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Recently I interviewed Dr. Aimee Duffy, as she discussed how to optimize the health of your adrenals. If you would prefer to listen the interview you can access it by Clicking Here.

Dr. Eric Osansky:

With me, I have Dr. Aimee Duffy. We are going to be chatting about the adrenals. I am going to give Dr. Duffy’s bio, and then we will chat about adrenal health, tying it into thyroid health. Dr. Duffy is the #1 bestselling author of Normal Doesn’t Have Side Effects. She is an award-winning speaker of Harvard Club in Boston, CNN, NASDAQ, New York City Bar Association, and the Philadelphia College of Physicians. Dr. Duffy has shared the stage with Martha Stewart, Suzanne Somers, Ice-T, and Dr. Oz. She is a frequent podcast guest and expert guest on ABC, NBC, CBS, and FOX Network TV shows. Thank you so much for joining us, Dr. Duffy.

Dr. Aimee Duffy:

Absolutely. I’m so excited to be here. Thanks.

Dr. Eric:                        

So excited to have you. Why don’t we go ahead and start off by discussing your background? How did you get into functional medicine?

Dr. Aimee:

Sure. I love to tell stories. That’s the best way people like to hear information as well. When I was younger, I absolutely loved babies. They were my favorite thing in the whole world. I had all the Cabbage Patch Kids with all their clothes and accessories. I became a babysitter at the early age of 11. I wasn’t allowed to stay alone with the babies, but I would go over to neighbors’ houses and play with the babies while moms were doing their thing.

Over the course of the next several years, I developed a great relationship with one of the families that I babysat for. They invited me when I was 17, a senior in high school, to be in the delivery room when their next baby was due to be born. That was really my first experience. I had never dealt with anything like that before. I was there. I got to see the whole thing. When that baby came out and was put on Mama’s chest, I thought this is the coolest thing ever. I want to be a doctor and do this. I am going to deliver babies. That was in high school.

I went through college and med school. I became the doctor that delivered babies. Over the course of my years, I have delivered over 1,000 babies. It’s been an amazing experience. What I found though was that when you’re not delivering babies, in that line of care, you’re doing a lot of women’s health and GYN-type stuff.

Early in my career in medical school residency, there was a lot of talk about hormones. The Women’s Health Initiative came out. There was lots of scary information about the concerns associated with hormone replacement. I found myself in these conversations with women. “What should I do about these hormones? Do I need to get off what I’m taking? I feel horrible. You have to fix me.” “Well, we have these hormones, but we’re hearing they have a lot of negative things. My job is to do you no harm, so I don’t know that’s the best option for you.” We didn’t have a good solution for that. Get stuck between a rock and a hard place of having horrible symptoms or risk the negative side effects. I didn’t think that was a good place for anybody to be, myself in trying to help these patients, or them having to make that decision on their own.

I started doing a lot more research and reading about hormone therapies. I came across this idea of bioidentical hormone therapy that I had never heard of in medical school or residency. That was like Alice in Wonderland, where she goes into the tiny door, and it opens up, and it’s this amazing world of beauty and knowledge. Where did this come from? Why aren’t we talking about this more?

When people first think about bioidentical hormones, they are thinking about estrogen, progesterone, and testosterone. Really, this is where we’re rolling into adrenals. Cortisol is a hormone. Thyroid is a hormone. Are there ways we can test, understand what’s going on with a patient, and then evaluate it in a better way to help them get back to normal again? Ultimately, that’s what our goal is.

I started with these patients who were really feeling miserable, whether they were having classic hormone symptoms, but they are also fatigued, they can’t lose weight, their hair is falling out, their libido is horrible, or they’re having painful intercourse. Their gut is a mess. They didn’t even think that was something they needed to talk to the doctor about because they are so used to having gut issues. That is where I started to really find the results: when we could test those patients, see what their issues were, and respond more naturally. That is where my book Normal Doesn’t Have Side Effects comes from.

When we are getting things back to normal in terms of hormone levels, be it the sex hormones or thyroid, people really start to feel better. You don’t have to worry about all those side effects. We are doing it in a more natural way. That’s really what started my process: going through the steps to get to those types of patients. Now, that’s the type of patient that I see in my practice for the most part. That’s where we get started.

Dr. Eric:

Always want to try to address the root cause of the problem, which of course we both do. There is a time and place for hormone therapy as well. Now that we have some of your background, why are the adrenals important to our health?

Dr. Aimee:

If people hear about adrenals, they don’t really know what that means, but there is a lot of chatter in advertisements for supplements about cortisol and stress. I must have high cortisol levels because I’m so stressed out all the time. What I have found over the course of my 15+ years doing this in practice is the adrenals are your stress hormone, but they are also really important for other things, like your immune system. They’re anti-inflammatory.

When we talk about the pandemic that we have been living in, and everyone being so stressed out, their cortisol levels are not normal. That could be affecting their ability to fight off infection and immunity. Not having the appropriate stress response, it starts to mess with your brain. You have to think about what the adrenals are supposed to do in the first place, so you can understand why if they are not working right, what the consequences could be.

When you wake up in the morning, your cortisol levels are high. It’s time to wake up. The sun comes up. You’re ready to go. Over the course of the day, your cortisol levels go down. Let’s imagine that at 1pm, you get chased by a saber-toothed tiger. You would have a fight or flight response. Your cortisol and adrenaline go way up. You’re able to outrun the tiger. Run fast, jump high, lift heavy things. You won’t stop and go to the bathroom and eat a snack. If you sprain your ankle, your body is smart. It doesn’t want to let you feel that pain, so you can keep running. Otherwise, if you stop, you won’t make it. That adrenaline is really important for our survival.

In that scenario, maybe you find a cave. You outrun the tiger. You catch your breath for 20 minutes. You go back to your home, and everything’s fine. You rest a little bit that afternoon, and you go back to normal.

What happens where we are now, fast forwarding from caveman days to here, is we have so much stimulation, starting with setting an alarm clock and turning on lights before the sun comes up in the morning to getting in the car to dealing with your schedule. Especially now with our smart phones, we have constant notifications all the time interrupting us. It may not necessarily be stress although everybody knows what stress is. That stimulation constantly throughout the day. Driving in your car, it’s not relaxing. You have to be on alert all the time. Your cortisol levels are always a little bit higher. You get home and turn lights on. Even though the sun is going down, we are not calming down. We have screens in front of us. We are not sleeping well. We call that “tired and wired” when you’re exhausted throughout the day but are not getting adequate sleep.

What I tend to see more in my practice is low cortisol. We have really used up all the reserves. What the adrenals are supposed to be doing, we have asked them to work so hard over time. We are running a marathon uphill without ever taking any breaks. That starts to lead to what we call adrenal dysfunction. It used to be called adrenal fatigue, and a lot of people understand that. It’s an imbalance in that pattern of high in the morning, low at nighttime. The signals from your brain start getting confusing. The brain is telling you, “I am being chased by a tiger, but you are not responding.” That gets really confusing. When there is really something stressful going on, like you get sick, or you do have an injury, then the signals are all messed up, and you are not able to recover appropriately.

What happens more so indirectly from cortisol dysfunction and adrenal fatigue is that it doesn’t allow us to do the things that we know we need to be doing to maintain our health. When you’re tired all the time, you are less likely to exercise appropriately. You’re not getting adequate sleep when your cortisol levels are cattywampus.

One of the most common symptoms that I see is carbohydrate cravings. You tend to crave salt and sugar because your brain is saying we need energy from somewhere, especially later in the day. We tend to go back and forth between this salty snack, this sweet snack. Margaritas are a favorite because they are both salty and sweet. Then we are frustrated. “I want to eat healthier, but I tend to crave these things.” Then we start rationalizing, “I have a busy day. I’m tired. I am just going to order pizza tonight.” We are not able to get over that hump and do the adequate lifestyle management things that we need to do. These people become overweight.

It starts to affect other hormones. There is definitely a connection between the adrenals and thyroid. There is also a connection between adrenals and progesterone; that’s a big one. Other hormones, too. Everything starts to fast forward. I see women who are going through menopause or feeling menopausal earlier, late 30s, early 40s because their cortisol levels are tanking, and it’s messing up the whole hormone connection there. There is some direct correlation with adrenal dysfunction and health, but it’s more indirectly because it’s not allowing us to maintain healthy habits. We start to get overweight diabetes. We are going to have blood pressure issues. More high cholesterol. It just goes on and on from there.

Dr. Eric:

We mentioned low cortisol. When I dealt with Graves’, I did a salivary test, and that definitely showed my cortisol levels were in the tank. My DHEA was low. I don’t know if you commonly see that, too.

Dr. Aimee:

Absolutely.

Dr. Eric:

For those listening, DHEA is also an adrenal hormone. It sounds like it’s not just emotional stressors, but also you mentioned the importance of diet when it comes to adrenals.

Dr. Aimee:

Right. The other thing that I talk about with adrenals, and I mentioned the stressors from the outside in terms of either work stress, home stress, finances, time management, we have all these stressors. A lot of people are taking care of elderly family members who are sick, and that’s a big stressor on life, those sorts of things. Everybody understands what stress means from the outside.

What a lot of people don’t understand is the stressors that are happening on the inside. That is where we deal with diet and gut. If we are eating and ingesting or being exposed to things that your body looks at as foreign or a threat, so any kind of chemical, all of our standard American die that is full of chemicals right now; medications you might be taking. We can’t control 100% the air we breathe and the water we are drinking. Now our insides are being exposed to these threats. It really sends the exact same signal to your adrenals. The brain is not delineating between that tiger chasing me and I just ate something like gluten. That is a very popular one. I just ate the McDonald’s McMuffin or something like that (I don’t know what it’s called now). If you eat that, your body goes, “What is this thing? It looks like a threat.” It will send all those same signals as if we are being chased by that tiger.

Those internal stressors are affecting your adrenals just as much as the outside stressors. You may not recognize that. People go, “Man, I ate that, and now I don’t feel good.” Maybe they don’t notice it at all, but later, they feel really tired, or they are having some aches and pains in their joints because of the reaction they had to the food they ate earlier that day or in previous days.

When you think about diet, what do I need to do to support my adrenals? There really isn’t an adrenal diet if you want to think about it that way. You need to think about what are the foods I am going to put in my body that are going to help heal and fuel my body and restore it as opposed to the foods that will be a threat? When you are ready to sit down and eat something, you are holding it in your hand, is this going to be fuel and restorative for me, or is it going to cause more stress to my body?

Dr. Eric:

Most people know what foods they should eat and what they shouldn’t eat, to some extent. Some people classify whole wheat pasta as being healthy. Like you said, there is gluten in that. There are other foods people might think of as being healthy. We know refined foods and sugars are not good for us. Unhealthy oils, like canola oil and seed oils like sunflower seed oil and peanut oil. Definitely agree most functional practitioners (hopefully all…) agree that people should be eating whole healthy foods, plenty of vegetables, and avoiding those refined sugars, unhealthy oils. There is no specific adrenal diet. There are books on adrenals that talk about diet. Everybody is different.

You mentioned adrenals can have an effect on thyroid health as well as the sex hormones, especially progesterone. Can you get deeper into how that has an impact?

Dr. Aimee:

In both scenarios, there are different things that happen. Sometimes it’s hard as practitioners even to figure out which one is driving the bus. People come to see me all the time,” I was diagnosed with hyperthyroid. I am on Synthroid. Maybe I felt better for the first month, or never really felt better although they told me my labs were better, but I still have all these symptoms.” Ok, what’s going on there?

For me, that’s a great place to look at other things, like hormones and adrenal function. Even though their labs say their thyroid levels are okay, they still have all the same symptoms. There is definitely a communication between the adrenals and the thyroid. It’s not really easily defined in my opinion as a direct, if you have low cortisol, you will have hypothyroid. It doesn’t always work that way.

I’m sure you’ve talked about this in your podcast before, but to take the inactive thyroid hormone and convert it to the active thyroid hormone. There is an ability to take the inactive thyroid hormone, which we call T4, and convert it to active thyroid hormone, which is T3, that hits your receptors and does the work. It takes an appropriate amount of cortisol to do that. There is a lot of other factors that go into that. It’s not a direct thing. If you don’t have enough cortisol, if your body is under stress, it won’t be able to make that conversion. In your blood work, your thyroid may look okay, but if your thyroid hormone is not getting to your tissues, then you won’t feel the response to those symptoms. There is definitely a connection there between adrenal and thyroid.

In the hormone section, if you look at the steroid hormone pathway, they all start with cholesterol. There are different signals that move it down. This is biochemistry 101 that I was awful in in medical school. Now I use it every day, which is crazy. You have progesterone. Right below that, you have cortisol.

What I typically see in my practice is women who are pre-menopausal, so they are under 50. Let’s just make it easy that way. If they start to have hormone-related symptoms, like night sweats, more irritability, irregular periods, weight issues, “Something is up with my hormones. Can I be in menopause already? It’s too early.” They’re 41. Usually, what happens is it’s the adrenal dysfunction, the low cortisol that starts to pull progesterone down because our body’s #1 job is to keep us alive. We are all about survival first. If you can’t run from that tiger, then you won’t make it. It doesn’t matter if you have the progesterone there to procreate because progesterone is important for helping you ovulate and prepare the uterine lining for baby and pregnancy. That’s where libido comes from, too. If your cortisol levels are low, it starts to pull your progesterone down, and you start to have hormone-related symptoms. That is really coming from the adrenal dysfunction.

In other women, we see them when they are 53/55, and they are like, “Man, I was feeling great until I hit menopause. Boom, all these symptoms showed up.” That is probably more the hormone changes that turned around and affected their cortisol levels. You can see it in two different places, but there is definitely a connection between those hormones.

One of my favorite things to talk about, and I’m going off on a tangent a little bit, is the connection between thyroid issues and estrogen. In post-menopausal women, why do women get thyroid disease more than men? It’s more rare in men. Oftentimes, we are seeing it in this older group. I have heard patients tell me all the time, “My doctor told me it’s normal for women to have low thyroid. They put me on my medicine. They didn’t talk about why or where that’s coming from.”

Estrogen is really important to help regulate the little protein called thyroid hormone binding globulin that carries the thyroid hormone around in your blood and delivers it to where it’s supposed to go. If you have low estrogen, it’s counterintuitive, but it increases that thyroid hormone binding globulin. It increases the carrier. All your thyroid hormone gets stuck to that, and it’s stuck to this protein and not being delivered to the tissues.

When women start to go through menopause, and their estrogen levels go down, they have less available thyroid hormone. Even if maybe their thyroid is actually producing what it’s supposed to produce, it’s not getting to where it needs to go. When people are frustrated, “I still have thyroid symptoms even though I’m taking this medication every day. Do I need a higher dose?” you need to look at that bigger picture and think, “Are we out of balance from a hormone perspective, whether it’s progesterone or estrogen affecting the thyroid and adrenals?” They all communicate together beautifully.

That’s why I love doing saliva testing. You get a really nice picture of what your cortisol levels are, estrogen, progesterone, DHEA, testosterone. It’s like putting music notes on a page. You can see how they all dance and work together and start to create a better balance there. Of course, thyroid normally is tested in blood. We don’t do saliva testing for thyroid. But you have that side by side. You can start to see the connection there in how all the hormones work together. In my opinion, you really can’t put blinders on and say we are going to deal with your thyroid and not look at the other parts of that hormone cascade picture.

Dr. Eric:

Just to repeat what you said: If you have low estrogen, that will increase the thyroid binding globulin. You will have less free thyroid hormones in the bloodstream. You need healthy adrenals to have healthy estrogen. If you have low adrenals, it’s common to see low estrogen and low progesterone. Like you said, there is an interrelationship, but that is where the adrenals tie in as well. There are other things that relate to having healthy estrogen levels as well. I’m glad you brought up that thyroid/estrogen relationship. Thank you for doing that.

A couple of questions I have. How about high cortisol? You see mostly low cortisol, but I’m sure you see some high cortisol. I know I do when I do saliva testing for example. Obviously, with an acute stress situation, we’ll see cortisol rise. But then there is that middle stage. I’m sure you’re familiar with the three stages of adrenals.

Dr. Aimee:

Definitely. I can see some high cortisol. Because I see so many people with cortisol levels that are low, I’m not saying that you can’t have high cortisol, but I’m usually questioning my interpreting of that. There is some triage there. What was going on that day? Did you have any surgery lately? Have you been on any kind of steroids? Do you do a Flonase for allergies every day? It’s so rare to see high cortisol that I want to make sure that’s actually real. Sometimes I will repeat the test again because if it doesn’t fit their clinical picture, that may not make sense.

The reason it’s so important to connect those two and determine if it’s real is our treatment approach is very different. They may have similar symptoms. For people with high cortisol, they are going 120 miles an hour, so they will be tired from that. They may still have fatigue and difficulty sleeping and things like that. You want to be able to make sure that is really what is going on because our treatment for high cortisol is going to be more telling the brain, “I’m not being chased by that tiger.” We use more calming herbs. L-theanine is a great one for that. Things that will help your brain turn off. My goal there is definitely supporting a symptom, but it’s more trying as much as we can to prevent them from getting worse and going into that low cortisol/adrenal fatigue stage.

Just like I made the connection from low cortisol, you need cortisol. Too much cortisol is also not good. It overwhelms the system. You will still probably see some dysfunction from a thyroid perspective as well. Again, it’s not a direct, if somebody has high cortisol, they will have high thyroid. If they have low cortisol, they have low thyroid. But they do talk to each other and connect.

Dr. Eric:

I agree with you in that if cortisol is very high, it’s a good idea to ask the patient on that day of collection if anything crazy was going on. I remember once, I had a specific patient, where their morning cortisol looked good, but in the afternoon, there was a spike. The last two cortisol levels on the saliva test looked okay. I asked her if anything was going on that day. She said she was studying for a test around lunchtime, which coincided with the saliva sample she took around that time. That makes sense.

Dr. Aimee:

I had a story like that real early on. When you’re first learning about this stuff, you have to learn from somebody else. I would do all these saliva tests and call the lab to ask about this particular person. It took some time to learn it. This person, I remember it was the same thing. It was a 2pm spike or something like that. Everything else looked normal or what I expected. After several questions and conversations, I found out that she was putting some sort of steroid spray or cream on her dog every day. It was that time of day. “I always put it on at lunchtime.” She didn’t connect that when she is putting this steroid cream on her dog, that would affect her saliva test. Once we figured that out, we did it the right way without exposure to that, and it came out okay.

The other thing that’s really important, and we should do this with all of our tests, is if the clinical picture doesn’t fit with what you expect the pattern to be, then that’s another reason for questioning. Again, I’m expecting somebody, when they fill out their intake form, or we’re having conversations, that their adrenals are going to be tanked. Then it’s not. Whether it’s high or even when cortisol is normal or appears normal, the way they are describing their symptoms, I would have expected them to be flatlined. Even then, I might say, “Tell me about that day. Was it a super stressful day?” In some patients, their norm may be really low, but the stress of that day increases their cortisol enough to make it go into the normal range.

That becomes the art of this medicine: Even though this test looks normal, this doesn’t fit the clinical picture. That happens in thyroid, too. This person has every single symptom of thyroid dysfunction, yet their thyroid levels look totally normal. That’s a little bit different. It’s not a direct relationship to what was going on that day, but it makes you start thinking, what else is creating those symptoms or the inability of the thyroid hormone to get where it needs to go? That should prompt you to look more directly into adrenals and gut health, too. If your gut is not happy, then you’re not absorbing that thyroid hormone that you’re popping into your mouth every day, and it’s not doing its job.

Dr. Eric:

Good point. You want to look at the whole picture and take into consideration the test. That’s also why we do a health history to get other information. Sometimes we need to dig deeper. Maybe do a comprehensive stool panel or other tests. Thanks for pointing that out.

Getting back to the adrenal testing. You do saliva testing. I’ve done saliva testing for years. Why do you do saliva testing over blood tests? I know the answer to that, but for those listening who figure, “Why can’t I just go to a LabCorp or Quest or somewhere else and get a morning cortisol?”

Dr. Aimee:

Specific to adrenals, there are two parts to that question. The first part is we talk about an adrenal pattern. I mentioned it earlier, but your cortisol goes high in the morning when the sun comes up. Over the course of the day, they go down. The sun goes down, and it’s helpful. I see a lot of patients where their morning cortisol may be pretty normal, but by the time they get to noon, they’re tanked. It’s bedtime for them. That’s why they’re complaining of all this afternoon fatigue. “I can’t stay awake at my desk. My kids drive me crazy when they get home at 5pm. I’m trying to make dinner, and they’re screaming. I feel crazy. I think I need some antidepressant or antianxiety medication” when their cortisol levels are low.

If all you do is go into a lab and get a one-time cortisol test, that’s not giving you an adequate picture of what the whole day looks like. Especially if someone is having trouble sleeping, it’s very common to see a little rise in cortisol at nighttime as you are getting ready for bed. If they are not sleeping well, rather than, again, us going down the traditional path of needing Ambien or some other prescriptive medication for sleep, if we see that their cortisol level is going up, there are certain supplements we can do to help stop that. You can get better sleep.

It’s really important in my opinion to get that full four cortisol test throughout the day to adequately see what that pattern looks like. That is step #1.

Step #2, sort of what I mentioned earlier about the stress. Let me go backwards for a second. Ideally, we want to collect the cortisol sample 30 minutes after you wake up. That’s when it should be at its peak. There are plenty of studies that show us that your peak cortisol level is going to be 30 minutes after you wake up and are ready to get out of bed. Imagine trying to wake up, get dressed, get in the car, find LabCorp, get a needle stuck in your arm, and have that test all done in 30 minutes. That’s unrealistic, but that will also be stressful. You will end up with a high or even a normal morning cortisol level that then doesn’t tell us the actual clinical picture of what’s happening throughout your day.

That’s my interpretation of why I do saliva testing for cortisol specifically. Yes, you can measure cortisol through blood. It’s accurate from the perspective of what your cortisol level is in your blood at that moment. But it’s not accurate of your personal clinical picture of what’s going on with you.

Dr. Eric:

The only way to look at the Circadian rhythm of cortisol is the saliva test or the dried urine test. I don’t know if you use Dutch testing in your practice.

Dr. Aimee:

I have a little bit. I like the saliva test better, but I do find the Dutch test helpful. That’s one of those things when you are starting to troubleshoot, and that clinical picture doesn’t fit. I have had times, and this can be a little bit confusing. This gets advanced. When somebody’s cortisol level is really low, so I’m treating them as such. I’m giving them lots of cortisol herbs or even hydrocortisone. That’s another conversation we can have. They are responding as if their cortisol level was high. They are saying, “This is really stimulating me. I can’t take this.” It’s not doing what we expect it to do.

There is a phenomenon where people make cortisol and get through it really fast. It doesn’t show up as readily in the saliva test because it’s already gone. The Dutch test, doing a urine analysis, gives us the cortisol metabolites that have been through. There are some cases where you can have low cortisol on a saliva test, but it will appear high in the Dutch test. That is somebody who actually has high cortisol; they are just super fast metabolizers and getting rid of it quickly. That’s rare. I have heard of that at conferences and things. I have had probably less than a handful of patients who fit that picture. That’s where I have found Dutch testing to be helpful.

Dr. Eric:

As far as the metabolism itself, those metabolites, it’s very common with hyperthyroidism, which a lot of people listening to this have. You prefer saliva testing, and you also use saliva testing for the hormones, too. You don’t test hormones in the blood, like progesterone or estradiol?

Dr. Aimee:

What I have learned and trained in my saliva testing courses, which I now teach to other providers, there are a few parts to that. One of the parts is hormone levels change throughout the day. That has been tested in bloodwork. I have seen the studies several times, where they took two women and tested their estrogen levels every 10 minutes. It looks like an EKG machine. It’s all over the place. Collecting four samples throughout the day, taking a pooled sample and getting one number that is more accurate of what your overall day hormone levels look like, especially if you are on hormone replacement.

Whatever your hormone replacement regimen is, you want to catch a nice balance. What does the average look like rather than a one-time blood test in the morning, and you took your hormone replacement that morning before you showed up? That level will be high. Or vice versa. If you took it yesterday, and now is a sample where it might be low, so that’s confusing. Having that test throughout the day can give us a nice average level. I do like doing saliva testing for that. It’s not impossible, but it is quite difficult to be able to go to a lab four times a day and get those tests done and then average those numbers. That’s not realistic. That helps.

The second part is we talked about thyroid hormone binding globulin, which is a protein that the thyroid hormone sticks to. You have the same kind of protein for your other hormones as well. Hormones don’t usually just hang out in the bloodstream. They have to be attached to those proteins, which carry them to the receptor sites on the tissues, whether that’s your hair, skin, breast, ovaries, etc. Blood testing misses those hormones that are stuck to that protein, so you don’t get accurate levels of what hormone is actually being presented and what the tissues are being exposed to. Oftentimes, in the bloodstream, you are getting the leftovers. It wouldn’t be unusual for it to be low. That could be inaccurate. By the time it’s high in bloodwork, then it’s really high in the rest of your body. That is going to cause side effects and things we don’t want to deal with. I find saliva testing to be more accurate in terms of actual physiologic. Where are these hormones going? What is your body being exposed to?

Dr. Eric:

If someone is cycling, do you have them do one of those cycling saliva panels?

Dr. Aimee:

We can get into a topic of irregular cycles. If they can test somewhere between 18-21 days, which is basically a week before their period is supposed to start, that is when the progesterone level is going to be at its peak. After you ovulate, progesterone levels start to go up. If you get pregnant, it will keep going up. If you’re not pregnant, it starts to go back down again.

18-20 is when it should be at its peak. If somebody is low then, then it’s very likely they will be low the rest of the time, too. That is where we are focused for progesterone in particular. Estrogen does change. It peaks a little bit earlier, but we can have a nice level of what we expect it to be during that time as well.

When somebody is cycling, estrogen is probably not the issue because they are cycling, which means they still have adequate levels of estrogen. It’s looking at progesterone and the balance in their cortisol levels. I haven’t found it to be helpful. I did it in the beginning when I was first learning. There are some labs that have you do eight days throughout your cycle or 11 days. That’s just a pain in the butt for the patient to do, and it’s not very exciting for me to interpret all of those numbers and results. I try to simplify things with getting the best information. That’s what I have found to work really well. Do that test about a week before their period is supposed to start.

Dr. Eric:

Let’s talk about treatment. I know you mentioned high cortisol, you don’t see a lot of those cases, but you mentioned L-theanine. When it comes to low cortisol, you mentioned hydrocortisone. Some practitioners will give licorice root or adrenal glandulars. What approach do you take? Does it vary depending on the person?

Dr. Aimee:

Absolutely, it varies, depending on what their levels are. I have various adrenal supplements. There are so many out there that can be overwhelming and hard for me to choose sometimes. Either I have another practitioner who says, “This is working really well for me,” or a little bit of trial and error.

As a physician and a mom of four, my cortisol levels were not very good for a long time. I have tried every single adrenal supplement out there. Even treated myself for a couple years with hydrocortisone. I have personal experience on that level as well.

I have adrenal supplements that I call mild, medium, and hot. Kind of like salsas. If you have that cortisol pattern that is a rollercoaster, you may be high, then low, then high, then low. It’s hard. Do I give them a more stimulating adrenal supplement or a shut down the adrenal supplement?

There are some supplements out there that are more adaptogenic. More mild, let’s just try to balance things out a little bit. That’s where coming to the brain, having some L-theanine or something calming that way can be helpful.

The medium one is that cortisol is okay in the morning but tanks later in the day. I call that the Gatorade of the adrenals. Those herbs we commonly see, like ashwagandha rhodiola. We see some other herbs there. Lots of B vitamins. The P5P.

The hot one is in addition to some of those herbs, we add some adrenal glandulars to that. There is a lot of supplements that have mixtures of adrenal glandulars as well as other herbs. Siberian ginseng is found in a lot of those supplements to get the brain working a little bit.

I play around with those. Which one depending on which the patient’s symptoms are in terms of what sort of support we can give to the adrenals. Hydrocortisone, I have used a lot in my practice. I think it’s a great tool, especially for that flatlined person.

Let me go backwards for a second. Remember when I said earlier that when you are sprinting this marathon uphill all the time, that is wearing out your adrenals. We can give you Gatorade throughout that process so you can keep sprinting. Ultimately, one of our goals in long-term treatment of adrenal dysfunction is to lower the slope. We have to start working on that stress. We have to make that hill less steep. That comes from working on outside stressors. I can’t manage your stress for you. I can’t go to your job and help you figure that out. What are some things we can do with meditation and breathing and getting you back into parasympathetic mode? There is a lot of conversation we have about that.

Also, those internal stressors. That will go back to the dietary stuff. Let’s start eating to minimize that stress on the side.

Treatment of adrenals is not just pop that new supplement, and you will feel like a million bucks. Ultimately, that is what I started doing. I had great results with that. Patients would come back six months or a year later and wonder how long they have to be on these adrenal things. It felt good at the beginning, but some of those symptoms are coming back. This should be a magic pill. If you don’t support the adrenals to heal, then those supplements are just the Gatorade that is keeping you going on that hill.

Now, hydrocortisone fits very nicely in that when somebody is literally, “I cannot get out of bed. You’re telling me that I need to eat healthy. I can’t even process that. I can’t even think about going to the grocery store. I don’t care about eating. I don’t even eat anything, and I’m still overweight. Everyone thinks I should be a skinny mini because I hardly eat. I can’t sleep. I can’t do anything. My brain is a mess.” You see a flatline cortisol. We may need to use hydrocortisone for a while. That could be anywhere from three months to two years in some patients until they can really start to recover. If they aren’t in a place where they are going to be able to do the things they need to do to start healing, we have to get them feeling better.

Hydrocortisone is bioidentical cortisol. We use it in physiologic dosing, which means that your own body normally, in a perfect world, makes about 30mg of cortisol a day. I might start with 5-10mg in the morning and another 5mg in the afternoon trying to create that normal high and low curve. It just supports the process. Then they are starting to feel better. It takes them about a week or so to notice it. It’s not like you’re popping an Adderall and running around cleaning out closets. It’s not stimulating. But they start to notice they’re less tired, and they need less of a nap or didn’t need a nap at all today. They are going through the motions of regular life.

Now we can start introducing the supplements to support the adrenals to do their job. If the brain is not sending the signal, those supplements won’t do anything. You have to get the brain back.

I tell them hydrocortisone will do three things. Help you feel better and control some of those symptoms. Let your adrenals rest a little bit. Here they are on this hamster wheel trying to run this marathon of life, and they never get a break. We have to let them rest. We are not suppressing them. That’s what prednisone does. Hydrocortisone is let’s stay on this hike, but I will carry your backpack for you for a while, so you don’t have to work so hard.

The third thing it does is it resets the brain to say, “This is what’s normal.” High cortisol in the morning. Low at night. We will do that over and over every day for 30 days, 60 days. When you take it away, the brain is like, “I need cortisol.” Send the signal. Your adrenals have rested. You have some Gatorade in there. Now everything starts to work the way it’s supposed to.

Dr. Eric:

If you were to give a summary or action steps people can take if they feel like they are experiencing problems with adrenals. You can’t always go by symptoms. Can you give them some action steps? I’m sure there are things they can do on their own with stress management and diet.

Dr. Aimee:

What I have experienced is the more knowledge people have, the more they will have power to support their own health. They will be empowered as opposed to depending on others. Of course, you might need to depend on a doctor like me or you to help you get started in that path.

