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 super excited to chat with today’s guest, Evan Brand. He is going to be chatting about the mold-gut-thyroid connection. I am going to dive into Evan’s impressive bio here. He is a Board-certified holistic nutrition and a functional nutrition therapy practitioner, who has transformed the lives of thousands of clients with his online practice by finding and fixing the root causes of fatigue, depression, anxiety, digestive, and other issues. Evan solved his own health struggles using the same advanced lab testing, strategies, and protocols that he now uses in the clinic. 

He has accumulated over 22 million downloads of his podcast and has been featured on hundreds of other health podcasts, webinars, summits, as well as practitioner training events. He also offers at-home functional medicine training courses through his Functional Academy of Medicine and Epigenetics, also known as FAME, on gut, mold, and energy issues. Thank you so much for joining us, Evan. Appreciate you being here.

Evan Brand: 

Thanks for having me. I was looking back because I had you on my podcast six years ago, 2017.

Dr. Eric: 

Wow, that long. It’s great to have you now on my podcast. I know you will share a wealth of information with the listeners. 

Let’s give your background for those who aren’t familiar with you. How did you start doing what you’re doing today, get to the point where you have one of the top podcasts in health? 

Evan: 

The podcast was really just a way for me to learn. I was in it for myself at the beginning. It was very difficult to reach some of these practitioners, naturopaths, and functional medicine people that knew a lot. You’d have to fly to their clinic, or you’d have to pay $500-$1,000 an hour to get ahold of these people. Well, what if I just start interviewing them? I can get information from them to help myself. As I started to get better, I thought, well, other people need these pieces of advice and information. Practitioners are booked. People are booked out. Why don’t I start helping people? 

I had personal training certifications at the time. I went into the Nutritional Therapy Association and picked up the FNTP credential, which taught me food is medicine. I also learned a lot of hands-on things that I ended up using in a brick-and-mortar practice; I worked out of a chiropractic physician’s office for a while. I started getting his patients so healthy that they didn’t need an adjustment every week, so that was a natural parting of the ways there. 

I left the brick and mortar and went full-time online with my practice in 2015. At the time, it was the Wild West. Nobody was doing online telemedicine then. I know that sounds like yesterday, but in the internet world, that was a long time ago. It was a new idea. I can stay here in Oregon, Idaho, or California, and you will send test kits to my house? That was odd. 

I guess I was ahead of my time there because now, a lot of the practitioners that reach out to me for coaching—I do a lot of doctor and business coaching nowadays, and I am coaching these people to convert their brick and mortars. I had a guy in the middle of California in Beverly Hills. He’s a 70-something conventional MD who has been practicing for 35 years. We’ve taken this guy from 25 employees and $40,000 a month in rent for his Beverly Hills office to just online. He has two employees, and he’s happier than he’s ever been.

My joy and love now is helping other practitioners, but also I still do clinical work three days a week. I’ll have people from California to, yesterday, Australia, South Africa, all across Europe. People who are seeking answers that they can’t find locally. People who have been to five, 10, 20 doctors, and they call me as the last effort, the last hurrah. Usually, we uncover things that have never been uncovered before, so it’s a true blessing.

Dr. Eric: 

That is an awesome story. That’s also funny about working for a chiropractor and getting people better to the point where they didn’t need weekly adjustments. Being a fellow chiropractor, I can understand the chiropractors in the practice not being too happy about that, but obviously, that’s good. That’s what you want. You don’t want someone to come in on a weekly basis or 2-3 times a week for many weeks, many months.

Evan: 

It was funny how it worked out. A lot of it was adrenal issues. Nutrition was a big piece of it as well. I still implement a lot of nutritional therapy strategies. These were people back in Kentucky, where they are eating garbage. They come in with their big Polar Pop; it’s this giant, probably 64-ounce soda. They will put that down and put down their Oreos and get adjusted and go right back to the bag of Doritos in their purse afterwards. It was just a mess.

I encourage people if you are in a brick-and-mortar practice like that, and you do have a lot of hands-on skills, I would try to implement the things we are talking about today. You can increase their health and their outcome. If you’re worried about the financial piece of it, like, “Hey, well if I get everyone so well, and they don’t need adjustments every week,” now they will tell all their friends and family, “This guy turned my life around.” The referrals you’ll get will totally maximize your ability to help more and generate more revenue. If you’re freaked out about getting people so well there will be nobody left to help, I promise that won’t happen.

Dr. Eric: 

How long have you been helping people with mold? That’s the topic today. I know you recently started- How long have you been speaking for Great Plains? Now they’re Mosaic Diagnostics, I believe. You have been lecturing for them. How long of a focus have you had on mold issues? 

Evan: 

It started in 2017 or 2018. My wife and I built a house, and it was a on a cross base foundation, which is a terrible idea. Don’t do cross bases. Try to do a slab or even a walkout basement. A cross base is basically a basement that you can’t see. You’re not down there to check on it. 

We built this new house. I love trees, so I plant trees everywhere I move to. We had this water hose connected to the house. I was dumb. I was watering trees in the winter. I thought I needed to. I left the hose on, and it froze. That busted a sillcock valve in the crawl space. There was some water in there, and that evaporates up to the home and creates mold. 

I was having blood pressure issues and all sorts of problems. My friend Jack Wolfson, a cardiologist, I texted him, “I’m having these weird blood pressure issues. I’m dizzy when I wake up.” He texts me back in one word in all caps, “MOLD.” After that day, my life was never the same.

My wife and I were reminiscing and laughing about it. It’s not funny because it put me through hell, and we are still recovering. When I went to investigate, I got stung by a wasp at the same time. I found the water, and I got a wasp sting on my hand at the same time. It was a whole cascade of symptoms. 

I’d say 2018 is when it all started. Now, you and I are recording here in late summer 2023. I don’t think I’m 100%. I don’t know if you ever fully get 100% back from a mold incident. Your immune system gets affected. Your endocrine system gets affected. Your GI system gets affected. Your brain, specifically your limbic system, gets affected. Now, you’re stuck in fight or flight, whether you want to or not. You become more hypersensitive. I had debilitating chemical sensitivity to all sorts of fragrances, laundry, dryer sheets. If I’m around people, I don’t like it. I want people to be fragrance-free. It’s better for your health and others. I still react to it, but it’s far less, maybe 90% less than it used to be.

Dr. Eric: 

You’re a lot better, not quite where you used to be. You might not get to 100%, like you said. It’s also a lesson for those listening who might be dealing with mold toxicity. This isn’t a three-month process. It’s not a six-month process. Let me ask you: Can it be a three- or six-month process? Is it something where no matter the case, it will probably be a few years where you get to the point where you’re 95% or 98%? 

Evan: 

The fastest recovery was in a three-year-old little boy. We ran his organic acids test, and he was colonized. We also ran his mycotoxin profile. Do you post video, or do you just post audio for the podcast? 

Dr. Eric: 

The podcast portion is just audio, but I do post this on YouTube. If you want to share anything, we could do that.

Evan: 

Let’s do it. A picture is worth a thousand words. I will show you the case that answers the question of timeline. Many people are unrealistic with their expectations. As you know, I love the OAT test. It’s amazing. This is a first-morning urine sample that people run. You get it back to the lab. When you have yeast or mold issues, you’ll then spit off these organic acids. We can infer based on what we find in the urine what’s happening internally. 

You can see here in this poor boy—this is a three-year-old. The mother had five children and ended up working on the whole family, including the mom. They had tree roots that busted through the foundation in their home. They had water that came into the basement. They all had mold toxicity. You can see here this marker, 5-hydroxymethyl-2-furoic. For folks listening, we are looking at these long words that indicate that this boy was growing, and/or he was colonized for Aspergillus, probably in the gut, but also the sinuses. 

Arabinose was very high. We knew we had a candida problem. Bacterial overgrowth was a mess. He had some Clostridia, which we’ll often see in mold. Oftentimes, you will see mitochondrial issues, too. People with chronic fatigue, there is a massive link with mold there. 

In his case, neurotransmitters were okay, but a lot of times, you’ll see low dopamine. Ochratoxin, which is one of the most popular, common mycotoxins we find, that affects the part of the brain that makes dopamine. We will often see issues with energy, drive, focus, and concentration. In his case, he looked okay. Nutrient levels, we’ll often see those crash out quite a bit. 

This was in April 2021. We put together a protocol, and we retested in April 2022. Just less than a year. You can see we pretty much fixed everything. No more colonization. No more candida at all. Tiny bit of bacterial overgrowth on this one. The Clostridia was normalized. 

That’s about the fastest you can do it in my opinion, a year. It doesn’t mean it’s a year to feel better. It just means a year to really resolve it. That would be really fast, especially if you have been sick for 20, 30, 40 years. People have to know and remember that if you had mold exposure when you were a kid, and genetically you don’t detox it well, and now you’re listening to this at 52 years old, and you want to get better in a year, that’s unrealistic. You’ve had this stuff for five decades; you won’t get it out in a year. 

It’s important for the practitioner to set realistic expectations of the timeline. We are so used to that conventional medicine model. You take antibiotics for a week, and everything is better. That’s just not the case. You’re going to feel better gradually though, sometimes within just a couple of weeks or months, using the right protocol, the proper binders, antifungals up the nose and in the gut. You can make significant progress with depression, fatigue, sleep issues, gut problems, etc. 

Dr. Eric: 

I think you’d agree that probably all cases, you need to address the source of the mold. Either get rid of the mold or remediate. There are people who are not in a position to move. I’ve come across patients, and I’m sure you have, too, who for whatever reason, they couldn’t remediate. Maybe the spouse wasn’t on board, or whatever. If that’s the case, is there any hope of taking binders, doing things from a glutathione perspective? Do they really need to get rid of that source of the mold? 

Evan: 

Great question. It’s like a seesaw. If you have a fat guy on one side and a skinny guy on the other, the fat guy will always win. If you take that analogy and visualize that for the rate of detox as opposed to the rate of exposure. If you have this massive exposure, your bathroom or kitchen leaked or your basement flooded, you have exposure off the charts, and you’re doing a couple capsules of charcoal per day, you will lose the battle. 

But if you flip that, and you were able to remediate some of the issue—you can’t fix the whole house, but you fixed the wet wall or the cabinet that flooded—your rate of exposure is now lower than your rate of detox, then you win the game. 

You can implement fresh air into the home. If you have decent weather outside, and you can open your windows and flood the place with fresh air and dilute the mycotoxins, that’s obviously helpful. If you spend a lot of time outside, and away from it, maybe you work outside the home. Maybe you have the ability to work out in the garden during the day and air the house out if you truly can’t cut it out. 

Cost-wise, it shouldn’t be much. Some of these remediation companies will charge you $10,000+. You have to be careful about vetting these people. If they do mold testing and remediation, it’s probably not a good idea because they’re biased. Of course, they will say it’s a problem and need to remediate. I would try to find an independent tester that doesn’t do remediation. Sheet rock is not expensive. If there is wet drywall and baseboard, cut it out, pick a new piece in, patch it up, paint it up, put your new trim back on. You’re done. 

People get overwhelmed by this conversation because it’s their personal home. It’s their sacred space. It’s their sanctuary. People think that when they talk about mold, it means they’re dirty. No. My house was pristine. I had air filters in every room. I had a whole house water filtration system. This was a top-notch house. It was still moldy and still made me sick. Get rid of any brainwashing you have. Don’t feel that you’re dirty or a messy person or a nasty person if you have mold. This happens to the best of us. I’ve seen houses that are $2-3 million, and they’re moldy. I’ve had clients in these $1 million+ homes that are moldy. 

It’s the husband usually who is a skeptic, who’s this online guy. What does he know? Guess what? The wife continues to suffer, and then it affects their marriage because now she is exhausted, so she has no sex drive. The husband’s mad about that. Dude, look, if you want a good sex life, fix the mold. If you use that as the carrot in front of them, usually they’ll get motivated enough to fix it. If they can save their sex life and marriage, unfortunately, our hedonistic, human traits can’t be ignored. If you lean into that, usually you can get these people on board to fix the home.

Dr. Eric: 

You mentioned, which I agree, about hiring someone who maybe is not doing the remediation because they are more likely to find something that might not be there. What do you think about doing it on your own? There are companies like Mycometrics, where people can order the test and do it on their own without hiring a specialist. 

Evan: 

I love it. I think it’s a great place to start. I encourage almost every client I work with to do that. If you are going to do a HERTSMI or an ERMI, where you go around and grab a bunch of dust and send it back to the lab and see what shows up, you can do that. 

I prefer the petri dishes. They are these plates that have a gum resin on them, where mold can start to grow. These petri dishes, you put them on the floor in various rooms of the home for an hour. You put the lid on, mark them with the room they’re in. 

Also your car. A lot of cars are moldy. Mercedes did a recall on 2.5 million cars because mold was growing in the air conditioning system. Even if you have a luxury car, it could be moldy. If you drive somewhere, and by the time you get to work you have a headache, consider that it could be your car. 

These petri dishes are cheap. They’re like $3. If you do it with a lab analysis, it’s like $30 for a plate. You get a health score. 

Based on that score, we also like to see what’s in the home. Does that match up to what’s in the urine? 90% of the time, it does not match. This means that mold exposure was from years ago. That was the moldy college dorm. That was your previous house. That was your childhood home. That was your grandma’s house you hung out in. It’s rare that we find current exposure as the source. It still happens. We often find that this is a story that started long ago, but we’re just now getting the answers, just now getting the data.

Dr. Eric: 

Just to clarify, you’re saying that someone might do a home test for mold, or even have someone come to the house and test for mold, and it might be negative, yet they will show positive findings on either an OAT or a mycotoxin test? 

Evan: 

Exactly. They scratch their head and say, “Where the heck is this coming from?” It was probably a long time ago. Could be months, years, decades. Or it could be their office. If the office is in a commercial building with water damage, something like that. We try to find it. Sometimes, we don’t find the source, so we have to assume that it was from the past. 

It’s also been proven that mold toxin goes through the placenta. This could even happen from birth. I have been fortunate to test many young children. Almost half my practice is children these days. We see kids who are six months old off the charts with mycotoxins, even if they are living in a new house or apartment. Then we test the mom. The mom has the same mold toxins but way higher. Oh my god, look, we have just opened up the dam through the breast via the breast milk and/or the placental transfer. That’s how we see it. 

Same with flame retardants. Unfortunately, breast milk is highly contaminated with various toxins. It’s a bit thing, where we are seeing one and two-year-old children who have major gut issues, major skin issues. We are even seeing thyroid antibodies in young children. It’s very difficult to get blood on them. When some things are severe enough, we do. We are seeing Hashimoto’s in young kids. It’s nuts. 

Dr. Eric: 

When it comes to mold in children, do you treat them the same as far as using binders and glutathione? Obviously, you try to get rid of the exposure. But is the actual treatment similar? 

Evan: 

Yeah, the protocol is the same. We use more liquid protocols than capsules. Certain binders, you have to open up, but we can mix them in with juice or applesauce. I try to find alternatives to the capsule formulas. We use liquid antimicrobials instead. We do nasal sprays. It works great. 

Kids get better faster. Their immune systems are generally more robust than us adults. Their thymus is much bigger, so they have this big immune reserve if you will that we don’t. It’s a lot easier, and it definitely makes you look like a better practitioner when you’re working with a kid because you can get them better in half the time that it takes for an adult to get better generally. 

Dr. Eric: 

You brought up an example of a patient’s organic acids test, which showed mold. Let’s say everything was negative the first time you tested. Have you seen where the OAT is negative, yet the urinary mycotoxins test is positive? 

Evan: 

Yeah, that’s a great point. There are two things that can happen. You can be colonized for mold, meaning you’re a mold factory, so you’re growing it. Maybe you had a lot of exposure, or the exposure was long, or your immune system was weakened. For example, maybe you had COVID, so your immune system was weak, and you got exposed to mold and became colonized. That’s what we look at on the OAT. Are they growing it? Do we see on page one these yeast or fungal metabolites elevated, indicating they are currently growing mold? 

Or, if that’s all negative, but the mycotoxins are positive, then we assume they are just a mycotoxin reservoir. That’s the most accurate thing. Technically, it’s not a mold. It’s a mycotoxin they are holding in them. it’s a mold fart. That’s the mycotoxin. We see that all the time. Half the people are colonized, and half aren’t. 

But you still have to work on the client and not just the paper. If we see that there is gut issues and skin issues, maybe we run a stool test on them as well, and we see dysbiosis or other infections. As you know, a lot of these herbs are pretty broad spectrum. If I am working on parasites, let’s say, I might have some herbs in that formula that also kill yeast and/or fungus and/or mold anyway. Even if the OAT wasn’t a big smoking gun for mold colonization, we’re probably helping to fix it anyway. 

Dr. Eric: 

It sounds like you don’t test everybody for urinary mycotoxins. Is that correct? 

Evan: 

I do. If budget permits, I am going to tell them, at least initially for our first call together, I want everybody to have an OAT and a myco. I am seeing too many to ignore it. If budget doesn’t permit, or if this person says, “Hey, I know I feel better on binders. I’ve already done this in the past,” okay, fine. If you don’t care to see the numbers, these tests aren’t perfect. They’re good but not perfect. If you’re not wanting to spend the money or can’t spend the money, and/or you’re already feeling good on binders, just keep them up. I’m okay with that.

Dr. Eric:

I can’t say I test everyone for the urinary mycotoxin test, but when I do test for that, I typically use Great Plains, now known as Mosaic. Have you had Dr. Neil Nathan on your podcast? 

Evan: I haven’t. He’s not a fan of that. I know he likes RealTime. 

Dr. Eric: 

I think he uses both, right? I think it was him. Maybe it was someone else who uses RealTime and Great Plains/Mosaic because sometimes, I’ll find mycotoxins on one but not the other. 

Evan: Vibrant is another competitor as well. I’ve used them before. Vibrant showed mycotoxins in me personally that I didn’t see anywhere else. I don’t know what to make of it. 

If you talk with Neil, he basically says binders for life. I’m cool with that. These things that we’re using—zeolite, clay, silica, fulvic acid, chlorella, etc.—these are great for heavy metals and pesticides. We are all exposed to that, too, no matter how hard we try. I love the idea of keeping up with low dose binders. Maybe your test missed something. Maybe your mycotoxin test wasn’t perfect. I still do binders. 

