people completely reverse even type two diabetes within two to three weeks of changing their diet, getting on a good stress regime, sleeping, moving, all the basic foundations of good health. That’s how we can reverse this and prevent it.

There are genetic factors that play in. I have a lot of the genes that predispose me to diabetes, so I have to be a little bit more careful than maybe somebody else who doesn’t have those genes. For the most part, the genes are a little bit of it, and the lifestyle is much more.

Dr. Eric:

Similar with autoimmunity. If someone has the genetics for Graves’ or Hashimoto’s or another autoimmune condition, that doesn’t mean they will necessarily develop the condition. Same thing. If someone has certain genetics, doesn’t mean they will certainly develop insulin resistance.

Dr. Ritamarie:

Just because they don’t have the genetics doesn’t mean they won’t develop it. You can outsmart your genetics with good diet and lifestyle, but you can also defy your good genetics and get diseases if you mistreat the body. It’s like a car. We don’t put jellybeans in the gas tank. “It must be tired because of that high octane fuel. I’m going to try something else.” Doesn’t work that way. Gums up the mechanism. Same here.

Dr. Eric:

I’m glad you expanded beyond diet because diet plays a role, but you mentioned stress and sleep. If someone is only getting four or five hours of sleep consistently, that could also be a factor.

Dr. Ritamarie:

Huge factor.

Dr. Eric:

What testing do you recommend? As you know, most conventional medical doctors just look at a fasting glucose, and that’s what they go off of when it comes to insulin resistance and diabetes.

Dr. Ritamarie:

The fasting glucose is actually the last thing to change. You can have this problem going on for decades. That’s why I said a long, long, long time. You can have it go on for decades because the fasting glucose goes too high. Plus their ranges for fasting glucose are a little too wide and not narrow enough.

The other tests I recommend is insulin. Test your insulin. We can see kids in their teens with hyperinsulinemia. You can tell by some of their behaviors. The point is you can test the insulin. You can test the fasting insulin.

You can test something called hemoglobin A1C. It’s not quite as accurate as it could be sometimes in somebody who is extremely anemic or an intense athlete, but you get a general range. Hemoglobin A1C is how much of your red blood cells are sugar-coated. We all have some percentage of them that are sugar-coated because they’re bathing in this glucose in the serum.

Around 5 is a good amount. A little bit less, a little bit more. The conventional medicine looks at 5.6. By the time somebody gets to a 5.6 in hemoglobin A1C, their average glucose is around 119. As it starts to go up, we are getting all of the complications of diabetes in somebody who has never been diagnosed. I have worked with patients who have had complications that are typically diabetic: diabetic nephropathy, diabetic neuropathy, diabetic retinopathy, but they are not diabetic. Doctors say, “Your glucose is 95. You’re just fine.” They missed the boat. This poor person, because of the swings up and down over the years, make a difference.

I remember one person having that situation. He went and got his A1C checked, and it was 10. More than double what it should have been. No wonder he was having these things. Because of his big, wide variations in swings, by the time he made it to morning, he was okay. It was “normal.” Probably because he was producing so much insulin, and his insulin was high as well, that it got his sugars down when he had the eight-hour sleeping window.

Most of them are not recommending what I recommend: postprandial glucose. You get yourself a little glucose meter, poke your fingers, and see what your meals are doing, what your stress level is doing. What happens when you don’t have a good night’s sleep? What happens when you exercise versus when you don’t? You can see all of this.

I have been talking about these forever. I have been having people test their glucose that was prandial for the last 20 years. But more recently, there is these things called continuous glucose meters. You can actually wear it. I have one underneath. A bright blue patch. It’s got a little filament, not even as thick as an acupuncture needle, that is under the skin. It’s detecting the glucose. You know at any moment what the glucose is. “Oh, I just ate a donut. My glucose is 192. I just had a nice salad with avocado and tomato and lettuce. My glucose is 98. Wow, what a difference.” There are all kinds of ways that people can be empowered to take charge of their own health. I know that’s what you and I are all about.

Dr. Eric:

Definitely. When it comes to the levels, you mentioned with hemoglobin A1C, around 5, so a little bit higher, a little bit lower. If someone is a 5.4/5.5, you’re suggesting-

Dr. Ritamarie:

I’m suggesting let’s get you really taught and educated about how you get it lower, how you get it down to 5/5.1/4.9. It’s an early warning sign.

Dr. Eric:

Are there concerns if it gets too low?

Dr. Ritamarie:

Sure. If it gets too low, probably someone is in a hypoglycemic state most of the time. You talk about hyperglycemia and hypoglycemia. Hypoglycemia is “The blood sugar is low. We have to eat something to bring it up.” Most of the symptoms that people are having when they feel like they are hypoglycemic is actually hyperglycemia. The blood sugar is too high, but it’s not getting into the cells, so the cellular sugar is too low.

If the A1C goes down to 4.5, maybe your average glucose is in the 70s, but that means there may be times where it’s lower. You just have to watch. Is the person symptomatic? What’s happening overnight? What’s happening with their meals? They may just have very tight control. Their body keeps it in a very tight range. We investigate further if it goes too low. You need sugar in your system to get cellular function.

Dr. Eric:

When it comes to insulin, some functional practitioners like to see that fasting insulin below 5. Would you agree with that?

Dr. Ritamarie:

Absolutely. Between 2-5 would be the “ideal” range. Between 2-3 is even more ideal. That’s the range I like to see it. If someone has a fasting insulin between 2-3, it could be perfect, or it could be a sign that they actually have been very high, but they are heading into a pancreatic failure or have antibodies that are attacking their pancreas. I always investigate that. I look at their symptoms. What are the other factors playing in?