Yes, there are steps you can take on your own. If you think you have adrenal fatigue, look at a list of symptoms. It’s very easy to Google this. If you look up the symptoms that you have, and it feels like adrenal fatigue, you can look at some of those supplements and say, “Maybe I need some Gatorade.” They won’t hurt you. They are pretty safe supplements to take for the most part. If our goal is to get you to feel normal again, and you don’t feel normal, then you stop taking it. If you’re feeling overstimulated, or it’s upsetting your stomach, you can stop taking it. It’s not super dangerous to take an adrenal supplement necessarily.

But if you have so many symptoms, it’s hard to be subjective. “I feel this way. I took a pill for a week, two weeks. Didn’t work. How do I feel now?” Having objective measures of what is your cortisol now? How intense is it? We talked about the different phases of adrenal fatigue. If you are so low on that spectrum, those supplements won’t do anything for you. That doesn’t mean you don’t have adrenal fatigue, and the supplement didn’t work. Your brain is not sending the signal, so it doesn’t matter what you have there.

There is some trial and error with supplements out there. You can experiment. If it makes you feel better, that gets you one step ahead of the game. Again, we have talked throughout our conversation about the importance of everything working together. You might have adrenal fatigue symptoms. Is it because your hormones are out of balance? Your thyroid’s not working?

Finding a practitioner that is like me or you that can do some more objective testing and help you understand what is going on, where is that balance. If that is overwhelming for you, you can start with the basics. Let’s get us back into parasympathetic mode. I tell my patients all the time to Google how to be parasympathetic. There is a lot of good information out there about the things I can do to get out of that fight or flight mode, out of that stress mode. It’s easier said than done.

I have been doing a lot of talking on cold water plunging. There are a lot of studies on that. If you don’t have a tank where you can throw a bunch of ice water and get into a cold water plunge, you can turn your shower cold at the end of your shower. I think that’s fascinating. Even if you don’t have adrenal fatigue, it will be helpful for you.

At the end of your shower, turn it to as cold as you can possibly manage. The colder, the better. Count to 30. Your first response will be to hold your breath. “If I have to be here for 30 seconds, I can’t hold my breath that long,” so it forces you to start breathing and exhale. You have to do that calm, big, deep breath to help your body relax while you are in that water. The more you do that, that’s a great way to force yourself into that parasympathetic mode, that calm mode. If you can mimic that throughout your day, you don’t always have to be in the shower, but you can start help managing your stress a little bit better.

Back to the diet. Whatever you want to term it, whole food diet, I tell patients all the time: The closest you can get to nature in the least steps possible, that is the diet you want to be on. Pick an apple. Hopefully it’s organic. Pick an apple, and eat it. There are no steps to prepare that apple. Protein in meat is different. You want the minimum amount of steps. Nothing added to it. Get that raw meat. Cook it however you want to cook it, and eat it. Your veggies, as much as you can, raw veggies. One step. Steam them, sauté them, roast them, whatever. Minimal steps.

When you start thinking about something like whole wheat pasta, like you were talking about, or what we think is healthy grains and carbs, we didn’t go out and pick a stalk of wheat and chew on it. Even then, when you take the wheat and grind it up into flour after drying it out, we don’t sit there and eat spoonfuls of flour. That all has to be mixed with something else. These preservatives get in there to prevent it from getting moldy and hard. There are 52 steps to get from where it came from to your mouth. That’s an easy tool to let patients start looking at foods. How many steps? Three or less, that’s your diet you need to be on. You can start there. That will make some big changes before you find a practitioner like myself or another integrative functional practitioner that does more in-depth testing.

Dr. Eric:

I do take my cold showers. Not fully cold. I alternate. I do hot, cold, hot, and then finish up with cold. I recommend those. I can’t say I do it every single time, but most of the time, I do it.

Where can people learn more about you, Dr. Aimee?

Dr. Aimee:

My own personal website is AimeeDuffyMD.com. You can find links there to my book, Normal Doesn’t Have Side Effects. Also, if you click Learn More, you can flip over to my website for Carolina Integrative Medicine, which is my practice. You can also go to CarolinaIntegrativeMedicine.com. We have lots of info about what we talked about today, maybe not in quite so much detail. Adrenals, hormones, gut health.

There is a place where you can click Work with Me, which will get you to schedule a free discovery call with my team. We will chat with you for about 15-20 minutes. What is going on with you? What are your health issues or goals? If we’re a good fit to work together, that will get you set up on our schedule to go through the labs and the consult. That’s how people find me.

Dr. Eric:

Wonderful. Thank you so much for sharing this wonderful information with the audience. I’m sure they learned a lot about adrenals and sex hormones. Appreciate you taking the time for this interview.

Dr. Aimee:

You’re welcome. I enjoyed it.

Recently I interviewed Julie Michelson, as she discussed AIP diet tips and troubleshooting. If you would prefer to listen the interview you can access it by Clicking Here.

Dr. Eric Osansky:

With me, I have Julie Michelson, who is a national board-certified functional medicine health coach, bestselling author, international speaker, and the host of the Inspired Living with Autoimmunity podcast. Through her journey of overcoming more than a decade of decline with rheumatoid arthritis, Julie became passionate about functional medicine and using lifestyle to create healing. Julie is an expert in supporting others achieve the changes necessary to experience true healing. Thank you so much for joining us, Julie.

Julie Michelson:

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

Dr. Eric:

You are welcome. I am excited to have you as well. We are going to be discussing diet with a focus on autoimmune paleo (AIP) diet, giving some tips and troubleshooting. Before we dive into this, I would like to have you talk a little bit about your background, how you became an AIP-certified health coach and how you got into what you do now, helping people with autoimmune conditions. Of course, we said a little bit in the intro because you had rheumatoid arthritis, which I’m sure ties into that.

Julie:

It does. It is just one of the diagnoses I had. When I was in my early 30s, newly single mom with three little kiddos, I was diagnosed first with rheumatoid arthritis. I was told when I was diagnosed to expect to decline. There was nothing I could do except take the medications they gave me. On their end, what they would try to do was slow my decline as much as they could and keep me as comfortable as possible. Unfortunately for me at the time, I believed that. I had great doctors. Everyone seemed to agree. When you are diagnosed with something like that, that’s your fate.

I of course did decline for over a decade because that’s what I was expected to do. I kept piling on the prescriptions. I was on 10 prescriptions at the end of 11 years at once. I was taking 10 at a time. It wasn’t working. I was unable to work. I was resting while the kids were at school, so I could handle that afterschool to bedtime window. I had severe brain fog. I was in severe pain. They were trying to get me to put a handicapped placard on my car to save energy and steps. That was the current conversation at the time that I luckily had my aha moment, my dark moment, my light moment, whatever you want to call it.

My youngest daughter begged me, “Please don’t die and leave us.” Obviously, I couldn’t promise her that. What I said that changed my life, and hopefully a lot of people’s lives because this is why I do what I do. I promised her, “I would try everything.” In that moment, I realized I hadn’t tried everything. I tried every medication they had me try, thinking that was everything.

Luckily, I had the history of a little bit of improvement with diet change that I had done on my own. That was where I started with diet. At the point I made that decision, I was already gluten-free. My son had been diagnosed with Celiac a few years before that. To support him, I went gluten-free with him. We would do it together. I noticed my joint pain had gotten a little bit better by going gluten-free. Come to find out, I had Celiac.

I remember even back then, asking my doctor, “Wow, if this helped a little bit, what do you think about dairy? I’ve read that nightshades can be a problem.” “No, nightshades is one in a million. It’s not really a thing.” Back then, I believed her. It was enough. It was stuck in my head, and that’s where I decided to start on my own.

It took me years. AIP wasn’t around yet. I was uneducated. I thought I was eating Paleo at that point. I was still eating corn. I didn’t know corn was a grain. I was eating loads of sugar. I was still avoiding fats, even healthy fats, because I still had that mindset of fat is bad. It took a long time. It was a process.

I am really fortunate that without even managing my other underlying causes, just over the years, by continuing to tweak diet and learn, I was able to get well enough to reduce the brain fog, so I could learn more and continue down the journey. It has become my life’s calling not only to help people but also to shout from the rooftops, as you do all the time, that we can heal. People need to know that autoimmunity is not a death sentence; it can be turned around.

Dr. Eric:

Well said. I definitely agree. Your rheumatoid arthritis is under control?

Julie:

I have no symptoms. I have been symptom-free for about six years, maybe longer now. Time keeps marching on quickly.

Dr. Eric:

True. You mentioned AIP wasn’t around. Same thing when I was diagnosed with Graves’ in 2008. There was no AIP then. I started out with more of a modified Paleo diet, you could say. I was still eating nuts, which I had to eliminate later on because I was having some issues. I wasn’t 100% certain it was due to nuts, but when I cut them out, I progressed further.

Why don’t we talk about AIP? Could you give a brief overview of what the diet entails?

Julie:

Absolutely. I want to start right away by saying when people hear AIP, they think diet. We are going to focus on food today, but AIP is a lifestyle. It’s important for people to understand that they may dial in their diet perfectly, but if they are not actively managing their stress, not sleeping well, not in community and connected with others, not handling toxins, not moving properly at the level for their body. If one thing is perfect without the rest, I can guarantee you it won’t get you the results you’re looking for. To me, diet is a low-hanging fruit and such a big driver. It’s not just a diet.

What AIP is, as far as the food plan, it contains a comprehensive elimination diet, where we are eliminating all of the most common drivers to autoimmunity. I say “most common” because usually by the time most of us are diagnosed with an autoimmune condition, we know we have leaky gut. When we have leaky gut, we have food sensitivities. A lot of them can be to really healthy, nutrient-dense foods that aren’t on an autoimmune list, things like spinach. I try to stop saying kale because people are tired of hearing about kale. There is no one written plan that is going to be optimal for everybody. But AIP is so comprehensive that we now have great scientific studies behind it.

As you mentioned, it’s a Paleo diet. It’s just beyond that. The key, and the part I think gets the most misunderstood, is yes, the elimination phase is very restrictive. It’s supposed to be a phase. It’s not supposed to be a lifelong thing unless someone really needs to be avoiding all of those foods long-term. You mentioned Paleo. It’s completely grain-free. Yes, even oatmeal. These are the things people like to negotiate all the time. I know we will get into that later. It’s sugar-free. It’s sweetener-free. No legumes, nuts, seeds, eggs, nightshades, alcohol. What else am I missing?

Dr. Eric:

Paleo allows eggs, nuts, and seeds. You mentioned those are not allowed.

Julie:

No dairy.

Dr. Eric:

No nightshades, grains, legumes, alcohol. Of course, it goes without saying: no unhealthy oils.

Julie:

No processed foods. All of those additives and chemicals, we’re talking about a whole real food eating plan.

Dr. Eric:

Even certain spices are not allowed, correct?

Julie:

The ones that aren’t allowed are either nightshades or seeds.

Dr. Eric:

Speaking of coffee, would you say that falls under the legume category?

Julie:

It is a bean. Coffee may technically actually be a seed. I can’t remember which category it’s in. Full confession: I have coffee right here. It’s earlier here than it is where you are. I have done my reintroductions, and I am okay with coffee although I am not okay with other legumes. I don’t eat legumes.

Dr. Eric:

In your situation-

Julie:

Where we start is not where we end up ideally. That restrictive phase is a phase.

Dr. Eric:

I agree. I look at AIP as more of a starting point. It’s a phase. When I have someone start on an AIP diet, and I can’t say I have every single one of my autoimmune patients start there, but for those who do start there, I usually will try to encourage them to go at least three months. Even 30 days is better than nothing. But a minimum of three months. What do you have to say as far as duration of that phase?

Julie:

It’s individualized. It’s going to depend on response. I’ve had the rare occasion where we’re working toward a full AIP elimination, and someone feels phenomenal. If someone is feeling amazing, then I will say, “Okay. I don’t need to get more restrictive.”

I agree. It depends on where they are. What are their symptoms like? How long have they been struggling? It usually takes at least a good 60 days. Here’s the thing I find. I will start with an at least. I don’t say 90 days to anybody because I don’t want to scare them off. I do say, “This will depend on you.” Nobody believes me when I tell them this, but I always tell them, “I promise, I will be encouraging you to do reintroductions. You are not going to want to.” At the beginning, it sounds really hard and overwhelming. When it is the right thing, and you feel amazing, nobody wants to put those things back in because they don’t want to feel crummy again.

For me, the whole purpose of AIP is information and power. It’s not about the elimination. It’s about the reintroductions and really learning what each of those foods is doing. People don’t understand. I have people ask me all the time, “Are we creating a food sensitivity? I have been eating tomatoes my whole life, and now they bother me.” I liken it to because I am over 50, that fuzzy TV screen, those of us in my age group remember when the antenna wasn’t just right. You have so many little sources driving your inflammation that you can’t feel what just one is doing. That is the beauty of this protocol.

I know we may touch on some other eating plans. The thing I love, I am working on my Bredesen certification, and I have worked with a Bredesen-certified physician. That’s an Alzheimer’s plan. Anyone familiar with the Wahls protocol. All of these things come down to the same thing. They are all grain-free, dairy-free, nutrient-dense, loads of veggies, lots of good healthy fats, and no sugars. All of the higher-level diets have some level of ketosis involved. There is a crossover. I study all of them and see these are the things that must be important no matter what your diagnosis or symptoms are.

Dr. Eric:

I agree. I want to talk about grains. Toward the beginning, you picked a little bit on oatmeal. Before the interview, we were chatting a bit. That is one of the things patients like to introduce. Oatmeal, rice is common. As you mentioned, a lot of these diets avoid grains. Why are grains not part of AIP or a Paleo diet or a ketogenic diet? Keto might be different. You are trying to get into ketosis, so there are different reasons.

Julie:

I think that’s still part of it. There is more than one answer, and there is overlap. We will start with the easy part. Grains are going to increase your carbs. At some point, for everyone, carbs become inflammatory. Just that alone, without the other reasons, is why someone who is dealing with chronic inflammation needs to be careful of their carbs.

I have gentled as I have aged and coached more and more. I did pick on oatmeal. The reason I picked on oatmeal is most people think oatmeal is really good for them. It’s marketed really well. I had a client recently who was a type one diabetic who was eating oatmeal every morning for breakfast. She had no idea that was bumping her blood sugar. Easy reason #1 that carbs can be a problem for people.

Also, certain gluten-free grains, because gluten is another thing- Everyone who works in the autoimmune world will agree that gluten is a problem, especially for those with autoimmunity. One problem with other grains is molecular mimicry is a thing. They can send similar signals and trip similar immune responses. Some of those proteins are similar. That’s another piece of the problem.

I go by what I see. When I first started coaching elimination diets, we would introduce gluten-free grains all lumped together. We would do oats, rice, and corn. I don’t do that anymore. We need to know exactly what each particular driver is doing. I do have clients that are okay with rice when all is said and done. Even those clients can’t eat rice every day, or they will bump their inflammation back up. My kids would tease me, “Not all grains are evil.” I did used to be so, “No, grains are bad!” The ones I think sometimes people can eventually handle in moderation are rice (cook it, cool it completely, then it becomes a resistance starch, and you can eat it) and oats here and there. I don’t eat oats. I will occasionally have sushi if I pour MCT oil on it. It really does depend.

Through coaching hundreds of people through this process, corn is a big problem for people. They typically have no idea. That is another reason why I think the gluten-free movement is not that great. I thought it was great with my son before I knew better, but that food is just loaded with junk and high-sugar stuff and corn.

Dr. Eric:

Some people might say it’s organic, so it’s GMO-free. It’s not just the GMOs. It’s the corn itself. Even if you have organic corn, it’s something you still want to avoid, arguably not just when trying to restore your health, but generally. It’s difficult because so many products, especially if it’s packaged and gluten-free, will usually have corn.

Julie:

Humans were not designed to be able to process grains, from the way we chew. There are a lot of reasons when we look back. If we think of paleo, that’s this approach. How did we eat in Paleolithic times? What are we designed for? We weren’t sitting around eating carbs all day. We weren’t sitting around all day either. When you think of what that mindset means, that’s what it means.

Dr. Eric:

They didn’t sit around eating popcorn, speaking of corn.

Julie:

My daughter was just teasing me about that. When I said I was doing Paleo all wrong. I thought I was eating Paleo, and I was having popcorn almost every night, when I had that treat mentality still. No, they weren’t watching movies and eating popcorn.

Dr. Eric:

Some people might be able to get away with some gluten-free grains, possibly rice and maybe oats. The thing is you never know how someone is going to respond. When someone is trying to negotiate, it’s up to the person. We can’t force people to follow any type of diet. We just give recommendations. What I always say is if you deviate, it’s ultimately up to you. You might progress fine. But we just don’t know. If that’s a risk you want to take, if you go 30 days or a few months, then you hit a road block. If you hit a road block, we don’t know for sure that you’re eating bad food. If you’re eating rice, we don’t know for sure that’s why you’re not progressing. If you’re eating strict AIP, we can’t blame it on certain foods. If you’re eating that food, then we don’t know.

Julie:

It’s the scientific approach. That is why I believe wholeheartedly the proper reintroductions are the most important part. Then you’re not guessing what does rice do to me? I don’t always coach AIP straight as it’s written. We use it as a framework. If you ask Sarah Ballantyne, that’s what it was designed for. In order to be a resource for people, you have to give them the framework.

I just had a potential client come to me until she told me she was vegan. I said, and I know you have a question about that, that I was not the right coach to help her heal unless she was willing to incorporate some animal protein into her diet. Luckily for both of us, she said, “I will do whatever you tell me to do. Let’s get started.” As a vegan, some of her really high sensitivities were things like soy and a bunch of the wonderfully nutrient-dense vegetables she was eating.

Here is where I love the food sensitivity panel not only as a backup but how to get a vegan not to eat soy. You show them data that their body is having a problem. For me, it made that part of my job so much easier. She just reintroduced kale last week. She did a full elimination diet and has been very slow to reintroduce. “Please, can we do kale now?” “Sure.” She can’t eat kale; it’s not her friend. And she loves kale. It doesn’t even have to be an evil food, like my kids think I think, on that list of things. Now, her body has told her that. If she had been eating that the whole time, she wouldn’t have gotten the results she got on her elimination phase because she would have had inflammation the whole time.

Like you said, it’s so important to take it out, and then to really feel. I’m one of those. I get it. I was eating gluten my whole life. I didn’t have gut issues. I thought it was fine. When they wanted to test me for Celiac, they told me, “You have to eat two pieces of wheat bread a day for a week or 10 days” in order to get an accurate read before the biopsy. That’s where I learned that. It didn’t happen. I couldn’t. I was that sick. That’s that sense of your body can tell you. Had a health coach told me however many years ago that was, 15 years ago, I shouldn’t eat gluten, I probably would have still dabbled in gluten. Feeling what it does to my body, it’s a never ever food for me.

Dr. Eric:

Definitely listen to your body. One thing I want to say about soy. You do a food sensitivity panel, and soy comes back positive. The one flaw with that, in my opinion, is if it comes back negative, you’re not just avoiding soy because you’re sensitive to it.

Julie:

Which is why it’s on AIP.

Dr. Eric:

Exactly.

Julie:

I run into that all the time. I try to explain I’m doing that panel for extra data. I’m looking for things like kale on that panel.

Dr. Eric:

You’re looking for foods that are allowed on AIP.

Julie:

That are nutrient-dense that I would normally encourage you to keep eating. To clarify, I take soy away from everybody all the time. That’s not usually one they argue with me a lot about. It’s usually dairy. “I only eat cheese.” I will offer to everyone contemplating, whether it’s AIP or any eating plan, to take a week and become truly educated about what you are eating. I have had so many people say, “I avoid dairy,” and there is dairy in the products they are using even if they are not eating straight dairy. I’m not picking on dairy. My family was in the dairy business, so I love cows. It’s not about that.

Dr. Eric:

Even dark chocolate. That is also not allowed on AIP. Some people might think they are eating dark chocolate, but it will have milk chocolate in there without saying. If you look at the label, it will say so.

Julie:

But they will have casein added, which is a dairy protein. I had that recently with someone, “I am eating these dark chocolate keto things.” “What’s in them?” “Oh, there’s milk in here.” If you have one takeaway from this conversation today, the starting point for everybody is really being truly aware of what you are eating because often we think we’re avoiding stuff, and we’re not.

Dr. Eric:

Quick question about food sensitivity testing. I personally don’t do a lot of it. Do you do IgG testing?

Julie:

I do IgA and IgG testing. I do the combo.

Dr. Eric:

You have them do the blood draw first without doing any type of elimination diet.

Julie:

The panel I use, they will send a kit right to the house. It’s a finger prick test. There is plenty to eliminate just on AIP. Most of the time, unless somebody is, “No, I want to go all in right away,” we’re stepping toward that, whether it’s slowly or rapidly, anyway. We get started right away while we are waiting for those results to come back.

Dr. Eric:

Let’s talk about constipation. That’s a common problem, where people are used to eating whatever they eat, whether it’s fast food, or maybe not eating a lot of unhealthy foods, but are eating grains and legumes, etc. Not necessarily a vegan/vegetarian, but a person in general who gives up all these foods. All of a sudden, they are experiencing constipation. What tips do you have for them?

Julie:

I’m going to go way back. I just had this conversation with a physician I work with. Sometimes we forget to start at the beginning. Are you drinking enough water? We jump to, “What can I take to help me with constipation?” There is often an adjustment period. It is interesting. I don’t experience that very often with the clients I walk through AIP. It could just be the way we handle that transition into the full elimination. It’s very rare actually for me. I know it is a big problem in the AIP community in general. #1 is how much water are you drinking? We have to be flushing things out. Look at that first. It sounds so basic, but it is so important. This could be why I don’t see a lot of it in my practice. AIP, we focus on the elimination phase and what you’re avoiding.

The other important piece is what you’re including. We’re including a lot of nutrient-dense vegetables. Here’s that crossover with AIP and Wahls and the Bredesen recode. Lots of vegetables and a variety: leafy greens, colors, cruciferous veggies. Those all have fiber. That could be a good reason why we don’t see a lot of it. I am not going to say my clients within a week are eating nine cups of veggies. That’s not true. But it is important, and it does help. “I need my oatmeal so I can poop.” We’ll find another way.

I’m not a physician. I work with a physician. Typically, if there is an adjustment period, we encourage people to make sure they are getting magnesium. They may have to increase that intake for a little bit to keep themselves regular. Typically, then they can back off. Most of us are deficient in magnesium, and there isn’t a part of your body that doesn’t love it. Tell me what you do for constipation.

Dr. Eric:

Similar to what you said. Make sure they’re hydrated. Make sure they’re eating plenty of vegetables. Like you said, it can sometimes be challenging because they are not used to eating a lot of vegetables at first. They are not making the transition to eight or nine cups a day initially. They might only be eating two or three servings a day. That can be helpful to increase the vegetable intake. Magnesium, I agree. If you’re constipated, citrate-

Julie:

Or a blend if you don’t want to go overboard. I’m guessing you would do the same, but for those listening who don’t know how much magnesium to take, it’s a brief, maybe unpleasant experience. You want to keep increasing your dose until you have too much motility, and then you back off. If you’re taking capsules, you drop it down one. That’s usually how we do it. You can do it gently. Then the beauty is once you get the veggie intake up, and the body is adjusted, you can drop down. It’s a really important supplement. We all need magnesium. I personally love blended forms. Different parts of the body like different forms of magnesium.

Dr. Eric:

I don’t recommend citrate for most of my patients. It’s just for-

Julie:

Motility, yeah. Absolutely.

Dr. Eric:

I like glycinate and other forms of magnesium, like malate. Just focusing on constipation, I would say citrate. You could also take a blend. Nothing wrong with that.

I will also say movement. I had this conversation recently with someone who experienced constipation after following AIP. She wasn’t moving around enough. I told her my experience. I was really sluggish when I was in my early 20s. I would have a bowel movement almost once or twice a week. My diet was horrible growing up. These days, I have regular bowel movements. Sometimes it’s on the sluggish side. But if I am sitting too much, which I try not to do—I have a treadmill desk, so I can walk and work at the same time—if I start moving, it’s usually not a problem. But if I do everything else, and I’m not moving, that can be a problem when it comes to constipation.

Julie:

I’m so glad I asked you. It’s like the water. These are things our body needs to be doing. When we were talking about Paleo, they were moving all the time. Whatever that level looks like for you, it doesn’t mean you have to go out and do a HIIT workout. Get up.

Dr. Eric:

Exactly. I don’t know how many patients you see with Hashimoto’s or Graves’. Hashimoto’s is more common.

Julie:

Yes, more common. It’s such a common crossover, I find, whether it’s a secondary or primary diagnosis in autoimmunity. Definitely ¾ of someone sharing a different diagnosis also has Hashimoto’s. Not as much with Graves’.

Dr. Eric:

I’m bringing that up because there is controversy in the world of thyroid health with iodine. I wanted to get your thoughts about sea vegetables, which are really high in iodine. Do you recommend sea vegetables to your patients with Hashimoto’s?

Julie:

I do. I know everybody takes a different path. They are nutrient-dense. We do need iodine. Most of us aren’t getting iodine in our diets elsewhere. They are not hopefully eating iodized salt anymore by the time we are getting going. We are looking for other good sources to support them.

We also use labs a lot. I work with a functional medicine physician. Whether it’s in my program or with the patients at the clinic, we are always doing labs as well. Working with the women I work with, one of the things that we see a lot, women who have cystic breasts need iodine. Sometimes supporting iodine in them will clear something. We look for signs and test as well.

Sea vegetables, people aren’t usually coming in and saying, “I eat a ton of these. Is that okay?” That won’t be the bulk of somebody’s diet. I think it’s really good to incorporate.

Dr. Eric:

Just to confirm, you are not really seeing problems with your Hashimoto’s patients as far as sea vegetables go?

Julie:

We don’t. A lot of it comes down to how many are they eating? I’ll qualify that. He doesn’t have Hashimoto’s, but I have a client right now who is an avid podcast listener and reader and learner and loves wellness. For the people who think they should be eating a ton of sea vegetables and are intentionally trying to do something good, that can be a problem. Everything in balance is what I will say. I don’t have people that really need to be avoiding sea vegetables.

Dr. Eric:

In the last few minutes, I want to do something I haven’t done before.

Julie:

Oh boy.

Dr. Eric:

I want to do a rapid-fire round, where I bring up a topic and have you give your opinion for 30 seconds.

Julie:

Let’s do it!

Dr. Eric:

Ashwagandha and AIP?

Julie:

I say no.

Dr. Eric:

Because it’s a nightshade?

Julie:

Yep.

Dr. Eric:

Pea protein powder and AIP?

Julie:

No, it’s a legume.

Dr. Eric:

Bone broth powder and AIP?

Julie:

Bone broth and AIP, yes.

Dr. Eric:

I knew you’d say yes to bone broth. I am purposefully bringing up the powders because there are so many. I’m sure you get, “I don’t have time to make bone broth, but I will add this bone broth powder to my smoothie.”

Julie:

I will ask what is in your bone broth powder? It’s the trick answer to the trick question. It’s about becoming a label reading master. There are AIP-prepared bone broths. I understand not everybody wants to make their own bone broth. Going back to my formerly vegan client—who still identifies as vegan. I said, “You can’t say you’re vegan when you eat salmon four days a week and drink bone broth and eat eggs. You’re no longer a vegan.” If you can’t handle chicken feet, there are reasons. I would never ask her to make her own bone broth. She hasn’t jumped to the beef world yet. You have to read your ingredients and know what’s in there.

Dr. Eric:

What’s your favorite cooking oil?

Julie:

Depends on what I’m cooking and how. I love avocado oil. To me, it’s a middle of the road oil in the sense that it doesn’t taste like coconut. It doesn’t have an intense flavor. It’s very mild, and it can handle a higher heat than olive oil. I don’t like cooking with olive oil; I like dressing with olive oil. Coconut oil as well, we use.

Dr. Eric:

Chlorella and spirulina in AIP?

Julie:

Again, it’s going to be a non-answer. It’s an individual thing. I’m a fan of chlorella. I mentioned I occasionally take sushi. I will take chlorella when I eat sushi to try to bind some of those nasty things. It’s going to depend on your autoimmune pathways as to whether you can handle certain things or not. Those are not typically a problem for people. It’s almost like the sea vegetable thing. There is such good stuff in both of those things. For the most part, people can handle it, but I would be aware. I would take them as an introduction. I would take them when you’re feeling well and eating clean, and you see how your body feels about it.

Dr. Eric:

I bring it up because I’m pretty sure Sarah Ballantyne says not to eat it. It’s a No on that list.

How about AIP and ghee? Which I asked you about when you interviewed me on your podcast.

Julie:

You must get this question a lot. The answer is yes, we allow ghee. If you know you have a dairy allergy, don’t do ghee. The proteins are gone, so it’s one of the ways to make AIP more successful for people is to allow them to have ghee. I almost added it in my list of cooking oils. I don’t know if it’s an oil oil.

Dr. Eric:

Last rapid-fire question. Reintroducing gluten and dairy if remission has been achieved.

Julie:

Yes. I believe everybody should reintroduce everything. Gluten and dairy are absolutely the last two on the list. When I have people reintroduce dairy, I have them do different dairies at different times. I will have them do goat separate from cow. Goat might be an occasional food for someone, and cow may be a never. I want people to feel what it does so that six months later, they don’t end up at a birthday party where they accidentally had the birthday cake. It was loaded with gluten and sugar and dairy, and now they are in a flare with no idea what it was. I do believe everybody should reintroduce everything. I will reiterate because I have to: I believe they should avoid gluten for the rest of their lives.

Dr. Eric:

I didn’t expect that response. How about if they reintroduce gluten, and they feel perfectly fine?

Julie:

I cry. It has happened to me literally twice out of hundreds of people. It’s very rare, and I cry. Then I explain. We review leaky gut and autoimmunity and how this all happened to begin with. I still remember you talking about the occasional pizza. For them, I say have a little gluten in Italy. It seems to be less of a problem there. Don’t make it a part of your regular diet.

Dr. Eric:

Thanks for that. I know we are just about out of time. Anything I didn’t ask that I should have asked? Any last words you want to give to someone who is thinking about following AIP and isn’t sure they will be able to stick with it?

Julie:

I can say it can sound overwhelming, and it will be way easier than you think once we get into it. I think we may have talked about this on my podcast, but as you make changes, you will start to feel better. You will have more energy to make more changes, which is why ripping off the Band-Aid and just jumping in from a standard American diet to a full AIP elimination is probably not going to work.

Look for support, whether it’s someone doing it with you. Find a coach. This is why there are coaches. You want to really be supported through that process.

I would say if you’re thinking of it, but it seems overwhelming, and you’re still eating gluten, then go gluten-free. Take one step. Look at the elimination plan. I always tell people to start with the easiest thing. What is the easiest thing they think they can eliminate successfully, so they can start to build some momentum?

Dr. Eric:

Thanks for that. How can people learn more about you and your services, Julie?

Julie:

The easiest place to find me is JM.Coach. That can then take you to my free mini course, my website, my social handles, my podcast. It’s my gateway to anything you might want to know. JulieMichelson.com is my website.

Dr. Eric:

The name of your podcast is Inspired Living with Autoimmunity.

Julie:

Come check it out. If you need more Dr. Eric, we did a great episode there.

Dr. Eric:

That was fun. This was fun, too. Thanks so much for taking the time to share your thoughts on AIP and other diet aspects.

Julie:

Thank you so much for having me. I always enjoy chatting with you.

