Recently I interviewed Dr. Beverly Yates, and we talked about insulin resistance, type 2 diabetes. If you would prefer to listen to the interview you can access it by Clicking Here.

Dr. Eric Osansky: 

Excited to chat with Dr. Beverly Yates. We are going to be talking about insulin resistance, type 2 diabetes. I am going to dive into Dr. Beverly’s bio. 

Dr. Beverly Yates is a licensed Doctor of Naturopathic Medicine. She is the nation’s leader in online type 2 diabetes care. Her virtual practice has programs and supplements to help people lower their blood sugar naturally at home without ever having to step foot in a clinic. 

Dr. Yates is on a mission to help three million people heal from type 2 diabetes and prediabetes. She used her background in MIT electrical engineering and work as a systems engineer in Silicon Valley to create effective online programs for people with diabetes to achieve blood sugar control and live the life they love. 

Dr. Beverly is also an internationally recognized speaker and expert in diabetes and heart disease. She is the published author of Heart Health for Black Women: A Natural Approach to Healing and Preventing Heart Disease, and co-author of multiple books, including Jack Canfield’s The Soul of Success: Volume 2. Dr. Yates is writing a new book on type 2 diabetes and prediabetes based on her Yates protocol, focusing on five practical, enjoyable steps for reversing type 2 diabetes and prediabetes and living the life you love.

Last but not least, Dr. Yates has been featured in numerous media outlets, including ABC, CBS, NBC, PBS, NPR, Black News Channel, FOX, SiriusXM, mindbodygreen, Essence Magazine, Good Housekeeping, Women’s World, Reader’s Digest, Rodeo Press, and more. Again, thank you so much for joining us, Dr. Beverly.

Dr. Beverly Yates: 

You’re very welcome. I’m looking forward to our conversation. I hope people listening can get some benefit and clarity from it. 

As you well know, there is all sorts of information that’s available. Some of it is not good information, and I think it’s challenging for people who aren’t health professionals to tell what’s actual and helpful versus things they probably ought to steer clear of. 

Dr. Eric: 

I definitely agree with that. Before we dive into the topics, can you talk a little bit about your background? How did you start focusing on helping people with insulin resistance and type 2 diabetes? 

Dr. Beverly: 

Sure. Originally, my focus clinically when I first graduated from naturopathic medical school was on heart disease. I had had an amazing journey with one person who had severe congestive heart failure during my clinical training, as we went through the residency and internship process. Other folks I had worked with had problems with stress, sleep disorders, gut problems, skin, those things. Often in the realm of what we would consider to be primary care.

My shift to diabetes came for two reasons. One was something that became clear to me in the mid-2000s to the 2010s. This amazing shift of people coming into the clinic who had prediabetes and type 2 diabetes and insulin resistance or some kind of metabolic dysregulation. I saw this big uptick that also matched any of the grassroots data you could find from the CDC or other places. You saw the big shift coming into the 2000s of more and more people showing up with blood sugar problems. It fueled my own growing sense of alarm because those are the kinds of metabolic problems that are deadly and shorten lives. People have a low quality of life.

To me, part of the concern was this was a threat to humankind, but also, because it is so lifestyle-sensitive, it’s good news. You can do something about it. It’s not something where we’re helpless. You have to know specifically what to do. Poking around, Googling for tips is not going to get it done. You have to take care of it now. 

Sometimes, people don’t have that sense of urgency. They don’t feel a fire lit under their butt because the ebbing tide of their health is a gradual, relentless shift. It isn’t a big spike to misery; it is an ongoing cycle. They might not feel the same mortal threat someone feels when they have a disease like cancer or some neurologic diseases that can be so devastating, and it is quickly obvious that they are devastating. This is gradual devastation. Nonetheless, it’s devastation.

The other reason was my own realization as I reconnected to my family of origin on my father’s side, my birth family. My parents divorced when I was about a year old, so I didn’t get to know my dad’s family when I was growing up. As an adult, I gathered up the courage—God bless my best friend, as she was a great model for this—to go and reach for that relationship. God bless my mother because she didn’t interfere. She encouraged that connection. She was so brave to do it because I know she was upset with him, but she did it anyway because she thought it would be helpful to me. What a gift a mother can give a daughter.

As I got to know them, I found out that my father was one of 13 siblings. All 13 of them had some kind of diabetes. They had type 1 diabetes, type 2 diabetes, prediabetes. I would argue now that type 1.5 was possible. The glycemic issues on that side of the family, you don’t usually hear of 100% prevalence in one generation of a disease. It’s just amazing. I had seen the issues around unhealed, unrecognized, improperly treated blood sugar devastate that side of the family. That got my undivided attention. 

At that point. I was making the transition from being an electrical engineer to becoming a licensed Doctor of Naturopathic Medicine. Now, I was becoming equipped with the tools to make sure my own health could stay healthy. Hopefully, knock on wood, continue to do the things to stay out of trouble. Myself and a handful of other cousins in that generation don’t have diabetes. 

Boy oh boy, I tell you, what a wakeup call. That shifted my clinical work and focus. Two things: the change in the general population, and the fact that it became personal for me. 

Dr. Eric: 

You mentioned a lot of people don’t take it seriously enough. Can you explain what are some of the consequences of unmanaged type 2 diabetes or insulin resistance, which eventually could and often does lead to type 2 diabetes? 

Dr. Beverly: 

One of the things that can go on is people may come to find that they have mild cognitive impairment. They may have problems with their memory and ability to stay organized and live a normal adult life. This is what precedes the onset of dementia and Alzheimer’s typically. There is a reason why Alzheimer’s is often called type 3 diabetes because of this threat to the brain in the face of this rising tide of unrelenting blood sugar. 

I want to emphasize for people that it’s often the folks who have prediabetes who will wind up with dementia or Alzheimer’s. You don’t necessarily have had to go all the way from prediabetes to type 2 diabetes. Some people think that only if you’re a type 2 diabetic, you are at risk for brain health. No, no. This is what I’m telling people. 

I watched this happen in my own family on my husband’s side with my mother-in-law. At the time, when this first started, I was an engineer, so I didn’t know. Knowing what I know now, I wish I had known it then, so we could have helped her and helped her quickly before this became a problem. 

Anyone who is sitting there feeling a little smug, thinking “I am a prediabetic. A1C range of 5.7-6.4, I’m okay.” No, you’re not. Please take it seriously. 

Just to define what is type 2 diabetes? That is an A1C. A blood test is measured as such. 6.5 and higher. 

Dr. Eric: 

Prediabetes, do you consider it synonymous with insulin resistance?  

Dr. Beverly: 

For most people, most of the time, yes. It is quite possible to have insulin resistance and not have an A1C above 5.7. I think it depends on the factors of your life. There is no such thing as one size fits all. That old 1950s advice of eat less and move more in today’s busy, complex, stressed-out world is just inadequate. There are plenty of people who are eating less and moving more, and they aren’t able to get in and stay in a healthy blood sugar range. They have this ongoing problem.

I think when it comes to insulin resistance, it’s a warning sign. It also should be a motivation to stay in a healthy range, eat healthy foods, foods that are great for your body. They don’t cause you to have a big food coma or energy crash. They don’t cause gas and bloating. You can eat and have normal digestion and even energy. 

I think one of the things that might be misunderstood around insulin resistance is that it can precede other serious things, but you can do things that are helpful to keep it from becoming a problem. If you have consistent, regular exercise, that is always helpful. People ask, “What’s the best exercise?” It’s the one you’ll do. That’s the best exercise. Forcing people to do exercise that they hate doesn’t work. If you like to dance, dance. Whatever movement that you can do qualifies. 

Eating foods that you know are healthy for you and not causing blood sugar spikes and crashes. That’s important. If you have the blood sugar rollercoaster, if you have a lot of ups and downs, that is hard. It’s hard on your brain, your moods. You become more irritable, or maybe you’re hangry. It’s hard on your entire body and psyche. You want that even flow for your blood sugar measurements. 

It’s great if you can get a glucometer and test strips and test your blood sugar, so you know what’s going on. I think that should be in everyone’s home health kit. 

If you find it’s painful to stick your finger and get a necessary drop of blood, if you’re in the U.S., you can always get a prescription written. If you’re in other parts of the world, it’s over the counter. You can get a CGM, a continuous glucose monitor, and wear it for a few weeks, to see where you’re at, what’s going on. 

You might find that some things you think of as being unhealthy for you might be fine from the point of view of your blood sugar. I’ll bet you there are two or three things you do that you think are healthy for your blood sugar that are not. You will see these massive spikes that stay up for hours. That’s your clue. That’s not good. That’s a problem. 

Dr. Eric: 

I’m guessing if someone has not just type 2 diabetes but prediabetes, you recommend a CGM. Is there a time prior to that? If someone’s hemoglobin A1C is on the higher side, like 5.5-5.6. Is there a threshold where you recommend that it’s a good idea to get the CGM? 

Dr. Beverly: 

Yeah, that’s a great question. There is a transitional phase. When an A1C shows a steady climbing pattern. Say you’ve been checked over the course of the past two years every six months, so we have four data points. Maybe your A1C started out at 5.0. Then 5.3. Then 5.5. The last time you checked, it’s 5.6. Clearly an upward trend. It would be a great idea to have a CGM or use an old-school glucometer and test strips, just to see what your blood sugar reactions are to the foods that you eat and beverages you drink, so you really know how you’re doing. 

To me, the CGM wins because you can get that health data from overnight while you’re asleep. You’re not typically waking up in the middle of the night to do finger sticks unless you already have a problem. I do know people who have type 2 diabetes who do finger sticks if they wake up at 3am or 4am as a way to check and test. I think there is a lot to be said for having a great night’s sleep and having continuous data. 

Dr. Eric: 

Agreed. You talk about hemoglobin A1C. What are your thoughts on other markers like fasting glucose or fasting insulin? Do you rely primarily on hemoglobin A1C? 

Dr. Beverly: 

No, we look at the bigger picture. Fasting blood sugar or fasting hemoglobin, the morning sugars as some people refer to it more informally, are really helpful. They’re a guide because it lets you know if your blood sugar resets overnight. 

Here’s the deal. After you eat dinner, until you go to bed, then you go to sleep, then you wake up the next morning. That entire period should be your fasting window. Fasting literally means you are not eating any food. You are not drinking anything either that could cause a rise in blood sugar or insulin. At that point, you will be drinking water. Maybe unflavored herbal tea, not a sweetened one, something with a bland flavor. We are not trying to invoke any kind of sweet response.

When you wake up the next morning, here’s the deal. Sleep, every day for all of us, is an opportunity for your entire body, mind, spirit, psyche, gut, everything to reset. Part of the reset that you should be able to enjoy and experience is getting to a healthy blood sugar range. 

Your fasting morning blood sugar numbers should be 75-95. I love it when it’s in the 80s, so I know it’s not too low. It’s not hypoglycemia, which most people would say is 70 or lower for a fasting morning blood sugar number. It’s not too high, like 105-120 or even in the 200s. It should have reset to under 100. 

If that’s not happening, then that means your blood sugar is at a higher level in terms of its average blood sugar exposure; therefore, your A1C number is more likely to be higher. Not always though. There are people who have higher morning sugars, yet their A1C is okay. It’s not in a prediabetes or type 2 diabetes range. 

Dr. Eric: 

Have you also seen discrepancies sometimes where maybe hemoglobin A1C is on the higher side, but fasting insulin is on the lower side? Is that a false negative? Sometimes, it can be frustrating when they oppose each other. One looks like the person has maybe not yet prediabetes but heading in that direction. Then you look at another marker, and it looks perfectly fine. Maybe not necessarily fasting glucose. Even that, too. As far as focusing on fasting insulin and hemoglobin A1C, do you see sometimes one marker looks good, and the other marker on the higher side? 

Dr. Beverly: 

Yeah, they can be a paradox. Let’s talk for a moment about fasting insulin, to tie off what you had asked earlier. I do look at fasting insulin. I love to see it in the single digits, 9 or under. If it’s a 4 or 5, yay. We know that when the body is fasting, insulin is down; therefore, it’s not in a mode of trying to store excess glucose somewhere. Otherwise, it will try to park the extra glucose as fat. 

If the fasting insulin number is higher, like 20, 25, 30, your insulin is working overtime. It is trying to find a way to work with all the glucose. If it’s not signaling well with your cells, then the available blood sugar that should be grabbed by insulin and taken inside the cell as energy is saying, “We have to put this energy somewhere.” It starts to park it as extra fat, often in the abdominal cavity, particularly around the abdominal organs, or inside the liver. This is different than the fat that is just under the skin, the subcutaneous fat. That kind of fat gives off lots of inflammatory cytokines, those chemicals that can cause damage. It’s not a good kind of inflammation; it’s damaging. If you see those together, fasting blood sugar is high and fasting insulin is high, that is a problem you need to address. 

You can see the paradox of if fasting insulin is higher, but A1C is okay, or you can see a fasting insulin number in the single digits and A1C is still higher. You’re looking at windows in time. The A1C is an average of the last 3-4 months of your life in terms of your average blood sugar. Your bone marrow every day is putting out brand new red blood cells. That’s the good news. If they are coming into an environment of high blood sugar, they will get sticky with that extra blood sugar. 

If I can just take a moment to explain the process because I find people often don’t know what is A1C? Why do we care? Is it okay if we take a peek at what that’s about? 

Dr. Eric: 

Sure, go for it. 

Dr. Beverly: 

Great. Hemoglobin A1C, or A1C, is a measure of the average amount of blood sugar exposure your red blood cells have had over time. Your body naturally every day creates and puts out a fresh new set of red blood cells for you. 

What happens inside that red blood cell, you might remember from science class in middle school or high school that there is a chemical called hemoglobin. That heme molecule sits in the center of the red blood cell. Its job is to exchange carbon dioxide for oxygen. The carbon dioxide leaves, and oxygen comes in. 

When this is a healthy working mechanism, you will have energy and feel good. if for some reason the works are gummed up, your energy system will crash. You won’t feel as good. You are more likely to feel fatigued; you might need to take a nap. You can’t get through your day.

Here’s why: When you have too much glucose, this exchange of oxygen and carbon dioxide is getting compromised. The extra blood sugar, those molecules, stick onto this hemoglobin molecule, the heme, and gum it up. Therefore, this easy exchange is more like where it’s just too much to work. It’s a much different process. Which one will be a better flow? 

This is where the blood sugar complications that happen create a process called glycation. With that comes that damage that causes the heart attacks, strokes, and other flow problems for your vasculature. Your blood literally can’t flow as well as it should through your cardiovascular system. That’s why diabetics tend to have problems related to gummed up blood with too much blood sugar. 

They are at risk for diabetic retinopathy, losing their vision and going blind. 

They’re at risk for having their kidneys be destroyed and wind up on dialysis. Kidneys hate extra blood sugar. They don’t like it at all and will cause you to pee a lot and do whatever needs to happen to try to change how much glucose concentration is in your blood. 

Your nervous system doesn’t like it either. That’s why people get peripheral neuropathy. Fingers, toes, nose, things going on with their ears, problems with their mouth and dentition, their pelvic floor. Men wind up with erectile dysfunction, and women wind up with clitoral dysfunction. Inability to enjoy sex and reach orgasm. This is all a function of blood flow. When it gets compromised, these are some of the symptoms that show up. 

Problems with the immune system. The immune system is a part of this system. People become much more vulnerable to infections and infectious processes. They will have wounds that don’t heal. If they have gone numb, they can’t feel they were injured, and they got wounded. It becomes bad. Things become abscessed. It’s terrible.

In terms of the lower body circulation, the legs and feet are really sensitive to this. People wind up with amputations and start to lose body parts. They lose toes or lower legs or the entire leg. I have known people who have had double leg amputations off of this. They got terrible advice and followed it. Maybe they didn’t know it was terrible advice on how to deal with their diabetes. Or they ignored good advice. Both roads will lead you to the same destination of the awful consequences of diabetes. It leads nowhere good. You have to be proactive about it.

The good news is there are five basic lifestyle choices that will make the biggest difference in turning it around where possible or preventing further damage. 

Dr. Eric: 

Are you okay with sharing at least some of those steps? 

Dr. Beverly: 

Sure, let’s go through it. There are five steps I bundled up in the Yates Protocol. As much as it might seem that it’s obvious, you still have to do things that are specific or relevant to you and your needs and how you live your life. It’s a proven program with customizable elements. We are all unique individuals. 

The bull’s eye of the target is nutrition, and I know you will agree with me on this. You have to have a healthy nutrition that gives you good blood sugar, good glycemic control. We cannot ignore the importance of food in this. It’s literally let food be your medicine, and let your medicine be your food. 

In that, you have to understand what foods you’re eating that are having a good blood sugar response for you, and which ones are causing you spikes. Which ones put you on that rollercoaster, where you are slamming up and down? Not good. 

Sometimes, healthy foods can have unusual reactions. On a generic list, people would say things like cauliflower, quinoa, berries would probably be okay for most people, particularly in a normal portion. There are people who have unusual blood sugar reactions to seemingly healthy foods. If you’re one of them, this might be why you’re struggling to get control of your blood sugar. 

It’s good to test and not guess. That’s why I’m a fan of either the glucometer and test strip idea or using a CGM, so you know what’s going on. How are you responding? You might find that a smoothie or another combo is not a good combo for you. Or maybe you are keeping yourself from eating bananas, potatoes, sweet potatoes, yams because you think they will spike your blood sugar. You should test and be sure. They might be fine for you. Just because they weren’t okay for your neighbor doesn’t mean they’re a problem for you. 

The next is meal timing. The time of day you eat your food matters for good blood sugar control. In particular for insulin resistance, same advice. I will give you two tips here. 

One is to make sure that you allow at least 3-5 hours between your dinnertime and when you put your head on your pillow to go to sleep. The reason I say that is this is part of the magic of getting your blood sugar to reset overnight. You have to give your gut a rest. You don’t want to have a heavy meal and go to bed on it. This is a disaster for a number of reasons. It will more likely lead to heartburn or GERD and most likely will lead to higher blood sugar numbers in the morning. You won’t have time to reach that healthy range.

The other tip is this: I notice for many people who have type 2 diabetes, they often get so busy in the middle of the day that they forget to eat lunch. That’s a mistake for two reasons: 

Our body expects input on a rhythm. When we fail to meet that rhythm, things get out of order. Your whole hormonal system, including your thyroid system, is unhappy when you are inconsistent.

The other thing is you get so hungry that by the time you eat dinner, you are ready to eat whatever. That is where people make mistakes because they are hungry. They will eat the fastest, simplest, easiest thing because it solves the problem quickly. In an environment of 24/7 food, much of it is ultra-refined and highly processed. This is not good.

Step three would be the power of sleep. Sleeping is healing, and healing is sleeping. We have to get rest. Be able to restore, regenerate, and help those rest mechanisms. Some people have a phenomenon where their blood sugar rises around 4am or 5am. That’s an inappropriate response. It should rise a little bit to get you ready for your day, so you don’t pass out when you go from horizontal to vertical. It shouldn’t spike when you’re sound asleep. If it does, you need to do something about that, and that will determine your activities during the day to get rid of that bump.

The next piece around that for sleep is to know that it should be a friend. If you’re struggling with sleep, if you get feedback from someone that you snore a lot, or even worse, that you go completely silent and don’t breathe. Maybe your family member or lover tells you this. There are even apps that can help you. If you live on your own or don’t sleep with anyone else, you could still get this data. You should have a sleep study done because this is serious. This could be life-threatening. You could have sleep apnea or some other disorder that needs to be assessed. Test, don’t guess. It’s a rallying cry.

The fourth step is stress. Stress is underappreciated in the general public on how many things it can break. I liken stress as the bully that grabs you by your genetic collar and slams you against the wall of whatever is hanging out in your genes, your epigenetic expression. This means that some of us will be more vulnerable to problems with diabetes than others. Some people don’t have this as their weak link. Maybe it’s asthma or osteoporosis or any number of things.

Our fifth thing of course is exercise and strength training. Here’s the beautiful thing about this. It’s true for all of us at any age or stage. Exercise, active working of muscles, our blood sugar sponges. Whenever you can exercise, take that opportunity. It makes the difference. Those muscles open right up and are like, “Yes, give us that glucose.” You will see a rise. It is natural. Don’t freak out. 

You will see a rise in your blood sugar while exercising because your body is mobilizing the energy sources to meet the demand of your active working muscles. It’s a good thing. Active working muscles are a blood sugar sponge. If you see a spike, you can start to do wall squats and sits or go for a walk. There is a lot you can do to get that blood sugar down. When you exercise, you will see it up. It should reset in about a half hour to an hour. Normal occurrence. Nothing to worry about.

Dr. Eric: 

Earlier, you mentioned the most important exercise is whatever someone is willing to do. Ideally, you would say it would be a combination of some resistance training along with cardiovascular exercise? 

Dr. Beverly: 

Yeah. I think cardiovascular, as long as you are physically able and not in pain or otherwise compromised, ideally should be about five days a week if you want to do something about insulin resistance and diabetes. In this case, the regularity of that rhythm makes a difference.