It helps with die-off from gut infections or other issues we’re working on, like Lyme, bartonella, babesia. The die-off from that stuff can be intense, and the binders help mop that up. Zeolite can help with histamine issues. A lot of these people have histamine problems as well. 

I like to implement binders for everyone, even if the test says nothing is there. We will still use it and say what they report back. If I’m sleeping better, which is my story, I started experimenting with binders for bed. My wife and I both noticed we’re sleeping better. We started using it with our kids, and they slept better, too. Everyone needs binders at night. Done. 

Dr. Eric: 

Everybody in the household is taking low dose binders on a wellness basis then? 

Evan: 

Yeah, we are. My kids do. My wife and I do, too. I do a couple capsules a night. Sometimes, I’ll do them in the middle of the day as well if I feel out of it. I still sometimes experience brain fog from it. When you are colonized with mold and/or candida, a lot of people will have brain fog. You walk into the pantry and forget what you’re looking for. You forget your keys. Where’s your phone? You’re always losing something. That type of brain fog can happen a lot with candida, too. 

Mold is the bad guy that allows these other things to take place. If you have been working on candida and bacteria, and you’re struggling and not beating that, it’s like this relapsing phenomenon. Assume there is mold there. Candida rarely occurs in isolation. 

I did a summit on candida years ago in 2017. At the time, I didn’t know much about mold. Now that I look back, all these people that have all these candida problems, we were using herbal antimicrobials to hit those, herbal antifungals. The candida would come back. Let’s rotate herbs. Now I realize, crap, that was mold. Mold was allowing the candida to come back. Mold was giving candida the opportunity to thrive. Candida produces acetaldehyde, which is very similar to alcohol. People feel drunk and spacy with candida. That would get better temporarily, and then they’d relapse. Now, I go back and test those people, and they all have mold.

Dr. Eric: 

Wow, that’s something that is definitely overlooked. I don’t know if you can answer this, but if you had to put a number on it, what percentage of clients that you see would you say have the mold problem? I’m sure it’s high because a lot of people now know you as a mold expert and see you. Yours might be higher than the average person. If you had to guess the average household maybe that doesn’t see you, would you say it’s 50%, 60%, 80%? 

Evan: 

I’d say probably 90%. 

Dr. Eric: 

Wow.

Evan: 

It’s huge. I think it’s the biggest epidemic facing the country if not the world right now. I know you’ve seen this with your clinical work. Even in the last five years, the average person is sicker and more complex and more sensitive than ever before. There is a lot of things that go into that. Media and bioweapons and other things that play into this. Overall, I find the population to be getting sicker, more sensitive, more nutrient depleted, more depleted of vitamins and minerals. Therefore, this mold is the final dagger, if you will.

It’s probably 90%. It’s very rare these days that I test someone and don’t show up with something. You’re right. A lot of people are saying, “I heard you talk about this. I had this exposure. I have 50 symptoms. Can you help?” 

There are still average guys. I had a case in California. This is some real estate investor guy who said, “Hey, I feel pretty good, but I heard you, and I want to get a good functional medicine workup. I don’t have many complaints.” We looked at this guy’s lab, and he is colonized with mold. His mycotoxins were off the chart. “You’re sure you have no energy issues? You’re not depressed or anxious? You don’t have erectile dysfunction? Your blood pressure’s okay?” “Yep, I’m fine.” 

This is weird, but I don’t want to ignore this because mycotoxins are very carcinogenic. Ochratoxin affects the brain and kidneys. Things like aflatoxin can affect the liver and be a big driver of liver cancer. “Look, if we don’t want you to end up with some neurodegenerative disease as you get older, let’s get this stuff out now.” 

We got this guy on the protocol. Now, he is losing body fat. He was working with a personal trainer, and he couldn’t lose much body fat. Now he is leaning out. We are seeing some cool benefits, even though he didn’t have many complaints. Now, he is saying, “I am not as tired as the end of the day. I thought that was normal because I’m working hard.” But you shouldn’t be crashing at 3pm. You should be able to keep going. That’s fun, when you see a case where supposedly, they’re okay, but you fix them anyway, and now they’re better. That’s always rewarding. 

Dr. Eric: 

It is a lot of fun when you see someone, the life changes they make and their health.

Thyroid. As you know, this is the Save My Thyroid podcast. People want to know: How does mold affect the thyroid? Let’s dive into the mold-gut-thyroid connection.

Evan: 

Sure. I would say it’s a domino effect, like everything else. There is this perfect storm that happens. Do I think that Hashimoto’s and Graves’ and other thyroid issues can happen on their own with stress and that sort of thing? Maybe. The more I look at this, I really think of the thyroid issue as the effect, the end result. Here are the domino effects that I have seen. I’ll just lay it out to you the way I perceive it now. I’d love to hear your thoughts on it, too.

Step one is a trigger, if you will, like mold, for example. Let’s role play and say you had this mold exposure. That weakened your immune system. Now you develop candida overgrowth. While the backdoor was open, so to speak, now you have developed Klebsiella, which we know is a big bacterial trigger of any sort of thyroid issue, autoimmune thyroid. Now, you have Klebsiella and maybe Prevotella and Proteus. Now you have a diagnosis of RA and Hashimoto’s or Graves’. You have this multiple autoimmune thing happening. Now, we see you have gut inflammation. The nutrition’s off. You’re super stressed. You’re working too much. Your kids are crazy. Your marriage is on the rocks. All those things add up. Boom, you happen to test blood, and there is a big thyroid issue. I think there is probably other things predating you seeing that manifestation there. 

I’ve seen cases where we have seen TPO antibodies in the thousands, like 2- or 3,000. We have seen that drop thousands of points just by fixing what I’m describing to you: the candida, the bacteria, the mold piece. All of a sudden, antibodies go way, way, way down. I didn’t even give any “thyroid support” or thyroid protocol. Maybe I did basic stuff, like zinc, selenium, those things. 

It’s actually rare that I have to make a full thyroid protocol. It’s almost as if these other gut detox protocols are actually helping the thyroid. It’s almost like we are removing the roadblocks that allow the thyroid to be under attack in the first place.

Dr. Eric: 

I agree. In most cases, it’s not a thyroid problem. Graves’, Hashimoto’s, they are immune system conditions that affect the thyroid. All these things you just mentioned, the mold, the candida overgrowth, the Klebsiella, all these other factors can affect the gut, which you need a healthy gut to have a healthy immune system.

One thing I don’t think either one of us mentioned is mold can increase the permeability of the gut as well.

Evan: 

Good point. There is some good literature on that. If you put in PubMed “leaky gut” or “mycotoxin leaky gut,” you can find it. 

These people who are so clean with their diet, they’re confused. “How could I have some autoimmune issue? I’m off gluten, dairy, grains. I’m doing the perfect diet that everyone tells me to do,” this AIP diet. Yet their gut is still a mess. 

That’s right. Not only do the lipopolysaccharides and the endotoxins from bacteria affect the gut barrier, but mold toxin does as well. If you’re taking all these leaky gut protocols, leaky gut supplements, but you’re full of mold and mold toxin, you’re not going to get fully better.

Dr. Eric: 

What impacts will moldy foods have? We focus more on the indoor air. If someone is eating grains or nuts that are moldy on a regular basis, I would assume that also could prevent someone’s gut from healing.

Evan: 

Yeah. I think this is tough to prove. If I were to give you a pie chart of exposure, I would say the biggest piece of the pie is 90% inhalation. You breathe on average like 20,000 times a day. Versus you’re eating and snacking 3-5 times a day. Just your overall consumption is significantly less in the diet, I think. 

It is true that you can have moldy coffee, moldy chocolate, moldy grains. For example, there is one study out of Guatemala. Apparently, liver cancer is very high in Guatemala. It was connected to moldy corn tortillas, which are a huge staple in the diet down there. Corn can be highly contaminated with various mycotoxins. This also can affect fertility and create miscarriages and birth defects and other problems for females. 

Remember that we are talking gut-thyroid here, but there is this big endocrine system effect as well. A lot of mycotoxins are highly estrogenic, so if you’re having breast tenderness or other problems, female issues, hormone problems, PMS, and worse, that could also be a part of it. 

I would say the diet is a smaller piece. I will say this is probably why some people feel better on a grain-free or more paleo template. They have already eliminated some nuts, seeds, grains, so they got rid of the mold. 

You won’t have a moldy steak. Now, the cows, if they’re fed grain that’s moldy, moldy corn that is sprayed with glyphosate, and the GMO products are in the cow’s diet, could that impact the quality of the meat? I would say so. I would still prefer people to get pasture-raised meats if they can. 

Overall, if you had to choose your battles, and you had the option of living in a moldy home and eating clean, or living in a clean home and eating a McDonald’s hamburger patty with no bun and cheese, I would probably do that. The buildings will really wreck you far more.

Dr. Eric: 

That’s interesting. Obviously, you’re not recommending for people to eat McDonald’s hamburger patties. But if they had to choose between being in that moldy environment and not eating as clean as you would normally recommend, that does make sense.

I know you use natural binders. What are your thoughts on cholestyramine? I am asking you for a reason, not just for the mold. I don’t know if you know this, but cholestyramine can also bind to thyroid hormone. It’s actually used as a treatment for some people with hyperthyroidism. This is in the literature. I didn’t know this years ago. I found it in the research. 

Since then, I have had some patients get cholestyramine prescribed by their endocrinologist if they are unable to tolerate antithyroid medication. It’s not ideal, definitely not the first line of treatment. I wanted to get your opinion. What do you think of cholestyramine in general? In this situation, for the binding of mycotoxins.

Evan: 

That’s cool. I didn’t know that. It’s a pretty remarkable compound. Folks listening that might not be familiar with it, it was created sometime in the ‘60s or ‘70s. It was used as a cholesterol-lowering medication. Statins came out, and they work in a different mechanism than this. Cholestyramine fell off. Maybe there is not as much profit in it. I don’t know what the story was as to why it became this forgotten-about product or compound. You can get it compounded from compounding pharmacies, which I have, and I have personally taken it.

I’ll tell you this though. Nobody is talking about this. It’s frustrating. If I would have gotten more warning on this, I wouldn’t have messed with it. 1) It’s tough on the gut. I think it really exacerbated histamine problems for me. I don’t feel like I had many histamine issues until I started to use cholestyramine. I don’t know if it changed something with the gut barrier, if it was too harsh, if it was detoxing too strong, and that aggravated my mast cells, creating more histamine issues, or what the mechanism was. I definitely felt that it messed up my gut.

Secondly, there is an impact on the mitochondria from cholestyramine. I think it made my fatigue issues worse. Most people don’t mention that. If you’re a Ritchie Shoemaker-trained MD, a lot of these conventional mold doctors make fun of natural binders. Natural binders have saved hundreds and hundreds of cases in my situation. These people were at the end of their rope, and we got them better with natural binders. This idea that one is better than the other, or natural compounds can’t work, it’s simply not true.

Cholestyramine in the beginning though did get me out of the hole. I was in a dark place for a while. I had a lot of dizziness and vertigo. When I started it, I almost had instant relief. It’s a much stronger binder than something like charcoal. Stronger, meaning it’s a tighter bond to that toxin, whereas charcoal is a weaker bond. Think of it as a strong magnet versus a weaker magnet. 

When you’re using something like charcoal, it is true that some of the mycotoxins will essentially fall off and get reabsorbed back into the system. You can have a die-off or a Herxheimer reaction from binders. You would think binders are just this perfect, benign substance, and all it will do is pull bad things out of you. 

When I was taking 6-8 charcoal capsules per day, to experiment, I was messed up. I was not feeling well. That told me, “Hey, this is not a perfect product.” When I did cholestyramine, it was so strong that I almost felt more clear-headed with the natural binders. 

There are pros and cons to everything. Do I think it’s necessary to get better? No. But cholestyramine apparently is one of the only compounds on the planet to get out nonstick chemicals. Like the forever chemicals we hear about. It appears that cholestyramine can bind to those and pull those out. That’s cool. Maybe at a minimum, I at least pulled chemicals out of my body that natural compounds wouldn’t. 

Dr. Eric: 

That’s interesting. I didn’t know that. I can’t say I’ve had a lot of patients on cholestyramine. Typically, they’ll either be on the herbs, things like bugleweed or motherwort for those with hyperthyroidism, or they will be on antithyroid medication. If they can’t tolerate the medication, and the herbs aren’t effective, if it’s a choice between getting their thyroid removed or radioactive iodine or the cholestyramine, I will recommend the cholestyramine. 

Evan: 

Agreed. They probably have mold toxin anyway, so why not give them cholestyramine? Then you are helping them with thyroid and detoxing them. in your case, it would be a good strategy. 

I love that you use and implement motherwort. You are one of the few guys who know and talk about motherwort as much as I do. It’s one of my favorite herbs. I take it a few times a week, 5-10-15 drops sometimes. 

The stress and trauma and grief associated with this whole conversation is significant. We are talking uprooting people from their family homes. We are talking having to sell or remediate or renovate. You’re talking marriage stress, financial stress. There is a lot of other collateral damage that happens with this whole conversation. Motherwort is not only a great tool for the thyroid cases, but it’s amazing for emotional trauma and grief, heart palpitations, afib, atrial flutter, blood pressure irregularity. Motherwort is a really good ally throughout this process.

Dr. Eric: 

I agree. It also has some antimicrobial effects as well. It’s cool that you take it on a regular basis. I didn’t know that. 

I know there is so much more we could cover, but I know you have to run soon. Before we wrap it up, is there anything burning in you that you want to say? Did you want to give a summary? If someone is suspecting they might have a mold problem, what would be the next steps? 

Evan: 

If you haven’t done some good labs, test your home, and test your body. That would be a great investment. If you wait until you get the cancer diagnosis or the Alzheimer’s diagnosis or some other really scary thing that will have a lot of pharmaceutical interventions and potentially surgeries and all of that, you can save yourself from some of that if you get your body clean. You get these toxins out. 

This is not a rare situation. This is an extremely common situation. I bet a large amount of money that folks listening and/or their family members, their parents, their children, their grandchildren are probably walking around with mold toxin in them because the average person spends roughly 95% of their time indoors in the modern world. 

Versus just a short time ago, in the 1800s, when we were all farmers, we were all outside all day. Even if the old farmhouse was moldy, which it was probably less moldy because they used plaster and not drywall with paper backing, so the housing materials have changed. How tight our homes are have changed. There is a lot of things that have happened in a very short amount of time in terms of building technology that have made us more prone to having mold issues. 

I encourage people to remember that this is a multigenerational problem. I have tested grandma, daughter, granddaughter, and I have seen it through the family line. If you are one of those people who walks around saying, “Hey, mental illness runs in the family,” you’re maybe indicating there is mold illness running in the family. That’s why you’re all chronically fatigued, obese, depressed, anxious, etc. Of course, nutrition plays a role. 

But I have seen these families where they are all crazy. Mold causes rage. If the kid’s having behavioral issues, the mom is on an antidepressant, and the grandma had a nervous breakdown, these are the things you have to look for in people in a workup, to plot the dots here. “Grandma was nuts. Mom’s nuts. Kids are nuts. Okay, we have to figure this out.” 

If you dig deep enough, you’ll spend a couple thousand bucks to do a really good workup on yourself. If you do this, you will save yourself massive suffering. You’re potentially going to save your marriage if it’s not good. You will save the money from not having to send your kid to behavioral therapy and speech therapy and occupational therapy and interventions that you’ll try to do to mitigate the toxicity. 

The speech can be affected in children as well. That’s something that most practitioners don’t recognize. 

There is also a big link, and that’s why you and I love and have used Great Plains/Mosaic because of the link between autism spectrum issues and mold toxin. Any child who is on the spectrum at any level, any degree of severity, we are going to run chemicals and mold toxin. Guess what? We will find it 99/100 times in these kids. 

This is something I hope will become more popular and mainstream. At this time, there is very few people talking about this. Even less pediatricians talking about this. I know some really good functional pediatricians. Even they are not doing the work that I’m doing with this stuff. 

That’s why I have built up and had to become an expert in kids, mainly because I have three of my own, but also because who else is going to save the kids? 

At the current rate of toxicity that I’m seeing and the current rate of fatigue, behavioral issues, lack of motivation, I really don’t know how society will continue to function if we don’t start getting people healthier. Who is going to be the garbage man? If everyone is too tired to pick up a garbage can and throw it in the back of the truck and drive away, who is going to take care of society? How is society going to continue to run if our health is so chronically bad like this? We have a mess on our hands.

I hope people like you and I can put a dent in it. We need others out there. If you are a parent, and you need help, reach out. Let’s help your family. 

If you’re a practitioner, I would encourage you to learn about this stuff. If you’re interested, I have functional medicine training courses that people can take. I have over 1,200 students in there. A lot of them aren’t practitioners. It’s maybe an 80/20 split. 80% health seeker, 20% practitioner. 

The big flagship one I have is called Better Belly. This is a course where I have taken a lot of case studies and put them into an easy to understand and digest format. I’ll show you real quick. We could probably get a coupon code, too. If people want to get a better deal on it, they can. This is a fraction of the cost of one semester of college, and you will learn way more than you will in college, I promise. 

This course, I have a full curriculum. It’s over 53 lessons, anything from ulcerative colitis and Crohn’s, IBS, candida, candida protocols, stomach acid. We talk about SIBO and SIFO, H-pylori, Clostridia, heart issues, parasites. I have all these calls where I am on them with my clients, and you can listen to what the clients are saying. A histamine intolerance case study. We go into lab testing, supplements. I have some mold experts here. This is a professional mold inspector. This guy here owns a mold testing company. Here is a talk I gave on how mycotoxins create all these issues. I have a presentation on how to improve your home health. There is a lot of stuff. 

I am motivated and hungry to get this out. I am going to keep charging full speed ahead. I appreciate our time together. It’s been great. 

Dr. Eric: 

Same here, Evan. Can you verbally say the website? Where can people sign up for Better Belly? If they want to work with you one-on-one and check out your podcast? 

Evan: 

It’s EvanBrand.com. Everything is there. You can check out the podcast, too. We will get you on there as well. You will see Eric’s pretty face on the podcast soon. The podcast is free. The courses are paid. A consultation, I have me and another functional practitioner on my team. If you all need help, we’ll be here.

Dr. Eric: 

Awesome. Thanks, Evan. Great chatting with you. Definitely check out Evan’s podcast. Look into his Better Belly course. If you want to set up a consultation with Evan, contact him and his team. Thank you so much for this conversation. I learned a lot as well. 

