Recently, I interviewed Dr. Felice Gersh, and we talked about PCOS and its connection to thyroid autoimmunity. If you would prefer to listen to the interview you can access it by Clicking Here.

Dr. Eric Osansky: 

I am very excited to chat with Dr. Felice Gersh, as we are going to be talking about polycystic ovarian syndrome (PCOS), diving into hormones, especially estrogen. 

Let me go ahead and give Dr. Gersh’s impressive bio: Dr. Felice Gersh is a board-certified OB-GYN in integrative medicine and is a multi-award-winning author, speaker, and busy clinician. She was one of the first board-certified integrative gynecologists in the United States. She is the author of multiple bestselling books, including PCOS SOS: A Gynecologist’s Lifeline to Naturally Restoring Hormones and Happiness; PCOS SOS Fertility: The 12-Week Plan to Optimize Your Chances of a Successful Pregnancy and a Healthy Baby; and Menopause: 50 Things You Need to Know: What to Expect During the Three Stages of Menopause. She combines the most evidence-based, safest, and efficacious ways of helping all women of all ages optimize their health. Thank you so much, Dr. Gersh. It’s a pleasure having you on the podcast. 

Dr. Felice Gersh: 

Thank you for inviting me. I’m really excited, forever and always, to get to talk about my favorite issue that so many women face: PCOS. 

Dr. Eric: 

With that being said, let’s give a little bit more of your background. How did you focus on PCOS? Obviously, you’re an OB-GYN, and you deal with women’s health issues and hormones. You have a great deal of experience with PCOS, so if you could talk about that please? 

Dr. Felice: 

This is a familiar story in many ways for us in healthcare. We do often get the most interest in our own personal journeys involving our own health. I had to diagnose and treat my own PCOS, and I didn’t get any help from highly respected OB-GYNs in my medical school, my residency. Finally, I had to do my own deep dive and discover that the reason I went two years without a period, I had endless acne issues, and I couldn’t get pregnant was because I had PCOS. 

I saw in my own private practice so many women developing PCOS, many more so than I saw in the early stages of my career when I was a resident. This is an epidemic now. So many of them came to me after seeing many previous doctors and didn’t even get a diagnosis, let alone a therapeutic approach to treating it. 

Like so many of us, we just took the bull by the horns, and I had to figure it all out. Looking at the science, the data, and doing a deep dive into what is going on in the bodies of women with PCOS? Whenever you hear the word “S” for “syndrome,” it means it’s a grab bag. It’s an all-inclusive syndrome. That means there can be different etiologies. You have to go through and see what is the underlying cause? 

That’s where the integrative approach becomes so critical. We don’t just treat symptoms, which is not an insignificant thing to do. You do want to treat symptoms. But we want to get to the basic root causes as much as possible to try to really resolve the problem, not just cover up symptoms. It’s been an ongoing journey for me for decades, trying to unravel this issue. 

After many years of starting and never finishing, I got together with my brilliant daughter, who is my co-writer on all my books. She put me on a schedule of delivering this chapter and dictating for her. Together, we got our books written on PCOS and continued the journey of treating PCOS, educating on PCOS, and helping women all over the world to deal with this very common but often devastating healthcare condition.

Dr. Eric: 

You mentioned very common. How common is it? 

Dr. Felice: 

No one keeps good data. From the best we can judge, it’s anywhere from 10-20% or more of reproductive-aged women. It doesn’t go away when you hit menopause; it blends into the other issues that women with menopause are dealing with. Now finally, it’s been recognized—it wasn’t for many years—that women who have had PCOS for all their reproductive years, when they get into menopause, they have a higher rate of developing cardiovascular disease and other issues involving metabolic dysregulation. It’s not like it disappears. It just becomes less readily evident because of some of the symptom changes. The underlying metabolic changes and underlying risks remain and are actually accelerated in women who’ve had PCOS. 

It’s such a prevalent thing. When you think about it, the bare minimum is 10% of reproductive-aged women. I really think it’s closer to 15 or even 20%. 

When I was talking about PCOS a few years back, a little before the pandemic, I was in India. Nobody wants to admit they have PCOS there if they are women in India because it’s a fertility problem, as well as other things, and they don’t want to have that stigma. They think in that particular population, it’s well over 30% of young Indian women who are dealing with PCOS. It’s a worldwide problem. There is no continent that doesn’t have it. In fact, some of the best research on PCOS has come out of China and Iran. It’s amazing how this problem is everywhere in every group, every ethnicity. 

Dr. Eric: 

Wow, 30%. Even 10% is pretty high, so 30% is really astronomically high. Like most other health conditions, do you find that it has been increasing over the years compared to 10-15-20 years ago? 

Dr. Felice: 

Absolutely. That has been not only my observation, but it’s everyone’s who is in this field. We believe it’s driven by modern lifestyle changes. What we call the SAD diet (Standard American Diet), filled with processed foods, devoid of essential nutrients and fiber. 

The loss of our vital Circadian rhythm due to all the blue light exposures and lack of adequate sunlight. People are often in rooms with no windows, or they’re covered. They have all that blue light, television, computer screens, phones, that they look at into the wee hours of the night often. Sometimes, people are checking their cell phones at 2am and getting that blue light into their eyes. 

The loss of activity. The sedentary lifestyles that so many people are leading. 

The ubiquitous chemicals, the endocrine disruptors. These chemicals that interfere with the normal hormonal signaling functions in the body, particularly estrogen. Endocrine disruptors that we call xenoestrogens. 

It’s the conglomeration of all of the things that have changed in the world since ancient times. Now, people live longer, and that’s fantastic. But we have a whole new array of medical issues that we’re confronted with. This great increase in the incidence of PCOS is one of the offshoots of modern living. The chemicals, the diet, the stress, the change in sleep habits, light exposures, and so on have all joined together to exacerbate the underlying issues that are causational in terms of PCOS.

Dr. Eric: 

The endocrine disruptors are still very rampant. Especially with bottled water, you’d figure that fewer people would drink it. I think there is more awareness. It’s in the research; it’s not just people saying that bisphenol A (BPA) and these other endocrine disruptors are issues. If you walk into Costco, it’s amazing how many cases of bottled water there are, and people drink that every day. I assume a lot of people listening to this are not doing that, but in general. I’m not surprised you mentioned that.

Getting into the Circadian rhythm and blue light, you’re saying that not getting enough sleep and being exposed to blue light could also be a developmental factor?  

Dr. Felice: 

Absolutely. It’s all related. I’m glad you mentioned BPA. BPA is the endocrine disruptor that has the most research in women with PCOS. I’m sure they’re all involved, and there is some about phthalates, the pervasive scents and soft plastics. BPA, they have shown that in women who are pregnant, the BPA in them- BPA is in so many different things, like plastics and can liners. It used to be in dental sealants, baby bottles. It’s in almost every single person when they test for it. It actually concentrates in the fetus. The levels in the mother are significantly lower than the levels in the fetus. 

This is a very powerful endocrine disruptor. When the endocrine system, the hormonal system of the body is being developed during fetal times, it only gets one chance to be developed properly. What they’ve found is that the receptors for estrogen, and there are three types, but the alpha and beta are altered in women who develop the worst PCOS because of these exposures in utero. Like I said, the most research is with BPA. 

It turns out that estrogen that comes from the ovaries, estradiol, known as E2, because there are three estrogens in an adult female. E1 is estrone. E2, which is the one the ovaries make, estradiol. E3, which is estriol, the dominant estrogen that the placenta makes in pregnancy. It turns out that inherently, genetically, women with PCOS have a little bit less ability to convert testosterone, the precursor hormone that is also made in the ovary, into estradiol through the action of an enzyme called aromatase. 

Now, that is a very mild deficiency of estradiol in a healthy woman from ancient times. But now, this problem of not adequately producing estradiol becomes magnified in ways we’re still learning about in women with PCOS. It’s like fuel to the fire when you don’t make enough estradiol in the ovary, and then the estrogen receptors are not working well. They are not receiving so well. The signaling function of the hormone is sub-optimal because the receptors are not as receptive because of the impact in uterine life. Also, probably at key times during puberty. 

In fact, when they have done levels of adult women with PCOS, they’re finding higher levels in them even as adults. Not because they are exposed to more, but maybe genetically, they are not as good as getting rid of it and processing it through the liver. It’s this whole perfect storm in women. 

It turns out that estradiol is really critical for managing and maintaining our master clock, which sits atop the optic nerve in the hypothalamus portion of the brain that helps to control all the timing of our organs and our Circadian rhythm. When you don’t have enough estrogen being made by the ovaries, or the receptors aren’t working properly, you innately have a state of jet lag. You’re living across different time zones. That is a disaster for metabolism, which is creation, distribution, and utilization of energy. 

You have this problem. When you compound it, that is why it’s always an insult to injury by getting too much blue light, not getting adequate sunlight, going to bed at the wrong time. Then you are taking, once again, a problem that is already there and making it that much worse. 

I always say the first step in solving a problem is to understand it. That is why it’s important to understand how foundational it is to have the Circadian rhythm, to have light, to have the right foods, to have a healthy gut. All that plays into having a healthy metabolism and a healthy reproductive system, how it’s all intertwined. All of this is in disarray in women with PCOS today.

Dr. Eric: 

I want to talk more about estrogen. When it comes to testosterone, you mentioned the problem with conversion of testosterone into estradiol. Is that why one of the characteristics is higher androgens, higher testosterone? 

Dr. Felice: 

That’s totally perceptive of you. That is correct. Remember, PCOS is a syndrome. I’m going to talk about what we’ll call classic, or the most conventional form of PCOS. It’s also other ways that you can have the manifestations that are very similar, but they’re actually from different underlying causes. That’s what makes it confusing to a lot of people. 

Let’s call it the mainstay type of PCOS. If you think of it as an assembly line, first, the ovaries make testosterone. Then the testosterone moves from one part to a different part of the ovary. It moves to the granulosa cells, where the enzyme aromatase, under the influence of the hormone from the pituitary gland called FSH (follicle stimulating hormone) converts the testosterone into estradiol. 

Now, the pituitary gland, under the influence of the brain, makes LH (luteinizing hormone). That is the hormone that tells the ovary to make testosterone. The brain has censors. It’s mastering everything, keeping control, keeping tags on everything. If the brain notices there is not enough estrogen being produced from the ovary, it will put out a signal to the pituitary to make more LH because from LH, you will then trigger the production of testosterone. All estradiol that is produced in the ovary, E2, is derived from the conversion of testosterone. 

The brain says, “Please, ovaries, make more estrogen.” It tells the pituitary gland to tell the ovary to make more testosterone. But, uh oh. There is a snag here in the assembly line. You’re making plenty of testosterone. Totally different skillset to make testosterone. You are not efficiently converting it into estrogen. You end up with too much testosterone, not enough estrogen. The brain keeps saying, “Where is my estrogen? Make more.” So it keeps putting out more LH through the pituitary, and making more testosterone.

Now, when you have more testosterone, it actually begets more testosterone. It changes the gut microbiome. When you have an altered gut microbiome under the influence of testosterone, it turns out that it stimulates more testosterone. Then you have all that testosterone, not enough estrogen. It creates inflammation in the body through an altered gut microbiome. There is a whole bunch of different mechanisms that come into play. When you have more inflammation, you have more insulin resistance. Then you have more insulin, which also triggers through the increased production of another little hormone called IGF1 (insulin growth factor 1), which can move into the ovary and trigger the ovary to make even more testosterone. You have inflammation, insulin resistance, more testosterone adding fuel to the fire. 

You can see where this dynamic is going. You have a woman with not enough estrogen, too much testosterone, too much inflammation, insulin resistance, abnormal gut microbiome, leaky gut. It’s like metabolic havoc. 

You have to look at each part of the equation to help each woman to overcome what’s going on in her body that is causing so much havoc. Because of the elevated testosterone, women with PCOS often will get cystic acne in the jawline, which is very resistant to conventional treatments. It’s very difficult to clear it up. 

They will often have facial hair, and they have to deal with electrolysis, laser, shaving. There is extra hair that is not making women feel feminine. They have the female version of male pattern hair loss, which is called androgenic alopecia. They often have fine, thin hair, which also isn’t feeding their egos either. 

Because of all of these problems, they are not ovulating because the same trigger to making the estrogen is also helping to trigger ovulation. That is not happening regularly. They are having irregular cycles. They are having infertility. PCOS is the #1 cause of female infertility. They have very high rates when they do get pregnant of complications because of all this inflammation and insulin resistance going on in their bodies. They have high rates of miscarriages, preeclampsia, gestational diabetes, hypertension, babies that are too large or too small because of placental problems, preterm delivery. It’s a really huge problem in terms of their overall body health and their reproductive function. 

Dr. Eric: 

If I’m understanding you correctly, it seems like all of this is stemming from too much testosterone caused by the lack of conversion of testosterone into estradiol. The excess testosterone alters the gut microbiome, causes inflammation, which leads to insulin resistance, which I was going to talk to you about. It’s a whole vicious cycle. It sounds like testosterone, that conversion process, is the culprit. 

Dr. Felice: 

Well, that’s the initial. When you add in, like I mentioned, that the estrogen receptors in the body are malfunctioning because of exposures to endocrine disruptors, it’s adding that much more level of complexity. 

It turns out that estrogen in the form of estradiol, which is the form that is essential from the ovaries, that hormone has receptors in every single organ system of the body. It’s key to regulating our gut function, neurological systems, cardiovascular systems, musculoskeletal systems, skin, and so on. It turns out if you have malfunctioning of the estrogen receptors, they’re not as sensitive. 

A lot of people have heard of insulin resistance. The insulin doesn’t work properly because of resistance of the receptor. That is the same thing. You can think of it as estrogen receptor resistance. It’s caused by the exposure to these endocrine disruptors. 

Without adequate estrogen being produced in the ovary, and without adequate function of the receptors, then it’s just that much worse because estradiol actually maintains the production of nitric oxide, which keeps arteries dilated and healthy, so you don’t get hypertension. It works to keep the proper neurotransmitters, like serotonin, dopamine, acetylcholine, which are involved with memory, focus, emotions of all kinds in the brain. It maintains the autonomic nervous system, so you don’t have sweating or problems with sleep and emotions and tachycardia. So many things are going on when you don’t have enough estradiol being produced, and it’s not functioning properly on the receptors. 

Then you have all of this surplus testosterone, which is another big problem from so many perspectives. Having all of that extra testosterone is interfering as well in metabolic functioning, gut functioning, and of course, all the side effects that it creates, which are horrible for a woman’s life. 

You can see, it’s a big deal. That’s why I’m so passionate about it. The only conventional treatments have hardly changed at all in many years. We need to think out of the box a lot more about how to approach this condition. 

Dr. Eric: 

Estrogen gets a bad rap sometimes. When you hear the term “estrogen dominance-” I am guilty of using that as well. In most cases, it’s the xenoestrogens and synthetic estrogens like birth control and oral contraceptives. That’s another question. Can taking the pill be a factor in the development of PCOS? 

Dr. Felice: 

I actually think so. I can’t prove it. This is a theory that I have been basically thinking about. It turns out that birth control pills, which are one of the mainstay treatments of PCOS- It’s clearly helpful in certain symptom control issues. It basically shuts down your ovaries. That whole thing I described about the assembly line, where you make too much testosterone, and it’s not converted to estrogen properly, that is shut down. If you take the ovaries offline, then a lot of that is going to be better. 

When you have a lot of birth control pill estrogen on board, it increases a protein made by the liver called sex hormone binding globulin (SHBG), which helps to bind up excess testosterone that is circulating. That can help with acne. 

When you are on birth control pills, it’s not real human hormones. Actually, if you looked at it on Toxicology.gov, which is a division of the National Institutes of Health (NIH), the ingredients in birth control pills are technically endocrine disruptors themselves designed to prevent fertility. It’s used in other ways, these hormonal but fake human hormones. They are not human hormones at all. They can disrupt the way the ovaries work completely. They shut them down. Then you get the hormones that give you the illusion of having regular cycles. You have regular bleeding, but you are not ovulating. Your ovaries aren’t doing a darn thing. But it can improve symptoms.

Here’s the problem: they are not real human hormones. Most birth control pills have a chemical in them called ethanol estradiol. It’s not real estradiol. Just putting on that extra molecule changes everything. It’s a different chemical. It turns into estrone primarily when it gets metabolized in the body and through the liver. 

Most of the estrogen that is circulating turns out to be estrone, which only binds primarily to one of the estrogen receptors called alpha. That creates an imbalance in the body. The ovaries make estradiol, E2, which has a balanced effect on the different receptors. 

Remember, what birth control pills are are endocrine disruptors. That is what they are. You have a different effect. What is happening is that particular type of estrogen is more pro-inflammatory. That’s why women on birth control have higher risk of getting blood clots. Fortunately, because they are given to people who are younger, their incidence is so low. Even if you increase the risk quite a bit, it’s still in terms of absolute numbers going to be a low incidence. 

The problem is that birth control pills can also tend to cause high blood pressure. That’s why we never give birth control pills to old women, to women who are smokers, especially over 30-35. We don’t give it to women who just had a heart attack. We don’t give it to women who have had blood clots of any kind, in their veins or lungs. We don’t do that. These are real risk. 

Here is the problem: Women who have PCOS already have an inherent higher risk of blood clots and hypertension, high blood pressure. This is a higher risk group. There is published data to show that women who have PCOS and are given birth control pills have a higher risk compared to the average population of women of developing a blood clot. I feel that women with PCOS should be viewed similarly to women who have had prior blood clots or women who have uncontrolled high blood pressure or smoking women, older women, and so on. It’s a higher risk group. 

Here is the other thing. When you are on birth control pills, you’re not activating anywhere near as much as you would normally the beta receptor. Mostly, what you’re putting into the body is estrone, which activates and binds to the alpha receptor.  If you are on birth control pills for a very long period of time, the beta receptor may start to malfunction. We know this when we have done research in women in menopause. It’s a little bit of a use it or lose it. If nothing is working on the receptor, over time, the hormone receptor becomes less functional. It may or may not come back into pristine shape, or whatever best shape it would be in, after you give them the hormone that they haven’t had for quite a bit of time. 

What I’m finding is women who have never had any sign in the past of PCOS got put on birth control pills because they had cramps, or they were sexually active at a young age. A whole variety of reasons. They didn’t have PCOS-like symptoms at the time they went on birth control pills. Then they are on them for 15, maybe even 20 years. Now, they’re in their early 30s and want to think about having a baby. Then they go off, and suddenly, they have every symptom of PCOS. They have irregular cycles, terrible acne, and growing hair. They go to their doctor and say, “You have PCOS.” I never had PCOS before I went on the pill.” 

I think what’s happening is that it’s creating that problem with the receptors that I talked about, that women with PCOS have from their exposures to endocrine disruptors. Maybe it’s also impacting how the ovary itself is working because remember, when you are on birth control pills, the ovaries aren’t doing anything. They are put out of commission. The ovaries may be rusty and are working to create estrogen.  There is something going on here. I have no published data. But my observation, and I do believe in observation. It’s a lower level of evidence than a peer reviewed, placebo controlled, double blinded study. Observation is how most every great discovery in the history of mankind was made, not through a pharmaceutical study. 