That doesn’t mean it has to be for two hours a day. 30-40 minutes daily for most people will be fine. As we get older, the 30-minute mark is super. You don’t have to pound yourself. It’s not like you are preparing for a half-marathon or marathon every day. Everyone has to rest and reset. 

If you are paying attention to sports, you are seeing professional athletes tap out sometimes depending on the sport and strategically resting because they have so much more information and data, so they don’t get worn out. As a result, in some of these careers, like basketball or soccer, some of these more aerobically and anaerobically intensive sports, people have longer careers than they used to. These athletes are taking much better care of themselves than was historically the case because they have better information.

The thing about strength training, especially as we get older, particularly for women, as we enter our 50s and 60s, from what I understand from the research and other experts I work with, it’s best to train three times a week. When you first start a weight training regimen, you will start off in a way where you are emphasizing great form. You may start with lower weights for the first 2-3 weeks. Work with a personal trainer, so you know what you’re doing and don’t injure yourself, so you can keep going.

Once you have your form down, then you want to emphasize going heavy. Let’s say you started out with five-pound weights. Then you want to graduate to 10, 15, 20. Particularly for women. This is important both for bone health, so you can avoid osteoporosis; balance, so you don’t wind up with a fall that we hear about older people going through, which opens up a Pandora’s box of problems. You also want to have good blood sugar control and maintain it as you age. Working with your musculature and neuromuscular balance and those receptors, like your inner ear, that give you balance. You want to be able to do these things. 

That piece of self-care, every day if you commit to that 40 minutes or so, whether it is the aerobic side or the strength training side, whatever exercise you will do is the best. It could be dancing. Just get it done. Make sure that is on your calendar. If they already have diabetes or insulin resistance, now your first and primary job in your life is going to be your self-care. These are often very generous people. They are the rock of their community. They do so much for others. You have to do this for yourself. Self-care has to be job #1. That way, whatever else happens the rest of the day, you have already taken care of you. 

Dr. Eric: 

I agree with everything you said. We all know diet is important. Not everybody follows a healthy diet or eats a healthy diet. When it comes to supplementation, there are also a lot of supplements that potentially can help with blood sugar, or at least play a role. They are not a substitute for diet. What are your thoughts on the supplements out there, like berberine, alpha-lipoic acid, even chromium and magnesium? 

Dr. Beverly: 

I’m a real fan of alpha-lipoic acid. I think its oxidative fighting powers are great. It’s a wonderful antioxidant. I personally use it to protect your nervous system and all the other things that might be affected by free radical damage. Whether you live in an environment that has more environmental toxicity, or to combat the normal changes that come along with aging, it’s a great member of the toolbox.

Chromium is one of the minerals that is often deficient in the diet. You can test for it to see how much chromium someone might need.

Another consideration is berberine. When I went to naturopathic medical school, we were always taught to be cautious about the use of berberine. It might be too antimicrobial and disturbing of the gut microbiome. 

In today’s world, there has already been so much damage to people’s microbiomes that berberine can be helpful. It might be a shorter-term tool or a longer-term tool. It depends on a person’s health history. Some people as kids were given antibiotics back to back to back many times for ear infections, like it was candy. It’s an odd thing. It depends on the kind of medical help people got when they were little. If you know that’s in your history, you probably need to do some other microbiome replenishment strategies. 

Berberine can be helpful for blood sugar management in and of itself. It may not necessarily be an automatic problem for the gut’s microbiome. 

Things like fenugreek. There is banaba. Any number of other things. Gymnema. I am a real fan of fenugreek and gymnema, especially if people have cravings. They find they have such a sweet tooth that it ruins any ability to make good choices around the things they eat or drink. It can help reset the tongue and buy you some time.

The good news is the cells on the tongue turn over every 10-14 days. You get a whole fresh crop. Within the course of half a month to a full month, you can really change your palate if you want to. If you are struggling with cravings, know you can take charge of it.

Dr. Eric: 

With berberine, there is some controversy. I had Dr. Jason Hawrelak on the podcast; I’m not sure if you are familiar with him. He has a site called Probiotic Advisor and is an expert on the gut microbiome. He is opposed to berberine because of some older studies. Most of the newer studies seem supportive of berberine and the gut. 

I don’t know if you are familiar with Dr. Rhonda Patrick, Find My Fitness. She does a lot of research. She had an episode on her podcast on berberine. That was one of the things she covered about the gut microbiome. According to her research, it doesn’t seem like it’s negative. At least short-term. If someone is taking it for six months or a year, it may be unknown. For taking it for a few months even, she didn’t seem too concerned. 

Dr. Hawrelak would probably say not. Specifically what he said, maybe if someone takes probiotics with the berberine, it would be okay to replenish. You could tell he wasn’t a big fan of that. Again, Dr. Rhonda Patrick said it was okay. The research I have done. If you go into PubMed and search for berberine and gut microbiome, most if not all of the recent studies are all positive on the effects of berberine on the gut microbiome. 

Dr. Beverly: 

It is interesting to see that shift in the research. People’s own lived experiences and the environment we are in right now, it’s not only more complex, but we have more chemicals in the environment that we are often eating or being exposed to unwittingly than has ever been true before in human history. We are all in the midst of a giant experiment, and the outcome is unknown. We are the laboratory. Maybe that’s why people have different points of view or experiences with berberine.

I haven’t seen any catastrophes from it. It’s been fine. I have also had so many things in my toolbox as a naturopathic physician that I haven’t had to rely on one thing in order for it to make that clinical difference. 

Dr. Eric: 

What are your thoughts on metformin? 

Dr. Beverly: 

It’s a helpful medication, and it buys people time. I always tell anyone who has type 2 diabetes, prediabetes, type 1, insulin resistance that you still have to do lifestyle pieces. Obviously, in the case of type 1, where someone’s body no longer makes insulin, for the rest of their life, they will need to take insulin as a medication. We don’t have a cure for type 1 yet. I’m hopeful they will figure that out, but we’re not there yet.

You still need to do all you can not to be on that blood sugar rollercoaster. Those spikes and the crashes can be devastating. For type 1, potentially deadly. Absolutely to be avoided. You want to keep everybody, wherever they are on the blood sugar response spectrum, in that healthy zone as much as possible. 

With that in mind, paying attention to those lifestyle factors—nutrition, meal timing, stress, sleep, exercise—is the way to go. When you get and stay in that healthy range as much as possible throughout the day and night, now, you’re keeping yourself out of the danger zone for the nasty consequences of uncontrolled diabetes. 

Dr. Eric: 

There is a time and place for certain medications. I wanted to get your opinion. 

Dr. Beverly: 

It serves a place. I am not opposed to medication. It absolutely buys us time. If that’s the thing that’s working, do it. You still have to do lifestyle stuff though. 

Dr. Eric: 

I definitely agree with that. Circling back to the consequences of diabetes, you know that most if not all of the listeners have a thyroid or autoimmune thyroid condition. Have you seen any relationship between blood sugar imbalances and thyroid imbalances or thyroid autoimmunity as a trigger or contributing factor? 

Dr. Beverly: 

Absolutely. I’m glad you asked that. When I think of the thyroid, I think of the whole hormonal system, the endocrine web if you will. I do think of it as a spider web. If you pluck one strand, you will see the whole thing quiver. When you look at the system, I think of the thyroid as the conductor of the symphony. If the thyroid is not functioning well, if it’s under autoimmune attack, or if it’s just hypo or hyper, you really want to get that into balance because it will drag down other things with it.

What I have classically seen is if someone has been really stressed, if they have a clear diagnosed thyroid problem, often the next thing that breaks if they haven’t gotten the help they need is their cortisol regulation will go bonkers. If cortisol becomes out of balance, because it is meant to be a life emergency system, and not a normal life system. What I mean by that is cortisol is there as a partner to let you respond to an actual emergency. Most emergencies were brief, not sustained. In today’s world, I don’t know. Things are changing. 

You’re supposed to be able to be superhuman with the use of cortisol and adrenaline rushing through your bloodstream for 10 minutes. This is how you hear about a petite woman who is maybe 90 pounds soaking wet lifting a car off of a loved one. A superhero move in that moment that she ordinarily wouldn’t be able to do. She can because it was a clear threat. Able to perform a miracle. 

In that process, if it’s a 10-minute moment, it’s okay. Your body will eventually bring your cortisol and adrenaline back to a normal level, and you will be all right. But if you are under threat, real or perceived, maybe you live in a place that is dangerous. Maybe you have a terrible work environment. Maybe your family relationship or love life is just a harmful, difficult thing. Maybe you have gotten some other kinds of surprises that are shocking to the system. 

What will happen is cortisol and adrenaline will get so used to being elevated and high that any time they go up, at the same time, your body releases glucose because it thinks you’re lifting the car off the loved one. Or you need to run away from something. But you’re not getting the exercise that goes with that activity. You aren’t burning off the extra cortisol or adrenaline. Therefore, it keeps circulating in your blood system, and it has the opportunity to act like little jackhammers on your blood vessel, putting pockmarks if you will along the way in your vasculature, particularly around the heart. Therefore, you’re more at risk for things like heart attack and stroke. This is where this comes from. 

That is why people who have combinations of problems that include diabetes are more likely to have cardiovascular problems and heart attacks. You want to get your thyroid situation straightened out. If you have thyroid and adrenal problems, you need both straightened out. If you don’t, they will cause the insulin resistance that leads you straight to prediabetes and type 2 diabetes. One link grabs another link grabs another link grabs another, and you need to unlink them.

The good news is working on one or two usually yields a result and lowers the threshold of risk for the others. 

Dr. Eric: 

I agree. It’s amazing how everything in the body is connected. Those five factors that you mentioned earlier, incorporating those, it’s not just about blood sugar, but those could help with- I don’t want to say everything, but a lot of things, if not everything. 

Dr. Beverly: 

It’s incredible. That is so helpful in healing. No one situation is too complex. It’s all figure-outable. The path won’t be linear. Get to know yourself better. 

Dr. Eric: 

Again, you shared a lot of great knowledge. I want you to let everyone know about your upcoming summit. Of course, other places people can find out more about you if someone wants to work with you. Talk about your summit that’s coming up.  

Dr. Beverly: 

Sure. I’m the host for the online Reversing Type 2 Diabetes Summit. It will be live and free October 3-9, 2023. You’re welcome to check that out. 

My websites are DrBeverlyYates.com and NaturalHealthCare.com. We are literally redoing that one right now as of our recording. It will be up and wiggling by the time this is released. 

We will have opt-ins for more information about CGMs, for people who want tasty, simple recipes for blood sugar management. One of the fun things about that is it includes both options that have meat as well as plant-based, 100% vegetarian and/or vegan recipes. Wherever you’re eating, whatever is working for you, because I know nutrition is not one size fits all, I got you. People are welcome to grab those. 

Dr. Eric: 

This was an amazing conversation. Thank you so much, Dr. Beverly for talking about insulin resistance and type 2 diabetes. 

Dr. Beverly: 

Thank you. Please make sure you’re following Dr. Eric wherever he may be, so you get all the latest posts. He has been very focused on his mission for working with thyroid and autoimmune support, and I love when colleagues have a clear focused mission. Let’s all link arms together and work together to have this world be healthier.  

Dr. Eric: 

Agreed. Thank you so much.

Recently I interviewed Stephanie Grosvenor, and we talked about the three core body systems that can help to reverse thyroid autoimmunity. If you would prefer to listen to the interview you can access it by Clicking Here.

Dr. Eric Osansky: 

Thank you so much for joining me. I am very excited to chat with today’s guest, Stephanie Grosvenor. We are going to be discussing the three core body systems that can help to reverse thyroid autoimmunity. I am going to dive into Stephanie’s short but sweet bio first.

Stephanie is a holistic nutritionist and functional medicine health coach, specializing in simplifying health for you, so not only do you live a life that improves the way you look, feel, and age, but one that you are excited to wake up to and live every single day. Thank you so much for joining us, Stephanie. 

Stephanie Grosvenor: 

Thank you, Dr. Eric. It is fantastic to be here with you on your show. 

Dr. Eric: 

Fantastic to chat with you. Really excited about getting into the three core body systems. Before we do this, could you give your background? How did you get started? How did you become a holistic nutritionist and functional medicine health coach, which led you to- I know you have your own health journey. 

Stephanie: 

Of course, I’d love to. My health journey or complications that I had with my health started when I was four years old. I didn’t realize how early these things started. I went through about 15 years of experiencing severe health issues, ranging from chronic inflammation, chronic fatigue, weight gain, acne, severe digestive issues, and food sensitivities. 

I probably spent a good five years jumping from doctor to doctor—this was when I got into my 20s—looking for answers. Why am I so tired all the time? No matter how much sleep I get, why am I constantly tired? I had terrible acne. I never had that, but the moment I hit my 20s, my weight ballooned, my acne came up, these digestive issues were so bad. Even when I was just drinking water, I used to get severe pain. 

Every doctor I went to told me I had food poisoning. You can’t have food poisoning for five years. There needs to be some kind of relief. People wanted to put me on antibiotics, which I knew aggravated the digestive problems I had. When it came to my acne, dermatologists tried to put me on contraceptives and Accutane and other things to fix the problem, none of which I ended up doing. I knew something else was going on, and I didn’t want to use these methods they were talking to me about.

Eventually, when I was about 25, I found functional medicine. After my research, using Dr. Google and YouTube University, and all these things you have to be careful to use, I decided to take control of my own health. Everywhere I was going, I wasn’t getting the answers or support I needed. I dove into functional medicine, reading everything I could get my hands on, and started to implement a lot of the stuff I was learning.

After 15 years of health issues, within four months, I was able to clear up my acne, get rid of inflammation. My food sensitivities dramatically decreased. All of a sudden, it felt like the weight was falling off of me because I tackled the inflammation and focused on looking after and fixing my gut. All of a sudden, everything else fell into place. 

That’s really what sparked my interest in getting into this field. Understanding that food is medicine, and it plays such a big role in our health. I ended up going back to school, getting qualified as a holistic nutritionist, and going to go further into becoming a full-blown functional medicine doctor or practitioner. 

Looking back at my own journey for so many years, I had great functional doctors on my team. I realized that wasn’t what I needed. I didn’t need another doctor at the time. I needed support. I didn’t know that health coaching was a thing when I was going through my own health journey. 

As I was investigating different universities and where to study to become a practitioner, I came across health coaching, and I thought, this is it. This is what was missing in my journey, and this is the gap that I want to fill for other people to give them that continued support in between working with a practitioner. So valuable. When you bring a coach onto your team and create that really strong collaborative care team, that is when you see accelerated results. That is where you see true lifestyle transformation. That’s my journey. That’s my story. 

Dr. Eric: 

I agree with you. I love health coaches; they have their place along with practitioners. It took about four months for you to restore your health. I’m guessing diet played a huge part in that? 

Stephanie: 

It definitely did. Just to be very honest and realistic, four months is where the initial bulk of the healing took place, but it took me a total of about 2/2.5 years to achieve that full healing, optimal function. It’s something you have to work on every day. We are exposed to so many toxins and stressors. Those initial four months, that was the major healing phase for me. 

Diet played a huge role, really looking at what I was consuming. At the time, I was eating what I thought was a healthy diet: low fat yogurt, low fat cottage cheese, whole wheat bread, all this stuff that we have been taught for so many years is very healthy. I was doing smoothies with lots of fruit. I was drinking green juices or vegetable juice, but I was doing it at 9pm. A lot of things I thought were healthy that didn’t quite support my healing journey because I just didn’t know I was doing things incorrectly. Diet played a huge role. 

Coming back to what does my body need right now? It’s not looking at it as a good food versus a bad food. What is good for me right now? What is bad for me right now? Taking out the things that were contributing to inflammation and gut dysbiosis. Including a lot of whole foods, lots of color, lots of variety. Completely changed my life. 

Dr. Eric: 

I think a lot of people were in a similar situation. That includes myself. I remember those days many years ago when I was eating whole wheat bread, and I thought it was healthy because it wasn’t white bread. Sometimes, I’ll tell stories of when I used to eat soy nuggets, which I look at the ingredients now and cringe. I thought it was a healthier alternative. There are some health benefits to organic, fermented soy, but the soy nuggets I was eating were not healthy. The perspective has changed for myself and you and I’m sure many others are listening to this. 

For some people, maybe they’re in a similar situation that we were in, where they think they’re eating healthy, but not necessarily. 

One other thing I wanted to mention. You mentioned it was four months where the main healing took place, but it was really a 2.5-year journey. Just the other day, I had a patient with Graves’ I was consulting with, and she told me, “I want to be the quickest to get into remission.” Her goal was in two months. That’s really quick. It’s great to be ambitious and want to restore your health quickly. But  I was explaining that you want to have realistic expectations. 

I’m glad you said this, not to discourage people, as some people do heal quicker than others. Two months, even four months, is really quick, especially when dealing with a chronic health condition. 

Stephanie: 

Of course. You’re right. People need to have realistic expectations. Otherwise, that impacts your motivation, and it does impact your dedication. If you are expecting to fully heal and get rid of all your symptoms and get off all your medication within two months, and if it doesn’t happen within two months, a lot of times, people want to throw in the towel. “I have been so dedicated, and I’m not where I want to be.” 

We need to remember that where we are right now, it didn’t happen in two months. It happened over five, 10, 15, up to 20 years. Your autoimmune condition may have only been diagnosed recently or within the last few years, but generally, these start to happen many years ahead of time. It takes a long time for us to actually get very sick.

The good thing is it doesn’t take as long for us to heal. We will heal much faster. That doesn’t mean it’s going to happen in two months or three months. You have to stick with it and know every single day, you are doing something to support your body. You are going in the right direction. 

The other thing I want to add onto that: I personally don’t feel it’s good for us to try to do everything all at once. We want to look at your detoxification system. We want to look at your stress, your gut. If you are trying to fix all of these things at once, not only does it put more stress on you mentally and physically, but it puts too much stress onto your body. Your body can only handle so much at once. Stress is one of the leading causes of developing an autoimmune condition or thyroid dysfunction. With anything we’re doing, we want to take a faced approach and make sure it’s as less stressful as possible.

Dr. Eric: 

Agreed. One thing we also should add is it’s not unrealistic, I don’t think, to get results, like start feeling better in a few months, 2-3 months. That’s the good news. We’re not saying it’s going to necessarily take a year before you start feeling better. But to optimize your health, it does take a while. In most cases, it will take more than a couple of months. To start feeling better, noticing changes in your blood test, after 2-3 months, that’s not unrealistic. 

Stephanie: 

Not at all. 

Dr. Eric: 

Now, let’s dive into the three core systems. I don’t know which one you want to start with, but I’ll let you take over, Stephanie. 

Stephanie: 

I’m grateful for the opportunity to talk about this because it’s one of my favorite things to talk about. Let me give you an overview of these three core systems that we want to focus on. The first one is your liver and your detox system. The second core system is your gut and digestive system. The third one is your immune system and inflammation levels. 

I mention them as three different systems. They are. But what we need to remember is these three systems are very closely linked. When one is affected, it will cause an effect in the other two systems as well. The good thing is once we start to rebalance them, you will see those improvements in the other two systems, too. They are so closely interlinked. You can’t really affect one without having downstream effects on the other two. 

Why I mention these three core systems is because you cannot have a symptom or a diagnosis, whether it’s chronic or autoimmune, without having an imbalance in one, two, or three of these core systems. An imbalance in this is going to lead to declining health. Therefore, when we are looking at healing, we really want to pay attention to these three systems. Are they working effectively? Are they working efficiently? What imbalances may be present that we can start to correct? 

The first one I’d like to look at, especially when it comes to thyroid issues, is your detoxification system. A lot of the time, I hear from people that they do not focus on detoxification because they don’t consume alcohol. There is this idea that the only time you need to detox is if you are burdening your body with alcohol, and that is not the case. 

Something else that comes up a lot is “If I have a liver, if I have a kidney, and if I drink water, my detoxification system takes care of itself.” Unfortunately, with the toxic burden that we carry in today’s world, our detox system needs a lot more support. It is something I personally feel we should all be focusing on every single day. We are exposed to toxins through the food we are eating, with pesticides, through the water we drink, the air we are breathing, the personal care products we use, the cleaning products we use. The coffee you are drinking in the morning is laden with pesticides and mold. I don’t say this to scare anybody. We all are exposed to this. I say this to bring awareness for you and why you need to be looking after your detox system.

Research shows that especially for women, we are exposed to up to 200 chemicals by the time we even leave our house in the morning. If you think about that, that is quite a scary statistic. Therefore, we need to help our body out a little bit. We need to give our liver a helping hand. This is why I tend to focus on the detoxification system first. 

Every time a client starts to work with me, we go through a very deep assessment of the body. My focus always used to be on gut health. Gut health is central. What I started to notice a few years ago through these assessments is everybody I was dealing with had some degree of toxicity in the body, or a sluggish liver. We can’t fully heal the gut if our liver is not functioning properly, if our detox system is compromised. Your gut plays a role. Your gut is part of your detoxification system. 