 

There are many natural agents that can modulate the immune system.  And when it comes to autoimmunity, some of them are controversial, such as the herb Echinacea.  I decided to do a deep dive into some of the more common medicinal mushrooms to see if they can benefit those with Graves’ disease and Hashimoto’s, and I must say that I was impressed.

Many people are aware of the nutritional value of mushrooms, but they are also recognized for their medicinal properties. Medicinal mushrooms have actually been used since ancient times.  Research has shown them to have antimicrobial, anti-inflammatory, immunomodulatory, antidiabetic, cytotoxic, antioxidant, hepatoprotective, anticancer, antioxidant, antiallergic, antihyperlipidemic, and prebiotic properties (1) (2) (3).  These activities are attributable to many bioactive metabolites (1).

The Significance of Polysaccharides                                             

In this blog post I’ll mention a few times the importance of polysaccharides, as these are structural components of the fungal cell wall. It’s the diversity in monosaccharide composition and structure that causes them to have different biological activities (R1), including antitumor, immunomodulatory, antioxidant, anti-inflammatory, antimicrobial, and antidiabetic activity. The best known and most abundant are α- and β-glucans (4).  Heteroglycans, peptidoglycans, and polysaccharide–protein complexes also contribute to biological activity (5) (6) (7). They are mainly responsible for immunomodulatory effects due to their ability to bind to specific cell wall receptors and stimulate specific immune responses.

Here are some of the most popular medicinal mushrooms:

• Chaga (Inonotus obliquus)
• Cordyceps (Cordyceps sinensis)
• Lion’s Mane (Hericium erinaceus)
• Maitake (Grifola frondosa)
• Reishi (Ganoderma lucidum)
• Shiitake (Lentinus edodes)
• Turkey Tail (Trametes versicolor)

Before diving into some of these medicinal mushrooms, I’d like to first discuss some of the health benefits they offer:

• Anti-cancer effects.  Although the focus of this post is how medicinal mushrooms can help with autoimmunity, they are actually more well known for their anti-cancer effects.  One study showed that a water-soluble extract from a cultured medium of Ganoderma lucidum mycelia suppresses the development of colorectal adenomas (8).  Another study showed that Ganoderma lucidum might prevent some cases of skin cancer (9).  Yet another study involving Cordyceps sinensis shows that it inhibited breast cells in mice (10).
• Cardiovascular/metabolic health. A number of studies show that medicinal mushrooms can benefit those with insulin resistance and type 2 diabetes.  One study looked to see if the medicinal components in edible mushrooms can benefit those with diabetes mellitus (11). Out of 23 edible mushrooms studies, 13 varieties were found to have anti-diabetic properties, including Ganoderma lucidium, Hericium erinaceus, and Agricus bisporus. Another study showed that Agaricus brasiliensis and Ganoderma lucidum can potentially treat and prevent diabetes mellitus (12).  Yet another study showed that Ganoderma lucidum can provide beneficial effects in treating type 2 diabetes by lowering the serum glucose levels (13).

• Hepatoprotective benefits.  We all know how important the liver is, as it plays an important role in drug elimination and detoxification.  There are a lot of things that can cause liver damage, including infections, and many medications, including antithyroid medication (i.e. methimazole and PTU), which is commonly prescribed to those with hyperthyroidism.  A few different studies show that Ganoderma lucidium has hepatoprotective effects (14) (15).  Another study showed that the mushroom Agaricus blazei normalized liver function in patients with chronic hepatitis B (16).

• Neurological benefits.  Evidence shows that culinary-medicinal mushrooms may play an important role in the prevention of many age-associated neurological diseases, including Alzheimer’s and Parkinson’s diseases (17) (18).  The action mechanisms include reducing oxidative stress, neuroinflammation, and modulation of acetylcholinesterase activity, protecting neurons or stimulation, and regulating neurotrophins synthesis (18).  Ganoderma lucidum, Grifola frondosa and Sarcodon scabrosus have been reported to have neurite outgrowth and neuronal health benefits (19).

• Respiratory benefits.  One study looked to see if medicinal mushrooms can have a prophylactic or therapeutic effect against the pneumonic superinfection and severe lung inflammation that often complicates COVID-19 infection (20).  This involved the mushrooms Basidiomycota Agaricus blazei Murill, Hericium erinaceus, and Grifola frondosa.  Another study showed that β-glucan polysaccharides isolated from different species of mushrooms (including Lentinus edodes and Hypsizygus tessellatus) can help with inflammatory lung conditions (21)

5 Medicinal Mushrooms That Can Benefit Thyroid Autoimmunity

Now that you know some of the health benefits that medicinal mushrooms have to offer, let’s go ahead and take a look at some of the individual medicinal mushrooms.

Reishi (Ganoderma lucidum).  You might have noticed that Reishi was mentioned a lot above, as it is probably the most widely studied medicinal mushroom.  It has been widely used for the prevention and treatment of various health conditions, including gastric cancer (22), hypertension (23), arthritis (24), hepatoxicity (25), diabetes (26), asthma (27), nephrosis (28), and immunological disorders (29).

So how can Reishi benefit people with Graves’ disease and Hashimoto’s?  Well, autoimmunity is characterized by an imbalance of regulatory T cells (Tregs) and Th17 cells. In order to suppress autoimmunity you want to have an abundance of Tregs and a lower amount of Th17 cells.  And numerous studies show that Reishi can help with this Th17/Treg balance (30) (31).

Cordyceps Sinensis.  Although there are multiple species of Cordyceps, C. sinensis is the most documented one.  Research has shown that its properties include antiaging, reparative, anti-cancer, anti-inflammatory, and as an antioxidant (32).  One study showed that C. sinensis has a protective effect on rats with gastric damage (33), while another study showed that it can also benefit the kidneys by reducing proteinuria, improving renal function, and inhibiting glomerular sclerosis (34).

As for it’s effects on the immune system, one study showed that C. sinensis reduced IL-17 (35).  Earlier I mentioned how Th17 cells play a role in autoimmunity, and they secrete IL-17 cells.  So essentially C. sinensis reduces IL-17 by decreasing Th17 cells.  Another study showed that it can increase the antioxidant Superoxide dismutase (SOD) (35).

I came across a very interesting journal article that looked at the effects of C. sinensis on autoimmune thyroid disease (36).  This included 44 patients with Graves’ disease and 56 patients with Hashimoto’s Thyroiditis.  The study showed that at the end of treatment TPO antibodies and TSH receptor antibodies decreased by 40.06% and 46.94% of baseline in the Graves’ disease patients.  TPO antibodies and anti-thyroglobulin antibodies decreased by 51.30% and 39.49% of baseline in the Hashimoto’s patients.

Lion’s Mane (Hericium erinaceus).  Hericium erinaceus is a medicinal-culinary mushroom widely found in East Asian countries, and it is well known for supporting nerve and brain health (37) (38).  Not only can it improve cognitive function and possibly prevent dementia (39), but it also might be an option for the treatment of depression (40).  In addition, it can treat certain neurological conditions, as it contains neurotrophic compounds that can pass through the blood-brain barrier (41) (42).  It has also been used as a treatment for Alzheimer’s disease (43) and ischemic stroke (44).

This wouldn’t be my first choice of mushroom to help with autoimmunity, as I definitely would prioritize Reishi and Cordyceps.  That being said, it does have some immunomodulatory properties.  One study showed that Hericium erinaceus improves immune function by enhancing cell-mediated and humoral immunity, macrophage phagocytosis, and natural killer cell activity (45).  In addition, this mushroom was found to upgregulate the secretion of secretory IgA.  Another study showed that extracts from Hericium erinaceus can relieve inflammatory bowel disease by regulating the immune system and the gut microbiota (46).  One way it accomplished this was by increasing regulatory T cells (Tregs), which as mentioned earlier, can help to keep autoimmunity in check.

Maitake (Grifola frondosa).  This is an edible mushroom with both nutritional and medicinal properties, and is also known as “hen-of-the-woods”.  While it is increasingly found in many nutritional supplements, it’s also considered to be a healthy food, as it is a good source of protein, fiber, and minerals (47).  The different polysaccharides from G. frondosa possess various bioactive effects including immunomodulation (48), antitumor (49), antivirus (50), antidiabetic (51) and anti-inflammation (52).

From an immune system standpoint, I just mentioned that some of the polysaccharides from this mushroom have shown significant antitumor, immunomodulatory, and anti-inflammatory activities.  But when it comes to autoimmune conditions such as Graves’ disease and Hashimoto’s, having a healthy gut is important.  And the reason for this is because most of the immune cells are located in the gut.  And G. frondosa (along with some other medicinal mushrooms) has been shown to regulate the gut microbiota (53).

Chaga (Inonotus obliquus).  This mushroom is widely used by people in China, Russia, and Korea, and like the other mushrooms discussed so far, it has numerous health benefits.  Perhaps the main bioactive compound is Inonotus obliquus polysaccharide (IOPS), which possesses antitumor, antioxidant, anti-virus, hypoglycemic, and hypolipidemic activities (54). Of these, it seems like many of the studies focus on how chaga can help with the treatment of cancer and type 2 diabetes.

I didn’t come across any studies which showed that Chaga can specifically help with Graves’ disease or Hashimoto’s.  However, it does have immunomodulatory effects, and a couple of studies show that it can regulate the Treg/Th17 balance (55) (56).  One of these studies also showed that oral administration of IOP in mise can help with the tight junction proteins occludin and zonulin, which are associated with a leaky gut (56).

Are Mushrooms Safe For Autoimmunity?

There has been controversy over whether mushrooms are safe to consume in those with autoimmune conditions such as Graves’ disease and Hashimoto’s.  This is especially true with mushroom extracts found in supplements.  The concern is that some label them as being “immunostimulatory”, and thus might exacerbate the autoimmune response.

However, the research I presented in this post suggests that they don’t necessarily “stimulate” the immune system, but instead “modulate” the immune system and in many cases help with the Treg/Th17 balance, which explains why they can be beneficial in helping people with autoimmunity.  So based on my research I not only think it’s fine for people with autoimmune conditions to eat mushrooms and consume certain mushroom extracts, but in many cases it can actually be beneficial in modulating the immune system.  That being said, if you eat a certain food or take a specific supplement and don’t feel right, then listen to your body and stop consuming it.

Can Mushrooms Directly Impact Thyroid Health?

I wasn’t able to find any research showing that any of these medicinal mushrooms have any direct effects on thyroid health.  This doesn’t mean that you can’t benefit from these if you have a non-autoimmune thyroid condition, as they can improve one’s immune system health in different ways.  Plus I mentioned how they have other health effects that can benefit those without a thyroid or autoimmune thyroid condition.

Are There Any Risks With Taking Medicinal Mushrooms?

With any supplement there is a concern over safety, especially with long term use.  But overall medicinal mushrooms seem safe to consume…especially the ones discussed in this post.  One study showed that Reishi is well tolerated and could be safely used continuously for long periods of time (57). And anecdotal use of Cordyceps in the treatment of cancer patients has produced promising results at 3–5 g of Cordyceps daily with zero reports of Cordyceps related toxicity (58).

Another study looked to evaluate the safety of erinacine A-enriched Hericium erinaceus in rodents over a 13-week period using different dosages, and revealed no mortalities nor noticeable toxicological effects in all the rats (59).  Another study looked at the cytotoxicity of IOPS, and the results also showed that 20–160 μg/mL of IOPS administration was safe and would not produce drug toxicity (60).

In summary, medicinal mushrooms in both food and extract form can potentially be a good option for immune support for those with Graves’ disease and Hashimoto’s.  This is especially true with Cordyceps Sinensis, as I mentioned the study which showed how this can potentially benefit people with Graves’ disease and Hashimoto’s.  But I also discussed how other mushrooms can help with the Treg/Th17 balance, which is a key factor in addressing any autoimmune condition.

Have you taken medicinal mushrooms? If so I’d love to hear about your experience in the comments section below.

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Recently I interviewed Dr. Carol Lourie, as she discussed an integrative approach to breast cancer. If you would prefer to listen the interview you can access it by Clicking Here.

Dr. Eric Osansky: With me, I have Dr. Carol Lourie, who is a dedicated practitioner with over three decades of clinical experience as a naturopath, acupuncturist, and homeopath. She has helped thousands of women recover their health and restore their life through her holistic protocols involving focused nutrition, targeted supplementation, lifestyle changes, and a centered mindset. According to Dr Carol, the key to wellness is to understand that treating the symptoms of a disease is not going to help you recover your health. You need to get to the bottom of the cause to begin your health journey. I definitely agree with that, and I’d like to thank you for joining us.

Dr. Carol Lourie: I’m really honored and excited to be here. Thank you for having me.

Dr. Eric: Why don’t we start out with your background, Dr. Carol? How did you start helping people with breast cancer?

Dr. Carol: I didn’t start out by focusing on breast cancer. I started out by wanting to go to medical school many years ago. Then I was living in a spiritual community in New York, and my roommate had cancer. I went with her to Memorial Sloan-Kettering where the doctors told her, “There’s nothing more we can do. You’ve had a ton of radiation. You can go home and probably die in a few years.” She was in her 20s, and she looked at me and said, “No, I don’t think so.”

She investigated and discovered this doctor in Long Island who was doing detoxifying diets using iridology. You need to understand this was in the mid-70s when the word “detox” was not a household name. I started working in his home office. I saw people come to him, all different types of people with all different types of medical conditions. I was extremely naïve in the power and beauty of natural healing.

A young woman came in with acne, and I thought to myself, “She has acne. What’s the big deal? Why is she here? You go on antibiotics.” Then she came back a month later. Her skin was clearer, she had lost weight, and her whole energy was different. I saw that with a lot of the people who came to see him. That was my introduction to another way in working with illness and disease.

One day, I was going through this very large pile of paperwork. Out popped the catalog to the National College of Naturopathic Medicine. I thought, “Hmm, maybe I should go here instead of regular medical school.” That was the beginning of my journey of becoming a naturopath, acupuncturist, and homeopath. I have been on that path ever since, and that was a long time ago.

The beauty of natural medicine is it is science-based, and it takes the best of both worlds. It’s not one or the other. You don’t want to pit natural medicine against regular medicine. It’s a bad idea to make it “us versus them.” You want to use the best of both worlds no matter what your illness or disease is.

Dr. Eric: When discussing an integrative approach to cancer, what is your definition of that?

Dr. Carol: That’s a good question. Ideally, it’s everyone’s definition. You want to take the best of both worlds. Integrative or complementary is using what regular medical oncology has to offer and adding in the other side of treatment, which is to reduce the side effects, prepare for chemotherapy, protect your healthy cells. When you are done with active treatment, to recover from radiation/chemotherapy, restore your health in your gut, reduce the oxidative stress caused by radiation. The third phase is to reduce the risk of recurrence.

Dr. Eric: Do you know what the rate of recurrence is?

Dr. Carol: It can still happen even 20 years after you have been initially diagnosed. The risk is greatest in the first 2-5 years. There can be up to 15% recurrence rate. You don’t want to be in that statistic. There is a lot you can do to make sure that is not you.

Dr. Eric: There are people who are listening to this, and it’s easy to put yourself in this situation when you’re not in this situation, meaning some people might be thinking, “If I had breast cancer, I wouldn’t want to get chemo or radiation.” An integrative approach is you are thinking about people might go through those procedures, but you want to address underlying imbalances and prevent a recurrence. Do you have any thoughts on those who want to completely go natural and don’t want to receive any chemo or radiation?

Dr. Carol: A lot of that decision needs to be based on the parameters of the tumor and what comes back from the pathology report. Sitting down with both your oncologist and an experienced integrative doctor, making that decision from the standpoint of what is going to ensure my longevity for the long term? I want to note that men also get breast cancer, but that is not the community I work with, so I am going to use the word “women” because that is who I work with. There are women who adamantly refuse to do medical oncology work. That is their choice, of course. There are clinics I know of in Europe which use non-medical methods to address the tumor and cancer. I can refer someone there. My area of expertise is the woman is under the care of an oncologist, and I am offering supportive supplements and clinical advice regarding reducing side effects through nutrition and homeopathy. I am not the primary doctor treating this illness.

Dr. Eric: Can you talk about the diet? Is there a specific diet you recommend for breast cancer?

Dr. Carol: There is a lot of varying options out there. I have women come into my practice who are keto; vegan; doing the Budwig protocol, which is cottage cheese and a certain type of oil, which I think is absurd; vegetarian; the standard American diet. They are overwhelmed and don’t know what to do.

There is a lot of research on the ketogenic diet. If there is a case of brain cancer or epilepsy, keto has been beneficial for brain disease. There are people who feel that even with breast cancer, you should be on the ketogenic diet. I have more of a modified Mediterranean approach. It’s gluten-free, very low carbohydrate, and almost all sugar-free. It verges between ketogenic and modified Mediterranean. We need to reduce the amount of sugar available to the cancer cells.

In 1918, there was this German scientist named Otto Warburg who won the Nobel Medical Peace Prize. His discovery was that cancer, given a choice between glucose and oxygen for what I call the cancer gas tank, chooses glucose, even though it has to work much harder and go through a much more difficult pathway to get there.

The ketogenic diet is very low sugar, and that’s what happens when you don’t eat carbs. People have to live, and they have families. It can be very difficult to live in a family unit if you are eating only keto. You don’t want to have to cook one way for yourself and another way for your family. The modified Mediterranean takes the best of both worlds. The research which has gone into the modified Mediterranean diet over 25 years with thousands of women has shown that eating this way has resulted in a reduced risk of breast cancer.

Dr. Eric: From what I understand, if someone absolutely wanted to follow a strict ketogenic diet, there is no problem with that. It is just restrictive. It might be difficult if you live with other family members since you might have to prepare multiple meals. The modified Mediterranean diet is not easy to follow, but it’s not as difficult as keto. It sounds like it’s effective, or else you wouldn’t be recommending it.

Dr. Carol: I think it is easy to follow. First of all, this brings in an important concept for the way I work and how I want to encourage women to view what they are doing with their life. It is easy because you are choosing to do it.

The way the standard American diet proposes that you eat does not support health. There is a lot of research which shows that the standard American diet quadruples the cancer rate. That is a really clear indication how you were potentially eating and how you should, want to, or choose to eat, now that you have a cancer diagnosis, there needs to be a change.

Modified Mediterranean is filled with luscious food. There is a lot of healthy fats in it. It is easy to prepare. It is wonderful for not just you but the entire family. You can go out to eat and order appropriate food. You can go to someone’s house and hopefully enjoy what they are having. It encourages health all around. I think it is easy. But it is definitely not cereal from a box with milk for breakfast, which nobody should be eating no matter what.

Dr. Eric: Definitely. That is how I ate growing up.

Dr. Carol: We all ate that way growing up.

Dr. Eric: How about stress and emotional trauma? Can you discuss the connection between those and breast cancer?

Dr. Carol: It’s almost impossible to be an older person and not have had something upsetting or traumatic happen in your life outside of being diagnosed with cancer. Many times, when I first start working with a woman, I ask them, “Have you had any trauma or upsetting experiences in your life?” She will say, “There was this incident that happened 25-30 years ago, but it couldn’t be that.” The reality of it is it absolutely can be.

We have a protective mechanism in our body. When something upsetting or traumatic happens, we take a breath in, and the energy of that event goes into our cells. It hangs out there. We process it at the level we are able to handle emotionally at the time. The rest of it is stored in our psyche and our cells. Over periods of years, with added stress and busyness and elevated cortisol and the chaos of life, all of a sudden, the overload of all of that emotional work and restraining can pop up. You can have a lot of unexplained depression and anxiety and the creation of illness. It doesn’t just have to be breast cancer. It can be an autoimmune problem, insomnia, gut problems, or some other form of cancer. Incorporating and acknowledging the trauma of the past into the healing you choose and want to do in the present is very important and helpful.

Dr. Eric: Do you recommend any techniques—mind/body medicine techniques, working with a counselor, etc.—or does it depend on the person?

Dr. Carol: I am a big proponent of therapy. I think therapy is really wonderful. There are different forms of therapy. I think it’s important to interview the therapist. I think women should be working with women therapists. You need to interview the person you are choosing to see to make sure you feel comfortable and safe with them, and the type of therapy they do is a match for what you’re looking for.

You go into therapy not just one time. Ideally, you go in and do a bit of work, settle, and then go back because other stuff comes up. Being in therapy off and on throughout your life is a healthy way of looking at your mental health.

Dr. Eric: How about the impact of environmental toxins, such as xenoestrogens? How have those impacted cancer rates?

Dr. Carol: I will give an example of a 35-year-old woman who came to see me. She walked into the office, and I have a scent-free office. She had on enough perfume that you thought you were on the ground floor of Macy’s. For those of you who can’t relate to that statement, it’s the makeup area, and it smells unbelievable. She walked in, and I said to her, “Tell me about scents.” She said, “I love scents. I have those plugins in the wall. I have those sticks in the oil.” This was the cincher for me. “I spray my sofa with Febreze.”

There are, as you mentioned, xenoestrogens. They are estrogen blockers. These are certain chemicals which look like estrogen. Estrogen in your body needs to be metabolized to be excreted in the healthy form. In order to do that, it needs to go int the parking garage and park, and the nit’s bound to a receptor and excreted. Xenoestrogen or estrogen-looking chemicals take up the parking spot in the garage. When the healthy estrogen goes to park and be excreted, there is no space for it, and it turns into an unhealthy version of itself. That is what is known as estrogen dominance. That can create infertility, PCOS, lots of menstrual irregularities, endometriosis, and breast/vaginal/ovarian cancers. Detoxifying your home is a very important aspect of recovering your health.

I said to this young woman who came to see me with a diagnosis of unexplained fertility, “Could you go home and put every single item that you use to clean your house on the counter and take a picture?” There were 29 items on that countertop. I said to her, “You don’t have unexplained fertility. We have an explanation. There are too many chemicals.” We had to throw out her sofa because she couldn’t detoxify it. She spent a week cleaning everything, getting eco laundry detergent, and throwing out all of her shampoos and soaps. Within three months, she was pregnant.

I should explain that when you wash your clothes and maybe use a dryer sheet, when you get in the shower or sleep, your pores are open. You wrap your body in a towel, and the chemicals from the detergent and the dryer sheets are absorbed into your skin. Your skin is a porous organ. All those chemicals you use in your laundry, shampoo, body wash all have chemicals that block healthy estrogen from being excreted. Detoxifying your home is the first step of reclaiming your health.

Dr. Eric: I assume you recommend things to support detoxification rather than just minimizing exposure.

Dr. Carol: Yes. Now we are getting into supplements. I am a big proponent of supplements. I think they are really important. Women say to me, “Can’t I get everything from the food I’m eating?” Even if you are eating 100% organic, if you have breast cancer, you need to support the pathways that block the cancer and increase the pathways that promote health at a level that eating a regular diet, even organic and lots of phytonutrients from vegetables, you need more than what you can get from your food.

Dr. Eric: In addition to supplements, do you recommend other methods of detoxification, such as infrared sauna? Gerson recommends coffee enemas.

Dr. Carol: I’m not a big coffee enema person. I’d rather do Epsom salt enemas. What happens when you use Epsom salts is you take two tablespoons, boil the water, add the Epsom salts, dissolve them in a glass jar, and add them to your enema bag. It’s a little bit of water with Epsom salts with the rest of the bag. What the salts do, and this is from the doctor I studied with originally, is it pulls toxins from your gut and your lymph.

It’s not about being constipated. You don’t want to use an enema to help you eliminate your daily evacuation. You want to use your enema very targeted, not all the time. You need to prepare when you do that. You want to change your diet the day before. Eat very lightly. Do the enema. The day after, eat very lightly before you go back to your regular diet.

Dr. Eric: You are not recommending daily enemas then.

Dr. Carol: Absolutely not. If you have constipation to the point where you are not eliminating daily, we need to do some work as to why you are not able to evacuate on a daily basis. There are a lot of Americans in the U.S. who are constipated. People come in and say, “I go to the bathroom maybe every other day. I’m not sure. Maybe every couple days.” As we get your health better, we need to have one evacuation in the morning and then another smaller one 1-2x a day. That is a healthy elimination of toxins.

Dr. Eric: Getting back to supplements. There are a number that could help with detoxification. There is milk thistle, n-acetyl cysteine, alpha lipoic acid.

Dr. Carol: You mentioned all the ones I was thinking of, yes.

Dr. Eric: Do you also use supplements like DIM to help with estrogen metabolism and calcium D-glucarate?

Dr. Carol: I use calcium D-glucarate, but I don’t use DIM. Well, it depends. If a woman is on tamoxifen or an aromatase inhibitor, I think DIM is contraindicated, or you don’t need it. We have to stack the supplements because they are on a lot. We have to be specific about what we take.

Sometimes people say to me, “Can’t I just take DIM instead of an aromatase inhibitor or tamoxifen?” You can’t really take enough DIM to block the estrogen. If you have estrogen-positive, hormonal-positive breast cancer, you want to block the uptake of that hormone. The problem with tamoxifen is it isn’t without its side effects, just like aromatase inhibitors. Tamoxifen is anti-estrogenic in how it blocks the hormone from your breast. It’s pro-estrogenic with what happens with your uterus. There is a 15% risk of getting uterine cancer.

Before a woman, ideally, is prescribed tamoxifen, I encourage her to speak with her oncologist to get what is known as a CYP2D6 enzyme test. That enzyme is the enzyme that breaks down the tamoxifen. If you have a deficiency in that enzyme, you will get an increase in the tamoxifen byproduct, which can contribute to lots of oxidative stress and an increased risk in uterine cancer. You need to be prepared to speak to your oncologist about this. There are certain supplements and methods we use to reduce the toxicity and side effects of tamoxifen and aromatase inhibitors.

Dr. Eric: I wasn’t going to get into the genetics, but since you brought it up, would you recommend other genetic testing? Like for the COMT enzyme or MTHFR.

Dr. Carol: Those are fine to know about. If you’re MTHFR-deficient, we want to make sure you are getting the right form of folate. If you’re COMT-deficient, we know that your pathways to metabolize are a little deficient, so we have to make sure you are taking enough calcium D-glucarate and berberine, and maybe doing a castor oil pack on your liver once or twice a week. Those are not the major driving factors of what has contributed to your breast cancer.

There is no one thing, I should say, that makes or creates breast cancer. It takes awhile for this tumor to develop. When you’re initially diagnosed, most of the time, it’s not a surgical emergency. You can take a week or two to get a second opinion.

If you have children at home that need to be taken care of, develop a care tree. The kids are being dropped off at school and being taken to their extracurriculars. You need to involve friends and family to take care of your children and bring food. Women multitask so often that when a woman of the household is not feeling well, a lot of things are too much for her spouse to take on. It does take a village ideally to get through breast cancer.

Dr. Eric: How about testing? Do you recommend testing the hormones through the blood or dried urine testing?

Dr. Carol: If a woman wants to check her hormones through a Dutch hormonal panel before she either starts treatment or after treatment is over for a while before she goes on tamoxifen or an aromatase inhibitor, I think that’s a valid thing, especially if it’s a young woman.

There are women getting breast cancer earlier, at the age of 32. I have several young women. If you get breast cancer at that age, and there isn’t a family history of either breast cancer or colon cancer, we want to understand what is happening with your estrogen and hormone metabolism. The Dutch hormonal panel tells us how your hormones are being broken down, and at what level there is a problem, so we can target that in addition to whatever medical treatment you are doing.

For older women who are on tamoxifen or an aromatase inhibitor, that test is not valid. It’s not going to give us any valid information. There are other tests we can do.

Dr. Eric: If someone is taking tamoxifen, they wouldn’t want to do the Dutch test for looking at estrogen metabolites.

Dr. Carol: No, it’s being disrupted by the drug. Aromatase inhibitors block aromatase enzyme. The aromatase enzyme is the enzyme that is responsible for taking the androgen, which is then broken down into estrogen and progesterone. That is blocking the conversion from the androgen. It is not a valid test if you are either on one of those types of drugs.

Dr. Eric: Is there anything people shouldn’t do with regards to supplements or foods they shouldn’t take or eat? There is some controversy with phytoestrogens like soy or flax. If you don’t mind, can you talk about the phytoestrogens?

Dr. Carol: In answer to the question of to soy or not to soy, because I wrote an article about that, where we need to start is looking at the Japanese culture before it became Westernized, i.e. fast food and American-style processed food. When it was pure Japanese culture, they had almost no breast cancer. That right there is research for the answer of soy or not to soy. Their soy was non-GMO. If you’re getting organic, non-GMO soy, and it hasn’t been fried in a toxic saturated fat oil and turned into a soy snack, soy and gluten-free tamari are fine.

Are we eating eight ounces of tofu seven days a week? That’s a problem. How can someone really do that? If you are eating four ounces of steamed tofu, like I made a kale and tofu dish last night for dinner, and I had two thirds of a block of organic tofu in it, and I will have some for lunch today, there is nothing the matter with that. That is not going to increase the estrogen in your body.

Neither is soy milk. I am not a big proponent of soy milk. Even though people do their best to make sure the soybeans are non-GMO, it is very difficult to control all of that. If you are drinking eight ounces every day, that’s a lot. At this point, there are so many nut milks you can drink that you don’t need to be drinking soy milk if you want a non-water product to drink.

I don’t think there is a problem with soy. The caveat is it needs to be organic and non-GMO, and you shouldn’t eat it every day of the week.

Dr. Eric: I assume flax is okay, too?

Dr. Carol: There are two different types of flax. There is a lighter seed and a darker seed. You want to buy the darker seed. You want to make sure it’s organic. You want to smell it before you bring it home if it’s in one of those bulk things. Flax as an oil is sensitive to heat. If it smells fine, you want to bring it home, put it in a glass jar, and keep it in the freezer or refrigerator.

What I recommend is you use a mortar and pestle before you put it in your smoothie to break up some of those seeds, or you get yourself a $10 coffee grinder you just use for the flax and pulse it two or three times. You don’t need to make apowder of it. You want to break up some of those seeds. If you don’t want to do any of that, fine. People put it into their smoothie whole and drink it every day. You get more of the lignans available.

What are we doing, eating a pound? We are eating a tablespoon or two in our smoothie. Sometimes this verbiage gets out there, and people go, “I can’t eat flax.” Flax is a healthy oil. It’s a powerful antioxidant. It has positive anti-inflammatory lignans in it. I think flax is a wonderful thing to eat every day.

Dr. Eric: What I do is buy organic whole flax seeds and do what you mentioned. I put a tablespoon in a coffee grinder and add them to my smoothie.

Dr. Carol: It’s an easy way to get a lot of positive lignans. I should say that Dr. Eric’s area of expertise is the thyroid. Often, the stress of going through cancer can bring out a latent thyroid problem. There is fatigue that is associated post-chemotherapy/radiation/surgery. With the addition of hormone-blocking drugs, there is a lot of fatigue that shows up. One thing we need to look at is have you developed a thyroid problem?

If you are having unexplained fatigue, when you go to the doctor, too often they will say, and this is an upsetting phrase for me, “Let’s just put you on some antidepressants for a while and see if that helps.” I am not opposed to antidepressants, but I don’t think it should be the first line of therapy.

If you’re having unexplained fatigue, first of all, it’s not unexplained. You have been through an arduous 18 months or longer of treatment. It can bring up a thyroid problem. There is a lot of emotional trauma that women tend to put on the backburner when they are getting through treatment. When you finish, it comes rushing up, and you are emotionally overwhelmed.