My observation—and I think it’s valid, but I can’t prove it—is that long-term use of birth control pills actually can promote the development of PCOS in women when they go off of them.

Dr. Eric: 

As far as alternative treatments, is it as simple as trying to minimize, if not completely eliminate, exposure to synthetic estrogens, birth control, xenoestrogens, doing things to detoxify estrogens from your body? Does it go beyond that? 

Dr. Felice: 

It’s everything you just said. I always have to say, being pregnant when you’re not ready and don’t want to be pregnant is a very big deal. I am totally in favor of birth control. I just feel everyone needs what is called informed consent. If they do go on birth control, there are certain better choices than others. They need to have a full array of options. Then they can choose. What do they feel is their best option at that time? Understanding potential pros and cons. 

In terms of approaching women with PCOS, it’s a global lifestyle program. You have to deal with everything that you mentioned and more. You have to lower exposures as much as humanly possible to all kinds of chemicals in cleaning products, personal care products, air that we breathe, water that we drink. It comes off of clothing that we wear. There is nothing we can do to make us live in a pristine world. That’s not gonna happen. But we have to try to make the best choices that we can to lower our toxic exposure, to lower what is called our toxic load. Then, to do everything we can to improve gut and liver health, how most of these toxic chemicals get eliminated from our bodies. 

There are other things we can incorporate, like saunas, which are helpful. Hydration, because we do also eliminate through the kidneys. There are a variety of things we can add on. But the primary is healthy liver, healthy gut. We deal with that by doing certain- We call that in my office a reset, or others call it a detox. It’s giving supplements and food that will support healthy gut integrity, gut function, and healthy liver function, to help the liver do its job. We can’t actually eliminate toxins by anything that we do. What we’re doing is facilitating our own bodies to do the best job that our bodies can do to eliminate the toxins and lower the toxic exposures. 

We have to work on our Circadian rhythm by going to bed at a reasonable time and trying to go to bed and getting up at the same time. Sleeping in a very dark room so that we can have the optimal production of melatonin, which has been shown to have receptors on the ovaries. The melatonin that a woman produces at night while she is sleeping is optimizing her ovarian health and fertility, thereby her metabolic health. Getting adequate sleep is so critical. Like I said, a dark room. I wear a sleep mask because there is too much ambient light coming in my windows, and doodads that have lights in my bedroom. I like a sleep mask. They come in very comfortable designs, so everyone can find one that is agreeable to them. 

Trying to avoid blue light. Ideally, none for a good two hours before you go to bed. If you absolutely must, then get blue light-reducing glasses to try to reduce the exposure. Try to do other things before you go to bed like take a relaxing bath or shower. Listen to podcasts or audiobooks. Play board games with someone you live with, like Scrabble or Bananagrams. Read a paper book or magazine. Those things still exist. Try to stay off of devices as much as you can for a couple of hours before you go to bed. 

Take some time to do some exercise if you can. Any movement is better than no movement. Fitness is a vital sign. Exercise is medicine. Fitness and exercise play a huge role in everyone’s health, definitely in women with PCOS.

Eat a whole food, plant-focused diet. Predominantly eating plants, lots of different vegetables, colors of the rainbow. Eat some fruit. Don’t go crazy overboard. Try to have a lot of servings of vegetables and some fruit every day. Go as much as you can organic. I know it’s hard and impossible to be 100%, but as best you can, choose organic. Try not to eat too much animal protein, which is a little harsh on the digestive system. Try to keep it to three ounces or so. 

If your gut is not SIBO, another topic, then you should try to eat a lot of fiber foods. Fiber is the food for the gut microbiome, which is disrupted. The first study of this came out from China: Women with PCOS have an abnormal gut microbiome and have impaired gut barrier or leaky gut. We have to work really hard to nurture our gut microbial population, those trillions of microbes that are essential to every health function of our bodies. The way that you nurture them is with plants and lots of them, and high fiber foods that they love. They will love you back. They will help you maintain a proper weight and feel good and have good brain function, good mood. We now know it’s linked to everything in the body, having the right microbial population or gut microbiome. I love plants. 

Eat diversity. Lots of colors. Nuts and seeds. Whole grains can actually help you lose weight and lower insulin resistance, like buckwheat or millet or quinoa. They are not powderized. They are not milled. The whole grain itself. Resistant starch, like cold potatoes, can actually also nurture your gut microbiome, and they won’t raise your blood sugar. 

The other thing that is so critical now, and this is very trendy but appropriately so, is time-restricted eating, or intermittent fasting. It’s really important for everyone, particularly for women with PCOS because they live a naturally jetlagged life because of not having their Circadian rhythm innately right. You have to do everything to try to work through our peripheral clocks. Every organ has cells that have their own clock genes. By eating in a timed way, you can actually help properly set the Circadian rhythm, so that all the organ systems of the body will be working in the same time zone, which is really important for overall health. 

By timed eating, try not to eat more than three times a day. Try to have at least a 12-13-hour fast from dinner to breakfast. Try to have your first meal by two hours after you’re awake. Try to eat more of your food in the first part of the day when we’re most insulin-sensitive. Our digestive tract works the best in the first half of the day and goes on strike as the night progresses. That’s why people who eat late at night often have heartburn, indigestion, and so on. Eating late at night is really prevalent. Especially women with PCOS tend to have a disrupted appetite system and often want to eat at night. That’s the worst thing you can do. 

You have to work really hard to get into the habit of trying to eat more food in the first half, and then stop eating at least three hours before you go to bed. Have about a 13-hour fast until breakfast. All of this can work dramatically to improve the health status of women with PCOS. 

Dr. Eric: 

With any health condition, you want to take a whole body approach. It seems like there is no exception with PCOS. Appreciate you sharing that. 

As you know, most people listening to this podcast have thyroid or autoimmune thyroid conditions. One question I wanted to ask is is there a relationship between thyroid and PCOS? One connection I can make is with the disruption of the intestinal barrier. At least with autoimmune conditions, you have that leaky gut component. Having PCOS in that way might predispose someone to an autoimmune condition such as Graves’ or Hashimoto’s. I don’t know if there are any connections you are aware of.

Dr. Felice: 

You hit it right on the head. That is the main one. After that first study came out of China in 2015, multiple other studies have come out, showing consistently that women with PCOS have in fact impaired gut barrier/leaky gut, the wrong gut microbiome, or dysbiosis. That definitely is a precursor to autoimmunity. 

We know that Hashimoto’s thyroiditis is the most common autoimmune. Women with PCOS have substantially higher incidence of Hashimoto’s, or autoimmune thyroid disease, than the average population, which is high enough as it is, as I’m sure all of your listeners are aware. 

This is a big deal because a lot of conventional doctors are not even screening for the antibodies for thyroid. Anti-TPO, thyroid globulin antibodies. They just get a TSH. They are missing the whole picture of what’s going on in women with PCOS. This is really important because this is critical for overall health. You talk about thyroid all the time. Thyroid hormone has receptors everywhere. It’s critical for every metabolic function in the body.

Here’s another interesting fact: Estrogen, in the form of estradiol, when you have a normal menstrual cycle, and the estrogen levels in the first half are rising, and then spike, which creates ovulation, that upregulates or turns on and makes more functional thyroid hormone receptors. Without adequate estrogen present, women will often have symptoms of hypothyroidism, even if you test the levels in the so-called range. 

They have symptoms of low thyroid because once again, it’s not just having the hormone. It’s having it work properly on the receptors to create the effect in the cells. When you don’t make enough estrogen, then you’re not going to have proper thyroid receptor function. 

That is an extra problem for women with PCOS. Even the thyroid they’re making isn’t working optimally. This is a huge deal. Thyroid is so critical for everything: for heart function, for brain function, for metabolic health, for reproductive health. This is such a big area that every woman with PCOS needs to have a very comprehensive workup of her thyroid tests. Looking at the gut to repair the gut. 

Of course, it’s so complicated. The whole thyroid story is so complicated. You can’t properly convert from T4 to T3 if you don’t have a healthy gut and liver and have all the right nutrients on board, which means you have to have proper digestion, which is often impaired. 

Thyroid is a huge issue in women with PCOS. I’m so glad you brought that up.

Dr. Eric: 

I had to bring it up since this is the Save My Thyroid podcast, so I wanted to pick your brain. With testing, you’re absolutely right about doctors not doing a full thyroid panel along with antibodies. 

When it comes to testing for PCOS, with all your patients, do you do all the sex hormones and the pituitary, FSH, LH, SHBG, insulin? Pretty much does everybody get the work in your practice? 

Dr. Felice: 

They do. I love data. I’m good at guessing, but I’d rather have data than just guess. In women with the mainstay form of PCOS, they will have a high LH to FSH ratio. Their LH is going to be produced in really high amounts because the brain says, “Make more estrogen,” so the precursor is testosterone. The LH goes up. 

There is a problem with the FSH, which we don’t even fully understand. The FSH receptors don’t seem to be working well. The production of FSH from the pituitary gland is also inadequate. There is not a problem with the feedback system. You get too much LH and not enough FSH. That’s a very classic finding, to have what they call a high LH:FSH ratio.

You always want to check prolactin. Prolactin is a hormone that the pituitary gland makes. If you have too much prolactin, that itself increases androgen, or testosterone production, and the androgens from the adrenals, which includes testosterone. 

You have to do a workup to do the rule-outs. I have said that PCOS is a syndrome. There can be other etiologies besides the mainstream, mainstay one. That is a diagnosis of exclusion. Everyone out there who has PCOS or thinks she has PCOS needs to know this. 

You have to go to a doctor who rules out that you have an adrenal tumor, or what you have is something called acquired or late onset adrenal hyperplasia, or you have a pituitary tumor producing too much prolactin. There are things you have to rule out. When you rule out those things, you’re left with the more standard type of PCOS. It’s really important to understand to a significant degree that because PCOS is a syndrome, and it’s based on findings and symptoms. You need to rule out the other causes of those same symptoms that would have a different treatment approach.

Dr. Eric: 

Makes a lot of sense. You shared so much valuable information. I could talk about this for another hour. Before wrapping up, is there anything specifically that I didn’t ask you that I should have asked you? Any last words that you have? 

Dr. Felice: 

I think the message I want to make sure I leave everyone out there with is a message of hope. When I describe what goes on, I know it can be overwhelming, and it sounds so negative. I want you to know that honestly, through lifestyle changes, that alone, just changing what you eat, when you eat, exercise, sleep, working on stress. We didn’t have time to talk about mind/body practices and stress. Discovering what your thyroid is like, treating it as necessary, and so on. When you actually make lifestyle changes, you can have unbelievable transformations in the body.

I’m not getting into pharmaceuticals. There are some appropriate uses of pharmaceuticals that I call “a bridge to health,” which can help to slow down a lot of the progression and reduce symptoms in a very safe way while you work on healing the body. Sometimes, I have to give hormone therapy in terms of giving human bioidentical estradiol and progesterone. It’s one of those catch-22s. You have to give the hormones to allow the body to heal. Once it heals, you don’t have to give the hormones because it will make them so much better and naturally by themselves. Sometimes, you have to give drugs to slow the production of testosterone.

I’m an MD. I will prescribe drugs when they’re needed. I always look at the safest, most efficacious approach. What are the risks and benefits of every drug? 

I want to leave a message of hope. If you have PCOS, there is so much that we know now that I didn’t know back when I was trying to figure out what was wrong with me. You can get your life back. You can have a beautiful life. Don’t give up. Keep working ‘til you find the right person to help and work with you. 

For people who want to learn more, I wanted to share that I have a health summit that is coming out right after Thanksgiving, November 28-December 4, being produced by Dr Talks. It’s The PCOS SOS Summit. I’m the host, and I interview about 50 experts in the field. We cover so many aspects of PCOS that you will eat up. 

I want people to know this is available. It can be purchased, but it doesn’t have to be. It’s available for free online. Anyone who signs up can access it. If you go to DrTalks.com, you can sign up. If you go to my website, you can find it as well. 

Dr. Eric: 

Where can people learn about your books or buy your books? Amazon. Can you also mention your website? 

Dr. Felice: 

Sure. My website is named after my medical practice, which I am in. This is a converted exam room. I have an exam table over there. This is my makeshift studio. It’s called TheIntegrativeMedicalGroup of Irvine. It’s a brick-and-mortar practice. I see patients all the time. I can also do telemedicine. My website is IntegrativeMGI.com. for Medical Group of Irvine. I hope you will come and visit me. Maybe I can help you. 

Follow me on Instagram. I try to post reasonably frequently. I wish I could get time to do more. My Instagram is Dr.FeliceGersh. 

My books are available on multiple sites. The easiest of course is always Amazon. 

Dr. Eric: 

Wonderful. Thank you again, Dr. Gersh. It was a pleasure chatting with you about PCOS, talking about estrogen. Thanks for tying it into thyroid health. I’m sure my listeners learned a lot. I did as well. 

Dr. Felice: 

My pleasure. Anyone who needs me, just let me know. That’s my mission: to help women with all sorts of problems. Thank you so much for inviting me on. 

Dr. Eric: 

Thank you. Definitely visit Dr. Gersh’s website if you need a consultation, or again, if you want to check out her books. Definitely register for her summit.

 

Recently, I interviewed Dr. Brian Plante, and we talked about vector-borne infections, including Lyme, bartonella, and babesia. If you would prefer to listen to the interview you can access it by Clicking Here.

Dr. Eric Osansky: 

I am super excited to chat with Dr. Brian Plante as we are going to be talking about vector-borne infections, including Lyme, bartonella, and babesia. 

Let me give Dr. Plante’s impressive bio here: He is a licensed naturopathic doctor with extensive training in integrative, whole-person healthcare approaches. He works closely with those suffering from complex immune dysfunction, including Lyme Disease, chronic viral infections, environmental toxicity such as mold illness and heavy metal toxicity, autoimmune disease, mast cell activation syndrome, fibromyalgia, chronic fatigue syndrome, chronic encephalomalacias. Through compassionate listening, detailed instruction, and a commitment to helping patients see lasting change in their lives, he hopes his presence will leave each person feeling deeply supported through their journey to optimal health. Thanks so much for joining us, Dr. Plante. 

Dr. Brian Plante: 

Thanks so much for having me. 

Dr. Eric: 

I’m really looking forward to having this conversation about vector-borne infections with an emphasis on Lyme, bartonella, and babesia. Before we do this, can you give your background? You focus on a lot of complex conditions. How did you start down this path? 

Dr. Brian: 

I was always really interested in some of the more challenging cases, where you have to think like a detective and put all the pieces together. When I did my residency at a naturopathic clinic in the Sacramento area a few years ago, I saw a lot of tick-borne infections and mold toxicity. I don’t think I had realized, being in school in Portland, Oregon, just how prevalent it was in California, particularly northern California and the Bay Area. Part of it arose from an aptitude and desire to work with more complex cases. But a big part of it came from the demand. There was just such a need in that area geographically, and there weren’t many of us. 

The doc I trained with, Dr. Jamie Kunkle, taught me most if not everything he knew about it. I got about five years of education in about a year and a half, and it took off from there. Like I said, the need for support with those conditions. 

Dr. Eric: 

How common are vector-borne infections? Some people get the impression that they’re only common in certain areas, for example, the Northeast. Other areas, they are not as common. Do you see them pretty much everywhere? I don’t know if you work with people remotely, so if you have an opportunity to work with people in different states, and you see them being widespread. Or if you consult with colleagues who say it doesn’t make a difference where the person is if they are susceptible to getting these infections. 

Dr. Brian: 

I do work remotely and get some of that first-hand- I don’t necessarily want to call it data, but exposure. They are a lot more prevalent than people realize, including in places where we previously didn’t see a high prevalence. There are places in the country where it is much higher incidence, particularly the East Coast. When we are working with cases like that, it’s not uncommon for people to have had two, three, or more exposures to an infection. This time, it’s a lot more severe in their acute presentation.

Even in southern California, I have seen cases of Lyme. The ticks that are endemic to this area are not well known to be carriers of Lyme. We are scratching our heads a little bit about that. I have also seen cases in Arizona, where it wasn’t suspected to be as common. 

I’m always asking about tick bite exposures as well as fleas and other biting insects. Cats and dogs because they still think there is a lot we don’t know about just how these organisms can be transmitted. I suspect they are a lot more prevalent than we realize. 

It is important to delineate between a Lyme infection, maybe where you have the organism, and Lyme disease, where there are a lot of observable symptoms and an increased need for treatment. I still think there is a lot of debate on just how common these organisms are and to what extent we really need to be screening for them and treating them in patients with a variety of chronic degenerative conditions. 

Dr. Eric: 

One of the questions I was going to ask is can there be vectors other than ticks? You answered that because you mentioned fleas. I don’t know if mosquitoes could also transmit; there is some controversy over that. Would you say ticks are the most common? Is it just something we don’t know? 

Dr. Brian: 

Good question. For Lyme, the black-legged ticks on the Pacific side and the East Coast. I am not remembering the exact species names. They are the primary vector for Lyme. 

With bartonella, it’s cats and fleas that are more common transmission vectors than ticks. We can talk in more detail about that if you’d like. 

The jury is still out on mosquitoes. I wonder about babesia because it reads a lot like malaria. There have been instances where I have had people with babesia with no other known animal exposures, and their mother didn’t have it, so they weren’t born with it. 

The ones leading the research are the veterinarians, particularly in the bartonella landscape. I still think unfortunately there is a lot we don’t know as a medical community, and even in the veterinary community, about how these organisms can be transmitted. 

Dr. Eric: 

I was diagnosed with chronic Lyme in 2018. Not only did I test positive for Lyme but also bartonella. There was no evidence of a tick bite. Just because there was no evidence doesn’t mean I wasn’t bitten by a tick. It makes me wonder if fleas could possibly be a source. Whether it’s a flea or tick, it sounds like with Lyme, there is a greater chance of ticks. Is there any evidence of fleas with Lyme? Or is it pretty much ticks with Lyme, and then with bartonella and babesia- 

Dr. Brian: 

I haven’t heard specifically about fleas with Lyme. I would have to do a more updated literature review on that and see if there is anything newer out. The statistic that is most recent that I heard is about 30% of people living in the United States with Lyme disease never recall having had a tick bite. I suspect that is underreported. There are questions about tick size, particularly the young ticks. Whether we did actually get a bite but didn’t see it, or if there are other animal and insect vectors. It’s probably a little bit of both.

Dr. Eric: 

For those who have gotten bit by a tick, and they know they got bit right away, how soon- Obviously, the sooner you act, the better. Let’s say within three days, but others say a few hours as far as transmission of someone getting Lyme or bartonella. 

Dr. Brian: 

We used to think the tick attachment time, like how long it was embedded before it was removed, was a significant determinant of the risk of transmission. Some of the newer data has questioned that and suggested that it doesn’t really matter how long the tick has been attached. It was only attached for a few hours, but we did have to remove it with tweezers. 

I still recommend sending off the tick to be tested as well as testing the person for antibodies although there can be issues with that test in terms of how quickly we are going to see those responses. It’s very common to do some sort of empiric therapy or treating early if there is suspicion. There doesn’t seem to be a clear association with how long the tick was attached. 

Dr. Eric: 

Do you have a favorite lab that you send ticks to that you recommend? 