First of all, we want to look at supporting this. Generally, what I would recommend for people is just a general detox, maybe up to 14 days. Of course, everybody is an individual. Forgive me, I’m speaking generally now. When you work with a practitioner such as Dr. Eric, we would look at customizing a program based on the patient’s needs. Generally, looking at a 14-day detox support program. 

What that would look like is using food as medicine. Food is always the core pillar that we look at. That would be eating a lot of cruciferous vegetables: broccoli, cauliflower, kale, even things like mushrooms and onions and all those good things. Getting a lot of that into your diet.

We want to look at slowly starting to clean out your exposure to toxins through your home and personal care. This doesn’t mean I tell people to go throw everything out at their house. What can you start to replace? Look at the things you are using most often: your daily stuff, your deodorants, toothpaste. As one finishes, purchase a healthier alternative. 

It’s become so widely available now. It’s not difficult to find non-toxic products. If you look at places like Sprouts, Whole Foods, even Trader Joes or Wal-Mart and Target are getting a lot more into healthy, non-toxic, organic foods and products. Companies like Thrive Market, an online wellness store, have such great clean products on there as well. Slowly starting to replace the things that you get exposed to most regularly, one by one starting to clean them out.

We also want to look at supporting your detox system with supplementation possibly. Things like glutathione are helpful to bind toxins and get them out of your system. If you are looking at a hormonal imbalance, if you are dealing with estrogen dominance, we may support that detoxification with something like DIM broccoli extract. 

One of my favorite ones to use, especially if somebody is dealing with a thyroid issue, is something called NAC, n-acetyl cysteine, which has been shown to be effective for a lot of people dealing with thyroid conditions. It helps with your inflammation levels, your cellular health in general. We may look at using supplementation as well. Does that support you with detoxification?  

Dr. Eric: 

It sounds like you use a combination of diet, supplementation. One thing I wanted to mention, because there might be some people listening who heard you say “cruciferous vegetables like broccoli, kale, and cauliflower,” and there are some who might be concerned about the goitrogenic properties of cruciferous vegetables. I’ve said elsewhere that I’m not too concerned about these foods being goitrogenic. Maybe if someone is eating five cups of raw broccoli or kale per day. Usually, it’s the opposite problem, meaning these people aren’t eating enough of these foods.

I haven’t seen much of a problem when it comes to the goitrogenic effect, so I agree with you. Whether someone has Hashimoto’s or Graves’, I think it’s fine to eat cruciferous vegetables. Listen to your body. If someone is having a lot of bloating/gas, maybe they have some digestive issues, SIBO or something else going on.

Other than that, most people do okay with the cruciferous vegetables. I don’t know if you have anything to add to that.

Stephanie: 

I completely agree with you. There is such a fear around the goitrogens as you said. In my experience, that research had a place, but it is a little bit outdated. 

As you said, listen to your body. Most people are doing fine with cruciferous veggies. It’s actually supporting improving their health, not deteriorating it. 

If you are concerned, you can focus on eating your cruciferous vegetables cooked. That will impact the effect it has on your body, and it will minimize. If you are worried about goitrogens, cooking will decrease that. 

However, in my experience, it hasn’t really been a problem. If you are eating a lot of cruciferous veggies, or veggies in general, and you are experiencing a lot of bloating, we will jump into gut health in a minute. That is often a sign of dealing with SIBO. SIBO, small intestinal bacterial overgrowth, is something we often see come about with thyroid issues, especially Hashimoto’s. Everything slows down. The whole body is slow. Your metabolism is slower. This can increase it quite a bit. 

Dr. Eric: 

Before we talk about digestion, can I ask what your thoughts are on sauna, especially infrared sauna? Also, things like colonics and coffee enemas. 

Stephanie: 

I missed the first part. You asked about colonics and coffee enemas? Was there a third one? 

Dr. Eric: 

Infrared sauna.  

Stephanie: 

Yes. Personally, I do recommend saunas. One of the ways that we get toxins out of the body is movement and sweating. We get toxins in two forms. You get your fat soluble and water soluble. We are only going to get those water-soluble toxins out through sweating. You want to detox at the rate that is comfortable for your body. Too much too soon can have negative effects.

What I would say is as we are going through the digestive system, through your gut health as well, that will support this detoxification. The problem is if you are releasing too many toxins into your bloodstream all at once, and your pathways are not clear enough for your digestive system, those toxins are going to be reabsorbed elsewhere. 

If you are doing saunas, you don’t want to go every day for 45 minutes or an hour. You want to start slow. You want to make sure that you increase your hydration as well as look at your mineral balance. If you are sweating out too much trying to detox but are not bringing back the magnesium or potassium, you are going to feel quite bad. We don’t want that to happen. Yes, saunas. I do like it very much. 

Coffee enemas, I know there is mixed research on it. Coffee enemas are shown to be very good for parasites, any that are in your liver. It has been shown to get rid of that as well as parasites in the gut. Coffee enemas, I don’t mind. If that is something that people want to explore, I am happy to walk them through that process.

Colonics are something I am a little bit more cautious of. To each their own. This is your healing journey. Colonics are something I wouldn’t do initially, unless you find a practitioner that you are very comfortable working with. You need to do your research on these things. Personally, I wouldn’t recommend doing colonics until you have gone through a gut protocol because you don’t want to cause any more disruption. A lot of the time, the things you are trying to do with colonics by cleaning all of that up, we can do with food, supplementation, or herbals. 

Dr. Eric: 

I agree about saunas. One thing I sometimes say, if someone has hyperthyroidism, especially if it’s unmanaged, they might not want to go in the sauna. If they have an elevated resting heart rate, sauna elevates your resting heart rate more. Otherwise, I am a big fan. I went to the sauna this morning myself. I try to do it at least twice, if not three times a week. 

As far as coffee enemas and colonics, I am not opposed to them, but they are not parts of my toolkit. I don’t commonly recommend them, but a lot of people do benefit from coffee enemas, and some people benefit from colonics/colon hydrotherapy. 

Do you want to go into the second core body system, which I believe is gut? 

Stephanie: 

100%. I’d love to. This is my main area of focus. It’s my favorite thing to work on. It’s the area that had the biggest impact for me on my own health journey as well as where I see my clients make the biggest improvement once we start focusing on your gut. 

Your detox system will affect your gut, and your gut health is definitely going to affect your detox system. Of course, as I said earlier, they work hand in hand. 

When we are looking at gut health, this is particularly important with thyroid conditions. In 98% of thyroid conditions, you will see an underlying case of leaky gut. The two main gut conditions that we are seeing that specifically relate to the thyroid is what we call leaky gut. 

Dr. Eric, I don’t know how much detail you want me to go into this. I’m sure you’ve discussed it a bit on your podcast. Do you want me to recap or carry on with the others? 

Dr. Eric: 

Sure, why don’t you go ahead and give a brief recap of what a leaky gut is? 

Stephanie: 

Over 70% of the adult population is dealing with leaky gut to one extent or the other at this stage. I assume almost every time I see a client, you can see straight up just from their symptoms without having to do testing if leaky gut is present or not. As I said, if you’re dealing with an autoimmune condition or thyroid issue, you pretty much guarantee that leaky gut is happening. 

What happens is your digestive lining, your gut lining, is very thin. It is only one cell layer thick. I will give a very simplified explanation of this. Basically, these cells that make up your gut lining are very tightly packed together. What happens with leaky gut, this is caused by stress, the food that we eat, medications, toxins. There are a host of different things that contribute to leaky gut. What happens is these cells are tightly packed together, the only thing that can get through that barrier is supposed to be your nutrients: vitamins, minerals. That gets into your bloodstream and is then transported around the body to where they need to be. 

With leaky gut, these cells that are closely packed together start to separate. They start to open up. All of a sudden, you have these big holes, gashes in your digestive lining. That’s what we call leaky gut or gut permeability. 

Now, it’s not just vitamins and minerals that are getting through, but it’s toxins, toxins that are supposed to be pushed out in our stools are now escaping and getting into our bloodstream. Digestive pieces of food are getting through there. Bacteria that live in our gut and are supposed to only be in our gut are escaping into our bloodstream. 

Depending on the research you’re looking at, it’s anywhere between 70-80% of our immune system lives in and around our gut. What happens is when these toxins or food or bacteria, these invaders, are escaping our digestive system and getting into our bloodstream, it is triggering our immune system. Our immune system realizes, “Hang on, these guys are there. They shouldn’t be here. There is an invader; there is an enemy.” The immune system starts a process of inflammation in the body and the production of antibodies. 

We know if we have an autoimmune condition, we have antibodies. They are these bullets that the immune system creates to attack the enemy, to attack the invader. Unfortunately, sometimes the immune system is so overloaded and exhausted that it becomes a little bit confused. These antibodies, these bullets, are no longer attacking invaders. It starts to attack our body as well. This is one of those big links between gut health, leaky gut, inflammation, and autoimmune disease. It’s something we definitely want to look at.

Every time toxins are escaping into our bloodstream, it also increases the load on our liver and detox system, right? You can see that link. The moment we can kill that leaky gut, we create a friendlier communication and clearer communication between the bacteria in your gut and your immune system. We prevent toxins and invaders and these unwanted things from getting into our bloodstream. Therefore, decreasing inflammation and the antibodies. That’s definitely something we want to look at supporting.

The second thing we see a lot happening in the gut is what we call gut dysbiosis. We have trillions and trillions of bacteria that live in our digestive system or in us and on us: on our skin, our lungs, our mouth, everywhere. We have more bacteria in us than we have cells that make us a human being. I always say that because of this, we are basically a very advanced walking, talking piece of bacteria. We have trillions of these things. The fact that we have so many should be a very clear indication that this is something we should be paying attention to and looking after. 

What we want is high amounts of very good bacteria, and we want the bad bacteria very low. We will never get rid of the bad bacteria, but we want to keep them low. The good bacteria keeps your bad bacteria in check. It prevents it from overgrowing. Through our diet, medications, toxins, unfortunately our good bacteria is being killed off. This gives our bad bacteria an opportunity to grow. A lot of these bugs in our system are opportunistic bugs. They will stay nice and calm and quiet until they see an opportunity, and they are going to strike. They are going to colonize and take over the gut. 

This increase in bacteria also leads to leaky gut, but it leads to symptoms like gas, bloating, abdominal pain, fatigue. It can even lead to joint pain. Yeast overgrowth like candida can lead to a lot of fatigue and joint pain. 

Cravings is a huge one. Generally, we see bad bacteria feed off of sugar. The more bad bacteria we have, they will scream at us, “Feed me.” They want sugar. This creates these intense cravings. I say to people all the time, “Your cravings for sugar are not because you don’t have willpower. It is because of this dysbiosis, and bugs are screaming at you.” 

When we can correct that dysbiosis and get rid of the bad bacteria and increase the good ones, they will also scream at you for food. Except their preferred food is fiber. That is where you will start having cravings. I promise you this is possible. You will crave broccoli, spinach, fruits and veggies because the good guys in your gut want this. 

When we are working on gut health, we need to look at balancing that good and bad bacteria. Again, we do this largely through food. We want to cut out the foods that feed the bad bacteria, and we want to get a variety of different, colorful fruits and vegetables. We are getting a lot of phytonutrients, the things that give food its color. We need a variety of phytonutrients. We need a lot of fiber. 

For me personally, I don’t think it is possible to fully heal your gut using food alone. I do encourage supplementation when it comes to this. Let me not say you can’t heal it with food alone, but it is going to take far longer. 

I do encourage the use of some supplementation with gut health. Depending on what you are dealing with, I would adjust supplements. Some people may need a digestive enzyme to help them digest their food properly, to absorb the nutrients. We use things like collagen and glutamine to help heal that gut lining. If you don’t have SIBO, we will look at using probiotics to increase your good bacteria. We use things like omegas, Vitamin C, Vitamin D, zinc to help strengthen your gut lining and create a healthier communication between your gut bacteria and immune system. We use supplements like that to support gut health.

We like to include a lot of fermented foods. Your probiotic foods: kimchi, sauerkraut, miso, those sorts of things. If you can get your non-GMO, organic good miso. When you are dealing with a thyroid condition, miso is probably the one that I would leave out. Focus on the sauerkraut, kimchi, those fermented foods. As I mentioned, we want prebiotic fiber. We want to feed that good bacteria with lots and lots of fiber. That would be our approach to healing leaky gut or gut dysbiosis. 

If you have signs of yeast overgrowth or severe bacterial infections, we may look at including some anti-microbial supplements. This is something I don’t recommend people do on their own because you don’t want to damage the gut further. I recommend that you work with somebody who knows what they’re doing. You may end up bringing in things like oil of oregano or wormwood or these herbals to speed up the process of getting rid of that bad bacteria, the parasites, the infections in your gut. Does that support Dr. Eric? 

Dr. Eric: 

Yeah, that was great. I agree with what you said. Obviously, a combination of diet and supplementation, like you do fermented foods along with probiotics or digestive enzymes or agents to heal the gut. That was great.

One thing I do want to ask when it comes to finding out if you have dysbiosis, whether it’s parasites or SIBO. Do you recommend testing, whether it’s a comprehensive stool test or a SIBO breath test? 

Stephanie: 

I do. It depends on who I work with. When they come to me, I do a full intake form and medical analysis. Based on that, I can generally tell them that we need to start out with testing. If you do have a diagnosed autoimmune condition, a thyroid issue, I would say go ahead and get tested straight up. There are certain bacteria that we want to know how severe is the overgrowth. That, we can’t tell without testing. 

For a lot of people, I recommend testing off the bat. That would be something like a GI Map. I do love the OAT test as well. Fantastic. It doesn’t give you a comprehensive stool or gut analysis, but it does give you some clues. The reason I like it is because it gives you an overall view of your cellular health. If we are looking at gut testing specifically, something like a GI Map would be the best one to go for. 

You obviously need to get this done through a functional or integrative practitioner. Your GPs are not necessarily going to be able to order that for you. You need to be trained in how to interpret these tests. I recommend you use a functional or integrative practitioner for this. 

A GI Map is a really good test. You can then do the SIBO breath test as well. What I recommend for people to do when they’re ordering the test is make sure you are checking for hydrogen SIBO, methane SIBO, or combination. I know in the U.S., it’s pretty good. Most of your practitioners specializing in SIBO do test for all three because the treatment plan would be slightly different. However, in South Africa, if I’m not mistaken at the moment, they only do a hydrogen SIBO test, and that’s not what we want. Make sure you’re asking your practitioner to test for everything, and then treat accordingly. 

You can definitely test off the bat. I don’t do that for everybody. Depending on what they are dealing with, depending on if they can afford testing or not. I would put them through a 6-8-week healing protocol. Generally, most of your symptoms are going to improve through that. Regardless of what bacteria, whether you are dealing with dysbiosis or leaky gut, the treatment protocol is going to be largely the same. A few minor differences here and there, but you will be looking at probiotics, prebiotics, collagen, L-glutamine, bone broth, lots of fiber. We would put them through a 6-8-week gut healing protocol, and we always see massive improvements.

At the end of that protocol, if there are still symptoms that have not resolved themselves, then I would definitely recommend going for further testing. 

Dr. Eric: 

For those who are not familiar with the OAT, that stands for organic acids test. It’s a urinary test that looks at a number of metabolites related to the gut, like yeast, bacteria, clostridial (depending on what lab you use), neurotransmitter markers, detoxification markers, nutrient markers. Pretty comprehensive test. 

You mentioned at the beginning that there are overlaps between the three core body systems. The third one that you haven’t discussed is the immune system, but you kinda did discuss it because most of the immune system cells are located in the gut. What else do you have to say about the third core body system, the immune system and inflammation? 

Stephanie: 

Everything that we have spoken about, looking at incorporating more cruciferous vegetables, looking at eating the rainbow, getting lots of variety of color and fiber into your diet, all these things, even though we focus on them, when we are looking at the detox phase and the gut health phase, we are looking at something else. Throughout all these phases, everything we are doing is also supporting bringing down your inflammation levels.

Sometimes, if you are taking pharmaceutical meds to treat a certain condition, they generally have side effects on other parts of the body. They have negative side effects. When we are using food as medicine, they also have side effects on other body systems, but they are generally positive. Everything we have spoken about, even the supplementation—collagen, probiotics, etc.—are supporting bringing down your inflammation levels.

One of the things I really want to mention here is gluten. We haven’t spoken about that yet. Gluten is something that is severely damaging to your gut health. Even if you are not gluten-intolerant, even if you feel like “I’ve been eating gluten for years, and I don’t have any bloating or stomach issues,” bloating is not the only sign of a digestive problem. I can promise you now that gluten is not doing you any favors. It’s one of my non-negotiables if I work with someone who has a thyroid condition: get off of gluten as soon as possible. 

This ties in with your inflammation because gluten is one of those molecules. If you think of it like a little blade, when you are eating gluten, it’s like a little blade making those slits in your digestive system, contributing to leaky gut. 

What happens with your immune system that is around your gut, we see something called molecular mimicry. What this means is that gluten itself, as the protein, when you look at the structure of the protein, it is almost identical to that of your thyroid. Gluten creates leaky gut, this permeability. These gluten proteins are getting into your bloodstream. Your immune system sees them and goes, “Oh my goodness, there’s an invader. Let’s create bullets to attack to get rid of these gluten proteins.” Your body starts to produce these antibodies, these bullets. All of a sudden, as it’s floating through your bloodstream looking for the gluten, it comes across your thyroid, and it goes, “Oh my goodness, this is the same thing,” and it starts to attack your thyroid. This is molecular mimicry.

If we want to stop the attack on your thyroid or minimize the antibodies, one of the best things you can do is to stop eating gluten. Not for two weeks. This is a big mistake I made in my healing journey. I went from eating gluten every day to eating gluten once every week or once every two weeks. I thought I have such little gluten in my diet that it’s not a problem. 

The reality is there is no such thing as a low gluten diet. Unfortunately, we do find gluten in spices, sauces, etc. You need to understand how to read your labels. You need to start looking at your food labels. 

What happens in the body is you stop eating gluten for seven days or 14 days, and the immune system says, “All right, the threat is not there anymore. Let’s decrease the amount of antibodies we are making against the thyroid, against gluten.” Your body slowly starts to decrease, which is great. All of a sudden, you have that one bite of a cookie or that sauce that has some flour in it. Gluten is present, and the immune system says, “I was wrong. Produce the antibodies. We need inflammation. The danger is still here.” 

You need to get to a point where your body has stopped producing those antibodies completely. Gluten is a big driver of inflammation and your thyroid antibodies. 

When we can minimize the toxic load in our body, that is when we will bring down inflammation. Does that support? 

Dr. Eric: 

I agree with what you said about gluten. A client of yours says, “No problem, I will give up gluten, and I will just substitute it with non-gluten products. I will have gluten-free pizza, pasta and cookies.” Is that okay, since all of those are gluten-free? 

Stephanie: 

Absolutely not. Let me put it this way. Everything should happen in phases. If you want something to be sustainable, it needs to be easy for you to do. This is why healing and doing everything in a month or two months or three months for me is not really realistic. If we try to do everything all at once, if we are doing too much, as I said earlier, it’s going to cause a lot of stress on the body. 

The first thing I would really do with people before we look at stopping gluten is what can we add into our diet that you don’t have? Can we add berries? Can we add fermented foods? Can we add colorful fruits and vegetables? Then we can look at removing gluten, dairy, and other inflammatory compounds. If that means at first that you are having one gluten-free cookie every day, but you’re not having the pizza or sugar or gluten cookies, if that’s what we need to do at first, for the first week or two weeks, then that’s what we do, with the goal of getting off of all of that stuff completely. 

Some people will come in and say, “I don’t want that stuff. I’m going all in. Let’s do it.” I love that. What are you able to stick with? What is the pace that you’re going at? Obviously, the faster you can implement these things, the faster you’re healing. 

But when I talk about gluten-free, I encourage people to eat foods that are naturally free of gluten. Your cauliflower doesn’t have gluten in it. Your broccoli doesn’t have gluten in it. Quinoa doesn’t have any gluten in it. If you are someone who wants that starchy grain, if your gut can tolerate quinoa, that’s something you can look at doing as opposed to couscous. 

A lot of the time, these gluten-free products, your cookies, pretzels—are just pieces of starchy, white nonsense. It’s tapioca starch and other things that have so many additives in them that are spiking your blood sugar. It is not feeding your gut bacteria. They do not do any favors. 

A gluten-free product marketed gluten-free is not a healthier option. People get confused, thinking that just because it doesn’t have gluten or dairy, that means it’s healthier. There is a difference between something being good and healthy versus something being slightly less harmful or harmful in a different way. It’s like thinking diet soda is healthier. It’s not healthier just because it doesn’t have sugar. It’s damaging in a different way.

To answer your question, no. If you can get all of that stuff from the beginning, 100% do it. 