If they have a fasting insulin of 1.5, hemoglobin A1C of 5.1, a fasting glucose of 79, they feel good, they have good energy, then it’s perfect.

But if they are complaining of some other things, then I would want to do what’s called a postprandial insulin. I have them eat their highest carbohydrate meal that they typically would eat and then check it to see if the pancreas responds, to see if that insulin level goes up. It shouldn’t go up a lot, but it should respond. If not, it might mean they have some pancreatic failure going on.

Dr. Eric:

How soon after eating would you recommend that?

Dr. Ritamarie:

Usually 45 minutes to an hour. When you look at studies, it shows the insulin and glucose peak right around 45 minutes.

Dr. Eric:

With regular fasting insulin, or even postprandial, I haven’t done postprandial insulin testing, but I do regular insulin testing all the time. Do you get concerned if it’s a 6 or 7, or do you not really get concerned until it’s in double digits?

Dr. Ritamarie:

I get concerned as soon as it’s above 5. When I say “concerned,” that means I’m educating somebody. There is an indication you are producing too much insulin. Here are the downsides of too much insulin. Oh, you have a history of cardiovascular disease? Too much insulin stiffens your blood vessel lining, so you are more prone to have a heart attack if you go to run for the bus because your blood vessels can’t expand. High blood pressure, thyroid resistance, and other cellular hormonal resistance. At that point, I’m investigating, and I’m helping them to bring it down within the 2-5 range.

Dr. Eric:

Thyroid resistance. Let’s talk about how that relates to insulin resistance and also how that presents on a thyroid panel.

Dr. Ritamarie:

It doesn’t present on a thyroid panel. Here’s the deal. It can present as a perfectly normal thyroid panel. Normal TSH, normal T3, T4, free T3, free T4. But the person has clear symptoms of thyroid problems. We go, “Wait a minute.” The typical Western approach is you have constipation, here’s a laxative. If you have depression, here’s an antidepressant. If you have dry skin, put some moisturizer on it. They are not addressing it as a combination. Those are low thyroid symptoms. I always say if it looks like a thyroid problem, and it sounds like a thyroid problem, it’s a thyroid problem. But it’s not with the thyroid itself.

Those numbers look good, yet the person presents with thyroid symptoms. It’s usually because the receptors have become resistant. There are some really common imbalances that affect the thyroid receptors that cause them to underwork.

We have homocysteine. How many people do you test homocysteine? I listened to your podcast episode on your favorite tests. You test homocysteine on people. Elevated homocysteine can damage the thyroid receptors. We’re looking at that. What is elevated homocysteine caused by? Usually a deficiency of Vitamin B6, B12, folate. There are a number of other things that are less important, but those are your majors. We look at that.

Deficiency of Vitamin A can affect the thyroid receptors. If somebody is not getting enough Vitamin A, or they are getting enough Vitamin A in their diet but have a problem with fat digestion and fat-soluble vitamins, those are two very important things.

But the most important one that I think most people suffer from is either excess cortisol or not enough cortisol. In order for those thyroid receptors to work properly, we need the right amount of cortisol. Stress can respond. Cytokines, we all have heard of cytokines over the last few years in terms of cytokine storm. Cytokines are inflammatory mediators in the body. Excess inflammation, excess cytokines damage the thyroid receptors.

Last but not least, our good old friend, insulin. Insulin not only causes receptor resistance for insulin, but it causes receptor resistance for thyroid and other hormones as well.

Dr. Eric:

On a thyroid panel, it might very well be normal, so you can’t always pay attention. In some situations of thyroid hormone resistance, you will actually see thyroid hormone levels look on the higher side. In the case of hyperthyroidism, that would result in depressed TSH, but in the case of thyroid hormone resistance, sometimes you will see it elevated on a thyroid panel. TSH will actually be elevated as well, which shouldn’t be the case when you have too high.

Dr. Ritamarie:

Yes. In fact, that’s why it said it can look normal. There is no classic way it presents. I always tell people when they’re looking to solve their thyroid problems, and I give people a document that shows different kinds of imbalances, if the T4 is low and the T3 is good, or vice versa, what to do, so we can address those imbalances. If you don’t address that there might be thyroid resistance, you can address all those other things that are out of balance, get them in perfect balance, have the panel look perfect, yet there is still a problem. They are still symptomatic. I always say to address that.

Right from the start, assume thyroid resistance. If you’re wrong, great. Check the homocysteine, Vitamin A status. Address the stress levels. Address the insulin. That’s super important.

Yeah, excess of any hormone can cause resistance to that. It’s a clue: When that hormone is high, it’s turning off those receptors.

Dr. Eric:

Thanks for clarifying. As far as fixing the problem, diet, stress management, getting proper sleep, all these diet and lifestyle factors. The homocysteine, which could oftentimes relate to nutrient deficiencies, specifically some of the B vitamins and other nutrient deficiencies like Vitamin A. Trying to address all these imbalances.

Dr. Ritamarie:

Absolutely. What I find, and you may find this in your patients as well, is people want quick fixes because that’s what they have grown accustomed to throughout their lives. If you have a headache, pop Motrin. If you have heartburn, pop some antacids. That’s not the way the body really works. There is no quick fix. We have to address the underlying causes.

We have to look at what’s the gut function like? A lot of thyroid issues, especially the autoimmune, we have some sort of leaky gut usually. Hyperpermeability of the gut lining. We have some inflammation, some dysbiosis. We have to address that.

We have to address all the different stressors on the body, not just the mental and emotional stressors, but heavy metal stress, mold, all kinds of things like that. Chronic low-grade infections that aren’t resolved. There are all sorts of things we need to look at in the big picture.