Evan: 

Thanks for having me, man. 

Recently I interviewed Mira Dessy, and we talked about ingredients that can trigger thyroid autoimmunity. If you would prefer to listen to the interview you can access it by Clicking Here.

Dr. Eric Osansky:

I am super excited to chat with today’s guest on men’s health. We are going to be talking about men’s hormones, tying that into thyroid health. I have Dr. Tracy Gapin, who is a Board-certified urologist; a world-renowned men’s health and performance expert; and the founder of the Gapin Institute for High Performance Health.

Dr. Tracy is a thought leader, a professional speaker, and the author of the best-selling books Male 2.0 and Codes of Longevity. He has over 20 years of experience focusing on men’s health, human performance, and longevity. He has been featured in Entrepreneur Magazine, Dave Asprey’s Biohacking Conference, and NBC. Recognizing our healthcare system as broken, Dr. Gapin created the proprietary G1 program designed to help entrepreneurs optimize their mind and body to function at the highest level. Thank you so much for joining us, Dr. Gapin. 

Dr. Tracy Gapin: 

Thanks so much, Eric. Glad to be here with you today.

Dr. Eric: 

This will be fun. Before we get into men’s health and hormones, can you talk about what led you to taking more of a functional medicine approach? For years, you had a general urology practice, correct? 

Dr. Tracy:

Exactly. I like to say I am a recovering urologist. I spent 23 years in traditional allopathic medicine as a very busy clinical urologist, doing robotic surgery every day, treating prostate cancer, kidney stones, you name it. 

About halfway through my career in urology, through my own health issues, I came to realize that we were really failing men. I found that we were great at treating disease, symptoms, problems, but really bad when it comes to helping men with the common issues that they complain about. “I want to have more energy and focus. I want to lose weight. I want to have better sex. What do I have to do to live longer?” I found in traditional medicine, as a “men’s health expert,” as the urologist I was, we didn’t have the answers for them.

Selfishly, to overcome my own health issues, I went down rabbit holes. I started studying and getting certifications and going through courses and programs and research. I fell in love with precision medicine and epigenetics and functional medicine and wearable technology and peptides and all this world-renowned generative medicine and longevity. I put all these concepts together and created what is now the G1 program. I was able to transform my own health. When I shared this same approach with my patients, they had the same great results.

Many years ago, I made the decision that it was time to step forward and commit myself to doing this. I made the very massive decision to jump off a cliff a few years ago, and I stepped away from traditional medicine. I launched the Gapin Institute for High Performance Health, where I can now spend all of my time working with high performing individuals to help them with those challenges that I mentioned: I want to have more energy and focus. I want to lose weight. I want to have better sex. I just want to live longer. It’s fun. I love what I do now.

Dr. Eric: 

Wonderful. I know you’re in Florida. Is it Sarasota? 

Dr. Tracy: 

That’s right. 

Dr. Eric: 

Awesome. Let’s dive into the hormones. What are some of the main reasons why so many men have low male hormones, especially with an emphasis on testosterone? 

Dr. Tracy: 

Great question. We can look at things like our crummy diet, the standard American diet, with the high trans fats and pro-inflammatory Omega-6 fats and the high processed, refined carbs and sugars. We can look at the stress in our daily life and chronically elevated cortisol that we know are crushing our gut and putting us in a catabolic state. We can look at the poor sleep we’re experiencing. We can look at the lack of exercise and sedentary lifestyles. We can look at all of these factors that definitely come into play.

Without question, in my opinion, the single biggest factor when it comes to low testosterone is endocrine disruption. The toxins in our environment that are crushing our health. We can look at toxins in our food, in our water, in our personal care products, that are around us each and every day. Studies have clearly shown they are crushing endocrine function. They crush thyroid hormone function obviously and testosterone especially.

Dr. Eric: 

Any specific ones? There are obvious ones like drinking out of plastic water bottles and other sources of plastic with xenoestrogens.

Dr. Tracy: 

Exactly. BPA and phthalates are used to make plastic water bottles, food containers. They are used to line metal cans. They are ubiquitous. They are almost everywhere.

We can also look at things on our food, like our crops are sprayed with pesticides, herbicides like Atrazine. Atrazine is the second most commonly used herbicide behind glyphosate. Clearly shown to crush testosterone function in men. 

We can look at a lot of the chemicals in our personal care products, like laundry detergent especially. We are washing our clothes in these laundry detergents that we are bathing in our skin on a daily basis. These chemicals have been shown to crush hormone function. It’s about recognizing where these toxins are and making the little decisions every day to avoid them.

Dr. Eric: 

Of course, that’s a big reason to try to eat organic. Try to use natural cleaners, cosmetics.

Dr. Tracy: 

Absolutely. A big one is our water supply. A lot of people aren’t aware of this. Men in this country are on birth control. I say that jokingly, but our water supply is tainted with synthetic estradiol, which is from women’s birth control. The synthetic estrogen does not get filtered very well by our water treatment plants. What happens is we are drinking synthetic estrogen. What it’s doing is it acts like glue to an androgen receptor. It binds to the receptor and doesn’t let go. It switches on and never turns off. That disruptive estrogenic effect is what is crushing testosterone production and function.

Dr. Eric: 

I imagine it’s both the water that we drink and bathe in, or is it mainly just oral consumption? 

Dr. Tracy: 

Certainly, when you’re bathing, it comes into play as well. It’s a short contact time when you’re taking a shower, and you don’t tend to absorb it nearly as much through your skin. It’s much more a factor in the water you’re drinking.

You mentioned plastic water bottles. Any time you are drinking water, it’s going to be in your body longer. I carry a stainless-steel water bottle everywhere I go. I use a water filter at home for my water and ice. I think that’s one of the biggest sources of estrogenic stimulation in our body. 

Dr. Eric: 

We have chemicals from food, cosmetics, cleaners, and water. How about the impact of stress? How big is that when it comes to the low hormones? 

Dr. Tracy: 

It’s a big deal. I’m glad you brought it up. A lot of people don’t talk much about stress. Most of the high performing individuals I work with, they’re entrepreneurs. They’re uber-wealthy, super rich, young men who have already retired and are now busy building new businesses. They are professionals, lawyers, accountants, other doctors, and athletes. What a lot of men don’t recognize is the chronic stress in their life that is having a major effect. A lot of guys don’t realize this, but we can test for this. There are ways we can quantify this with cortisol testing.

Chronic stress, and we’re talking specifically about psychological stress here. Other stressors come into play here, like dietary, nutritional, sugar, food sensitivities, issues with dysbiosis in the gut, all these other things I look at as “stress” to our human operating system. 

Psychological stress, men tend to discount it. “It’s not affecting me much at all.” We can quantify it, and we do a lot of cortisol testing with our clients. We can see chronically elevated cortisol. 

You ask the question of what it does. It has a major impact. What cortisol does, and I know you’ve talked about this in the past, is the thyroid system gets affected. It affects TSH production and comes into play when we look at T4 conversion into T3. It certainly affects thyroid production and function.

With testosterone, what it’s doing is it’s going back to the brain and turning off the natural releasing hormone, luteinizing hormone (LH), and testosterone production. Cortisol in and of itself can be very significant and have a great impact on testosterone production and ultimately function.

Dr. Eric: 

With all of your patients, do you do adrenal testing and focus on stress management techniques? 

Dr. Tracy: 

Absolutely. We’ll talk about the big picture in a moment. It’s super important to look at adrenals, things like DHEA, which is coming from the adrenals; cortisol; and all the other key hormones that are coming into play. It’s like a symphony. Men don’t recognize we have over 50 hormones in our body. Testosterone gets all the attention, and it’s where we started the conversation here. It’s important to recognize there are a lot of hormones that come together and all influence each other to some extent. We start with testosterone but have to look at all the other hormones as well and understand how they all interplay.

Dr. Eric: 

How about insulin? Insulin resistance is a big factor, too. That also affects not just testosterone but other hormones.

Dr. Tracy: 

It becomes a vicious cycle. You mentioned cortisol. I will give you an example of how this is all connected together. I’ll work with men, and they’ll stay up until 1am working on a project, or maybe they’re just binge-watching Netflix. I don’t know. But they’re staying up late. Then they will fall asleep and wake up 2-3 hours later. They can’t fall back asleep again because their mind is racing. Classic elevated cortisol picture. 

What that’s doing is promoting inflammation by raising cortisol. That elevates blood sugar. That puts stress on the pancreas, trying to release insulin to control this blood sugar elevation. Over time, it can’t control it. Over time, the pancreas gets overburdened and stressed, and that is ultimately how rising fasting insulin and post-granulin levels rise. 

It gets to the point where your body can’t handle it anymore. You’re storing it as fat. What does all that do? It crushes testosterone production and function as well. That excess visceral fat you’re producing from the cortisol, inflammation, and insulin resistance is taking that testosterone and turning it into estradiol as well. Now, you’re tanking your good, healthy, optimal testosterone to estrogen ratio. You have that estrogen to testosterone ratio. 

That is a quick summary about how it all plays upon itself. Low testosterone, high estrogen in women will promote further chronic inflammation and insulin resistance, and it becomes a vicious cycle.

That’s metabolic syndrome. It’s about correcting that entire ugly process that happens. It’s ubiquitous in guys. Once they hit 40, 45, 50, it happens in almost every guy unless they’re aware of it and make the real decision to do something about it. 

Dr. Eric: 

It’s definitely widespread, and it is this vicious cycle. What I see is diet plays a big role, but usually depending on the severity, many times, just cleaning up your diet, it’s certainly often not sufficient alone to reverse this process.

Dr. Tracy: 

Exactly. This is why I really believe strongly- My philosophy is based on a systems model, understanding that we have all of these systems that come into play, and you can’t focus on any one of the hormones. We have over 50 we have to look at. You also have to look at your nutrition and your gut health, and get your microbiome cleaned up. You have to look at stress and how that’s affecting cortisol. There are various types of stress. You have to look at detoxification pathways. Are you optimally clearing those toxins from your body? You have to look at sleep. So many of these high performing individuals that we work with have crummy sleep, whether it’s intentional or not. Correcting sleep is a big part of breaking that cycle.

Dr. Eric: 

How about some of the common signs and symptoms of an androgen deficiency? 

Dr. Tracy: 

A lot of guys will notice decreased energy, fatigue. They may want to take a nap later in the afternoon. There’s something wrong if you’re taking a nap in the afternoon. You should not need a nap. That is typically a sign of endocrine problems.

These guys will have cognitive alterations, where they can’t think as quickly or clearly when they could before. They can’t make decisions. Mental acuity is off. They call it brain fog.

Sex drive will be one of the most common symptoms that men notice initially. Decreased libido. Impairment in sexual function can come into play. 

Guys will sometimes have difficulty sleeping. Testosterone will cause issues with sleep, which obviously will promote low testosterone as well. That is a cyclical issue.

Guys will start to put on belly fat. They have fat around their belly they can’t shake. So many guys will say, “I run on the treadmill every day. I’m eating perfectly clean. I can’t seem to lose weight.” When I hear that, it makes me think of hormone issues. It typically centers around testosterone as one of the first parts of that.

Dr. Eric: 

You mentioned earlier about thyroid. Can you talk about the impact of thyroid hormone on testosterone? 

Dr. Tracy: 

It’s interesting. So many people think that thyroid issues are solely a female problem, but they’re not. We see a lot of guys who have most commonly clinical hypothyroidism that is undiagnosed that they don’t realize is a problem. I’ve seen hundreds of men over the last 20 years now who come to see me and are on testosterone already but feel like crap. They have low energy, they can’t lose weight, they’re sluggish, and they end up having great testosterone levels but crummy T3 levels. A lot of these guys have issues with metabolism, energy, weight loss, poor sleep. A lot of it is associated, as you know, with microbiome issues, too. 

There is this common finding that almost every man that has low testosterone will have some element of at least subclinical hypothyroidism as well. We know that elevated TSH will suppress LH production from the brain. High TSH will suppress the natural releasing hormone effect on the pituitary. Therefore, low LH leads to low testosterone. There is a clear connection there. 

There are also common variables, where just like chronic inflammation and insulin resistance, microbiome issues, stress, can also affect thyroid. Those same underlying etiologies are affecting testosterone production as well. Very common to see guys with both testosterone and thyroid issues. 

Dr. Eric: 

One thing that caught my ear is you said T3. When we talk about testing, when it comes to testosterone, you focus more on free testosterone than total testosterone, not that total testosterone isn’t good to test, too. Same thing with the thyroid. The T3 is the free thyroid. Many doctors just look at TSH and T4 and neglect that T3.  

Dr. Tracy: 

Eric, it kills me. We have a couple of endocrinologists here in town that I’ve gone to war with. The fact that I’ve had patients who will come in, and they’re being told that their Synthroid is working great. Their TSH looks great. They have never had their free T3 checked. They check their free T3, and it’s 2.8. You fix that, and it is amazing how that can drastically impact their life and change their brain function, their energy. They’re alive again. This is a great example of how so often, it’s not testosterone; it’s some of the other hormones that definitely come into play as well. 

Dr. Eric: 

I agree. A number of people listening to this have hyperthyroidism. Typically, you get elevated sex hormone binding globulin (SHBG) here. With that pattern, you would expect to see lower free testosterone levels, correct? 

Dr. Tracy: 

Yes. High SHBG will bind to testosterone, so you’re right. Free T will be lower. In those cases, it’s tough to artificially lower SHBG. There are not a lot of great maneuvers that will do that. You need to go higher on testosterone therapy to get free testosterone to where it needs to be. 

Dr. Eric:

Let’s talk about testing. When someone comes in, what do you do as far as blood testing, adrenal testing, whatever you want to talk about? Lead the way. 

Dr. Tracy: 

I’m obsessed with advanced diagnostics. That’s the beginning when clients work with us. We do a lot of blood tests, saliva testing, stool testing, urine testing. 

Blood testing, we’re looking at all the major hormones. Testosterone, free T. We are looking at estradiol and DHEA sulfate, which is a common problem in these guys as well. It’s a fairly misunderstood hormone, but it’s very important when it comes to men’s health. It does help men with a lot of the same things that testosterone is responsible for: energy, mood, metabolism, etc. 

A lot of guys are deficient in DHEA. I’ll find also that if men are on testosterone therapy, their DHEA sulfate levels will typically be much lower than they need to be as well. It does suppress DHEA production very commonly.

In women, it tends to stimulate DHEA levels for whatever reason. I don’t think we clearly understand why. In men, DHEA levels are suppressed when on testosterone therapy.

We look at free T3, free T4, thyroid, TSH. We are looking at thyroid antibodies. 

We are looking at markers for growth hormone. IGF1 is not perfect, but it’s an easy serum test to assess growth hormone function. Understanding its limitations. 

Looking at insulin, fasting insulin, homeostatic assessment of insulin resistance, fasting blood sugar. Looking at micronutrient levels, advanced lipid markers, which can be closely correlated with insulin resistance for sure. 

For salivary testing, we look at cortisol in men, recognizing that they all tend to have some element of adrenal dysfunction, whether they are hypercortisolism or whether they have already crashed and need support. Somewhere in between is pretty common. 

We do a lot of microbiome testing, looking for dysbiosis, looking at gut integrity and permeability, looking at markers of food sensitivities that are pretty common in men. 

We do some urine testing, specifically organic acids testing. A lot of these guys have candida, mold, etc. 

Looking at markers of energy production, mitochondrial function, as well. A lot of lab testing.

I really believe that it all starts with getting hormones optimized. 

Dr. Eric: 

I really like organic acids testing. When it comes to the gut microbiome, do you do a GI Map or GI Effects? 

Dr. Tracy: 

We’re doing a GI Map right now. We seem to be getting great results with that.

Dr. Eric: 

For adrenals, I do a lot of saliva testing, too. I do some dried urine testing. Do you also do Dutch testing as well? 

Dr. Tracy: 

We do Dutch testing. You bring up a good point. I love Dutch testing when we’re looking at estrogen metabolism. The 2 4 and 16 hydroxy estrone, the metabolism of testosterone into estrogen. We’re looking at methylation, DHT. That third page is the money shot. You look at oxidative stress on the last page, the neurotransmitter markers.

The cortisol, I don’t use much at all. It’s interesting when you talk to the folks in Dutch. They concur with the research I’ve found. Urinary cortisol testing is not validated like salivary testing is. I really believe that saliva testing is where it’s at. Serum would be great, but you can’t do that nearly as easily. Salivary in my opinion is where it’s at for testing cortisol. 

Dr. Eric: 

Would you have them do a Dutch complete and a saliva test? Would you have them do the hormone portion of the Dutch and then the saliva test? 

Dr. Tracy: 

I can do Dutch+. It comes with the salivary test with it. I will look at the metabolized cortisol part of the urine, but I don’t personally put much stock in those numbers.

Dr. Eric: 

Okay. That’s good to know. With the testosterone in Dutch, I’m sure you’ve noticed this, that a lot of times, it’s low. Even in the report, it says it’s common to have false low results. They recommend testing it through the blood if it’s low. Do you also find a lot of low readings? 

Dr. Tracy: 

We do. I’ll use serum for testosterone typically rather than dried urine. 

Dr. Eric: 

With the blood, do you test for DHT or androstenedione? Is it free testosterone and total testosterone? 

Dr. Tracy: 

I tested DHT in the past. The issue is, what are you going to do about it? I don’t test it on every man. Some guys have hair loss issues; DHT is the culprit there. Stimulation of DHT receptors is what would cause me to be concerned there. I don’t check those on every guy. 

I don’t think I have intentionally checked androstenedione. Maybe I should, but I haven’t serum-wise. I know you see that in the Dutch and some of the organic acids tests. A test has it. I have never tested it. Do you test that? 

Dr. Eric: 

I don’t. I was asking you because you’re the expert. I want to make sure that I shouldn’t be testing that.

Dr. Tracy: 

I have never seen a value for it. When I have checked DHT, I don’t know what to do with it. Let’s say you check DHT, and it’s high. What are you going to do there? If the guy has no symptoms or major androgenic side effects, I won’t do anything about it. If he is having problems, like male pattern baldness, excessive acne, and we decide to block that, what are we going to do? It’s a 5-alpha reductase inhibitor like Finasteride. I know from the research out there with post-Finasteride syndrome, that it can be pretty devastating when you crush a guy’s sexual function permanently, irreversibly with that drug. I honestly try to avoid it if I can. 