Dr. Eric: 

I love that response. The only other thing I’ll add, which obviously we can’t cover everything. There is so much more we could chat about, and you could talk about. When it comes to the immune system, you mentioned stress earlier. Chronic stress drags down the immune system and can make people more susceptible to viruses. You want to do things from a stress management perspective. 

Sleep, same thing. Lack of sleep is inflammatory. Both stress and sleep are very important for optimizing immune system health. 

Stephanie: 

Definitely. You are so right. Both of those things impact your detoxification and gut health as well. A lot of your detox happens at night while you are sleeping. Between the hours of 1-3am is a very active time for the liver. If you are not getting quality sleep, you are not detoxing your body. Your brain gets detoxed. It gets cleansed at night while you’re sleeping. If you don’t get that deep restorative sleep, that won’t happen. You will wake up feeling tired and foggy brain. Sleep is incredibly important as well as stress management, specifically for thyroid issues. We know that stress is one of those major triggers for autoimmunity and thyroid. 

When I talk about stress, all these three areas that we have just discussed is a form of decreasing your stress. We didn’t mention it in that way. A lot of the time, people look at stress as the mental or emotional side. “It’s my finances, it’s my job, it’s my family, it’s my relationships.” These things that cause mental or emotional stress. 

What people misunderstand is there are three different kinds of stress that we are exposed to on a daily basis. It’s the mental or emotional, which we all recognize. Then we have the physical stressors as well. Physical stressors could be the parasites or bacterial overgrowth in your body. That creates an immune response. It triggers your immune system into overdrive, and that creates a stress response in the body. 

Then we also have our chemical stressors, which are things like the pesticides and toxins that we are exposed to. By focusing on these three areas we discussed today, you are indirectly supporting your body or reducing the amount of stress, what we call allostatic load, on your body. 

Dr. Eric: 

Wonderful. Obviously, there is a lot more we can both talk about. Is there anything you really wanted to talk about other than the three core systems? Anything I should have asked you that I didn’t ask you? 

Stephanie: 

Just because this is a save my thyroid podcast, and I am sure you’ve had many people talk about this, one thing I think is worth noting, if you are dealing with a thyroid condition, looking at nutrient deficiencies are important as well. When we improve our gut health, you improve the absorption of nutrients, so this will support that. Dr. Eric, I’m sure you will have a lot more to add and speak about within this.

In my experience, some of the most common nutritional deficiencies that we see that are aggravating your thyroid condition are magnesium, B12, Vitamin C, Vitamin D. These all lead to a compromised thyroid function. Always getting tested first. We don’t want to supplement with a bunch of selenium and magnesium if we don’t know what our levels are. It’s very important that you get tested and start to work on those deficiencies. The nutrients that really do support your thyroid function: magnesium, Vitamin C, Vitamin D, methylated B12, omegas, and I’m sure there is one or two I’ve missed. Those are the ones that come to mind. Selenium. Looking at that. 

Also, reminding you guys: take it slow. I know we have discussed a lot. I don’t want health to seem overwhelming because it’s really not. There is a saying that I don’t know if you’ve ever heard. How do you eat an elephant? It’s one bite at a time. One thing at a time, one small thing. You don’t fail when you fall off the wagon. Don’t throw in the towel if you didn’t have a perfect day staying on your plan. You only fail when you give up. Every day, if you can focus on what is one thing I can do for my health today? What is one thing? Is it that delicious, nutritious meal I ate? Is it taking my supplements? Is it going for a 10-minute walk? Is it sitting in gratitude for the fact that I am alive? Do something small for your health every day. Not only will it benefit your physical health, but it will benefit your mental health and support your motivation. 

Dr. Eric: 

Well said. Stephanie, where can people find out more about you? I know you have a monthly membership, the Healthy Mastery Academy. Feel free to talk about that. You also have an upcoming health summit. 

Stephanie: 

If anybody wants to follow me on Instagram, I’m @UnlimitedYouCoaching. Every day, I post different recipes and tips and tricks. You see the quick things I do in my own life to make health simple. 

That’s my goal. I really want to make health as simple for you as possible. I’m not somebody who likes to spend a lot of time in the kitchen. Cooking is not a passion of mine. As I said earlier, if something is going to be sustainable for you long-term, it has to be easy. If you follow me, I will show you ways to make things much easier on a day-to-day basis.

This is what we do in the Health Mastery Academy as well. It’s a monthly membership group program. Every month, I give you a different meal plan, one to support inflammation. The next month, we focus on foods that support the gut. This month, we are doing a high fiber meal plan. We also pair it with monthly challenges for accelerated results. Lots of fun. Really great community.

Dr. Eric, you’re featured in there as well. One feature is the access to a video vault, where we have done trainings with practitioners from all around the world on how to heal your condition at the root cause as well as how to create optimal health. Within the membership, you get access to all of this. It’s a one-stop shop. I encourage you guys to check it out. You will find it on my website, www.UnlimitedYouCoaching.net. On the home page, there is a button for you to check it out. I encourage you to take a look if it’s of interest to you.

Dr. Eric, you are also this year coming back onto the Healthy Living Blueprint, an online summit. You and I have had three chances to be together on these events, which I am so grateful for because you have so much wisdom and value to offer everybody. The enrollment opens on September 18, 2023. If you are interested in attending, it’s completely free. Shoot me a DM on Facebook, and I can send you the link, if this is before the podcast.  

Dr. Eric: 

The summit will be live for registration once this episode goes up. Thank you so much, Stephanie. It was great chatting with you about the three core body systems. Look forward to maybe having you back on the podcast again in the future. 

Stephanie: 

Thank you, Dr. Eric. It’s been an absolute pleasure. I hope your audience got some value out of what we had to share today.

Recently I interviewed Evan Brand, and we talked about mold-gut-thyroid connection. 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. Melinda Ring. I am going to dive into her impressive bio, and then we will talk about culinary medicine. 

Dr. Ring is director of Osher Center of Integrative Health and clinical associate professor, departments of medicine and medical social sciences at Northwestern University, Feinberg School of Medicine. She has an active clinical practice, directs medical trainee education, and clinical and faculty fellowships in integrative medicine. She founded the Cooking Up Health culinary medicine course and conducts research as well. 

Dr. Melinda contributes to textbooks and research articles in the field of women’s health and integrative medicine. She has published several books on integrative medicine, including The Natural Menopause Solution. She is a frequent contributor to news outlets. 

She is the chair of the board of the American Board of Integrative Medicine. In 2021, she received the Bravewell Distinguished Service Award from the Academic Consortium for Integrative Medicine and Health, which is one of the highest honors in the field of integrative health. Dr. Melinda, thank you so much for joining us. 

Dr. Melinda Ring: 

Thanks for having me. Looking forward to our conversation. 

Dr. Eric: 

Same here. Before we dive into culinary medicine, if you could give a little bit more of your background. How did you start focusing on that? 

Dr. Melinda: 

It’s an interesting question because if I think back to my childhood, I grew up in the ‘70s and ‘80s. Food was very much processed food and Wonder bread and TV dinners. That is what was healthy. I never actually learned how to cook. What we knew about nutrition was very different from what we know about it now. 

I had a brief window of time between college and medical school. I begged my way into getting a job as a sous chef at a fancy restaurant in Ann Arbor. I spent the summer making salmon en papillotes, making our own sausage from scratch, and doing a lot of different things I had never learned before. 

When I went to medical school, we learned nothing about nutrition. The only real nutrition we had was about IV nutrition for inpatients. Even when we were talking about diabetic patients, where it’s such a difference, we learned about how to dose insulin, but we didn’t learn how to counsel patients on what to eat.

When I was in practice, I knew to tell someone to eat a low sodium diet. Giving them a handout doesn’t translate to real-world nutrition. After my integrative medicine training, which was very nutrition-focused, as you know, I started to think about bringing those together. That’s where this idea of marrying culinary medicine, which has been defined as the art of cooking with the science and nutrition of medicine, really appealed to me. We decided to create a course for health professionals, so we can try to train more doctors, more health professionals to help their patients down the road. 

Dr. Eric: 

Very cool. How long have you been doing this? 

Dr. Melinda: 

Probably for the past eight years. We started a course at Northwestern, and now we’ve expanded it. It’s being taught at other institutions. It’s not a patient directive. I get inquiries from my own patients, “How can we take your culinary medicine class?” Right now, that’s not what we offer although there are definitely others who offer things like that. I might do that myself down the road. But right now, Cooking Up Health is aimed at making sure people’s doctors and other health professionals understand culinary medicine, so they can help their thousands of patients. 

Dr. Eric: 

Is it mostly other integrative doctors? Do you actually get conventional medical doctors who express interest? 

Dr. Melinda: 

We’re trying to start early. In a few weeks, we are starting a cohort of first- and second-year medical students. They will go into all kinds of fields. Nutrition is relevant to everything, from surgery to dermatology to primary care. It’s definitely focused on everybody, not just integrative doctors. 

Dr. Eric: 

Wonderful. How do you incorporate it into your actual practice? It sounds like you don’t actually teach your patients how to cook; you just encourage them to eat whole, healthy foods. Do you encourage them to use recipes? 

Dr. Melinda: 

To some degree. Nutrition is always a part of what I talk about to patients. Yes, providing resources for them. I tend to have a very educated, health-oriented patient population. They tend to already be aware to some degree, but it’s really diving more deeply into how to make this a practical thing in an already busy life. 

We can’t do cooking that takes three hours to prepare when somebody has other things going on. When I have a patient who has two jobs and is raising kids, telling them to use this fancy cookbook to prepare food is just not gonna work. It comes down to what are some of the quick and easy ways to make healthy nutrition realistic and delicious? 

Dr. Eric: 

Makes sense. Batch cooking, do you recommend that? 

Dr. Melinda: 

Love batch cooking. Absolutely. There is a cookbook I got recently by this nutritionist cook, Love and Lemons. In it, for example, she says, “You just got organic zucchini from Costco, and you have a whole bunch of it. Here are three nights of completely different recipes you can do. You prep this on day one, and then you will use this day two and this day three.” Those are the kinds of things I think help. 

They also help reduce food waste, which is such a big issue in our country. People buy all this stuff and throw it out at the end of the week because they’re starting to not look so great or are a little wilted. Helping people learn to avoid some of that food waste is important, too. 

Dr. Eric: 

How important is food when it comes not to just overall health, but when dealing with health conditions? You know the listeners of this podcast here pretty much consist of people with thyroid and autoimmune thyroid issues. What role would you say food plays in helping someone to recover, or from other autoimmune health conditions or conditions like cancer? 

Dr. Melinda: 

To me, integrative medicine always starts with lifestyle. Diet is one of those pillars of health. I love dietary supplements. I love other approaches, like acupuncture and energy therapies. Those will do very little if somebody is not also addressing nutrition, getting enough sleep, moving, managing stress, having joy in their life. It’s essential basically. 

I think it’s critical both to feeling better with whatever you’re dealing with now, but also it’s one of those root cause things, which is having a healthy diet will prevent disease down the road. You have to start there.

Dr. Eric: 

Good answer. I agree with that. 

One question I have is picky eaters. Growing up, I always used to be really picky. Even these days, I’m still more on the picky side, but I eat more of a variety. How do you deal with picky eaters as far as someone who wouldn’t use a lot of spices to make it more flavorful? Do you have any feedback for those listening who might just want to have their burger and sides? Hopefully not French fries. “These are the five foods I’m eating on a regular basis.” Maybe it’s a vegetable or two sometimes. If you could give some advice on how they could increase the variety. 

Dr. Melinda: 

I have two boys. One of them is a picky eater. I think it depends on what we’re talking about. With kids, it’s a very different situation than adults. 

With kids, the bottom line is you need to get those fruits and vegetables into the diet. Getting those things started early, when they’re developing a taste for it, is important. Now, I am a little bit of a purist, and maybe not the best example because I actually prefer all of my vegetables and fruits without a lot of sauces, without a lot of spices. I love them just in their natural taste, maybe steamed or roasted, but not with a lot of stuff on it. 

For other people, trying to- For example, if they are pasta lovers, adding vegetables into that, even if they’re frozen, and mixing them in. Doing muffins and making them zucchini muffins and hiding it in. Finding ways to incorporate it. Smoothies are always a great way. People love to get things in that way. I don’t love the fruit and veggie blend powder type things. I don’t think they’re a replacement for real food. 

It takes a while to develop a taste for something new. If somebody has been eating a very restricted diet, sometimes they have to give it a chance and say, “I am going to commit to eating this, at least three times, before I say I don’t like it.” Even if it’s one piece of broccoli, allow their taste buds to adapt and appreciate it. Maybe eat it mindfully. Notice it more. Appreciate it more. 

Dr. Eric: 

Those are good points. Growing up, I really didn’t eat vegetables. As an adult, I wasn’t crazy about eating vegetables. Going through chiropractic school and learning about nutrition, I realized I needed to eat healthier and incorporate vegetables. It was a slower process. A lot of it was a mindfulness around eating them and realizing how much good it’s doing to my body. The smoothies, which I still to this day incorporate into my practice. It’s best to start when you’re young. 

I still come across adults, and I’m sure you do, too, where they are hardly eating any vegetables. Some listening to this absolutely love vegetables, I’m sure. When someone refuses to eat vegetables, it’s more of a challenge. 

You also brought up the powders. I’ve had people bring that up, too, as a substitute. “Can I have a veggie and fruit mix powder?” Exactly what you said. I tell them the same thing. It’s probably better than nothing, but it’s definitely not the same as eating whole veggies and fruits.

Dr. Melinda: 

ConsumerLab.com did a review of them. The FDA came down on them because they will make these claims like, “Has 12-14 servings in a single drink.” That’s some false marketing.

Dr. Eric: 

Good to know. You said Consumer Labs? 

Dr. Melinda: 

ConsumerLab.com. Are you familiar with them? 

Dr. Eric: 

Yeah. 

Dr. Melinda: 

They test the quality of supplements and see what they’re supposed to have and that they don’t have things they’re not supposed to have, like heavy metals. That’s another resource I oftentimes will recommend to patients for supplements. It’s one of the better ones. 

Dr. Eric: 

You also mentioned as far as when you eat foods, sometimes you’ll steam them. Sometimes, you’ll roast them. Do you also eat them raw? Do you recommend a combination of raw and cooked veggies? Or is it mainly cooking? 

Dr. Melinda: 

I think it varies. It depends on the patient really. I don’t only see autoimmune issues. I see all kinds of things. A lot of my patients have gut issues. They may do better or worse, depending on what their situation is, with raw versus cooked. 

Cooking alters the nutritional content of food. It alters its availability, sometimes in positive ways, and sometimes in negative ways. When we talk about something, for example, like goitrogens, which are a big topic in thyroid, cooking degrades them. In that case, cooking may be the preferred option versus eating a bunch of raw broccoli dipped in a dip. I don’t have a universal, I only eat cooked food. I’m certainly not a raw foodie either. I like it all. For patient tolerance, it really depends on their situation.

Dr. Eric: 

That makes sense. If someone is experiencing a lot of bloating when eating salads or cruciferous vegetables, it’s probably easier, at least for the time being, to cook them. On the other hand, If someone is fine eating salads and other raw vegetables, it sounds like you just go with the flow and let them continue eating raw vegetables. Pretty much how they prefer it as long as they are able to tolerate it without any symptoms. 

Dr. Melinda: 

Yeah. I also am envisioning this shift to a more integrative culinary medicine movement. For example, if we think about ayurvedic medicine and how it describes people as having different doshas and different combinations of doshas, in Ayurveda. Somebody who has a Pitta, a more heated dosha constitution, may do better with raw, cooler type foods. Somebody who is more Kapha may need more cooked foods. 

There are different ways of looking at food and food preparation. Looking at what’s right for someone, it’s certainly what feels good to you, but it can go even beyond that, depending on what is the lens through which we’re looking at food.

Dr. Eric: 

One thing I didn’t say in the beginning: Are you a vegan, or just vegetarian? 

Dr. Melinda: 

I like the term “plant-forward” or “plant-based” more than vegan. That makes it sounds like I will never eat this, versus I will eat a lot of these great, lovely plants. I do have some dairy in my diet. Not a huge amount. Certainly some honey. Occasional eggs. I am not completely vegan for sure. 

For me, it’s a combination of health, connection to the world, and being an animal lover. It’s a big holistic reasoning for me versus just for health. 

Dr. Eric: 

Okay. It’s philosophical, not just health reasons. 

Dr. Melinda: 

Philosophical, environmental, spiritual, you could say. I’ve done some things like shamanic journeys, and my spirit animal was this beautiful, big deer who came. I’m not eating you anymore. You can look at it in a lot of ways. I’m just very happy that science backs me up. Eating a lot of plants is a good way to go. 

Dr. Eric: 

I can’t say I’m vegetarian, but I do agree that you want to eat a lot of plant-based foods. I would recommend mostly plant-based. I think you would agree that if someone does choose to eat meat, like beef, it should be grass-fed beef, preferably organic. If they eat chicken, organic, maybe pasture-raised. You said sometimes you eat eggs and dairy, so I imagine when you do that, you try to eat organic. Do you prefer raw dairy, or is it just regular organic? 

Dr. Melinda: 

Organic, yeah. You have to be knowledgeable about the labels. Organic eggs don’t necessarily mean that they’re healthier. It doesn’t necessarily mean that the chickens had free range. You do have to be a little cautious. Unfortunately, unless you have your own chickens, those free-range options may be more expensive. That’s what I get for our family. 

Dr. Eric: 

You get organic, pasture-raised then? 

Dr. Melinda: 

Yeah. 

Dr. Eric: 

How about spices? I know you said for vegetables, you usually eat them plain. I would think with other- 

Dr. Melinda: 

I do love spices though. 

Dr. Eric: 

Can you talk about some of your favorite spices? 

Dr. Melinda: 

I’m sure you can guess what my favorites might be. Turmeric is certainly one of them. The vibrant yellow spice that comes from the curcumin longa plant. It’s been used in culinary traditions for thousands of years. It is used in Ayurveda and is used for all kinds of conditions. 

One of its major constituents is that curcumin, which makes up 2-5% of turmeric, really has so many therapeutic effects. Everything from antimicrobial, protection against cancer, anti-inflammatory for sure. It helps to inhibit this NF-kappa beta molecule that turns on genes related to inflammation. Whenever we talk about inflammation and autoimmunity, curcumin is one of my top choices, and turmeric, whether it’s used in golden milk or a good curry.

Dr. Eric: 

I think a lot of people are familiar with the benefits of turmeric, curcumin, even though a lot of people take it in supplement form. That has benefits, too. Therapeutic value. Including it in your food enhances the taste, and you’re still getting those therapeutic properties. 

Dr. Melinda: 

Another one is ginger. I love ginger. Typically, raw. It has gingerol in it. That is anti-inflammatory and antioxidant. It’s been studied more when we talk about inflammatory conditions for things like osteoarthritis more than, say, Hashimoto’s or Graves’. It’s been shown to have benefits comparable to pain medications for something like knee osteoarthritis. 

I do love ginger. I use that in all kinds of ways. It might even just be taking some raw ginger and brewing it in hot water and having ginger tea. Easy to do. A. lot of people like to add some raw ginger, if they are making smoothies. It adds a little bit of a bite to it. I think it makes it a richer taste. Ginger is for sure another one of my tops. 

I love cinnamon. We think about it for diabetes, blood sugar regulation. Maintaining that blood sugar is so important for lowering inflammation. Cinnamon may activate these insulin receptors and inhibit enzymes that inactivate insulin. Cinnamon, top favorite. Love it on my oatmeal and on a baked apple, on just about anything. I will highly recommend cinnamon. Those are my top three. 

Dr. Eric: 

Those are a good top three. As far as diet goes, there are a lot of different diets. There’s paleo, Mediterranean, carnivore, autoimmune paleo, etc. Do you have a favorite diet? Are you of the mindset that there is not a single diet that fits everybody? 

Dr. Melinda: 

I think that’s probably been a little bit of my hard part in terms of writing a book or doing some things. I don’t think there is one best diet, and only one diet that works for everybody. I do think that anti-inflammatory is the way to go, which means a lot of plants. That doesn’t necessarily mean no meat, but it means very little meat to me. 

The diets that are more meat-heavy I would say are the only ones that I have a bit of a conflict with. I’m sure there are people who feel great when they eat a lot of meat. From my research, that’s just not the direction that I recommend patients go. 

Often, patients are told not to eat gluten or dairy if you have an autoimmune disease. Don’t eat grains. Those to me get more nuanced. 

Dr. Eric: 

Nightshades as well are pretty common.

Dr. Melinda: 

And the nightshades fall into that category as well.

Dr. Eric: 

It’s a little bit different. There are health properties to tomatoes, eggplants, and peppers. Everybody is different. I’ll admit that my autoimmune patients, I tell them to at least take a break from nightshades. I don’t say to avoid them forever. There are some people who choose not to. Maybe they follow more of a paleo diet. Eat some nightshades, and they might still progress well and do okay. It’s almost like playing it safe. Let’s see how you do without them. Eventually, you have to reintroduce them.