Dr. Eric:

You’re right. A lot of people will focus on the diet, the stress, and the exercise, but they still might see elevated hemoglobin A1C and/or fasting insulin, but they might have disruption in the gut microbiome. They might have a higher toxin load. They might have stealth infections. Sounds like there are a lot of things that could at least be a contributing factor when it comes to insulin resistance and thyroid resistance issues.

Dr. Ritamarie:

A few years ago, I did an all-day workshop on hormone resistance. Nobody is teaching this. People need to know how to address it.

Dr. Eric:

I know you kind of answered this, but if they have cortisol resistance, they’re thinking cortisol/adrenal stress. But they can’t just block out time for mind/body medicine. They should do that, but if that’s all they do, it’s probably not going to address the cortisol resistance.

Dr. Ritamarie:

We have to do it all. We can’t just pick and choose. The yogis want to do the stress piece. The foodies want to do the food piece. The marathoners want to do the exercise piece. There is such a thing as overexercise, which we can talk about another time. We can’t just address the pieces that we like, that resonate. We have to address all of it. The sleep is huge. I don’t know about you, but people come in and tell me, “I can’t fall asleep. I can’t stay asleep. I can’t sleep more than six hours.” That’s putting a huge stress on the body and the hormone balance.

Dr. Eric:

I definitely agree. Sleep is a priority. You can’t negotiate the sleep.

Dr. Ritamarie:

I tried. That’s when I developed insulin resistance.

Dr. Eric:

Most of us notice a difference, even if it’s not reflecting right away in the blood sugar. Like you said, it can take years for that to develop. But it can affect the body in many other ways.

How about exercise? You mentioned exercise. Everyone is different. Some people listening to this might not be able to engage in certain types of exercise. On average, do you recommend more resistance training, cardio, high intensity interval training (HIIT)?

Dr. Ritamarie:

All of the above. It depends on the person. Ideally, do all of that stuff. But not everybody can. People have injuries in certain parts of their body, and they can’t move that particular area.

For blood sugar balance, the HIIT works really well, burst training, 30 seconds to a minute of all out, rest for 2-3 minutes, and do it again. Or do it throughout the day. You go for a walk, and then you run or climb a hill for 30 seconds to a minute, get your heart rate going, and then continue to walk. Other people do separate times throughout the day, 30-60 seconds of exercise. People find that easy to incorporate.

There is such a thing as overexercising, especially if there has been a lot of stress, and the adrenals have been going. Too much exercise for your constitution right now creates a cortisol release. That cortisol release puts you into stress mode. We have to watch it. If you are someone who says, “I want to exercise,” and you go out and do all out, weights, interval training, and then come back and can’t exercise again for 3-4 days because you’re exhausted. That’s a sign that you overdid it.

The hardest thing is when athletes burn out. They just want to keep doing it, and they can’t. The couch isn’t a bad idea right now. Just walk around the block a couple of times. Keep it light. Keep your heart rate going. Keep the oxygen flowing.

But I find that it’s harder to get people who are avid exercisers, who are burned out, to slow down. That’s even harder than some people who have been couch potatoes and don’t want to start it. But it’s super important to get the right balance of exercise for you.

Dr. Eric:

Agreed. I mentioned in past episodes where I was guilty of overtraining, and I’m pretty sure that was a contributing factor to the development of my Graves’ condition years ago. You don’t want to be a couch potato. You want movement to be a regular part of your daily routine, but you don’t want to overdo it in the gym or at home.

Dr. Ritamarie:

Even at home, there are so many little things you can do. If you have a staircase, running up and down the stairs 2-3 times can get your heart rate up. If you have a knee problem, you won’t do that. Work with your body and the limitations to find things.

There are these little exercise things you can put on the table. They’re like a bicycle. You can put it for your feet, but you can use it for your shoulders. If you have knee problems or hip problems, put it on the table, and you can work your heart rate up by using them as an arm exercise. There are a lot of options.

Dr. Eric:

The last thing I want to briefly chat with you about is intermittent fasting. We chatted a little bit before the recording started, but to remind you that some of the listeners have hyperthyroidism and might be losing a lot of weight. It’s not a perfect fit for everyone. On average, would you say if someone is dealing with insulin resistance, and let’s say they are gaining a lot of weight, is that something you usually address?

Dr. Ritamarie:

Intermittent fasting, I have been talking about it since before it became popular. I have been teaching it since like 2008 in my programs. We didn’t call it intermittent fasting; I don’t remember what we called it.

Meal spacing, let’s space your meals out. No more than three meals a day. 12 hours between the last meal and the first meal, minimally. If you can go longer, great. Finding your fasting window. Some people do great by skipping breakfast and starting to eat later in the afternoon. Some people do horribly with that, but they are really good at eating first thing in the morning, having another meal, and a light dinner. 2-3 meals a day.

Some people are doing one meal a day, but some of the research I have seen on that is it actually backfires. You gorge yourself, and you are putting all of these calories in at one time. I have a continuous blood sugar meter, so I find if I overeat at a meal, even if it’s all low glycemic stuff that I normally would eat, my blood sugar will go up. It’s just too much of a load all at once.

I’m a real big fan of intermittent fasting. I have seen amazing results with it to help people get past the plateaus of weight loss. I’ve seen it work really well for folks who have mitochondrial disruption, so their energy is low. People think, “Oh my god, I can’t not eat to get energy.” Yeah, you can. It can work really well. There is a lot of research to that effect.

It works well for brain stuff. That’s where a lot of the ketogenic diets came from. When you have intermittent fasting, you’re going longer periods of time. You have more of an opportunity to get into a ketogenic state, especially if you do a 16-hour, overnight, or from bedtime to whatever. That will help you to get into a state called autophagy, which helps your body do cleaning out. There are so many benefits to intermittent fasting.