Dr. Brian: 

I thought you were going to ask me that. I remembered the University of Massachusetts for a while had one. I should have looked that one up before this. I haven’t had to do it in a while, to be honest. I don’t see a lot of acute cases where I’m located. If you have a resource page, I can give you an updated list after this. 

Dr. Eric: 

Yeah, that’d be great. I can put it in the show notes. Medical Diagnostic Laboratories, they do some testing for vector-borne infections. I think they also look at the tick, too. I don’t know if these other places are free. I’m pretty sure they charge to evaluate the tick. 

Dr. Brian: 

I think so. 

Dr. Eric: 

How about symptoms? What are some of the common signs and symptoms? I know there can be a lot of them. Not to focus on all of them, but I guess, some of the more common ones. If there are differentiating factors. With babesia, night sweats are common. That’s maybe one differentiating factor. If you could dive a little bit deeper. 

Dr. Brian: 

There is a lot of overlap. There can also be some variation between acute presentations or new infection versus chronic or long-standing, well-established infection. 

With Lyme, we can see the hallmark summer flu symptoms, in the sense of feeling flu-like headaches, fatigue, brain fog, muscle aches, or joint pain. We tend to see a lot more joint pain with Lyme than with the other ones, at least in my experience.

With bartonella, we can see more neurologic or neuropathic symptoms: numbness, tingling. I see a lot of foot pain with bartonella, like pain in the bottoms of your feet. Bartonella infects the blood vessels. Anywhere where there are small blood vessels, if there is inflammation in those, we can see more unusual pain presentations. We can see headaches as well. 

The hallmark for me is the psychiatric symptoms: irritability and rage, especially if folks have reported parents or the patient themselves. “It doesn’t feel like it’s really me; I am overcome with this episodic rage and irritability.” That was one of the most eye-opening symptoms for me when I was in residency. I saw a few teens and young adults who presented, and they were quite irritable and difficult to work with. When we did antibiotics, we started to see some improvement in their entire temperament, which was very eye-opening.

With babesia, the differentiating symptoms are the night sweats and air hunger, feeling like you just can’t get enough air in. That’s because it’s a protozoa or microscopic parasite that infects the red blood cells. It can affect oxygen uptake at that level. 

We can see fevers and chills with all of those. Of course, the classic tick-borne relapsing fever, which is a type of Borrelia infection in the same genus as Lyme but a different species. Actually, there are several species that can cause that. We tend to see relapsing fever, meaning you have fever for a few days, and then not for a while, and then it comes back.

Lyme and babesia, we can see some psychiatric symptoms as well. I often recommend testing for all three because there can be so much overlap. There can be times where you’re like, “This is for sure babesia,” and babesia is negative, but bartonella is positive. And vice versa. You think it will be bartonella because it’s a pediatric, autoimmune, psychiatric, or PANS case, and we end up finding it’s babesia driving the neuroinflammation. 

Dr. Eric: 

If you will test for Lyme and bartonella, even if it’s someone not experiencing the night sweats and air hunger, would you still recommend testing for babesia? 

Dr. Brian: 

If their budget allows. Cost is the biggest barrier when it comes to some of the specialty, higher sensitivity testing. We could do a whole talk on testing. There is not a perfect test. Ideally, yes. I would test for the big three. I might even look for tick-borne relapsing fever or Rickettsia as well, which includes Rocky Mountain spotted fever, anaplasmosis, orientia. I am more concerned about those on the East Coast, or with acute presentations, than I am with chronic ones. 

Dr. Eric: 

Are you able to rank the prevalence? Would you say Lyme is the #1 vector-borne disease that you test for that comes back positive? Bartonella is second, or maybe bartonella is #1. 

Dr. Brian: 

Some of this is regionally dependent. In the current CDC statistics, Lyme is by far the most prevalent. Part of why I got so interested in bartonella as a topic and specializing in working with that in my time in the Sacramento area is I was seeing quite a bit more bartonella than Lyme in that region. That has not been the case in southern California, where I have been for the last year. It was also less the case in the Bay Area, where I was practicing for a year as well, and San Jose. Of course, we work with people all over the San Francisco Bay Area, where tick-borne infections are well known to be prevalent, particularly Lyme. But I remember being surprised. 

I don’t want to misquote him, but at the time, Dr. Kunkle was fairly convinced that bartonella was as common or more common than Lyme. Babesias, we are seeing a lot more around the east coast, but it is here on the west coast and beyond as well.

Part of that is tick habitats are expanding. With climate change, we have longer seasons. Ticks are surviving through the winters more. There is also a lot more transportation, so you have ticks going to regions where maybe they weren’t in previously. It’s very difficult for us to say definitively just how prevalent these infections are, not to mention the issues with diagnostic testing. 

Dr. Eric: 

In your practice, it sounds like you help with all of these, but you have more of a focus on bartonella. That is more of a specialty when it comes to these vector-borne infections.  

Dr. Brian: 

Initially. Like I said, I’m seeing a lot less of it in the last couple of years, which I suppose is good, that it’s not present in this area. I was fairly well trained in managing bartonella in my first couple years. It’s thrown me for a loop a little bit. What I’m finding is that I am needing to test for all three as a result because I’m seeing the ones that I didn’t expect to see, and I’m not seeing the ones, particularly bartonella, that I was expecting to see. 

Dr. Eric: 

Before I pressed record, I asked you if we could talk a little bit about dysautonomia, POTS, because in some cases, that is associated with these infections. 

Dr. Brian: 

Yeah, I see it frequently, as well as with long-haul COVID. What dysautonomia is is any condition affecting the function of the autonomic nervous system, which is the automatic nervous system, the part that regulates non-voluntary functions, like breathing, heart rate, blood pressure, temperature regulation. Those are the primary ones. 

We can have a variety of mechanisms from these vector-borne infections that trigger dysautonomia. One is the actual direct infection of the Vagus nerve by some of these organisms. That has been postulated as one theory of chronic Lyme or differentiating between chronic Lyme as an infection and post-treatment Lyme disease syndrome, which is when you have all the same symptoms but are not responding as favorably to antibiotic therapy. That can occur in the Vagus nerve. I suspect that is a big part of what we are seeing with long-haul COVID causing dysautonomia. The inflammatory signaling that happens with these infections is very complicated and part of why they are so difficult to test for.

The primary assumption, which is that an infection is going to stimulate the immune system to make antibodies, and we are going to rely on those antibodies to determine whether or not that infection is active. That assumption doesn’t apply with some of these low abundance chronic infections. 

These organisms have evolved and adapted the capability of creating anti-inflammatory and immune disruptive signaling molecules as a response. They can often confuse the immune system, which creates a very altered landscape of cytokines and other inflammatory mediators. Those can impact how blood flow to the autonomic nervous system is regulated. It can cause oxidative damage to autonomic neurons. Of course, that gets complicated quickly if we add environmental toxicants, like mycotoxins for mold and toxic metals and organic chemicals. 

The short of it is I do frequently see dysautonomia with chronic infections, especially when there are several infections present and environmental toxins. Our approach is to not only address those contributing factors, but to restore regulation to the nervous system. Depending on where the damage is, that can look different from person to person. 

Dr. Eric: 

You mentioned mold. How common is it for people who have mold when dealing with these infections? 

Dr. Brian: 

Arguably, extremely common in my experience. I often use the analogy of the overflowing bucket. Anything toxic, inflammatory, infectious, or traumatic, both physically or psychologically, which are not ultimately separate in terms of the effects they have on our physiology, gets added to the bucket. When we start seeing the bucket close to overflowing and actually overflowing, that’s when we see symptoms. That is when we see chronic illness not responding to conventional, symptom-based management. 

More often than not, the folks who have the most severe, nonresponsive cases other than vector-borne infections have unaddressed environmental toxicity. They may have genetic factors that influence how quickly they are able to metabolize those things, or they have an ongoing exposure that they don’t know about, or they thought they were fine until they moved to a moldy apartment, and that’s what overflows the bucket. They find out they actually have Lyme. 

In fact, I was just seeing somebody about a month ago, maybe 2-3 weeks ago, who knew she had chronic Lyme and was doing treatment in Mexico—stem cells, ozone, those kinds of things. She thought her Lyme was flaring but found out that it was actually a severe mold problem in her new apartment. Now, we’re working on detox. It oftentimes is the obstacle that people don’t realize is still there. 

Even just a couple of days ago, I was talking with somebody who I have been working with for a while. We were going down the bartonella rabbit hole. We assumed mold was already dealt with because she had already worked with a provider who had done detox therapies. We found there were still significant levels of mycotoxins, all of the classes of them, in the urine. There was some ongoing excretion going on, or colonization of mold in probably the sinuses or GI tract, which hadn’t been addressed. 

It’s difficult both for the practitioner and the patient to try to parse these things out and figure out what’s making them sick. Is it Lyme, bartonella, or mold? Yes. To some extent, it’s how these organisms and toxins have dysregulated the immune system, mitochondrial energy production, and the nervous system, and how all of that can affect hormones, the gut, other organ systems. We often have to repair and support those organs in their function while also addressing the things that are triggering the imbalance in the first place.

Dr. Eric: 

Since it is so prevalent, do you do a urinary mycotoxin test on everybody? Does it depend on their history? If you suspect that it might be a mold problem, that’s when you have them do it? 

Dr. Brian: 

Similar to specialty testing for vector-borne infections, none of these tests are perfect. We have to think about their limitations. I am always transparent with patients about that. 

Urine mycotoxin testing is one way we can determine if there are elevations in mycotoxins coming out of the body. Because it’s only measuring what’s coming out of the body, we don’t currently have blood mycotoxin testing available although I’m told it’s being looked at. Food can affect it, if there are food-borne molds. 

Also, the rate of excretion, which depends on how able a person is to detox, if we are going to see those levels high. People always want to know, “Does this tell me there is mold in my environment now, or does it tell me it’s from a previous mold exposure?” We don’t know that. We just know it’s coming out of the body. 

Usually, my approach to mold assessment in a patient is to have them do a screening. Can I mention specific labs? 

Dr. Eric: 

Sure. 

Dr. Brian: 

I do a screening home test kit, like a self-collect, dust sample through EnviroBiomics. I like the Actino Plus HERTSMI-2. It looks for mold. Like an ERMI, but more refined though. The Actino looks for a bacteria that is associated with water-damaged buildings that some of the newer research suggests may be more responsible for chronic inflammatory response syndrome or sick building syndrome than the mold itself. But it does not produce mycotoxins, at least not to my knowledge. They are looking at slightly different things. 

Test the home, and test the patient. If a screener like that comes back positive, I try to get them have an inspector come out who is sufficiently trained. There is quite a bit of debate as to what criteria are needed for an inspector to be trustworthy in that regard.

Also, I might think about doing a Lab Corps or Quest blood panel looking at the chronic inflammatory response markers, which are immune markers that tend to be dysregulated and in mold illness. 

If budget allows, I will also do a nasal culture for antibiotic-resistant Staph, which is associated with water-damaged building exposure. I will do fungal culture as well. 

Maybe an organic acid test, which is a urine test, but it will tell us if there is GI colonization of mold. By colonization, we mean there is living mold, mold spores that got in and created an infection in the area rather than just inhalation or ingestion of mycotoxins without there actually being living mold. 

The diamond approach would be to test the home, urinary mycotoxins, test the sinuses and/or gut, and look at how the immune system is behaving. Usually, if we get two, three, or even four of those things, it gives us a clearer idea as to where we need to be focusing our energy. 

Dr. Eric: 

How about Lyme? What are your favorite labs to look at Lyme, bartonella, babesia, or other vector-borne infections? 

Dr. Brian: 

I still prefer IGeneX over Lyme. It’s reliable. I haven’t seen a lot of false positives with it. 

People often ask me about Vibrant Wellness given the low cost. I have not found this to be a particularly sensitive test, which is maybe a point of contention with some. I have talked to other colleagues in my profession who find that test to be fine. In my experience, I have done split sampling before with patients who could afford it and done either IGeneX or Galaxy Diagnostics for bartonella. We found it on those and did not find it on Vibrant. 

I usually use IGeneX. It just came out in the last year and a half with a Babesia ImmunoBlot that I have found to be quite helpful. Currently, I am using IGeneX for Lyme, babesia, and tick-borne relapsing fever. Using Galaxy Diagnostics, which is co-founded by a lot of veterinary researchers, I am using that one for bartonella. 

You mentioned MDL. That is a decent screener as well. I just have less experience with that one. 

Dr. Eric: 

When I was diagnosed with chronic Lyme, I worked with a Lyme literate practitioner. I was mentioning IGeneX because that is who I was familiar with. She mentioned MDL. She is like, “Let’s do that. It’s less expensive. It may not pick it up, but it might. If it does, it could save money.” I was listening to her advice, and it did pick up chronic Lyme as well as bartonella. IGeneX is the most well-known lab for those.

Why do you prefer IGeneX? I know they test for different species of Borrelia. I don’t know if it’s the same with other vector-borne infections. Is it because they look deeper than the antibodies, the comprehensiveness of the test? 

Dr. Brian: 

I was an undergrad chemistry major, but I don’t have a lab science background. I’d have to get into the methodologies that they’re using. I’ve just found it’s a relatively low false positive rate. Of course, there will always be false negatives that we have to think about. Is it missing an infection? If suspicion is high, the International Lyme and Associated Diseases Society (ILADS) still recommends that these are clinical diagnoses rather than laboratory diagnoses, meaning if suspicion is high, and other conditions have been ruled out, you still want to treat them. As well as talking with other professionals who are Lyme literate physicians, it has stood the test of time. 

They continue to refine their approaches by adding new tests, but they don’t seem to be- Excuse me, in my experience, chasing bells and whistles. I don’t do PCR through them. I just use the ImmunoBlot, which is a more sensitive western blot for Lyme as well as the Babesia ImmunoBlot.

I have seen bartonella missed a couple of times, which is why I use Galaxy. I use their antibody test, the IgG immunofluorescence assay, which is about $500. It’s about the same cost as the individual infections on IGeneX. It gives you a titer number, which I like. If you see it as borderline, you may be interpreting that a little different than if you see it as maxed out to the maximum dilution. You will see those numbers come down with appropriate treatment. 

Dr. Eric: 

A lot of people listening to this have Graves’ or Hashimoto’s. Have you seen a relationship between these vector-borne infections and autoimmunity, whether it’s thyroid autoimmunity or other autoimmune conditions? 

Dr. Brian: 

Empirically and clinically, yes. The data varies on which organisms are associated with what in terms of autoimmunity. Essentially, the way I explain it to patients is the concept of molecular mimicry, which is that there is a molecular structure or protein on the bacterial cell wall or cell membrane that looks structurally very similar to the proteins on our own cells. 

If a battle ensues between the immune system trying to get rid of the organism, there can be priming of the immune system to react to very similar molecules that it may see in the wild, so to speak, aka in the rest of the body. The immune dysregulation that we tend to see in autoimmunity is often activated initially by an infection or toxin or both. 

When we’re thinking about autoimmune thyroid disease specifically, I am almost always having a conversation about vector-borne infections, opportunistic viral infections like the herpes viruses or COVID. I have seen some Hashimoto’s specifically following COVID, as well as mold and heavy metals because we know mercury can be thyroid-toxic.

Dr. Eric: 

Quick question with viruses. Would you consider Epstein-Barr to be more like a stealth infection when it comes to viruses? 

Dr. Brian: 

Good question. The herpes family of viruses is a large family. It includes herpes simplex 1 and 2, which are the viruses we typically think of when we think of herpes. The virus that causes chickenpox and shingles is also in that family, as is EBV and cytomegalovirus, as well as a few others. One of them that is often tested for is human herpesvirus 6 or HHV6. 

I consider these to be opportunistic infections. What that means is they are fairly ubiquitous. About 90% of adults have been exposed to them and produce antibodies to them. But under normal, healthy conditions, the immune system is able to keep them in check, and we don’t seem to have major problems. 

When the immune system is compromised, either from a more primary infection like the ones we’re talking about, the environmental toxins, or just being in fight or flight all the time, whether that’s from PTSD, chronic illness, the medical trauma of living with these conditions, we tend to see a lot more reactivated and chronic herpes viruses. 

I see a lot of providers going and trying to play whack a mole with these infections. To some extent, people can get transient relief. Oftentimes, if they are persistently activated, not seeing those antibody levels come down on blood testing, there is something more primary going on that needs to be addressed. 

Dr. Eric: 

If you could talk now about some of the treatments that you prefer for these vector-borne infections. Related to that, you mentioned with bartonella, you will see the titers going down. I am guessing the same with the others. 

The second part to the question: Can you get rid of these permanently? Are these like EBV, where you will always have it? Is it possible to permanently eliminate Lyme, bartonella, babesia from your body? 

Dr. Brian: 

I am skeptical that we can entirely eradicate these infections permanently, in the sense that we are not going to see eradication, and then they return later at another time. That’s not the goal that I communicate to patients. It’s a great question though. I think I’ve talked about this in the past as well. 

The goal is to promote more of—it sounds hippie to say this—a harmonious relationship between the immune system and the other microbes. Essentially what we want to do is restore appropriate immune signaling, or promote more immune regulation, where it responds as needed to an acute infection, but is less reactive in an ongoing sense to organisms that may not be causing active problems. I’m saying that overly simplifying the TH1, TH2, TH17, T regulation, regulatory T cells, different branches of the immune system that have different jobs in all of this. If we can marginalize the infection, if we can get the relative burden of it down to the extent that the immune system can pick up the slack and do what it’s supposed to do, we tend not to see as many problems. 

I have often said that if we had enough money to screen two million people in the general population who are asymptomatic for these infections, we would probably find positive results in several of them who were not sick. When we’re starting to see problems in terms of chronic degenerative disease or complex chronic illness, it tends to be when the immune system has multiple insults that it’s trying to deal with at the same time. Restoring immune competence, regulating the nervous system, and marginalizing the infection are the primary goals, as well as correcting any damage these infections may have caused by activating the immune system in the way that they do. 

Dr. Eric: 

Do you use a combination of treatments, like antibiotics or other things you may use? I don’t know if you use herbs or ozone. 

Dr. Brian: 

I highly individualize it. When I was trained, Dr. Kunkle used a lot of prescription antibiotic therapy, including IV antibiotic therapy, along with the best of what naturopathic medicine has to offer.

I always joke that my last name, Plante, was fitting for using a lot of herbal medicine. I love plants. They are incredibly useful in that they tend to be a little more sparing of the good microbes and tend to be broadly acting. They have a lot of coverage against a variety of not only vector-borne infections, but several of them are also anti-fungal, if there is opportunistic yeast overgrowth. Many of them are also anti-viral. If we don’t entirely know what we’re treating, or testing is cost-prohibitive, or it’s really complicated, I will often rely more heavily on the botanicals. 

The best results that I’m seeing are when there is a combination. If a patient can tolerate prescription antibiotics, I will use those alongside herbal medicines as well as trying to correct the underlying immune signaling, promote adequate detoxification, and die-off support. If hormones and other systems are impacted, we target those as well. 