With gluten, I know some of your thoughts because I mentioned I listened to some of your other interviews. I guess gluten, I’m more strict on. The question is does everybody need to avoid gluten forever? Is it bad if someone goes to Giordano’s in Chicago or other good Chicago pizza? Is it a bad thing every now and then to have gluten? Let’s hear your thoughts on that. 

Everyone listening knows my thoughts. I tell them to avoid gluten at least while healing. Even dairy. Nightshades, definitely not as bad as gluten in my opinion. They have some good health benefits. I’d love to hear what you think. I know it’s different than what I think.  

Dr. Melinda: 

It may or may not be. I will often recommend it for my patients who are coming to me initially with autoimmune disease who are not feeling great, even on their optimized thyroid medication. I will oftentimes recommend a gluten-free, dairy-free, elimination diet. We may do a trial of that, especially if there is some concern about leaky gut. Then we are trying to do some gut healing. 

To me, then we need to eliminate all of the major things that could be exacerbating the inflammation while we give the gut time to heal. Because there is such a high prevalence of Celiac in people who have diabetes and people who have autoimmune thyroid disease. For one, they have to get tested. It may co-exist. If they have Celiac, then it’s 100% no gluten. Sometimes, there is no gluten even in your skin products or other kinds of things. 

The question comes down to: Is this a forever diet versus a temporary one? Then it comes down to how does the patient respond to me when they reintroduce it after being off it for 8-12 weeks? When we think their gut is healed? I listen to the patient. I always tell my patients that I am not just treating a lab or a number on the paper, even if it’s a food sensitivity test. We always have to look at the patients and what their responses are. 

Dr. Eric: 

I look at it that way, too, as more of an elimination diet, not a forever diet. With the nightshades, definitely. With dairy, I can’t say I have been dairy-free. I dealt with Graves’ in 2008 and have been in remission since 2009. I can’t say that I never have a dairy. 

I can’t say that I have been 100% gluten-free, where I haven’t had any gluten or cross-contamination. If you have Celiac, you want to be super strict. If you don’t have Celiac, there are some people who choose not to completely 100% avoid gluten even if they don’t have Celiac. There is no need for us to have gluten. Some will say it’s playing with fire if you have a history of autoimmunity. Even if you don’t have Celiac, it could cause problems because it could potentially cause permeability of the gut. 

To me, it does depend on the person. For the most part, I am gluten-free just because like you, I am eating whole, healthy foods. If you are eating whole, healthy foods, you are typically avoiding gluten. I can’t say I haven’t fallen off the wagon every now and then. It sounds like you maybe share the same thoughts. Some people, if they don’t have Celiac, might be okay if they occasionally get exposed to gluten. It’s not going to be a problem with everybody. 

Dr. Melinda: 

Whole grains are very healthy. It’s not just quantity; it’s also quality. You’ve probably had reports of this, too. People go to Europe and are eating Italian pasta and bread, and they’re like, “I have no issues here.” They come back here and then aahh. Some of it might be pesticides and not necessarily the gluten itself. 

I have patients who are eliminated, and they feel great. Then they have no desire to do it. Then they know, “If I go and eat this birthday cake, I won’t feel so great the next day, but I’m not causing permanent harm.” I have others who have families, and it’s just easier for them. They don’t feel differently after doing an elimination diet. For them, it’s fine to keep it in moderation. I think I’m a little more lenient on those.

Nightshades, same thing. They have alkaloids in them. Some people do have reactions to them. Those tomatoes and peppers, all those bright colors, lycopene, have such health benefits with those polyphenols that I hate to cut out a whole category unless someone clearly has a reaction to it. 

This is where I get into testing and seeing what’s going on when you’re eating those things. If we eliminate them, and you get better, then you are reacting to them perhaps.  

Dr. Eric: 

You also mentioned the quality, which is important. Someone might say, “Well, I went out to eat, and I had a gluten-free pizza.” I also used non-dairy cheese like Daiya. There is probably glyphosate in whatever dough they’re using. Also, the oils that they’re using are probably not the healthiest. Some people get so caught up on gluten and dairy and other allergens but don’t look at what kind of oils they are cooking with. That’s not good for you. 

It’s one of those things where people want to live and go out to eat. Same thing. Every now and then, I want to go out to eat. I can’t say I’m perfect all the time. Some people get so caught up on gluten-free, dairy-free and overlook other sources.  

Dr. Melinda: 

Other aspects of the diet. It’s like when you go back to the ‘70s and ‘80s when fat was evil. Everybody was like, “I’m eating healthy. I’m eating all of these fat-free Snackwell cookies.” Of course, what happened? Now we have this sugar/diabesity epidemic. 

What are people replacing gluten with? If they’re eating all of these gluten-free cookies and other gluten-free processed foods, that’s not moving in the right direction for sure. I would rather have somebody have a clean, whole-wheat piece of bread than gluten-free cookies full of sugar and processed vegetable oil. But that’s me. 

Dr. Eric: 

Good point. You can get the Ezekiel bread, like the ancient grains, organic. Is that worse? That’s not gluten-free. Is that worse than eating gluten-free Oreos? Who knows what else they have? There Are healthier gluten-free cookies that are dairy-free and have everything natural. That would be a more interesting conversation, I guess.

As far as comparing, I would go with the Ezekiel bread. Maybe taste-wise, people would prefer Oreos. Who knows what else is in that Oreo though? 

Dr. Melinda: 

You have to look at the whole thing. If you’re doing whole foods, that’s one thing. We’re running into the same thing with the plant substitutes, like Beyond Meat and other kinds of things that are just rich in saturated fat. Whenever you try to eliminate and replace, and an industry makes something that’s artificial, it never turns out well down the road. 

Dr. Eric: 

Definitely agree. How about oxalates? I interviewed Sally K. Norton, who wrote the book Toxic Superfoods on oxalates. There is at least one lab, Great Plains, who is now Mosaic Diagnostics, that does urinary testing for oxalates. You can’t completely eliminate them. Are you concerned at all about really high oxalate foods, like spinach or Swiss chard? 

Dr. Melinda: 

It’s a bigger category, too. Yes, spinach, kale, beans, chocolate. Chocolate has oxalates. 

Dr. Eric: 

Sweet potatoes, yeah. 

Dr. Melinda: 

This whole idea of these anti-nutrients. Back to the gut. Do the oxalates irritate the gut lining in some people, causing leaky gut? Some of it may be gut. There are some studies about oxalate affecting some of our immune cells, these monocytes and macrophages and having them release pro-inflammatory cytokines and chemokines. 

What can I say? I think it’s an individual sensitivity. Those foods are healthy in general. Traditionally, we’ve always thought of oxalate elimination for people who have kidney stones. The question is: Do others need to? I just recommend balance. 

This is where I think people get nutrition confusion. They will be told, “Eat a low oxalate diet.” What’s a lower oxalate diet? Broccoli. “But I can’t eat cruciferous vegetables because I was told they have goitrogens in them. I can’t eat oxalates, and I can’t eat goitrogens. I can’t eat gluten, and I can’t eat dairy.” Then they end up on a super restricted diet and get malnourished. They don’t enjoy food and have orthorexia. 

For me, it will usually come back to moderation. If somebody is not eating handfuls of spinach and kale every day, then I’m not going to eliminate it from their diet. 

Dr. Eric: 

I agree. I used to say I stuff my smoothie with spinach. Then I randomly did an organic acids test that showed I had high urinary oxalates. That was one of the major changes I made. Not to say I will never have spinach, but if there are other substitutes for spinach. 

I can’t say I tell people not to eat sweet potatoes, dark chocolate. It’s difficult. Like you said, when combined with other foods, you could end up with hardly anything to eat, with oxalates, lectins, goitrogens, and other compounds. 

Dr. Melinda: 

It’s individual. We have to remember that we have different genes. Some people have a gene that may lead to a problem with oxalate breakdown. They do have a problem with it. Maybe that, too. 

You saw on the test that you had high oxalates in your urine. That doesn’t mean everybody has that. It also relates to the gut and the gut microbiome because the gut bacteria are involved in how we metabolize things. Our nutrient status involves how we counteract oxalates. It’s so complex that any broad generalization always turns me off.

Dr. Eric: 

I get it. 

Dr. Melinda: 

I like that you tested. That’s the answer. You individualize it to you, and you know. That’s really the best. If patients have access to integrative/functional medicine practitioners who can help refine what they need, that’s always going to be the best.

Dr. Eric: 

Even in my situation, I cut out the spinach, but I can’t say I really made a lot of other changes. When I did a retest, the levels dropped significantly. They were within the normal limits. According to Sally K. Norton, that might not mean someone still doesn’t have oxalates. On the test itself, it still looked a lot better without the spinach. It’s not like I cut out sweet potatoes. It’s not like I wasn’t eating any nuts and seeds. The spinach is one of the higher ones. I’m not saying never to eat spinach. I was just loading my smoothies with spinach every single day. Just like you said, everything in moderation. 

Dr. Melinda: 

Moderation is my mantra.

Dr. Eric: 

Before we wrap things up, I did want to talk about seafood. Besides philosophical reasons, I have concerns about the environment, not just heavy metals, but PCBs. Do you also have those concerns? If someone says, “I want to have fish,” would you say, “Maybe have it, but in moderation?” 2-3 days a week than every single day because of concerns. 

Dr. Melinda: 

If there is one category beyond- I’m sure you’ve seen this. There are the roots; that’s the best. Have a lot of roots. Fish is the next category. Then you stay away from the two-legs and four-legs. They get progressively worse. I tend to say if you are going to have some fish, especially those Omega-3 fatty fish in moderation, that can be a healthy part of an anti-inflammatory diet. Like you said, not a lot of high mercury fish. Get good quality. Don’t overdo it. In moderation.  

Dr. Eric: 

Excellent. Anything else that you wanted me to ask you that I didn’t ask you?  

Dr. Melinda: 

Riff on anything? No. I think people with autoimmune disease, thyroid disease, we’re gaining a better understanding of different medications that can be beneficial, different alternative treatments like LDN.

Here is a more eloquent way of saying it: I have some patients who come in and say, “I don’t feel well. I need to change my thyroid medication.” Or, “I’m not feeling well. I think we need to tweak my thyroid medication.” Sometimes, that’s the case. 

But a lot of times, it’s these other things, like lifestyle and diet and stress and not getting enough sleep. Those are the things that are the factor, not finding that magical proportion of T3/T4. That’s the bottom line. Sometimes, that helps, but ultimately, you need to have a great base for your lifestyle.

Dr. Eric: 

It’s amazing that you do that. A lot of medical doctors would just adjust the thyroid medication, and that’s it. It’s great that you obviously incorporate all the diet and lifestyle stuff that we’ve been chatting about here. 

Can you let people know where they can find out more about you? Share anything you’d like, like your website and any place people can find you.

Dr. Melinda: 

My best place is my link in bio, since it has links to everything. DrMelindaRing.com has links to free downloads on anti-inflammatory culinary medicine; a little booklet I created; my Instagram; my website at Northwestern; and all kinds of things. Just go to DrMelindaRing.com, and they can link to whatever they like. 

Dr. Eric: 

You’re on YouTube and TikTok? 

Dr. Melinda: 

A little bit. I’m not so consistent. I need to get better. 

Dr. Eric: 

That’s okay. I’m on YouTube, but as of recording this, I haven’t done any TikTok videos yet, so that’s okay.

Thank you, Dr. Melinda. It was a great conversation. Appreciate you being open and honest about everything. I agree with what you said: Moderation is the key as we all know, but we sometimes lose sight of that. Thank you so much for your time.

Dr. Melinda: 

Yeah, I enjoyed it. Thanks, Eric. Have a great day. 

Dr. Eric: 

You, too. Thank you.

Recently I interviewed Dr. Emily Kiberd, and we talked about mold-gut-thyroid connection. If you would prefer to listen to the interview you can access it by Clicking Here.

Dr. Eric Osansky: 

Hello, everyone. I am very excited to chat with today’s guest, Dr. Emily Kiberd, as we are going to be talking about keeping fit and muscle mass. This is the first time I am talking to anybody on the podcast in depth about exercise, building muscle mass, what to do and what not to do. 

Let me give Dr. Emily’s bio here. Dr. Emily Kiberd is a chiropractor, mama to Elvis and Brooklyn, and the creator of Thyroid Strong, which is the only doctor-designed exercise program for women with Hashimoto’s to learn how to work out with the burnout. She has been featured in Vogue, Women’s Health, Self, as well as Fortune for her expertise in strength training, injury prevention, and ergonomics. She also has a wonderful podcast called Thyroid Strong. Thank you so much for joining us, Dr. Emily.  

Dr. Emily Kiberd: 

Thanks for having me. Excited to be here.

Dr. Eric: 

Let’s talk a little bit about your background. Obviously, I gave a very brief bio right now. How did you make the transition? Were you always helping people with muscle mass and exercise? Over the last few years, did you make that transition? 

Dr. Emily: 

I have been a chiropractor since 2007. Coming out of school, it’s like adjusting, maybe doing some soft tissue work. It gets very boring in my opinion very quickly when you are doing the same thing every day. A certain number of people get better, and a certain number of people come back, “I still have some pain here.” Obviously, as a practitioner, you want to help as many people as you can.

The journey evolved. A lot of it was doing yoga teacher training and using yoga therapy in the practice. Then it evolved into doing strength training, knowing where there is too much mobility, too much movement, and where there is not enough movement. People assume there is a tight muscle, or something feels stuck, so we should release it. Get a massage or stretch or release. Oftentimes, that can be compensation for something else that’s not stabilizing. You have to work on that other place that is stabilizing that compensation. Sometimes, that tight place will let go. The practice slowly evolved into that.

As with anyone’s practice, it should be an evolution, I think, as you learn more. I am always curious and hungry for knowledge. In 2016, I had my first kiddo, Elvis. For the first year, I was just exhausted. All those symptoms that you think are “normal,” everyone’s like, “You’re a new mom.” This is not good. 

18 months post-partum, he’s walking around. I was exhausted. My hair was falling out. The outer third of my eyebrow was missing. Couldn’t lose about 25 pounds of baby weight. Every time I ate, my tongue would swell, and I had a little bit of eczema on my hand. I went through the primary care/endocrinologist. 

I went to two functional medicine docs, until I met my current functional medicine doc, Dr. Gabrielle Lyon. “How come no one has tested more than TSH? You have an autoimmune condition. You have the presence of thyroid antibodies. The official diagnosis would be Hashimoto’s, but it’s good that we caught it early. If you catch it early and figure out what the trigger is for that inflammation, you can go into remission.” That is exactly what happened. 

When on this journey of changing how I was eating. I let go of gluten. Basically anything I was eating, I was reacting to. I was having histamine intolerance. Kind of like mast cell activation syndrome. I could smell someone’s clothes. I knew they washed them in Tide, from 50 feet away. Especially in NYC, where you can smell everything. There are lots of odors. It was very intense. 

Part of the journey was finding out I had mold in my apartment, which can cause a histamine response and cause that overactive immune system. It can trigger Hashimoto’s as well. I had water damage and mold and Aspergillus. I did a lot of developing country travel in my 20s, so I had about three different parasites: hookworm, roundworm, and pinworms. I went on that journey of starting to decrease that inflammatory load. 

I was over training, which was the birth of Thyroid Strong. I was trying to lose the baby weight, and I was going to spinning classes. Sometimes, I’d do a double spinning class, so two 45 minutes back-to-back, so 90 minutes of spinning, about four days a week. Or I’d do a spin class and walk across the street and then do a high intensity interval training class, Barry’s Bootcamp. The weight would not come off, and it was very frustrating.

Part of this journey was not only addressing those underlying root causes but changing how I was eating and that lifestyle factor of dialing back my exercise and getting smart about it. Through my own journey, I was then seeing more autoimmune women coming into the clinic. I was co-treating them with different functional medicine docs in the area in NYC. They were addressing functional medicine, internal stuff. All the women had joint pain, muscle aches, and low muscle tone. The docs were like, “Hey, I need you to get them out of pain and put some muscle on them.” 

Probably in 2017, that was this evolution of seeing more autoimmune women. From that lens, from the angle of “How are they moving?” Normally, when you see a doctor, you’re sitting down across from them. They’re reading your labs and giving you a game plan or a supplement protocol, and “we’ll see you in X months.” I’m getting them moving, checking what’s moving too much? What’s not moving enough? How can they pick up things in certain ways? Checking their tone of the muscle, checking their deep tendon reflexes, which can change when you are hypothyroid, and looking at them through that lens. 

I’m going to guess a lot of women who have an autoimmune condition are not assessed in that way. A lot of doctors don’t do that. I don’t think there are a lot of doctors who are functional medicine or endocrine and do rehab and strength training. That was the birth of Thyroid Strong and seeing more women in person struggling. From the clinical practice, there were certain things that I picked up. Oh, this is a consistent finding, which is interesting that no one is talking about. It was really an evolution, starting in 2015. 

Dr. Eric: 

Wow, that’s some journey. Obviously, every person’s journey is different. I am also a chiropractor by trade and dealt with Graves’ Disease. I didn’t deal with mold, which it sounded like you had some serious mold issues, or parasites. 

One thing we have in common is I was also overtraining. I was overtraining prior to my Graves’ diagnosis and should have known better, both of us being practitioners. It’s not like they teach that in chiropractic school about training. Rehab to some extent. What you’re teaching definitely is not taught in school for chiropractors or medical school. It’s great you’re helping others, and it’s great you’ve been in remission with your Hashimoto’s condition. 

I don’t know where you want to start. Do you want to start with what you actually recommend as far as different types of exercise? There’s cardio, resistance training, high intensity interval training (HIIT). Do you recommend one of those, a combination, or maybe something different? 

Dr. Emily: 

Because fatigue is such a big component of Hashimoto’s, I want my exercise to be efficient and effective. I used to train for triathlons and marathons. Long states of cardio. I find that there is also, as you know, an adrenal component to Hashimoto’s. If I’m thinking I want my exercise to be efficient and effective, and I know being hypothyroid, it is harder to keep muscle on the bone. Muscle is essential to help with the turnover of thyroid hormones from the inactive form, T4, to the active form, T3. It happens in certain places: the gut, the liver, and the muscle tissue. 

Knowing that, I know that women want to lose weight. Those are the two biggest struggles: I’m exhausted, but I’m overweight, and I want to lose it. If I want my exercise to check those boxes, I like resistance training. Feeding the muscle tissue. 

I like women to be walking. A lot of women are like, this cultural mindset of, “Oh, I need to lose weight. I will put on my running shoes and go for a run.” It’s not the right message to be sending. 

When we put more muscle on the bone, the more muscle we have, the more calories we burn at rest. If we want to lose weight, but we don’t want to cause a Hashi flare-up or be bed-ridden for three days because there are definitely women who are so fatigued they can’t get out of bed, I like resistance training. I like it on the heavier side, so you can hit that fatigue. Lower reps and long rest breaks in between sets. I like kettlebells because they’re very forgiving when you are first learning form. They’re portable. You can travel with them. We can talk about why kettlebells are so great. That’s what I prefer. 

I would prefer that over HIIT, especially if that adrenal component is there. If women are burning candles at both ends in other aspects of their life. As you start to put on muscle, you’ll have more energy. You’ll be changing your body composition. The number on the scale might be the same, but you’ll notice your clothes are fitting better. The number on the scale might be the same because muscle weighs more than fat. 

I think this focus on let’s feed our muscle tissue if we want to lose weight, versus “Oh, I need to lose the fat.” When we talk about losing fat, it comes from this place of deprivation. Put yourself in a caloric deficit. Try to run it out. Versus if you focus on feeding the muscle tissue, your body composition will change. Your clothes will fit better. You’ll be burning more calories at rest. You’ll have more energy. 

Muscle is a very expensive organ. It requires more feeding of it. Ideally, protein. It’s almost like changing your body from a place of elevation, feeding your muscle, to this place of deprivation, which is starving yourself to lose fat. 

That’s how I like to get women to work out. If they want to run, like if it fills their soul, like if they have been a runner before, you still have to strength train. Even if someone likes to walk, I’ve had women who can walk 30 minutes, and then their back starts to hurt. Maybe it’s more core strength, more glute strength. Maybe it’s strengthening your butts or hamstrings. If you get that woman to resistance train three times a week, for someone who is deconditioned, I will work them up to three to four times a week. Then they can go for a walk for an hour and don’t feel pain.

I don’t feel like there is any downside to having more muscle on the body. The way you will get there is through picking up something heavy, putting it down, and doing it again, as well as making sure you’re getting your optimum protein every day.

Dr. Eric: 

We have people with both Hashimoto’s and Graves’ listening to this. I agree for both. Resistance training for those with Hashimoto’s and Graves’, it’s very common to lose muscle mass. With Graves’/hyperthyroidism, a lot of people are losing weight. Some people with hyperthyroidism do gain weight. Sometimes, it is the opposite problem. Either way, I like what you said. You might not see the changes on the scale. Not that they won’t. Some people will. 