But it’s not for everybody. You do need to be careful if you’re a menstruating woman. Don’t do it the week before your period because it can disrupt your hormones. If you find you start doing it, and your periods stop, it’s probably not the right thing for you. Like everything, it’s not for everyone.

It’s certainly not for someone with hyperthyroidism or who is underweight and has a high metabolic rate even if they’re not hyperthyroid. While everybody else is told to eat two meals a day, space your meals 4-6 hours, I say, “Eat every 2-3 hours,” because otherwise they will just burn away to nothing.

Dr. Eric:

Is there anything I didn’t ask you about insulin resistance or thyroid resistance that I should have asked you? I know there is a lot we could talk about.

Dr. Ritamarie:

There is so much. Here is the thing. If you are working on a thyroid problem, and you are ignoring your blood sugar, you won’t get very far with healing your thyroid. You must address both.

Dr. Eric:

Just a final summary as far as action steps, if someone is looking at their blood test report now and are seeing high A1C and/or fasting insulin, would you say to start with diet, cleaning up, whole healthy food, minimizing refined foods and sugars as a good place to start?

Dr. Ritamarie:

That’s a great place to start. Watch your sleep. Some people don’t sleep, not because they can’t sleep, but because they don’t get to bed. That was my situation. “I have plenty of energy. I can push it. I can stay up.” You do that and get a second wind. Just go to bed.

Make it a point to move your bedtime back so that it’s before midnight at least. Some experts would say by 11. I haven’t done that one yet, so I can’t recommend it yet. I have moved mine back to before midnight.

I’m really focused on getting 7-8, even nine hours of sleep. Some studies show that the closer you get to nine hours, the more rapidly the results and the shifts happen with healing insulin resistance.

Dr. Eric:

I can’t say I’m there yet. I usually strive for 7-8 hours, not that I wouldn’t love to get nine hours. Most nights, it’s 7-8.

Dr. Ritamarie:

Exactly.

Dr. Eric:

How can people find out more about you?

Dr. Ritamarie:

You can find me on Facebook. We post a lot there. It’s @DrRitamarie, I think. Same thing on Instagram. We are reviving our YouTube channel. Same thing. We are starting to do weekly lives and putting more content on there. If you’re a practitioner, we have a new website opening up soon. The URL is INEMethod.com. We have a lot of great resources for practitioners. I can’t wait to share those. My podcast is Reinvent Healthcare. Those are all great ways to reach me.

Dr. Eric:

Definitely check out the podcast. I mentioned I have listened to some of the episodes. Excellent information. Thank you so much. Thanks again for sharing your knowledge with us.

Dr. Ritamarie:

Thank you for having me. It’s my pleasure to do so.

Recently I interviewed Sarah Clark, as she discussed how to overcome infertility. If you would prefer to listen the interview you can access it by Clicking Here.

Dr. Eric Osansky: With me, I have Sarah Clark, and we are going to chat about fertility. When Sarah was 28 years old, she received a diagnosis of premature ovarian failure. She had both of her children through IVF (in vitro fertilization). Years later, she realized the root cause of her infertility was a food sensitivity and later a gut infection.

Sarah is a certified life coach with accreditation from the International Coaches Federation and a health coach with training from the Institute of Integrative Nutrition. She is the author of Fabulously Fertile: Supercharge Your Fertility Naturally. Her fertility coaching program, which includes functional lab testing, supports couples to make diet and lifestyle changes that dramatically improve the chances of a healthy pregnancy and baby. On her Get Pregnant Naturally podcast, she shares with functional medicine and natural fertility solutions, we can eventually reverse infertility. For more information, you can visit her website, FabFertile.com. Thank you so much for joining us, Sarah.

Sarah Clark: Thanks for having me, Eric.

Dr. Eric: You’re welcome. Let’s dive into your background. Let’s talk about how you started helping coaches with infertility.

Sarah: In my early 20s, I had irregular cycles. During my teen years, I had great skin, and all of a sudden, I got acne in my early 20s. I had a weird fungal rash. With irregular cycles and acne, I went to see my conventional medical doctor. They put me on hormonal birth control. That obviously regulated the cycle, but falsely, and helped the acne a little bit, but not a lot.

I’m a big planner, so I had a life plan of getting married at 25 and having kids at 28. I got married at 25. Shortly before I was 28, I knew I needed to get off the pill and figure out what’s going on here. I went off the pill. That is when I had the diagnosis of premature ovarian insufficiency or failure as it was known, which is a loss of function of ovaries before the age of 40. I was told the only way I would ever have children was through donor eggs. I remember the OB-GYN reaching up on her shelf, grabbing the brochure for IVF, and saying, “Here you go.” I was completely shocked, devastated. That wasn’t my plan of how to have my children.

But I didn’t take any time to grieve. I went straight into action. I got on a list for a donor egg. Back then, the donor egg profile came in the mailbox. I waited for the maternal and the paternal info. I got the profile. We were lucky enough on our first transfer to have our daughter. She is about to turn 21.

When I said “donor egg” back then, people didn’t know what that was. Now, we have more couples going through IVF. We have embryo adoption and embryo donation. I had a guest recently who did embryo adoption. She adopted an embryo that was frozen for 13 years. The natural siblings are 13 years to her little children, who are now two and four. Science can do some cool stuff.

We had a couple embryos left over. We wanted the kids close together. I was super stressed about having them close together. I went back in after a year. That first transfer did not work. I went on another list for a separate donor egg. We were lucky enough after three years to have our son. He is about to turn 18. I don’t know where the time has gone.