Coming back to the beginning, that’s why I didn’t order it. What am I going to do if it’s high? Probably nothing. I only order a test if I am prepared to do something about the results. 

Dr. Eric: 

That’s a great response. Why do a test if you’re not going to take specific actions based on the test results? It’s wasting the patient’s money.  

Dr. Tracy: 

There you go. I’ll do DHT every now and then. It’s not on my standard lab panel. 

Dr. Eric:

Let’s talk about increasing testosterone. I’m sure you get a number of people, and I’m going to ask you here right now: What can someone do to increase it naturally? Can they increase it to a healthy level naturally? Maybe it depends on how low it is. 

Dr. Tracy: 

Wonderful question. Yes, for the listeners, there are ways you can naturally boost testosterone levels without question. One of the biggest ways is heavy strength training. We are talking about moving heavy weights, specifically leg muscles like quad and hamstring and core and back, these big muscles in your body, doing heavy lifting. You can definitely raise testosterone.

Perfecting your sleep can definitely improve testosterone for the reasons we talked about in relation to cortisol. 

Lowering stress also has a big impact, for the same reasons. 

Getting sufficient micronutrients, things like zinc, magnesium, B vitamins. Good healthy nutrition. Getting enough fats in your diet. It’s a misconception that if you have a low fat diet, it will crush your testosterone. It won’t have a major effect, but you want key macronutrient ratios.

Sunlight can help. Believe it or not, sunlight has been shown to help testosterone levels, especially on the scrotum. I know it sounds crazy, but going out nude first thing in the morning for half an hour with direct sunlight exposure to the scrotum has been shown to help. Those are the natural ways that you can raise testosterone.

Let’s talk about how much. The key question that you ended there with is how much can it raise it? is it enough? We’ll talk about lab numbers in a moment. I think this would be a good tie-in. In general, what I find most of the time is you cannot get your levels up to where they need to be with natural approaches, unless you’re just a little low. If you’re a little on the low side, which I almost never see in my practice. Never say never. “You’re almost there. Let’s do some natural stuff to boost it.” No. Guys need to be 20-30 with free T3. Most guys are at 4, 6, 7, 9. Nowhere close to where they need to be. Yes, natural can help them to some extent, but not enough to get them to where they need to be optimally.

I will recommend those things anyway in addition to giving them testosterone. 

Dr. Eric: 

Makes sense. You don’t want to just give testosterone. You want to try to address adrenal imbalances if they have them or endocrine disrupting chemicals. Makes sense. I know you focus more on the free testosterone, but is there an optimal range for total testosterone that you like to see? 

Dr. Tracy: 

Depends on the SHBG. Assuming that our target is 20-30, I have had guys where total testosterone of 800 meant a free T of 21. I have had other guys with a total T of 1,400, and their free is still 12. Purely based on the SHBG levels. Total testosterone can be a guide for men, where you know where their SHBGs are. In general, the free T is the critical number there.

Dr. Eric: 

Thanks for that example. You really do need to do free testosterone. 

Dr. Tracy: 

Yeah, across the board.

Dr. Eric: 

How about estrogen? Is looking at estrogen in men important? Do you do blood testing like estradiol or total estrogens? 

Dr. Tracy: 

We do. This gets into some fun controversial conversations. Estrogen is not the enemy. A lot of men think estrogen is the enemy, and we have to lower it and get it down as low as we can. That’s not accurate. Estrogen is incredibly beneficial. It’s helpful for men when it comes to sexual function and energy. We know that estrogen has massive benefit when it comes to cardiovascular health. This is why postmenopausal women are given estrogen, not only for symptoms and quality of life, but we know it has some protective benefits.

For men, estrogen is not the enemy. What’s important is the balance between estrogen and testosterone. A lot of men come in with insulin resistance, and they’re obese and have super low T and very high estrogen. We want to get estrogen down, not by blocking it, but by reducing visceral fat and improving testosterone levels. That will help with that ratio.

When working with men, I do assess estradiol in all of them. When it’s elevated, my main question is: Is there a problem? Are there any side effects? Is there a reason to lower it? The main side effects that men would get from elevated estrogen would be breast tenderness, breast enlargement. They’re moody, they’re crying over puppy movies, they’re excessively tearful and emotional. We had a guy this morning who had some rage issues, where he was angry and short-fused. That is typically not what you see from high estrogen. You’re more emotional and effusive and crying. 

When you do have those symptoms, then it’s worthwhile to look at bringing estradiol levels specifically down. If there is no symptoms involved, then nothing says we have to bring it down to any certain range. 

The key question there is: If a guy does not have symptoms, what is the threshold for when you should lower it? When should you get concerned? Some doctors will tell you if you get above 60, if you get above 80. This one doctor I know will say he gets concerned when estradiol gets above 1,000. He says that jokingly because he doesn’t measure it, he doesn’t test it, he doesn’t care. He has no concern. He doesn’t block estrogen ever because he doesn’t think it’s a problem unless a guy is having symptoms. 

I do think there is some rationale for having some threshold to lower it down to a reasonable level. It’s arbitrary. Interestingly, there is no clear science that shows estrogen in men is harmful. This was for me quite shocking when I heard this. I looked, and you cannot find anything that says estrogen is specifically harmful in men. It’s really more the ratio of your hormones all together.

Dr. Eric: 

When it comes to helping improve estrogen metabolism in men, is it a similar approach to women, as far as helping to support detoxification, including methylation, and the gut microbiome? 

Dr. Tracy: 

100%. We are looking for the same 2 hydroxy estrone pathway on the Dutch. We want to make sure they are having healthy estrogen metabolism for sure.

Dr. Eric: 

DHEA, since it’s a precursor to testosterone, can you increase testosterone by taking DHEA? 

Dr. Tracy: 

Typically, no. Can you get some marginal elevation? Yes. Not anything substantial. You can’t use DHEA as a way to support testosterone production unfortunately. 

Dr. Eric: 

We will get to bioidentical testosterone. With DHEA, if it is low, do you typically give DHEA? 

Dr. Tracy: 

I do, understanding that when DHEA sulfate is low, it’s from one of a couple reasons. It could be low substrate, low DHEA, in which case giving DHEA should help that. 

It could be chronic inflammation. Inflammation can affect the sulfation process, so DHEA does not get converted to the biologically active form of DHEA sulfate. If you have bio salt issues or gut issues, that can also affect the sulfation process as well.

Yes, I give DHEA. You put guys on 25mg once or twice a day of DHEA, and I will typically see massive changes in their DHEA sulfate levels. If I don’t, that’s when I will start looking deeper into the gut or other reasons why it is not coming up. 

Dr. Eric: 

Let’s move onto testosterone. Most people who you work with, their testosterone is so low that a natural approach won’t get it up by itself. You will do things to improve adrenals and reduce toxic burden, but it sounds like really, the best thing to do in addition to that is to give testosterone. 

Dr. Tracy: 

Absolutely. I feel very strongly of the benefits of testosterone therapy. Without question, it provides incredible improvements in quality of life, whether it’s energy, cognitive function, sex drive, ability to burn fat and build muscle, general sense of wellbeing and vitality and feeling like a man again. 

It has amazing benefits when it comes to cardiovascular risk. We know that men with low testosterone have a markedly increased risk of cardiovascular disease and about a 30% increased risk of a major adverse cardiac event. Dozens of studies have shown the same thing. About 30% reduction in a major adverse cardiac event when you optimize testosterone.

We know men with low testosterone very counterintuitively have an increased risk of clinically significant prostate cancer. Flies in the face of everything I was taught conventionally in urology for 20 years. Men with low T have a higher risk of prostate cancer. In my opinion, there is negligible risk but tremendous benefit to giving testosterone therapy. 

Dr. Eric: 

What form do you give it? Is it injection, orally, or topically? 

Dr. Tracy: 

There are a couple different options. You can do injectable. An injectable comes subcute or intramuscular (IM). You can do topical. Or you can do pellets. I generally tend to recommend them in that order as well. 

Dr. Eric: 

I don’t know the average age of the person who sees you. If someone is in their 50s, 60s, 70s, this is just me talking, but there may be a greater indication to take testosterone. You do have to factor in the age. It does decline as we get older. 

If someone comes in in their 30s, and they have really low testosterone. As you mentioned, a natural approach is unlikely to increase it. Even someone who is on the younger side, would you still recommend testosterone? 

Dr. Tracy: 

This is where it gets a little tricky. A natural approach will be a little more effective in those men, but not enough to get the free of 6 to a free of 20. 

In young men, you have to recognize there is still some fertility issues to consider. If a guy is 30 years old, and you give him testosterone, you are going to be shutting off fertility, sperm production through negative feedback. Testosterone is going to tell the hypothalamus and the pituitary gland, “We’re good here. We have enough hormone. We’re fine.” It will shut off production of both LH, which is what stimulates testosterone production, and FSH from the pituitary. FSH is what tells the testicles to make sperm. 

When you’re giving a 30-year-old man testosterone, you are turning off sperm production, which may not be what they’re looking for. A young guy, you need to have a conversation about fertility. Are you and your partner looking to have more children at some point in the future? If so, there are other ways that we can stimulate testosterone levels to get where we need them without giving testosterone directly. That would be things like ACG, Clomid, other medications that can help boost testosterone. There is even a peptide that is somewhat beneficial as well. 

Dr. Eric: 

That was my next question, the peptides, if those could help boost testosterone. 

Dr. Tracy: 

Yes, I have used Kisspeptin a number of times. I have been fairly disappointed each time. It’s not quite as robust an outcome as you get with ACG and Clomid. 

Dr. Eric: 

Yeah. Do you use other peptides in your practice? 

Dr. Tracy: 

Yeah, I love peptides. I use a ton of them. Kisspeptin is the one that specifically we consider for boosting testosterone. 

Dr. Eric: 

Can you go over some of your favorite peptides for other purposes? 

Dr. Tracy: 

We use a lot of peptides for boosting growth hormone production. You mentioned the average age of guys in their 50s and 60s. We see guys typically between 40-60 or so. We see women as well. I have a nurse practitioner who focuses on women. Same approach. My passion and focus is certainly on men. 

Those guys, once you hit 40, growth hormone production declines by about 1% a year or so. Growth hormone is an anaerobic hormone that is responsible for growth, for muscle, for burning fat. It’s responsible for energy, cognitive function. In some ways, maybe you consider the fountain of youth for longevity. There is a lot of debate around that that is questionable. A lot of benefits of having good healthy growth hormone levels.

Rather than giving growth hormone, which has some negative consequences, we would rather stimulate your body to produce more growth hormone on its own. That is where some of the peptides are great at telling the hypothalamus, the pituitary gland to make more growth hormone. 

I love growth hormone peptides. We use a CJC Ipamorelin combination, which comes at it through two different mechanisms of action. Growth hormone releasing hormone (GHRH) is the hormone from the hypothalamus. 

I want to make a brief point about this. GHRH comes from the hypothalamus and tells the pituitary to make growth hormone. It also has a lot of systemic benefits on its own that are important. When you give growth hormone through negative feedback, you are turning that off, which you don’t want. 

CJC 1295 is a growth hormone releasing hormone peptide that works very similarly to have those same benefits that you’re looking for. That’s why that one is so beneficial. Tesamorelin is another GHRH peptide as well. Ipamorelin is a ghrelin receptor peptide that is paired with CJC because it will, through the ghrelin receptor, turn off somatostatin, which is what is slowing down growth hormone production. If you turn off the blocker, a double negative becomes a positive. By turning off somatostatin, you’re turning on growth hormone. 

There are a bunch of growth hormone peptides out there. A CJC and Ipamorelin combination are the two we use most commonly, I would say.

BPC 157 is a great peptide. It comes from the stomach. It’s incredibly powerful for reducing inflammation, whether it’s in the gut or systemically or in joints. I love BPC.

Thymosin alpha is an amazing peptide that comes from the thymus gland. It shrivels up and involutes and goes away once you hit puberty. It’s really important for immune function, and it’s great for boosting T cell production and function. 

Thymosin beta is another thymus gland peptide that is great for musculoskeletal repair. You can give that one subcutaneously in the belly, or you can give it subcutaneously near the site of injury for repair. That’s a cool peptide. 

We love peptides that help with mitochondrial function, things like MOTS-c, a great peptide for mitochondrial biogenesis. 

Peptides for sexual function, like PT 141 or Melanotan 2. 

Epitalon is incredibly only two amino acids in length. It’s been shown in animal studies to extend longevity. Epitalon is a really cool one.

Semaglutide, by this point, everyone has heard of it, it seems. It’s a GLP-1 agonist. It’s technically a peptide as well. It’s used for weight loss specifically. It decreases appetite at brain level. It slows gastric emptying to make you full quicker. It works in the pancreas to increase insulin secretion to help reduce blood sugar levels. The three different mechanisms of action. It’s fantastic for weight loss.

Tirzepatide is another similar one that has another peptide combined with it, GLP-1 agonist. It’s probably a little more effective than semaglutide. Both of those have shown amazing benefits when you look at lipid numbers and cardiovascular disease as well. Intimal medial thickness data as well. Remarkable improvements with those peptides. 

That’s just a sampling. We use a lot of them. Those are the top ones we use.

Dr. Eric: 

Are they all injected? Are some of them oral? 

Dr. Tracy: 

A lot of them are injectable. I didn’t mention ones like Semax and Selank. Those are great nasal spray ones for anxiety and mood stuff. PT 141 is a nasal spray. BPC can be either oral or sublingual or injectable. Dihexa is a great topical peptide for cognitive function and memory. Different routes of administration. Probably 2/3 or 3/4 of them are injectable.

Dr. Eric: 

Cool. Are they safe to take long-term? Are they supposed to be taken short-term? Any side effects that people should be aware of? 

Dr. Tracy: 

Great questions. The answer is there is not a lot of data on taking them long-term, like years and years. There is just no data out there. You won’t get randomized control trials like you will with Big Pharma. You look at the basic science, understand the mechanisms of action, and go with that. Everything we prescribe has research and studies behind it to demonstrate efficacy and safety. There are typically minimal side effects. 

Everyone is different and unique with different physiology. I had a guy who had an allergic reaction to CJC, and he had a massive allergic reaction to Tesamorelin. We can’t use those with him. That’s one guy in hundreds of prescriptions I’ve given. There could be side effects, but most people typically tend to have none.

Dr. Eric: 

Even with herbs, most people will do fine with herbs, but you could be allergic to a certain herb. 

Dr. Tracy: 

You never know. In general, we don’t tend to find much in the way of side effects or complications. 

Dr. Eric: 

One last question with peptides: Do you personally take any on your own? 

Dr. Tracy: 

I love to experiment. I have probably tried them all at one point or another. For about three years, I struggled with tennis elbow in my left elbow. I went through all kinds of peptides for that. I have been through all the growth hormone ones. I have used a ton of them now. 

I will emphasize for the listener that there are a lot of sources out there that are direct to consumers for peptides. I would caution anyone against going anywhere where the general public can run a credit card to buy a peptide. Any place like that that is direct to the consumer, there is no oversight or quality assurance compared to a compounding pharmacy, where there is much more regulation, much more of a close eye on quality control and assurance and certificates of authenticity. 

There is a study that came out last year some time that found that after testing, one of these commercially peptide companies had nothing in it; it was like saline. You have to be careful about what you’re buying. If you’re injecting it in your body, I’d get that from a pharmacy. 

Dr. Eric: 

That’s really important. 

Dr. Tracy: 

I’ll also emphasize: I put out these YouTube videos on peptides. I get all these comments about, “Can I buy some peptides?” We’re not a pharmacy. We don’t sell them. We prescribe them for our clients who we serve. People get the wrong impression from a YouTube video I made talking about peptides. We are not a pharmacy ourselves. 

Dr. Eric: 

Tracy, you brought up one peptide that helps with sexual function. It made me think about how you probably deal with a lot of men who have erectile dysfunction. When it comes to that, it sounds like peptides could help. Also, increasing testosterone, I imagine it also could have a role. As far as ED, there is also a blood flow problem, too. Is it a multifactorial approach where you address different things? 

Dr. Tracy: 

When I talk about ED, I like to conceptualize it as four main buckets of causes of etiologies of ED. One is blood flow, as you mentioned. It’s arterial inflow, and it’s venous outflow. An erection is simply an engorgement of blood that gets trapped if you will. That arterial inflow is dependent on nitric oxide. That’s one of the other hormones we test. We can test it in my office. We know that things like insulin resistance crushes nitric oxide production. Chronic inflammation crushes nitric oxide production. We know that systemic issues like gut health and hormones and diet have a profound effect on blood flow. Blood flow is one. Arterial inflow comes in, and venous leak going out, that’s one.

The second cause would be hormones. As you mentioned, low testosterone can definitely be a cause. Sometimes it’s DHEA, insulin issues, or cortisol issues. Even growth hormone, thyroid, or other hormones can affect it. Testosterone is probably the biggest and most common culprit when looking at ED.

The third bucket would be nerve function. You need normal nervous function down there for an erection. Make sure there is no issue with neuropathy, especially if someone is diabetic. Looking at the history of pelvic trauma, pelvic surgery, prostate surgery, colon surgery, stuff like that. That is the least common of the categories.

The fourth is psychological. This is more common than you think. Issues with stress, with infidelity and marital strife. A big one is porn addiction. It’s such a rampant problem right now, where guys are having issues with porn addiction. They are not interested in their partner. All of these psychological issues come into play as well. 

Four buckets: blood flow, hormones, nerves, and psychology. 

Dr. Eric: 

We covered a lot. Is there anything that I didn’t ask you that I should have asked you or anything else that you’d like to discuss before we wrap it up? 

Dr. Tracy: 

My philosophy has become a three-pronged approach. The first is advanced diagnostics. Know your numbers. We talked a lot about testing. 

I believe in a very individualized approach, and that’s where functional testing comes in. We didn’t talk much about genetics, but genetics comes into play when it comes to understanding what’s right for our clients. What foods should they be eating or not? Detox pathways. Additional support? What exercise is right for you? It’s amazing how much genetics can really help us fine-tune things. 

The third is precision lifestyle. This is where I have functional coaches who work with my clients because as powerful as the molecules may be that we prescribe, if you’re not doing the right things at home, then you’re not going to have nearly the success that you would otherwise. 

Advanced diagnostics, individualized approach, and precision lifestyle is where it’s all at, putting all those pieces together. 

Dr. Eric: 

Wonderful. Thank you again, Tracy, for this conversation. Where can people find out more about you? 