Dr. Emily: 

Yeah, for sure.

Dr. Eric: 

But if not, some might get discouraged. It’s important you mentioned that because muscle is denser than fat. Just to set those expectations. 

One thing you recommend in between sets is to take longer breaks. Are we taking two minutes or five minutes in between typically? 

Dr. Emily: 

If you go to a boutique or aerobics class, there is not really a break until the end of class. Maybe there is a 30-second break. I like women to do 60 seconds, 90 seconds. If someone is more seasoned, and they’re lifting really heavy, up to 2-5 minutes. It really depends on where they’re at on their workout journey. 60 seconds minimum. 

During that time, I like to have women toning their Vagus nerve. With Hashimoto’s especially, stress is a big piece of the puzzle. Stress can come in the form of emotional stress, physical stress, environmental stress like mold or parasites. There is this cultural message of “Don’t stress. Destress. Avoid stress.” Stress is inevitable. How can you lean into that stress to make you more resilient? 

One of the ways to do that is when you’re in a stress state, the quicker you drop into that calm parasympathetic, everything is okay, the quicker you can get out of the stress state and back to the parasympathetic state, usually the more resilient I find people to be, high performing. 

If you pick up a weight, it’s elevating your heart rate, breath rate, getting you out of breath. You take your rest break and have this moment to drop back down into the parasympathetic. I have some inside Thyroid Strong sing with their tongue on the roof of their mouth and try to extend their exhale as long as possible, ideally twice as long as their inhale. It’s almost like you’re training your nervous system. A lot of people train their nervous system seated or in a meditative state. You’re doing it after putting a stressor on your body. I like to do that during the rest breaks. 

It also makes the time go by faster if you’re not used to taking 60, 90, 2-minute breaks. People are like, doo doo doo. You get them to sing and hum and extend their exhale twice as long as their inhale, and it goes by quicker. That’s also why I like long rest breaks.

When women do that, I find they don’t get into that “Oh my god, I’m so tired after my workout I need a nap.” That’s very common. Women are like, “oh my god, I worked out, and I’m totally tanked out. I can’t function the rest of the day.” Our workouts shouldn’t take away from our day; it should enhance the rest of our day. It shouldn’t take us bedridden for a nap. It should energize us, if we fuel properly afterwards, and enhance our day. 

When you take a little bit of a longer rest break, and you’re doing these things that can help you drop back into the parasympathetic state, women feel more energized and not so tanked out the rest of the day.

Dr. Eric: 

Very cool. I’m going to try that during my next workout, too. You’re right. Even if people are taking a minute or 90 seconds or a couple minutes, depending on the intensity, most people are not doing anything. They’re just hanging out. Going to the gym- 

Dr. Emily: 

Checking their phone.

Dr. Eric: 

Half the people are on their cell phones. That’s great advice. How about frequency of resistance exercise? Do you recommend four times a week or less or more? 

Dr. Emily: 

Women with Hashimoto’s are on the spectrum. There is the Crossfitter, burning the candle on both ends, overtraining, six days a week. I’d probably drop that person to four times a week depending on their fatigue and symptoms. Maybe three. If you do three, they are itching for another day. So four days a week.

On the other end of the spectrum is a woman who is more deconditioned. She maybe walks 2,000 steps a day. She has maybe never touched a weight and is scared of them. That person needs to be worked up to three days a week. I do encourage walking as a form of exercise. I know a lot of women love to walk. It’s not resistance training or walking; it’s doing both. If someone is very deconditioned, this can be a lot. 

Those are the two ends of the spectrum. A sweet spot would be three days a week. If someone needs more, four days a week. Even my friends who are doing bulking hypertrophy programs, where they’re eating 2,500 calories a day, 250 carbs a day, they work out four times a week. They’re not doing six days a week. It’s too much, especially for the Hashi population, where you have to consider the inflammatory load. You have to consider fatigue and adrenal health when designing a program. 

Dr. Eric: 

Do you work out four days a week on average? 

Dr. Emily: 

Yeah. I try to walk every day. Bike my kids to school. Depending on what I’m working on, yeah. I would say 3-4 days a week. 

Dr. Eric: 

When do you prefer working out? Is there a best time to work out, like first thing in the morning or in the afternoon? 

Dr. Emily: 

If someone is trying to reset their Circadian rhythm, so maybe they have low cortisol in the morning and are dragging, it would probably be better to try to work out in the morning to spike your cortisol when it should be highest. Maybe out in the sun to get some sun in your eyes would be great.

Just by my nature, I am a mid-day worker-outer. Around lunch time. If I work out after 2pm, when I lived in NYC, I would get done with work at 7pm and go to a spin class at 7:45pm. Then I would be wired until 2am and wonder why. If I work out after 2pm, maybe 3pm, I get a second wind at 10pm when I should be going down. I try to push it earlier in the day, mid-day. 

Dr. Eric: 

I definitely want to talk to you about the kettlebells. Before we get into that, what do you recommend as far as protein intake? 

Dr. Emily: 

I think a lot of women are under-eating protein. I think protein should be prioritized. For people who are bedridden, the more muscle they have on their bones, the more likely they are to recover from their injury or sickness. 

For protein, I like to shoot for 1g per pound of ideal body weight. If my ideal body weight is 150 pounds, I will have 150g of protein a day. I will dose it equal. Sometimes, culturally, we dose dinner as a higher protein intake. Ideally, you would want it in more even amounts. In this example, like 50g for breakfast, lunch, dinner. I try to eat my protein first, and then I take in fiber, so vegetables. 

I have a history of being a grazer. I don’t sit and eat. I try to make myself sit and eat. There is a dose dependency, like a time frame. I try to get my protein within 25 minutes, versus eating a little bit, doing something, and eating a little bit more. 

There is a dose dependency to trigger toward, then muscle protein synthesis. We are eating protein for the amino acid profile. Protein is very satiating. It’s almost impossible to overeat protein. You would probably throw up if you did. Especially for the women who want to lose weight, it’s great because it’s very hard to overeat protein. It’s important to get protein in the morning after we’ve been in that fasted state and sleeping. Most women are undereating protein. 

Sometimes, I have women just change their protein intake, not even pick up a kettlebell yet, and they’re like, “Oh my god, I have so much energy, I don’t even know what to do with myself.” All they did was try to hit 30g minimum per meal. That triggers muscle protein synthesis. You get your 3-5g there. That’s what I try to shoot for. That’s really from the work of Donald Layman, who is a researcher who is retired now. But he was in that field, especially around boosting. 

Dr. Eric: 

I’m sure someone who is listening to this is thinking, “There is no way I can get 1g per 1 pound of body weight.” 

Dr. Emily: 

Ideal body weight. 

Dr. Eric:

Animal protein I would imagine is your primary source then of protein. 

Dr. Emily: 

Yes. Just so there is a complete amino acid profile. When I was first diagnosed with Hashimoto’s, and I was reacting to everything, I had H-pylori, stomach acid. I couldn’t really eat that much. I was doing a pea protein shake as a medical grade food because that was all I could tolerate while I healed my gut and worked through those triggers. 

I prefer animal protein. I know for some women who don’t eat a lot of animal protein, “five eggs for breakfast?” They feel like they are choking them down, and they’re full up to their chin. You might have to work up to that. I would say animal protein is my main source. 

Dr. Eric: 

Would you recommend if someone initially is struggling to get it through food, is it okay if someone wanted to supplement with protein powders or take amino acid supplements or both? 

Dr. Emily: 

Yeah, I think that’s fine. I have a protein powder that is made out of beef, Equip. The research is mixed. There is some research that shows the amount of protein you actually absorb from plant-based protein is less than what is stated on the package. Animal protein is a more absorbable form as a protein source. The newer research shows they’re equally absorbable. 

I wouldn’t be pounding soy protein, I’ll just say that, if you have a thyroid condition. But if you wanted to mix it up- Five eggs is 30g of protein per breakfast. Most women can’t eat five eggs. Why don’t you try two eggs and two sausage links, like chicken sausage? Or maybe you have two eggs and a protein shake. It doesn’t feel like you’re stuffing yourself full of food.  

Dr. Eric: 

That makes sense. Let’s talk about kettlebells. Why do you like kettlebells? What are some ways you recommend for people to use them? Do you just recommend kettlebells for resistance training? I’m sure you’d be okay with people using weights and bands. Do you just stick with the kettlebells, or do you have other things you incorporate into a routine for resistance training? 

Dr. Emily: 

As you go heavier in weight, you’re going to need heavier weight. If I deadlift 1.5 times my body weight, picking up 2 100-pound kettlebells is awkward because they are so bulky. Then I would use a hex bar or barbell. You have to learn the form with the barbell; it’s not very forgiving, especially as you are trying to get around your shins as you’re lowering down. 

If you take the deadlift, which is basically a hinge movement where you’re sitting your hips back, standing upright, squeezing your butt. If you think about a barbell, you have to navigate the barbell around your shins. It’s awkward as you’re lowering it down. 

You could use dumbbells. Where do they go? You have to shave your shins with them. Kettlebells, you can literally get right below your center, right below your crotch basically. You can sit your hips back, pick them up, and put them right below your center. A barbell is a little bit in front of you, so it’s away from your center. Little nuances like that. 

If you start someone with barbell deadlifting, it’s a little intimidating and awkward. Kettlebells, they’re much more forgiving when you’re first learning form. Your form ideally would be good and almost perfect, so you don’t injure yourself. But if your hips are too low or too high, you won’t injure yourself. But with a barbell, your form has to be dialed in, 98% perfect, in my opinion.

I also like kettlebells because there is this offset weight. Let’s say you will press overhead. If you have a dumbbell, the weight is on either side of your hand. With a kettlebell, the bell sits on the back of your wrist. When you’re holding the kettlebell in front of your chest, what we call the rapt position, you have to curl your wrist into neutral. You don’t want your wrist to be cocked back. You want it neutral. 

If they put their hand up and make a fist, and if you push down on the hand with the other hand, and then you make a straight fist, and you push, you can literally feel the shoulder stabilizing muscles. Your latissimus, your serratus, activate. Because there is this offset weight where the bell is on the back of your wrist, it forces you to create these points of stabilization in your body that doesn’t happen necessarily with a dumbbell. 

The other thing I love about kettlebells is you can use them ballistically. In Thyroid Strong, we do seven moves that are essential for people to do for life to be good at life: a hinge, a squat, some sort of push movement, a pull, a lunge, a carry, like you’re carrying your groceries, and some sort of control of rotation of your core. We work up to over the six weeks of kettlebell swings. We do drills, so you’re not just swinging a bell all over the place. Get your heart rate up. It’s a tool to get you breathy, get your heart rate up without going for a run, without doing more of a HIIT, where you’re doing 15-30 seconds of all-out work, and you’re getting your heart rate up to 80-85% of your maximum heart rate, and then doing 15-30 seconds of rest. That is more of a HIIT. You could do 10 kettlebell swings and get your heart rate up.

The other tools that could be used as ballistic moves would be a barbell. Now, you’re getting form. If you cleaned a barbell up to your chest, now you have to get your form dialed in. I like kettlebells because they have that ballistic potential to help you get your heart rate up.

Dr. Eric: 

It sounds like those who go through your Thyroid Strong program will become experts in using kettlebells. When it comes to form, I might be wrong, but I think you’re saying it’s not as important with kettlebells or dumbbells, but it may be easier to keep proper form with kettlebells. 

Dr. Emily: 

It’s more forgiving when you’re first learning. Because the weight can be under your center, versus in front of your center with a barbell, if you do a heavy carry, like if you have two bells and they are down toward your sides, and you are packing your shoulders, if you did that with a dumbbell, they are hitting your legs, and it’s awkward. Kettlebells are not. You can hold them down to your sides, and they glide past your legs. It’s just more forgiving when you’re first learning form. There can be a little more margin of error because that’s what happens when you learn form. You do it not that great the first couple of times. 

Part of Thyroid Strong is there are really good cues in working with patients in person to get someone into the perfect deadlift setup. Versus you might work with a trainer. Sit your hips back, grab the bell, stand up. Where do my feet go? Where do my knees go? Are my hips too low or too high? In Thyroid Strong, there are cues. You can get someone in the perfect starting place. 

There is just more margin for error when you’re first learning with kettlebells than maybe some of the other tools out there. 

Dr. Eric: 

That makes sense. I don’t know if you mentioned this earlier. Obviously, you spoke about having longer breaks in between sets and doing the Vagus nerve exercises, stimulating the parasympathetic nervous system. Do you have someone do 12 sets or 10 sets or just until they’re fatigued? Does that depend on the person? 

Dr. Emily: 

If women are more new, I typically have them do three sets. Someone who is more conditioned, four sets. In terms of reps, which is the number of times you pull a weight, and then a set- 

Dr. Eric: 

I mean, how many reps and how many sets. I meant to say repetitions specifically first.

Dr. Emily: 

For someone who is scared of picking up a weight and is more deconditioned, I might start them at three reps to get them to grease the groove of the movement, create that muscle memory. Once they’re starting to get into a groove of working out, 6-8 reps. I very rarely go over 10 because I am trying to factor in not wanting to fatigue someone, especially if they haven’t dealt with those other inflammatory loads in their body. That’s when I say, “You build muscle when you hit fatigue,” and fatigue, when you’re working out, by the last couple reps, on a scale of 0-10, you’re hitting a 7 or 8 in perceived exertion. That’s one way. That doesn’t resonate with me really well. 

The other way to think about it is by the last couple reps, you ask yourself, “How many more could I do?” If you have two more in the tank, that’s a good place to be. If you could do five or 10 more, then you need to pick up a heavier weight.

The third way to talk about it is on the last couple reps, the concentric phase, where you’re shortening the muscle, fatigue is when you can’t get full range of motion on that phase. That would be another way of considering failure. That’s where hypertrophy happens. That’s where muscle maintenance, growth happens. 

The fourth way that I talk about that a lot of people don’t talk about is do you lose form in default into this extension compression conversation? This is from learning and studying for the Prague School in the Czech Republic this technique called dynamic neuromuscular stabilization. They basically looked at how babies learn their movement patterns and how they hit their milestones. For example, the first six months of life, maybe three months, is literally trying to bring their knees up to 90 and create rigidity and a brace in their core. 4.5 months, they roll. At six months, they’re sitting. There are these milestones babies hit. 

A baby who is not developing properly, which is about 30% of babies, will default into this extension. If people don’t know what an extension is, it’s an arching of their back—to compress their spine to execute a movement. Versus using their intra abdominal pressure. Babies who don’t develop well will do that. They’re flaring their ribs and cranking their back out; you can see their paraspinals activated. 

We do that as adults when we hit fatigue. If you have ever seen a Crossfitter do a muscle up where they are holding rings and pushing through and pushing up, when a Crossfitter hits fatigue, they will literally crank into extension in their low back and neck to try and execute the movement. Versus using their core and using good intra-abdominal pressure.

Same thing when you fatigue in any other move. You will basically default into this extension/compression compensation. Basically favoring extension in the low back and neck. You will see this in a deadlift. People stand up and are pulling, pulling, pulling, and will over push through their hips and crank up their back. You will see it in a plank. Someone is simply holding a plank. Once someone starts to fatigue, their back will start to arch, and they will lift their chin to crank on their extensors. That is another way to know that you’re hitting fatigue.

In terms of reps and sets, you want to hit about 8-10 sets per muscle group per week. It’s a good place to be if you want to gain muscle or maintain muscle.

Dr. Eric: 

Like you said, if it’s toward the end of each rep, especially if it’s the last set and still kind of easy, that’s an indication to increase the weight. 

Another question with that: Do you recommend them for people in general, women and men, to keep on increasing the weight? Do you recommend a wellness weight, where they have reached a weight, and they should stay at that weight? Do they keep increasing the amount they lift? 

Dr. Emily: 

You want a program that has progressive overload. There is progression of the weight over time. There are other ways to progress without necessarily picking up heavier weight. It’s basically more time under tension. 

An example would be you do a squat. You hang out on the bottom of the squat for an extra second or two, or an extra breath, before you stand up. You didn’t increase the weight, but you increased your time under the load, which will then increase the volume. 

You could do 1.5 reps, so you go down in a squat, come up halfway, go back down, and then stand up. It’s another way to increase the load without necessarily picking up a heavier weight. 

I do that in Thyroid Strong because it’s a home base program. I don’t want women buying 20 kettlebells because they’re expensive. They don’t want to clutter their living room. So you have a 12-kilo, 14-kilo, and 16-kilo. That’s what we have to work with. Instead of you investing in a heavier bell, we’re going to do these techniques to keep more time under tension without necessarily having to pick up a heavier load. 

Yes, you want progressive overload. A great way to do it is to slow down the e-centric phase of any move. The e-centric phase, if you’re doing a bicep curl, this is the concentric, and this is the e-centric. Your muscle is lengthening under the load versus concentric, which is shortening. Any move where it has an e-centric phase, you make that 3-4 seconds. You stand up with a dead lift. As you’re lowering back down, you take 3-4 seconds to lower. It’s a great way to not necessarily have to pick up a heavier weight.

Dr. Eric: 

Women listening don’t have to keep on purchasing kettlebells. That’s one reason why I was asking that. 

One of the things prior to the interview that we were talking about is hypermobility. Talk about hypermobility and autoimmunity. 

Dr. Emily: 

I haven’t found any research on this. I go to PubMed every week and type something in and try to see if there is any research on it. 

What I noticed with women with autoimmune conditions that I was treating in the clinic was I’m looking at them through a lens of movement. What’s moving too much? What’s not moving enough? I will check a Beighton score, which is a physical therapy orthopedic test looking for hypermobility. The places you look are the knees, elbows, thumbs, pushing down and touching the soft part of the forearm, pinky bending back beyond 90. The last point is someone standing straight, bend forward, touch the floor, they can palm the floor. Kind of like a yogi, but they probably created biomechanical hypermobility. If those points come up in a Beighton score, there is a sign of tissue laxity/joint hypermobility. 

I was finding this in women with autoimmune conditions. It wasn’t 100% of the time. It was probably like 80-90% of the time. But it was significant enough to be like, Hmm, okay. All these women are coming in with joint pain and muscle aches, and they all want to get adjusted and a massage. 

Listen, no amount of massage is going to help create that stability and rein in that joint that is hanging out of the ligaments. We need you to resistance train, get stability and strength in the right places. A lot of women will feel tight in their mid-back. We can do some mobility drills and adjust you there, but you need ultimately strength. No amount of stretching or yoga is going to rein in the integrity of the joints. I noticed this in a lot of women with Hashimoto’s. 

Other people I have talked to, like Jessica Drummond, who is on the East Coast and is a physical therapist, she has noticed a lot of women with long haul COVID having this intermittent joint hypermobility or joint hypermobility post-COVID. Some of the trainers that I talk to who also do resistance training or programming for women with Hashimoto’s, they notice a lot of Hashi women have joints that are totally hypermobile. It was a clinical observation, but it was something that really guided how I cued and programmed inside Thyroid Strong.

Dr. Eric: 

Very interesting. Do you talk about that more in your program? 

Dr. Emily: 

Yeah. Let’s say you’re standing up from a dead lift. You’re at the bottom, and you stand up, knees straight. Most trainers would say, “Grab the weight, and stand up.” Someone who is hypermobile, and their knees hyperextend, don’t know where their center is. If you just ask that person to stand up, and they jam into their knees, they will get joint pain, probably on top of their hypothyroid condition causing joint pain anyway. 

I teach women to foot dial, which helps bring tension from the feet up the legs. Professional lifters do this. If you stand with your feet, toes turned out ever so slight, and as you’re standing up, you squeeze your heels together, but you don’t move your feet. You will literally draw tension, like your whole leg will activate: your quads, your glutes. You can stand up with straight knees without jamming them into hyperextension. That’s one example.

In the plank, if your elbows are straight, their elbows will hyperextend. You can get them to push through their index knuckle, which comes from how babies crawl. Babies who crawl and develop properly will ground their index knuckle into the ground. Babies who don’t develop properly will actually hang out on the pisiform side of their hand and crawl like this versus actually pushing through. In a plank, you can get someone to push through their index knuckle and turn their elbow crease toward their thumb and get them out of hyperextension. That helps activate your serratus. It helps your shoulder stability. 

If you did a plank where you are hanging out on the outside of your hands, and you’re hyperextending your elbows, you won’t fuel your shoulders into protraction, into the shoulder blade wings going down and wide across the ribs. Those are cues that are very specific from my background of studying how babies move as well as working with women and trying to get them into good form. Simply being, “Oh, don’t put a little bend in your elbow.” That’s not enough. If you just put a little bend in your elbow with the elbow hyperextension, you won’t feel your shoulder stabilize, which is important in a plank. Most people think of plank as a core exercise. It is full body tension. It is connecting shoulder stability to core stability. 