In my current practice, we don’t do IV therapy, at least not in the Orange County location. In my previous offices, we did quite a bit of IV therapy. This is a little more for viruses than for cancer, but high dose IV Vitamin C is an oxidative therapy that has an antimicrobial effect. We did a lot of IV ozone therapy, including EBU, or extracorporeal blood oxygenation and ozonation. You take blood out, ozonate it, and put it back in continuously although people have often done the 10 pass as well. I do find ozone to be helpful. I don’t think it is a miracle. It won’t do all the heavy lifting, but it can be very helpful.

The one that I am probably the most passionate about Is methylene blue, whether oral or intravenously. There are a lot of cautions to be mindful of if you are doing it intravenously. I like it because it has a mitochondrial regenerative effect. It enhances oxygen utilization by the mitochondria. It is also neuroprotective, in which many patients infected by these infections have neurological symptoms as well as complications. It is a mononucleooxidase inhibitor, so you get more serotonin, dopamine, and norepinephrine. Brain fog, depression, anxiety, those kinds of things, it can be very helpful for. It tends to be a little gentler on the good microbiome. 

I call it a prescription antibiotic, but it doesn’t really fit into the classic categorizations of antibiotics, like doxycycline. We can talk about specific regimens, too, if we want to. I’ll use a variety of tools tailored to what the person can tolerate and what they need. The best results I’m seeing are a combination of prescription antibiotics and herbal antimicrobials. 

Dr. Eric: 

With methylene blue, do you recommend IV or orally? 

Dr. Brian: 

It can be administered IV. You have to be very careful of its serotonin effects when it’s administered intravenously. If folks are on prescription antidepressants that interact with serotonin or other medications that raise serotonin levels, if you do either oral or IV methylene blue, you can cause serotonin syndrome, which is a toxicity caused by too much serotonin in the brain. IV, the risk is much higher. If that was being administered in the hospital for a non-antimicrobial purpose, but for something else, you’d have to be off antidepressants for several days to minimize that risk. 

I’m always cautious about that with folks, but I have done it. It can have a pretty potent effect. It’s potentiated by red light. It’s a photosensitive molecule that becomes more oxidative when exposed to red light wavelengths. There are some devices that shine red light on it. We used some at my last clinic. It was a wristband that shined red light on your wrist as the IV methylene blue was being dripped into the other arm, with the idea that it activates it from the inside. It is a lot more potent intravenously, both therapeutically and with the risks. 

Dr. Eric: 

I know everybody is different, but on average, how long is someone taking the methylene blue, either orally, or maybe not as long with the IV since it’s more potent? 

Dr. Brian: 

With oral, I’m typically averaging around six months, sometimes longer. Sometimes 9-12 months. Sometimes shorter, depending on how they’re doing. It will turn your urine blue. Some folks say their toilets got stained. 

I have only had a handful of folks over the years report a digestive upset or a urinary pain, which prohibited us from continuing with it. In many cases, it’s very well tolerated, and we don’t tend to see the GI side effects that we might see with prolonged other classical antibiotics. 

Dr. Eric: 

I know you have to go soon. I do want to ask you what are some of your favorite plant-based botanicals that you use? 

Dr. Brian: 

What I will often do is start with a broad spectrum formula, like a biocytin, which has a variety of botanicals in it. It’s a mild biofilm disruptor as well. It’s often not sufficient, but it’s a good place to start because it breaks up biofilm, but not in a way that flares people the way I see with the phase two biofilm disruptors. It has broad action. 

The one that has been shown in the research to be the most potent against multiple vector-borne infections is Cryptolepis sanguinolenta, which is a West African shrub. Sometimes, they can experience more significant die-off symptoms, so I don’t usually start with that one. 

I usually start with biocytin or Japanese knotwood, which has also been shown to be effective against all three. 

I think LymeDisease.org just recently published a post on a research article they were citing that made this chart, where they looked at what was effective against stationary phase bartonella and the Borrelia, Lyme, as well what was effective against babesia. They didn’t differentiate between the different phases of babesia. You look at it and go, “Okay, methylene blue has activity against all three. Japanese knotwood has activity against all three. So does Cryptolepis.” 

I like Japanese knotwood because it has resveratrol and other anti-inflammatory molecules in it. The die-off symptoms tend to be more mild. What I see with that one from a side effect standpoint is nausea, particularly at higher doses, like encapsulated versions of it.

Chinese skullcap can be helpful as well. 

Those are the main ones that I rely on. 

Cistus incanus, which is a rock-rose. That is a fun one that less folks are familiar with. It’s very broadly antimicrobial. If someone is dealing with viruses, yeast, tick-borne infections, a little bit of everything, you can make that as a tea. It’s a traditional Mediterranean herb that was used to keep people’s teeth clean. It has this wonderful floral flavor to it. That’s another one that is often used as a preventative. Dr. Kunkle, when he lived in Maine, would drink that as a tea every day to prevent infection. Those are just a handful of them. 

Dr. Eric: 

Just curious: Do you have any experience using homeopathy? 

Dr. Brian: 

I was trained in naturopathic medical school with some bioclassical homeopaths. I am using it a lot less in my own practice. It’s one of those tools that I really wish that I knew more about how to use expertly, particularly constitutional or classical homeopathy. It requires quite a bit of effort to get proficient at. 

I have had some folks report that DesBio was helpful, which I think is homeopathic in nature, as well as some of the nosodes, which are diluted forms of microbes themselves. I have a little more experience with low dose immunotherapy, which is in my opinion a cross between vaccines and homeopathy, but that’s the extent of it. 

Dr. Eric: 

You mentioned DesBio. I actually took some of their products when I was dealing with chronic Lyme and bartonella. 

Dr. Brian: 

The best thing I have heard is their viral protocol is apparently pretty good.

Dr. Eric: 

For EBV and cytomegalovirus, and parvovirus and herpes simplex, yes, they have a whole line against all these different viruses and vector-borne infections. 

Before we wrap it up, is there anything else that I should have asked you that I didn’t ask you? Anything else you want to wrap up with? 

Dr. Brian: 

I think what I would say is a lot of folks are asking the question about what is long-haul COVID? What is going on with that? We could do a whole talk on that. We won’t. What I often find is folks have undiagnosed and untreated vector-borne infections and/or environmental toxicities. That is what is causing the bucket or cup to be close to full before they got COVID-19. I’ve had a number of folks post-COVID-19 vaccination experience symptoms of long-haul COVID. Of course, there are approaches that are more specifically targeting the spike protein and issues with that. More often than not, I’m seeing untreated other infections. 

If you’re struggling with long-haul COVID, and are working with an integrative practitioner, don’t hesitate to bring the question of whether vector-borne infections could be influencing what your immune landscape is doing and why it is responding so significantly to COVID or the spike protein. 

Dr. Eric: 

You shared a lot of valuable information. Where can people find out more about you, Dr. Brian? 

Dr. Brian: 

If you go to our clinic’s website, AmenClinics.com, you can find me. You can also just Google me, Brian Plante, MD. I am not super active on social media. I do have pages, but I’m not super active. 

If you’d like to get some support, I do some health coaching out of state. I am currently only licensed to work deeply with patients in California. If folks have outside providers they are working with, I will often act as a consultant, which tends to work well if they are able to manage prescriptions. I’d be happy to support you. 

I’m going to put more content like this out there. Stay tuned if you are interested in learning more about these topics. 

Dr. Eric: 

Wonderful. 

 

Recently, I interviewed Inna Topiler, and we talked about common and uncommon causes of thyroid autoimmunity. If you would prefer to listen to the interview you can access it by Clicking Here.

Dr. Eric Osansky:

I am very excited to chat with Inna Topiler, as we are going to discuss common and uncommon causes of thyroid autoimmunity. Before we do this, let me give Inna’s impressive bio: Inna Topiler Mooney is a Board-certified clinical nutritionist with over 17 years of experience in clinical practice. She is the founder of an integrative practice Complete Nutrition and Wellness. She is also the host of the podcastHealth Mysteries Solved: Thyroid and Hashimoto’s Revealed and the educator behind the Thyroid Mysteries Solved step-by-step program. 

As a health detective, educator, thinker outside the box, and Hashimoto’s rebel, Inna loves getting to the real root of hypothyroidism and Hashimoto’s. She has helped hundreds of people balance it. She knows you are struggling, and she is here to tell you that you are not alone and show you as many possible answers as she can, starting right now. Thank you so much for joining us, Inna. 

InnaTopiler: 

Thank you so much, Dr. Eric. I am so delighted to be speaking with you today. 

Dr. Eric: 

Yeah, I am as well. I am really excited to chat with you about some common and uncommon causes. Before we do that, let’s get into your background. How did you start helping others with Hashimoto’s? 

Inna: 

Like probably a lot of practitioners, it started with my own health issues. They say if you have been in it and lived it, you can really, truly understand it. I know the very similar goes for you as well. 

For me, it started in college. I was just having a lot of issues: skin issues, digestive issues, fatigue. I went on to work on Wall Street after college. It was a really fun, glamorous job. However, I did not feel glamorous at all. I was having more of the same.In addition to the fatigue and digestive issues, I started getting brain fog, a lot of hormonal imbalances. You name it, and I had that symptom. I was only 22 at the time. I did the rounds of doctors. I saw different primaries. I saw anendocrinologist, a gastroenterologist, a gynecologist, and a dermatologist. None of these doctors were speaking to each other. Instead, they almost blamed me. I blamed myself. There were no answers. 

Finally, after rounds and rounds of doctors, I was diagnosed with Hashimoto’s. I thought hallelujah, this is fantastic. I actually have something that they know versus your labs are “normal.”“There is nothing we can do.” And I am feeling crappy. Great, what do we do now? Doctors said, “Well, your thyroid itself is actually okay now, so we do nothing.” I said, “What do you mean we do nothing?” “Well, your labs are in range, so we wait and see. We’ll wait and see until eventually the Hashimoto’s will destroy your thyroid because that’s what happens, and then at that time, we will give you medicine, and you will have to take it forever.” As you can imagine, I was not very stoked about this. 

At that point, I didn’t have much of a background. I went to school originally for finance. While I did have a lot of science background, I didn’t have the functional medicine background. Even then, without that, I knew this didn’t make any sense. Why would I wait and see for my thyroid to get destroyed? 

That’s when I started looking at a functional approach. I saw a clinical nutritionist who was able to show me so much of what was happening. We saw that even though the endocrinologist said my thyroid was “normal,” it was really not in the optimal range at all. My TSH was a little bit on the higher end. It was still within the lab’s range, but the lab’s ranges are so wide. I’m sure you talk about this quite a bit on the show, so your audience knows. My TSH was in the 4s, and ideally you want to be under 3. My T4 and T3 weren’t optimal. In addition to that, I had parasites, candida, mercury toxicity. I had 16 amalgam fillings. Every time I say that to people, they almost can’t believe that’s possible. Yep, I had 16 amalgam fillings. I had all types of hormonal imbalances, adrenal insufficiency, and copper toxicity. 

As we found those things, most people would say, “Oh my goodness, there’s so much stuff.” I was excited because there was something we could do. This doctor I worked with really explained, “This is because of this. This issue is because of this. This is how we solve it.” For the first time, I felt there was something I could do. 

We started working on all of these things. Diet was a big piece. I had a gluten sensitivity, which I refused to accept for a while, but I got around to it. I had one of the Celiac genes. Hewas able to put all of this together, so I could see this bigger picture, like a bird’s eye view. 

As I started working on each one by one, things got better and better and better. I don’t want to make it sound like it was all roses, and everything was perfect right away. It was a journey, and it took time. A lot of times, in healing, you take one step forward. Sometimes, it feels like two steps back. There was a lot of learning and figuring out. Either way, there was this goal of where I needed to be. 

With every trigger, as each got better, I saw improvements both in my labs and how I felt. It took a couple of years; it wasn’t overnight. But I saw such tremendous success. I’m 44 now. I started this journey at 22. I feel better now at 44 than I did at 22. It was really phenomenal.

From there, I started to help some friends. They told their friends, and I helped their friends. Then I decided, what am I doing here in finance? This is really what I want to do. I went back to school and did a few different programs. I did a master’s and some continuing education. Then I started my practice and never looked back. 

Dr. Eric: 

When you mentioned the 16 amalgams, that’s mind-blowing. That’s pretty much half your mouth having silver fillings. I need to ask: did you remove all of them correctly, like going to a biological dentist? 

Inna: 

I did. Thankfully, I realized that the fillings were an issue when I started to look into the functional medicine approach. I was then guided by this doctor on exactly how to do it. If I had found out before knowing, I probably would have gone to a conventional dentist, and then who knows. 

I still think in hindsight that I did remove more than what my body could handle at a time. Knowing now, I think I would have in the past removed maybe one or two at a time versus doing a whole quadrant. I probably would have done more prep work. But they did it in the best way they could at the time. 

Dr. Eric: 

That was going to be my next question. How many did you get removed at a time? It sounded like four at a time. 

Inna: 

It was three or four, yeah. There were many sessions of that. 

Everyone is different. It’s really important to optimize all the detoxification pathways before removing them. I was so shocked as to how many I had. I didn’t even think I realized I had that many. Coming to the realization that I have all of this mercury in my mouth, and it’s been in my mouth for at that point eight or nine years. I was just horrified at that thought, so I wanted them out as soon as possible. I think I myself rushed it a little bit because I wanted it out. 

I am amore sensitive person, and I find in general, people with autoimmunity, whether it’s Graves’ or Hashimoto’s, we’re the more sensitive people. Pushing isn’t always the best. A little bit at a time, I find, tends to go better. 

Dr. Eric: 

When it comes to common and uncommon causes, would I be right to say that environmental toxins and heavy metals such as mercury are one of the more common causes? 

Inna: 

Absolutely. I like to divide the causes in buckets. There are many things within the buckets. The way I look at it is we have the food bucket, the things that we’re eating that our body may not like for whatever reason, whether it is because genetically, we are not predisposed to processing it, or there is another sensitivity going on.

Another bucket will be toxins, whether that is toxins from the environment, food, water. These are things like heavy metals, pesticides, and any other toxins our liver has a hard time processing. 

When we think about toxins, it’s not necessarily how many toxins someone has or how big of a load it is, but it’s what is their detoxification capacity? You could take two people with the same amount of exposure. Say they eat the same type of fish the same amount of times a week. Yet one person can have more mercury than the other. Same with fillings. It’s what the body can handle. That would be the other bucket. 

There is also a bucket for infections. These could be all types of infections from chronic viruses to EBV to gut infections (candida, parasites, bacteria, H-pylori). Not a common cold, but other kinds of infections.

The fourth bucket is stress. We can have five podcasts on this, I’m sure. That’s what our nervous system is doing. If our nervous system isn’t regulated, which is all of us, for the most part, that is going to affect us. 

We also have to remember when it comes to stress, it’s not just emotional; there is physical as well. It’s foods, infections, and toxins; they are creating that physical stress. When we have blood sugar dysregulation, that is a huge stressor on the body that is physical. 

Then there is the emotional piece. It doesn’t mean that people have to change their lives, or they have to quit their jobs. It’s more about finding ways to manage things on a daily basis. I always tell people it’s not about, “Oh, you’re really stressed. Let’s have a spa day.” You don’t want to wait until you are so stressed that you are about to burst from the pressure. It’s about maintaining a level and continuing to lower that nervous system. Once you lower it, there is always a new threshold. 

I remember I was a lot more stressed than I am now. Now, I look back and I’m like, “This is nothing compared to 10 years ago.” Yet there is still more here. With every bit we downregulate, there is always that next level. It’s striving for that. 

Dr. Eric: 

I agree with you as far as doing something every day. Do you recommend mind/body medicine, like doing yoga or meditation or deep breathing on a daily basis? 

Inna: 

Yes, all of those things. It’s really important to try to find something that you personally like. Yoga is amazing, but not everyone is into yoga. If you’re doing something that your body doesn’t feel comfortable doing, or you don’t feel comfortable, it could be more stressful. 

I like breathing a lot. Breathwork can be really powerful. There are so many ways of doing it. As long as we’re breathing in a more full way, and not very shallow, just from the chest, that’s going to have a natural stress reducing ability to it. There are many different workshops on breath work, but there are simple things like a box breath, for example, where you breathe in for a count of five, hold for five, breathe out for five, and hold that for five. Most people have probably heard of that. But when asked, people will say they are not doing it. Every time you go to the bathroom, you could do that. It’s pairing this with something else. If you don’t make time for it, it’s not going to happen.

One of the things I personally started doing in the more recent years is waking up a little bit earlier. I do the Miracle Morning. Are you familiar with Hal Elrod? 

Dr. Eric: 

I am. 

Inna: 

I love doing this. If you’re not familiar, he has a book called The Miracle Morning. He talks about six things that overall have proven to be beneficial and doing each of those six things for a few minutes in the morning. It’s meditation, journaling, reading something that is going to stimulate your mind, exercise, affirmations, and I forget the last one. Do you remember? 

Dr. Eric: 

I don’t. 

Inna: 

I don’t do all of these things every morning. Sometimes, I focus more on one versus the other. Even if I don’t do those specific things, waking up before my kids is like being on offense instead of being on defense. Your day goes better. 

I am a fan of looking at what I want my day to be or what I want something to be like, sort of like that happy end result, and really focusing on that. Yes, I do the breathing and the journaling, but for me personally, what has worked is to be mindful of how I use my imagination. 

Very often, most of us will focus on what we don’t want. We’re not purposefully thinking about it; it just happens. Say that we’re in traffic. It’s very common for our minds to start thinking, and even possibly visualizing pictures, of ourselves being really late for work. Our boss is getting angry at us. People looking at us like, “Why are you here 10 minutes late?” Thinking, “I will be late. I will get in trouble. If I get in trouble, I won’t get this or that.” Most things we worry about don’t ever come to pass, but our imagination is working in that way, where we’re actually spiraling down. 

If we take that and think more about happy end results, or what it is that we want, when we are stuck in traffic, yes, we could sit there and be worried and have this tension in our stomach. Or we could say, “What do I want? I want to make it to work on time. What would it take for me to make it to work on time?” It sounds much lighter than “I will be late.” “What would it take for me to make it when I make it and for everything to be okay when I get there?” Sometimes, the traffic won’t go your way. It’s a different kind of energy. Naturally, the pictures that are going to circle around in our brain are going to be these more positive pictures. 

What I like about this is it’s a little bit different than affirmations. With affirmations, you are saying positive things. There is nothing wrong with affirmations. I find that if you say a positive statement, and it doesn’t resonate with you, then you feel like you’re lying to yourself. If someone is able to feel their own energy and focus, then it feels heavy. 

If you’re dealing with a health issue, say you’re feeling tired, which is a common thing for people who are dealing with thyroid issues. If you’re really exhausted, and you have autoimmunity with joint pain and some other symptoms, you’re told to say an affirmation that you’re healthy. Someone would sit down and say, “I’m healthy. My body is strong.” It’s a nice thing to say, but your mind or subconscious mind is going, “No, you’re not.” Then it’s this heavy energy, like you’re fighting with yourself. I find that not to be helpful. 

If you say something in a different way, there are a couple ways. “I am committed to eating in a way that is going to make me feel more energized today.” Sounds a little lighter. Or “What would it take for me to feel energized today?” You don’t necessarily have to have an answer to that question. Saying it that way feels like, “Let me open it up to see what comes and how I could be in that energy of flow versus that ‘Oh my gosh.’” 