Before you go on antidepressants, which might be your choice, let’s see if it’s a thyroid problem. Let’s see if detoxifying works. Let’s see if working with an integrative person for a month or six weeks works, if you have that time frame. If you are severely depressed and can’t get out of bed, that’s more like an urgent care moment. But if it is low-level depression, let’s do a differential diagnosis and see if it’s your thyroid. Do you need to detox? Do you need to do some therapy to appreciate and understand all the trauma you have been through because it is very disruptive of your life? It does create a ripple effect not just for you, but for your spouse and household.

The other component of this is when you are done with active treatment, your workplace and your family think, “She’s done now. She is going to be back to her normal self.” That is not necessarily the case. You may not be feeling well. You may have fatigue. You may have emotional trauma. You may have developed anxiety. All of these are real and appropriate. You are not back to yourself.

You may have had body changes. If you had surgery, you had one or two breasts removed. That is a big deal, even with reconstruction. It is not such an easy moment. Fatigue and depression are very common and normal. That is part of the emotional recovery work we need to do and help you with when you have been through cancer of any kind, especially breast cancer.

Dr. Eric: It sounds like it’s common for women who go through this to have fatigue and depression, which is not a surprise. You will recommend for them to do a full thyroid panel?

Dr. Carol: Absolutely. I love testing. I’m a big testing person. Testing provides us information about what’s going on in your body metabolically. Cancer is a metabolic disease. The more information we have, the easier it is to address that with nutrition, supplements, and lifestyle.

Just doing TSH is inept. We need to know if you are having inflammatory antibodies show up in your thyroid. Are you developing hypothyroidism/Hashimoto’s? Very rarely does a doctor do a complete thyroid panel the first time. If a woman knows to say to a doctor, “I want more than TSH. I want this, this, and this,” then they can hopefully have a doctor who works with them to get those additional tests done.

Dr. Eric: Agreed. Unfortunately, a lot of medical doctors will still only look at the TSH. Endocrinologists might go a step further and do a T4. Maybe free T4 and free T3. The antibodies, it depends. I deal with a lot of hyperthyroid patients. Usually, they will test for antibodies. With Hashimoto’s, the treatment is pretty much the same. If they don’t have antibodies, they will be given thyroid hormone replacement. Either way, I agree. Regardless of the symptoms, more hyper or hypo, do a full thyroid panel with antibodies.

The reason I wanted to interview you is because I have had some patients with breast cancer. Interestingly, I have had more patients with Graves’ who have breast cancer than Hashimoto’s patients. It could also be because I see more patients with hyperthyroidism/Graves’ than Hashimoto’s because that’s what I dealt with. Maybe there is a higher prevalence in Hashimoto’s, I’m not sure. Either way, there is that risk. I don’t even know if there is an association. I think the research is unclear.

Dr. Carol: Between thyroid disease and breast cancer?

Dr. Eric: Yes.

Dr. Carol: I don’t know of any. I’m not saying there is or isn’t. I haven’t researched that component of that illness and breast cancer. In my clinical practice, it’s not uncommon for a woman to develop a thyroid disorder after the physiological and emotional stress of treatment. I don’t think of hypothyroidism contributing to breast cancer.

Dr. Eric: From what I have seen, I don’t think so either. It’s a little bit iffy with hyperthyroidism. There are some studies, but it seems to be unclear as far as there being a connection. We will see what future research shows.

If someone was recently diagnosed with breast cancer, what are some action steps that she could take for those looking to take an integrative approach?

Dr. Carol: Understand the oncologist at the medical center has a certain area of expertise. Integrative care is not their skillset. They follow a protocol that has been researched: With this type of cancer, you get a mammogram, then an MRI and an ultrasound, and then a biopsy. That generates a pathology report. From there, it’s decided if you need neoadjuvant chemotherapy, which means the tumor is a certain size, it’s hormonal-positive, and they feel if they give you chemotherapy beforehand, the tumor will shrink. Hopefully you will be able to have a lumpectomy and not a mastectomy. There is a lot of decisions to make in that initial chapter.

Bringing in an integrative practitioner right away to help you, first of all, make sure you are getting the right tests. For example, if you have DCIS, the next moment, the oncologist should order an oncotype breast cancer recurrent index test. What that does is it gives you a number, which will tell you your risk score if you do chemotherapy and/or radiation. Doing that will reduce your risk of recurrence by XYZ%. That is important information. You want to know that.

Unfortunately, sometimes women have DCIS. I will ask them if they have an oncotype, and they go, “No, the doctor didn’t order it.” If you know that, you can say to the doctor, “My understanding is this is a really valid test that should happen with my type of breast cancer. I am wondering if you can order it.” It should be ordered.

There is other more advanced diagnostic genomics SNPs testing. According to the methods the oncologist use, they may not be used at the first stage level. For example, there is the Caris Molecular Intelligence test. There is the NeoGenomics test. Those go further into the genomic SNPs that created your breast cancer. They will give you chemo sensitivity. What types of chemodoes your tumor respond to? It will also say these are the clinical trials you might be eligible for.

The way medical oncology works is that test is not usually run as part of first line treatment. If you have the funds, you can talk to the doctor about it, and you will have to pay out of pocket because first line treatment will not cover those tests. If you fail chemotherapy, then your insurance can be billed, and it should be covered because it is part of second line treatment. There is a lot of information you need to know about that that is not normally discussed with your medical oncologist.

Dr. Eric: Is there anything I didn’t ask that I should have asked? Anything else you’d like to discuss?

Dr. Carol:I want to discuss reducing risk of recurrence because so often, women finish active treatment, ring the bell, and all of a sudden, the oncologist disappears, you are told to take a pill, and that’s it. That really isn’t it. Cancer is a metabolic disease. That gives you a lot of empowerment to reduce the risk of recurrence because you have the ability to make your body less hospitable to cancer recurrence. It doesn’t have to be random.

That is how I developed my Empowered Against Recurrence program, which is an online, live, group coaching program with me. You also get the other part of my program, which is science-based, educational, and you have 24/7 access to it. I am bringing this information to the world beyond the ability of who I can see in my clinical practice.

Dr. Eric: Where can they find out more about this program? I assume your website.

Dr. Carol: I have a website for this called EmpoweredAgainstRecurrence.com. You can go to my practice website, which is my name, CarolLourie.com. Use the Contact Me page at the top. Send me an email. I will send you the information I think is appropriate. I answer all my emails personally.

Dr. Eric: Thank you so much, Dr. Carol. I appreciate you sharing with everybody your experience and thoughts on an integrative approach to breast cancer. Anything else as far as resources? Or is everything on your website?

Dr. Carol: I have a lot of free downloads on my website, CarolLourie.com.

Dr. Eric: Wonderful. Thanks, again. I learned a lot today.

Dr. Carol: My honor and pleasure. Thank you for having me.

Recently I interviewed Kate Vasquez, author of the book “Estrogen is a B*tch”, as she discussed estrogen in detail, including the consequences of estrogen dominance, and of course tied it into thyroid health. If you would prefer to listen the interview you can access it by Clicking Here.

Dr. Eric Osansky:

Today, we are going to be discussing estrogen imbalances, including estrogen dominance, with Kate Vazquez. Let’s dive into Kate’s bio. Kate is a functional medicine physician assistant, founder of Radiant Health, and an award-winning, bestselling author of Estrogen is a Bitch. I hate saying that, but that is the name of the book. Kate helps successful, driven women get rid of PMS and fatigue by balancing their estrogen naturally so that they never notice their period again and can perform their best every day and become the confident leader, wife, and mother they aspire to be. Thanks for joining us, Kate.

Kate Vazquez:               

Thanks for having me. When I thought of the title of the book, I was hesitant to use it, too. I don’t know how everybody is going to take it. I explain in the book that we use words like that to create an emotion. The impacts estrogen has on our body, it causes a lot of crazy things to happen. I would never use this term toward someone else. I am just calling estrogen this word, but also helping women to understand what can happen in the body when it’s imbalanced. What can we do to help it come in balance, to help support our hormones? We do need estrogen, and we can make it our best friend. I completely understand and talk about it in the book as well.

Dr. Eric:

As we discussed before starting this interview, I am listening to the audiobook. I have gotten through most of it and am enjoying it. Why don’t you start out by giving a little bit of your backstory? What led you to write this book?

Kate:

My story has led me up to this point and writing the book. When I became a PA back in 2012, I started off in cardiology. I loved the heart and learning about it. After a few months, I realized it was very specialized, and I was forgetting everything. Plus my goal was to help people feel better.

I got into urgent care. I did ER for a short period of time, but I realized it wasn’t for me. It was way too crazy. I worked in urgent care for a long time. At first, I loved seeing people, making them feel better in the moment. If they had a cut, stitching them up. If they had a broken bone, putting a cast on it. I sent them off on their way.

After a period of time, I noticed a common pattern. The same people would come in sick all the time. “Why am I getting sick all the time? Why are these medications not helping me?” I didn’t have the answers for them. I felt frustrated because I wished I could help them, but I didn’t know how. We get into medicine to help people.

Looking back, I was always very active and focused on eating good, healthy food. I always believed adding in nutrition and fitness and lifestyle factors should be part of medicine, but unfortunately it’s not. You and I know. We weren’t taught these things. We dove into nutrition briefly. When we are practicing, we don’t have time to dive into these things. But these things are so important. They are the foundations of our health.

I don’t remember how I came across Dr. Mark Hyman. One day, I was listening to him talk about functional medicine, how it is the medicine of why. Looking at all the different systems and how they are all integrated. This is what I want to do. I was so excited to hear that and realized for the first time, I can practice medicine the way I felt like it should be practiced. I dove in and got my certification through the Institute of Functional Medicine and started my practice.

It was crazy because at the time, I had my own health issues as well. It started when I was a child. In elementary school, I started having headaches all the time. Doctors would tell me, “She just needs to eat more snacks.” When I got older, I was told it was stress. I was the only one in my immediate family who had migraines, and no one could pinpoint why.

When I went through puberty, I got acne. I figured it was genetics because my dad had it. I was put on birth control pills, which did clear my skin. A sign of hormonal imbalance. Then I had a lot of anxiety in middle school and high school. It continued on into my adult life. In college, I had a lot of GI issues, constipation and bloating. It was like a domino effect. One thing after the other was happening. In Western medicine, we look at it as separate things, but it was all the imbalances in my body.

When I learned about functional medicine, I learned how to heal my body. I focused on healing my gut, bringing in nutrients I was deficient in. I was so stressed out. I am a Type A personality, a recovering perfectionist. I created a lot of stress in my body. I had to learn how to adapt to stress. Unfortunately, you go to the doctor, and they just want to give you pills. Nobody taught me how to calm my body down, how to get my body back to the parasympathetic state. Of course, when I did testing, my cortisol was through the roof. It’s crazy to look back at all of the things that were happening and how each thing led to the next. The beauty of functional medicine is how to heal my body.

But I was still taking birth control pills. My husband and I weren’t ready to have kids, and he was worried that we would get pregnant as soon as I came off. He took some time, but he finally agreed to let me come off the pills about three years ago.

When I did, after all the work I had done, I was surprised at what happened. My hormones went crazy. I was shocked. I read Beyond the Pill and healed my gut. What is happening in my body? For the first time, I tested my hormones and looked into what was happening. I had low levels of progesterone because my hormones were suppressed for so long. I also needed to support the metabolism of estrogen in my liver. We are supposed to produce estrogen, use it, and break it down and get rid of it. A lot of us produce estrogen, use it, and recycle it, and keep using it over and over again. It tends to build up in our bodies. That is what was happening with me.

I had estrogen dominance, where estrogen became the dominating hormone. When I came off the birth control, for the first time in my life, I had irregular cycles of 35-36 days whereas I had always had regular cycles every month. I also had debilitating menstrual cramps. I also developed breast tenderness and gained some weight. Even though I have always been lean and active, I started gaining weight in my butt, hips, and thighs, which is a classic sign of estrogen dominance.

Once I learned what was happening in my hormones, I worked on balancing them naturally. After 3-4 months, I was successful. I had regular cycles. The PMS went away. I was able to get back to my regular weight. It was so crazy what happened.

I’m sure there are a lot of women out there who think they are doing the right things, eating the right foods, exercising, which I was, too. I had eliminated so many processed foods and sugars, dairy, gluten, all the things that were impacting my gut health. Even though I was eating the right foods and exercising, my hormones still went crazy. That led me to believe there was something more that was missing.

I want women to know if you are in that place, there is hope. There are answers. You just have to find the right person to help you discover what those answers are, why those things are happening in the body.

That was my experience with estrogen dominance. Once I figured that out, I started noticing the same patterns in my clients I was seeing. I recognized this was way more common than I realized. Probably 80-90% of my clients had this. Being able to help support their hormones naturally, it was a game changer for them.

At that point, I discovered I needed to write a book about it. I was thinking about all the effects of estrogen dominance. When estrogen is the dominating hormone, what happens to our body? We are miserable. We are suffering. Estrogen is a bitch. That phrase popped into my mind, which surprised me. I don’t like to use that term, but it’s so true. I’m sure a lot of women can relate to this. From that moment on, I knew I needed to write a book about it to educate women. Estrogen dominance is a medical term used in functional medicine, but most women don’t know what that is. I made it my mission to write this book and educate women.

Dr. Eric:

Thank you for sharing that. It’s important to remind people that even though estrogen can be a bitch, it is very important. You alluded to that while discussing detoxification. Some people have problems detoxifying estrogen. That’s one way people develop estrogen dominance. You will talk about the different types of estrogen dominance.

If you could start out by talking about the different types of estrogen. I’m sure there are some familiar, but I’m sure some are unfamiliar, too.

Kate:

Absolutely. It’s so funny because looking back, in school, I learned we had progesterone and estrogen. When I went into PA school, I realized we had different types of estrogen. There are four types. Our body produces three types. The fourth type doesn’t become present until women are pregnant. That is coming from the baby.

The three main hormones that our body produces are estradiol, estrone, and estriol. Estradiol is known as estrogen 2 or E2. This is our good estrogen. Estradiol comes from estrone, which is E1. The problem is that too much estrone in the body can become the bad or what I call the rebel estrogen. It can cause a lot of problems if we’re not careful. This is why it’s important to assess and look at the metabolization of estrogen in our liver.

The estrone is what produces three different metabolites. One of those is really good to have around because it protects our DNA, lowers our risk of the development of estrogen-related cancers like breast cancer.

The other two metabolites are the troublemakers. If those are high, one of them increases the proliferation, meaning it causes excess exponential growth of cancer cells if they are present. The other metabolite can also damage DNA. When you have these two ganging up, causing increased growth and damaging DNA, that is the perfect storm for cancer to develop. When the third one is high, it will protect our DNA and prevent that cancer from happening. That’s why it’s important to understand it’s not just one type of estrogen. We have multiple. One of them is really good, but the other can be bad if there is a lot of it. If we don’t have enough of the good to protect.

The third one, estriol, we usually have that in small amounts, except when women are pregnant. We have a lot of estriol that gets produced. I love estriol. This one is E3. It has anti-inflammatory and antioxidant effects. It helps to lower inflammation and protect our bodies. When women go through menopause and get on hormone replacement therapy, especially if it’s compounded estrogen, they have estradiol and estriol. A lot of women with autoimmune disorders will notice an improvement because they are now getting this estriol to reduce inflammation. It’s an amazing estrogen to have.

A lot of the time, estriol is not detected on bloodwork. I love doing urine tests to look at those estrogen metabolites, and we can see those three types of estrogen.

Dr. Eric:

I also like to do urinary testing on my patients (not everyone though), especially to look at those metabolites. It can also look at adrenals, the Circadian rhythm of cortisol, and the hormone levels in addition to the metabolites. Depending on what company you use, it might look at some other markers.

With regard to the metabolites, that 2-hydroxy estrone is the good one. Then you have the 4-hydroxy, the 16. When doing urinary testing, with the 4-hydroxy estrone, many times it is elevated, which isn’t a good thing. Sometimes, it does look good. Very rarely is it low. With the 16-hydroxy estrone, I see it sometimes elevated, sometimes normal. It’s not uncommon for me to see it low though. Is there any concern if that gets low?

Kate:

No. It’s good. If we see low levels of 16 and 4-hyrdoxy estrone, that is the goal. If we see slightly elevated 16 alpha or high levels, I always like to think, “What’s going on in the gut, thyroid?” Sometimes overweight women produce more of this metabolite. If I see higher levels of that, what do we need to address? It’s good to see low or below the detection limit of those two metabolites, the troublemakers.

Dr. Eric:

The test I use is the Dutch test.

Kate:

Same.

Dr. Eric:

Dried urine testing. They give a range. In a blood test, sometimes it will be less than such and such. There, they give a range with each of the markers. You’re saying that if it’s below the range they give, there is no concern.

Kate:

Yep.

Dr. Eric:

Very cool. Why don’t you talk more about the different types of estrogen dominance?

Kate:

That was another thing I discovered, too. You can look up estrogen dominance online, and people will provide all the recommendations. I realized we can’t necessarily go by that. There are different types of patterns. Everyone with a specific pattern should be treated differently.

The three types of estrogen dominance patterns I have established: The first pattern is normal progesterone levels to higher levels of estrogen. Talking about the Dutch test, for example, when we see those ranges, progesterone looks normal, but estrone or estradiol is really high, then that’s a sign of the first pattern of estrogen dominance.

The second pattern is low progesterone with normal estrogen. Estrogen may be within normal range, but progesterone is really low. Because of that, it will still create an estrogen dominance effect because estrogen is the dominating hormone. We don’t have enough progesterone in the system to balance that out.

The third pattern is low progesterone and high levels of estrogen. That was the most common pattern that I would see. The least common was the normal progesterone and high. I needed to support the metabolism of estrogen in the liver. Those are the three patterns I’ve seen.

Dr. Eric:

When it comes to symptoms, when someone has low estrogen, hot flashes, night sweats are more common. Can you talk about the different symptoms?

Kate:

Low estrogen, yes. When estrogen declines in menopause, a lot of women will get hot flashes, night sweats, trouble sleeping. They will also have vaginal dryness and sometimes increased urinary tract infections. Estrogen keeps our skin plump. When things are dry, it increases your risk of UTIs. Those are the more common symptoms of low estrogen.

With excess or imbalanced estrogen in the body, that is going to cause irregular periods. Normally, a menstrual cycle should be anywhere from 24-32 days. As long as it’s pretty regular every month and doesn’t vary by more than 1-2 days, if it’s 5-10 days off- If a woman has a 30-day cycle, and then it’s a 36-day cycle, and then it’s a 26-day cycle, that is an irregular cycle, and it is not normal.

Another symptom is heavy periods. If women are using tampons and pads and are changing them more than eight times a day and are soaking through all of them, that is a lot of bleeding. That is another sign of estrogen dominance.

The next sign is PMS symptoms. When progesterone is low, or starts to decline, especially as women will start to go through menopause, they will experience some signs of estrogen dominance, too. Not just women who are cycling but as they start to transition.

When progesterone levels are low, that’s when we get mood swings, anxiety, depression. Progesterone helps us with our sleep as well, so that is why we will experience insomnia.

Then menstrual cramps. What happens is right before we have our period, we release these chemicals called prostaglandins. Prostaglandins do increase inflammation and pain in the body, but it also helps the uterus contract. We have what’s called the endometrial lining, which is just inside of the uterus. It’s very vascular. A lot of blood vessels. When the egg implants, it needs all those nutrients to help the baby to grow. When women don’t get pregnant, we need the uterus to contract to get rid of that lining. Otherwise, estrogen will cause it to thicken over time. That’s what happens with some women. That can also contribute to heavy periods. If women have a lot of estrogen to cause thick endometrial lining, those prostaglandins, when they release, estrogen can cause an increase of more prostaglandins, which causes more of those menstrual cramps. It’s painful and debilitating.

Women, if you have those severe, debilitating muscle cramps, where you can’t go out and do the things you need to do because it’s so painful, you’re curled up in a ball, having to take Advil or Aleve to alleviate the pain, that is not normal. That is usually a sign of imbalanced hormones.

The fourth symptom is breast tenderness. Estrogen does cause the breast tissue to swell. It can cause painful, tender breasts. It can contribute to the development of cysts in the breasts. Women who have fibrocystic breast disease, that is usually a sign of excess or imbalanced estrogen.

Another symptom is weight gain, especially in the butt, hips, and thighs. Estrogen is responsible for the development of our curves when we go through puberty. When women gain weight, and they notice that it’s primarily going into their butt, hips, and thighs, that’s a telltale sign of estrogen dominance.

Those are the common symptoms that women will experience. They can also have fatigue, brain fog, acne, low libido, and even infertility.

Dr. Eric:

Estrogen and thyroid health, what everybody has been waiting for. Can you talk about the relationship between the two?

Kate:

When people have thyroid issues, they don’t necessarily look at the hormones. Estrogen does have a role in impacting the thyroid. When certain people have symptoms of hypothyroidism, and it’s showing on the bloodwork that their free T3 or free T4 is on the low side, that is because excess imbalanced estrogen can create more of the protein called thyroid binding globulin (TBG). When this happens, this protein binds up the thyroid hormones, which is not good. We don’t want that. We don’t want more thyroid hormone bound because the thyroid hormones are more active when they are free. When they are floating around, they can do their thing. When there is a lot of excess estrogen in the body, this protein increases. It’s binding up the free T3 and free T4. A lot of women will start to develop hypothyroidism because of that. That is one of the causes.

I’m sure you’ve talked about all of the different causes of hypothyroidism. Something that doesn’t get addressed is if there is estrogen dominance present. You can work on the gut, remove stress, remove gluten and dairy, and do other things. Are the hormones being looked at as well? I have had some clients not getting better thyroid-wise until we start working on the hormones, too. It’s something to keep in mind if you have thyroid issues.

Dr. Eric:

You mentioned earlier estrogen dominance playing a role with fibrocystic breasts. Something else that is important to mention is that many cases of thyroid nodules are caused by problems with estrogen metabolism. People can address that when they have thyroid nodules. There can be other factors as well. Many times, when you address problems with estrogen metabolism, that can resolve. It might not completely shrink the thyroid nodules, but it will often shrink them completely or at least decrease the size. If not, then of course you can look into other factors that might be responsible for the thyroid nodules. I did want to bring that up.

Kate:

That’s a great point. I didn’t realize until I started doing more research that we have estrogen receptors all over our body, not just in our reproductive organs, our breasts, uterus, endometrium. We also have them in the thyroid. That makes sense. If women are having thyroid issues, and there is excess estrogen present, it is also affecting the thyroid. That is a good point you made. If you have thyroid nodules or issues with the thyroid, hypothyroid symptoms or even hyperthyroid, I’m sure there is a link there, too.

We can talk about estrogen’s role in autoimmunity because women who develop Hashimoto’s have that imbalance or excess estrogen present. That is because one of estrogen’s roles is to regulate our immune system and inflammation. Because we have those receptors all over our body-

We have two receptors called estrogen receptor alpha and estrogen receptor beta. For the most part, when estrogen attaches to a beta receptor, it calms down our immune response and calms down inflammation. When estrogen attaches to more of the alpha receptors, it increases our immune system and increases inflammation in the body. That is another pathway that happens when people develop autoimmune disorders. *audio cut out*

Excess estrogen and hyperthyroidism. Excess estrogen and rheumatoid arthritis, lupus, Crohn’s, and ulcerative colitis. There are estrogen receptors in our intestines. It’s so crazy when you think about it. Women developing a lot of these issues, make sure to look at the hormones, too. Especially look at estrogen and make sure it’s being metabolized out properly, and that excess is not building up in the body.

Dr. Eric:

For those listening who have Graves’, that also could apply to you. Both Graves’ and Hashimoto’s as well as other types of autoimmune conditions, as Kate mentioned. Thanks for sharing that.

Because most thyroid conditions are autoimmune, around 90% of those with hypothyroidism have Hashimoto’s. I should also mention that Graves’ is the most common type of hyperthyroidism. There is also toxic multinodular goiter, which we discussed about the nodules and their relationship to estrogen.

You mentioned estrogen receptors in the gut. Can you talk more about the relationship between estrogen and the gut?

Kate:

Oh yeah. There are estrogen receptors in the gut. The gut is also responsible for estrogen metabolism. In our gut, we have trillions of microorganisms. We have bacteria, some viruses, parasites, and yeast. Everything should be living in community. The problem is when one of those organisms starts taking over and growing and knocking out all the good guys, this is called dysbiosis. When we get that disruption of our microbiome. That is a problem because we have specific gut bacteria that are responsible for helping estrogen to get eliminated from the gut. When we have that dysbiosis, that doesn’t happen.

Plus we have this enzyme called beta glucuronidase. This enzyme is supposed to allow estrogen to go through. It’s supposed to be low. When we have that dysbiosis, it causes this enzyme to increase in our intestines.

What happens is when estrogen is metabolized in the liver, it goes through two phases. Phase one is it’s active. Phase two, it becomes inactive. Then it binds to bile, and it goes to our gut. When it goes to our gut, and we have high levels of that beta glucuronidase, it takes that inactive estrogen and turns it back to its active form. Now the body is like, “We’re not eliminating estrogen. Let’s bring you back in and start using you again.” That is where that recycling comes in. That’s not good. We don’t want that to happen. We want to get rid of the excess estrogen. Our body is constantly producing it.

When it comes to gut health, that is the first thing I do when I work with my clients. Whether they have gut symptoms or not, almost everybody has issues with the gut. That is why it’s so important. Even if you don’t have constipation, bloating, or nausea, still get your gut checked. It can reveal a lot of information. If you have an overgrowth of bad bacteria, if you have that high beta glucuronidase, there are things we can do to address that. Get those good gut bugs back in. Support the metabolism of estrogen, so that enzyme will come back down, and you can get rid of estrogen. Gut health is so important because of that. It is related in helping estrogen to have that balance in our bodies.

Dr. Eric:

One thing that you mentioned in your book is if someone wants to test beta glucuronidase, they can’t just go to a regular medical doctor. If they have a basic stool panel done at LabCorp or Quest or another lab, they won’t test for that enzyme. They will just test for pathogenic bacteria and parasites, just a few of those that might cause diarrhea. If you want to look specifically at that enzyme, then you would want to order a comprehensive stool panel such as GI Effects or GI Map. It’s not a bad idea to take a broad look at the gut in addition to the beta glucuronidase.

Kate:

Absolutely. That was a common question I would get when I started my practice. “Can I just have my doctor order this stool test?” No, it’s not the same. That is because they’re just looking for an acute infection. If you took antibiotics and started having diarrhea, or you went to Mexico and developed diarrhea that wasn’t better after 7-10 days, that is when your regular doctor will order that stool test to find an acute infection. If you have one from E.coli or C-DIFF from the antibiotics, they would treat that with antibiotics if it didn’t get better.

The stool test I am talking about that Eric mentioned, the GI Effects or Map, those are way more comprehensive than what your doctor is going to do. The doctors are going to look for parasites or specific types of bacteria. It’s not looking at a full range of microorganisms in the gut and being able to determine how well you’re digesting food. The comprehensive stool test provides so much more information about the health of your gut. We can still have overgrowth of bad bacteria but without those symptoms. That’s why it’s so important to work with a practitioner that does testing that is more comprehensive to give us the whole picture.

Dr. Eric:

Let’s say if someone does both dried urine testing and a comprehensive stool panel, if they show on the dried urine test elevated 4-hydroxy estrone metabolite, and they show elevated beta glucuronidase on the GI map, it’s fair to say at least part of that estrogen dominance is due to dysbiosis, the imbalances in the gut. If on the other hand, let’s say they have an elevated 4-hydroxy estrone, and that beta glucuronidase looks okay, would you say it’s most likely caused by something else?

Kate:

For both scenarios, if the 4-hydroxy estrone is high, that is looking at phase two metabolism of the liver. Phase two is responsible for methylation. When it goes through that process, it goes through a pathway of methylation where we need B vitamins. We need B12 and folate. A lot of people have genetic mutations of this enzyme called MTHFR, which I had. That was part of my journey.

Dr. Eric:

Same here.

Kate:

Not only doing the hormone testing, but I started looking at my genetics. Had I not been put on birth control, this probably would have happened to me a lot sooner. Because I had come off of the birth control, it finally reared its ugly head. I had the MTHFR mutation. I needed to take in active B vitamins that have the methyl group already in them, the methyl tetrahydrofolate and the methylcholine because most vitamins over the counter aren’t active unless you are working with a practitioner, and you are getting the right companies that already have these active forms. When you have this, your body is not able to convert the inactive into the active forms. You’re taking these vitamins for no reason.

Yes, B vitamins are important for energy, but they are also important for estrogen metabolism. That is a great question. If the gut looks pretty good, and there is no elevated beta glucuronidase, but the bad metabolites are high, we have to look at what we need to do to support the two phases of estrogen metabolism. Sometimes we only need to support phase one, we need to support just phase two sometimes, and sometimes we have to support both phases. That’s why I like to do the tests because it can help me personalize what the person really needs and where that support is needed.

Dr. Eric:

Do you also look to see if the person has a genetic variation of MTHFR or COMT?

Kate:

Yes. COMT is also an important part of phase two. I will do genetic testing. If clients have already done 23 and Me, it is easy for me to pull that raw data and look at those specific mutations. I have recently joined with the DNA Company because they are doing an amazing job looking at those genetics. They even have reports looking at estrogen dominance, which I am super excited about. I already have a couple clients doing this test to dig into their genetics even further because once we can really understand- Genetics are the foundation, and lifestyle factors as well, pulling all those pieces together to support our body and healthy hormones.

Dr. Eric:

Years ago, I did 23 and Me on myself.

Kate:

Same.

Dr. Eric:

Same with my wife. I don’t know if it would be worth us doing it again. I imagine there is overlap with- They just give more information. For the sake of patients, that’s something I want to look into. It’s great to know you’re having a good experience with them.

Kate:

Oh yeah. They showed me all the reports. I love them. It’s what I do. It really helps a person understand their body. It’s not just about what’s happening in the body, but why. If we can have that understanding, there is nothing wrong with you; it’s just how your body is built.

That’s another thing with genetics. Some people don’t want to know what their genetic predisposition is, but in a way, it’s good to know because we can actually influence our genes. We can turn them on and off based off of our lifestyle and environmental factors. If we know that we can actually have the power to influence our genes, wouldn’t you want to know? If you are at risk of XYZ, you can do this and that to prevent these genes from being influenced and increasing your risk. There is so much power in learning.

I wanted to know what my Alzheimer’s risk was. I am a 3/4. I have some risk there. I know if I really focus on my lifestyle factors, consuming whole foods, reducing stress, supporting my hormones, I am going to have a low risk regardless of what my genetics say. I’m not worried because I know I’m doing all the right things.

Dr. Eric:

I want to shift back to birth control. Birth control can lead to problems with estrogen metabolism and estrogen dominance. If someone is taking birth control, and they are not experiencing any symptoms associated with estrogen imbalances, can that still be causing issues?

Kate:

When they are taking birth control?

Dr. Eric:

Yes.

Kate:

They usually won’t experience symptoms while on birth control. What happens is when on birth control, it suppresses all of our hormones. If women are experiencing symptoms of estrogen dominance before they get on birth control, they actually may feel a lot better. The PMS, the heavy periods, the irregular periods, a lot of women will have regular cycles again, lighter periods, no mood swings. Usually, birth control does help with that because it lowers the hormones. The problem is that once women come off, it flares back up again. It usually ends up being worse than when they got on it in the first place.

Dr. Eric:

They also might experience symptoms or signs that they don’t relate at all to the birth control, like gallstones. They might end up having surgery recommended, and the doctor might not even make that connection. Maybe they might not ask. They might go to a different specialist, and they don’t bring up birth control. That’s also something to consider.