Dr. Eric: 

I’m sure many listening are eager to get started. Where should they get started? I’m thinking Thyroid Strong should be a good starting point. If there is anybody who is maybe not ready to think about doing it on their own, could you give a few tips prior to joining you in Thyroid Strong? 

Dr. Emily: 

Thyroid Strong is six weeks. I have shorter two-week programs. If someone isn’t sure they want to fully invest, these courses are under $50. They are full recorded videos of workouts. 

I do a lot of stuff on my Instagram. My website is DrEmilyKiberd.com. Different workouts, moves, form cues. A lot on social media.  

Dr. Eric: 

Also, your podcast, which is also called Thyroid Strong. Is there anywhere else where they can find you? 

Dr. Emily: 

I’m on YouTube and TikTok. And I do have a private Facebook group for women who want to find out more. Sometimes, people don’t necessarily want to email or DM, so there is a Facebook group. Women are like, “Oh my god, I’m not alone. Here is 4,000 other women who also have Hashimoto’s and extreme fatigue or exercise intolerance when they work out.” The group is called Thyroid Strong. 

Dr. Eric: 

That’s not just for people who join Thyroid Strong. Anybody can join that? 

Dr. Emily: 

Yep. I have a separate Facebook group for people who join the program. Then we get really nitty gritty. There are videos and form checks and keeping people accountable and creating accountability buddies for their workouts. We talk a lot about protein and weights. 

Dr. Eric: 

Thank you so much, Dr. Emily. Appreciate your time. I always learn a lot when having these conversations, and today was no exception. I definitely learned a lot. Thanks again. 

Dr. Emily: 

Awesome, thank you.

Recently I interviewed Dr. Eric Balcavage, and we talked about  thyroid physiology. 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. Eric Balcavage, as we are going to talk about thyroid physiology. I am all about talking about the thyroid, but we can’t get into everything in his book. That’s why you need to get his book The Thyroid Debacle. Let me give Dr. Eric’s background. We will dive right in after. 

Dr. Eric Balcavage is the owner and founder of Rejuvagen, a functional medicine clinic in Chadds Ford, Pennsylvania. He is a nationally recognized speaker and educator on various health-related topics, including thyroid physiology, biophysiology, detoxification, oxidative stress, methylation, and chronic illness. Dr. Balcavage is a functional medicine practitioner and licensed chiropractor in PA, and he is the host of The Thyroid Answers Podcast. The podcast focuses on answering the pressing questions those suffering with chronic hypothyroid symptoms can’t get answered elsewhere. You can also find his educational Thyroid Thursday videos on Instagram and YouTube. 

Dr. Balcavage has made it his mission to change the way medicine looks at hypothyroidism. He is also the co-author of the book The Thyroid Debacle. The book is also co-written by Dr. Kelly Halderman. It addresses the problems of current allopathic and functional medicine approaches to hypothyroidism as well as the solution to restoring thyroid physiology. Dr. Eric, thanks for joining us. 

Dr. Eric Balcavage: 

Thanks for having me on, Eric. 

Dr. Eric O:

Before we talk about your book and thyroid physiology, what led you and Dr. Kelly to write the book in the first place? As you know, there is no shortage of thyroid books out there. Yours definitely takes a different perspective.

Dr. Eric B: 

I got into functional medicine really by accident. I had a family member who got diagnosed with hypothyroidism, fibroids, and anemia. They were told they were going to need a hysterectomy, iron supplementation, and thyroid medication for the rest of their life. That’s just the way it goes.I was asked to help, and I said, “It’s not what I do.” When your brother asks for your help, you start figuring it out.

I went back to my roots of chemistry. I was a medical technologist before I made the decision to go off to chiropractic school. I looked into chemistry, realized what was going on there, started doing my functional training with DatisKharrazian and Apex. That was a great footing. I’m sure you did some of those courses early on because Datis was the man early in the day.

As I started working in my chiropractic base and talking about what I was learning, I realized how many of my chiropractic clients were on thyroid medication. I really didn’t pay that much attention to it early on. I was more focused on what I was doing chiropractically. As I was talking to them, most of them felt maybe a bit better, but a lot of them still had signs and symptoms. A lot of them had weight issues, most of the classic signs and symptoms. I started talking about Hashimoto’s because that was this big thing. It’s an immune issue, not just the gland doesn’t fail one day. There is an immune-driven process. I started getting more into functional medicine.

As I was doing that, we had this philosophy in functional medicine, at least for my teaching, that the immune system was out of control, and it just started damaging the thyroid gland. Our job was to look for some of those stressors and triggers. Not that there was a lot of hope. This is an autoimmune condition. Your immune system has lost control and will damage your thyroid gland.

The other piece we looked at was T4, T3, reverse T3, and these other values that weren’t traditionally being looked at in medicine and making those decisions. The thyroid gland makes both T4 and T3, so maybe we should be doing a little bit of a different job. Maybe we should be recommending T3 as well. These silly medical doctors aren’t aware that T4 is not converting to T3 well, and it’s deactivating reverse T3 and changing the treatment based on that thought process.

The challenge I had the longer I went into this was I really struggled with the idea that the immune system just lost control and woke up one day and decided it was going to destroy the thyroid gland for no apparent reason. That didn’t sound like good logic. Why would the immune system just start attacking our own tissues? I thought there had to be something else going on. I was talking to a friend of mine. It doesn’t seem quite right that the immune system would do this. I never really liked the term “autoimmune condition.” It’s an immune-driven condition, but I don’t like the idea that the body willy nilly attack ourselves.

A friend of mine, Dr. Ben Lynch, who you know, we were preparing for a conference. He sent me a paper on the cell danger response. He said, “You need to read this.” When I read that paper, I was like, oh, we operate in two modes. We are either in low stress, homeostatic regulation, or we’re in a different state, allostatic regulation, which is an excessive stress response. I said, “This makes a lot of sense.”

Dr. Naviaux showed how depending on the situation, we use micronutrients for one pathway, but in other situations, we may use micronutrients for a different pathway. Our physiology adapts to our environment, to the stressors, to what’s going on. Maybe that is really what’s going on here. The cells change their physiology, and the immune system changes its physiology based on what’s going on in the body. I thought, maybe what we were seeing was more of an adaptive change versus this systematic control because if your immune system is out of control, it doesn’t sound like you will ever recover. If it’s an adaptive physiology, then we could find out what it’s adapting to. 

I got into a really deep look into the literature, papers, and research. The more I looked at it, it’s my philosophy in general that a lot of what we see with thyroid physiology is an adaptive response to some type of excessive stress response. If we can identify what those stressors are, reduce them, remove them, we can support the recovery of the physiology. In many situations, we see improved T4 to T3 conversion, reduced immune damage to the thyroid gland, and a thyroid gland recover in time. Many of my clients need less thyroid medication. The medication they take converts better, and a whole bunch of them in time don’t need it at all.

Dr. Eric O:

Makes sense. You’re not saying people with Hashimoto’s and even non-autoimmune thyroid conditions don’t need thyroid hormone. Most doctors are neglecting the physiology, so maybe some of these people don’t need to take thyroid hormone replacement. Others might not need to take as much as they are currently taking.

Dr. Eric B: 

In the allopathic model, the focus has always been on TSH and free T4. Early on, we’d say, “These silly allopathic doctors and endocrinologists are only running two tests. They’re not running thyroid antibodies. They don’t know that this is an immune-driven process.” I don’t think that’s the case. I think most of them realize it’s an immune-driven problem. We pretty much know it’s either an iodine deficiency issue or an immune-driven problem. If you’re in an area where there is sufficient iodine either in the environment or in our food sources, it’s probably not an iodine deficiency. That leaves me immune. Depending on what you read, it’s thought to be that 95% of cases of thyroid, especially hypothyroidism, are immune-driven.

I would argue that whether there are antibodies or not, almost all of them are immune-driven. If you look at the immune system of people who have glandular hypothyroidism going on and negative antibodies, if you look at their T cell panels, they are Th1 dominant, which will result in lower antibody production typically anyway. It’s still an immune-driven process.

The challenge in functional medicine to some degree is- At least I think what I was taught is the antibodies are like little Pac-Men eating away at the thyroid gland. TPO and thyroglobulin gobble it up. The literature shows that thyroglobulin doesn’t create any damage to the thyroid gland. TPO antibodies create very little. If they are not creating much damage, what is causing the damage? It’s the immune cells getting to the thyroid gland and creating the damage. In that situation, the T cells are creating a lot of damage, but if you’re Th1 dominant, you may not see it.

For the most part, what we’re seeing is an immune-driven process. The allopathic world knows that, I think, but they are coming at it from a point like, “We’re not going to suppress the immune system. We know the thyroid gland will get damaged. There will be a point where it can’t make enough anymore. We have a simple solution. We give them more T4. The thyroid gland primarily makes T4, so we will give it what it can’t make, and the patient should be good. The indicator that we’re going to use that shows that we have reached euthyroidism or normalized thyroid physiology, a TSH within a preset range. If I give someone enough T4 to bring the TSH into range, everything is right in the world.”

Unfortunately, that doesn’t work for a whole bunch of people. For the listener, T4 is the pre-hormone. It does have some functionality, but most of the functionality in the thyroid world comes from T4 being converted to T3 inside your cells and tissues. T3 binding to receptors, and that’s what is turning on your metabolism. We can make the assumption that if the thyroid gland is not working, and I just give the T4, it’s going to convert to T3. That doesn’t happen; we can measure what it converts into: T3 and free T3. Or reverse T3. 

In the allopathic world, they typically don’t measure those things. What you don’t see, you can’t manage. If you don’t measure it, you can’t manage it. If you don’t see it, the problem doesn’t exist. When we take a broader look at the panels, we can see that model. In a lot of patients that are taking T4-only medication, their conversion of T4 to T3 is not very good. That’s probably why they’re still symptomatic. They’re taking more T4 than they probably need, which is impacting the conversion factor. 

It also misses out on one other key piece: the assumption is that thyroid physiology is regulated by just how much thyroid hormone the gland makes. That’s not true. All the cells and tissues of your body have the ability to regulate how much thyroid hormone gets into the cell and how much T3 gets to the receptors. Cells have individual control. The analogy I typically use is- Do you have kids? 

Dr. Eric O:

I have two daughters. 

Dr. Eric B: 

Has there ever been a time where you told them to go to their room, clean it up, and they didn’t do it? 

Dr. Eric O:

Definitely.

Dr. Eric B:

Just because we put T4 into the bloodstream doesn’t mean that those cells and tissues are going to convert it into T3, which will stimulate the metabolism and upregulate the physiology. 

There is a challenge in that model that just assumes that that was going to happen. In functional medicine, I think we are aware that it doesn’t happen. Matter of fact, when you start to look at the panels, the more T4 you start to give somebody, and this happens sometimes in that allopathic model. When someone says, “I’m still tired. I still don’t feel good,” and maybe their TSH is 2, a physician might say, “Let’s drive it lower. I’ll give you more, and that must make it work.” If you look at a fuller panel and look at the T4, T3, and free T3, and maybe the reverse T3, you will see that as T4 goes up, there is a point where T3 conversion often goes down. That’s a big reason why a lot of people struggle with chronic hypothyroid symptoms, even though their TSH is either normal or maybe on the low end of the normal range or even lab low.

Dr. Eric O:

Does it all come down to addressing that cell danger response? I’m sure you’ve heard and learned that about 60% of that conversion takes place in the liver. Some of it takes place in the gut. There are other factors. Do these all tie into the cell danger response? Would you say it’s separate, where people need to do other things to optimize their liver health, gut health, adrenal health, but at the same time, also look into stressors that relate to the cell danger response? 

Dr. Eric B: 

I think the first part of it is some of the things we were taught about where T3 was made. The literature today is showing that those things aren’t correct. I was taught the same thing: 60% of the T3 was made in the liver by deiodinase 1. That doesn’t appear to be true in the current literature. 

What it shows is that on any given day, the average person is generating about 30mcg of T3. About 5mcg, maybe 10, depending on the individual person, is coming from the thyroid gland. Another 5mcg, probably coming from the liver. Another 5mcg coming from the kidneys. The rest of the T3 is coming from the peripheral tissues that can convert T4 to T3. The vast majority of T3 that is made in the body is not deiodinase-1 driven at the liver; it’s by deiodinase-2 conversion in all the tissues that have deiodinase-2. The cell brings T4 into the cell. It has this enzyme called deiodinase-2 that converts T4 to T3. That T3 goes to the receptors and gets used. It pops back off the receptors and into the bloodstream and contributes to the circulating level of T3 that we see on a lab report.

I think that we have to keep that in mind. Some of this stuff that we learned isn’t actually correct, based on the most current science. Do I think it’s important that we address the cell danger response? I think it’s critical. In my opinion, based on everything I’ve seen and read over the years, we assume that it’s just about how much T4 to T3 is in the bloodstream. Really, the individual cells and tissues have the ability to control what happens at that cell at that tissue. 

If I am a cell in low stress mode, I’m in manufacturing mode. I want to bring glucose, thyroid hormone, as much nutrition into that cell so I can make peptides into proteins. I can make hormones, generate hair, generate skin, burn tons of energy, feel and function awesome. Manufacturing mode. I need lots of T3 active inside the cell to do that. That high concentration of T3 also helps to contribute to turning off the immune inflammatory process.

If I’m a cell perceiving danger or a threat, whether it’s an organism, a toxin, hypoxia, whatever it is, what Naviaux and other people who talk about different aspects of the danger response within the cell, what a cell is typically going to do when it senses danger, is slow down the manufacturing process and ramp up the cell defense. 

One of the mechanisms that it uses to regulate almost every step of the cell danger response is the amount of T3 in the cell. Cells under stress, cells in danger, cells that are hypoxic are going to decrease the conversion of T4 to T3 inside the cell. 

It sounds like it’s a bad thing. It will slow down the metabolism. Actually, it’s a protective response. We are going to see that if somebody has got excessive cell stress going on, the thing that’s causing that toreduce conversion of T4 to T3 isn’t oftentimes an inability to convert T4 to T3; it’s not reverse T3 blocking receptors, but it’s the cell defense mechanisms in place that are saying, “We are going to downregulate the metabolism.” If you want to get into why that might be important, we can get into it.

For a simple standpoint, for the listener, think about your cells and tissues just like people. If I’m in low stress mode, I’m eating, sleeping, having sex, pooping, doing all these great things. If I’m perceiving danger, you can make me the best meal in the world, but I’m not eating it or digesting it well. If I’m fighting for my life, I’m not going to nap or have sex. I will be in defense mode.Our cells are like us.

Dr. Eric O:

When you say “stressor,” some people might think of emotional stressors, but you mentioned hypoxia. I’m sure there might be some people wondering what that is. “I’m probably not dealing with hypoxia.” How common is hypoxia? Can you talk more about that? Iknow on other episodes and in your book, you talk about things like mouth breathing, which a lot of people do. 

Dr. Eric B: 

A cell runs most efficiently when we have oxygen. We have these little engines inside the cells that are called mitochondria. The mitochondria can burn fuel, food energy, glucose, breakdown proteins into energy, or burn fats. Essentially, we take food energy, and we convert that food energy into cellular energy. We all learned about the mitochondria in 7th grade science class. We learned about the Krebs cycle, which nobody loved, because you had to memorize this thing. What that thing is doing is taking a glucose molecule and turning that thing into 36 ATP, which is your energy currency. We can use that ATP to do a whole bunch of chemistry reactions in the cell that make us feel and function good.

Thyroid hormone plays a critical role in that. But to run those mitochondrion efficiently, you need oxygen. Oxygen is a key piece. If somebody has decreased oxygen getting into a cell, the cell now becomes more anaerobic, without oxygen. It runs more in an anaerobic state, which essentially turns down the mitochondrial function. We become less efficient at getting cellular energy from our food. 

If a cell is in a low oxygen state, the mitochondria downregulate. We won’t make as much energy. What does that feel like? We may not poop as well. We may be more tired or fatigued. We may feel more dehydrated. We may feel chronic thirst. There are a whole bunch of things that we may experience: more pain, more muscle tension and spasms as a result. 

Getting oxygen to the cells becomes critically important. There are a number of things that can inhibit getting oxygen to the cells. One of the most common things that happens is people don’t breathe well. “I breathe a lot. Doesn’t that mean I have alot of oxygen in my system?” It’s not that simple. When we breathe out, we blow off carbon dioxide, and we bring in oxygen. Everyone thinks, “As long as I breathe in a lot of oxygen, I should have enough oxygen.” 

The same thing that we were talking about with T4. It’s not important how much oxygen is in the bloodstream as it is how much oxygen gets to the tissue. If I’m a red blood cell, I’m grabbing the oxygen that is coming in from the lungs, what you just breathed in. Now I’m going around the body and blood, and I will give up oxygen to the tissues, so they can run and function optimally. 

What allows that red blood cell to give up the oxygen? It won’t just give it up. The only reason that red blood cells give up oxygen is there is more of what we call carbon dioxide in the bloodstream. If there is less carbon dioxide, that red blood cell doesn’t want to give up the oxygen. It likes the oxygen, so it won’t give it up. 

If someone is mouth breathing a lot, they are oftentimes blowing off too much carbon dioxide, which means there is less carbon dioxide in the body, the bloodstream. They are breathing in plenty of oxygen. If you look at their oxygen on a medical test, it may show 99% oxygen saturated. That sounds great because the red cells are saturated with oxygen. That oxygen is only helpful when the red blood cells give it up. They will only give it up if there is more carbon dioxide. 

Someone who is mouth breathing a lot has a tendency to be more hypoxic. Someone who is mouth breathing especially at night is going to be more hypoxic. Just mouth breathing a lot through the day, blowing off too much carbon dioxide or mouth breathing at night is going to contribute to a downregulation of your cell physiology and an upregulation of the immune inflammatory response. That becomes a huge issue. 

How big of a deal is it? Diagnosis of sleep apnea is exploding. Everybody is wearing these fighter pilot masks to go to sleep. If you are wearing one of those things, if you have cavities or gum disease or disrupted sleep, especially if you go to bed with some stuffiness or congestion, there is a good chance you’re opening your mouth at night to mouth breathe, which will create hypoxia.

The other driver of hypoxia potentially is if we have carbon dioxide in the bloodstream, that carbon dioxide plays an important role. If there is a lot of acidosis in the body, the body can pull carbon dioxide out of the bloodstream to deal with the acidity in the body. That, too, can drop carbon dioxide and trigger this hypoxic state. Without the carbon dioxide, red blood cells don’t give up oxygen.

Dr. Eric O:

If someone has normal oxygen saturation, that doesn’t rule out hypoxia. If someone does a comprehensive metabolic panel and has low carbon dioxide, they probably have hypoxia. If someone has normal carbon dioxide levels, I assume that doesn’t rule out hypoxia. 

Dr. Eric B: 

No, it doesn’t rule it out. There could be other factors that prevent transfer. What is normal oxygen saturation? Someone might say 99% is normal oxygen saturation. Anything under let’s say 93% is problematic. 

I don’t think 99% oxygen saturation is normal. If you have your monitor on your finger, and it reads 99%, I don’t think that’s healthy. I think that’s a good indication you might not be doing a great job of transferring oxygen to the tissue.

I like to see my patients somewhere in 95-96% because that tells me that they are probably transferring oxygen to the tissues a bit better. Someone who had 99%, they feel and function awesome, everything looks great. Hey, it’s probably fine. If I have someone with chronic health issues, tiredness, fatigue, weight gain, under conversion of T4 to T3, and they have 99% oxygen saturation, to me, it’s a problem. 

As far as the carbon dioxide, oftentimes I assume that if I look at the blood panel, and carbon dioxide is within the reference range, and I typically look at a reference range of 25-28 based on some of the literature as an appropriate carbon dioxide range, the lab reference range could be much lower, down to 20. I don’t think that’s appropriate. I’ll also do calculations with sodium, potassium, carbon dioxide to see from a calculation standpoint if it looks like we have an imbalance. 

Dr. Eric O:

Anemia can also be a factor, which I’m sure is one of the reasons why you run a CBC in everybody. 

Dr. Eric B: 

Absolutely. If someone has an anemia pattern, they have less red blood cells typically to carry oxygen around the body. That can be a potential problem. The broader the panel we can run, the more important. 

Anemia in itself is another can of worms. What we tell most people is they have iron deficiency. The vast majority of people don’t have iron deficiency anemia. The vast majority of people likely have anemia of chronic inflammation. Many times, we are treating that inappropriately. We assume that if iron is low and ferritin is toward the lower end, that’s iron deficiency. I don’t think it is in a lot of cases.

Dr. Eric O:

Talking more about blood tests. You mentioned reverse T3 earlier. Is that something you recommend across the board? Would you say everybody should get reverse T3? 

I’ll say this:With hyperthyroidism, I stop measuring reverse T3 because everyone has elevated reverse T3. It doesn’t add value in my opinion. Again, feel free to give your opinion with that. As far as those with low thyroid or subclinical hypothyroidism, is it something you recommend for everyone? 