Dr. Eric: 

I love it. It’s important to reinforce blocking out time, even if that means waking up a few minutes early, like you do. That’s a big excuse people have: “I don’t have the time.” We’re not saying to sacrifice an hour or two of sleep. Maybe you could make up for it on the back end. We want you to get your sleep, but we don’t want you to have an excuse not to block out time for stress management.

What I tell people is even if you start with five minutes a day just to get into the routine. I’m like you. I recommend doing it every single day. If someone thinks they need to do it 20-30 minutes every day, that’s great to do, but it could be overwhelming, too. If you can start with five minutes, everybody can find five minutes. If they can’t, they really need to block out the time for stress management. Get into the routine of five minutes a day. Once you’re in the routine, you can gradually increase. At least that’s what I tell my patients.  

Inna: 

Absolutely. Once you’re in a routine, you could be mindful of what you’re feeling throughout the day. That’s almost the next step. If you start to feel tense, then you can actually stop yourself in the moment and see what are the thoughts that are coming up.

I’ll give you an example. This morning, I had a lot of things to do. I was rushing around to finish emails and notes and get my kids to school and get here for this wonderful conversation with you. It’s Monday morning as we’re recording this. Mondays are Mondays. There are always things to do. 

I had a lot of beef with Mondays back in the day, which I’ve really worked on clearing. I realized a lot of that came from my parents. “The week is coming. You have to work hard.” Blah, blah, blah. I cleared those beliefs because they are all beliefs you pick up as a child before you even have a logical mind. These are beliefs you pick up from other people’s mannerisms. They are not your own. I did a lot of clearing on that, so I feel better on Mondays overall.

But I noticed this tension in my stomach. I’m answering my emails. What is happening? Why am I so tense right now? Let me stop here for a second. What’s the belief here? I think the belief is that I need to get all of this done before 12pm, or else. I have to think, okay, or else what? What’s going to happen? Let me just clear any of this belief that something has to be done, or else. Then look at what it is that I want? What I want is to be able to answer the emails, so people feel supported by my answer, and do it in a way that is easy and has flow to it. When my body is so tight, I am not probably writing the responses that are going to give those people the energetic answer that they need. It’s seeing that in the moment and shifting the thought. 

As you shift your thoughts, it’s amazing what physically happens in the body. That energy controls your physicality as well. 

Dr. Eric: 

Yep, I agree. It’s not just about spending time in the morning, but mindfulness is important. 

Inna: 

Starting with something is great. Starting in the morning just to get in routine. Then you will have a very clear picture of what’s calm and what’s not. When you do have tension, you will recognize it. So often, people are all tense, and they have no idea because they don’t have a baseline for what relaxed is, or a new baseline. They may have an old baseline when they were more stressed. 

Dr. Eric: 

Let’s hit the food bucket. You mentioned gluten. I don’t want to spend too much time on gluten because a lot of listeners already know about it. I really want to get your opinion about other foods that might be problematic. Maybe there are certain foods across the board besides gluten, be it dairy. Maybe there are foods that depend on the person. Maybe you do food sensitivity testing. I really want to hear your thoughts on foods other than gluten. 

Inna: 

Agreed. We all know about gluten and the Celiac genes. We don’t need to belabor that. It does depend on the person with other foods. 

I typically find that dairy is an issue for a lot of people. Not everyone. Some people can tolerate raw dairy. I do use food sensitivity testing, but not a ton. I find there are so many labs and tests that it’s not that they’re not accurate, but they are not looking at all the pathways. We can respond to a food in many pathways. If you are just checking one pathway, like IgG, and it’s negative, that doesn’t mean you can’t be responding on an IgA pathway or from a cell mediator response. That’s where it’s tricky. 

I also think we can do a trial. I also refused to believe in the beginning that dairy was an issue for me because I loved dairy. What I have come to figure out—it took me a little while, and I so wish I had figured this out earlier—is dairy would react very poorly on my skin. I mentioned earlier that one of the biggest things I had was acne. I had many issues, but that was the one that bothered me the most because I was in my early 20s, living in NYC, and I looked like I was a teenager. I tried this cream, so maybe this cream made me break out. Or maybe it’s my period. It never occurred to me that dairy was this common denominator until I did some testing and saw dairy was an issue, but I still refused to believe it. Then I took out my dairy out. I used a cream with oil, yet my skin was still okay without dairy. Doing a trial, if someone isn’t able to afford to do a test or is not sure if their test is accurate. 

Typically, I like for people to give 3-4 weeks. Less than that is not enough time because that food has to leave your system. You can see how you feel. It’s not always direct. I was looking for more digestive issues, and I didn’t see any changes with or without dairy. I was getting gas and bloating, but that was more of the candida and some of the other issues I had. Not eating dairy, I was still bloated at the time because I hadn’t treated other gut issues. But with my skin, it was a night and day difference. It could be joint pain or brain fog or another symptom, so I think it’s worth a try.Typically, with autoimmunity, a lot of people do react in some way that is more negative to dairy. 

Lectins is another biggie. Lectins are found in grains, legumes. It’s impossible to take out all the lectins because they’re everywhere. Nightshade vegetables are high in lectins. For both myself and many of the people I see, doing a lower lectin diet is helpful, especially in the beginning.

The other thing with food is we have to be careful about eliminating too many things for too long. We were in the culture, especially probably 10-15 years ago, where people would go on a very strict diet and stay on it for a long time. We know it’s important to diversify the foods we eat because that helps in terms of diversification with gut microbes we have, having that nice variable microbiome. It’s not about taking out all foods and staying off of them. 

If you’re newly diagnosed or in a flare-up of Graves’ or Hashimoto’s or any autoimmune disease, it helps to be a little bit more strict and be extra clean. That’s where the lectins play a really big role. Then we slowly introduce them back in as we look at some of the other triggers. Usually, when we’re in a flare up, it’s not just one thing. There are usually a few different triggers happening at the same time. It almost overflows the bucket. 

The food helps. Maybe there is mold or heavy metals or H-pylori or another type of gut bug. As you work on all of those, you stay on a stricter diet. As those things are gone, you can start to open it up. 

It is important to open things up. I unfortunately have people who have been on a very restrictive diet, and they only have nine or ten foods that they eat. 10 years later, doesn’t help issues. We have to start to very slowly open it up for them. Long-term, you don’t want to be so restricted. 

Dr. Eric: 

I agree. I typically recommend an elimination diet as well. It’s not a permanent elimination diet. I want people to reintroduce foods. 

For those who aren’t as familiar with lectins, what foods have them? Nightshades, legumes, grains. Do you have people eliminate all of those initially? 

Inna: 

Initially, not for everyone, but if they are in flare-up, or we are trying to get things down, yes. It could be nightshades—tomatoes, peppers, eggplants—and grains. There are some other foods, like anything with seeds technically has lectins. Cucumbers, squashes. But those, I feel like we could be more lenient about. You can take the seeds out. I will scoop the seeds out of cucumbers and just eat them outside.

Beans also. But if you pressure cook your beans, the lectins are destroyed. Beans have some protein and good fiber, so there is benefit there. I always recommend to my clients to get a pressure cooker if you can. They are like $50 on Amazon. You can buy dried beans and soak them for a couple of hours and put them in a pressure cooker. The lectins are gone, and you can enjoy them. 

It’s another way to add carbs.When you’re taking out grains, you’re very limited on carbs. While some people can be on a very paleo diet, depending on your metabolic rate, some people don’t do well with a high protein, high fat diet with no carbs. They may need the carbs. Beans are good for that. Sweet potatoes and cassava are good, too. 

Dr. Eric: 

How do most of your clients deal with eggs? Do most people do okay? 

Inna: 

It depends. This is where I like to test and see if there is an issue. There are a couple labs I use. Sometimes, I use the Egg Zoomer from VibrantWellness. They look at IgG and IgA. They look at different metabolites of different proteins of the egg as it breaks down in the body. Some people are totally fine with it, and some people have every marker flagged. What about you? What do you find with eggs? 

Dr. Eric: 

I agree with you that initially, for a number of people, I do have them avoid eggs as part of an elimination diet. It’s usually one of the first foods I’ll have them reintroduce because they’re nutrient-dense, and I find a lot of people are able to tolerate them. 

I have never heard of the Egg Zoomer. I have heard of the Wheat Zoomer, so that’s interesting. There is a test that focuses on eggs?

Inna: 

Yep. They have the WheatZoomer, the Dairy Zoomer, a Nut Zoomer, a Grain Zoomer, and an Egg Zoomer. There is a seafood one. I think there are nine or so. 

Dr. Eric: 

I didn’t know. I was not familiar with the others besides wheat. I have had a few patients do that one. Vibrant America? 

Inna: 

Yep. 

Dr. Eric: 

I did look into them, but I didn’t look enough to see the other Zoomer tests. That’s interesting. Anything else with food before we move into the next bucket? 

Inna:

I would say gluten, dairy, and lectins are probably my go-to’s. With Hashimoto’s specifically, we also look at high iodine foods, which can be problematic, especially initially, if there is a flare up. Those are the biggest. 

Of course, sugar. No one really should be eating a lot of sugar that is in the processed form, so we try to limit that when we can.

I’ll give you a personal example with my antibodies. My antibodies have gone up post-partum with both my kids, but especially with my son because he was my first. There was a lot of stress and other stuff going on. I have been gluten-free the whole time. That didn’t change. I was gluten-free while pregnant with him and post-partum. 

My antibodies shot up very high. My TPO antibodies were over 1,000. At that point, the lab didn’t show where they were, but I knew it was over 1,000. Within a week of lowering lectins, they were 600. They went down 400 points. But who knows, maybe more, because it was over 1,000. It could have been 1,200 or 2,000. There was a drastic improvement there, and I have seen that with a lot of people that I work with. 

Dr. Eric: 

Very cool. What are some of the more common infections or microbes? Candida, I don’t consider an infection. To me, it’s more of an overgrowth. Same thing with SIBO. I don’t know if those would fall in the more common category. Let’s hear what you find in your practice. 

Inna: 

If it’s overgrown enough, those things can create a stress on the body and immune system confusion. H-pylori is a biggie. I see that quite a bit. 

On the virus side of things, EBV is a really big one. I don’t know if you find it as much in Graves’, but in Hashimoto’s, there is a big relationship. 

Recently, in the last couple years with COVID, there has been so much more EB reactivation. I have never seen this much reactivation in my practice ever than I have in the last couple of years. Thankfully, there are a lot of things we can do with a natural antiviral protocol and stress reduction that can bring those viral loads down. 

Mold. Lyme. I see them often, but I think because a lot of the people I see are coming to me specifically for hypo and Hashimoto’s. They may be coming from other practitioners who may be more general that they have seen. They have started to address some of that, so they may have that handled before seeing me. Sometimes, they haven’t, so we address it. 

What do you find? 

Dr. Eric: 

I dealt with chronic Lyme. To me, Lyme would be one of the more, from what I have seen, uncommon. It’s hard. EB, to answer your question with Graves’, just like Hashimoto’s, most people have it. It doesn’t mean it’s always a problem. I agree that since COVID happened, we see more reactivation. 

COVID itself, especially a few years ago, directly impacted people with both Graves’ and Hashimoto’s. In my practice, I see more people with Graves’, so I saw a lot of people who seemed to have a trigger with COVID. 

I would say viruses are common. I really think about viruses as more of a side effect. You mentioned stress. I think of other things dragging down the immune system, not to say I never use antivirals. If that’s all someone does, like all they do is put someone on an antiviral protocol, but they don’t address stress, and they are still eating inflammatory foods, and other things are dragging down their immune system, they won’t get optimal results. You could make the same argument with Lyme and other stealth infections. 

Recently, I interviewed Evan Brand, who I’m sure you’re familiar with. He was saying in his practice, and he focuses a lot more on mold. 80-90% of people. I can’t say I’ve seen that in my practice, as far as it being a factor in autoimmunity, where I have addressed the mold and needed to do so for people to get into remission. As far as my clientele, I don’t know if I would say that. To me, Lyme and mold are not rare, but I won’t classify them as more common causes. 

Infections, yes. H-pylori, I see a lot of people with that. Parasites, definitely a little bit controversial. I see them, but it’s one of those things where the stool tests are not perfect. You could have false negatives. You could also have the opposite, where you have a parasite that is not a problem. Sometimes, it’s hard to know if it’s a problem or not. 

When it comes to infections, the gut microbes are more common from what I see in Graves’ patients. SIBO, you would figure is more common with Hashimoto’s because there are numerous causes of SIBO, but when you have lower thyroid hormone, that could affect the migrating motor complex. I see a lot of people with hyperthyroidism who also have SIBO. Different mechanisms as a cause, but SIBO and candida overgrowth are common. 

The stealth infections like Lyme and bartonella. Maybe they’re there. Just because I don’t test everybody for them. We are improving the health of other areas. It’s almost like a side effect, where we help with that. 

Mold, I definitely see. I see more of that now than I did years ago. I still wouldn’t rank it in the top three. Technically, I don’t know if you would classify it as an infection. I think of it as a mycotoxin. 

Inna: 

More of a toxin than an infection, yeah. 

Dr. Eric: 

How common do you see stealth infections and mold? Do you see a lot of that in your practice? 

Inna: 

I do, but also, I’m in the Northeast. We are Lyme country here. It’s more common. It’s common everywhere, but possibly more common here. I don’t test every single person for it because the testing is expensive. It depends on their history and if it warrants testing. 

What you said is that it’s all about looking at it as a whole. Usually, it’s not one trigger. It’s usually 5-7 triggers. Can you get to all seven triggers? Maybe. But maybe not. If you think of it as this bucket, and if there are seven triggers, and the bucket is this full, if we take out three of the triggers and work on the stress, now the bucket is half full. Can the immune system get to a point where it can work some things out on its own? Maybe. I’d like to think so. 

Sometimes, it’s not about figuring out every little thing. It’s a very fine line. I really see myself as a health detective. I know you really do as well. The work that we do, we are trying to put this puzzle together. We want to look at all the different pieces and how they fit. In some cases, we can see it. It’s very specific. In other cases, it’s more vague. We do what we can. It’s like the lowering of the nervous system, the downregulation that we help the patient do. Then their body can take care of the rest. 

Dr. Eric:
I agree. I also don’t test everybody for Lyme. Do you test everybody for mold? Do you do a urinary mycotoxin test on everyone? 

Inna: 

No. If they have a history of living in a place that had water damage. With mold, you don’t necessarily have to have respiratory symptoms. But for people who do, like the sinus stuff, if I feel something in their history matches that, then we do. 

The mycotoxin test is a little bit iffy, too. The foods we eat also produce mycotoxins. That doesn’t necessarily mean it’s the environment. Either way, if it’s there, we work on changing the diet and making sure they have clean air and live in a place where there is less moisture in general. 

Dr. Eric: 

Agreed. That’s a good point. Just because you have a positive finding on a urinary mycotoxin test doesn’t mean it’s coming from the air. It could be coming from the food that you eat. I’m glad you brought that up.

Are you familiar with Medical Diagnostic Laboratories, MDL? 

Inna: 

They do the Lyme testing, right? 

Dr. Eric: 

They’re not too bad. You’re probably familiar with IGeneX because they are the standard, and they are pricey. 

Inna: 

Very. I just did one for my son, and it was $1,400. 

Dr. Eric: 

They are the gold standard for a lot of practitioners. When I was dealing with chronic Lyme, I was thinking about IGeneX. I worked with a practitioner at the time who mentioned we could do the IGeneX, but let’s do MDL first, which looks at Lyme and bartonella and other coinfections. Sure enough, it picked up the Lyme and bartonella. It was a couple hundred dollars. 

Inna: 

Much more affordable. 

Dr. Eric: 

Still, something I don’t do on everybody. If I am suspecting it, that’s the first thing I’ll look at. If it’s negative, but we are suspecting something still, you could do IGeneX. Figured I’d bring that up. 

I know we touched on chemicals with mercury. Are there other common chemicals or heavy metals? I don’t know if you test for heavy metals or other environmental toxins. 

Inna: 

Sometimes, I use the Mercury Tri-Test or Heavy Metals from Quicksilver. 

I do hair testing a lot. I don’t think that hair testing is the best for metals because some people don’t excrete things. Hair testing shows you what you excrete. But what I find is after a few hair tests, if you do one every six months and do some detox, you will see them come up if they’re there. 

I also like hair testing for mineral levels and copper. That’s something I find more so in women than men although I see it in everyone. Copper is an essential mineral, but when it’s higher than optimal, it almost acts as a metal. That’s something I’ve dealt with. It can have a lot of different symptoms and relate to a lot of different things. Because of high copper, you could have low zinc. For thyroid especially, zinc is so important as well as for the immune system. I like to rule that out. 

Dr. Eric: 

I like hair testing, too. I agree about copper. It doesn’t always correlate with the blood. You might see copper toxicity in the hair, and the blood might look good. 

Inna: 

Yeah. 

Dr. Eric: 

Do you test for adrenals? Getting into stress, do you do any salivary or dried urine testing? 

Inna: 

I’ll do Dutch, not for everyone. I used to test adrenals much more. Unless I’m really wondering, “Is the cortisol low at night, or is it high at night?” for most people, I can tell from what they tell me in their health history. I really put in a lot of mind/body techniques from the beginning. Especially if someone doesn’t have an unlimited budget, that wouldn’t be a test where I would allocate a budget if we really need to find a specific bug. I can almost tell here. 

I do use Dutch sometimes. Lately, I have been doing a lot of cycle mapping tests for my perimenopause women because that can create a lot of shifts very quickly in the body. I have a couple of adrenal formulas that I’ll use. 

I have to say over the years, for myself and in my practice, I’m using less and less adrenal stuff, if you will, and herbs, and really going more toward mind/body. I used to try to depend on ashwagandha because I was feeling low. Yes, they help, but I feel like it’s a little bit of a Band-Aid. Some of the adaptogens are good because they help balance, but it’s still nothing compared to what we can do with our minds. Taking an adrenal supplement when we’re going crazy stressing about it, it’s like it’s this tiny bird that we are trying to give to the person versus addressing the big pink elephant in the room. 

Dr. Eric: 

I agree. I like adaptogenic herbs. I think they have their place. I like more calming herbs for adrenals sometimes. I agree that it’s not a substitute. If you had to choose one, you would want to choose the lifestyle, stress management, perception of stress, mind/body medicine, along with diet and sleep. There is a time and place for supplements, and I recommend them. But if we had to choose between one or the other. I’m sure you see it, too. Someone walks into your office, in person or remote, and they have 20-30 supplements for the very first consultation, and they are not eating an ideal diet or managing stress. I would rather see the opposite. 

Inna: 

The one supplement I do use if I see high cortisol or suspect it is phosphatidylserine, because I think it’s so calming. People really feel a difference, especially people who wake up in the middle of the night between 1am-4am and stay awake for more than 15 minutes, where it’s hard to fall asleep. That really helps, so I use that a lot. 

I’ve found for myself personally, too many herbs don’t work well for my body. I’ll break out. With autoimmunity in general, herbs are wonderful, but we just don’t know. They could stimulate more TH1 versus TH2. I know there are certain studies that show these things, but how do we really know where we are? It changes with our immune system, so it won’t always be the same.