After I had my daughter, I had nine colds. Every cold turned into a sinus infection. I thought it was a good idea to take tons of antibiotics for all those sinus infections. I had chronic bladder infections, sinus infections, yeast infections, toenail infections, dandruff. My immune system was low. I caught every cold and flu that went by. I still wouldn’t have said I was unhealthy.

I was working in a corporate environment. I was in HR for years. I decided I wanted to bring a life coaching course into HR.When I did that, I had my own personal wakeup call. It’s always health and wellness I have loved. I took a health coaching course. That is when I discovered all these food sensitivities: dairy, gluten, and later, corn. I had gut infections, bacteria, and parasites.

The thing I discovered that took me forever was chronic stress. I actually thought I wasn’t stressed. When I got that diagnosis, I wouldn’t have said I was stressed. I am the kind of person who likes a lot of energy. Let’s go. That was stress all along. I was disconnected from my body. I didn’t discover this until years later.

Now I help people who have been told donor eggs are their only option. Most people have gone through multiple failed IVF cycles. We are helping them get pregnant naturally, or if they go to IVF, they get pregnant with their own eggs.

Dr. Eric: You said that with your daughter, it was successful the first time. With your son, you had to do two rounds?

Sarah: We had embryos left over from my daughter’s donor. That didn’t work. We went on another list for a separate donor. I had to wait for that. Then I had my son. Both times, it was on the first transfer of the fresh embryos, when they used to do fresh transfers. They do fresh and frozen now.

Dr. Eric: Is it common for everything to go okay with the fresh transfer?

Sarah: Usually with IVF, it takes three rounds at a cost of $60,000. The fact that it worked for me on the first fresh transfer, I had my daughter at 31 and my son at 34. The donor eggs were in their late 20s. That may have helped. Many people we see, that’s not the case. It’s been failed cycle after failed cycle.

Dr. Eric: Like you said, even if it does work on the first try, it’s very expensive. Ideally, you want to try to get to the root cause of the problem, so you can hopefully avoid IVF.

Sarah: Exactly.

Dr. Eric: Speaking of causes, can you talk about some of the common reasons why more and more women are dealing with infertility?

Sarah: We are coaching couples, even though we are primarily dealing with low AMH (anti-malaria hormone) or high FSH (follicle stimulating hormone). Typically, people are being told that donor eggs are their only option. 50% of fertility can still be a male factor. Even though males are being told their sperm is fine, they haven’t looked at it through functional reference ranges.

Typically, we are seeing all these missed healing opportunities. Obviously, thyroid issues. We see more hypothyroid issues, Hashimoto’s or subclinical thyroid issues. Especially with the high FSH, we see blood sugar irregularities and insulin resistance. We are seeing a lot of autoimmune disease in conjunction with low AMH and high FSH. Typically, Hashimoto’s and Celiac. They go do IVF and have an autoimmune disease, and no one does anything. No one has targeted changes.

We see food sensitivities, non-Celiac gluten sensitivity, gluten off the charts. People may have gotten gluten-light or 80% gluten-free. If you have a sensitivity, even a crumb will cause reaction in your body.

We see the chronic stress piece. Doesn’t matter how old you are. Whenever you decided you want to expand your family, there is a lot of stress in that when it’s not working. Especially if you have gone through failed IVF, thought that was your solution, spent a lot of time and money in there, and it hasn’t worked, fertility can impact all aspects of your life: your social life, seeing families at church, going out in public and seeing families and children and pregnant bellies. You may lock yourself off from some of your friends and family because it’s too painful. The chronic stress of this.

We see alot of trauma, either childhood trauma or trauma from the infertility diagnosis that needs to be addressed. We believe in a mind/body/spirit approach. We look at the biochemical stuff. It’s important to look at mindset and the spiritual side of it, really believing that the spirit of your baby is waiting for you. It’s ready to come down. Here she is. Many people feel that diagnosis from the reproductive endocrinologist can get embedded in their subconscious. “You will struggle. It’s not going to work. You can only use donor eggs.” People start to believe that. It’s really important to believe that you’re not broken. You’re fertile. You can conceive.

Dr. Eric: It sounds like you take a whole-body approach. You mentioned diet and the importance of gluten. Also stress and past traumas could have a big impact, of course. Sleep. You look at the whole picture.

Sarah: Yeah, sleep, for sure. We see a lot of people with dysregulated sleep. Tired and wired when they wake up. Unable to fall asleep. It could be gut bugs or gut infections. Nutrient deficiencies. We see a lot of sleep in both partners. People have struggled for years and can’t sleep at all. After making the changes, they are able to finally get their eight hours.

Dr. Eric: Let’s talk again about diet. You mentioned gluten, which a lot of people listening to this are familiar with the concerns with gluten and gluten sensitivities. You also mentioned Celiac. Even if you don’t have Celiac, you could have a gluten sensitivity. I’m sure there are some people who say, “How can eating gluten prevent myself from getting pregnant?” Either the impact on the female or male. Can you expand on food sensitivities and talk about the relationship between gut health and infertility?

Sarah: Yeah. A lot of people like me were put on hormonal birth control. That can predispose you to food insensitivities, gut infections, and nutrient imbalances. We see that a lot. With the food sensitivities, if you have a food that you’re eating, and it’s coming in every day, it’s causing inflammation in your body, then your body wants to survive, not procreate. It’s causing all this inflammation.

We have our couples start off with an elimination diet, taking out those top allergens, like dairy, gluten, soy, corn, peanuts, eggs, processed sugar, and alcohol for 10 days. Then we systematically reintroduce over the course of 30. You can really see how each food impacts your body. Most people who come to see us, it’s not a sick population, but they don’t know how unwell they are until they feel amazing. They could have niggling bloating, eczema, post-nasal drip, digestive issues. They don’t know how great they can feel when all those common but not normal complaints go away. The food piece is huge. We see people’s energy and all areas of their life improve by eating the right diet. Taking out those top inflammatory foods, reintroducing them.