Dr. Eric B: 

I like looking at it for a couple reasons, but not the reason the vast majority of functional medicine practitioners like to look at it. I said this early on, too, because it is what I was taught. T4 is this primary hormone that is made by the thyroid gland. Then it gets to the cell, and the cell has these enzymes, deiodinase, that can either activate T4 to T3, or deactivate T4 to reverse T3. That’s Cell-driven. The cell gets to determine if I am letting T4 in to convert to T3, or if I am keeping my metabolism lower and deactivating T4 to reverse T3.

When I’m looking at the thyroid, I never look at a thyroid panel by itself. A thyroid panel without context of someone’s signs and symptoms doesn’t really tell me much. I am going to look at a thyroid panel with at least one tissue marker, but at the beginning, I look at a comprehensive panel. I’m sure you do, too.

What is the significance of it? There are some in our space who say the reason people have tiredness, fatigue when they are on T4 medication is that reverse T3. T4 gets converted to reverse T3 inside the cell. That reverse T3 goes to the nucleus and binds to receptors, the nucleus, maybe the mitochondria, and blocks T3 action. 

It sounds good. People say it’s a mirror image of T3. A) It’s not a mirror image of T3. B) I haven’t seen much in the way of any true scientific data that says that reverse T3 blocks T3 from functioning at any level of significance. I just haven’t seen it. If someone says they have, I’m open to it. I like the idea that it does it, but I don’t think that’s what happens.

When I look at reverse T3, what I’m looking to see is a couple things. If I have a patient who is not on any medication, but they have signs and symptoms of hypothyroidism, and their TSH is normal, their free T4 is normal, whichever one somebody is looking at, I look at both. I want to see what their cells and tissues favor. Are they favoring the conversion of T4 to T3? Are they favoring the conversion of T4 to reverse T3? 

If reverse T3 is higher, and T3 is lower, then we can start to make some assumptions that maybe the reason someone has hypothyroid signs and symptoms is because the cells aren’t converting T4 to T3 the way we want them to. They are deactivating it. Then I know that I need to look for what is driving that under conversion or over deactivation. 

What does the rest of my panel tell me? Are there markers of inflammation here drivingthat process? What is the person’s story telling? Are there traumas, emotional stress, hypoxia, injuries, dysbiosis, faction, sleep disruption? I start looking for the reason why. 

I just don’t think that reverse T3 is the problem. I think the reverse T3 is an indication that there is some cell defense potentially going on. Let’s say there is a normal lab TSH, and reverse T3 is low. Some people think reverse T3 should be nonexistent, and should be really low. I don’t think that’s the case either. If T4 is low, and reverse T3 is low, and T3 is low, I know that we have a person who is not making sufficient thyroid hormone. The gland is not working. Therefore, there is not enough T4 to convert to T3. There is not enough T4 to convert to reverse T3. Regardless of what my antibodies are at that moment, we have a gland problem going on. There is not enough hormone being generated. 

I will go back to my labs, health history, health timeline, and say there are inflammatory mechanisms going on here that would cause thyroid hormone to be downregulated. If I have inflammation, inflammation is oftentimes going to increase conversion of T4 to T3, the hypothalamus, the pituitary early on, and can suppress TSH, even though I might need some more thyroid hormone in the system. I’ll use it from that perspective.

The third reason I want to take a look at reverse T3 is if I have somebody who is on thyroid medication, T4, and their doctor is happy they are getting enough T4 because their TSH is normal, especially if they have all the symptoms, we know T4 can easily lower TSH levels pretty quickly. The receptors in the brain are tenfold more sensitive than most of the peripheral tissues. You can normalize the brain much faster. If you have this inflammatory response going on, that can normalize it faster, too.

At the cell level, what’s happening? If they have high reverse T3, low T3, then I am probably getting an indication we still have this inflammatory mechanism going on. We need to identify what that is. They also may be taking more thyroid hormone than they need, especially if they’re struggling with some hyperthyroid symptoms: brain fog, insomnia, irritability, things like that. That’s why we might work with them to say the dose is too strong.

Again, I haven’t seen enough clear evidence that says reverse T3 blocks anything from happening. If you wanted to block anything, we would blame deiodinase-3, which is the enzyme that deactivates it. That’s how I use it.

I think the better way to assess what’s going on at the cell level is not just looking at reverse T3 because there can be things like reduced liver function that may cause reverse T3 levels to rise. If we just look at the free T3 to free T4 ratio, if that ratio is low, the cells aren’t converting T4 to T3 appropriately. There is probably some type of cell stress, cell danger mechanism going on.

If the free T3 to free T4 ratio is elevated, then we probably have a state where the cells are starving for thyroid hormone. There is not enough T4 in the system. They need to make more T3, and they are willing to do that. That’s where you will see the free T3 to free T4 ratio is high, above what we might call the optimal range of 0.31-0.34. 

In a situation where reverse T3 is elevated, maybe. Really, what I want to know is is it elevated because I have too much T4 in the system? Or is it elevated if I have some other inflammatory response going on? That is where we can look at the free T3 to free T4 ratio along with the reverse T3. If it was on its own, too much medication, we should be able to back that down. Then we should be able to see a better conversion occur. If there are inflammatory mechanisms going on, it doesn’t matter if we can back it down. We won’t see as good a conversion too early too soon if we don’t identify what’s creating that inflammatory mechanism and the downregulation of conversion. 

Dr. Eric O:

I have a few follow-up questions.You don’t want reverse T3 too high, but as you said, you don’t want it nonexistent or too low. If you could say what your healthy or optimal range of reverse T3 would be? 

Also, I think you mentioned the optimal range of free T3 to free T4 ratio, but if you could say that again. 

Also, you mentioned you test the total T4 as well as the free T4. I imagine you do the same for T3, the total and free T3. The optimal ranges for those. Why do you test both total and free hormones? 

Dr. Eric B: 

All right, the first question was what do I use for the range? It’s important to know there is the lab reference range, and there is what some people call the functional range. Where do we get these ranges at? It seems like a lot of practitioners have their own range. Some people may say it should be less than 9 or 10 or whatever. 

For me, when I am looking at the functional range, I am more of a research geek. I am looking at stuff and saying, “Where are we finding numbers here?” I have stayed somewhere in that 9-18 range. 

Every lab value has to have context. If you said to me, “Eric, my reverse T3 is 15. That’s optimal, right?” I don’t know. What’s your TSH, total T4, free T4, total T3, free T3? What are the ratios of these? I don’t know if that’s good. Is it good? Well, if your total T4 and free T4 is low, and your T3 is low, but your reverse T3 is 15, that is probably still inappropriate. You don’t have much thyroid hormone, and you’re still favoring the deactivation and not the conversion. Does that make sense? 

Dr. Eric O:

Yes.

Dr. Eric B: 

Even though I might use a reference range of 9-18, that is a starting point. I have to interpret the rest of the labs to see is that appropriate? If someone had a reverse T3 of 15 and lower values of T4 and T3, is that important? What do I make of that? I’m also going to look at the rest of the labs. Do I have any markers of tissue hyperthyroidism going on? Do I have elevated lipids, elevated triglycerides, elevated BLDL? Do I have glucose resistance going on? If I have tissue markers of hypothyroidism going on, and I have a reverse T3 at 15, and I have lower levels of T4 and T3, I think that reverse T3, regardless of whether it’s in a functional range, is still potentially problematic. 

Dr. Eric O:

Makes a lot of sense.

Dr. Eric B: 

That’s sometimes the challenge, even in functional medicine. We give allopathic medicine a hard time for saying, “They just look at an H or an L outside a lab reference range. We have a better reference range.” Just because our value is in the reference range doesn’t mean it’s appropriate. A lab value could be totally within a normal, optimal range and be inappropriate. It could also be appropriate. 

If you feel and function good, and you don’t have much in the way of inflammation, and your TSH is 1.2, someone might say that’s the optimal. Okay. But if you have inflammation, are tired and fatigued, have all the signs and symptoms, and your TSH is 1.2, is that appropriate? Or is the inflammation suppressing TSH, and that’s causing my T4 and T3 to be low? TSH is normal at 1.2, but my T4 and T3 is low, and reverse T3 is low. We have to interpret it. We can’t just say because it’s in an optimal range, it’s okay. Does that make sense? 

Dr. Eric O:

Yes, it does. Thank you.

Dr. Eric B: 

As far as the ratio of free T3 to free T4, this is a little tricky because the units of free T3 and free T4 are different when you get them on your lab report. I think you can go to Dr. Weatherby’s website. Do you know what it is? 

Dr. Eric O:

I can’t think of it.

Dr. Eric B: 

He has a website with calculators. You can go to his calculator and put in right off your lab report a calculation, and it will tell you if it’s in the ratio range. 

What I do is convert everything to similar units, picomoles/liter, and divide free T3 by free T4. If you look at your lab report, you can say, “How do I convert picograms/ml to picomoles/l?” The calculator will convert it for you. If you convert things to picomoles/ml, you divide free T3 by free T4. Based on the literature, the optimal ratio looks like 0.31:0.34. 

If that ratio is under 0.31, the cells and tissues aren’t doing a great job of converting T4 to T3. That’s where we have to find out what’s causing that reduced conversion. Is it low calories? Is it hypoxia? Is it organisms? Is it toxins? Is it emotional stress? Is it all of those things, a combination of those things? Which oftentimes it is. 

If the ratio is above 0.34, then we might have a situation where even though TSH may be normal, there is still not enough T4 in the system to convert to T3. If there is no cell stress response going on, and they’re in a homeostatic state, they will take as much of that T4 and convert it to T3 as quickly as possible. A certain level of T3 is a biologic priority.

Dr. Eric O:

Gettingback to the thyroid hormone, you always test total and free hormones. Again, I have a habit of mainly testing the free hormone. What is the significance? I know you talked in your book about carrier proteins and binding globulins. If there is a discrepancy with the free hormone and the total, maybe we are looking at a problem with the carrier proteins. 

Dr. Eric B: 

Yeah. For the listener, in the body, we make hormones, but we don’t want those hormones all being free. They would get either deactivated, metabolized, or utilized right away, and we wouldn’t want that. Hormones are made—sex hormones, thyroid hormones, other hormones, cortisol—and they are then bound to what we call a transport molecule or protein, a binding globulin. It’s like an Uber, and it transports it around the body. When there is a cell or tissue type that needs some of that hormone, that hormone becomes free of the Uber or free of the binding globulin. Now, it’s able to get into a cell or tissue. 

Why might it be important to look at both total and free, even though a lot of physicians have gone to just looking at free? “Free hormone is the only thing that matters, so we’ll just take a look at free.” But it does make a difference. If I have low free hormone because I’m not making much thyroid hormone, then I have to figure out why I’m not making as much. If I have low free hormone, but I have plenty of total, then I have to ask, why is it getting out of the Uber? Why is it not coming off a binding globulin? Is it a pH issue, a hypoxia issue? Is some other hormone I’m taking jacking up the binding globulins? We need to find that answer.

If you put more hormones into a system, the tendency is for the binding globulins to go up to manage it. Something is resulting in less hormones becoming free, and we need to figure that piece out. I want to look at both. If someone has low free, I want to know if it’s because they just aren’t making it, they have low total, or if it’s a binding globulin issue. Then I want to address that appropriately. 

If they have high free hormones, I also want to know if that hormone is elevated because they don’t have much. They’re not generating much, so there is not much on the binding globulin, to where maybe something is suppressing the binding globulin and causing a lot of excessive free hormone that is either being used or metabolized too quickly.

Dr. Eric O:

Thanks for that thorough explanation. I want to circle back to the cell danger response before we wrap this up. When it comes to inflammation, I think you look at more than just CRP and sedimentation rate. You look at seven inflammatory markers? 

Dr. Eric B: 

When we look at labs, there are a bunch of things we can look at from an inflammatory standpoint that would be on a general blood chemistry panel. CRP, there is high sensitivity CRP, regular CRP. Homocysteine could be considered a molecule of oxidative stress. We could look at fibrinogen as a marker of oxidative stress. We could look at elevated ferritin levels. 

That is another can of worms. The vast majority of people believe that ferritin levels should be somewhere in the 60-80-90 range. I think that’s absolutely insane. I start getting concerned when I see it over 25, but definitely if you have a ferritin level of 40 or 50, that is an indication of potential inflammation and oxidative stress. Again, needs to be interpreted.

For instance, “when I have low ferritin, I’m anemic.” Hold on. If your serum iron is low, and your ferritin is low, and you’re anemic, maybe you do have an iron deficiency. But we can run a soluble transferrin receptor test to find out if the cells are starving for iron or not. That’s another conversation. 

I don’t think the vast majority of people are. But ferritin could be a marker of inflammation. We could look at bilirubin. Again, we have to take into consideration if it’s low because they’re anemic, or because they are using bilirubin as an antioxidant because there is inflammation and oxidative stress going on.

We can look at elevations of uric acid. We can look at alkaline phosphatase on a general chemistry panel. We can also look at elevations of 125 Vitamin D and low 25 Vitamin D. How many people today are being blasted with Vitamin D probably inappropriately because they have a low 25 Vitamin D when that’s not really the activated form? The activated form is the 125. If they have an elevated 125 Vitamin D, that’s another good indication that they probably have some type of chronic immune inflammatory response going on.

Dr. Eric O:

We’ll need you to come back to talk about the ferritin because that was a surprise to me, that you like to see it at 25 or less, and also talk about the 125 hydroxy. We don’t have time to dive into that. 

I don’t know if you’re familiar with Dr. Alan Gaby. He wrote a big nutritional textbook. When going through my master’s, they were talking about how you don’t want to look at 125 hydroxy because it’s frequently elevated due to a compensation related to the parathyroid gland. This was now 10+ years ago that I went through that, so maybe the science has changed.

I know Dr. Lynch is a big advocate of testing for 125 hydroxy vitamin D. There are differences in opinion when it comes to testing for that.

Dr. Eric B: 

Think of the traditional role of Vitamin D. 25 Vitamin D and 125 Vitamin D with calcium regulation in the parathyroid gland. We know way more than that now. I’d say real simply, without getting too heavy into it, if we think about Vitamin D this way. There is very little food, except for cold water fish, that has any high level of Vitamin D. Right? Where do we get most of our Vitamin D? Sun exposure.

Cold water fish have a decent amount of it. If you believe that there is intelligence in the universe, that might make sense. In the areas where we have plenty of sunshine most of the year, there is very little food that has any appreciable amount of Vitamin D in it. Most of the Vitamin D comes from sun exposure. In areas where there is less sun exposure, there are more cold water fish, where we can consume those things. I don’t think we’re designed to be taking copious amounts of Vitamin D as a supplement orally. I know it’s a $4 billion industry, but it’s just my opinion.

The other thing we don’t know too much about Vitamin D is we only measure one component of it. We don’t measure Vitamin D. We measure 25 Vitamin D. We don’t measure what happens to 25 Vitamin D. Is it being deactivated from 24 to 25? Is it going into the fat cells? That’s another discussion of how that works and what I think is going on. Is it being over converted to 125 Vitamin D? When you do have elevated 125 Vitamin D, is there an inhibitory suppression of Vitamin D to 25 Vitamin D conversion at the liver? Some of the literature seems to show that’s the case. It’s a feedback loop that turns it down. 

I think we’ve taken Vitamin D, one number we can measure pretty easily, and decided that if it’s low, we just give more, more, more. Even in people that were giving 5,000-10,000 IUs per day orally, they still wind up with low Vitamin D. I don’t think we assess it right. I don’t think we look at the chemistry of what’s going on. I would make an argument that early on, it may make someone feel better, but long-term, it’s potentially problematic. 

Dr. Eric O:

Definitely going to dive more into the research and have more of a conversation on this in the future. 

I can’t have you leave without talking about some other things that you mention in the book about addressing that cell danger response. Obviously, a lot of it is the foundations. If you could spend the next few minutes talking about what else people can do. You mentioned hypoxia and breathing better. People know about diet, but you haven’t mentioned anything about diet. I know you’re not a fan of one specific diet;it’s all about eating whole, healthy foods. I’ll let you take over and talk more about that.

Dr. Eric B: 

There is foundational principles. Kelly and I talk about them in the book. I had a couple colleagues who read the book and asked about supplement protocols. They’re not in there because I don’t have a protocol for everybody. I think that’s problematic. Even though it’s not sexy, the things that create health issues are these foundational pieces. 

For the vast majority of us, better nutrition would go a long way to making us healthier, right? Whole food-based diet. One of the problems we’ve had in this industry is that we’ve circled the wagons and shot in. You and I both know that if you’re eating one diet, and you’re not feeling well, and you change to another healthy, whole-food diet, you will probably feel differently. Is there a benefit to doing a carnivore diet for a short period of time? Sure, you will change your gut biome, it will create some change in symptoms. Is a vegan or vegetarian diet potentially going to create a change in signs and symptoms? Probably. I don’t think we should be arguing about which whole food diet is the holy grail. 

What we should be doing is saying, primarily, 80+% of the time, try to concentrate what you eat on healthy, whole, in season if possible, foods. As close to the way it came out of nature as possible. Limit the amount of processed food. If most people did that, they would probably start to improve their health and wellbeing. I see it every day as we start to make those changes in clients.

I think respiration is critically important. This is from a guy who has a deviated septum and should have had surgery a long time ago. Breathing is critically important. We are designed to do most of the breathwork through our nose. A lot of us, because of chronic inflammation and other factors, we do too much mouth breathing. Excessive mouth breathing creates a hypoxic state. Just changing your breathing can change your health.

Going back to food. How you eat is becoming important. Not only should you eat healthy food, but you have to take the time to chew it and help digest it well. You see a lot of people who are eating on the run. Eating healthy food, but not sitting down to eat it, not putting themselves in a situation where they can digest it well, so they still have problems.

Sleep is critically important as well. I’m guilty of this. I went for years wearing a badge of honor that four hours of sleep is all I need. I’ll sleep when I’m dead. What it does is creates-In me, it created chronic inflammation, Hashimoto’s, insulin resistance, and all kinds of stuff because four hours of sleep + running businesses+ training + everything else I was doing broke me down. That was part of my cell stress response.

We hinted about emotional stress. What goes on between the six inches of your ears makes a huge difference as to if you get well. You will be stressed or not stressed. We all have stress in our life, and you will never escape it, whether it’s physical, chemical, emotional, microbial. What we say within our mind consciously or subconsciously plays a huge role in how we heal and recover. Far too many people take in too much negative or focus on the problem and not the solution. I think that drives a lot of angst in the system, a lot of stress response in the system, so that’s hugely important.

Diet, nutrition, sleep. We talked about respiration. Physical activity and exercise. That’s critically important, too. Some people don’t like to do it, but you have to move your body. You have to do some physical strength training. You have to do some level of cardiovascular training. Slow fitness works really well for a lot of people. You want some, not excessive.If you do a lot of excessive training, you have to balance that recovery time. If you’re not, that will be a problem.

Why exercise? I have a healthy lifestyle. Well, the healthy lifestyle is if you train and recover, if you train and train and train, and don’t allow for recovery, you will have chronic health issues. I am a perfect example of that. I drove myself into doing that.

We talked about emotional and microbes. The organisms are everywhere. If they overgrow in us, then that can potentially be a problem. Then we have our environment with the toxins and things we are exposed to every day. You will never eliminate those things completely. The best we can do to have a low tox life, the less stress on the system. I think I got most of them.

Dr. Eric O:

Yeah, I think you did. Most of the foundations, if not all. Where can people find out more about you, Dr. Eric? Feel free to share your website and remind them of your book and anything else. 

Dr. Eric B: 

The book is called The Thyroid Debacle. It’s available wherever you get your books. 

I have a podcast called The Thyroid Answers Podcast. It’s available on almost all platforms. You’ll be a guest sometime in the future. We have an interview scheduled.

I was never much of a social media person, but I got convinced to do some Instagram posts. That is primarily where I put out some content and information. 

One of the things I like to do is my Thyroid Thursdays, where I am trying to educate. I know sometimes, people go on Instagram and want the three simple tips. What I am trying to do with those Thyroid Thursdays is have someone understand the free T3 to free T4 ratio. Why is that important? Why is it maybe less valid if you’re taking T3, and you can’t really use that ratio necessarily to indicate what’s going on? I want to educate people. 

At the end of the day, getting well is not based on how many supplements you can take. I find far too many people are oversupplementing. Getting well and staying well is about understanding a little bit more about your overall chemistry and doing a really good job raising your level of health in all these things that we call fitness factors (your diet, nutrition, exercise, mindset, habits, behaviors). Then you will be healthy. That’s not the stuff that’s sexy.

Dr. Eric O:

Well said. It’s always a pleasure chatting with a fellow Dr. Eric. Thanks for being here and talking about thyroid physiology and blood tests. We will definitely have to have you on again in the future, and I look forward to being on your podcast. Thank you so much, Dr. Eric. 

Dr. Eric B: 

Thanks for having me. I appreciate it.