In general, I tend to err on the side of caution with herbs for autoimmunity for that reason. Some of them may not have a specific study. I have seen it myself and some of my sensitive people, as I have a lot who I work with. 

Dr. Eric: 

That makes sense. Anything else you want to cover? Anything that is more common or uncommon that we didn’t talk about? 

Inna: 

Here is one that is uncommon but maybe common with Hashimoto’s specifically and maybe with Graves’. I’m curious what your thoughts are on that. But Botox. It’s very popular. Even for people who are more into functional medicine, they say, “I wouldn’t want to put a toxin in my body,” but they do it anyway. We all do. We know it’s a toxin. Your liver will process it. 

It’s interesting. There was a study that showed it can affect the way the immune system works and the thyroid. It was more specific with Hashimoto’s antibodies going up. I don’t know about Graves’. I’m curious if you have any experience with that. That’s always something I tell people about. “Listen, it’s your choice. I can’t tell you what to do. But it’s something you probably may not have heard of from your dermatologist or whomever does your Botox, and it’s something to keep in mind.” 

Dr. Eric: 

I am familiar with the research, but there is nothing I have seen related to Graves’. I don’t think I have seen anyone in my practice where that has been a trigger. If it was, maybe I missed it. I would agree that if it is a trigger in those with Graves’, it would be a lesser common trigger. 

Inna: 

It depends on what else is going on. If there’s a lot of other stuff, this could be that little bit that skewed them over the edge possibly. 

Dr. Eric: 

Yeah, I agree. I was going to say one lesser common trigger as well, and I’ll get your feedback after I say it: breast implants. It could be a trigger. I have seen it. But it’s not 50% or even 20-30% of my population who has breast implants as a trigger. I don’t know if you have seen that in your practice. 

Inna: 

I don’t have very many people with them that I know of, but I have a few people who have had them taken out, thinking it was creating issues for them. I don’t think I have a big enough pool to speak as well about it. But there’s certainly a huge movement with taking them out and the different health implications, be it autoimmunity or toxicity. In general, anything that creates toxicity is going to have a possible effect on autoimmunity, depending on what our pathways are doing. 

Dr. Eric:

I agree. 

Inna: 

Just speaking of beauty stuff, another thing that can be a trigger for some people is fillers, specific types though. I interviewed a dermatologist who was a little bit more functional, and she was saying that the cross-linking fillers, like Voluma, and I forget the other brands. It’s the ones that cross-link, so they stay in the body longer. It’s like hydrofluoric acid that they cross-link with something else. I’m not sure of her exact wording. She feels like there could be something with that. If someone does get fillers, maybe ask the person who does your fillers if this filler you’re using is a cross-linking one or not. 

Dr. Eric: 

Interesting. Anything else that you want to share? Anything that I should have asked you that I didn’t ask you that you want to talk about? If you want to summarize some of the things you mentioned? 

Inna: 

Of course. When you are dealing with autoimmunity, it’s about looking at it from a whole-body perspective. Whether it’s Graves’ or Hashimoto’s or another autoimmune disease, of course there will be nuances of what we do. I think a lot of those are more specific even to addressing the thyroid function itself. The things you do obviously for hyperthyroid will be different from what you would do for hypo. If you do have hypo, there are a lot of different thyroid types, as I call them. 

What I find is when you’re dealing with thyroid autoimmunity, it’s this two-fold approach of supporting the autoimmunity while at the same time supporting thyroid function. Obviously, it’s different how we would support hyper versus hypo. You want to make sure you are supporting it for you and looking at those optimal ranges of where you want to be while you are doing all of the things to help balance the immune system. 

I like to look at the immune system as this very intelligent thing that knows what to do. However, when bombarded with a lot of different things, it naturally loses its footing a little bit. It’s not about, “Oh no, my immune system is kaput.” No, we don’t want to say that. Your body is so intelligent and amazing. It’s just clogged with these different things. It’s not about let’s get rid of everything because we sometimes don’t even know what it is, but let’s calm it. That’s why this nervous system stuff is so important. I don’t want to belabor the point. 

I am going to say it again: Anything you can do on a daily basis to be proactive. You want to make sure you’re in a place of balancing and relating in the body versus reacting. You don’t want to react to stress; you want to be ready for it to come. When it comes, you can handle that versus reacting afterwards. 

The calmer the nervous system, the better your immune system is going to function. The more of these other triggers that you take out, think of it as taking the burden off. Think of this intelligent being, which is your immune system. 

I almost imagine it as walking in ski boots, but not on the ski slope. It’s really hard. “Let me give you a hand. Let me take this boot off, and then this one. Let me show you how we could do it easier.” The immune system is like, “Okay, cool, now I can do this.” It’s not about rewiring it. It’s about slowing things down and helping it along, so it can come back and do its job and not be so hypervigilant. We don’t want to be in that state of “Let me shoot now and ask later.” That’s what happens in most cases with autoimmunity. 

Dr. Eric: 

Very well said. Where can people find out more about you, Inna? You can bring up your podcast and website. I think you have a program for Hashimoto’s. 

Inna: 

The best way to connect with me is on Instagram. I’m @InnaTopiler there. My podcast is HealthMysteriesSolved.com. All of the information about that is there. I also have a Hashimoto’s program for those listening who have it, where we get into that support and specific thyroid support. We made a special link for you guys. It’s ThyroidMysterySolved.com/DrEric. On Instagram, I answer all of my messages and am happy to connect. 

Dr. Eric: 

Thank you so much for this conversation. I really enjoyed chatting with you. I’m sure the audience learned a lot about common and uncommon causes. 

Inna: 

Thank you so much. I was really excited to be here and connect with you again. 

 

Recently, I interviewed Dr. Ben Weitz, and we talked about a functional medicine approach to thyroid autoimmunity. If you would prefer to listen to the interview you can access it by Clicking Here.

Dr. Eric Osansky: 

Very excited to chat with today’s guest, Dr. Ben Weitz. We are going to be talking about a functional medicine approach to thyroid autoimmunity. Dr. Ben also will be discussing his personal experience with thyroid autoimmunity. 

I am going to dive into Dr. Ben’s bio: Dr. Ben Weitz is a certified sports chiropractor and functional medicine practitioner. For more than 35 years, he has worked with professional sports teams. He wrote a book in 1998, The Back Relief Book, and has published several papers on the prevention of injuries and weight training. He is currently working on a book on longevity. He has a weekly podcast, Rational Wellness, which is now in its sixth year. This is devoted to all things functional medicine. His office is in Santa Monica, CA, and he sees patients for both functional medicine and chiropractic therapy. Thank you so much for being here, Dr. Ben.  

Dr. Ben Weitz: 

Thank you, Eric. Excited to be joining you and sharing some knowledge with your viewers. 

Dr. Eric:

I was on Dr. Ben’s podcast. We had a great time chatting. I’m sure this conversation is going to be great, too. 

Let’s get into your background. You started off doing sports medicine, sports chiropractic, which you still do. How did you get into the functional medicine side? 

Dr. Ben: 

I think it started because even prior to becoming a chiropractor, I got involved in bodybuilding. I started learning about how to change my body composition. How do I reduce my body fat? How do I eat in a way to maximize muscle mass and reduce body fat? I started learning how to change body composition. That got me interested in nutrition as part of my chiropractic practice. I thought, I can help other people to get in better shape and reduce their body fat. 

One of the first things that happened while I was practicing chiropractic, I think my first year in practice, Dr. Jeffrey Bland gave this seminar for Metagenics. I went to that seminar, and it blew my mind. For those who don’t know, Dr. Jeffrey Bland is the father of functional medicine. He would give these seminars that your neurons in your brain were just tingling afterwards. At the time, he was working with Metagenics. Metagenics would often send somebody out the next week to explain what Dr. Bland was telling everybody. I got really excited. That became an annual thing. Every year, I would go to watch Dr. Jeffrey Bland. For me, it was like going on a pilgrimage to Mecca. 

Dr. Eric: 

That’s pretty cool. I didn’t know he was associated with Metagenics for a while. I went through the IFM training, and he is affiliated with them. 

Dr. Ben: 

He started the Institute for Functional Medicine. 

Dr. Eric: 

Exactly. Prior to that is when he was with Metagenics? 

Dr. Ben: 

Yeah. He started his own company, HealthComm, that made medical foods. They linked up with Metagenics, and he became the science officer for them. He did that for many years. Of course, he started IFM. Most people credit him as being the father of functional medicine.

The other thing is he would put out this monthly tape of information about functional medicine. It started out as PMU, Preventative Medicine Update. I would get these little cassette tapes. At the time, every car would have a cassette player. Eventually, they switched to CDs. I would get the CD and listen to it in the car. Eventually, it became a podcast. That was a sad day. I remember I still had paid for that year’s subscription. He said, “Sorry, we are going to have to refund you.” It was great. I used to love getting those updates from Dr. Bland every month. 

Dr. Eric: 

He has a wealth of knowledge. I miss those days with the cassette tapes. Not that I don’t enjoy the modern technology and podcasts, but it brings back good memories. 

Let’s dive into autoimmunity. Can you explain at least some of the reasons why you think autoimmunity is so much more prevalent these days? Going back to the days of cassette tapes, 20 years ago, 25-30 years ago, wasn’t as popular. We have better diagnostics these days, but it does seem like there is a lot more people with autoimmune conditions.  

Dr. Ben: 

I don’t think there is any data to know 100% for sure, but I believe it’s most likely related to the modern diet, the modern food system where eating so much processed food and hybridized products, fruits and vegetables. So many of the foods are sprayed with pesticides, and animals are sprayed with chemicals. High levels of toxins that we’re exposed to in the environment, not only on our food, but in our air, our water. We are constantly getting exposed to toxic products that stress our immune system. They are in the chemicals we put on our skin. They are in the pots and nonstick pans we cook with. They are embedded in our furniture and car seats. The modern world is an assault on our immune system. 

Dr. Eric: 

I agree. There is no question that what we eat, the air we breathe, the water we drink are huge. It’s unfortunately not getting any better. The good news is that podcasts like mine and yours and many others are bringing more awareness, so people are becoming more aware. They are eating organic and purifying their water and trying to do other things to reduce their toxic load. Still, it’s an uphill battle. 

You were diagnosed with Hashimoto’s. I’m imagining when it comes to working with people, not that you exclusively work with people with autoimmune conditions, but I’m sure you see a fair share of people with autoimmune conditions. Given that Hashimoto’s is the most autoimmune thyroid condition, I’m guessing that might be the most common autoimmune condition you see in your practice? 

Dr. Ben: 

I don’t know if it’s the most common one I see, but I know it’s the most common autoimmune condition. We certainly have tons of patients with Hashimoto’s. 

I diagnosed myself. For years, I actually had an elevated TSH level. TSH is the hormone that is secreted by the pituitary to tell the thyroid to produce more thyroid hormone. If that is elevated above- People have different numbers, but 3 or 4. Some people say 2.5. Mine was around 7-8 for many years. I ignored it. Nobody paid any attention to it. I never had any symptoms, like fatigue, weight gain, or hair loss. 

I like to run my labs pretty regularly, a couple of times a year. I do pretty detailed labs on myself. I had been monitoring it for a number of years. My TPO (thyroid antibodies) have been mildly elevated, but not excessive, say 100-120, in that range. Normal is below 30. Ideally, you shouldn’t have any thyroid antibodies. Not generally considered something to worry about. I basically ignored that for a number of years.

One year, my TSH level went up to 9. I was searching around for some strategies to help myself deal with that. I had been hearing about the high dose iodine concept for quite a number of years. It always seemed wrong to me, but there is one very famous naturopathic doctor. Is he a medical doctor? 

Dr. Eric: 

Brownstein? He’s a medical doctor. 

Dr. Ben: 

He’s been talking about these super high doses of iodine. I said, you know what? Let’s give it a shot. For people who don’t know, iodine is the backbone of the thyroid hormone. When they talk about T3 or T4 as the different thyroid hormones, T3 has three iodine molecules, and T4 has four iodine molecules. You have to have adequate iodine, or that can lead to thyroid problems. 

For many years, before thyroid autoimmunity became the problem, the big problem for hypothyroidism in this country was that people had goiters from lack of iodine. The Midwest was considered the goiter belt. It was very common for people to have these enlarged thyroids because the thyroid would be working hard to produce more thyroid hormone. It’s all because the soil there was low in iodine. 

Many years ago, the United States started adding iodine to our salt. We have iodized salt. That was done specifically to reduce hypothyroidism. We saw levels of goiter drop incredibly. At the same time, levels of autoimmunity went up. We’ve seen the same thing in Iran and other countries around the world when they supplement the diet with iodine, typically by adding iodized salt. 

In this country, most people have enough iodine. But I, being a health care practitioner and fanatic for natural health, haven’t used iodized salt for years. There is really no super accurate way to measure iodine. There is an iodine loading test. You can do serum iodine. None of those are really considered super accurate. Maybe I don’t have enough iodine, I thought, because I had been using a pink Himalayan salt or sea salt, and I hadn’t used iodized salt for probably a decade or longer. 

I started taking the Iodoral, which is a brand product. I took the one with 12.5mg of iodine, whereas the average multivitamin will have 150mcg, like 1.5mg of iodine. Unfortunately, my TSH levels went the wrong direction. They went up to over 25 from 9. I realized that wasn’t right. What to do next? Stop iodine. Stop eating seaweed or any other sources of iodine. 

Then I did a stool test to look at my gut. I’ve had IBS symptoms off and on for years. Nothing too major. I found some things to work on in my gut, so I started taking some antimicrobials and worked on some other gut support. 

At the same time, I had done a NutrEval, which is this comprehensive nutrition evaluation. The ingredient that came up that I lacked the most was zinc. I decided that I wasn’t taking extra selenium, so let me add some extra selenium. 

I also looked at a genetic test that showed I had a couple of genes that make it difficult for me to absorb zinc. That made sense. Even though I had been taking some zinc, I realized I needed to take more zinc. Rather than take a big dosage at one time, I decided to take 15mg in addition to my multi and take it four times a day, possibly increase the absorption by taking it at different times of the day. I added the zinc. 

My goal is to keep Vitamin D for most patients in the 50-70 range. Mine was in the mid-40s. I would get it up to 50, and it would drop back to 40. I live in southern California. I don’t get a ton of sun, but I do play golf. I do get a certain amount of sun, yet it is very difficult for me to get my Vitamin D level up. Let’s really hit the Vitamin D. 

I experimented with different formulations of Vitamin D: fat soluble vs water soluble. I started taking between 5,000-10,000. 5,000 wasn’t cutting it for me, so I started taking 10,000 for a couple months, and then alternating between the two. 

I got my Vitamin D level up. I got my zinc level up. I also added some magnesium and brought my TSH level down to 4.7. I had gotten in to see my primary care doctor. What I do before seeing my primary care doctor is doing my own lab work and bringing it into him. 

The lab work that is allowed through insurance is pretty minimal. Most people don’t realize what they do to make the lab work look better. The typical lab work you’ll get from your annual physical is basically a chem screen, a CBC, and maybe a basic lipid profile. Now, a chem screen is a pretty basic test going through an automatic machine. It’s like 10-12 tests, something like that. They will put each test on a separate sheet of paper to make it look like it’s a lot of testing. They will do the same thing with the CBC. They will put each particular part of it on a separate sheet of paper. 

Patients come in to see me all the time, “I had all of my labs done, so obviously, nothing’s wrong,” which nothing could be further from the truth. Of all the lab tests they could have done, they had this much done, but it looked like a lot.

I run my detailed labs and then bring them to my doctor. When my TSH had gone up to 25, he had seen me and said, “Why don’t you take some thyroid?” I said, “Look, I don’t mind taking thyroid if I need it. I would definitely take it. But even though my TSH is high, and I know it’s very high, so far, my free T3 and free T4 are still within range. Are they at the top of the range? No. I don’t have fatigue or any other symptoms. At this point, let me try to work on some of the underlying causes of autoimmunity. Let me try to promote better thyroid health.” 

When I brought my TSH down, he just shook his head. He knew what he suggested, taking thyroid, I probably wouldn’t take it. 

Dr. Eric: 

You have never been on thyroid hormone replacement? 

Dr. Ben: 

I have never taken thyroid hormone replacement or even a prescription medication, other than a painkiller for a day or two after surgery. 

Dr. Eric: 

That is awesome. High dose iodine, I have my own experience with that. 

Dr. Ben: 

What happened to you? 

Dr. Eric: 

When I was not doing the functional medicine part and just the chiropractic, I still attended conferences that focused on nutrition. Standard Process seminars, as you are probably familiar with. They had some functional endocrinology seminars. Whenever they went to those seminars, they spoke about iodine and the thyroid, and they were high proponents of high dose iodine. They brought up Dr. Brownstein’s book, and I read it, Iodine: Why You Need It and Can’t Live Without It. 

When I dealt with Graves’, I took high dose iodine just because that was what I learned prior to being diagnosed. My experience was fine. My TSH also didn’t skyrocket to 25. With Graves’, you get the undetectable TSH typically. I was doing other things like taking bugleweed, which is an herb with antithyroid properties. I took bugleweed before the iodine. Even before I took the iodine, things were kind of normalizing, and the iodine pushed it a little more toward that hypo side. 

My experience was okay. It didn’t worsen my condition, or at least it didn’t seem like it. I have been in remission since 2009. Over the years, I saw good and bad with iodine. 

Dr. Ben: 

What would be the rationale to why iodine could help with hyperthyroidism? 

Dr. Eric: 

When you take high dose iodine, it has the opposite effect, where it can push someone more toward the hypo side. In fact, many years ago, some practitioners would use that instead of radioactive iodine. Sometimes, instead of antithyroid medication such as methimazole. 

When you think about it, it doesn’t make sense. Iodine is important for the formation of thyroid hormone, so why would you want to take higher dose iodine? In some people, it definitely makes it more hyper. In some people, it exacerbates the autoimmune response. It definitely has risks, and it’s not the approach I take these days.

I am sharing my experience because it was similar to yours. I did the iodine loading test myself. It sounds like you didn’t do the testing; you just experimented. I did what Brownstein recommended: took the iodine loading test, and it showed I was deficient. Iodine does have the potential to lower thyroid hormones. The problem is in some people, it can do the opposite. In some people, it can exacerbate that autoimmune response. I have seen some people where it worsens thyroid eye disease, which is common with Graves’. 

The approach I take today, I am definitely not anti-iodine. I have no problems giving a multivitamin with iodine or having people eat some foods that have iodine, whether it be some seafood or eggs. 

As far as the high dose iodine supplement, I usually stay away from that as far as my patients, recommending not to do that. Same thing with sea vegetables. I am more cautious with them eating seaweed and kelp. 

Definitely controversial. There is a book called The Thyroid Reset Diet, where the author recommends 200mcg of iodine or less per day. I’m not saying some people don’t need a real low iodine diet. It comes down to everybody being different. I do think the real high dose, because you mentioned you took 12.5mg. There are some people who have taken or are still taking 50mg, a lot higher doses. 

Now you said you had a stool test done. Do you remember what the stool test showed? 