We have them tweak it with food sensitivity testing. You may take out foods for 60-90 days. If it’s read on some of the testing, you take it out then. Most of the food, not gluten, you can bring back in, once you’re healing the gut.

We are doing gut testing, looking at the DNA of your stool. We see a lot of people with bacterial infections, fungal infections, multiple parasites. We see H-pylori. You won’t be able to absorb all your nutrients. Passing back and forth to partners. Once you heal the gut and work on gut repair, alot of those food sensitivities you may have, especially if you have leaky gut, your body is mounting that immune response to your favorite foods. People take the food sensitivity test, and lo and behold, you realize you are intolerant toall the foods you are eating on a regular basis. We see that a lot with our clients.

As you heal the gut and eradicate the infections and repair the gut and take out those inflammatory foods, then the body starts to come back alive. We just had someone here who has .02 AMH. She is very young, like 26/27. Within six weeks of working with us, her period is already back, and she hasn’t had it in years. We have had people get pregnant naturally when their AMH is .04. Conventional medicine turns their back on those people.

Dr. Eric: That’s awesome. Do you use the GI Map?

Sarah: Yes.

Dr. Eric: For food sensitivity, you said you start them off with an elimination diet and do food sensitivity testing.

Sarah: Yes, we start the elimination diet protocol that they follow. We use the Vibrant Gut Zoomer depending on where they are in the country.

Dr. Eric: Okay. Before doing these interviews, I always do my research and try to listen to an episode or two of the person guesting on other podcasts. I heard you did Dutch testing as well, yes?

Sarah: Yes. We may do an adrenal test to start with. A lot of times, it’s a type A, busy, ambitious person who in the past, they have done a whole bunch of stuff. Now they are throwing everything at this. Maybe their adrenals are completely fried, and their cortisol is flatlined. It’s important for them to see what is happening with their cortisol levels, so they can pull back and work on self-care.

We do the Dutch adrenal or a full Dutch complete, looking at your sex hormones, which pathways are going down, your melatonin. People in the fertility sphere will read It Starts with the Egg, a popular book by Rebecca Fett. There is some good information in there, but some of it is geared toward IVF. Taking melatonin can be helpful, but let’s figure out why it’s low in the first place. It may be necessary. People aren’t even taking magnesium. We use a Dutch test.

We do genetic testing. We do a female hormone panel. It will give us what’s happening with your blood sugar, your thyroid. It looks at the FSH number and more. Female hormone panel. Then it will tell us specific diet and lifestyle and supplement recommendations to support those genetic SNPs. It’s not just, “Here’s your genes. You’re doomed.” It’s, “We can support those with these targeted steps.”

We also do a blood chemistry view. We do a semen analysis, looking through functional reference ranges. We don’t do all these tests at once. They can be overwhelming. We could do a hair tissue analysis testing. Check to see if there are heavy metals or nutrient imbalances. Those can be helpful, too.

Dr. Eric: Quite comprehensive, it sounds like. As far as the semen analysis, a few questions. Do you require the couple to be present? Do you always also evaluate the male, or do you focus more on the female? How does it work in your practice?

Sarah: We will exclusively coach couples unless they are single by choice. By just coaching women, we are missing the whole other piece of the equation. Even if he doesn’t have any issues with his semen, there could be issues in the relationship. This infertility will impact all other aspects of your life. It will either pull you together or tear you apart.

Even when his semen analysis is fine previously, or they have gone through years of treatment- Typically, they have gone through IVF, so they have had a semen analysis. Sometimes, they have tried naturally for two years, and no one has checked the man’s semen analysis. We work with Legacy, a digital semen analysis at-home testing kit for men. They get their testing done. It will give you the count, DNA fragmentation, fertility, and more. We will look at that through the lens of functional reference ranges. We look at the male’s blood chemistry as well.

He has his own health goals. She will have her own health goals. Then they come together as a couple to discuss them all.

Dr. Eric: I’m guessing you have them both follow maybe not the exact same diet because it depends on the testing, it sounds like. It’s up to the person obviously. You would ask them to both follow a strict diet.

Sarah: Yes.

Dr. Eric: And make other lifestyle changes, too.

Sarah: Yes. If they are living together, cooking together, eating together, we wouldn’t want the woman over here making all her changes, and he is over there eating Big Macs and pizza. No. They are doing this elimination diet together. At the end of it, she will get more tweaking with food sensitivity testing. We will look at his semen analysis and blood to see if that’s necessary for him, if he presents with any kind of fertility issue. He has his own goals.

Sometimes, in the partnership, the woman ends up nagging the man to take his supplements, change his diet, get rid of alcohol and caffeine, but she needs to focus on herself. He will come over when he is ready. That’s why it’s important to have a coach here. We never recommend coaching your partner. It’s disastrous. Focus on yourself. We will coach the male partner. 99% of the guys are ready to make the changes. They are open-minded and ready to go. If they’re not, it’s not a good fit for the program.

Dr. Eric: I’m sure you screen them before, just to make sure they are both on the same page, and you can coach both of them.

Can you talk about environmental toxins in fertility? Obviously, that has been a huge issue overall, over the last few decades. It seems like it’s getting worse as far as our toxic world, the impact that that has.

Sarah: We always ask our couples to check all their products against the Environmental Working Group. You want to get lower than 3. You want to ditch the plastics. You want to slowly move up the personal care. You don’t want to throw it all in the garbage; as each one expires, you would get a new product that is non-toxic. All of these are endocrine disruptors. There are the Dirty Dozen in the EWG.