Kate:

I had a client coming to me. She was taking birth control. She developed gallstones. I told her, “You need to get off birth control.” She even asked her doctor, “Does birth control cause gallstones?” The doctor said no. It’s in the research and the literature, and it’s even in the excerpt they give you with birth control. It’s there. There is a link between birth control and the development of gallbladder issues.

One of the things that birth control does is it impacts the liver’s ability to produce bilirubin, which is what produces the bile. Bile gets produced in the liver and is stored in the gallbladder. It’s impacting that. Also, the prostaglandins, the synthetic progesterone, is in birth control and slows down the gallbladder’s motility. It’s not squeezing and functioning as it should. It slows down that mechanism. That is why birth control is really impacting gallbladder.

If you have gallbladder issues, and the provider recommends birth control, say, “Wait a minute. Isn’t there a link?” If you didn’t have gallbladder issues, and you developed them while you are on birth control, think about that, and have that discussion with your provider. There is a strong link there.

The long-term impacts of birth control can lead to estrogen dominance. Women get on it for hormonal imbalances, but birth control can make that worse, like what happened with me. I needed to support the metabolism with the genetics. Taking in these synthetic estrogens and not really supporting the metabolism of that definitely contributed to that.

It also impacts our gut health and the lining of our gut. When we think about the intestines, one is so thick and one is so thin, but we have this nice mucus layer that protects it. A lot of things cause insult to our gut barrier. It affects that mucus membrane. We have the barrier that is really tight, the tight junctions to prevent a lot of things from passing through. Only vitamins, water, and minerals should be passing through. When we have that constant insult to our gut lining, like birth control, medications, stress, toxins, and inflammatory foods, it’s going to cause those junctions to open up, and it becomes leaky.

If you look at the studies, there is a link between birth control and leaky gut. That’s what I ended up developing. I had leaky gut when I did the stool testing and discovered that. Why I had to do so much work to heal my gut after that. Also because of those estrogen receptors in the gut, there is a link between birth control and the development of ulcerative colitis and Crohn’s. Birth control’s impact on the body long-term is crazy.

As a PA, and I’m sure as a doctor, you probably weren’t taught all these things, what birth control can do. We know that if someone is smoking or have something that increases clotting, they should avoid birth control because birth control can increase clotting. We learn some of the contraindications, but we didn’t fully understand what birth control is doing to our bodies at a cellular level, its impact, and how that will contribute to issues later on.

I would see women, friends and coworkers, when they’d come off birth control and try to get pregnant. They would conceive but would end up miscarrying. That scared me, too. I don’t want that to happen to me. There was a reason why. Being suppressed for so long, the progesterone levels were really low. When they tried to conceive, it didn’t happen because progesterone wasn’t able to increase to maintain and sustain pregnancy.

There are so many factors when it comes to birth control and its impact on our hormones. For women, I want women to learn about it and have that informed consent. Know this is what is going to happen long-term. If birth control is an option for you, have that conversation with that provider first before going on it.

Dr. Eric:

When it comes to addressing problems with estrogen dominance and estrogen metabolism, you want to take care of what we discussed here. If you have dysbiosis causing the estrogen dominance, you want to address the estrogen dominance, methylation, glucuronidation. All of these are important, some more than others. If you’re taking birth control, we mentioned that.

We didn’t chat about xenoestrogens. You want to try to avoid plastics as much as you can, drinking out of water bottles. Thermal paper receipts are a source. It’s almost impossible to avoid completely eliminating your exposure to plastics but minimize that as well.

Kate:

The xenoestrogens are chemicals that are basically foreign estrogen. They mimic estrogen. They are structurally the same. When we are exposed to all these toxins, they are going to attach to the estrogen receptors in our body. Think like a lock and key. The lock is the receptor, and estrogen is the key. These chemicals look like estrogen, so they will be able to go into the lock. That is a problem. I do believe this is one of the main causes of estrogen dominance.

When I was learning about functional medicine and all these toxins in our environment, I was on the Environmental Working Group’s website, and they did a study on how women use on average 12 products a day and are exposed to 168 chemicals. When I read that, that freaked me out. I was mind-blown. I ran to my bathroom and read all the products I was using. I counted up all the ingredients. I was using over 100 ingredients. It was definitely an eye-opening experience.

I realized I needed to start swapping out all these products and reduce the toxic burden in my home. At first, it was overwhelming. I had to get rid of everything in my home. I realized it wasn’t practical, and it is expensive to do that. I don’t want people to think they have to get rid of everything. At the end of the day, like you said, you do the best that you can. Swapping things out one at a time. That’s what I did. I focused on swapping out my toothpaste, then my shampoo, then my body wash. What are the more common things I use? Swap those out. Then the makeup, then the detergent. Over a period of time, I had more non-toxic products in my home.

I used to warm up my food in plastic food storage containers. I’m sure we all did that at some point, not realizing that the heat was releasing all these BPAs and other chemicals that we probably aren’t aware of yet into our food. That is affecting our hormones and causing disruption and causing estrogen dominance. Swapping those out for stainless steel or glass containers. Then the non-stick cookware, replacing those. If you’re hearing this and haven’t done that yet, focus on one thing at a time.

The cool thing is the Environmental Working Group has this skin deep database. You can look at the products you’re currently using to see which ones are toxic and what you can substitute it for. I also like two apps, Think Dirty and Yuka. Those two apps are awesome, too. They have a scanner in them. You can scan your products. It makes it easier. Instead of trying to guess if something is good for you or not, scan it. It will tell you which ingredients are clean, which are dirty, or half and half. When you go to the store, take the app, and scan all the products in the store to find a better alternative.

Rule of thumb: If you are looking at a product that has fancy scientific names, that is probably a sign you should avoid it. I look for products that have lavender oil, olive oil, shea butter, coconut oil, etc. All natural ingredients. That’s what I’m looking for, not these fancy scientific names for whatever. Thankfully, there are some companies that will use the scientific name of lavender oil, but it should say “lavender oil” in parentheses, so you know it’s a natural ingredient.

Same thing applies to food, too. When we are looking at our food, read the labels. That was another game changer for me when I learned it. I learned about nutrition in undergrad, but I didn’t start reading labels until after PA school. I started reading the labels because I realized the impact that food was having on my health and my gut. I didn’t know what so many of these ingredients were. Fillers, thickeners, preservatives all create inflammation in our body and impact our gut health and affect our blood glucose. There are so many things they do to our body. I thought I was eating healthy, but in reality, I was eating all of these processed foods. I really focused on consuming as much whole foods as possible. Certain things that I would eat that were already packaged, I would make it my own.

Yeah, it is a lot of work, but my husband and I meal prep and plan, so this is a tip. If you don’t like to cook every day, get a partner to do it with you. It’s so much easier to do that. Make a list of 10-15 recipes. Make enough for 3-4 days. When my husband and I cook, we make enough food for four days. We’re only cooking twice a week. That’s a lot more doable than cooking every day. That way, we know what’s in our food. It’s homemade. It’s whole. It’s good for our bodies. That was another thing to do.

Reading the labels on your food you’re eating and products you’re using. Food can contain chemicals as well. Going back to the toxins, they are not only in the products we’re using, but in our food. I always recommend going organic as much as possible. Especially nowadays, prices of everything are going up. If you can’t do everything organic, Environmental Working Group has their clean 15 and dirty dozen lists. Focus on the dirty dozen: kale, strawberries, red peppers. Basically anything with a thin skin, you want to get those organic. Everything that has a thicker skin like avocadoes, bananas, oranges, those you can go non-organic if you need to. That thicker skin, you will peel it off anyway. You won’t eat it, versus blueberries and strawberries where you aren’t peeling their skin. Opt into the organic versions of those. We want to support our liver and gut.

I’ll have people ask me, “Should I do a gut cleanse or liver cleanse?” No, you don’t have to do anything crazy like that. Sure, if you want to drink dandelion tea to support your liver, I’m all for that. Don’t buy $100 of products to do a gut or liver cleanse. If you want to, you can, but just focus on whole foods. Cruciferous vegetables are good for detoxification. Fibers are good so you are going to the bathroom every day.

I don’t know if you were taught this in school, but I remember being told if someone is going to the bathroom every other day, and that’s normal for them, that’s normal. Don’t worry about that. No! I learned in functional medicine, that is not normal. If you are going to the bathroom every other day, every third day, once a week, especially if that has been your normal, that is not normal. You should be going to the bathroom every single day, so you can get rid of these toxins and support your liver and intestines in that detoxification. Reduce the toxic burden on your body in order to help your hormones and overall health.

Dr. Eric:

Broccoli sprouts are important when it comes to estrogen metabolism. If they don’t like broccoli sprouts, you don’t have to eat them. I know they can be important. Any other foods and/or supplements that you recommend to support estrogen metabolism?

Kate:

Oh yeah. Cruciferous vegetables. You want to increase fiber, so a lot of vegetables, leafy greens. Fermented foods, which contain all the healthy gut bacteria for elimination and support healthy bowel movements.

However, I do always like to give a disclaimer: If you feel worse when eating fermented foods, that’s a sign there is issues in your gut. Get your gut checked out. That happened to me. I couldn’t eat broccoli, cruciferous vegetables, fermented foods, even beans when I had gut dysbiosis. I also had what’s called overgrowth of bacteria in my small intestine, SIBO. I had to work on treating that, supporting digestion. Once I healed my gut, I was able to eat these foods again, no problems, no issues. If you are eating these foods and notice you are feeling worse, that is a sign that something is going on in your gut. Those foods are important though.

B vitamins will come from your leafy greens. Those are good for estrogen metabolism.

Foods to support progesterone production are healthy fats, like wild caught salmon, avocado, nuts and seeds. Foods that are high in Vitamin C like red and orange foods, peppers, strawberries, sweet potatoes. Increasing those foods supports progesterone production.

Dr. Eric:

Did you mention any supplements?

Kate:

I hadn’t mentioned them. Thank you for reminding me. As far as supplements, I like diindolylmethane (DIM), which is a compound from cruciferous vegetables in a concentrated form. You’d have to eat 3-4 cups of broccoli every day to be able to get the amount that you would get in a supplement. Go for it if you want, but that’s a lot of broccoli to eat in a day. DIM is really good to support phase one metabolism.

I always give the warning: If you think you have estrogen dominance, you’re having a lot of the symptoms, and you Google it, the first thing they will recommend is DIM. There are a lot of supplements out there that sell blends with DIM and other compounds. You have to be careful. When I talked about the different metabolites, you may not need support in phase one. It may cause things to back up and make things worse if you are not careful, especially if the other pathways aren’t supported as well. That’s why it’s important to do the testing.

If your 2-hydroxy estrone is low, when I see that on the test, I recommend DIM. I will see it go from low to really high. Reading the studies and literature shows DIM increases 2-hydroxy. I have seen it happen in the results with my clients as well. It’s good to reduce the risk of breast cancer. Get the testing first because you can make yourself feel worse if you’re not careful.

B vitamins are really good for phase two. Magnesium, phase two as well. B vitamins are needed for the MTHFR, and magnesium helps support that COMT gene.

If you don’t like to eat broccoli sprouts, you can get them in capsule form. Broccoli sprouts contain sulforaphane, which is a powerful antioxidant to help with phase two metabolism. Increasing broccoli sprouts and getting that supplement can really help.

As far as phase three, there is a supplement called calcium d-glucarate, which doesn’t decrease beta glucuronidase, but it helps to eliminate estrogen from your gut when you have high beta glucuronidase. The only thing to help lower beta glucuronidase is to support the health of your gut. Get rid of all the bad guys causing that dysbiosis. Support digestion, heal the gut lining. That will help that enzyme come down. In the meantime, calcium d-glucarate can help facilitate the elimination of estrogen.

Those are the common supplements I will recommend, depending on what phase needs support.

As far as supporting progesterone, if I see progesterone on the low side, I will also recommend Vitex. It’s an awesome herb to naturally support progesterone. However, don’t take it without getting tested and working with a practitioner. If you have PCOS, that can actually make you feel worse. If you have high LH, which is luteinizing hormone, compared to FSH, follicular stimulating hormone, it should be a 1:1 ratio. But if you have 3:1 LH to FSH, taking Vitex can cause LH to increase even more. That is why you can get worse if you are taking Vitex and have that mismatch and imbalance of LH to FSH. Always get tested before taking any of these supplements. If your LH and FSH is 1:1 and your progesterone levels are low, I love Vitex. That’s what helped me naturally to get my progesterone levels back up.

I mentioned the Vitamin C foods. Taking Vitamin C can be helpful. Our adrenals contain the most Vitamin C. If progesterone is low, what is happening with the adrenals? What does our cortisol look like? We also have to support the adrenals because sex hormones and cortisol are all coming from cholesterol. When our bodies are under stress, our bodies are focusing on survival. We will produce more cortisol and less progesterone. Progesterone happens when we are calm and relaxed. When we are in that state, now our body is thinking about reproduction. When we are in that sympathetic, fight or flight mode, it’s thinking survival. That is another thing I will look at, too.

If progesterone is low, let’s get Vitamin C to support the adrenals and that progesterone production. If cortisol levels are high, let’s get you on some adaptogens. I love different mushrooms and herbs, like ashwagandha, rhodiola, holy basil. Mushrooms like cordyceps and reishi are good for adrenal support as well.

Another thing for progesterone is eating primrose can be helpful. I’ll add that in. B vitamins like B6 are important. We need B12 and folate for estrogen metabolism and B6 for progesterone production. A lot of those nutrients will support progesterone, and the adaptogens will support adrenals. I think that’s about it. I dive into all these in the book as well.

Dr. Eric:

You covered a lot. Thank you so much for sharing. Thanks again for getting together for this interview. Definitely check out Kate’s book, Estrogen is a Bitch. Her website is YourRadiantHealth.com. If they want to learn more about you, anywhere else they should go?

Kate:

You can also find me on Instagram @KateVazquez_PA. I am there most. If you have any questions, don’t be afraid to reach out. I’m happy to answer any questions that you have, especially if they come up after this gets released. The book is on Amazon.

Don’t forget to check out the resources, too. I have some resources in the physical book, but I have a lot more online, which contains a meal plan and so much more.I created methods and programs to help women naturally support their hormones. If you have any questions, please reach out! Send me a DM on Instagram.

Dr. Eric:

Thanks for this interview, Kate.

Kate:

Thanks for having me, Eric.

 

Recently I interviewed Beth O-Hara, as she discussed how to 0vercome mast cell activation syndrome and histamine intolerance. If you would prefer to listen the interview you can access it by Clicking Here.

Dr. Eric Osansky:

With me, I have Beth O’Hara, who is a functional naturopath and functional genetic analyst. She has a doctorate in naturopathy specializing in functional naturopathic approaches and a Masters in marriage and family therapy. She has over 10 years of experience working with hundreds of clients with mast cell activation syndrome (MCAS), mold toxicity, and related conditions. She has been through this journey herself, going from bedridden in excruciating pain and unable to function to living a full and joyful life by addressing the underlying root causes. Her mission today is to empower those struggling with sensitivities and significant chronic illnesses to reclaim their own full potential through individualized, precision approaches. Thank you for joining us, Beth.

Beth O’Hara:                          

It’s great to be here. I’m so excited. I think a lot of people in the community you have will find some light bulbs going off in this conversation. There is a big link to what we’re talking about and thyroid issues.

Dr. Eric:

I agree. I’m excited as well. As I said in your bio, you had a significant health journey yourself. That’s what got you into this field. Can you share some of that journey with us?

Beth:

Sure. I find that it’s a journey that a lot of people in the chronically ill population can relate to. I’d like to start there because it gives people hope. I started developing health issues when I was a child. I was about eight or nine when I started having some strange symptoms. We had moved to the country into an old farmhouse. I’m in my 40s now, so this was a few decades ago. Nobody knew anything about mold or Lyme back then. It’s not even talked about enough now, but back then, it really wasn’t on the radar.

Looking back, the farmhouse had quite a bit of mold, so I developed mold toxicity at a young age. We were in the country. We played outside. We were bitten by ticks. I thought we were having a Laura Ingalls Wilder kind of adventure. I didn’t have the stamina that my friends had. I couldn’t keep up in sports. I didn’t have coordination. Then I was kicked in the head by a horse when I was nine and had a traumatic brain injury. I had severe anxiety. I was then in a car accident when I was 16 and had severe fatigue. I just couldn’t seem to come back from that. I would whip myself every morning just to get out of bed to get to school on time. I did keep moving forward.

I was very driven to go to medical school, and that was the only thing I wanted to do. I had no backup plan. To illustrate how important this was for me, for my birthday, all I wanted was copies of Grey’s Anatomy. That was all I cared about. I was the weird little kid going through the woods finding bleached piles of bones and trying to put the skeleton back together. This was my super interest and my passion.

I went to college. I developed fatigue and brain fog, and the anxiety was severe. My junior year of college, I moved into a duplex that was 150 years old. It smelled musty in the basement. I didn’t know about mold again. My health really crashed. I worked my rear off and had multiple scholarship offers to medical school, and I had to turn them all down.

Instead of getting to go pursue my dreams, I became this chronically ill person. By the time I graduated, I barely finished my Bachelors. I went from this high-performing person, working three jobs, teaching at a vocational school, doing independent study research, taking graduate school classes, to taking the minimal number of credits to graduate. Nobody could figure out what was wrong with me. I had joint pain. I had brain fog. I had severe fatigue. I had blood sugar crashes to where I had to eat every two hours. Just to go out of the house, I had to bring a snack. This continued to accelerate so by the time I was in my later 20s, I had to walk with a cane. I wasn’t really even walking; I was barely hobbling. The joint pain was like walking with ground glass stuck inside my knees and my toes and my fingers.

I was misdiagnosed with rheumatoid arthritis. Treatments didn’t help because it wasn’t the right diagnosis. If nothing else, I was persistent in trying to find help. I exhausted traditional medicine, holistic. I did homeopathy, shamanic work. I did anything I could do. I did therapy to clear any kind of emotional pieces. I was the most complex case that all the practitioners I’d seen had ever worked with. They would tell me, “I have never met anybody as complex as you.”

I became extremely sensitive. I couldn’t tolerate any medications or supplements. I was having paradoxical reactions to everything I tried. Practitioners started telling me I was crazy, that it was in my head. I wanted to be sick, and I was getting something out of being sick, which was the farthest from the truth. I share that part because that’s also a common story. I hear it every week in my clinic. I’m sure you hear that all the time.

Fast forward. I had seen about 75 practitioners. I just kept spiraling downward until I hit a whole year of being bedridden. I could barely function. It was a good day if I could get the dishwasher unloaded, and then I couldn’t get it loaded. It was too much.

But I did land on first histamine intolerance. I had itching head to toe. I had all kinds of GI issues. Sleep disturbances. I didn’t sleep for four years. Practitioners would tell me, “You can’t go more than two weeks without sleep.” Not true.

Then I learned about this thing called mast cell activation syndrome. This was when it was still in the theoretical phases. This is fairly new on the scene of traditional medicine. There have been studies and theories about this for a few decades. Case studies coming around 2000, theorized around late 1980s/early 1990s. When I saw the descriptions, I said, “Oh my gosh,” everything makes sense. My GI symptoms, my skin symptoms, brain fog, fatigue, anxiety. This horrific insomnia. All of this is connected. The bladder pain, everything I was dealing with. I had symptoms in every system. I was pretty severe.

Learning about that started shifting my mindset of what we were looking at. I realized we weren’t chasing all of these separate things. This is all connected. The next question was why? Why are these mast cells dysregulated? We knew I had Lyme and bartonella and babesia, but I couldn’t treat it. Then we realized I had mold toxicity. That brought this huge lightbulb to what was going on, why I had the nervous system dysregulation, why I was so sensitive. That allowed me to start to unravel what was happening. I unfortunately had this premed back then. Every moment in my brain would work, I was studying, I was pulling things out, I was chasing down anything that could help. I started putting pieces together.

Eventually, I did get my brain back. I got my life back. I can wear heels, which doesn’t sound like a big deal to most people but is super exciting to me. I was somebody who at 28 had to walk in orthopedic shoes. I don’t wear stilettos, but I can wear cute shoes. I can go hiking. I don’t have stamina like an athlete does, but I can exercise for an hour. That’s a huge thing for me.

I went back to graduate school. I got two graduate degrees. I started this busy practice. I work a little too much and am working on that. But I can do it. I feel vibrant. I don’t feel like the person from 15 years ago. Even telling the story, I feel like I’m talking about this other life. It’s not the life that I relate to today. I do have a lot of health maintenance. I’m not out there eating Pizza Hut and McDonald’s. I eat very clean. I take my supplements. I exercise. I do my castor oil packs. I do my sauna. I do all the things to take good care of me.

But you can recover. I was one of those cases that practitioners didn’t think I would come back from. I was told I would be in a wheelchair by the time I was in my 30s. I could expect to have really poor quality of life. That road I was going down, that’s what was to be expected. Fortunately, we know all kinds of things we didn’t know 15-20 years ago. I see very similar cases: People recover within 3-4 years. They don’t take the 15-20 years that it took me or the hundreds of thousands of dollars it took me. That is the light at the end of the tunnel that I want to share.

Dr. Eric:

Thank you so much for sharing that story. You have been through a lot, but it’s great you’re doing so much better. Like you said, you need to maintain your health. You can’t go out and eat anything, and I’m sure stress management is important. Diet and lifestyle is huge with any chronic health condition.

One thing I want to ask: Most listening to this have a thyroid or autoimmune thyroid condition. There are certain symptoms associated with hyperthyroidism and hypothyroidism, some of them more classic, some of them not as common. With MCAS, are there classic symptoms associated with it, or does it really vary depending on the person?

Beth:

Great question. Maybe we should start because this may be brand new for some people: What are mast cells? I like to think of these as our front-line defending and sensing cells of the immune system. They’re in almost every tissue in the body. The only tissue I have ever seen documented that is up to date is the retina doesn’t have mast cells. I used to think the brain didn’t have mast cells, but that has been disproven in the last few years. We even have mast cells inside the brain. They’re sensing every molecule of air, food, water, supplement, medication, anything you put in your mouth, anything that we smell, that we touch. They’re sensing stressors. It’s that role of chronic stress.

They’re also sensing what’s happening inside our bodies. They line the blood vessels. They’re sensing the blood going through the vessels. They have hormone receptors for things like estrogen, progesterone, and thyroid hormones. The thyroid tissue has mast cells. They have over 200 different types of receptors. Some of the most complex cells in the body. They’re also sensing for pathogens, viruses, bacteria, parasites, molds, yeasts. There are all kinds of censors for different types of medications, even Vitamin D, which is actually a hormone.

And neurotransmitters. They have receptors for many different types of neurotransmitters and neuropeptides. They have over 1,000 different mediators housed inside of them that they can release. Most people are familiar with histamine. They are one of the major cells that release histamine. A couple others in the body. Prostaglandins, cytokines, now a household name. We could go down the list. Cell signalers.

What they do is mobilize an immune response if it’s needed. For example, if you cut your finger, you don’t get the bacteria cleaned out, and it starts to get red and puffy. That is the mast cells creating local inflammation as a protective mechanism. If we get a surgery, we get some local inflammation around the surgical site. Part of that is mast cells protecting us. If we get sick, and we get sinus congestion and the sore throat, that is not the virus itself, that is our immune system launching a protective attack.

They should be doing this normal protective response and then restabilizing. They are releasing these inflammatory mediators to protect us and then restabilizing themselves. In MCAS, the mast cells have become dysregulated for a variety of reasons, but really, it boils down to an overload of pathogens, toxins, stressors. Stressors could be emotional trauma, injuries, surgeries, and so on. Any combo of those.

Instead of being security guards, or guards of the castle gate, they are on an eight-hour shift, they do their work, they protect you, but they get to take a break and recharge. Just like as human beings, if we work security duty, we would need to take a break and recharge. But we live in a world now that is an onslaught of chemicals, EMFs, mold. All this stuff coming at us. So much that we didn’t have 150 years ago, 1,500 years ago, 15,000 years ago. Our mast cells haven’t caught up to this rapid change in the world that we live in. Even the level of stress that we have, just getting the kids to all the extracurriculars and getting through traffic and trying to pay the bills and coming out of this pandemic. All the stuff we deal with day in and day out. The war in Ukraine. The amount of stress that we’re all under day to day is astronomical compared to what we used to have.

Now the mast cells, instead of getting to do their protective job and relax, are all on guard 24/7. Just like if we were on guard 24/7, we would lose our ability to think clearly and start to lose our fine tuning. Instead of just firing at pathogens and toxins, now they are firing at what I think of as butterflies. We can start to have increased inflammation for all kinds of reasons, things we may not even think of as being triggering. Some people get food triggers. Not all but some. Some people get triggered by perfume somebody is wearing in the grocery store. They get triggered by the fragrance in laundry detergent, by molds, and so on.

These mast cells can become hypersensitive and overresponsive. The important information about this is MCAS is now affecting 9-17% of the general population.

Dr. Eric:

Wow.

Beth:

It’s huge. That’s at least one in nine. We’re talking closer to one in seven people dealing with this. People have no idea. It’s one of the most under-recognized, under-addressed conditions.

How do you know if you have this? There is going to be inflammatory symptoms in two or more systems: skin, GI tract, thyroid, bladder, reproductive organs, muscles, bones, nervous system, brain. Anything like this. That’s what makes figuring out who has this tricky. You need to have other things ruled out. Make sure there is not a cancer, IBS, those types of things. But those are all linked to mast cells. If there is inflammation, there is some mast cell involvement.

Symptoms can vary greatly. To circle back to that first question, symptoms can really vary because it depends on which mast cells are activated, in what tissues, which of these thousand mediators are being over-released, and which receptors are overly sensitive. If we think about the number of possible combinations there, it’s almost impossible to calculate.

Some classic examples are people who have skin symptoms, like hives, rashes, flushing, allergy symptoms. We’re not talking seasonal allergies. That is there for a short term, with pollen, and then it’s gone. This is going to be year-round. It may wax and wane, but it’s not like you have it in the spring and fall, and then you’re fine. And it has to be multiple systems. Some people get anaphylaxis reactions or anaphylactoid reactions. Those are the really frightening, “My throat is closing. My chest is tightening. I feel like I’m going to pass out. I do pass out. Blood pressure drops.” You don’t have to have those to have MCAS. Not everybody gets skin symptoms, so that’s some misinformation out there. If you don’t have hives, you don’t have MCAS. That’s not true.

Some other presentations can be GI issues: acid reflux, constipation, diarrhea, abdominal pain, the visceral hypersensitivity kind of pain. It can be lung issues with congestion, asthma, chest tightening. We can have sinus-related symptoms: post-nasal drip; red, inflamed, itchy eyes. We can have issues with urinary burning and pain. For women, we can have menstrual difficulties. Muscle pain, joint pain, fibromyalgia-type pain. Hypermobility is really linked. Orthostatic, tachycardia syndrome. Blood pressure changes are rapid with sitting and standing.

Because there are so many symptoms, we could spend the whole time doing just symptoms. I did put together a symptom survey people can find for free on our website, MastCell360.com. Under MCAS, there is the Symptom Survey. That’s based on the symptoms clearly correlated in the research. The more symptoms you have, the more likely you have MCAS. You can just count them.

Every form of autoimmunity that has been studied in relationship to MCAS has been linked to the mast cells. That will include Hashimoto’s, Graves’, rheumatoid, autoimmune GI symptoms, eczema, psoriasis, all these things. The reason is mast cells sit at this interface of the immune system. They have a role in fighting off pathogens. When our pathogen-killing side gets overwhelmed, this chronic inflammation side comes up, and those work like a seesaw. We have this elevated TH-2 for a long time. Certain positions can open us up toward autoimmunity, branching off that TH-17 response.  You may not develop autoimmunity. As far as I know, I have not had autoimmunity fortunately. But there is a huge number of people with MCAS that do have autoimmunity. If you have autoimmunity, that is a dead ringer. Go check for MCAS.

I know that was a long answer. Hopefully that hit at what you were asking.

Dr. Eric:

You gave a lot of great information and answered some of the questions I had for you. With the prevalence, you said 9-17%?

Beth:

That’s what the population studies have shown.

Dr. Eric:

I assume it’s increasing just because of the factors you mentioned earlier, like the increased toxic burden, the mold.

Beth:

We do think it’s on the rise. Just looking at case presentations from decades ago, beyond the increased understanding. When I talk to people who have been in practice for 40-50 years, Dr. Neil Nathan is a mentor and friend of mine who has been in practice for 40 years. He talks about noticing that the cases have gotten more complex, more challenging. Have you noticed that in your practice?

Dr. Eric:

I have. I have been doing this now for about 12 years. I would say that I think with any practitioner, the more experience they get, the more complex patients they see as well because of that experience. I think it’s a combination, but I agree. I would definitely say over the years I’m seeing more complex patients compared to 10-12 years ago.

Beth:

What I am finding is what worked 10 years ago isn’t working today. We know that something is shifting. Someone came in with candida issues, and I could work with them on herbals 10 years ago. They would be cleared up in 3-6 months. Boom, they were happy. That was easy. It’s not knocking it out now. Even these organisms are changing with what’s happening in our environment.

Fortunately, we have the knowledge to address it. We need more practitioners working in this space. We have some trouble that we’re in around what’s happened environmentally.

Dr. Eric:

When it comes to multiple chemical sensitivities, is MCAS linked to that as well? Or is it a potential cause?

Beth:

There was a great study that came out- Tania Dempsey was a co-author on that study. They called it TILT; I’m forgetting the acronym. That study definitively showed a role of mast cells in chemical intolerances, which makes a lot of sense because these mast cells are sensing everything that’s happening chemical-wise, whether we’re getting it through skin products that have parabens or a Glade plug-in, and releasing inflammation. They line every nerve ending and the nerve sheaths.

Mast cells are interwoven with the nervous system. That is why I said it was really important that mast cells have receptors for neurotransmitters. They can also release certain neurotransmitters. The nerve endings have receptors for some of these mast cell mediators. There is this constant cross-talk. That’s why when we start to get into MCAS, if we have a flare, they are getting triggered and activated, we can get all these nervous system symptoms, like heart palpitations or throat closings being triggered from the nervous system signaling. That’s why we can get reactions within fractions of seconds.

When people say, “As soon as my husband starts grilling,” someone for whom that’s a trigger may literally start to have reactions before they register the smell because the limbic system has already registered it. There are mast cells in the limbic system. It’s sending a danger signal through the body. This is often when people are told they are crazy because they used to think that immune cells could react that rapidly, but it’s through that nervous system signaling that it’s happening.

Dr. Eric:

You mentioned an overlap between MCAS and different autoimmune conditions. Not everyone with MCAS develops autoimmunity, like you said. As far as you know, you don’t have an autoimmune condition. Just so I can better understand, some of the same triggers of MCAS could also affect autoimmunity, such as food, stress, chemicals, infections, the shift in the immune system, the TH-2 dominant condition.

Beth:

It is. We looked at all these chronic conditions, like autoimmunity, MCAS, cancers, bowel disorders, neurodegenerative diseases. We keep trickling them down to the same root causes: pathogens; toxins, including mold; chemical toxins; metals; and stressors. We underestimate the role of chronic stress, but it’s huge.

The model I found that describes it the most is the cell danger response (CDR) model developed by Robert Naviaux, who looks at when we have an overload of these events, then the body is going to go into protective survival mode. The expression of that is going to look different person to person depending on their unique biology. For some people, it’s MCAS with autoimmunity. For some people, it will be neurodegeneration or cancer. We can pull it all back to the similar to problem. How is it going to be expressed?