Dr. Ben: 

It showed basically dysbiosis. It wasn’t anything too dramatic. Overgrowth of some bacteria that shouldn’t be there and maybe some of the commensals lacking a little bit. I took some antimicrobials and followed them up with a gut repair program, so nutrients that specifically support gut health, which includes things like glutamine and mucilaginous herbs as well as taking probiotics and prebiotics. 

I generally employ some version of the four R programs. I want to remove those foods that are causing problems. We want to replace digestive enzymes, maybe hydrochloric acid. We want to remove excess overgrowth of bacteria, parasites, protozoans, fungal overgrowth, and pathogenic bacteria, etc. Then we want to rebuild after that. 

Dr. Eric: 

When it comes to triggers, you have already spoken about some of them. You just mentioned parasites and other microbes. You spoke a little bit about food and environmental toxins, how those are a big factor with autoimmunity. Are those some of the more common triggers? Would you say infections in your experience are up there, maybe the top one or two? Or is it more food? Do you see multiple triggers? What do you see in your practice? 

Dr. Ben: 

I see multiple triggers. What we’re talking about are things our immune system reacts to, which then ends up causing our immune system to turn around and react to our own cells, organs, tissues, which is what we refer to as autoimmunity. When our immune system is attacking us instead of outside invaders. 

You can basically break it down into food sensitivities, toxins, and infections. Those are the main categories. Unfortunately, we live in a super toxic world. Even trying to eat clean, stay away from toxic products, it’s impossible to do so completely. Everybody is going to have some level of toxins unfortunately. 

Dr. Eric: 

How about stress? Do you consider stress to be a trigger as well? 

Dr. Ben: 

Sure. We often see that as problems with adrenal function. Many of us have some level of chronic infections. As most of us now know, now that we are all experts on viruses, any virus you’ve ever had in your life, any cold, etc., remains in your body to some extent as the immune system remembers it. 

What can happen is you can have some infection that the acute phase cleared, but it’s still smoldering at a lower level. Or some virus gets reactivated. One of the things we’ve seen with post-COVID is reactivation of some of these chronic viruses, like Epstein-Barr or herpes. Those can smolder at a low level, and that can play a factor as a trigger in autoimmunity. 

The mechanism by which infections, food sensitivities, toxins, can lead to autoimmunity, the main understanding of how that works has to do with something called molecular mimicry. What that means is let’s say you have a food sensitivity to gluten, which is a protein found in wheat. Your immune system creates antibodies to gluten. Gluten is a protein, and that protein structure is similar enough to some of the proteins found in the thyroid, or the thyroid hormone receptor. Those antibodies, instead of attacking the gluten, attack your thyroid or thyroid receptors in the case of hyperthyroidism, or some other tissue in your body. Your immune system ends up attacking itself. That’s what autoimmunity is. 

From a functional medicine perspective, in addition to helping control the symptoms initially, we want to find some of these underlying triggers and remove as many of them as we can. 

Dr. Eric: 

Exactly. Sometimes, it’s challenging to do that. Sometimes, it’s challenging to find the triggers. But I agree. We need to do our best as functional medicine practitioners. 

Speaking of finding triggers, when it comes to viruses, a lot of people, if not most people, have Epstein-Barr. Would you agree that just having Epstein-Barr doesn’t mean it’s a problem? A lot of people with thyroid and other autoimmune conditions have it where it’s not an issue. Would you agree with that? 

Dr. Ben: 

Sure. We typically test for antibodies to Epstein-Barr rather than just seeing it. When it comes to infections like Epstein-Barr, just the mere presence of the virus is not the problem. The question is to what extent is your immune system mounting a response to Epstein-Barr? To what extent are you actively forming antibodies? Therefore, rather than measuring whether there is Epstein-Barr in the system, we typically measure antibodies. Then we look at whether there is a sufficient amount of antibodies that it looks like Epstein-Barr is potentially having a factor on your health. 

Dr. Eric: 

Then parasites. If they show up on a stool test, do you always address them? Does it depend on the parasite? 

Dr. Ben: 

Like everything related to health, especially functional medicine, there are controversies about parasites. One of the controversies is are any parasites actually commensal? I know some people will be aghast. What do you mean? A parasite is a good thing? Well, it turns out that in societies where worms are endemic in people’s guts, autoimmunity is much less prevalent. One of the theories about autoimmunity is that our immune systems don’t have enough to do because we grow up in this sterile environment. People who have parasites, their immune system is busy taking care of those and less likely to react against us. 

There are certain parasites that will show up, particularly protozoans, like Dientamoeba fragilis, D-fragilis, and Blastocystis hominis. There are prominent people in the functional medicine world. I’ve had discussions with Jason Hawrelak, who is one of the top experts at the microbiome and publishes Probiotic Advisor, which is a great resource for information on probiotics. He feels that most patients with either of those parasites/protozoans are essentially commensal. You don’t need to go after them. 

In my case, if I see Blastocystis hominis, it depends on what’s going on. I’m going to consider it as something we might want to target. I’ve had a number of patients where I think getting rid of Blasto was a major factor in restoring their health. I think it depends on the patient. 

There are a lot of things that are controversial. For example, H-pylori is a bacteria that is found in the stomach. It can be found on a stool test. I interviewed Dr. Steven Sandberg-Lewis, who is one of the world’s top functional medicine gastroenterologists. He says in most cases to leave it alone; don’t even test for it. 

I recently had a patient who has had chronic reflux for years. We’ve done all kinds of things. Now that we saw it on a stool test and targeted it, his whole life has completely changed. This reflux that he has had for his entire life is now gone. His life is so much better, just using some herbs that reduce H-pylori. I think it depends. 

Dr. Eric: 

I agree. I think we share the same perspective. I think you know I also interviewed Dr. Hawrelak. We had that conversation about Blastocystis as well. Nirala Jacobi, who lives pretty close to Dr. Hawrelak, focuses on SIBO. She also shared that perspective on the podcast about Blastocystis.

I’m with you. With H-pylori, same thing. If someone is experiencing reflux or heartburn, I say to treat it. In the research, there is a correlation between H-pylori and Hashimoto’s and Graves’. Correlation doesn’t always mean causation. It’s not like I’m recommending triple therapy antibiotics. Like you, I’m taking more of a natural approach with herbs. It’s not like we are wiping out all of the good bacteria. 

If we see it, and someone comes to see me with Graves’ or Hashimoto’s, which is typically the case, and it shows up, I won’t hit it hard. I don’t have prescribing rights, and you don’t either. Even if I did, with the knowledge I have now, I wouldn’t recommend antibiotics or in the case of parasites, metronidazole or flagella. I still take more of an herbal approach. There is controversy with that, and I’m glad we’re on the same page.

What do you do to lower your toxic burden on a daily basis? 

Dr. Ben: 

Examine the way you lead your life. Look at your house. Look at your clothes. Look at things you put on your skin. Eat organic as much as you can. If you are worried about the costs of organic, you can go to the Environmental Working Group. They give you lists, the Dirty Dozen. These are the ones that are most sprayed with pesticides. If you can eat these particular foods, like an apple or a blueberry- Blueberries grow close to the ground. They are not only sprayed with pesticides, but they are sprayed with fungicides and probably herbicides. At least eat those foods organic. Personally, I try not to eat anything that is not organic. That’s #1. 

Use safe personal care products. Don’t cook with Teflon. Don’t store food in plastic. Don’t use plastic wrap. Don’t use aluminum foil. Use glass containers. 

Try to lead a healthy lifestyle as much as you can. Don’t drink tap water. We use a reverse osmosis multi type of water purification system at our house. 

Don’t use toxic cleaning products. Don’t use toxic products to wash your clothes. Don’t even give toxic cleaning products to your housekeeper if you have one. They will spray it all over the place. 

Don’t hire a guy to spray pesticides all over your house. Find ways to deal with it as much as you can naturally. We’ll use a natural orange oil to kill bugs if we feel like we need to. Same thing with your pets. Try to avoid giving them toxic chemicals. Try to avoid having carpet in your house. Don’t buy a mattress that is sprayed with flame retardant chemicals. Don’t use toxic air fresheners. Those are some of the most toxic. Those are the things I’m thinking about.

Read labels. Start learning what are the terms that you want to look for. Anything that says it has perfume or fragrance in it, it has phthalates. You don’t want to eat it. Don’t buy anything plastic. 

Drink water out of a glass or steel water bottle. People use these plastic water bottles, and then they worry about if the water bottle is going to get hot in their car or something. That water bottle has probably been sitting in the back of Costco or some warehouse in 100-degree weather for a long period of time before you even got it. Don’t drink from those. 

Dr. Eric: 

Great points. I also drink reverse osmosis water. Do you do saunas? 

Dr. Ben: 

We have an infrared sauna at my house. 

Dr. Eric: 

Wonderful. I do saunas as well. 

Dr. Ben: 

I go to the gym and sweat as well. Sweat is a way to help detoxify you. I periodically do a detox program a couple of times a year. 

Dr. Eric: 

Like a 21-day or two-week one? 

Dr. Ben: 

I will typically do like 10 days. I will do UltraClear RENEW and supplement it with liposomal glutathione and take some binders. 

Dr. Eric: 

All right. I have a question about Vitamin D. You said you like to see the levels between 50-70. You do the 25 hydroxy Vitamin D test, correct? 

Dr. Ben: 

I have done the 125 as well. 

Dr. Eric: 

What are your thoughts on the 125? 

Dr. Ben: 

Have you heard about the Marshall Hypothesis? 

Dr. Eric: 

Yeah. Have you had Dr. Eric Balcavage on your podcast? 

Dr. Ben: 

No. 

Dr. Eric: 

He has a book The Thyroid Debacle. He was talking about 125 hydroxy on my podcast. You probably are familiar with Dr. Ben Lynch, who wrote the book Dirty Genes. 

Dr. Ben: 

Yeah.

Dr. Eric: 

When I attended one of his seminars a number of years ago, in either 2016 or 2017, he was supporting 125 hydroxy. When I was going through my master’s in nutrition, they were saying not to do that because of the parathyroid gland’s compensating. Typically, you will see 125 hydroxy elevated often when 25 hydroxy looks good or low. You can’t rely on 125. His perspective, Dr. Balcavage, was that it’s not true. 

I’m like you. I will take 5,000 IUs of Vitamin D daily because I rely on the 25 hydroxy. Even when I went through IFM, that is what they also were talking about, 25 hydroxy, not the 125. It’s just an interesting perspective. 

Dr. Ben: 

You know what? I went through a period where we were running a 125 on every patient a number of years ago. We were using this one lab that had all these markers and included the 125. I did that on 100+ patients, and it was hardly ever elevated. I think it’s a very rare thing that that happens. 

The concept is you are converting all of your Vitamin D to the active form, 125, so therefore your 25 always looks lower than it should. You don’t really need to take more Vitamin D. That is the concept that you’re talking about.

Apparently, that happens in sarcoidosis, maybe one other autoimmune disease, and not in the common autoimmune diseases that we know. I don’t know. After running that 125 over 100 times, I didn’t see it elevated. 

Dr. Eric: 

Interesting. 

Dr. Ben: 

That’s my experience. It’s always better to test rather than guess. We have to be judicious about how many tests we are going to run because these functional medicine tests are out of pocket for the patients. We use a lab that gives them a discount price, but it’s still out of pocket. I try not to do tests that don’t change what I do clinically. 

Dr. Eric:

That sounds good and makes sense. That’s what all practitioners should do. There is no reason to do testing if you’re not going to do something based on the test results. 

Dr. Ben: 

Absolutely. I do think it’s better to test than to guess. 

Dr. Eric: 

Agreed. I definitely like testing. Not overdoing it but looking to try to find answers. 

Dr. Ben: 

There are so many people who don’t even know. I picked up a guy a month ago, and he had no idea he had thyroid problems. His thyroid antibodies were over 500. And he was so grateful that I told him that he had hypothyroidism. He is doing great now. There is no way we would have known. He had no clue. 

Men typically don’t even get their TSH measured. It’s not part of your chem screen or CBC. It’s just not done, especially for men, because hypothyroidism is much more common in women. Men with hypothyroidism are not often picked up. The only way we would have picked that up is because we included that in our testing. 

Dr. Eric: 

I agree. It’s unfortunate that the medical model, they just do the basics, the bare minimum, whatever insurance will cover. 

Dr. Ben: 

That’s the whole thing. That’s the thing that nobody talks about. The health care system is controlled by insurance companies. Unfortunately, that’s the case. Insurance companies want to pay for the most minimal amount of testing possible. If your primary care doctor starts ordering a bunch of tests other than what the insurance companies recommend, they either won’t pay for it, and the patient gets stuck with a big bill, or the doctor will get threatened by the companies. 

Dr. Eric: 

One more question I have for you: Do you test people for a leaky gut, or do you just assume that people have a leaky gut? 

Dr. Ben: 

I typically do include zonulin as part of the gut test. There are a couple ways you can test for leaky gut. As far as I’m concerned, I think the most accurate is the old test we used to do, which as the lactulose mannitol test. That test involved drinking a solution of lactulose and mannitol. That was the best way to determine a leaky gut. 

Since we hardly ever do that test, I include zonulin as a marker in the stool test. I’m gonna assume that most of my patients who have gut problems have a leaky gut. If you run food sensitivity tests, and the patients come up with 30 different foods that they’re sensitive to, you can assume they have a leaky gut. 

Dr. Eric: 

You brought up another question. In that case then, if you do a food sensitivity test, and someone shows up with 30 foods, do you not tell them to avoid the foods? Do you focus on healing the gut? Or do you heal the gut by telling them to avoid those 30 foods? 

Dr. Ben: 

It depends. If the patient is there primarily for gut health, or we are just testing the gut because it’s part of something else. Sometimes what I’ll do is look at those numbers. Depending upon the test, only ask them to take out the foods that are the highest range. 

I tend not to do a lot of food sensitivity testing because I find those tests not as helpful, partially because sometimes one of two things happens. They react to everything, or they react to nothing, except like oysters, and they don’t even eat oysters. Either one of those are not clinically helpful. I have not found most of the time food sensitivity testing that helpful. But some of the patients want to run it. Sometimes we are searching for answers, so we’ll do it. 

I also think so many people react to gluten and dairy that I know can be helpful to test, especially if it will reinforce to the patient why they shouldn’t eat it. A lot of times, we just ask them not to eat gluten or dairy. 

Dr. Eric: 

I do the same thing. I’m not a big fan of food sensitivity testing. I have people go on an elimination diet and have them avoid gluten and dairy. 

Just because you brought up that scenario, I wanted to ask. I don’t do a lot of food sensitivity testing, but if someone tests for 30-40 foods, and a lot of them are healthier foods like broccoli and avocado and asparagus. If someone does it on their own, and if they come back, I will tell them to avoid the higher foods. You spent the money on it. Depending on the test, if it’s a scale of 1-5, and they are a 5 for avocados, I will tell them to avoid avocados to play it safe. Typically, it does relate to the gut, and that is what we need to do. 

Dr. Ben: 

One of the big issues has to do with the fact that after being in practice for so many years, I realize that what we say can have a big impact on people’s lives. I know that some of my patients listen to me a lot more than my wife does. They will sometimes take what I say to their grave. 

I’m careful about taking food away from people. In my mind, sometimes, I’m thinking we will take it out for a few months and then test it back in. Depending upon the patient’s mindset, if they are feeling better, I have a number of patients who don’t want to bring any of those foods back. They end up with a very limited diet. That’s not healthy either. 

I think we need a diverse diet with a lot of different colored fruits and vegetables, healthy fats, quality proteins, etc. I don’t think we want a limited diet. If the person has any tendency toward anorexia, if they are very thin, I’m really cautious about taking food away from people. We do it when we need to. We try to do it for short periods of time and try to emphasize the importance of bringing the foods back. If they have a reaction, then maybe take it out. 

Dr. Eric: 

That makes sense. Is there anything else you’d like to discuss? Anything that I didn’t ask you that I should have asked you? Do you want to do a summary? If someone is wondering if they have autoimmunity- 

Dr. Ben: 

You didn’t ask me what the earth speed velocity of a pigeon is. Just kidding. That’s a joke from Monty Python. I’m sorry for not being serious. 

Dr. Eric: 

That’s fine. I’m not a Monty Python fan, so I didn’t get it. You can definitely kid around on this podcast. You don’t have to be 100% serious. Dr. Jacob Teitelbaum, have you spoken with him? 

Dr. Ben: 

I have not.  

Dr. Eric: 

You’re familiar with him though? From Fatigued to Fantastic, it’s a pretty popular book. 

Dr. Ben: 

No. 

Dr. Eric: 

If you want to have a real funny conversation, he’s a real funny guy. It was a good conversation, too. But I was laughing throughout the podcast. 

Dr. Ben: 

Hopefully not with arcane jokes that nobody gets.

Dr. Eric: 

Do you want to cover anything else? Or give a summary of what are the most important things someone can do if they have been diagnosed with an autoimmune condition? 

Dr. Ben: 

For people who are dealing with some level of autoimmunity, and people don’t even know they have autoimmunity. A lot of people have hypothyroidism, and they are given Synthroid. End of story. 

We know in the United States the majority of cases of hypothyroid are related to autoimmunity. Patients go to rheumatologists and are given some drug that lowers their immune system, and I think we have all learned that having an immune system that doesn’t work very well is not a great thing, especially when there are dangerous viruses around or cancer, etc. 

I think we have to spread the word that there is a reason why your immune system is attacking yourself. It’s just not acceptable to simply take a drug that suppresses your immune system. Look, I totally understand that there are autoimmune diseases like Crohn’s or ulcerative colitis and others that can be life-threatening. There is a place for these drugs. But even patients who take those drugs should see a functional medicine practitioner and work on trying to find the underlying triggers, why your immune system is attacking yourself. 

Your immune system is not designed to attack itself. It’s designed to attack pathogens, foreign invaders, etc. It should not be attacking your own cells, tissues, and organs. If that is happening, take whatever drugs may be necessary to control the symptoms. As you have been able to show, even a very serious condition like hyperthyroidism, which can damage your heart, can often be controlled just using herbs and not taking the dangerous drugs. Other conditions may need to take those immune-suppressing drugs. Try to work on the underlying triggers. 

Talk to your doctor after working on removing as many of those triggers as you can. If you can’t possibly reduce the dosage or wean yourself off those immune-suppressing drugs, overall, you will be healthier by not having your immune system suppressed. 

Dr. Eric: 

Thank you for summarizing that. Where can people find out more about you, Dr. Ben? You have your podcast and your website. 

Dr. Ben: 

Check out Rational Wellness Podcast. You can see the video version or listen to the audios. You can go to my website, DrWeitz.com. You can find out more information about me, my clinic in Santa Monica. I’m available for consultations for functional medicine and chiropractic. 

Dr. Eric: 

All right. Thanks again, Dr. Ben. It was great chatting with you about autoimmunity. 

Dr. Ben: 

Thank you so much, Dr. Osansky. 

 

Recently, I interviewed Dr. Anna Cabeca, and we talked about a unique approach to optimizing sex hormones during menopause. If you would prefer to listen to the interview you can access it by Clicking Here.