Make sure that you have filtered water, that you’re not drinking out of a plastic water bottle. All of these things can leach into the body and disrupt the endocrine system. If it’s freaking you out, and you want to go around the house with a garbage bag, we say to slowly do it as each one expires.

I interviewed Dr. Shanna Swan, who wrote the book Count Down. She had a study that just came out talking about how in the last 40 years, male fertility has dropped by 50%. A lot of it is due to some of the environmental toxins, like glyphosate spread on food crops. Make sure you go organic. Stuff that’s in our water, over 85,000 chemicals we’re exposed to. Looking at that stuff is really important as a first step. Go organic. Cheap food is not good. Good food is not cheap. You can do the clean 15 or the dirty dozen. Make sure the dirty dozen foods are organic. The environmental toxin piece is key. Slowly do it.

Dr. Eric: Organic food, filtered water, cleaning products, cosmetics. A lot will be in their own home because once you step outside, there is only so much you can do. Do you recommend air purification systems or supplementation to help the detoxification process?

Sarah: You can get an air filter and do that. Blue light impacts the body, too, from the tablets and screens. We recommend blue light blocking glasses.

From a supplement perspective, we are recommending a whole protocol based on the testing, your health history. We have binders and things to mock up if we see exposure. With detox symptoms, we look at doing rebounding and dry skin brushing. We always recommend a castor oil pack over the liver to help move the sludge out of there. We have some teas, like milk thistle tea

Drink lots of water. Many people come to us, “I am drinking 1-2 glasses of water a day.” Make sure you have a good filter, like a Berkey water filter. A Brita is okay; it’s not our favorite. Get a glass or stainless-steel water bottle to drink out of.

Dr. Eric: I’m not a big fan of Brita, but it’s better than just drinking tap water.

Sarah: People do the fridge or the tap.

Dr. Eric: Fridge is not much different. I would agree with that. Do you ever recommend infrared sauna?

Sarah: Yes, we can recommend that, too. It can be good.

Dr. Eric: Earlier, you said you see mostly hypothyroidism, which is a lot more common than hyperthyroidism, which is what I and a lot of my patients deal with. We also get listeners who have Hashimoto’s. Most people who have hypothyroidism have Hashimoto’s. When you see someone who has lower thyroid hormone levels, and part of the testing is to see if they have Hashimoto’s, if they haven’t been diagnosed, you test for the auto antibodies and maybe recommend for them to see a practitioner with prescribing rights to be on thyroid hormone. How do you handle your hypothyroid patients?

Sarah: 99% of the people we work with, there is something going on with the thyroid. They have been told their TSH is normal, and it’s 3 or 4. Typically in the reproductive endocrinology world, for fertility treatments, they like to have it under 2 or 1.5. They may be taking a T4 supplement, a Synthroid or levothyroxine. Maybe they are already taking that. No one has looked at the full panel or the antibodies.

We are not diagnosing, but we see things out of alignment. The physician on our team is licensed in about 27 states, so she can do a prescription with a consult with her. Practitioners in other states can then get a prescription. Sometimes people are like the idea is to be off the thyroid medication. For us, bioidenticals may be necessary. Thyroid medication may be necessary. It’s also important to do the targeted diet and lifestyle changes with them because medication alone is just a Band-Aid.

We have had people with antibodies at 900 and making these changes come down under 100. People who have Hashimoto’s and are trying to get pregnant before they come to see us with repeat miscarriage, failed IVF cycles, and it hasn’t worked. No one addressed the Hashimoto’s or the high antibodies.

There is lots to do from a thyroid perspective. I do a masterclass and ask the question, “How many people here have a normal TSH?” All these people are struggling with low AMH and high FSH. No one has looked at the full panel, the T3 or T4. There is no due diligence. The doctor can’t run it because of insurance issues and stuff like that. So dig deeper.

Dr. Eric: Sometimes, what we’ll see is they will say it’s normal, and it is normal according to the lab reference range, but it is outside of the optimal range. TSH is maybe 3.8, which is within the lab range, but definitely above optimal. Same thing with the T3 and/or T4. It’s on the lower side but still within the lab range but outside the optimal range.

Sarah: Yeah, that was me. My TSH was 3.5. My hair was falling out. My skin was dry. Everyone is like, “Your thyroid is normal. There’s no problem.” But there was a problem.

Dr. Eric: Before we started the interview, I mentioned that years ago I wrote a blog post on infertility. There are a few statistics. I wish I could say I remember it all, but I have it right here. One of the studies show that the prevalence of infertility was 47% in those with Hashimoto’s and 52.3% in Graves’. Either way, whether you have Graves’ or Hashimoto’s, much higher incidence, prevalence of infertility.

Also, you mentioned the TPO antibodies. I did come across some studies that show that in female infertility, there is a higher prevalence of positive TPO antibodies when compared to controls. A few other studies have shown increased risk of miscarriage with thyroid autoimmunity. There was one more here that showed that during the first trimester, the pregnant woman with autoimmune thyroid conditions carries a significantly increased risk for miscarriage. Actually, even when they had normal thyroid hormone levels, so when they were euthyroid. Obviously, the low thyroid hormone levels are a concern. Or high if you have hyperthyroidism.

Most of the evidence I presented was related to the autoimmunity. Whether you have Graves’ or Hashimoto’s, definitely get the thyroid hormone levels balanced, but you also want to do things to improve the health of the immune system.

Sarah: Going to IVF when you haven’t addressed these things, you’re at a higher risk for miscarriage and the devastating effects of that.