Dr. Tracy: 

My website is GapinInstitute.com. If you text the word “Health” to 26786, we have a simple cheat sheet for 10 strategies to achieve high performance health today. 

Dr. Eric: 

Awesome. This was an awesome conversation. I learned a lot. I’m sure the listeners will learn a lot. Thank you so much. 

Dr. Tracy: 

Absolutely. A good time.

 

Recently I interviewed Mira Dessy, and we talked about ingredients that can trigger thyroid autoimmunity. If you would prefer to listen to the interview you can access it by Clicking Here.

Dr. Eric Osansky: 

I am super excited to chat with today’s guest, Mira Dessy. We are going to be talking all about ingredients, which isn’t a surprise because Mira is known as the Ingredient Guru. She is the author of The Pantry Principle: How to Read the Label and Understand What’s Really in Your Food. Mira believes it’s not just what you eat, but what’s in what you eat. She teaches clients how to navigate the grocery store’s mammoth packaged food stock to decipher confusing food labels and find real food solutions for chronic health issues. Thank you so much for joining us, Mira. 

Mira Dessy: 

Thanks so much for having me here. I’m really excited to chat with you.  

Dr. Eric: 

Same here. Excited to talk about all the different ingredients. Why don’t we start off with your background? How did you become known as the Ingredient Guru? 

Mira: 

That’s a really good question. It’s actually a very long journey, but I’ll tell you the short version. I used to be in a completely different field. I was a database administrator for an international research firm. Over a period of time, I got sicker and sicker, and I wound up having a lot of health challenges going on. Ultimately, I was diagnosed with five different autoimmune disorders. During that time, I amassed a collection of doctors and prescriptions. It’s funny now but wasn’t funny then. My joke is if there was an “ist,” I had it: endocrinologist, gastroenterologist, cardiologist, I had them all. 

As I was trying to work with these doctors to figure out what was going on, I realized nobody was talking about food. There were a few minor suggestions, but really nothing intensive. A friend of mine gave me a book about artificial colors that rocked my world. I was like, “Holy cow, I had no idea this could make that much of a difference.” 

I will share that at the time, I thought we were eating very healthy. I cook. I make all of our food. We still had processed things in the house. We belonged to a CSA. We did all the things. But there was still a lot of junk. As I began to go through my pantry, just looking at artificial colors, I was blown away by how much there was. Then I began to do more research and discover more problems with things. 

I wound up going back to school, became certified as a nutrition educator, and from there, began to work on not only improving my own health, but as people saw me getting better where I lived, they asked for my help, too. That began the process of my practice, which led to the book. I kept saying the same thing to people all the time. From there, everybody kept saying, “You know so much about the label.” One day, one friend said to me, “You really are the ingredient guru.” I said, “Ooh, I like that.” That’s how I got to where I am. It was not an overnight thing. It was a very long journey. 

Dr. Eric: 

That definitely is a very catchy name. It sounds like ingredients have played a big role in helping you with your five autoimmune conditions that you were diagnosed with.

Mira: 

Absolutely. My primary was ulcerative colitis. For anybody who has or knows someone with ulcerative colitis, it is a very challenging disorder. It impacts your body’s ability to absorb nutrients, so you can be nutritionally very deficient. You have to know where a bathroom is at all times, regardless of where you are. Your gut is overwhelmed. You’re exhausted, worn out. Your body is so depleted because the gut is the core of our health and wellbeing. 

I am happy to say that all these years later, I get regular colonoscopies because it’s prudent to do so. My last colonoscopy, I was told that I have no signs of ulcerative colitis in my system at this point. I like to share that because I want people to know it’s never too late to change your diet and your lifestyle. I was in my 40s when I was diagnosed with autoimmune health issues. I made changes, and here we are. Things are definitely much better. 

The other thing that I really want to encourage people to know is there is also not one path to that. You have to find what’s the right fit for your bio-individual body. I just happen to believe that ingredients are a foundation for anyone regardless of what your health condition is or what your body requirements are. 

Dr. Eric: 

When it comes to the harmful or controversial ingredients—some of them are proven to be harmful, and some of them are controversial—how does the United States compared to other countries? I know some countries are more strict when it comes to their standards regarding ingredients. 

Mira: 

There is one way that we are better than a lot of other countries, and that is that we do clearly identify it on the label. Many other countries use something called an E number. It’s an E followed by three digits. You have to know which ones are the good ones and which ones are the bad ones. That’s hard. Ours flat-out say Blue #2, or polysorbate 80. Ours are very clearly identified. It does make it easier to read the label once we develop the habit of doing that.

When it comes to what’s in what we eat, we are not great. One of the things that is most frustrating to me is how there is a global food net because big food is really ten major companies, maybe seven at this point because there have been some mergers. They make food for us, and they make food for other countries. What they make here, they make differently overseas because they know the legislative requirements are different. They are either going to have to put a warning on it because it’s harmful, or they’re not allowed to use it at all, so they don’t. It frustrates me to no end that they’re willing to do it where they have to, but not because it’s the right thing to do. 

Dr. Eric: 

When it comes to food labels, I wanted to talk about that because that’s what you do. You help people understand food labels. How reliable are food labels? Do they intentionally try to be sneaky? They’re hiding the ingredients. Do they have to reveal everything that is actually on the food label? 

Mira: 

That is such a great question. The answer is it depends in terms of can you believe the food label. I will say there are some things they’re allowed to do, where they’re not necessarily lying about it, but they’re given a pass. For example, if something has less than .5% of trans fats or sugars, they’re allowed to say there is zero. That is less than .5 grams per serving, the serving being determined by the manufacturer. It makes sense that sometimes, they might go, “Oh, a serving is two cookies.” I’m going to go out on a limb and say not many people look at the package and go, “Oh, I should only have two cookies.” 

The other thing that happens is they are masters at using something called front of package labeling. This is where they put all the buzz words and things they know are attractive to the consumer on the front of the package. They want to try to convince you not to flip that package around and look at the label. They may say, “Made with organic blue corn,” but then you look at the other ingredients, and they’re not that great. “A full day’s Vitamin C,” and the other ingredients are not great. They want to put whatever they think will be most attractive to you. These days, a lot of it is finding ways to get the word “organic” in there, even if they just have one organic ingredient. You will notice they won’t say “organic corn chips;” it will say, “made with organic blue corn.” They don’t have enough of an organic process to say the whole thing is organic.

The other thing that is really challenging about the label is that it’s broken down into two parts. The top part is the nutrition panel. The bottom part is the ingredient panel. In the nutrition panel, it’s based on 2,000 calories a day. Not everybody needs 2,000 calories. I know very few people who do math. If you perhaps only need 1,800 calories a day, you won’t sit there and recalculate everything. If you eat more than a serving size, you won’t recalculate everything. It gets very confusing and overwhelming to know exactly how much you’re getting.

There are a couple of ways around disclosing certain negative ingredients. For example, they can say less than 2% of, and they don’t have to tell you how much is in there. They hide under terms like “natural” or “flavor.” 

Also, I am seeing more and more instances of certain foods where BPA can be part of the packaging. It’s in the can liners and everything else. If you have canned goods, if the lining is BPA, they don’t have to tell you that there is BPA in there. It’s part of the can. 

In cereal, they have BHT and BHA. Sometimes, they’ll put those embedded into the plastic package. Those boxes usually are plastic, so that is a form of bisphenol, whether it’s BPA, etc. They may say “BPA-free,” and everybody gets excited about that. But there are all kinds of bisphenols. There is BPS, BPF, and more. If it’s plastic, chances are it is a bisphenol. Those are hormone disruptors, endocrine disruptors, not good for us. If they’re touching the food, they can get into the food. 

Dr. Eric: 

Good points. Going back to what you said about organic, where a food can have a single ingredient that is organic, and then they will say “Includes organic corn,” another word is “natural.” A lot of labels say “natural,” which doesn’t necessarily mean it’s good. Natural is not equivalent to organic. Do you want to talk more about “natural” flavors? 

Mira: 

Natural means almost absolutely nothing. When it comes to animal products, natural does have a small legislative oversight that says they are not allowed to use added hormones, antibiotics, that kind of thing. However, my joke is if they thought it would sell more, they’d put “natural” on shoe polish. It means nothing. They can take a conventional product, put the word “natural” on it, and they often do. Consumers think, “Oh, it’s less than organic, but better than conventional, so I will buy that.” Really, they’re buying the same thing at a slightly higher price.

I love that you brought up natural flavor. That brings up one of my favorite least favorite ingredients, which is natural flavor can be anything. There is one in particular called castoreum, which you will never see on a label unless you’re apparently buying some weird liquor over in Scandinavia somewhere. They proudly announce it’s castoreum liqueur. It is made of the anal gland secretions of beavers.

Dr. Eric: 

Wow. 

Mira:

Here’s the thing. At a conference, I was once sharing about this. Someone raised their hand and asked, “Is it bad for you?” It apparently turns out that it’s not harmful for you, and there are homeopathic remedies that do use castoreum, which is fine. 

My objection is that they are trying to hide it, so they hide it under “natural flavor” or “natural vanilla flavor.” There is not a vast amount of castoreum in the food supply at this point because we no longer harvest beavers for the fur trade. Or I don’t think we harvest as many as we used to. I believe they no longer put it in cigarettes although you should still stop smoking. I object to the fact that they’re trying to hide it. They’re not telling you what’s in there. 

When they are using colors, they may say “natural color,” and they may not tell you that it’s coming from bugs, for example. Cochineal comes from bugs. They try to use those words to disguise what they’re doing because they know that consumers would be upset about it.

Dr. Eric: 

As far as ingredients derived from bugs, does confectioner’s sugar also-? 

Mira: 

Not confectioner’s sugar, but shellac, confectioner’s glaze. For example, the shiny coating on candies, jellybeans is often made from shellac. That comes from the lac bug. 

At one point, Starbucks had a drink, a strawberry frappuccino that came in a bottle. They used to make it with plant-based colors. They switched to carmine or cochineal, which comes from the bugs. This being the age of the internet, somebody found out and twigged. The world was up in arms, 1) because vegans don’t eat bugs. There are some people who for religious reasons don’t eat bugs, so they were really upset that they didn’t know it was a bug ingredient. There was such an outcry that Starbucks gave up and went back to plants.

I’m not saying that bugs are bad for you. I’m just saying I want to know what’s in my food. If you choose to eat bugs, and many cultures do, that’s a huge thing, that’s totally fine. I just want to know what’s in my food. That is why you have to read the label. 

Dr. Eric: 

I agree. Now, there are protein powders made of crickets. As long as the person knows that that’s what they’re adding to their smoothie, or however they’re consuming it. It’s another thing when the person doesn’t know that they’re eating bugs. I definitely agree.

Let’s talk more about some of the more common ingredients to be concerned about. I know I asked you if you could tie at least some of them into autoimmunity since a large part of the listener base has either Graves’ or Hashimoto’s. If you have one autoimmune condition, you are more likely to have more than one, like your history. I’m sure others will have other autoimmune conditions in addition to an autoimmune thyroid condition.

Mira: 

For the ones that are highly tied to autoimmunity, we’ll come back to that in a minute. I will say in general, I think most people are aware at this point that anything artificial should be avoided: artificial flavors, colors, sweeteners. Those are all really harmful to the body, whether you have an autoimmune disorder or not. They’re just straight up not good for us.

One of the other things a lot of people are not aware of is plant gums and carrageenan, which is often included in that category. The reason I encourage people to be mindful of those is because of the impact they can have on the gut. Carrageenan is not a good choice. It comes from seaweed. It can be very disruptive and overwhelming to gut function and has been linked to causing ulcerative colitis-like symptoms. We don’t want carrageenan. Unfortunately, it appears in almost every aisle of the grocery store. You have to read the label to watch out for that.

Plant gums are not necessarily harmful. They’re often used as thickeners or emulsifiers. I appreciate that food producers are trying to find plant-based alternatives for that. The challenge comes in when you look at how much you are getting. There is no number that says, “It’s this many parts per million or this much of these plant gums,” but if you’re buying alternative dairy and other products that are thickened with plant gums, maybe a soup, all of a sudden, you start to get a lot of it. Frozen confections have it as well. It’s just a matter of being aware of what’s on the label. 

If you are someone who is struggling with some gut health issues, or maybe you notice every now and then, out of the blue, you start having tummy troubles, you may want to look at what you’re eating and read those packages to see if there is a common thread. My practice tends to focus primarily on gut health. For most of my clients, we find there is a lot of correlation between the food gums. 

Dr. Eric: 

For those who need a little bit more clarification, you’re talking about xanthan gum, guar gum. 

Mira: 

Yes, xanthan gum, guar gum, locust bean gum.  

Dr. Eric: 

Some might not know what plant gums mean. 

Mira: 

Sure. The other one that I think people need to read the label for to be mindful of is sugar, only because it appears in so many things. Food producers have realized that people are starting to read the label a little bit more, which is great. I’m really happy to see that. People have also learned that on the ingredient panel, products are listed in order of volume. The more of something there is, the higher up on the list it is. 

In order to make sure that sugar is not the #1 ingredient, they start putting lots of different kinds of sugar in there. They may have rice brand syrup, maltodextrin, sugar, agave nectar, all kinds of things. You want to read the label. 

Try to keep your sugar intake as low as you can because too much sugar does overwhelm the gut. Of course, sugar, salt, unhealthy fats, gluten are all highly correlated with autoimmune health challenges. 

If we can talk about some of the less common things that people need to watch out for, I would like to point out that anybody listening at this point probably has a page full of notes. This is really overwhelming. This is not a one and done process. My goal today is to share with you about some ingredients that are not a great choice for health, much less autoimmune health, and to help people recognize those, so that one at a time, you can begin to knock those out of your diet. 

When you look at the list at the end of this call, and you see some of these things, and you start reading labels, “I can look at lowering how much guar gum I have in my diet. I can look at knocking out food colors. I can look at reducing sugars. I can look at some of these other ingredients.” One at a time. Just approach one thing at a time. Everything you’re doing now is one thing more than you were doing yesterday. Over time, it will all add up to be a really big impact.

Dr. Eric: 

Before you go over those ingredients, getting back to sugar, can I ask you about your thoughts on some of the more natural alternatives like stevia or monkfruit? There is also allulose. 

Mira: 

Sugar is actually a huge category. We could talk for a whole hour about that. In a nutshell, I will say the sugars that I definitely want people not to include in their diet—hopefully at this point everyone knows high fructose corn syrup is really bad for you. The other one is agave nectar. Not a great choice. It is a diet/diabetes-friendly sweetener because it is low glycemic. The challenge is high fructose corn syrup is only 55% fructose by volume, and it’s bad for your liver and our system. Agave nectar, the way it’s processed in our culture, is 70% fructose by volume. It’s even more fructose, which is more challenging for your liver.

The non-caloric sweeteners like monkfruit or stevia, I know a lot of people like them because we just love sugar. We are programmed to seek it out. We want to have our cake and not have the calories. There are studies that show that they can be a better option than artificial sweeteners. However, some people are very sensitive to them. Excessive consumption can impact the gut microbiome. If you are going to enjoy stevia or monkfruit, you still want to have those in moderation. 

When it comes to allulose, I will share that I am not a fan. Part of the challenge with allulose is it is naturally occurring. It shows up in things like dates, raisins, and wheats, but in very minute amounts. We have now gotten to a point where we have learned how to process it, so that we can get a lot of it. Many of my gut health clients find that allulose does not agree with their system. They wind up having bloating or diarrhea or other health issues. I’m not a fan. 

Dr. Eric: 

If you could move on to those other ingredients because I know you’re ready to dive into more.

Mira: 

Often, if you read the ingredient label—which I really hope people do, and if you don’t, I would love to encourage you to start—there are things on there that we don’t know, and our human habit is to skip over them. We go to the things we do know and ignore the things we don’t know. 

When it comes to autoimmune health, there are a couple of ingredients that are really challenging. We definitely want to make sure we are avoiding those. They are nanoparticles, which means they are very small. Studies have shown they can have a major impact on the body as a whole, but they also can very heavily impact our immune system. We want to make sure we are avoiding them. 

They are titanium dioxide. It’s a whitening agent. It appears in a lot of gums and baked goods. It also appears in toothpaste. It’s kind of weird how they use titanium dioxide as a whitener because we somehow have been conditioned to believe that things need to be bright white. Titanium dioxide does that for us. It’s not a good choice for us, so we shouldn’t be eating it.

Another one is silicone dioxide. That’s an anti-caking agent. They use that, so things don’t get clumpy and stick together. It’s for the manufacturing process. We want to read the label and avoid that.

The third non-traditional ingredient that I really encourage people to avoid is- The name is so long that they abbreviate it on the label. The name is tert-Butylhydroquinone. On the label, you will see it as TBHQ, all capital letters. It’s a preservative. There are studies showing that it has a really huge impact on our immune health. It appears in so many products. 

This is a really great point to share that the FDA does require immunotoxicity testing. When things come to market, they test them to show if they have an immunological response. So many of the ingredients that we look at today—and I include titanium dioxide, silicone dioxide, and TBHQ in this category—they were approved decades ago. Nobody goes back and redoes that FDA approval process. It’s very rare. It was a major win when the FDA decided that trans fats were no longer generally recognized as safe. Normally, once something is approved, it just rides forever. As a consumer, you really need to be proactive about the choices that you’re making.

Dr. Eric: 

That’s really scary when you think about the ingredients that many of these foods have. I appreciate you sharing some of them. Titanium dioxide is also not just in foods, but a number of supplement companies will include it. We have to look into other ingredients. As you mentioned, toothpaste. 

A lot of people are familiar with gluten as being harmful when it comes to the gut. A number of reasons why not just people with autoimmunity but people with non-autoimmune conditions should also avoid gluten.

One question someone asked me recently: Hidden sources of gluten. I know there are hidden sources of corn, like maltodextrin and ascorbic acid and others. Are there any hidden sources of gluten? Or is it pretty obvious? If it has wheat, we know it has gluten. If it has barley, rye, it has gluten. Oats are commonly cross contaminated with gluten. Are there any hidden ingredients, where it might indicate that there is gluten in a certain food, but the person might not know it unless they are really familiar with the label? 

Mira: 

The biggest way that gluten can be hidden in food, especially if it’s from a non-wheat source. Wheat is one of the top nine allergens. If there is any wheat in a product, they have to disclose it. If it’s run on equipment that also runs wheat, they have to disclose that. 