Dr. Eric Osansky: 

I am super excited to chat with Dr. Anna Cabeca, as we are going to be discussing a unique approach to optimizing sex hormones during menopause, talking about alkalinizing the body as well as maca root. It’s going to be a lot of fun. 

I am going to dive into her bio here, which is very impressive. She is the bestselling author of The Hormone Fix, Keto Green 16, and MenuPause. Dr. Anna is triple Board-certified and a fellow of gynecology and obstetrics, integrative medicine, and anti-aging and regenerative medicine. She holds special certifications in functional medicine, sexual health, and bioidentical replacement therapy. She lectures frequently on these topics throughout the world to large audiences and is known nationally as The Girlfriend Doctor. She is the host of The Girlfriend Doctor Show. 

She has personally developed natural products to help women balance hormones and thrive through menopause, including the highly acclaimed Julva cream for the vulva and Mighty Maca Plus, which is a powerful superfood blend. She now lives in Dallas with her daughters, horses, and dogs. Thank you so much for joining us, Dr. Anna. 

Dr. Anna Cabeca: 

Great to be here with you. Thank you for having me. 

Dr. Eric: 

Again, the pleasure is all mine. Let’s start out with a little bit of background. How did you get into more of an integrative approach in your practice? 

Dr. Anna: 

I went to an osteopathic medical school. Then I went to residency at Emory University, so a very allopathic institution. During that time, my mom, who had been part of getting the best health care through our U.S. military and some of the best doctors that we had in northeast Pennsylvania, she passed away undergoing a second heart surgery. I was in residency at this time. I thought to myself, God, this should have never happened. This was a surgery that was supposed to give her another 15 years. 

It really made me look at our roots. How was it that my mom and two of her brothers, out of nine siblings, who all came to the U.S. were now deceased prior to other older relatives in the Middle East in war torn areas? It made me think, what is the underlying root cause? 

That led me to a very integrative approach. Leaning on my osteopathic background, digging into functional medicine and root cause medicine. It took me on a journey. Then I had my own personal health crisis with early menopause, prediabetes, nearing prediabetes, obesity. Well over 240 pounds. Working 80-100 hours a week. Then diagnosed with early menopause at 39 years old. I was told I would never be able to have another child. That literally took me on a journey around the world, looking for answers. 

With the grace of God, I reversed early menopause and then naturally conceived and had my youngest daughter at age 41. Spontaneously, no intervention. A blessing. I’m now 57 with a 15-year-old, and God help me. That’s where I’m at right now. 

Dr. Eric: 

That’s a wonderful story. You mentioned you’re 57 now. How do you feel? I imagine you’re feeling pretty good. 

Dr. Anna: 

I’m amazing. I came out of retirement. I definitely recognize when things are off. I see this in my patients, too. They have known things are off. Yet they have had the symptom treatment approach versus the root cause approach. That’s really important. 

I moved from Georgia during the pandemic to Dallas, Texas because there was a rodeo school nearby that my daughter was training at. My youngest, who is just loving horses. I have lived on an island for 22 years, St. Thomas Island, Georgia, just south of where you are, Eric. When I first moved here, I thought they had the best restaurants, no lines, no traffic. I love this city. It was July 2020. Traffic is another story right now. Takes me an hour to get 20 miles. We’re here because we have the horses, and she is still in the rodeo. 

I just started back in clinical practice here. It tells you that energy and vitality. To pursue your dreams at any age. For everyone listening, not to give up. 

Dr. Eric: 

I’m sure you’ve had a lot of people tell you that you don’t look 57. You look a lot younger.  

I bring that up, the question of how you feel, because a lot of women in general don’t feel good, but the focus here is menopause. It’s not normal to feel lousy. It’s common but not normal, correct? 

Dr. Anna: 

That’s right. I always like to say menopause is natural and mandatory; suffering is optional. It takes more than hormones to fix your hormones. My first book is The Hormone Fix. This just came out in paperback yesterday, so I am carrying it around with me. Hardcovers, I love them, but they are so heavy. 

It’s my magnus opus. I go into details about the many things we can do to resuscitate our glandular function, like we do with our adrenal glands. How we can use lifestyle and what we do with our thyroid, to resuscitate our thyroid gland, to reconnect our mind and body together. The whole HPA, gonadal, thyroid axis connected, communicating heart and mind together. That’s the practice of good medicine. 

I reflect upon the hundreds of thousands of dollars I spent on my education and how many years. It’s all come in handy. Now I tell people to get a good night’s sleep. You have to eat better. For me, it’s the key to a great lifestyle. You have to think positive. You have to move more. You have to laugh more. You have to play more.

What I can actually do with my prescription pad and surgical knife, very little is necessary. Not none, but very little. Still have to claim some.  

Dr. Eric: 

Excellent book. I listened to it on Audible. A big reason why I call this episode “a unique approach to optimizing hormones” is because in your book, not that you don’t talk about hormones, but you don’t focus on them primarily. What are the main three hormones that you focus on? 

Dr. Anna: 

As a gynecologist and obstetrician, I studied all the reproductive hormones, the pathways, the enzymes that take them down a certain pathway, etc. Starting with cholesterol to progesterone to DHEA to testosterone and estrogen. 

Going through my own health journey, my own health crisis, and a second menopause, let’s say, ages 47-48, I recognized that even though my hormones were dialed in, things were still off. The hot flashes, mood swings, difficulty sleeping, anxiety. I was a hormone specialist. I lecture on this stuff. 

If we look at our hormones, and this is the best way I have found to explain it, if we consider our hormones the students at a university, every student at a university has its own purpose, its own mission, its own goals. That’s awesome. 

The professors of the university, these are the two more powerful hormones. They are leading a student body. If they’re not doing well, they’re chaotic, they come in drunk or high or whatever, there is chaos in the classroom. For me, those professors are our hormones, insulin and cortisol. 

When we’re insulin resistant, insulin is screaming essentially at the students to get in order. There is chaos in the body, and it leads to inflammation. Cortisol dysregulation leads to acidifying physiology and when our body is in a breakdown mode. It’s really dangerous for women in perimenopause and menopause at any age of course, but definitely during this time period, because we are more susceptible to help those reproductive hormones and testosterone compared to men of course. Cortisol is very acidifying to the body. 

I like to consider the dean of the university. Someone is governing the professors. If they are left on their own or mismanaged or being yelled at, or whatever the situation, if it’s a bad academic environment, the head of the university isn’t doing a good job. Then the professors won’t do well. Then the students won’t do well. 

For me, the dean of the university is oxytocin. Oxytocin is the most powerful hormone of our body. When it is on, it is prioritized in our life through many things. Our body makes oxytocin naturally by loving, playing, orgasm, massage, doing things we love, getting out in nature, having fun. All of these things create the hormone of oxytocin. It’s a very benevolent hormone, a very godly hormone. It’s the hormone of positivity, joy, goodness, generosity, kindness, the gifts of the spirits as it says in the Bible. That’s oxytocin as the head of the university.

I look at those three. If I was a physician and wanted to do things efficiently as a woman, mom, single mom, and all the many hats we have, we can go through treating- Let’s treat the hot flashes this way. Let’s treat the anxiety this way. Let’s treat insomnia with this thing. But when it comes down to the most powerful changes I can make, it’s by empowering oxytocin, then managing cortisol and insulin, and then the other reproductive hormones. That is the hormonal hierarchy. 

Dr. Eric: 

Most people have chronic stress these days. That is a big problem when it comes to healthy oxytocin production. You talk about this in your book. If you have chronically elevated cortisol, it will be very difficult, if not impossible, to have healthy oxytocin levels. 

Dr. Anna: 

Yeah. If you are in this high stress state, like if you are a soldier on the front lines and are charging forward toward the enemy, it’s not a time to love your enemy. They don’t exist in unison very well. 

The big thing with cortisol to remember is we are 100% capable of managing our stress, our thoughts around stress. Our internal environment is not dependent on our external environment. I have been to the pits of hell. I have been to the depths of grief and sadness and despair. I say that with complete compassion for those of you listening who are struggling. Our internal environment is independent of our external environment. 

I remember a urologist in med school, and he said to me one day, “Anna, you’re the only one who can upset yourself.” “No, my boyfriend can really piss me off.” He said, “No, you choose how to react. You choose how to respond in that situation. You choose what you put your energy into.” I will never forget that statement. He was totally correct. Just reframed it in my mind. All that stress went away. 

It is the blessing of the present moment. It is the gift of being present. Present presence. Combine those two. You want a gift. Get a present. That is where we really do have some control. A lot of control. 

Dr. Eric: 

I definitely agree with you. There are certain tools that can help. I don’t know if you still use this. In your book, you mentioned the Muse headset. Do you use that? 

Dr. Anna: 

Yeah, I have it on my desk upstairs. I am downstairs in my home office right now. I have the Muse headset. I have to get back on that for focused meditation, especially when your thoughts are so distracted, to bring you very clearly into this present, to be able to focus attention. That Muse is really good. Biofeedback is amazing for this reality check. 

Dr. Eric: 

I never used that. You also mentioned the Inner Balance from HeartMath, like heart rate variability. I have been using that for a number of years. There are a lot of great tools out there to help with stress management. 

With insulin resistance, is that where a Keto Green diet and trying to get people into ketosis comes in? 

Dr. Anna: 

The Keto Green program, the beauty of it is it’s not just a diet; it’s a lifestyle. The keto part is the part that when we are managing our blood sugars, when we are becoming more insulin-sensitive, when we stop snacking, cut out sugars and high carbs, and intermittently fast, we become more insulin-sensitive. That is key to managing progesterone, testosterone, estrogen, and where they are going. 

This whole concept of insulin resistance is so crucial because women in perimenopause become more insulin resistant. Those who are suffering from hot flashes, you think the answer is estrogen. The answer is about becoming more insulin sensitive. Insulin resistance is a cause of underlining hot flashes. 

I didn’t know this when I started with my Keto Green program. Patients were saying, “I don’t have hot flashes. I was having them every 20 minutes, and they’re gone.” Within two weeks of following the Keto Green diet and lifestyle. You’re becoming more insulin-sensitive, and your body is like, “Oh man, I can chill out now. I can rest.”

Same with cortisol. The alkalinizing factors in foods that we eat, the mineral content, nutrient content, fiber to feed the gut. All of those good things are critically important for our body’s gut microbiome and metabolism. When we are fasting for extended periods, when we are in ketosis for extended periods, we can shift into a more acidotic state. 

Blood pH isn’t going to change much, but urine pH is a really good bio marker. The alkalinizing foods. That is also the cortisol piece. Cortisol is acidifying. Oxytocin is alkalinizing. You can be eating the perfect green diet and still be in a very inflamed, acidic, imbalanced state because of cortisol. 

By empowering the most powerful hormone in our body, oxytocin, with gratitude practice, journaling, positivity, mindset, focus, presence, working in the here and now, that can make a huge difference on your physiology. That was so eye-opening for me. As I went through my own journey and figured out what was going on and looked at what is the research day about this? It’s been fascinating. So much more needs to be done in women’s health.

Dr. Eric: 

Most people aren’t doing it. Even the practice of expressing gratitude every day, it’s something that is not going to take an hour or two for people to do. Most people won’t block out the time just to take a few minutes to do that.

Dr. Anna: 

I have a helpful tip I can share with your audience. The practice that I have that really has kept me alive is before I open my eyes in the morning, it’s a reflection on the day before. Where did I see love yesterday? Where was I loving? Where did I see love? Where was I loved? What am I grateful for? Where could I have laughed? Where did I laugh? Where could I have laughed more? What was amusing? Those three questions, before I open my eyes, that’s a practice I do every day. 

Dr. Eric: 

Wonderful. As far as being alkaline, you said you test the urine pH. That’s first thing in the morning or throughout the day or both? 

Dr. Anna: 

Every time you pee, initially, when you start out, check your urine pH regularly. What gets measured gets managed. It’s eye-opening. After a workout, you will be acidic. I want you to wake up alkaline. I want you to go to bed alkaline. Your body needs to rest and repair itself while you’re sleeping. You’ll see the nights you’re more alkaline, the deeper sleep you get. You’ll also recognize that you wake up more alkaline. When you’re not sleeping through the night, you wake up more acidic. It’s a good marker. You understand what’s happening to your physiology. It gives you one measure to say, “What can I do to improve this outcome?” 

Dr. Eric: 

Maca root. I haven’t had an expert on maca. I have been taking your Mighty Maca. I have been adding it to my smoothies. Why do you like maca root? What are some of the benefits of it? If you could talk a little bit about what differentiates your product. I know it’s not just maca; it has other things in there. 

Dr. Anna: 

When I was 39 and diagnosed with infertility and early menopause, again, I was devastated. I went on a healing journey. Our girls were seven and nine at the time. I had one in college. We went on this healing journey. 

One of the first places we went was to Peru. One of the nurses that worked with me in my private practice was a nurse midwife in Peru before she came to the U.S. She still has been working with me since 2000. She has had different roles throughout the years. 23 years, she has worked with me. I loved her family. 

We went to see her family in Peru. Everywhere we went, they would say, “If you’re infertile, drink maca. If you’re tired, drink maca.” They would elbow my husband, give him a wink, and say, “It’s the Peruvian Viagra.” Y’all know we were drinking some maca, right? 

But I couldn’t stand the taste. I’m from a family of cooks, chefs, bakers, and gourmands. This is such a powerful superfood, and the history of maca is fascinating. That was the first thing. What is this? As this skeptical doctor/scientist that I am. What is it about maca that makes it so amazing? 

The research shows that maca has specific proteins that are unique to it, maceins. It also is rich in arginine, which increases nitric oxide, which increases blood flow, which lo and behold is how Viagra works. Huh? Fascinating. 

It’s adaptogenic. It really helps you in times of high stress, low stress, as a preventative. It does so much good in and of itself, Peruvian maca.

I started using maca, but I started mixing it. What other superfoods are out there? I couldn’t stand the taste. I’m of the belief that if you have an aversion to something that is supposed to be good for you, that partially defeats the purpose. I started mixing it with other superfoods: cat’s claw herb in Peru, acerola cherry, mangosteen, and green tea extract. I found superfoods as we traveled around the world. Part of this miraculous healing journey that we had. I blended these things together. Lo and behold, my periods returned. Within a year or so, during sometime in that journey, 2006/2007/2008, I became pregnant with my daughter, Ava Marie. 

When I come back to Georgia, I have to keep taking these superfoods. I have to keep taking it. I worked with a manufacturer to reproduce what I was making, using organic Peruvian maca, these highest quality ingredients, and blending them together. Just a small amount for me, my family, and some of my patients. My first batch was 500 bottles. That was the smallest batch they would let us make. Within months, that was gone. Word of mouth had started spreading. Now we are all around the world with Mighty Maca.

What we have seen clinically is the most important. We have Mighty Maca babies. We have seen a reduction in hot flashes. We have seen an improvement in day 21 progesterone. We see an improvement in DHEAS. We see an improvement by 70-200% in two months of adrenal function. Just taking Mighty Maca Plus for two months, we have seen a 70-200% improvement in adrenal function. 

The reason I combine some of the ingredients—the fibers, the enzymes, the liver support, the detoxification support—is because part of that is to support our body’s natural hormone production, so we can use more of what resuscitates the glands, like I mentioned earlier. Our body is using more of the hormones that we’re designed to use. 

Dr. Eric: 

Like I said, I have been adding it to my smoothie. 

Dr. Anna: 

And it tastes great. 

Dr. Eric: 

It does. I have been adding it to my wife’s smoothie, and she is very particular. She is very picky about taste. I can vouch for the taste. I haven’t added it outside of my smoothie. I think if anything, it does make the smoothie better. There are other powders I’ve added where you can notice it makes it almost unbearable. Definitely does not do that. It’s good tasting. 

I asked someone else on the podcast a while back, over a year ago, and she didn’t have knowledge about maca. I was excited to chat with you about maca. 

You also have another product, Julva. 

Dr. Anna: 

Yes. That’s another product I created from my own health journey. Also, as a gynecologist, seeing women suffer unnecessarily with vaginal dryness. Initially through my work with patients who had a history of breast cancer and working on optimizing their sexual function, I found out we can use androgens and pro-androgens like DHEA to help improve the vaginal tissue very safely—it’s not contraindicated—in women who have had breast cancer or any other cancer. Healthy levels of DHEA are a marker for a decreased risk of cancer. 

I started compounding formulas for sexual health and vaginal formulas, topical formulas. For compliance, and my own self and patients, I created my product Julva to help with the whole vulvar area, the perineum, for sexual health, but also for incontinence, bladder health, and vaginal support. It has been a blessing in so many ways. 

I combined it with plant stem cells from the Alpine rose, which are known to decrease- They are part of really high-end cosmetics because it is anti-aging. It helps with collagen formation, decreases fine lines and wrinkles. I will enjoy my laugh lines and smile lines here. The effects they have down there are we don’t want them: incontinence issues, lack of pleasure, discomfort, pain. 

I had a patient in my clinic yesterday, and she has been married for 28 years. She is in her late 50s now. She said that it’s like a ring of fire when she has sex. She has been struggling with this. She has been to her primary care, her gynecologist. They gave her some vaginal estradiol tablets, and she is not noticing any improvement. We have known this for two decades: DHEA is so much better for vaginal and vulva tissue. 

Let’s not forget the other important parts of our anatomy. The way I created Julva was to combine it with plant stem cell technology and with emollients to help it absorb deeply into the tissue. We know that DHEA works at the cellular level and helps with turning back the hands of time, so the natural moisture production, so you’re not reliant on a lubricant. With pelvic floor exercises, it decreases incontinence symptoms. We have over 5,000 five-star testimonials on my website. The stories are just beautiful. Just a shoutout for everyone who has left a testimonial because it’s so important to hear your voice. 

Dr. Eric: 

Thank you for creating these products and the Keto Green. I know you have to run, but one thing I quickly wanted to say is when it comes to DHEA, I know you test for DHEAS. One thing I liked that you said in your book is you don’t start out with massive amounts of DHEA. If someone has a DHEA deficiency, you start out with 5mg. If necessary, gradually decrease. I am glad you do that because I’m like that, too. If I recommend DHEA, which I don’t for everybody, but I recommend starting at a lower dose, not jumping into 50mg right off the bat.

Dr. Anna: 

What we do when we do that is suppress the body’s natural production. I do hormone replenishment, not replacement. I never want to suppress or take your body’s ability to heal away and rely on something external. We use it as a complement to our lifestyle and mindset and all of these things. We use these in companionship because it’s never just a pill, a program, a peptide, or anything else. It’s a lifestyle that we have to create. It’s a mindset. That is what I want everyone to know. It’s within their power to be healthy. Healthier tomorrow than you are today. 

Dr. Eric: 

Well said, Dr. Anna. Where can people find out more about you? Where can people get those products if they want to get them? 

Dr. Anna: 

Come to my website, DrAnna.com. You will see my storefront there. There is information on trials that you can get. I’m @TheGirlfriendDoctor on social media, like Facebook and Instagram, YouTube. Lots of great free content for you guys to enjoy. 

Dr. Eric, thank you so much for having me on today. 

Dr. Eric: 

It was a pleasure. Thank you. Appreciate you sharing your thoughts on optimizing hormones and talking about maca and your other products. Thank you so much, Dr. Anna.