Dr. Eric: If a couple has problems conceiving before looking into IVF, they should seek someone with experience like you. When would you say that IVF is necessary?

Sarah: It’s a very personal choice. IVF can be necessary if there are structural issues. We think most people are fertile, but there are other healing opportunities that haven’t been addressed. IVF is there to push it. If we address the chronic stress, food sensitivities, mindset, all of this is how we get you out of the fight or flight, down to the parasympathetic, reduce inflammation, and get you in that receiving stage. Then you can get pregnant naturally.

IVF can be there. It’s typically in the patience piece. We find more of an average of 12-18 months. We have a six-month program, but then it goes into our monthly piece. It’s 12-18 months before you can get pregnant. People want to push it. It’s a personal choice. Obviously, the older you get, you may feel your window is closing in, so you have to do it. To me, there is never any negative side effects of you working on your health. Either you get pregnant naturally, or IVF will actually work.

Your RE won’t tell you any of this stuff. I heard an RE say the other day, “You should go gluten-free and dairy-free.” That’s good. Some of this stuff is permeating into the conventional side of things. Typically, it’s pushing you over there.

It’s a personal decision. You have to do what feels right for you. They are selling packages of IVF. Buy a three-cycle package. A lot of insurance and egg freezing. There is a Wild West of fertility industry, which is billions. The stuff that’s going on in the world right now, infertility, 1/8 mistakes and 1/8 couples are trying. Most people know someone who is struggling. It’s only going to get worse because of all these environmental toxins and things that are coming at us.

To me, working on your health first, either pregnant naturally or doing IVF, when you’re ready, if necessary, then you can make that decision.

Dr. Eric: Are there a lot of side effects associated with IVF?

Sarah: I have done an episode on that. Some of them can be at higher risk of ovarian cancer and other things from these drugs. There is not a lot of research around some of these things. If you are pushing your body to do something that it’s trying to say, “Hey, I’m not ready right now,” because the reproductive system will be deprioritized, and it wants you to keep walking and moving. You’re pushing it. We don’t really know.

Even with IVF children, both my kids, I didn’t figure any of this out. Both of them have food sensitivities. Both of them have mood imbalances. I didn’t work on my stuff beforehand, so they got that? Maybe. I think so. Epigenetics, they are saying you can pass infertility on to your children. We want it done yesterday is the culture we’re in. Taking the time to prepare your body instead of rushing, it just makes more sense.

Dr. Eric: Yeah, I definitely agree. I also speak with many women who I’m working with on their thyroid conditions or autoimmune thyroid conditions. Many of them want to get pregnant, too. They are at the age. They are telling me, “Can I start trying within three months or six months?” They are putting a timetable on it. I definitely understand.

I agree that you want to try your best to avoid the IVF, but even if you end up doing the IVF, you want to try to do things prior to that to improve your health, not just jump into the IVF. It makes sense that you wouldn’t want to give it just three months or six months. Maybe in some cases, it depends on the person. If six months isn’t enough, 12 months might be the answer for you. It would be a shame for someone listening to give up after six months and get the IVF when they maybe just needed another three to six months.

Sarah: Just to dig a little bit deeper on some of these things. If you have a targeted plan with testing and someone looking at it to see how we can optimize it. Many times, people are finding generalized guidelines of fertility diets and superfoods. These things may work for someone else and not you. If you take a targeted, functional approach, and have a team to help you dig in and work on a lot of these limiting beliefs or dealing with stress, this can be helpful, too.

Dr. Eric: If couples have been struggling with infertility and really want to try to avoid IVF, what are some action steps they could take?

Sarah: If you are ready to go hardcore, do the elimination diet. I have an episode on my podcast about how and why to do the diet. If that’s too hardcore, at least go organic. Really work on the diet piece with your partner together.

Second would be focus on sleep. The most restorative sleep is between 10pm-12am. Go to bed before 10 if you can. Really prioritize sleep. Get the full amount.

Work on your intimacy. It’s not just about baby making; it’s lovemaking. Date nights. There is often a lot of strain on the relationship. Reconnecting with your partner. Don’t put joy on hold until the baby comes. Focus now on what makes you happy.

That whole self-care piece. It’s a buzz word, but it’s important to mother yourself and parent yourself now before your future child comes.

Work on diet, sleep, and dig into that self-care to get yourself out of the fight or flight. If you are feeling panicked, and you feel your eggs are too old, dig into that piece. You are fertile. You are a parent now, the moment you start trying. Dig into that intuition that you know your body better than someone else who may have labeled you with this diagnosis. It’s important to know that and be empowered by that.

Dr. Eric: Wonderful. Is there anything we missed? There is a lot of information on your podcast. Anything else, or did we cover at least the basics?

Sarah: The basics are covered. It is this mindset piece of if you have the diagnosis, you are not the label. To dig deep or get a second opinion. Don’t let the medical gaslighting of you, thinking “I should get my full panel,” and your doctor won’t run it. Know your numbers. Dig deeper. Take charge.

Dr. Eric: Definitely check out Sarah’s podcast, Get Pregnant Naturally, as well as her book Fabulously Fertile. Also, you have a fertility challenge opt-in. The website is FertilityDietFreebie.com.

Sarah: There are summer recipes available there. There is a meal plan and grocery shopping list. It helps you dig your toe into the fertility diet. It takes out those top allergens. There is some awesome food in there. It’s not about you starving.

As the seasons change, if you’re listening to this later on, there will be fall recipes, winter, and spring. Right now, we’re doing summer.

Dr. Eric: Thank you again, Sarah. Appreciate you sharing your experience and knowledge with everyone. Look forward to maybe having you back in the future.

Sarah: Thanks for having me, Eric.