For the other top gluten-containing grains, if they use the word “starch,” that means it can come from anything. Often, it does tend to come from gluten, unless they’re saying a specific source. If they say “tapioca starch,” that’s different. They could say “modified food starch” for example. That can come from just about anything. That really is the key word that you want to watch out for. 

I will share that at first, you have all this information and are trying to watch out for all of these ingredients. Like I said, one at a time please. Nobody wants you to spend 10 hours at the grocery store trying to shop. 

Let’s say there is a food your family likes, and it has modified food starch in it. Usually, they tend to have things grouped together by type. I encourage you to take the time and look through some of the others and see if you can find something that doesn’t have that ingredient in it, so you can begin to make that transition one product at a time to those things that are going to represent a better choice for you and your family.

Dr. Eric: 

When it comes to organic produce, I assume you’re safe if you’re buying organic whole foods. For example, let’s say you’re buying gluten-free, organic cookies. Is it safe to say there are still potentially less desirable ingredients? Maybe not the artificial colorings or flavors. What are your thoughts on packaged foods that give the perception of being healthier, whether it’s cookies or cereals? 

Going back to what you said earlier, it might not be 100% organic. But even if it is certified organic, is it safe? It’s probably safer than other foods, like getting Chips Ahoy or Nabisco. There are still ingredients that people should be concerned about, right? 

Mira: 

Great question. Certified organic means that it is typically, depending on what it is, they can be 90% organic and made with organic ingredients, or it can be 100% organic, and they have the full certification with the stamp. 

I will lead with I love cookies. This is not a bash against cookies. A 100% organic, gluten-free cookie is a treat, and I love them. I think one of the challenges is we have to remember that it’s still a treat. It doesn’t matter if it’s gluten-free or organic. It’s still going to be sugar and processed food. Be mindful of that.

The example I like to use is years ago, this was during the whole South Beach phase, where they came up with these Snackwell cookies. They were fat-free cookies. People were like, “Ooh, fat-free cookies, I can eat all the cookies I want,” and they eat a whole sleeve. It’s still a whole sleeve of cookies. It doesn’t matter what it says on the label. 

If you happen to find a 100% organic, clean ingredient, gluten-free, delicious cookie that you love, I invite you to enjoy it, savor it, and remember it’s still a treat. 

Dr. Eric: 

I agree. I’m a cookie person, too, not that I eat cookies all the time, but I love a good organic, gluten-free cookie. 

I wanted to talk to you about Trader Joe’s, as well as some other grocery stores like Whole Foods. There is no perfect place. One thing that’s irked me with Trader Joe’s, and I don’t do all my shopping at Trader Joe’s, but with the GMOs, they claim on their website that they don’t use genetically modified organisms in their products. Yet they won’t label their products as non-GMO. We’re taking their word for it. What are your thoughts on something like this? It shouldn’t annoy me because I won’t buy what I’m not sure is not modified, but it would still be nice. 

Mira: 

I shop at Trader Joe’s. However, there is a limited amount of things that I buy. I try to be as careful as I can about it. 

Trader Joe’s’ big thing is almost everything in that store is Trader Joe’s brand, which means they are private labeling other companies’ products. They’re not manufacturing them themselves. They’re taking somebody else, going, “We like this product and want you to package it for us.” That’s common. Grocery stores do it all the time. WalMart has Great Value. At Whole Foods, it’s 365. Whatever the private label is, the grocery store is not manufacturing that. They are just private labeling it, so they can sell it for less money because it’s their in-house brand.

Many of the products Trader Joe’s sells may have that GMO Project Verified label on it. My understanding is when Trader Joe’s private labels, they’re not allowed to use that non-GMO label. They would have to pay for their own labeling. I don’t think they want to do that because that costs money, and those costs would get passed onto the consumer. They would rather sell for less. 

I know they say they verify their own products, and they do all of the due diligence to make sure that there are no genetically modified ingredients. However, I have seen more than once where people have asked for the documentation. These are investigative journalists or other places, who have asked Trader Joe’s to share their documentation, and they say, “Nope, that’s proprietary, private information we don’t share.” I really don’t know what to think about that. I would think that if they were doing their due diligence, and they could verify that everything was non-GMO in there, they would be happy to share that. That’s what consumers are looking for these days. It’s a little bit misleading on their part to say, “We have done our due diligence, and we’re satisfied with the level of what’s in there. We’re not going to tell you though.” 

You have to be careful about what you purchase there. Make the right choices for you. I don’t remember off the top of my head, but there are certain products where  I am pretty sure I know who the original manufacturer is, and I know they’re non-GMO. I am comfortable buying it. If I don’t know, I don’t buy it. 

Dr. Eric: 

The goal wasn’t to pick on Trader Joe’s. Like you, I do some of my shopping at Trader Joe’s. They say one thing on their website, yet, as you said, they’re not willing to disclose anything. I guess that’s a good reason, as far as the documentation piece, but if they are private labeling and are not allowed to put on the products that it’s GMO-free, I can understand that. 

Mira: 

I love that you pointed out no grocery store is perfect. I shop at a number of grocery stores because like everybody else, I have to buy groceries. No one grocery store is going to have everything you need. For a long time, Whole Foods had this halo of perfect ingredients. Not everything in there is perfect either. They may have more than average, but they still are going to have some things that are not a great choice. 

This is where learning how to read the label and how to make choices that represent what you want to consume for yourself and your family, you vote with your wallet. That gives you the ultimate control. 

Dr. Eric: 

I agree. I do a good amount of my shopping at Whole Foods, but you’re right. There are plenty of products that have unhealthy oils or are not gluten-free. Wherever you go, you need to be an expert in reading ingredients, which is where you come into play, and your book and website. I’m so happy we’re having this conversation. Is there anything that you wanted to talk about? 

One thing which leads us to your website and your book: How can people become better educated when it comes to reading labels? What action can they take other than listening to this conversation? What resources do you have other than your book? 

Mira: 

Obviously, I love my book, and I really encourage people to have it. It’s a great resource because it teaches you how to read the label. It has seven simple rules for healthy grocery shopping. Then we break down different sections of the grocery store to help you learn. This is not meant to be an all at once process. I didn’t get here overnight. I don’t expect anybody listening to this to do that either. If you make a few changes as you go along, six months down the road, you will look back and go, “Whoa, look at how far we’ve come.”

If you’re already making changes, then this can help you take it to the next level and go even deeper into that. 

The book is great because it’s available on Amazon. It’s easy to get. 

I also have a newsletter called Food News You Can Use. Every Tuesday, my newsletter comes out and shares more stupid stuff that they do to our food. I shouldn’t say that. It’s mostly letting you know what is coming, what food producers are doing, or what to watch out for, but when somebody has a good move, they’ve made a change that I approve of, I do share good news as well. It’s basically helping people understand the state of food. 

The easiest way to get the newsletter is to go to TheIngredientGuru.com, and it’s on the front page to sign up. 

Dr. Eric: 

Would a good starting point be to purchase your book, and then also sign up for your newsletter? 

Mira: 

Yep, that is a great starting point. One of the other things I really want to encourage families to do, and this comes out of my own personal experience, is it is important that you not make these decisions in isolation. If you’re going to make changes for your family, in terms of what they’re eating, help them understand why we’re making these changes. Get their buy-in. 

With my family, I was like, “This is what we’re doing.” There were a lot of arguments. I could have saved myself so much headache if I had simply said, “Here are three other options. Let’s try all of these and see which one we like better.” Or, “This is why we’re making this choice.” At the very beginning, I didn’t know. 

Truthfully, I was fighting for my life. I was so ill, I was living my life on the sofa. I couldn’t function. It was martial law in the kitchen in my house. But that is not the way that it needs to be. I really don’t want anybody else to have to go through that. If you can get buy-in from your family, everybody will be healthier, and your kids will grow up to be healthier adults and raise a healthier next generation. They’re going to know to avoid all of these things that are non-nutritive, negative ingredients. 

Dr. Eric: 

I’m glad you mentioned that. I want to expand on that as far as when someone is healing, I definitely recommend for them to be super strict. When someone is in your situation or my situation, in a state of wellness, is it safe to say that occasional exposure to some of these ingredients—I guess it depends on the ingredient, but let’s say canola oil as an example. On a daily basis, I’m sure you’re pretty good. Do you indulge every now and then? Do you follow an 80/20 rule or a 90/10 rule? If you go to a party or a wedding, do you ever stray, or do you bring your own food? When you go on vacation, do you always eat in and not go to a restaurant? I guess the question is: How can people deviate, especially those with autoimmune conditions, once they have restored their health? If so, what guidelines do you typically recommend? Or what do you follow? 

Mira: 

That is such a great question. I work with my clients on this a lot. I believe the home should be as clean as possible. You are the one who is in ultimate control over that. Try really hard not to have anything that is not within your guidelines. 

When we do go out to eat, we do go over to friends’ houses or family gatherings. When I am in those situations, I don’t sit there and pick apart, “Was this made with whatever?” Nobody wants that. I recognize that the food is made with love, and I am consuming it from a healthy standpoint. 

There are certain things that I will not do. I still don’t eat gluten. I still look out for certain ingredients, like if I am at a party, and someone has M&Ms, I won’t eat those. If it’s clearly identified as one of the ingredients that I definitely know I don’t want, I will avoid that. I feel like that’s a pretty reasonable way to live in the everyday world. 

Your home is your castle, and it is as close to complete in terms of ingredient sovereignty as you can get. Outside the home, what are your guidelines? I know for example, some people can’t do dairy. If you can’t do dairy, why are you going to do that just because you’re away from home? You can still watch out for it. Just be mindful. 

Dr. Eric: 

Is there anything else you wanted to chat about? Anything that I didn’t ask you that I should have asked you? 

Mira: 

I really want to encourage people to start where you are. Start here. Start with one thing, whether it’s avoiding some of the nanoparticles that we talked about, or avoiding the artificials, or watching out for how much sugar is in your food because food producers hide sugar in everything. Pick that one thing, and you’ll be on your way to making healthy choices. It is totally achievable. It’s not a mystery. It just takes focus and practice. It’s not about perfection; it’s about progress. Practice helps progress. 

Dr. Eric: 

Couldn’t agree more. Definitely check out Mira’s book The Pantry Principle. Can you let them know about your website again? 

Mira: 

Yes, my website is TheIngredientGuru.com. 

Dr. Eric: 

Besides your newsletter, you have an option to sign up for other things, too? 

Mira: 

I do. I also have a new membership, which is really wonderful. We call it The Kitchen Table. As part of The Kitchen Table, you get access to all of my programs. I have a Preparedness Pantry Masterclass, a 21-day nutrition reset. I also have a whole bunch of e-books in there. All of my library. There is more coming. We also have three live calls a month that people can connect and learn more and build a community together. 

Dr. Eric: 

This was a wonderful conversation on the different ingredients. I learned a lot, and I’m sure the listeners did as well. 

Mira: 

Thanks so much for having me on. It was really lovely to chat with you.

Recently I interviewed Dr. Betty Murray, and we talked about the world of hormones, discussing everything from progesterone and its role in women’s health to postpartum thyroiditis. If you would prefer to listen the interview you can access it by Clicking Here.

Dr. Eric Osansky:

I am very excited to chat with today’s guest, Betty Murray. We are going to be talking about hormones with a focus on progesterone, and we will also be talking about post-partum thyroiditis a little bit.

I am going to dive into Betty’s bio: She is a nutrition expert, Ph. D., researcher, certified functional medicine practitioner, and speaker. Betty helps women over 40 harness their hormones to lose weight, optimize sleep, restore energy, and thrive. During her research for her Ph. D., Betty made several key discoveries that led to hormone and metabolic imbalances that plague women over 40. Restoring balance to these key metabolic and hormone pathways is the basis of her hormone reset program. This program has helped her, and hundreds of clients lose weight easily, reduce hot flashes, restore sleep, and turn up their energy without living on a diet of deprivation.

She is also the host of The Menopause Mastery podcast and the founder and CEO of Living Well Dallas Functional Medicine Center. She is a frequently featured nutrition expert on FOX News Broadcasting, CW 33, NBC, and CBS. Thank you so much for joining us, Betty.  

Dr. Betty Murray:

Thank you for having me.

Dr. Eric:

You’re welcome. I’m excited to chat with you about progesterone. Before we do that, let’s get a little bit more into your background. What led to you starting to talk about hormones? It sounds like you had your own hormone journey.

Dr. Betty:

I would love to say I didn’t. The truth is, especially for women, none of us get a pass on menopause. It’s going to happen whether we like it or not. My hormone journey actually started after my functional medicine journey. I really came to the functional medicine and functional nutrition realm from my own diagnosis of colitis and later on Celiac. It was me searching for ways to fix those autoimmune conditions and also repair my digestive disorder. I fell in love with it and obviously found a way to take care of that and also get rid of my symptoms. I can’t call it “cured,” but I have been without symptoms for over 18 years.

When I entered into the very last part of my 30s, and my early 40s in particular, it was like something radically changed in my health. Everything that had worked for me before stopped working. I started getting acne on my chin. I started gaining weight despite eating a low carb, high protein diet; doing high intensity interval exercise; having adequate rest periods. All of those things that we tell everybody, particularly people in my profession, to do.

It led me on this journey. I was diagnosed as hypothyroid. I am not actually Hashimoto’s. I have subclinical conversion issues. I was put on thyroid medication. We played with that for a long time, trying to figure out what was going on. I was told that I had all of these different problems. “Maybe you have adrenal fatigue. Maybe you have this or that.”

Basically, my entire 40s, I felt like I was in this endless fight with my hormones. It actually was what led me back for my Ph. D. I was also having all the other things you associate with perimenopause: PMS, mood swings, sleep problems, heavy periods, too frequent periods. When I got into that Ph. D. program, I really started digging and looking at the metabolic effect of these hormones, not the stuff everybody was talking about, but the things that aren’t being talked about, what’s happening inside the powerhouses of your cells and other things. I was able to reverse a lot of those symptoms as I went into menopause. I can say now at 53, going on 54, I feel better than I did at 35 and have a better harness on my hormones.

There is so much that has been missing in the medical community. Anybody that listens to my podcast knows I am pretty angry about the gaslighting of women’s health and the prepared ignorance of let’s not talk about what’s really going to happen in this perimenopausal season to menopause. For some women, that starts in their 30s because that’s where you start to see fertility challenges. We don’t talk a lot about what’s happening.

That’s why I’m on this soapbox now. My transition into menopause started in my late 30s and took over a decade, and it was really uncomfortable. I was already an expert in a lot of these things. I hate to say it, but it’s because I had such a horrible perimenopause that I’m here today talking about hormones.

Dr. Eric:

That’s common, but common isn’t normal. When women have these extreme symptoms like hot flashes and night sweats, a lot of people conclude, “It’s normal. It’s perimenopause, post-menopause.” Your goal is to help women not have those symptoms; even though they’re very common, they aren’t normal.

Dr. Betty:

Right. That’s true.

Dr. Eric:

Let’s dive into progesterone and talk about why. If you could discuss why so many women have, I guess it’s not only progesterone deficiencies, but hormone deficiencies overall, with an emphasis on progesterone.

Dr. Betty:

Certainly. All of our hormones are like a symphony. In a symphony, you will have the director of the show who will decide what the ambiance is of the actual experience. What experience do they want to have? That is your hypothalamus.

Then you have your pituitary. That’s in the brain. The pituitary is the conductor. It will talk to the symphony and tell the wind section what it needs to play, the brass section to play what it needs to play, and the percussion to do what they need to do.

The hypothalamus and the pituitary are constantly getting information not only from what we think, what we eat, what we do, but from our senses, the chemicals we get exposed to. I think a lot of the dysregulation we see comes from this onslaught of what’s happening at the pituitary and hypothalamus. Our environment is so much more toxic, and there is so much more going on today than there was even 50 years ago.

But what’s really happening is the downstream effect. When you look at those different parts of our endocrine system, we have our thyroid, our adrenal glands, our ovaries that produce our sex hormones, and we even have the pancreas that’s producing insulin. Those are all the different parts of that symphony.

The truth is, I like to look at it this way. My research bears this out. The most primary hormones that get precedent over everything else outside of your metabolic hormones like insulin, because we have to be able to shuttle glucose into our cells, and that’s what insulin does, or we wouldn’t survive.

When you step outside of that very basic need, the adrenals are your canary. They are helping your body understand: Are you under stress or not? Are you in fear or flight? Do you need to fight for your life?

When we look at our sex hormones, our sex hormones are luxuries. Progesterone and estrogen, they’re for when the world is safe and happy, and procreation and continuing the species is awesome. If our adrenals are constantly sending out this gigantic stress response, the world’s not safe, I’m starving on the Serengeti, it will alter those sex hormones.

The big thing that people need to know is that all of these hormones play together. Unfortunately, particularly in the conventional world, they get parsed out into these individual hormones. My endocrinologist only does thyroid. My gynecologist will help me with my sex hormones. I gotta break it to you, they’re a surgeon, not a hormone expert, in most cases. We don’t look at them as this grouping of an orchestra that are playing together.

When we look at the sex hormones, it really is the combination between our three different estrogens that fluctuate throughout the course of the month and a pituitary hormone that instructs the ovaries to get ready, pop the egg out, shoot it out so that it can end up in the fallopian tube, and hopefully by the time it gets to your uterus, we get implantation because we have a combination of the sperm and egg. Progesterone helps prepare the uterus for implantation for growth of the fetus.

It’s that combination of those hormones that fluctuate throughout our month that make up the female hormonal cycle. For most people, it’s somewhere between 24-28 days, up until about 34ish would be a normal cycle. Some people are longer, and some people are shorter. We can get into why that may be.

Progesterone is a really important hormone for fertility. At a minimum, if we do not have enough progesterone, the uterine lining is not prepared to carry a fetus. It is more likely that we will have miscarriage, for instance, as one of the major things.

Dr. Eric:

I’m glad you mentioned the hypothalamus and pituitary because I commonly say that you need to have healthy adrenals in order to have healthy sex hormones. Same thing with the thyroid. Even though a lot of cases are autoimmune, you still have that communication, the HPA axis, and the HPT (hypothalamic pituitary thyroid) and HPG axis. It sounds like that’s one of the areas you focus on when it comes to improving health of the hormones as well, is making sure the person does have healthy adrenals.