In terms of these triggers, for example, food, certain smells, they are variable from person to person. Some people have histamine intolerance. Lectins are big in autoimmunity. Oxalates are a big deal in the thyroid. They enlarge the thyroid and can disrupt the thyroid functioning. A lot of times, it’s where the biochemistry is getting disrupted by something underneath. We peel back to why. If we can address that why, many times, the expression and sensitivities will improve.

I used to be so incredibly sensitive. If someone is on an elevator, I couldn’t go in because I couldn’t take the risk that they were wearing any type of fragrance. I don’t want to risk passing out in the elevator with a stranger. I couldn’t take an Uber or a taxi because they would have those fragrance things. When I couldn’t walk, that was oxalates, I realized over time. I can tolerate a much wider variety of oxalates now. I don’t eat beets, sweet potatoes, almonds, chard, or spinach now, but I can eat all kinds of foods that I couldn’t eat before with a dressing. The mold toxicity, the Lyme layers, the load is off of my body. We see that a lot in autoimmunity as well. People may have to be careful with lectins long-term because those are different in terms of activating. There are leptin receptors on mast cells, so it’s part of that link.

Dr. Eric:

I also read a journal article that said mast cells can potentially decrease regulatory T cells, which keep autoimmunity in check. That is another potential mechanism to make someone susceptible to an autoimmune condition.

Beth:

It’s through this cytokine network. There are inflammatory and anti-inflammatory cytokines. That level is beyond what I understand right now. Serious immunologist level. They’re communicating to the B cells, T cells, and every kind of immune cell there is. I think of mast cells as being one of the big conductors and orchestrators of the immune system, keeping everyone in check. They are not the only cells doing that, but they have a big role to play. If your conductor gets out of sync, the whole orchestra will be out of sync and start to get dysregulated, too.

Dr. Eric:

Are there any other links you know of between thyroid health and MCAS?

Beth:

One of the biggest ones is mold toxins. This was a game changer in my practice in terms of really jettisoning the successes we got. We realized how common this is. Many people are underestimating the impact of mold on their chronic illness. Either they get a urine test, which shows low levels. They don’t realize those are fat soluble, so everyone has low levels on the first test. Or they only get one test, so it looks negative, so they don’t go any further.

Mold toxins have a huge effect on the thyroid. I do more frequently see hypothyroid. The thyroid needs iodine. In the mild toxicity population, I see iodine supplementation, until that mold layer is addressed, can tip people into hypothyroid. I did that to myself. I know I mentioned before I had hypothyroid. I was trying to get a little bit of iodine in. I am not old enough to have perimenopause; I think I’m not ready yet. I started having these heat flushes, and I was sweating. I didn’t used to sweat. All of a sudden, I am sweating in December. I run cold all the time, and I like it to be 78 degrees. I am hitting it down to 70, and my husband is cold. He is the Canadian, so he is usually hot.

We do have to be careful with that. I don’t know the exact mechanism of why, but I find people are more sensitive to iodine. It has a real disrupting effect on the thyroid function itself, on the thyroid hormones. We often will see that hypothyroid state. It usually gets better. I’m sure you find gluten being a big role with those proteins being so similar to thyroid. Getting the mold toxins out. If people can’t get those Hashimoto’s antibodies in check, they will get those mold toxins addressed, and they will usually drop down pretty well if other triggers are handled. Not if someone is eating gluten.

Dr. Eric:

A lot of people who have mold also have Lyme. If someone has mold and Lyme or coinfections like bartonella, would you prioritize the mold? The first problem is trying to get rid of the source of the mold.

Beth:

That is often a game changer for people who have had cases like mine and can’t tolerate Lyme treatment. Or people who have had Lyme for years and years and still have symptoms. There is often this missing mold layer. If someone has acute Lyme, they were just bitten by a tick last month, they have the fevers, and they are trying to fight off the infection, that’s a different story. People who have had chronic Lyme for years, like I did, if there is that mold layer, I find it’s much better to peel back the mold layer first for a few reasons.

Lyme and mold have very similar symptoms. When I say Lyme, I mean that to mean tick-borne infections. Particularly bartonella can look like Lyme. Not everyone gets this, but lightning bolt pains, or these shooting pains that move around. Tinnitus is really common. One of the most challenging symptoms. If you clear the mold layer, about 30-40% of cases, at least that I see, can spontaneously clear the Lyme. The body’s immune system kicks in.

That happened for me. As I worked on these other layers, my Lyme symptoms went away. They’re nonexistent. I never tolerated the antibiotics or stronger herbals. But about 60-70% have to address the Lyme or tick-borne infection layer. They tolerate the treatment so much better because you have gotten this massive toxin load out. As you are killing these pathogens off, the body is not trying to clear all these mold toxins with the biotoxins. The immune system is in better balance since mold toxins are huge immune deregulators.

We don’t give mold toxins the kind of credit they deserve in terms of how toxic they are. To put it in context for the listeners, they use these mold toxins for chemical warfare. Mycophenolic acid is used as a chemotherapy drug, and it’s one of the most toxic. They are highly carcinogenic. They disrupt every system of the body. It’s extremely estrogenic. It’s numerous times more powerful than human estrogen. Lots of reproductive cancers and other issues associated with that, like endometriosis and PCOS. We need to take this seriously. Neurodegenerative issues, Parkinson’s, Alzheimer’s, are linked to it. Big deal.

Dr. Eric:

You mentioned histamine is just one of many mediators released by mast cells. Can you talk more about the relationship between MCAS and histamine intolerance? How someone could know if they just have histamine intolerance versus MCAS.

Beth:

The symptoms can be similar. Histamine intolerance, we’re just talking about histamine. We’re not talking about tryptase or any other mediators. Histamine intolerance happens when the histamine in our bodies exceeds the capacity of the enzymes that break it down to remove it. The major enzymes we talk about are DAO, HNMT, which is dependent on methylation. Some of our more savvy listeners probably found that out. There are these other enzymes rarely talked about that are related to it: ALDH, which also breaks down alcohol. People with histamine intolerance often have trouble with alcohol as well. That pathway is affected. Acetylation, there is liver pathways. There is a glucuronidation pathway involved, and so on.

DAO is one of the big ones. It’s made primarily in the small intestine. You can have genetic issues that can impact that. If you have any kind of gut inflammation there, that will affect those small intestinal brush border cells in being able to make it as well. If you have nutrient depletions, too. If we can’t break it down-

I like to think of it as a sink. The histamine coming into our bodies through our foods or that is being triggered and released by the mast cells, that is the water coming out of the faucet. These enzymes are like the drain. If we have water pouring into the sink, and the drain is clear and open and large enough for the water flow, the sink will keep draining, and we are fine. If that water exceeds the capacity of the drain, or the drain gets clogged and gets smaller, the sink will overflow, and we will get those symptoms.

They can be similar because histamine is triggering the mast cells. The mast cells have four different types of histamine receptors. We can get GI symptoms, like acid reflux or diarrhea, constipation, flushing. People familiar with flushing after red wine. When I started getting into nutrition, I got into the Weston A Price work, which is wonderful work. I am a 150% person because I overdo everything. My kitchen looked like a laboratory. I had my kefirs and my cultured veggies and kombucha and raw milk. It’s all high histamine. I couldn’t figure out why I was itching head to toe 24/7, scratching my skin until it bled. I realized I was overdoing the histamine. Let’s dial this back.

Other foods like walnuts, spinach, cashews, peanuts, strawberries, pineapple, we have a thorough list on our website. I want to caution people to use a well-researched list. Dr. Janice Joneja’s work is really good. There is a SIGHI list. A lot of lists online are copied from other lists, and they make mistakes in the copying. About 95% of them have errors. Make sure you use a good list.

That’s histamine intolerance. If all that’s someone has, and they don’t have MCAS, the symptoms are usually much milder.

With MCAS, the symptoms will be more varied, complex, and intense. Someone could have MCAS and not have histamine intolerance. They may have issues with the other mediators with no problems with histamine. I have had some people come through who did a low histamine diet trial for six weeks. I usually ask people to do low histamine and low lectin for six weeks, see if you get a symptom improvement, and then introduce some high histamine foods to see if you get an increase in symptoms. That is the easy way to determine.

If you add in some DAO supplementation- Methylation supports are too tricky in this population, so I don’t do them early. That’s usually about two years into a program. If we get big improvements, histamine intolerance is on the table. I don’t get very many people who just have histamine intolerance. I’ve had a few, but I’m overkill for that, so I don’t see many of those people. They have usually figured it out on their own and are much better just doing those steps and are good to go. You still want to go, why? Why aren’t you making DAO?

I’ve had just a handful of people who only have MCAS without histamine intolerance. Most of my clients have both. They find they do get some symptom relief reducing the histamines and supporting that DAO and other histamine degrading pathways and what’s affecting them. It doesn’t clear it up. It’s not going to do enough.

That’s what I found myself. I followed the low histamine diet for about two years, thinking I found the Holy Grail before I knew MCAS. This will handle all my symptoms. It brought it down a good 20% for me, and it’s still very important. You can recover with that, too. I used to be very limited in the foods I can tolerate. As long as I don’t overdo it, I can have about 10 strawberries. I take my DAO, and I am pretty good to go. That is coming from about 10 foods I tolerated before.

Dr. Eric:

Do you do testing? I know you do genetic testing for DAO. It looks at other things. Do you test for histamine or any other testing related to this intolerance or MCAS?

Beth:

There is a test, Precision Point Diagnostics for DAO and histamine. It’s a good test. It’s not one consumers can get on their own, so I often don’t talk about it because of that. They can get it through you. That’s a fairly good test. It’s not 100%. If someone is on antihistamines, the histamine may look lower than it would otherwise.

In terms of mast cell mediator tests, I don’t ask people to get it because I am a consulting practice. I don’t diagnose. I don’t need it. But also, the problem with those tests is the histamine, the prostaglandins, and so on, to be accurate, they have to be kept chilled from the time of collection all the way through the processing, including the centrifuge has to be chilled. If not, it’s likely to show negative. These mediators are up and down the bloodstream very rapidly. I have known practitioners who had to get that positive mast cell mediator result for insurance coverage for a patient. They had them trigger a flare, which is always hard on people; then have them come in and sit in the office for eight hours; and draw their blood every hour on the hour hoping to catch that spike. There is still a lot of challenges in that testing. There are people who have access to the cold centrifuge labs and can get those samples handled properly. It’s hard to do.

Dr. Eric:

Could you give some action steps where people could heal from MCAS and histamine intolerance?

Beth:

I’d love to. The absolute first thing I tell people to do is I have different phases we work through. The first phase is stabilizing. It means that we are going to identify and lower triggers. If that means we haven’t done a clean out the cleaning product, we will do that. Make sure we are not using bleach or bigger trigger items. Clean out personal care products. Make sure the diet is clean. Most of the people who come in to work with me have already done a lot of work on this. I am not usually starting with gluten, sugar, or dairy. Working on those things and processed foods.

Mold exposure is huge. Most people think they have no mold in their home. It’s rare for me to work with someone who doesn’t have mold in their home once we look for it. Many times, people brought inspectors in to check. They tell them there is no mold issue, but they only run an air sample test, which is the least sensitive. They are comparing your spores of mold outside to inside, which makes no sense because- As an analogy, there are a million cockroaches outside. There are 2,000 cockroaches in your house. You are still not going to be happy with 2,000 cockroaches in your house. Same with the mold. We can’t be mold-free, but we need to be out of the toxic molds, the ones triggering to mast cells. The non-toxic molds aren’t as concerning unless you’re allergic. It is hard to find a good remediator and inspector who understands this level of sensitivity to mold.

That is the trigger management side. You talked about stress management before. Toxic relationships. People don’t realize if you are in a toxic relationship with an abusive person, that will keep your body in a fight or flight state as well.

We work on nervous system support. That is very specific limbic system and vagal system work. Both of those systems have to be worked on simultaneously. We can’t just do one or the other. These are much more refined than a YouTube meditation. Keep doing those; those are great. But we are talking about real specific practices here.

Mast cell stabilizing supplements. Some of my favorite starting points- Is your audience really sensitive?

Dr. Eric:

A small percentage. I would say the majority aren’t.

Beth:

I put my clients into three groups. I will start with the easy category. I don’t get many of those. People who are in the easy category can take some of the combo products out there that are mast cell-supporting. They usually take quercetin. They might be able to handle bromelain or stinging nettle. Those can work. I love the quercetin, perilla seed extract, Chinese skullcap extract. Vitamin D is huge for mast cell stabilizing. Being well hydrated is antihistamine. It’s important.

We mostly work with our sensitive compliance population and our super sensitive people who are struggling with any supplements and medications. Sometimes we will start people with microdosing, and we will take a few granules in water, stir it, and take a couple sips, and that’s it for the day. That entry can be helpful for really sensitive people.

Sometimes when people are super sensitive, I will start them with little sprinkles of baking soda. Baking soda is mast cell stabilizing. Many people have found that it calms down a flare for them if they do a quarter to half a teaspoon of baking soda. If there is high blood pressure, that might not be the right thing for you. Or if someone has extremely low stomach acid, that can make their stomach feel bad. But even sensitive people can do a little baking soda, too. That is our starting point.

All through that, we are looking at what are major underlying issues? What are the root causes? Like we talked about before, if mold is there, I almost always find it if I dig enough, and we look at the right panels for people. Some people are looking at panels that are missing it for them. Then we will address that mold layer.

We have to bring our symptoms down. We have to stabilize first. Once we start detoxing, we will have these swings in symptoms up and down. If someone is way at the top of what they can handle, I don’t want to flare them anymore and have them feeling worse. We will start with some precision targeted binders, going to some liver lymph support. Elimination is key. We have to address the constipation before we do any binders. Then that anti-fungal layer. That lays it out big picture framework.

Dr. Eric:

Thank you so much for sharing. That’s why you said most of your patients, it takes a few years to get them to the point where you are now, correct?

Beth:

On the really short end for adults, we are looking at a year and a half if they are not too complex and have some short mold exposures. Most people are looking at between 2-4 years. If they are really severe like I was, and I had about 30 years of mold exposures from place to place, that can take about 5-6 years. Generally, people are getting improvements as they go along. There is a very small percentage of people who may not feel better until they get all of the mold out of their system and the Lyme treated. That is the hardest case for the client to stay persistent with. It takes a lot of patience, trust, and faith that this will lead them somewhere. That persistence is key. This is hard work. I know your audience knows that. It’s not just taking two supplements, and you will be done soon.

Dr. Eric:

The big thing is that there is hope. It sounds like you are high on the spectrum of complex conditions. It’s great that you’re giving hope to the listeners with complex conditions.

Beth, where can people learn more about you? Your website is MastCell360.com. Can you repeat some of the resources you mentioned?

Beth:

We have the symptom survey on the website. We have our foods list if people are looking at histamine and want a lectins histamine list or an oxalate histamine list. We have a Facebook group, a nice community there. People can do both groups. They complement each other nicely. We have courses that get people started. Wellness stabilization steps, the nervous system, and mast cell supporting supplements. We have what I call my MC360 Precision Mold Masterclass. That helps people get started on their mold journey. They may need a practitioner somewhere along the way because you know how complex that is. It needs to be individualized. It helps people make choices and get going.

Dr. Eric:

Thank you so much for doing this, getting together. I’m sure the listeners learned a lot about MCAS and histamine intolerance. Please do visit Beth’s website, MastCell360.com. Sounds like there are some wonderful resources there.

Beth:

Thank you. I appreciate you having me on and all the work you do as well. We can help people get better faster.

 

Recently I interviewed Julie Olson, as she discussed how to stop hormonal hair loss. If you would prefer to listen the interview you can access it by Clicking Here.

Dr. Eric Osansky:                                                                                                              

With me, I have Julie Olson. We are going to be talking about hair loss with a focus on hormonal hair loss. Julie Olson is a triple certified evidence-based nutrition expert. She specializes in female hair loss as well as gut health and gluten issues. Julie is known to skillfully investigate, discover, and communicate root cause resolutions to naturally regrow hair and regain health. With more than 10 years’ experience collaboration with functional and integrative practitioners as well as her training in functional medicine, Julie has transformed over 700 women’s health and hair. She creates personalized health and hair rebuilding programs for clients that are realistic and sustainable for long-lasting results. This process empowers clients to take control of their own health. Julie’s program restores women’s luscious locks naturally by getting to the root causes of their health and hair loss so that they look and feel their very best. Thank you so much for joining us, Julie.

Julie Olson:                    

Thank you, Dr. Eric. I really appreciate being here.

Dr. Eric:

It’s great to chat with you about hair loss. A lot of people experience it, including a lot of my client base as well as yours since that’s what you focus on. Let’s start off with your background. How did you start helping others with hair loss?

Julie:

Good question. I have been doing this for 10 years. It wasn’t until the last couple of years where I had so many women come to me a hot mess, like I was before I got into nutrition. One of their chief complaints was hair loss. After I got them into balance, their hair started growing back. I experienced severe hair loss before I got into nutrition when I was transitioning over into the field. I didn’t know what to do, so I actually was walking in to get Rogaine. Thank goodness I didn’t because that’s a life sentence. If you get off of it, normally your hair all falls out anyway. It’s a pharmaceutical that has side effects. I really want to let women know that there are natural alternatives out there a lot because all you hear about is Rogaine or other pharmaceuticals or laser or hair plugs. It’s not fair. Like we’ll talk about, it all starts in the gut anyway.

Dr. Eric:

That’s true. Pretty much all health conditions seem to start in the gut. You’re right, the Rogaine still to this day is relied on by a lot of people. Once people are on it, they have to stay on it, or else they lose all their hair when they get off of it, correct?

Julie:

Yes. Normally, that’s what happens. Even on the bottle, it won’t say that. It happens to the majority of people that get off of it. Since it doesn’t happen to 100% of people, they don’t really have strong warnings about it. It’s misleading.

Dr. Eric:

I’m not too familiar with Rogaine as far as side effects, but I’m guessing just like other medication, there are other side effects as well.

Julie:

There is another medication called Finasteride, which is mostly for blocking DHT. A lot of men take that. The side effects are horrible. They lose all their sex drive. There has been a lot of studies actually where men got off of it, and they still didn’t have that sex drive at all. It’s pretty scary.

Dr. Eric:

Yeah, it is. Another reason I’m glad we’re having this conversation. People who might be thinking about taking the medication could realize that you can address the cause of the hair loss. Why is it important to figure out what type of hair loss someone has?

Julie:

That’s really important because you need to address it as soon as possible. You have to isolate the root causes. There are different root causes, and there are different types of hair loss. You have to address them differently. There is no one size fits all. Also, it’s easier to stop the process from getting worse and thicken your existing hair than regrow your hair that’s already gone.

To get more technical, hair follicles become very tiny; they call it miniaturization. Scarring can take place, especially with female hair loss. These conditions usually progress through hair shedding. The more shedding, the faster the miniaturization can take place. This can cause scar tissue, compacting all hair follicles, making regrowth nearly impossible.

Then hair growth exhibits enormous cellular turnover. Some people call it a mini organ because it has such an active metabolism requiring really good nutrients and absorption of those nutrients, which requires an enormous amount of energy. If you’re not absorbing your nutrients, or you’re not eating enough, or if your body is unbalanced, then it’s really hard to achieve hair growth. You probably get a lot of clients as I do who come to you. They might be eating well, but once you start doing functional labs, oh gosh, they’re not even absorbing their protein or healthy fats. It’s peeling back the layers and getting on it right away.

Dr. Eric:

People I work with mostly have thyroid or autoimmune thyroid conditions. The thyroid hormone imbalance can be a big factor. Like you said, if they’re not absorbing nutrients, that also could play a huge role when it comes to hair loss. I’ll let you talk about some of the different types of hair loss. Again, we’re going to focus on hormonal hair loss, but feel free to talk about other types as well.

Julie:

The hormonal hair loss is called chronic telogen effluvium. The main causes are hypo and hyperthyroidism; SIBO; dysbiosis of the gut; nutrient deficiencies or surpluses; and heavy metal toxicities. Those are the main causes. Functional lab tests that I know you do as well can help address it right away, like the full thyroid panel, SIBO breath test, stool analysis, food sensitivity panel, and heavy metals. Even looking at the parathyroid. That’s a hormonal one.

The gut, depending on whether it’s healthy or not, really can produce or block hormones that cause hair loss disorders. They have linked it in a lot of studies. What happens is we have not only our gut microbiome, but we have our skin microbiome. Now they are saying we have our scalp and hair follicle microbiome. It becomes systemic. If we have dysbiosis, it’s not like what happens in Vegas stays in Vegas. It’s not that. It’s systemic throughout our entire body when we have that dysbiosis of our gut. It has a huge impact on our endocrine system, which regulates the secretion of our metabolism and different hormones, including our sex hormones. That being said, if there is any dysbiosis in the gut, studies really show that shifting that bacterial balance to the positive can have a huge favor in hair growth and hair health.

Dr. Eric:

Just another reason to focus on restoring the health of the gut. You are going to talk about the 5R protocol, which I definitely recommend to my patients as well. Before doing that, a couple of things.

One thing with the lab tests. You mentioned SIBO (small intestinal bacterial overgrowth), which could affect the absorption of nutrients. You also mentioned sometimes doing a comprehensive stool panel. Do you recommend those tests on all of your patients? Or does it depend on the history?

Julie:

It absolutely depends on the history. I didn’t even mention the DUTCH test, the hormone test that is important, too. I know you do these. I take each client case by case. I have them fill out- Do you use the living matrix questionnaire?

Dr. Eric:

I don’t. I am familiar with it. It’s from IFM, right?

Julie:

It shows the timeline of the client. You start to put together patterns, and it helps with detective work of deciding what labs to run on them or not. Like you, I like to test, not guess. You can waste a lot of money and time going down the wrong path.

Dr. Eric:

I agree. It’s a catch-22. I don’t want to over-recommend testing. I don’t want to go crazy with the testing. As you mentioned, you could also waste a lot of time if someone doesn’t do any testing, or they just do one test at a time. I would say I’m a little bit more on the conservative side, but that being said, I do run a number of comprehensive stool panels. SIBO testing is more based on their symptoms- The comprehensive stool testing is also based on the health history, but I’d say the SIBO test, at least in my experience, the symptoms are usually more overt. Even that is not always the case.

You can’t always go by symptoms. That’s the challenge when dealing with any kind of condition, including gut. Someone might experience constipation, diarrhea, gas, bloating, but there are also people who just feel fine from a gut /digestive perspective. Then you might do a comprehensive stool panel and still pick up H-pylori or something else. Same thing with SIBO sometimes. There is no perfect method, going by symptoms or doing testing. You have to pick and choose. Like you said, I do prefer to try to find answers rather than say, “Let’s treat someone blindly for SIBO or assume they have H-pylori and treat them for that.” I think we’re on the same page with that.

Julie:

That goes right into the 5R protocol. I spend a lot of time in the first R, remove. There is usually a plethora of things to remove and get in balance. I usually take people off all supplements. People come to me on supplements that they don’t know why they are taking. They’re not even on good quality ones. It’s education as well. Then go through replace, reinoculate, repair, and rebalance. It’s a little different for each person, especially if they have SIBO. As you know, you have to be careful about some probiotics and prebiotics. It can be a fine line. I think it’s really fascinating though. I love the detective work part of it.

Dr. Eric:

I agree.It’s challenging. Sometimes it can be frustrating because certain conditions, like I deal with a lot of Graves’ and Hashimoto’s patients. Autoimmunity is complex. You are right with that first R. A lot of people will be taking probiotics or digestive enzymes or drinking bone broth. Those are all part of the 5R, just the other Rs of the protocol. A lot of people will neglect that first R, remove. If you don’t remove the factor that is causing the increase in intestinal permeability, that leaky gut causing the dysbiosis, you won’t heal the gut.

Julie:

Exactly.

Dr. Eric:

We’re also going to talk a little bit after about fecal microbiotic transplants. I’m excited to chat with you about that. Let’s talk a little bit about some of the causes of the disruptive gut microbiome, the leaky gut. I know you mentioned food sensitivity testing, so there is food as well as other things.

Julie:

I want to mention that the pandemic has been really devastating for hair loss, especially for women, just because of our hormonal makeup. Hair loss between 1-4 months after getting it. They’re really struggling. There are Facebook support groups with 11,000 women. Men can join, too, but it’s really affecting women, hair loss after the pandemic. I really believe maybe they got it so badly just because their gut is out of balance.

If you look at this tree that I put together of root causes, our hormones are created in the gut anyway. If you get that imbalance, then that’s part of the chronic inflammation. Then you will have nutrient deficiencies, malabsorption, high DHT. Even women can experience that. Crash diets, poor digestion, even chronic insomnia, undereating, overexercising, underexercising, high fever, infections, pathogens, parasites, autoimmunity, toxic overload (we talked about heavy metals), even trauma/PTSD. The last couple of years have been pretty traumatic for a lot of people. The list goes on and on. Candida. People don’t associate hair loss with candida fungal overgrowth.

A big one is the thyroid. I want to mention that gluten, especially with your Hashimoto’s patients, you know there is a huge link between gluten and thyroid. Even with hair loss. It’s a cross-reactivity with the gliadin antibody, which attacks the hair follicle. They did one particular study with alopecia, the autoimmune hair loss. The subject was doing pretty well and then started eating a gluten-filled diet again, and the hair loss got worse. That is one of the big causes in making it worse, a mediator of everything.

Dr. Eric:

I wouldn’t make the connection directly. You said there is a cross-reactivity-

Julie:

Part of the gluten protein attacks the hair follicle.

Dr. Eric:

Wow, okay. In a perfect world, we would all avoid gluten. Very important especially for those with autoimmune issues. A study in 2015 showed that gluten can cause a leaky gut in everyone. Even if someone doesn’t feel bad eating gluten, you want to cut it out of your diet. Another reason to avoid gluten now.

Dietary fatty acid imbalance. I probably should test everybody for that, but it is an optional test when I send my follow-up to the patients. It seems like they are almost always deficient. I pretty much put everyone on omega-3 fatty acids. It’s not like I’m neglecting it if they don’t do the testing. I just tell them to take a fish oil supplement. That can cause problems like dry hair if not hair loss. It’s amazing all the different potential causes of hair loss.

Julie:

Even Vitamin D plays a role in stimulating new and old hair follicles. When there is not enough Vitamin D in there, hair growth is stunted. It’s just amazing how even though conventional practitioners now are testing for Vitamin D, I get alot of clients that come to me and have been tested for it, but no one managed to tell them, “You’re too low at 20.”

Dr. Eric:

You have to look at the optimal ranges. Many conventional medical doctors just look at the lab range, which is 30ng/ml or less. If it’s 30 ng/ml or greater, they will say everything is ok. Optimally though, you want at least 50. Maybe even 60-80. 20 and lower is not good.

Julie:

Some are even going up to 100ng/ml.

Dr. Eric:

Yeah, some labs will go up to 80 or 100 as far as the range. Are you talking about the range or the lab itself?

Julie:

Some of the new functional levels are anywhere from 60-100 instead of 60-80 now.

Also, iron is a big important nutrient in hair loss, but the caveat is you can also get too much iron, and you can lose hair. That was one of the reasons why I lost hair years ago. I didn’t know I had gluten sensitivity (not Celiac), and I was anemic because of that. I wasn’t absorbing my nutrients. It’s important to do a whole iron panel, just like a thyroid panel. You want to look at the ferritin. It needs to be at 70 at a minimum. If you get over 300, you will lose hair. That’s way too high. Some say over 200. It’s a narrow range, just like the thyroid.

Dr. Eric:

That’s true. Another reason you want to do a full iron panel is ferritin could also increase due to inflammation.

Julie:

Same with iron.

Dr. Eric:

If you do an iron panel, and everything, serum iron, iron saturation, ferritin is high, it could be inflammation, but also you need to be aware of a potential iron overload. If iron is looking good, iron saturation is looking good, TIBC is looking good, yet ferritin is 300-400, then that’s probably a good indication of inflammation over iron overload. That’s good to know as far as you need ferritin to be at a certain level when dealing with hair loss, but you don’t want it to be too high. If iron is too high it can cause oxidative stress, which overall isn’t good for the body. What are your thoughts on biotin in hair loss? A lot of people will run to get the biotin.

Julie:

Let me add one more thing about iron first. Iron is important because if it’s too low or too high, it affects the hair growth cycle.

Biotin is way overrated. It’s like the last hair nutrient you need. If you don’t have enough biotin, it can cause dry, brittle hair. It doesn’t help with the hair growth process. They put so much biotin in these supplements it’s ridiculous. It’s like they haven’t done their research. It’s way overrated.

Dr. Eric:

Good to know. If it’s part of a B complex or multivitamin, maybe not a big deal. What you’re saying is people shouldn’t run out to buy a separate biotin supplement when it comes to hair loss.

Julie:

There are other supplements that are more important. Biotin just helps to keep your hair from getting dry, brittle, and thin. Our hair is mostly protein, but it’s the branch chain amino acids you only get in animal protein. That’s why a lot of vegans struggle with hair loss because they aren’t getting those amino acids.

Dr. Eric:

You recommend to make sure you get some animal protein in the diet. Even if you are eating animal protein, but are low in hydrochloric acid or digestive enzymes, and having issues with digestion/malabsorption, you might not be digesting those amino acids, which could play a role in the hair loss.

Julie:

Yes. There was another study done on a subject who had H-pylori and was losing hair like crazy. Once they corrected that H-pylori, their hair started growing back. Their absorption was all messed up, so how can you grow hair?

Dr. Eric:

H-pylori is a bacterium in the stomach that could affect stomach acid secretion, which is important for breaking down nutrients and amino acids. If you have H-pylori, in my opinion, you want to get rid of it. There is some debate about It in the functional medicine world.

Do you want to dive into the fecal microbiota transplants? I know you have anew published abstract.

Julie:

I do. There are four subjects. One was a 20-year-old man who had CDIF. I call it the gut reset.

Dr. Eric:

As the name implies with the fecal microbiota transplants, it’s pretty much putting the stool of one person into another person. Of course, they do testing, which is not done as much as it probably should be. In the United States, it’s only officially for those with cdiff. I know functional medicine practitioners will recommend it for other conditions, but as far as the conventional medical world, it’s just still known for cdiff in the U.S.

Julie:

They did these studies, and one had cdiff. He had alopecia universalis. That’s losing hair all over his entire body. After the procedure, he grew hair everywhere that he was supposed to, where he hadn’t seen hair for years.

A 38-year-old man also had alopecia universalis. Same. He saw dramatic hair growth afterwards.

A 34-year-old woman had ulcerative colitis and hair loss. She had a huge improvement with hair growth even after a six-month follow-up.

My favorite one is an 86-year-old man. This man was told he would never grow hair, just like the other people in the study. He had a history of colon cancer, depression, and diarrhea. He grew his hair within four weeks after the procedure. He also had alopecia. It improved all his other health issues, too.

They are mostly doing this for other reasons in Europe and Canada. We are always far behind.

The reason I like to mention this is because it proves the fact that if you clean up your gut and get it in control and in balance, you can grow hair. Obviously, you can help other conditions, too. It proves the point. It’s pretty radical, and it’s not easy to get.

Dr. Eric:

A connection to how important the gut is. If you take the stool from a healthier person, seeing that dramatic impact on someone’s health. We’re not just talking about gut issues but hair. Alopecia areata- Are all of them autoimmune?

Julie:

They’re all autoimmune, yes. Areata is the most common. That’s the one that Jada Smith is experiencing.

Dr. Eric:

This is timely because of that. Unfortunately, the medical world doesn’t do anything to help with the gut to focus on the autoimmune component. Same thing with other conditions. There is hope. It’s amazing the connection with the hair loss. A lot of people might be surprised at how in depth we’re going with the gut. If you have an unhealthy gut, that can affect hair loss and other aspects of your health. If you have done everything, such as taking supplements, especially biotin, if you have an iron deficiency, if you’re not eating enough protein, there are so many different factors that could lead to hair loss. Arguably, most of these factors are related to the gut.

It’s great to go into so much depth about the gut microbiome and the fecal microbiota transplants. It’s important to show research when it’s available. Hopefully within the years to come, there will be more and more studies coming that show the relationship between FMTs and hair loss as well as other health conditions. Thank you so much for sharing this.

Julie:

Another study just published in the Journal of Nutritional Medicine and Diet Care found really strong evidence linking the gut to the diet with development of alopecia. Still, people are not convinced that the diet is going to have a huge role on our hair health.

Dr. Eric:

It’s not just about gluten. We spoke about gluten. We spoke about some of the things you should avoid, but there are things we should be eating to help support the microbiota, like vegetables. Eating a good variety of them. A mostly whole food diet, I’m sure you agree.

Julie:

A supplement people don’t think about with hair loss is niacin. It gets the circulation to the scalp. That’s another problem. People aren’t getting any circulation to their scalp. Niacin helps break down the buildup of DHT and calcium that can cause hair loss. A simple hack of standing on your hands or head, getting that circulation to your scalp. It feels good, too. Sleeping on a silk pillowcase retains the moisture in your hair and is good for your skin. There are simple hacks to keep things better aligned.

Dr. Eric:

Do you recommend hanging upside down?

Julie:

An inversion table. Or standing on your head or hands at the gym. Getting circulation to your scalp is important.

Dr. Eric:

You mentioned niacin as a supplement. Do you have thoughts on silica?

Julie:

Silica, collagen is great. Selenium, zinc, manganese are other top ones that also help with thyroid health. Selenium is another tricky one. People think they need selenium, but they end up taking too much.

Dr. Eric:

Or they combine that with Brazil nuts and get too much. Or iron overload. With selenium, that’s the case. Other nutrients, something like magnesium, probably not as big of a risk. You can overdose with anything. But the consequences or side effects are worse when taking too much iron or selenium compared to too much magnesium. Is there anything else we should discuss?

Julie:

Going through the 5R approach again. You could jump in there and not get to the foundation of what’s going on. You can waste so much time and energy. I know it’s all based in functional medicine and nutrition. Other practitioners are out there trying to help, but they can be more of a detriment than helping because they are not starting at the beginning.

Dr. Eric:

Let’s say if someone is experiencing hair loss, and there could be many causes as we discussed, where would you start? It sounds like you would start with that 5R protocol.

Julie:

I would start with my questionnaire and the functional labs. Then the first R, removing. I build from that. A lot of my clients come from dieticians or dermatologists, who would throw supplements on them and say eat better. It’s not all about that. You might be even eating well, but you’re under chronic stress, so you’re not absorbing your nutrients. There is something going on in your gut. Then I have to start over with them. They get frustrated because they already spent money with these other practitioners. I’m sure you get those people, too.

Dr. Eric:

I agree. Diet is a piece of the puzzle without question. Pretty much every functional medicine practitioner recommends to their clients, or hopefully, to eat a healthy whole food diet. Food could be part of that first R. Dairy and corn could also be factors, just like gluten. It could also be gut infections. It could be H-pylori or parasites. SIBO-

Julie:

Epstein-Barr. That’s what I had.

Dr. Eric:

Stress by itself can have such an impact on our gut and overall health. Of course, being that most people listening have a thyroid or autoimmune thyroid condition, even though you definitely want to focus on the gut, sometimes you do need to initially take, in the case of hyperthyroidism, antithyroid medication or herbs like bugleweed. In the case of Hashimoto’s, maybe take thyroid hormone replacement. Focusing on the gut is important, but you might need to do something to help balance the thyroid while you’re addressing the cause of the problem.

In the case of hyperthyroidism, the goal isn’t to be on antithyroid medication permanently. With Hashimoto’s, it might be different. They might need to be on thyroid hormone replacement long-term. I agree that the 5R protocol and having a healthy gut is important, but in many cases, people do need to take either the medication or herbs to help with the balancing of the thyroid hormone.

Julie:

Absolutely. Determining their food sensitivities, I used to do this when I worked in a functional medicine practice with an MD is put them on an elimination diet the first appointment. They really struggle with it. What I do in my practice and find more effective is do a blood test for food sensitivities. Then they see it. The elimination diet, they might be eliminating something they don’t need to because everyone is so different. At least in my experience, when they can see it, it’s more helpful.

Dr. Eric:

Good point. In our practice, we do a lot of the elimination diet. You could go back and forth as far as the perfect method. What I have been thinking about doing is both actually. Give them the option of doing a food sensitivity test. There is also mediator release testing, MRT. There is IgG testing, too. Starting with that, and also incorporating an elimination diet. There are pros and cons of each. You might eliminate something you don’t have to. You might be eating something that you’re sensitive to. An elimination diet, you aren’t usually eliminating broccoli or avocadoes, but you could be reacting to those. Food sensitivity testing is not perfect either. I have been thinking about combining the two or giving the option to the patients to focus on one or the other. Another example of how different practitioners practice differently.I can’t say I have been a big fan of food sensitivity testing over the years.

Julie:

We should talk because I agree. There are a lot of really bad food sensitivity tests out there. I only trust a couple. One of them is newer in the market. They take insurance a lot. What I like about it is they test not only the IgG, but the IgA, the IgE, the IgE4, and the complements. You’re seeing their allergies, sensitivities, and complements. It’s like 188 foods. A good amount. Then you can layer it. It takes most major insurance companies.

Dr. Eric:

That is good. I have used Cyrex Labs in the place. I do like them, but they are a little bit pricey, and I don’t think insurance will cover them. The ones you can order on your own, those are not too accurate. With any test, that has been the case, even with comprehensive stool testing. There  are ones I stopped doing because I didn’t find them to be accurate. I like the GI Map. GI Effects from Genova is also good. But that’s a great point. In this day and age, you can order tests on your own. Just like the supplement you mentioned, quality is important. We think about it with tests, but the average person thinks a test is a test. A stool panel is a stool panel. The point is, choosing the correct lab is extremely important as well.

Julie:

They can waste a lot of money on a lot of tests.

Dr. Eric:

This was a good conversation. We went beyond hair loss, but it does relate because we spoke about food sensitivity testing, which ties into what was discussed earlier.

Julie:

It’s like picking a scab. If you keep eating those foods you’re sensitive to, it will affect your hair.

Dr. Eric:

Thank you so much for sharing everything. Where can people find out more about you?

Julie:

JulieOlson.net is my website. I have a phone number on there, my office number. They can find me on social as well.

Dr. Eric:

Thank you so much, Julie. Appreciate you joining us. You shared a lot of valuable information.

Julie:

Thank you so much, Dr. Eric. It was really a pleasure.

 

Recently I interviewed Dr. Achina Stein, as she discussed depression, including how it relates to inflammation and thyroid autoimmunity.. If you would prefer to listen the interview you can access it by Clicking Here.

Dr. Eric Osansky:

With me, I have Dr. Achina Stein, who is an osteopathic physician, a board-certified psychiatrist, and has been in practice since 1994. She is a certified practitioner of the Institute for Functional Medicine, a distinguished fellow of the American Psychiatric Association, an Azarias energy healer. She was awarded the Exemplary Psychiatrist Award by NAMI Rhode Island in 2008. Located in Rhode Island, she is the co-owner of private practice Functional Mind LLC. She is the #1 Amazon best-selling author of What If It’s Not Depression? Your Guide to Finding Answers and Solutions. She has a YouTube channel and podcast by the same name. Thank you so much for joining us, Dr. Achina.

Dr. Achina Stein:

Thank you for having me, Dr. Eric. My pleasure.

Dr. Eric:

I’d like you to start off by giving your background. How did you start out in psychiatry and eventually getting into the functional medicine world?

Dr. Achina:

We’re going back almost 30 years.

Dr. Eric:

I guess we could focus more on how you made that transition to functional medicine and not just giving anti-depressant medication.

Dr. Achina:

That’s an easier question to answer. I was a traditional psychiatrist, working in a community health center. I have worked in the prison system. I have worked on consultation liaison in hospitals. I liked moving around because I loved having different perspectives. I worked on the child unit, on the geripsychiatric unit. I have basically treated all ages primarily with medications and psychotherapy. I am trained in psychotherapy.

I was finding that I was hitting a wall in treating certain people where they just weren’t getting better. I am one of those people who gets a thorough history, spending a lot of time with my patients, more than the average psychiatrist. I really want to try to figure out what’s going on. Why aren’t they getting better? I spent a lot of time already talking about diet, exercise, sleep, and habits. There was this feeling that in my gut and my heart that I was missing something.

Around that same time, coincidentally, I don’t believe in coincidences. At the same time, my son had a significant mental health crisis. This was back in 2010. He was 14 years old. He basically had a tiff with his brother that ended in a meltdown, resulting in him standing on a fifth floor ledge of a building ready to jump. That is the kind of thing that kids tend to do. They feel like it’s the end of the world in that age group, anywhere from 10-16. Something happens, and it’s the end of the world. He just lost it. It wasn’t something that we anticipated. It was just out of the blue.

He became severely depressed and very anxious, and he had insomnia. I thought, Oh well, this is it. This is my son who is now having an exacerbation of symptoms based on our family history. Both sides have pretty significant depression and suicidal ideation with attempts. Actually completed suicide attempts. This was very concerning for us. I was blindsided by this. Here I am, a psychiatrist, and my son is having a serious situation. I did not see it coming. It makes you think about your parenting skills and why you didn’t see it coming.

The thing that made me think that something else was going on was the fact that he was not able to read at all. This was a kid who was an avid reader and had really good memory skills. He would read it once and know it. He would hear songs once and know all thewords. That kind of memory. And he was not able to read and retain. I felt at that point, because of my skills, there is something neurological going on. I really honed in on this is a brain-based, neurological problem and not psychiatric, so to speak. I took him to many doctors, and they weren’t able to explain it.

I had to do a deep dive in research myself and find other practitioners to help me. Serendipitously, I came across a functional medicine practitioner and had him see my son. I asked him if I could shadow him because I was so intrigued by what he was doing. I shadowed him for a period of time, and that’s why I decided to have him see my son.

Long story short, he got him well. He made changes to his diet. He found that he was nutritionally deficient. He had Celiac Disease. He had a considerable amount of inflammation in his body as a result of having long-term, long-standing constipation since he was a baby; long-standing eczema since he was a baby. You take symptoms that are pretty serious and think that’s normal, but it’s not.

A lot of those symptoms, including the constipation and the eczema, completely resolved. It took a little while for the depression and anxiety to resolve. Mind you, he was on four medications at the beginning for psychiatric purposes. He was on an anti-depressant, anti-anxiety, sleep, and stimulant for concentration. He was not my kid. He was able to come off all those medications by the end of two years.

What we found was the reason he couldn’t read was because he had double vision. He had diplopia. His eye muscles became very inflamed, so much so he had double vision. That actually was the symptom that took the longest to resolve.

Once you learn those things, you can’t unsee them. You can’t practice. I became certified in functional medicine. I left my job as a medical director at a community mental health center to practice functional medicine with the gentleman, Dr. Levitan at Visions Health Care at the time, and started working for his organization. There was no other organization that did this kind of work locally, so I worked from them and learned functional medicine. Once that practice closed, I opened my own practice with my partner Sally Davidson. Here we are, almost five years later.

That’s all I do now. I have a handful of patients I see for psychotherapy. That’s my mission: to tell people about this. After we got my son well, I did the functional medicine approach to my own health issues. I have Hashimoto’s, which has been stable for a number of years. I had depression as a result of that and was on medication. I have since been able to taper myself off that medication as well and am doing great.

Dr. Eric:

A few things you mentioned. You mentioned inflammation, and you mentioned symptoms related to the gut, including constipation. It’s only been recent, and I can’t even say all psychiatrists, you would know better than myself, but many psychiatrists still think about depression as related to the brain. Same thing with anxiety. No relation to inflammation or the gut. It probably comes down to the training you also had in medical school. Would that be correct?

Dr. Achina:

As a DO, we are required to do a year internship in all other disciplines. I delivered babies. I saw kids in pediatric rotation. I did surgery. We are required to do an internship, which is followed by three years of psychiatric residency. I am very comfortable talking about medicines and medical issues, much more than the MD counterparts.

Like I said, I have always talked about medical issues with my patients, particularly in the community health mental center. Many patients do not like to go to doctors. They have to go to their psychiatrist to get their medications. They are either paranoid, or they don’t trust them. I would really talk about their medical issues and connect the dots for them. This is before I did functional medicine. I had that mindset talking about diabetes or weight or hypertension. There was a point where I would be monitoring some of these things for them. Now I really need you to see your primary care person. I can’t manage these things. It was such a logical transition for me to become a functional medicine doctor because that was a piece that was missing for me in caring for my patients. It made so much sense.

I remember seeing a patient at the community mental health center who said, “Is it normal to see pills in your stool?” Undissolved. I had to ask myself, Is it normal? I don’t know. No, it’s not normal! It’s not normal to see pills in your stool. Whole pills. That means you’re not digesting at all. It’s not normal to see large particles of food in your stool. You’re not digesting. That’s a major root cause of mental health issues. You’re not digesting and assimilating all your nutrients, fats, and proteins, which are so necessary for the brain and the rest of your body. With the brain being so sensitive, you absolutely need to be able to digest, absorb, and assimilate your food.

As I became a functional medicine doctor, there were patients in my mind. Oh, that’s why that person didn’t get better. All these people would pop into my mind about what I could have done differently. I am always thinking about them. Still to this day, there are puzzles that I have not solved. That’s how I approach people. I like to solve problems and issues and try to figure out what’s going on and keep digging and digging and digging and finding out what’s going on with that patient.

Dr. Eric:

Since a healthy gut microbiome is important for overall health, including mental health, everything is connected, that sounds like that’s a big part of what you do. We could talk about leaky gut, I guess, but do you want to try to find out the cause of the leaky gut, or the dysbiosis, the imbalance in the gut flora, and try to address that? When you see that, I’m guessing you see dramatic changes in your patients’ depressive-like symptoms.

Dr. Achina:

Absolutely. Depression is just a symptom of inflammation when it comes- That’s not 100% true. It’s the root of the root of the root really. It’s figuring out where the inflammation is coming from. We look at biological causes, psychological causes, social causes, and physiological or functional causes. It’s really connecting the dots.

The depression is just one manifestation of that complex of symptoms. If someone has an underlying autoimmune process going on, then the root cause for the depression really is that autoimmune process, or at least one layer. You want to find all the layers. It could be because your job is stressful. It could be that you have a toxic boss. It could be that you have three kids, and one of them has special needs. It could be that you had trauma from your early childhood. All of those things cause your cortisol levels to go up, which can cause a leaky gut.

It always comes down to in my mind five things: foods, infections, chronic infections, toxins, and stress. All of those really affect your hormones, particularly cortisol, your stress hormone. If you are looking with that foundation of issues at those five things, you will definitely find all the root cause. It’s looking in all of those realms. What most psychiatrists do is look at the biological and possibly the psychological and possibly the social. They don’t really connect the dots in terms of nutritional deficiencies.

I have a patient today who had a Vitamin D level of 18. Her primary care provider put her on Vitamin D, but only 1,000 or 2,000. She sees a psychiatrist. She has seasonal affective disorder. They don’t think about these nutritional deficiencies. Never asked what bloodwork had been done. At least hers never did, she says. Some psychiatrists have more training around this, looking at B12 and folic acid, which are highly connected not only to depression but other issues. It is looking at all this nutrition.

Nutritional psychiatry, believe it or not, is a brand-new field. Integrative psychiatry has been around for a decade, but it’s not really as accepted. But it’s coming around. People are learning more and more about these connections that are in the field. Especially the newer graduates are learning about inflammation, brain inflammation, BDNF alpha, and all of these things that are now in the literature. You might learn these things, but it doesn’t really come into practice honestly for 10 years. It takes 10-15 years to see it in everyday practice, where it’s common knowledge. But at least, it is moving in that direction.

I can say I was asked to be the plenary speaker for an American Psychiatric Association conference out of Oklahoma. I was asked to talk about my methods as a pioneer in the field doing this. They considered me a pioneer doing this. I have been doing it for 10 years now. It is good that they asked me. They could have ignored me, “Oh, she does that thing.” People want to learn. I am seeing shifts in a positive direction around this. It will take its time, but it will happen.

Dr. Eric:

I’m sure it’s moving in the right direction. More and more younger psychiatrists coming out of school are getting different types of training than you did when you were in school. It will be more than just dispensing medication in the future. Unfortunately, that sill happens probably too frequently.

You mentioned you had Hashimoto’s before the depression. I work with a lot of Graves’ patients and also had Graves’. Just like Hashimoto’s, it’s autoimmune. With Graves’, anxiety seems to be more closely associated, but Graves’ patients can also experience depression as well. That is tied into the inflammatory process as well as the leaky gut that is associated with autoimmunity. Essentially, anyone with any autoimmune condition, would you say they are at an increased risk of developing depression because of the increased inflammation and gut issues?

Dr. Achina:

Sure. Some more than others. Lupus, multiple sclerosis, MCI have higher incidence of depression as well as Hashimoto’s and Graves’. Much more than the other types of autoimmune diseases. Definitely Celiac. You will see certainly low levels of depression and anxiety across the board, but the more severe types of depression, you will see in lupus in particular. It can actually show up first as an initial symptom of lupus.

About 50% of patients with hypothyroidism have been given a diagnosis of major depressive disorder. Hypothyroidism is a major root cause. It happens to be the one illness that is searched for as a possible explanation for a major depressive disorder. If bloodwork is not done to look for that, then the average doctor is not practicing the standard of care. That’s been done for at least as I’ve known and even before my day that getting a TSH—there are certainly limitations with getting the TSH—but there was an effort to determine whether or not a person had the depression from hypothyroidism. There is certainly not enough data nowadays to know if you have a sub-clinical hypothyroidism that is playing a part, or just not looking at the entire thyroid panel. It’s so important to do a full thyroid panel. There are still many doctors today who don’t believe in getting a full thyroid panel.

Dr. Eric:

True.

Dr. Achina:

I have to convince doctors to do a full thyroid panel. It’s just a matter of not being educated about these things. Eventually, things like that will catch up.

Dr. Eric:

You mentioned sub-clinical hypothyroidism. For those who don’t understand, that would be an elevated TSH, and thyroid hormone levels are within the lab reference range. It might be lower than optimal. If someone has overt hypothyroidism, where the thyroid hormone levels are below the lab reference range, that could definitely increase the risk of having symptoms of depression. It sounds like if I heard correctly, if someone has sub-clinical hypothyroidism, that could also be a factor when it comes to depression even if the thyroid hormone levels are within the lab range.

Dr. Achina:

I think so, yeah. It depends on what the numbers are and what else is going on. I have seen when people have had high levels of adrenal-

Dr. Eric:

Cortisol?

Dr. Achina:

Cortisol levels. Their adrenaline is up all the time. They’re energizer bunnies and under a great deal of stress. The thyroid will downregulate to balance as a normal response to the adrenals. It’s looking at the whole picture. Why is that happening? Why is the thyroid putting on the brake? Sometimes the thyroid goes into hibernation and shuts down the metabolism on some level, so it goes into safe mode. Like our computers go into safe mode, our bodies go into safe mode. How? By downregulating the thyroid.

Not everyone needs to be treated. I wouldn’t necessarily say they have a disease or disorder, but it’s a dysfunction. In a way, it could be an appropriate function or a response to something else happening in the body.

Dr. Eric:

Some of the things we mentioned, they have Hashimoto’s, that inflammatory process, the gut microbiome, there are other things as well. You mentioned testing for the thyroid, but are there any other types of testing? You mentioned nutrient deficiencies. Do you do neurotransmitter testing? What type of testing do you do? It might vary depending on the person. If someone comes in, and you’re suspecting depression, what are some basics that most people get? If there are other tests that you might give some people, too.

Dr. Achina:

I get a stool test through GI Map. If I suspect SIBO, I will get a breath test through Aerodiagnostics. I get the organic acid test from Great Plains Lab. I will also get a whole battery of bloodwork: CBC, CMP (comprehensive metabolic panel), homocysteine, lipid panel. A cholesterol below 160 is very concerning with depression. Vitamin D, Vitamin A, copper, zinc, magnesium, selenium. Those are critical minerals that are needed under a stressful environment. Imbalances in those areas can cause depression and anxiety. HSRCP, DHEA, which is a marker for stress hormones like cortisol. This is bloodwork. An Omega 3/6 panel to see what the balance is of Omega-3s and 6s. I’m sure I’m missing something else.

Dr. Eric:

You don’t have to give everything. I was just trying to get an idea. But that is pretty comprehensive, even if you have left a few out.

Dr. Achina:

I don’t necessarily just treat the depression and narrow my focus as depression resolution. I treat the whole body. I have always treated the whole body. It’s the other symptoms that will help me to understand where the depression is coming from. If somebody has metabolic syndrome and insulin resistance, then depression can be caused by that. If they have a low cholesterol, and they have anorexia, then the depression can be coming from that. It’s really looking at patterns in the symptoms and patterns in the bloodwork that will help to find the root causes of the depression. I go after the root causes, and the depression resolves because I see the depression is a part of that pattern. It’s part of the manifestation of what is happening in the whole body.

The times where I really hone in in terms of specific symptoms is after doing a full gut restoration: removing what’s causing inflammation, repairing what’s missing, reinoculating the gut microbiome, repairing the gut lining. What happens is the fog clears. Then there are pieces of that depression we can then really focus on. It might be childhood trauma. It might be that their life is so stressful that they are not taking time to rest. Of course, we have already addressed sleep, exercise, movement, and diet by that point. It’s honing in and fine tuning the approach to specific things that are happening that keep triggering the inflammation, like the toxic boss or the marital problems or not knowing how to manage the kids at home or giving time to yourself or having chronic feelings of guilt, fear, shame, or anger.

You asked about neurotransmitter testing. I used to do it quite often earlier when I started doing functional medicine, but I don’t find them to be useful. It is a dynamic process. You can really figure out where there needs to be support by just getting a really good clinical history.

Dr. Eric:

I agree with the neurotransmitter testing. I don’t do it. I don’t use the organic acids testing on everybody, but I do it on some of my patients. That looks at some of the metabolites related to dopamine, serotonin, epinephrine, and norepinephrine. Of course, that gives so much more information like yeast and candida and mold markers and indicators of detoxification.

Dr. Achina:

The beauty of that test is that first page, the microbial organic acid, especially the clostridia. You can’t really pick that up without testing.

The thing about depression is that many of the symptoms of a major depression are things you would see in a classic sick syndrome: low energy, sleep problems, thinking problems, appetite problems, concentration problems. If somebody had the flu and was really sick, you would feel that way. It just happens to be that people with major depression feel that way every single day all day.

What I hadn’t been trained in is to look at that as this is a whole body illness that just happens to be affecting the brain. It’s the brain hardware and software. Why don’t we look at this as a whole body problem? If you had a problem with your computer hardware, it will glitch. Our brains are just glitching on some level.

I find that when people don’t feel well, their perceptions of what’s happening around them changes, including their perceptions of any trauma that they may have had in the past. When you’re not feeling well, you’re not processing things well. Things come up that in the past probably wouldn’t have come up if you felt well. Just the not feeling well shouldn’t necessarily be considered that you have major depressive disorder and completely isolate it from the body. Your head is connected to the body. It’s all connected. To treat it as a separate entity is a huge disservice to people.

Dr. Eric:

I definitely agree with that. With any type of condition from a functional medicine standpoint, you want to take a whole body approach. Pretty much all conventional medical doctors take the opposite approach. More and more practitioners are learning about functional medicine and keeping an open mind.

When it comes to diet, is that one of the starting points, too? Pretty much with all functional medicine practitioners, it’s changing diet. Where do you start when it comes to diet? Is it just eat whole healthy foods? Do you require your patients to go gluten-free or dairy-free?

Dr. Achina:

Ideally, I would want them to be gluten-, dairy-, and sugar-free in the beginning. I always start where the patient’s at. If they have never been gluten- and dairy-free and don’t have the resources or support around doing that, they have to start in baby steps.

If they are terrified of this deficit of things they have been eating, I’ll start with adding some fruits and vegetables. Generally, people who are on the standard American diet will be devoid of fruits and vegetables. Starting by adding things, it’s easier to add things first. That might not be the case for some people who have a really hard time with vegetables. It’s a negotiation.

With the patient, where are you willing to start? This is where you need to be. This is my experience in being gluten- and dairy-free. It’s worth doing an elimination diet. I have found that the whole 30 is something that people can wrap their heads around as a modern elimination diet. That might be a good place to start for some people.

Essentially, my goal is to get them to a Mediterranean diet. Then maybe a paleo. Then potentially, if they still need some more push or oomph in the clearing of brain fog, let’s say, I might push to keto. If they are still having energy issues or brain fog, the ketogenic diet. I don’t believe that people should stay on a diet long-term. Diets should evolve seasonally. They should evolve based on what other issues are happening. I use the diet as a way to shift the metabolism, shift the microbiome in order to heal.

Then you can start adding things back. I have had people be able to add things back in that otherwise they thought they would never be able to. A lot of times, you can reintroduce these foods, but there is a proper way to do these things.

Dr. Eric:

You mentioned low cholesterol. I’m glad you brought that up because it’s very common for people with hyperthyroidism to have low cholesterol. That could be a factor in depression. You mentioned you don’t like to see the levels below 160, correct?

Dr. Achina:

Correct. Below 160 can definitely be causing depression. Cholesterol is a building block of insulation around your brain cells. Your brain is 80% fat. Cholesterol is fat. You need enough cholesterol in order to make hormones, too. There are studies that show cholesterol levels below 100 or even 80 can cause chronic suicidal ideation daily. There are multiple studies that show that.

Unfortunately, when we have people in the hospital, it’s not even a test that’s drawn. In kids, teens, and young adults, it should be drawn. A lipid panel is rarely drawn in the younger age group. I think it should be part of every battery of tests when it comes to depression and suicidality.

Dr. Eric:

When it comes to low cholesterol, if someone has hyperthyroidism, they have to address the elevated thyroid hormone levels. It could take time for that to increase. When it’s not related to hyperthyroidism, do you have any strategies for low cholesterol? Sometimes it can be genetic. Do you mostly try to increase it through diet?

Dr. Achina:

Other than food, like eating eggs, cholesterol is made by the liver. Sometimes, the liver gets congested, and it doesn’t have the machinery running in terms of making cholesterol. There is a supplement that is made by a company called Sonic. You can get it from New Beginnings. There is only one company I know of that makes cholesterol pills. You can take some supplements to boost your cholesterol level. I have had a couple of patients with autism that have taken that. I see low cholesterol in quite a few kids with autism as well.

Dr. Eric:

When someone comes in with depressive-like symptoms, just to summarize, we know that you want to address the cause of the problem and treat the whole body. What were some of the first steps you would take? If someone is convinced they need to see you or a different psychiatrist that practices functional medicine, what should they expect?

Dr. Achina:

Doing a screening to make sure you’re not in an acute crisis. I would make sure that you’re safe and that you were able to function on some level because functional medicine does take work, and it is time. You have to be well enough unfortunately to do the work of changing your diet, doing exercise, and all of these habits that need to be in place.

If you are having an acute depressive episode, and you’re in crisis, you shouldn’t go to a functional medicine doctor to help you. You really should see someone who can stabilize you possibly with medications or even hospitalization if that is necessary. Sometimes people have called me, and they need to go to the hospital because they are safe and are not functioning. If you are hearing voices, if you are having chronic suicidal ideations, if you are paranoid, you should seek help right away and get stabilized first. Once you’re stable, then come see me.

I’m not going to be able to help you until you are able to do the work that is required. Your brain needs to think on some level. That doesn’t mean to say it might not be hard, but you have to be able to do a certain amount of work over time. You won’t get results immediately, but you could get results within 30-60 days. I see people feel so much better just by changing their diet in 30-60 days. Sometimes that’s faster than people who start an SSRI and didn’t change their diet at all.

I would say that making sure you’re safe, making sure you’re not in a crisis, and you do have to be willing to do the work and invest the time. Creating that space for yourself, putting yourself first, putting your oxygen mask on first, saying you deserve it, and you are worth it is a really important mindset change.

Having a destination. Where do you want to be? You need a destination. It’s not just, “I want to feel better.” It’s not about suppressing symptoms. It’s about being well. You have to have an idea of where you’re going in the process. I have people do this exercise to have in their mind’s eye, “This is where I want to be, and these are the things I want to be doing when I’m well.”

Dr. Eric:

Where can people find out more about you? There is your book I recommend getting, What if It’s Not Depression?

Dr. Achina:

You can find my book on Amazon. You can get it at my website, FXNMind.com. I have another website, AchinaSteinDO.com. I am also on Instagram and Facebook. On Instagram, @Dr.AchinaStein. On Facebook, it’s “What If It’s Not Depression? with Dr. Achina Stein.” I have a YouTube channel, too. You were one of my guests, so we can watch your video. Other experts in root causes of depression as well as tools to resolve symptoms of depression and anxiety. Thank you.

Dr. Eric:

Thank you so much, Dr. Achina. It was great chatting with you. We might have to have you on again in the future because there is so much totalk about, and I have so many other questions.

Dr. Achina:

Great. I would love that. Thank you so much for having me. It was my pleasure.

***

Dr. Eric:

It’s just amazing how important the gut microbiome is when it comes to depression and anxiety. For years, practitioners would just focus on the brain. There are plenty of psychiatrists who still do this. I’m not saying there isn’t a time and place for medication. But it really is important to focus on the health of the gut.

If you or someone you know is suffering from depression, please have them check out this episode. Perhaps also send them to Dr. Achina’s YouTube channel so they can learn even more about how to overcome depression and anxiety without relying on medication.

That being said, here is a clip of Dr. Achina and I chatting about SSRIs:

***

One thing I wanted to quickly ask you, as far as SSRIs, a lot of people are on medication, including a lot of children. What are potential long-term consequences of being on medications? One is just not addressing the cause of the problem and masking them with medications. Are there any side effects?

Dr. Achina:

First of all, medications do poop out. At some point, they really don’t work any longer. What it can do is cause some neurological problems in terms of this imbalance of serotonin and dopamine. You end up becoming low in dopamine, resulting in these neurological issues almost like Parkinson’s symptoms. It’s not called Parkinson’s, but there are people who have these neurological symptoms related to low dopamine. That is a long-term risk of being on SSRIs.

As a result of taking them for a long time, it really changes the balance in your brain on an almost permanent level. When you try to come off of these medications, many people do have a discontinuation or withdrawal syndrome that is really hard for many people. It’s very painful in many ways. People get zapping, ear ringing, tinnitus, dizziness, lightheadedness, nausea, upset stomach, headache, even neurological symptoms in terms of finger sensations. There is a whole list of symptoms that people can have. Dyskinesias, which is abnormal movements. Akathisia, which is a restlessness, ants in the pants feeling. These are not comfortable feelings. Unfortunately, people end up having to go back to the dose that they were taking. Although it’s not necessarily doing anything for their depression anymore, they have to take it because they can’t get off of it.