Dr. Betty:

Absolutely. The adrenals are responsible for the vast majority of progesterone production. We do get some from the ovaries. In my case, my ovaries are gone. They have petered out. I don’t have any. It would just be the adrenals.

That peripheral adrenal progesterone production, the adrenals make progesterone. That can be pulled through a pathway to make cortisol. If I’m under stress, and my body’s depending mostly on that adrenal production of progesterone, I may actually be using it as substrate to make cortisol to continue that stress response.

I don’t work specifically in fertility, but I have helped lots of people get pregnant. My populations skew a little bit older, not that I haven’t done it. When I have worked with women who are struggling to get pregnant, who have no major definable problems with egg quality and other things, nine times out of ten, it’s probably because they are so stressed, and the concept of trying to get pregnant is stressing them out, that they are probably making their own progesterone somewhat deficient.

If we just let up off the wheel a little bit and let go, I always tell them, “I need you to go on vacation. Chill out. Play around with each other like rabbits. Come home.” Chances are, we might be lucky, especially if it’s around that ovulation time period. We may be shortchanging our progesterone just because we have some of that substrate from the adrenals being used to make cortisol.

Dr. Eric:

You alluded earlier that doctors have their own focuses, and they never will talk about adrenals when it comes to problems with the sex hormones. It’s great that there are practitioners like yourself and myself. As you mentioned, the body will always prioritize cortisol over the sex hormones. If someone’s in a chronically stressed state, there really is no way around that. You could take bioidentical hormones, but that’s not fixing the problem. There is a time and place for bioidentical hormones. I don’t know what your perspective is on that. I’m not against them. But it frustrates me that when that’s all they do. You go to someone who prescribes bioidentical hormones, and they don’t do anything from a diet and lifestyle perspective; all they do is give the hormones.

Dr. Betty:

There has been an explosion of doctors who have their toes in the water of maybe looking at things slightly more holistically in most positions. Obviously, I am a Ph. D, not an M.D. D.O., or N.D. That’s the beauty of my world. I will just talk about the research. What does it mean? How does it apply to you? I have no vested interest because I am not prescribing. But I have clinician prescribers in my office who work with me.

I think they have their place, but you will never get really good physiological function if you are just throwing hormones in, and you don’t correct some of those underlying diet and lifestyle pieces that will keep driving that adrenal function. Believe me, I was the first to go, “I’ll sleep when I’m dead. I want to find a pill to make up for what I don’t want to do because I’m a type A, FOMO person.” I just want to do more. It’s my nature.

The truth is, I protect my sleep like nobody’s business. I make sure I relax and meditate and exercise appropriately because that is what is keeping me young as I age. We have to do those other pieces. Hormones are part of it, but they aren’t the only part of it.

Also in my case, I was given all kinds of hormones. I was still 35 pounds overweight as a practicing nutritionist and ex-body builder. Obviously, if it was just a hormone problem, that would have fixed it, and it wasn’t.

Dr. Eric:

You took bioidentical hormones in the past?

Dr. Betty:

Oh yeah. In a complete disclosure, I am menopausal now, and I am absolutely on bioidentical hormones now. Throwing in thyroid medication and progesterone because it was obvious that I was estrogen-dominant, it helped a little bit, but it wasn’t correcting some of the underlying damage that had really happened. It was a pick apart treatment process that didn’t work very well.

Dr. Eric:

You’re on bioidentical hormones now, and you were in the past. The difference is in the past, that’s all you were doing, and you weren’t doing anything to improve your health otherwise, or at least optimize your health. You have been doing this for quite a while.

What are some of the common symptoms of progesterone deficiency?

Dr. Betty:

For a lot of women, this can start even in their 30s. The first thing is, like we were talking about fertility, if someone has infertility issues, there is a high probability it’s a low progesterone level in the second half of the cycle. That’s an easy thing to look at. Depending on who we are genetically, we may not make very much. There are metabolic disorders like polycystic ovarian syndrome (PCOS) that is defined by a lack of progesterone production because of problems with the pituitary.

When we look at the symptoms, I would say the big ones that start to show up are things like sleep. Progesterone has a powerful effect for one of the receptors in our brain for a neurotransmitter called GABA. GABA is our major anti-anxiety neurotransmitter. It’s what also helps keep us asleep. Often, as progesterone levels decline, the sleep starts to get pretty sketchy. That was a significant problem for me. My sleep was very sketchy. Insomnia, interrupted sleep, that would absolutely be one of the symptoms.

Then you can look at some of the other things. A lot of the other symptoms can be things like fibroids, fibrocystic breast disease, heavy periods, clotty periods, periods that become more frequent. Anything that has to do with abnormal periods can be part of that.

If you look at even mood issues, estrogen and progesterone, this is where you start to get into a sketchy game. Either one of them being way too high relative to the other or way too low relative to the other, you can also see some pretty significant mood issues. If someone gets to the second half of their cycle, let’s say the 10 days before their period, and they’re raging mad, irritable, weepy, angry, all of those things, it may very well be because progesterone is deficient.

You can even get the acne, particularly along the cheek line and the chin, as a sign of abnormal hormones and relative estrogen dominance relative to progesterone. Those are some very basic, easy symptoms that could be a sign something is off.

Dr. Eric:

Sticking on the topic of estrogen. Talk about both progesterone and estrogen. If someone has too much estrogen, that could be considered an estrogen dominant condition. Even if they have normal estrogen but low progesterone, that also is considered estrogen dominance as well, correct?

Dr. Betty:

Exactly. It really is the relative relationship between these hormones that sets up a lot of those symptoms. When they get wildly out of balance to each other, it’s almost natural. Natural isn’t ideal, but it’s almost natural for most women to experience some of that as they get into that menopausal timeline as they start moving toward menopause. Progesterone declines long before estrogen does.  

Dr. Eric:

Is there any concerns with too much progesterone, which I assume doesn’t really happen unless someone is taking progesterone? There are concerns if someone has excess estrogen. If someone takes a progesterone cream, and they’re taking more than they need to take, is there any concern with that?

Dr. Betty:

When you look at the studies out there, we don’t generally see a lot of occasions with a wild increase of progesterone relative to estrogen. When we get into the scenario where progesterone levels might be problematic, could be things like post-partum depression. Progesterone levels, when we’re pregnant, particularly those last two trimesters, they’re off the chart. If progesterone is way too high, you will see things like water retention.

I have not been pregnant—I am child free—but anyone who has been pregnant, when they get to the last half of their pregnancy, they will feel like they are water-logged. Excess progesterone can cause edemas, water retention, things like that. If somebody was supplementing or had a scenario where their progesterone was peaking more than their estrogen, they may get more water retention, fluid retention.

If we look at the overall mood scenario, PMDD, which is a much more severe form of PMS, it’s basically premenstrual disorder. It is a diagnosis. It is a label. But it is when the second half of the cycle results in some pretty significant psychological problems. It has been implicated in women doing acts of violence. There is some literature out there showing that it may be a brain reaction to that wild change in progesterone. The brain is responding adversely to it. We don’t know for sure, but it seems like it may be that. Post-partum and PMDD may be associated with these wild shifts in progesterone levels.

If we look at a woman supplementing with progesterone, and maybe she is getting more than what she needs, usually you will get weird things like breast swelling or tenderness. If you have too little, you can also have that. You can track it to the intake.

What’s interesting is when you look at the supplementation with progesterone, there is good literature out there showing that it’s quite effective as a sleep aid, particularly in women much past menopause. It has positive effects, too.

Dr. Eric:

When it comes to determining how much progesterone someone would need, that’s where testing comes into play. That’s where I want to talk about hormone testing, focusing on progesterone, but feel free to talk about some of the other hormones. Do you have a favorite test, whether it’s blood testing or dried urine testing? These days, a lot of practitioners are doing that.

Dr. Betty:

There is advantages and drawbacks to all of them. Serum testing is less ideal, for multiple reasons. It’s ideal because it’s easy. You probably will run other labs, so it’s easy to throw them on top. You will blood draw for your metabolic panel or your other things you might be looking at.

When you’re looking at sex hormones in blood, all our hormones have binding proteins. Those binding proteins, think of them as a taxicab that pick up the hormone, drive it around, and drop it off at whatever target place it needs to do its job. When you look in blood, you can’t distinguish between how many of your hormones are in the car and how many are outside. You could falsely be dosing inappropriately because you can’t tell how many are free. The free hormone is the important hormone. That’s where it’s available to do its own work. Those binding globulins can tie them up. It’s a less favorable one.

The other thing is progesterone is very fast from production to tissue, so it basically gets made and used very quickly. You could easily dose improperly if you are looking at blood alone. But sometimes, we do what I call quick and dirty bloodwork to see what’s happening. We are already getting a bunch of other things. Especially if insurance might pay for it, it might be worthy to check.

Saliva can show you the free amounts. It’s a pretty good judge of progesterone although it can often project really high salivary levels of progesterone when it may not be that physiologically high. It has some advantages.

Personally, I prefer either the dried urine spot, the Dutch test, or a 24-hour urine test for hormone metabolism. Both of them test the same things, except the dried spot can also give me the cortisol rhythm throughout the day because you are getting multiple tests throughout the day to see what your adrenals are doing.

The reason why hormone testing in urine, I think is advantageous is you’re getting free levels. We are picking up the free levels of the hormones. We can see if it’s adequate or not for age. Is it a physiological range that is known to help things like bone mineral density and osteoporosis and all those other pieces?

We can also see the metabolites. Once we’ve made these hormones, they do their job, and they get sent to the liver to get packaged up to get thrown out. That packaging process is a multi-step process that is driven by our genetics, can be interfered with by toxins, and have some limited capacity potentially in different people. The dried urine test and 24-hour urine test shows us those processes at each step of the way. You can really see once I get my hormone to the liver, can I wrap it in the three different wrappers I need to, so I can throw it out in the trash? Every single one of those steps has to be done in order with the right ingredients at the right time, or you can’t get rid of those hormones.

Those tests are better to judge adequacy and what happens after you use it. I like them. They are obviously more expensive usually than bloodwork. Maybe not. If you’re paying for bloodwork with LabCorps or Quest out of pocket, sometimes those can be very expensive, whereas this test gives us more data.  

Dr. Eric:

I agree. There is a lot of different advantages to doing a test like the Dutch test. One thing I like is when looking at post-menopausal women, it gives that post-menopausal range. If you do a blood test, and someone’s progesterone is 0, the lab considers it to be perfectly fine.

Dr. Betty:

I know.

Dr. Eric:

If progesterone and estrogen levels are nonexistent, it’s okay. The Dutch gives the pre-menopausal range and the post-menopausal range. I like that. For cycling women, there is a cycle mapping opt-in as well, so you can look at it throughout your cycle. I like the Dutch test as well.

You also mentioned the hormone metabolism. When it comes to estrogen, do you see a lot of people with elevated 4-OH and 16-OH metabolites?

Dr. Betty:

Absolutely. I am an open book online. I have played my entire review of my own genetics as a podcast. If anybody wants to know what genetics means, you can listen to my podcast and hear my own personal genetics.

I am heavily mutated in that pathway, so I have two mutations on that CY1P1B1 gene, which for anybody who doesn’t know what that is, that’s a less favorable estrogen metabolism pathway. It makes a toxic metabolite called 4 hydroxy estrone. I am on hormones, but I watch what my hormones are doing by using the Dutch test. I use nutrition to modulate it because I want the positive effects of hormones to keep me healthy in all those other things, but I want to make sure I get them to the trash.

I do see a lot of people with very high levels, particularly of 4 hydroxy, or the propensity to have high levels, and we do a bunch of things to bring them down, myself included. I use myself as a lab rat of one all the time, to see what happens if we do this on this pathway?

Dr. Eric:

I might have to get you back one day to talk about genetics and methylation and all that fun stuff.

Dr. Betty:

Absolutely.  

Dr. Eric:

What are some ways to increase progesterone? Obviously, there is bioidentical hormones, which you’re taking. I want you to talk more about that. One question also when it comes to that is taking it during post-menopause. Do you think that every woman in post-menopause should take hormones? If not, should everyone with a hysterectomy take bioidentical hormones? If you could talk a little bit about the botanicals, herbs such as vitex/ chasteberry.

Dr. Betty:

Sure. I’ll start at the younger end of the spectrum. Let’s say it’s a woman in their late 30s. Maybe they’re like me, and they woke up one day and feel like they’re in puberty again. Something went wrong. In those cases, where maybe their progesterone isn’t peaking quite where it’s supposed to be, because progesterone declines long before estrogen, that is a perfect time to use things like chasteberry, vitex, or vitex dong quai, even things like maca. Those herbs have been shown to modulate some of these pathways and favorably push toward progesterone, relative to estrogen. Sometimes, we can get some improvement in our hormones just by putting some things in there that swing that spectrum a little back toward progesterone. I use those quite a bit in my practice.

Now, as somebody moves into that 40s spectrum, chances are the progesterone is declining pretty quickly. There are some over the counter versions of progesterone that are topical and made from sweet Mexican yams. Most of the time, you’re looking at a biological effect of about a 20mg dose of progesterone with something like that. Those might work a little bit in that very early time period. You might stack that on top of some of the herbals.

As you start to get into the real loss of progesterone, that is where you start getting into prescriptive needs. Progesterone can really be given in two ways that I’ll focus on. It can be given as a cream or an oil, but a topical delivery, and it absorbs very easily subcutaneously. Lots of things absorb through your skin, everything really. When you are starting to get to those doses, most of the prescriptive doses will be 100-200mg.

That can be given orally as well. What’s interesting about oral progesterone is when you give it in a powder form that you have in a capsule, it’s poorly absorbed and utilized. Progesterone, in order for it to be adequately used, it has to be in an micellized form. It has to be micronized. When they micronize that progesterone, they make that fat soluble hormone water soluble, so you can absorb it.

When you look at the clinical studies of the efficacy of a topical progesterone compared to a micronized progesterone orally, the oral works better if sleep is an issue. If a woman can’t sleep, they have insomnia, or it’s really interrupted, my general recommendation is to go to an oral. Oral progesterone has no real concerns with liver metabolism and toxic metabolites.

Estrogen does. That’s what we were talking about before. You don’t really want to take an oral estrogen because it has to go through a first pass through the liver before you can use it.

Years ago, when Premarin was one of the only things available on the market, it has a lot of history of safe use. It really does. I know in the functional medicine community, we are very anti-Premarin. It’s because it’s got 17 different estrogens, and humans only have three. However, there is over 50 years of history, and there is low risk, even with Premarin.

Today, we have a much more eloquent and bioidentical, which means exactly like what our body makes, way to give estrogen. The woman who may need progesterone as they go through their 40s is often going to start needing estrogen somewhere before they get to the end. The cliff dive of menopause. Estrogen is better given topically. There are some utilizations of pellets, which are subcutaneous fat and muscle application, where your body is metabolizing it through the tissues. It’s a more efficient way to give it. Estrogen topically means it’s going to hit your blood supply, get used, and then it ends up in the liver, so it doesn’t go through first pass liver.

I believe personally that regardless of whether a woman has a uterus or not, years ago, doctors would not prescribe any progesterone if a woman had gone through a hysterectomy. They thought progesterone’s only need was to protect the uterus from excess estrogen increasing the lining of the uterus and causing estrogen bleeding. But we now know progesterone has a huge impact on the body and the brain. It’s necessary way beyond the uterus.

I am of the mindset that you replace both. You take them to physiological dose. Not just my hot flashes got better, but you want them to produce their physiological effect, so you get the bone protection, brain protection, heart protection, mood protection, and other things. I believe in doing both.

On the other side of that equation, I also believe women should be on testosterone therapy, even though the FDA has not approved testosterone therapy for women. Every woman listening, we make 3-4x the amount of testosterone on any given day than the highest level of our estrogen at its absolute highest. It is an important hormone for women. It’s just never been looked at because there was an extraordinary male bias in the science and research community that drove everybody to push that hormones were unsafe, and definitely they thought women didn’t need testosterone.

Dr. Eric:

What form should women take?

Dr. Betty:

Same thing. Really topically. Topically or a pellet, something where it’s absorbing through the tissues instead of going through the liver.

Dr. Eric:

You take topical estrogen, topical testosterone, and do you take topical progesterone orally? For progesterone, oral is better for sleep.

Dr. Betty:

Yes.

Dr. Eric:

Okay. I didn’t know that. Does topical progesterone help at all if someone has sleep issues?

Dr. Betty:

It doesn’t seem to be as powerful. Everybody always thinks of progesterone as something for the uterus. It’s to protect the uterus from excess estrogen, or it’s to get the uterus ready for fertility. Progesterone has these effects, like the holding of the receptor for GABA, so it has a calming effect. It also has a calming effect on levels of dopamine and the NMDA receptor in the brain, so it has a modulating mood effect on its own. Progesterone acts a little bit as an analgesic, so it has a painkilling side to it, too. It has all these multifaceted pieces to it that we would benefit from.  

Dr. Eric:

If someone has a hysterectomy, it sounds like in just about all cases, if not all cases, you would recommend all three hormones?

Dr. Betty:

Absolutely. The thing is, you could get things like a little bit of hair loss, but you can get hair loss from too little testosterone and too much testosterone. You can get hair loss from the loss of progesterone and estrogen. That’s where testing, like the Dutch test, comes in. Even if you’re on these hormones, you can see that’s going to happen, and you can put things in to stop it.

I have a tendency for hair loss with testosterone therapy, and if I am not protecting against that based on my genetics. I can put things in like stinging nettle and saw palmetto that push away from the production of a hormone called di-hydro testosterone or DHT, which causes hair loss. There is a lot that can be done to watch and modulate, so we get the best effect of the hormones and reduce the side effects that may be from them.

Dr. Eric:

With perimenopause, if someone is at the beginning stages, I am trying to figure out when it comes to the herbs. Do you use chaste tree or maca or dong quai more in pre-menopause before they hit perimenopause and post-menopause? Or which stage? Do you combine the two bioidentical hormones along with the botanicals?

Dr. Betty:

I definitely use the botanicals in perimenopause, especially somebody who is early on and doesn’t necessarily need hormones. I use them with hormones. Because those herbs shift those hormone pathways a little bit, they have some positive effect on how you detox your estrogens. Often, you can put them together with some of the other nutritional compounds that make it easier for you to get your estrogen down the cleaner pathways.