There are many doctors who don’t know how, and we’re certainly not trained, to be able to taper a patient off of these medications safely. When we were trained, and this was when I was working as a psychiatrist, our understanding is once you’re on a medication, you have to stay on it. Now you have this illness that will never go away. That is far from the truth.

If you address the root causes, you can absolutely bring the body back into balance. I have been quite successful in getting many people back into balance and getting them off of medications as well. It takes a while. It’s not for everybody.

If some people have been on four or five medications- That’s the problem. One medication poops out, so you get put on another medication, and another, and another. It’s this whole polypharmacy that at some point, the side effect combinations of these can cause side effects. The #1 cause of death in this country is being on all these medications and no one managing the drug-to-drug interactions that are occurring. The solution is to keep increasing the dose until a person is so frustrated that they just stop the medications without even discussing it with a doctor because the doctor won’t support that. That seems to be the trend.

Of course, you will find the occasional doctor that will work with you and try to reduce and discontinue these medications. For the most part, there is no training around what to do. It’s very important to find someone who knows how to do that.

Also, know there is definitely risks in taking these medications as well as benefits. I’m not suggesting that you shouldn’t take the medication. You have to look at the risks versus benefits at the time. These medications can be lifesaving, but you want to have the conversation and have good, informed consent around the decision. You also want to have aplan to come off of it when it’s time.

I liken it to rehab. If you ever had a car accident, and you had multiple broken bones, and you need the jaws of life to get you out of the car, you are going to want to be helicoptered to the hospital and be in surgery and fix whatever needs to be fixed, etc. But you know that you will come out of those casts. The plan is coming out of those casts once you heal.

There is no plan like that in psychiatry. There really isn’t. There will be crises. Things will happen. My son had an acute mental health crisis, and he was put on meds. Thank God there were meds. But there was no plan for him to come off of them. Fortunately, for him, I became a functional medicine doctor and was able to do that with him.

There is hope that can happen. I’m not anti-medication. I am pro-informed consent. There is certainly a place for them.

Dr. Eric:

Thank you so much for sharing that. It’s probably a good idea for someone who is taking a medication, and if their doctor isn’t willing to help them wean off, they probably should see someone like you. Would you say they need to have a functional medicine background, or is it just the fact that many conventional doctors refuse to help people wean off? Like you said, once they’re on it, it seems like all they do is over time increase the dose. Someone like you would definitely help them, but other conventional medical doctors that do help people.

Dr. Achina:

There are definitely organizations that do help people come off of SSRIs. There is one major one out of England that is a huge proponent of trying to get people off of SSRI medications. There are other possibilities. If you needed a supplement, there are things you can use like L-theanine and GABA. There is taurine, tyrosine, 5HTP, SAME, all of these natural formulations. There are combinations as well. A combination of vitamins and things that work really well and can help to stabilize you while you are searching for the root causes. It doesn’t have to be these heavy-duty medications.

In a severe crisis, you should try the medications. But if it is mild to moderate, sometimes there are risks in medications. Medications in certain populations like kids and adolescents can cause suicidal ideations or a manic episode. There are risks in taking them. You want to make sure the benefits far outweigh the risks when you are choosing to take a medication.

There are supplements you can take instead of taking medications. I don’t recommend taking them while you are on medications because there are drug to drug interactions. You want to avoid combining the two. That’s not safe at all. There are things like serotonin syndrome that can put you in a crisis. If you are listening to this, you need to work with someone who knows what they’re doing in this arena.

 

Recently I interviewed Dr. Wendie Trubow, as she discussed many of the different environmental toxins that can not only affect the thyroid, but one’s overall health as well. This is one episode that everyone can benefit from listening too, regardless of whether you have Graves’ disease, Hashimoto’s, or a non-autoimmune thyroid condition. If you would prefer to listen the interview you can access it by Clicking Here.

Dr. Eric Osansky:

Today, I have Dr. Wendie Trubow. We will be chatting about environmental toxins. I am going to dive into Dr. Wendie’s bio here. Dr. Wendie is a functional medicine gynecologist with a thriving practice at Five Journeys. She is passionate about helping women optimize their health and lives. Through her struggles with mold and metal toxicity, Celiac, and other health issues, Dr. Trubow has developed a deep sense of compassion and expertise for what her patients are facing. She is co-author of Dirty Girl: Ditch the Toxins, Look Great, and Feel Freaking Amazing. It’s a great book with a great title. Thank you so much for joining us.

Dr. Wendie Trubow:

My pleasure. Thanks, Eric. Great to be here.

Dr. Eric:

Great to have you. If you could talk about why you decided to write the book, get a little bit into your backstory.

Dr. Wendie:

When I was 48, I went off the cliff. I blamed it on perimenopause. In reality, it was because I had gotten a level of toxic exposure that I was now showing symptoms from. I had a lead exposure just before turning 48 in September. The next year, in April, I was 48, and we went to Notre Dame right after it had burned down. We slogged through the dust, came home, and I gained nine pounds, had a rash on my face, eyes, nose, under my lip. I wanted to rip off my face. My hair was falling out in droves. What was going on?

It took me a few months to figure it out. I do functional medicine. I applied all the testing to myself. My thyroid was fine, perfect, never better, amazingly because I had always been a little off. My adrenals were good. My gut looked good. My minerals/nutrients looked good. What’s going on?

Finally at the end of the summer, I heard a report on NPR that said when Notre Dame burned, 500 tons of lead were released into the air. The closer you were to Notre Dame, the more exposure you got; the farther away you were, the less exposure you got. We were legit there right after it burned. I turned to my husband and said, “Oh my god. I must have gotten lead exposure. It’s not perimenopause.” #notperimenopause. It’s lead.

I did the testing, and I was higher. I did the testing for mycotoxins, and I had four strains of mycotoxins, which are the toxins that mold puts out when it’s in your body. For a penny and a pound, I did all the testing. I tested environmental toxins, things like gasoline fumes, nail polish, makeup, plastics, flame retardants. I was positive for a bunch of those. I am such a dirty girl! We need to write that book if I have all these toxins.

Eric, I’m the poster child. I don’t eat gluten because I have Celiac. I don’t eat cow’s dairy. I don’t eat sugar or processed carbs. I don’t drink alcohol. We eat organic food. What’s there to give up? Yet I have all these toxins. If I’m doing all this work, and this is what I have, what does everyone else have? That’s why we wrote the book.

Dr. Eric:

Most people know we live in a toxic world. You are eating clean and doing other things to reduce your toxic load, yet you had a higher toxic load. It makes you wonder if someone like you is taking such good care of your body. On average, I’m sure our listeners are doing things to improve their health and eat healthily. Those people also could have higher toxic loads just like you did.

It’s great that you wrote the book. I have read the book. As I was telling Wendie before this interview, I have all my questions. I wrote notes. I do research on all my guests. Here, I wrote down notes. Part of it was selfish because I wanted to learn from reading the book. I wanted to benefit from the information.

Dr. Wendie:

I am every person. I’m not special. Every person has this. Nobody gets through the toxins testing negative. They come out and are like, “I’m so cool. I have nothing.” Nope. If you live on this earth, you’ve got these, too.

Dr. Eric:

Exactly.

Dr. Wendie:

It’s horrifying. Bad news. You need a hashtag, #badnewspodcast. It’s depressing. But it’s fixable. That’s really the take-home message. It’s fixable.

Dr. Eric:

That’s the good news. No matter what we do, we can’t completely eliminate the environmental toxins. Like you said, the good news is we can do things to minimize our exposure, reduce our toxic load. That’s what your book is about. Then you will share some of the things here that you could do as well. I’m going to dive into these questions here. There are so many different things.

Dr. Wendie:

I know.

Dr. Eric:

I don’t know where to start because I know we’re not going to get to everything. I want to make sure to get to the more important things. You could always interject. But how about xenoestrogens, the endocrine disruptors? Most of my audience have autoimmune thyroid conditions. If you could talk a little bit about those.

Dr. Wendie:

I totally can, but I think we should go up a level before we dive into that if it’s okay and talk about where do you get this stuff from? What do you need to look out for? How do you think about it? If you think about it, anything can be a toxin: too much sugar, too much alcohol, too much smoking, too much sleep, too much sex, too much stress, whatever. We’re looking at the things that we’re exposed to on a regular basis that are causing problems.

The way to think about it is what are you putting in your body directly? What are you eating, drinking? Are you using plastic water bottles? Are you drinking alcohol? Are you eating sugar? Is your food organic? Are you eating grass-fed meat or not? What’s going in there?

What’s going on there? Makeup products, shampoo, body washes, lotions, all of that on your body.

What’s around you? That’s your environment. Do you live near a highway? Do you live near a golf course or a farm where they are spraying? Do you have poor air quality, water quality? That goes back to in you. Do you pump your own gas? Do you have an electric car? There’s lots of layers here.

When you are looking at toxins, what you want to do is be systematic. I think it’s easiest to start with what are you putting in your body. That’s where the xenoestrogens often come in. Plastic water bottles are everywhere. You cannot get away from them. They are so harmful. The plastic water bottles leech these xenoestrogens into the water. Think of kombucha. Nobody ever thinks of it as a plastic bottle. That’s how it comes at Whole Foods. Plastic bottle. Or those juices that come in a plastic bottle. It’s not just water. It’s anything in plastic that you’re putting in your body.

That also includes things like if you’re storing warm food in plastic, it’s leeching into your food. They go into your body. It mimics what your body thinks of as hormones, and it confuses the body and disrupts your normal hormones and throws it off. They are called xenoestrogens.

They’re just as hard to get rid of for a lot of people as other toxins. Because they’re everywhere, they start to build up. They particularly impact the endocrine system, especially the thyroid. The poor little thyroid is like, “What are you doing to me?” It’s like waves crashing on the shore. It never ends. Xenoestrogens can be particularly harmful for the thyroid, high and low and autoimmune. It’s all three.

Dr. Eric:

A few things to point out, which I know you mention in your book. It’s not just about BPA. Some people will say, “I have a BPA-free water bottle.” There are other analogs like BPS, BPF, and more. From what the research shows, some of those are even worse, or at least just as bad as BPA.

Dr. Wendie:

Here’s the problem, Eric. We have been effective at putting out hundreds of thousands of synthetic chemicals, materials, substitutes. Only about 500 of them have been tested for whether they are harmful. The biggest issue is that often in our quest to continue iterating and make it better and make it less harmful, it’s not being tested. It can often be more harmful than the original.

How do you quantify harm? If you have cancer, it’s bad whether it’s cancer or cancer. When you say the word “cancer,” it’s still bad. I’m not necessarily looking for do you want to level up on your plastic? No. I’m not looking for going to a better plastic. I’m looking to get rid of the plastic wherever possible. Making choices that mitigate it and trying not to bring in another source as you’re mitigating. It can be hard.

Dr. Eric:

You’re right. One thing that you mentioned in your book is a study showed that we’re eating about 2,000 tiny pieces of plastic per week. It’s equivalent to eating a plastic credit card each week.

Dr. Wendie:

In a year, yeah. It’s crazy. Not a week, a year. But there is microparticles everywhere. It’s funny. I was talking to someone who is really into fish. The problem with fish is all fish are contaminated now because the microparticles wind up in the fish, and they eat it, and it doesn’t get digested and broken down. If it does, it goes into their body. We eat the fish; we eat the plastic. It’s endemic.

Dr. Eric:

Real scary. When we talk about fish, a lot of people are concerned about the heavy metals like mercury. There are many other toxins that they get exposed to. That’s a great point. That’s a good question. Everything is risk versus benefit. Where do you stand where it comes to fish, recommending wild salmon or other types of fish? Do you just tell your patients to refrain from fish?

Dr. Wendie:

Isn’t that funny? I was talking about if you are getting plastic when you are eating wild-caught fish, but fish that is farm-raised, you’re not getting the wild-caught, but you’re also not getting their freedom to run around. The diet they are fed is not as matched to what they need. There is a trade-off.

I never, ever, ever, ever eat high mercury fish. Period. It’s not negotiable. We don’t eat it. It’s so funny. Even moderate mercury fish, one of my family members made black cod. I think that’s a high mercury fish, and it was high enough that it was considered moderate. I didn’t eat it. I spent years trying to get rid of my toxins. I’m not going to retox.

I say to people: You have to live on this earth. It has to work for you. I have four kids. My mother-in-law and mom eat with us a lot. We have a live-in nanny. We often have nine people eating. We don’t live on a farm. We don’t have access to as much as people who might live in the South and have year-round growing stuff. You want to make it work for your life.

Try to pick a better choice. If you can do wild-caught, that’s great for the cold-water fish. If you can’t, don’t go too crazy over it. Just don’t eat the high mercury fish that are wild-caught because they have eaten all the fish and aggregated all the mercury in them. I would draw a line there. Then I would say sometimes depending on where you live, you might not be able to get either wild or farmed depending on what’s local and fresh. It’s a navigation process.

Dr. Eric:

Can we talk about heavy metals? Start wherever you’d like to start. Mercury, cadmium, arsenic, lead. You mentioned lead earlier of course.

Dr. Wendie:

Pick your poison. They’re really common in a lot of people. My almost 18-year-old has mercury. I’m sure it’s from me. When you separate it into the generations, if you’re 75 and older, you were exposed because it wasn’t as regulated. You were exposed to mercury, which is the fillings and fish.

You were exposed to lead from chemical processes, lead pipes. 10 million homes still have lead pipes in the United States. They create an inflammatory state, and in some people, this will manifest as high or low thyroid, autoimmune disease. The inflammation itself leads to disease. However your body goes down the path of disease, you can show up with that. The metal is the lead pipes. Anyone who lives in a home built before 1978 most likely has lead in the paint. When you hear about people talking, “I did a weekend warrior. I knocked down the wall,” I’m like, “Oh, you got exposed to lead.” Living in that house as it settles, it dusts, you breathe it, you eat it, you touch it, you absorb it. That’s the lead and mercury.

Cadmium is from oysters. West Coast oysters have high levels of cadmium. Some batteries have cadmium. You can get exposed that way.

Arsenic, everyone knows about the rice. That’s the most common way we get exposed to it.

Thallium comes from organic vegetables from California. Acute exposure can make you very sick. High exposure can make your hair fall out. Typically, people don’t aggregate it as much as lead and mercury and sometimes cadmium. I don’t see a lot of cadmium exposure. I’m on the East Coast though. We’re not eating West Coast oysters. They’re not fresh.

Dr. Eric:

You said thallium is in organic vegetables from California.

Dr. Wendie:

The soil is contaminated. It’s grown organically, which is great. The green leafy vegetables have high levels of thallium in them.

Dr. Eric:

Is there anything people can do? There are those rinses, or they can make their own. Does that help at all?

Dr. Wendie:

No. Here’s what I’ll say. Alcohol is really stressful for the liver, our bodies, the adrenals, the gut. When you drink alcohol, the body is changing its focus from normal detox to alcohol detox. If you’re looking at what are the ways to support my liver and improve my detox, the first thing I would say is don’t drink alcohol. It’s so stressful, and it distracts your liver from doing what it normally does. Then it says, “It’s a toxin. I have to detox from the toxin.” Particularly if you’re female, we’re not set up to deal with alcohol the same way men are. Even two drinks a night is way too much for a lot of women.

Dr. Eric:

Another factor is it can increase permeability of the gut. Maybe if you drink just a little bit, it might not. A lot of people tuning in have autoimmune conditions such as Hashimoto’s or Graves’. Another reason to try to avoid alcohol. I did some research for one of my past books. Even red wine, because people ask all the time about red wine, white wine, there are some studies that show that red wine even increases the permeability. Not to mention the toxins, if you are not getting an organic wine as well.

Dr. Wendie:

I would agree with that. Put yourself in two buckets. If you’re perfectly healthy, cool. You can have a couple of drinks a week. If you are struggling with any issue, particularly autoimmune, endocrine, then I would say alcohol is not your friend, and it’s setting you back. I know that’s not popular. At this point, people are like, “Okay, I’m done.” Click. It really is very harmful for the liver, the adrenals, and the gut.

Dr. Eric:

How about aluminum? How frequently do you see that in your practice?

Dr. Wendie:

Not as frequently actually. Aluminum foil, you can get it. My family thinks I’m crazy. I’m like don’t put the food right on the aluminum. Put it on the parchment paper. I’m not making my own parchment paper. I’m not making my own aluminum. I have to trust that at some level, the chain is cleaner. I don’t see any toxicity from aluminum all that often. I don’t see high levels typically. You really have to use a lot of aluminum for it to add up. It’s just not one I see that often.

Dr. Eric:

When it comes to testing, are you using provoked urinary testing?

Dr. Wendie:

Yes. We do a baseline test to make sure there is no acute exposure we’ve missed. Maybe someone did a weekend warrior project, and they got a huge exposure. That should show up on the baseline test. Then we’re looking at a provoked test.

The reason you want to provoke it is your body knows these metals are very toxic, so you are not going to have it in your bloodstream unless you can’t cope with it, unless you’ve overloaded it. You’re going to store it in your bones, organs, fat, and brain. The provoked testing pulls it out from the storage depots so that you can actually get a sense of what’s going on here. Is it worrisome? Is it not worrisome?

Dr. Eric:

For those listening who aren’t familiar with the provocation testing, there are different chelating agents. I’m guessing you use different ones like EDTA, DMPS.

Dr. Wendie:

We use DMSA in our practice. We get it from the compounding pharmacy. They make it up for us. When we do IVs, we use EDTA, DMPS. We use EDTA orally at home, too. We use everything. For provoking, we use DMSA.

Dr. Eric:

Also, I think in your book, unless I wrote it down wrong, you said one of the major sources of mercury is corn syrup. It’s not just fish and silver fillings.

Dr. Wendie:

Right. For people who eat a lot of high fructose corn syrup, the process used to make that high fructose corn syrup has mercury. It’s a contaminant. It gets into the high fructose corn syrup. By the way, high fructose corn syrup also has really high levels of glyphosate and pesticides. You’re concentrating everything in that corn into this syrup. The pesticides and the persistent organic glutens don’t get removed. The mercury is present because of the processing. It’s used as a processing aid. It’s kind of crazy that that’s being put in our food.

Dr. Eric:

That is pretty crazy. I didn’t know it had a lot of glyphosate. I know a lot of things have a lot of glyphosate. We could chat a little bit about it. What can people do about glyphosate? Is it try to eat organic and make sure you have purified water?

Dr. Wendie:

Yeah. Glyphosate is the most commonly used herbicide in the world. In 2014, in the United States, we used about 400 million pounds of glyphosate on the crops. People use it on their lawn. Their landscapers use it. It’s called Roundup in the commercial use. It’s applied to everything. It’s also applied as a desiccant. After you’ve harvested, it’s applied to the fields to dry them out faster, so they don’t get moldy, as well as the product. It’s used in a lot of different manners.

It was originally developed as an antibiotic. It has microbiome disruptive capabilities as an antibiotic. It disrupts the microbiome, and it’s classified as a probable carcinogen by the World Health Organization. In medicine, you can’t say this causes this. You’re not allowed to say this. But you can say it’s implicated in four separate cancers. It’s not in your favor.

When you’re looking at trying to get rid of it, one of the low-hanging fruits is to say I am going to eat organic because they’re not putting glyphosate on their crops. But there is contamination that happens. If you’re eating chickpeas, all the chickpeas in the United States are contaminated. You do your best. Try for the organic, but know you’re going to get some. There’s drift. Organic farm on the right, non-organic on the left. Non-organic sprays, wind blows, and it gets onto the organic crops. There is a lot of contamination that will happen that way.

If you have glyphosate, it is pretty easily removed from the body as long as you’re not taking in so much that you’ve loaded the system. It’s pretty readily water soluble. If you improve your liver function, sweat, get enough rest, and avoid filling the pump up with glyphosate, it should be pretty easy to come out.

Dr. Eric:

That’s good to know. Just try your best to minimize exposure. Do things to improve your liver health. That will help as well not only with glyphosate but of course with all other toxins.

In your background, you mentioned urinary mycotoxin testing. I wanted to ask you a quick question about coffee. I’m not a coffee drinker, but a lot of my patients are. I don’t really tackle the mycotoxin issue, the mold issue with the coffee beans. I’m bringing it up now because I want to get your opinion.

Dr. Wendie:

This is like alcohol. Taking away coffee is like taking away alcohol. We can talk about it, but people are going to be mad at you.

Dr. Eric:

If someone insists on drinking coffee, I’ll recommend drinking an organic brand. Organic doesn’t necessarily mean mold-free.

Dr. Wendie:

No. There are two brands I know of that are specifically tested for mycotoxins in the coffee. One is Bulletproof, and one is Purity. I’m sure there is more out there. I haven’t tested them. I don’t drink coffee. If you can imagine me, this is how I am, so I would not do well all hopped up on anything. I don’t drink coffee either.

But coffee is very moldy, as are grains. If you’re eating a lot of grains, those are really high in ochratoxin. You are going to want to minimize the grains and the coffee. Those are big sources for people when they are getting exposed.

Dr. Eric:

Seems like most of the time, if I do urinary mycotoxin tests, I will use Great Plains Lab. There is Real Time Labs as well. Ochratoxinis very commonly high. I think it could also come from inborne air sources, but it’s good you mention that because a very common source is food.

Dr. Wendie:

Food and water damaged buildings, those are the ways you get it.

Dr. Eric:

How about fluoride?

Dr. Wendie:

I’m not a huge fan of fluoride. I’m going to get in trouble for saying too much about fluoride, but it is a toxin. Can we move on?

Dr. Eric:

Yeah, we can move on. There are plenty of other toxins to talk about. Let me get your opinion. What are your thoughts on microwaving? Even though it’s not really directly toxin-related, it is. When you talk about radiation, EMFs.

Dr. Wendie:

It’s not well studied. My friend was giving me grief because one of the examples I give in the book is our daughter did this science experiment where she fed a plant with microwaved water cooled and Bunsen burner water cooled. The plant with the microwave water died. He was like, “That’s an n of one. You can’t quote that!” I can quote it, but it’s not well studied. It does kill the food. You’re diminishing the quality of the food by throwing it in the microwave.

The next layer is if you are using a pre-packaged food, then it’s inevitably got chemicals, pesticides, plastics. It’s stored in plastic often or in a container that has BPA or some other chemical that will leech into your food. Then you heat it in that. You are releasing even more chemicals into your food. There are a lot of layers to this.

We divorced our microwave. I remember my youngest was two. We had a microwave and an oven underneath. The oven went. I was like, “Let’s get rid of the microwave, too.” We got a double oven. On leftover night, it’s harder. It really is. We have 10 things we’re reheating. What a mess. All these pots and pans. But it is healthier for you not to use your microwave.

Dr. Eric:

If someone does have a microwave and are unwilling to get rid of it, you would recommend not standing right next to the microwave when using it.

Dr. Wendie:

Don’t keep peering in. The other thing I would say is microwaves are somewhat lower on my hit list. What I want to understand is what are you eating? How are you living? It’s not usually the first thing I’m saying, to get rid of your microwave. Once you’ve fixed your food and lifestyle, and you’ve leveled up all this stuff, then get rid of it. It’s relatively low on the list. But if you’re going to use it, no plastic in the microwave, period. It has to be ceramic.

Dr. Eric:

I agree. How about flame retardants? Can you talk about those?

Dr. Wendie:

Yes. If you’re a smoker, you need flame retardants in your bed. Think about it. Our ancestors lived in tenements, thickly settled. If one person set their bed on fire, they set the whole block on fire. It was a huge hazard many years ago. If you’re a smoker, definitely get a bed with flame retardants.

However, if you’re not a smoker, the odds of you being in your bed when you have a fire are so small as not to justify the harm that the flame retardants are doing to you. They are tremendous endocrine thyroid disruptors. If you think about it, you spend eight hours, maybe more, every day in that bed. You are pulling in those flame retardants into your body. They then disrupt the thyroid and the rest of the endocrine system, too. It’s really important if you’re getting a bed to do your best not to get flame retardants in it. That goes for furniture, too. If you’re buying a new couch, a futon, whatever furniture you’re buying, it’s important to look for if it contains a flame retardant in it.

Dr. Eric:

The bed would be a priority because hopefully you’re spending at least six, seven, eight hours at night getting sleep. If you’re spending a third of your life in the bed, you want to have a bed that is not only not flame retardant but free of other chemicals, too. I actually have an avocado mattress.

Dr. Wendie:

I have a birch.

Dr. Eric:

Cool. Since we’re talking about the bedroom, I was going to ask you about air purification systems. That leads us into what to do to reduce one’s toxic load. Before we go there, are there any other toxins, chemicals I didn’t bring up?

Dr. Wendie:

Yes.

Dr. Eric:

I know there’s a lot of them. But are there any I missed you really wanted to focus on? Or did I hit the more important ones?

Dr. Wendie:

I would say the ones I would add in are if you pump your own gas, stop. You’re being exposed to the gasoline additives. Those are extremely harmful for you.

If you are wearing makeup or using nail polish, you want to make sure your makeup is natural because phthalates are a huge source of endocrine disruption. A lot of makeup contains phthalates as do plastics. Nail polish also disrupts the system.

Water quality is really important. Some people live in areas where their water is not safe. You want to know if that’s you. Test your water. Know whether it’s reasonable for you. Filter it if it’s not. Your skin is both a detox organ and an absorption organ. If you’re applying toxins every time you get in the bath and sit in it, it’s not safe for you. Know what you’re getting exposed to.

Dr. Eric:

I’m glad you brought water up. I’ll quickly ask you your opinion. Obviously, everyone has different opinions. What do you recommend as far as water purification? At least drinking water.

Dr. Wendie:

It depends what kind of water you have. If you have municipal water, that’s different from well water. You’re going to need to tailor your reaction based on what you have. We have used municipal water. The quality is pretty good. The perchlorate was a little bit high. We wanted to make sure there was no fluoride or other things, so we have a number of levels.

We have a whole house water filter. My favorite one, because of the flexibility of it, is Aquasana. What I mean by that is if you have well water, you’re going to get the thing that irradiates it, but we don’t have well water. We don’t need to worry about bugs. They have an irradiation option. They have the filtration for various stages of what you’re dealing with. I really like that because it’s components you add on together.

If you have high levels of perchlorate, the only thing that gets rid of it is reverse osmosis. There is no whole house reverse osmosis I’ve found. You have to put it on pointed use. This is where I start to say pick your battles. We have four kids, and we have done all these DIY projects and expanded the house. We have all these bathrooms. How many filters am I going to put in my house? You can put one on everyone. What we say to the kids is, “Don’t drink from your bathroom. Drink from my bathroom. Drink from the downstairs bathroom.” We have selected filters. Pick your battles. We put the whole house filter and then the point of use. Go from there. Water quality is important.

Dr. Eric:

It definitely is, which is why I asked you. I give people my opinion every now and then, but it’s nice to get another opinion from another practitioner, especially one who wrote a book focused on toxins. Thanks for letting us know.

What are some action steps people can take to reduce one’s toxic load?

Dr. Wendie:

Sure. I always recommend starting with food. No question. You do it three times a day, maybe more. Maybe you eat five times a day. Eat amazing food. Organic and local is the ideal. I live in Massachusetts. There is no local food right now. That goes out the window. But if you can, organic, local.

Minimally processed, meaning you can identify what it is based on what it looks like. It’s not, “Hmm, mystery.” Don’t eat mystery food.

Sugar falls into that category of alcohol. Minimal sugar. Sugar is very inflammatory. Disrupts every system in the body. Try to minimize your sugar content or avoid it completely.

Don’t drink alcohol, or drink very little. Make sure your coffee is mold-free. Don’t drink from plastic bottles. Just not plastic water, but it’s plastic bottles, period. That’s the food.

Then the next really impactful thing is, especially for women because we use so many products in the course of a day, is whatever you’re running out of, there is no magical, you have to do this first. Whatever you’re running out of is the thing you should focus on because you’re about to buy it. If you are about to buy something, go to EWG.org or ThinkDirty, and look up the product you’re using. Maybe you hit the jackpot. You got it right, and it’s healthy and clean. Cool, keep going. But if it’s not highly rated, then that’s the opportunity to look for a replacement. When you’re ready to order, order that.

As you do that, in the course of a year, I can’t tell you how many things we order in the course of a year. It’s impactful if you say, “Every time I order, I’m going to level up.” You’re going to make a huge difference over the course of a year. This is not a thing you do in a week or a month. This takes- I’m three years in.

By the way, you get greenwashed. If you don’t look at what EWG or Think Dirty say—these are both apps—you can totally get snookered. I’m all excited. I find this new product. I think it looks great. I forget to check EWG because there’s a sale, and I’m running late, and I’m running around, so I buy it. I’m all psyched. A month later, I go, “Well, that was silly. I never checked that. Let’s check that.” I got greenwashed. The package is all natural, no chemicals. You know what? Not as good as they said it was. Be careful with the things that are touting how amazing they say they are. Don’t take their word for it.

Iterate. As you are getting new things, clean it up. I had a patient who had really high flame retardant in her system and thyroid disruption. I said to her, “Did you just get a new bed?” She said, “I did.” I was like, “Okay then. If you just got a new bed, get a good air purifier.” It’s a lot of money to buy a bed. But if you’re in the market for a bed, get one without flame retardants in it. Same with a couch. Make choices when you have the ability, control the narrative, and change the outcome. You don’t have to get rid of all your furniture at once though. That’s not sustainable.

Dr. Eric:

Agreed. Definitely better to get an air purifier. Next time you’re on the market for a new couch or mattress, then try to get one without flame retardants.

To summarize, start with food. You spoke about water. Cleaning products, cosmetics, furniture, if you can, but if not, when you get furniture the next time, make sure. In the meantime, if you do have a mattress, especially if it’s newer- How about if someone has a mattress that is five years old? Would you still recommend getting an air purification system?

Dr. Wendie:

Probably not. I think they’re great in general. If you have an older mattress, it’s probably done the majority of its offgassing. Although maybe not. It is designed to be the life of the mattress. I’m not sure if you’re still getting exposed to that.

I would say you’re never going to regret getting an air purifier. Ugh, my air is clean! No. You’re never going to say that. It’s one really nice way to level up. You won’t regret it. I’ll put it that way.

Dr. Eric:

We have one for the office and a few for the home. I wanted to again get your input with that. Thank you for sharing. Where can people find out more about you? Obviously, there is the book. Definitely check out Dirty Girl: Ditch the Toxins, Look Great, and Feel Freaking Amazing. I know you can get it on Amazon. Maybe on your website, too.

Dr. Wendie:

Yep, it’s cheaper for people on Amazon. Then we have a free guide that’s meant to be a companion guide to the book. Now that you’re ready to clean up your life, you might be like, “Well, what’s the best pan to use? What’s the best cleaning product to use? What’s the best mattress to use?” We put that all in a guide for people. It’s FiveJourneys.com/Promo.

On all of the social media handles, Instagram, Twitter, Facebook, LinkedIn, I’m Wendie Trubow, M.D. This was a decision I made when I was 13 to spell my name this way, and I stuck with it. My website is FiveJourneys.com. Our podcast is Five Journeys: Live Like You Matter.

Dr. Eric:

Wonderful. Thank you again for this interview. I learned a lot. I’m sure the listeners learned a lot. They’ll definitely learn a lot more in the book. There is so much more we could have covered. Just limited time here. It would have taken all day to cover everything in the book. Check out Dr. Wendie’s book. Thank you so much, Dr. Wendie. I do appreciate it.

Dr. Wendie:

My pleasure, Eric. Great to be here.