Foods like the brassica family and broccoli and brussels sprouts and kale. Berries. Even caffeine, which has been vindicated and helps you make cleaner estrogen. Rosemary extract. Thyroxine helps you get a cleaner pathway for estrogen detox. Adding nutrients like that can help also improve the estrogen detox. Indole-3-carbinol, DIM, even citrus bioflavonoids and hops can help you make cleaner estrogen pathways.

Often, you can combine those with those herbs in particularly someone who might be starting on hormone therapy to make that cleaning pathway really clean. Everything is moving in the right direction. I use them all the time, and I use them all the way through menopause.

Dr. Eric:

Very cool. I want to spend a few minutes on postpartum thyroiditis. Before we talk about that, is there anything else I should have asked you about progesterone that I didn’t ask you? I’m sure there is a lot more you could talk about, but anything urgent?

Dr. Betty:

No, I got to hit on the big ones. If every woman listening to this walks away and says, “Huh, maybe I need to explore this because it might be a bigger deal,” especially if you are in the age range where it makes sense to look at it, then I have probably done my job.

Dr. Eric:

Very good. Let’s spend a few minutes on postpartum thyroiditis. I know you have a lot of experience with that. I want you to focus on the management, but also, I don’t know if you want to talk about what postpartum thyroiditis is and how frequently you see it in your practice.

Dr. Betty:

I do see postpartum thyroiditis even though I don’t necessarily work with people on the fertility side. Postpartum thyroiditis is a pregnancy-induced Hashimoto’s with antithyroid peroxidase antibodies. What I have found, and you can probably speak to this as well, is that often, this is a subclinical Hashimoto’s. The antibodies were already present before pregnancy. It’s the hormone changes that radically shift what’s happening in the pregnancy itself, and that’s the ensuing inflammatory response.

I like to think about it this way: When we’re pregnant, one whole side of our immune system takes a nap. Otherwise, if it was paying attention, it would kill the fetus. We have a foreign entity in our body. A lot of it is this inflammatory response of those hormones shifting, the reduction in progesterone, the increase in estrogen relative to it, the turning back on of that immune system, and also the increase in prolactin, because prolactin is immune stimulating. Prolactin is the hormone that brings in breast milk. All of those things are just right for an opportunity for thyroiditis postpartum.

Dr. Eric:

How do you manage it? I know that’s not your focus, but when you do see someone with postpartum thyroiditis, what do you do to help manage the symptoms?

Dr. Betty:

If we look in the research, there is some pretty good research that nutritional selenium, adequate levels of selenium and taking supplemental selenium, both even pre-pregnancy. If somebody is like, “Hey, I know I have antibodies, but I am not fully Hashimoto’s,” or “Maybe I am Hashimoto’s, and I don’t want to have a thyroid storm afterwards,” we can use preventative selenium. If someone is experiencing that, using appropriate selenium from that.

I also look at the usual anti-inflammatory things. Taking your inflammatory foods out. Particularly gluten, even if you aren’t Celiac, even if you’re not sure you’re gluten-sensitive. Remove that immune stimulating food because it does poke holes in our intestinal walls. It can increase this immune response, even if somebody is not Celiac.

I also look at some other really inflammatory foods: sugar, dairy, processed foods. In some people, we might even remove grains for a period of time because they tend to be more immune stimulating.

I often look at the amount of iodine, whether it’s too much or too little. On either side, if it’s too much or too little, you can see an increase in thyroiditis. You may agree or disagree with me, but there has been this prevailing story in functional medicine that was started by a particular physician or researcher. Everyone who had thyroid problems really needed physiological doses of iodine.

I see just as many people who may have thyroiditis, postpartum and/or an uptick in Hashimoto’s antibodies, and some of it is probably being driven by too much iodine. Yes, if we don’t have enough, and our soil is depleted, but chances are, people are eating foods with iodine in it. The relative risk of somebody being severely iodine deficient is probably not what’s being promoted out there. I very much believe in doing an iodine to creatinine ratio, really looking at that and adjusting the diet to increase or decrease that iodine level.

Dr. Eric:

I agree that you want to be cautious with iodine. I was on the iodine bandwagon years ago, just as far as the higher dose of iodine, and realized that that’s not a good idea for a lot of people with Hashimoto’s and Graves’. That being said, if someone is pregnant, they probably want to take a prenatal that has iodine, but just a smaller amount of iodine. You don’t want to go to the other extreme, where you are completely restricting iodine during pregnancy because iodine is important for the development of the fetus, especially the brain.

I agree as far as taking separate iodine supplements during pregnancy. That could be a contributing factor.

That’s good advice with selenium. A lot of people don’t know that they have Hashimoto’s during pregnancy. If someone does know that they have it, they could take the proper precautions. I guess it’s a good argument for anyone to try to eat a healthy anti-inflammatory diet, do things to manage stress.

Also, it sounds like you agree. Some people talk about birth as being a trigger, but it’s almost like the straw that broke the camel’s back. The person had the antibodies prior. It’s not like the birth caused Hashimoto’s. As you know, it takes years for that process to develop.

Anything else that you wanted to talk about with postpartum thyroiditis? I know there is probably not a lot to talk about, but I wanted you to give an overview.

Dr. Betty:

I think we should be testing for these things before we think it’s a problem. You’re going to develop Hashimoto’s over time. It’s not something new.

The other thing people need to realize is when we look at lab reference ranges, and some of them may vary by lab, they didn’t go out and get 1,000 of the healthiest people on the planet and go, “What’s the perfect range?” They picked 1,000 random, probably medical students who were sleep-deprived, sick, and tired, and did theirs. Maybe someone got lucky, and they looked for antibodies. They are just slightly below diagnostic criteria. I always look at those things, and they’re like, “Oh, you’re fine.”

You shouldn’t be creating antibodies to your own body parts. If you are skirting the high side of normal, something’s brewing. If I know that, I can take proactive steps. Just because somebody is in the reference range doesn’t necessarily mean that won’t progress to something later on. It may not, but it may. It’s important to look at it as the N of 1, that person, and what’s the likelihood for that to increase?

Dr. Eric:

I agree. You want to look at the optimal ranges. The problem is that most of the time, they will just do a thyroid panel. Many times, just a TSH. If the TSH is on the higher side, but within the range, they won’t look any further. They should be doing predictive antibody testing, where they look at the thyroid antibodies, especially the thyroid peroxidase and antithyroid globulin antibodies, even if the TSH is within range, because it takes time for that process to develop, where the TSH becomes out of range.

That’s a good point, all pregnant women, the argument for them to have the thyroid panel as well as antibodies. I don’t think it will happen anytime soon in conventional medicine, but in the functional medicine world, probably a good idea.

Where can people find out more about you, Betty?

Dr. Betty:

Obviously, you can listen to Menopause Mastery. I have some men who follow me. Even if you’re not in menopause, we’re talking about this trajectory time period, as these hormones change. You can follow me there.

You can find me at BettyMurray.com. On that website, you can get to a What’s Your Hormone Type quiz. It’s a questionnaire that takes about 2-3 minutes. It will help walk through a bunch of symptoms and help you figure out what hormone imbalance you may have. You can figure out if your adrenals are fried, if your sex hormones are causing a problem, if it’s thyroid, if it’s your metabolic hormones. It helps distinguish that, and it has its own personalized report that comes from your questions.

Dr. Eric:

Check out Betty’s podcast as well as her quiz. Thank you so much for chatting about hormones, especially progesterone, even though you also spoke a good amount about estrogen and a little bit about testosterone, as well as postpartum thyroiditis. You shared a wealth of information, and it was a pleasure having this conversation.

Dr. Betty:

Thank you, Dr. Eric. It was really fun being on.

Recently I interviewed Dr. Rani Banik, and we talked about how to approach nutrition in a way that supports eye health, the key nutrients to be aware of, why you might need an eye health supplement, natural solutions to improve eye health, the significance of gut health, eye health resources you can access. If you would prefer to listen the interview you can access it by Clicking Here.

Dr. Eric Osansky:

I am super excited to chat with today’s guest who is a return guest because we are going to be talking about how to optimize eye health. I have Dr. Rani Banik, who just released a new book called Beyond Carrots. It’s an excellent book; I have read it.

I did interview her in a previous episode, but for those who didn’t listen to that, I am going to go through her bio again. Dr. Rani Banik is America’s integrative eye doctor. She is a Board-certified ophthalmologist and fellowship trained neuroophthalmologist with additional training in integrative and functional medicine. Dr. Rani focuses on the root cause of eye diseases and uses integrative strategies for conditions such as dry eye, thyroid eye disease, macular degeneration, cataracts, glaucoma, and other autoimmune diseases of the visual spectrum. She also has a special interest in migraine with visual symptoms, multiple sclerosis, and eye stroke. Her treatments are based on nutrition, botanicals, lifestyle modification, essential oils, and supplements. Thank you for joining us again, Dr. Rani.

Dr. Rani Banik:

Thanks so much for having me back. It’s really a pleasure to be here.

Dr. Eric:

It’s great to chat with you again. Really excited about the release of your book. Why did you feel the need to write your new book? This has been in the making for a few years, right?

Dr. Rani:

It has.

Dr. Eric:

Last year, off the record, we spoke about it. Why did you feel you had to get this book out into the world?

Dr. Rani:

A few reasons. I work directly with patients. I have a brick-and-mortar private practice in New York. In that practice, I can only reach a certain number of people. I really wanted to get this information out to a broader audience, not just the people who are coming in with known eye issues, but people who may be worried about their eyes, and they really don’t know where to turn for guidance. Perhaps they are parents worried about their children’s eye health. Perhaps they’re children of older parents who are now experiencing issues, like macular degeneration or glaucoma or cataracts. They’re looking for more natural solutions. The first reason is because I wanted to reach a bigger audience.

The second reason is because a lot of my colleagues in the eye care space don’t know about nutrition. For example, going through medical school, I only had about four hours of official nutrition training. In those four hours, I remember learning about carbohydrates and proteins and fats and macronutrients, basically Vitamin C and scurvy. If you don’t have enough Vitamin C, you can develop scurvy. That was the extent of my nutrition education.

I was never taught nutrition anytime during my internship, residency, fellowship, or afterwards. It was only when I trained in functional medicine that I really began to understand the impact of nutrition. I wanted to get this information out to my colleagues, both ophthalmologists and optometrists, so that they can learn, but also, they can share this information and counsel their patients about nutrition as well.

Dr. Eric:

As you know, a lot of people listening to this have Graves’, and a number of them have thyroid eye disease. The good news about this book is it’s not just targeted toward any specific eye condition. Anyone can benefit from this book. Is it safe not to say those only looking to prevent conditions like cataracts, but even those who currently have eye conditions can benefit from reading this book?

Dr. Rani:

Absolutely. Doesn’t matter where you are on the spectrum of your eye health. What you can learn from this book will benefit you, whether it’s now or in the future. Some things can also be reversed in terms of eye issues using the power of nutrition. It is really applicable to anyone in their eye health journey, and also for the entire age range, from children to older adults. That’s really how I wrote it, was to be very broad and give people the foundations for what they need to include in their diet, and how to think about nutrition for eye health.

Dr. Eric:

In your book, you mention the three categories of eye nutrients. Can you talk about those three categories?

Dr. Rani:

I’ll preface this by saying the eye is very complex. Even though it’s a small organ, it’s about the size of a golf ball, it has over 40 different parts. Each of those different parts have certain nutritional requirements. When I categorized the three classes of nutrients, I thought about “What can go wrong in terms of the metabolism of those different eye health parts, and how can we support that?”

The three categories are mitochondrial nutrients, nutrients to support energy production and mitochondrial health because the eye is very metabolically active. Even though it’s so small, it consumes a tremendous amount of energy.

The second category is antioxidant nutrients. So many types of eye disease are linked to oxidative stress, whether it be cataracts, glaucoma, macular degeneration. All three of these eye conditions are linked to oxidative stress.

The third category of nutrients is anti-inflammatory nutrients. Many chronic types of eye diseases, there is a component of inflammation involved. Not just the autoimmune eye conditions, like thyroid eye disease or multiple sclerosis, autoimmune conditions like that, but other eye conditions also typically have some inflammatory component to them.

Dr. Eric:

The three categories are mitochondria, antioxidant, and anti-inflammatory, just to repeat.

Dr. Rani:

Yes. I list out all the nutrients in my books. It’s overwhelming when you first look at it because it’s not just one or two nutrients; there are over 30 nutrients we need to get in our diet to help support our eyes. In terms of those three categories, there is a lot of overlap. What you’re taking to support your mitochondrial health may also help provide antioxidant protection for your eyes. What you’re taking as an antioxidant can also sometimes overlap with the anti-inflammatory category. Yes, there are over 30 nutrients altogether, but there is a lot of overlap in terms of the benefits of these nutrients.  

Dr. Eric:

I’m not going to have you go over all the nutrients because they can read your book for that. Can you talk about some of the more common nutrients, starting with those that help with oxidative stress? Maybe two or three or however many you want to list.

Dr. Rani:

Sure. We typically think of antioxidants as Vitamin C, Vitamin E, Vitamin A. Glutathione is the one that gets talked a lot about as well. These are all really important antioxidants for our body and also for our eyes.

Specific to the eye, there are three antioxidants that many people may not have heard of that are super important. These three are all the macular carotenoids. You may have seen them listed n a supplement, or maybe they’ve been talked about for other issues like brain health. For eye health, these three antioxidants are the most important. They have fancy names: lutein, zeaxanthin, and meso-zeaxanthin.

First of all, our body can’t make these three nutrients. We need to get them from an outside source, be it our diet or a supplement. Our body takes these antioxidants and selectively deposits them in the retina. These nutrients have a yellowish color to them. When we look in the back of the eye, we can see a yellow pigment in the retina, which are representative of these nutrients in the eye. They serve as our eye’s internal sunglasses and internal blue blockers. If you’re going to choose to focus on these antioxidant nutrients for eye health, you need to make sure that you’re getting lutein and zeaxanthin in your diet.

Meso-zeaxanthin is harder to come by from diet alone. There are some marine species that provide meso-zeaxanthin in small amounts. Most of the meso-zeaxanthin gets converted from lutein. Have enough lutein in your diet. Have enough zeaxanthin in your diet. That is the most overlooked antioxidant protection that people don’t realize.

Dr. Eric:

Briefly, bringing up thyroid eye disease because oxidative stress also plays a role in that. I don’t think these nutrients are mentioned in relation to thyroid eye disease. Not to say they can’t help, but you can elaborate on that.

One of the nutrients that’s mentioned the most is selenium. Would you say selenium, which of course is a mineral, can also be beneficial for other diseases besides thyroid eye disease?

Dr. Rani:

The studies haven’t been done looking specifically at selenium for those types of eye conditions. What I’ll tell you is that not only is selenium an antioxidant, but it’s actually very important for mitochondrial function. You have that overlap there. If you’re taking a good amount of selenium in your diet, having some Brazil nuts every day, or taking a supplement, that will also improve your mitochondria’s ability to produce energy. For thyroid eye disease, I recommend selenium to all my patients. There are studies to back that up in terms of the benefits there. I think it is really important.

Be careful because you can overdose on selenium. You want to be careful in terms of your dietary intake. I usually recommend no more than three or four Brazil nuts a day, maybe even just two. Be careful with your selenium intake.

Dr. Eric:

I agree. You don’t want to overdo it with selenium, especially in supplement form. It’s interesting. With Brazil nuts, I haven’t heard of a Brazil nut toxicity, but I would agree that I never tell someone to eat unlimited amounts of Brazil nuts if you’re going to rely on the Brazil nuts. It also depends because every Brazil nut is different, unlike a supplement, where you know the dosage. You want to be cautious about giving too much selenium.

What are bioflavonoids? I am bringing this up because you mention them in your book. If you could talk about some of the more important ones for eye health.

Dr. Rani:

Bioflavonoids come from plants. They are very potent antioxidant nutrients. The plants develop these chemical compounds to protect themselves against disease, invasive bacteria, other species. They’re a plant’s natural protective defense. If we eat plants that have bioflavonoids in them, that defense gets conferred to us also.

Bioflavonoids, there are so many out there. They have identified at least 4,000 different ones that come from different plants. The ones I would say are most important for our eyes, the ones that have been studied and shown to benefit include quercetin. You may have heard of this, especially because it’s also great for immune health. Quercetin got talked about a lot during the pandemic as a great immune-boosting supplement. Quercetin has been shown to help the retina for conditions like macular degeneration.

Resveratrol is a potent bioflavonoid. It’s been shown to help with optic nerve issues as well as retinal issues.

Then there is Epigallocatechin Gallate, which is EGCG. This comes from green tea. EGCG is a very potent bioflavonoid. It’s been shown to be helpful for optic nerve health as well as retinal health as well.

These are all plant-derived compounds. What I tell my patients is to try to include a diversity of plants in your diet to try to get a lot of these bioflavonoids into your system. It’s not that you have to be plant-based in your style of eating but be plant-rich. Have a diversity of different colors to provide you with these bioflavonoids. Not the same leafy green every day, but cycle through the different shades of greens, different shades of purples and blacks and blues and reds and yellows and oranges. You will naturally provide your body and your eyes with all of these bioflavonoids.

Another class of bioflavonoids that are really important are the anthocyanins. They are pigmented compounds, very richly found in berries. That’s another great eye health food that I recommend to my patients: Have colorful berries in your diet, and you’ll be providing your body and eyes with these powerful antioxidants. Blackberries, blueberries, even strawberries, raspberries, goji berries, all good for your eyes.

Dr. Eric:

I agree. You want to do as much as you can through diet. Very important to diversify.

Leaky eye syndrome, you talk about in your book. I’m thinking a good number of people listening to this have not heard of it. Most of us have heard of leaky gut syndrome. Having a leaky brain, the disruption of the blood/brain barrier. What is leaky eye syndrome? How can this be invented and/or healed?

Dr. Rani:

Leaky eye is a term that I came up with. That’s probably why you haven’t heard of it before. I introduce it in my book. As I was doing my training in functional medicine, like you learned about leaky gut and leaky brain and leaky heart and leaky skin, I was thinking, “We have leaky eye as a disease as well, but it never gets talked about.”

What is it? It’s not a single type of eye issue. It’s a category of retinal disease in which the blood vessels become damaged, and blood and protein and fluid leaks out from blood vessels into the retina, where it’s not supposed to be. Basically, it’s because there is damage to the blood vessels and inflammation that causes leaky eyes.

The prototypical leaky eye syndrome is macular degeneration. What happens in macular degeneration is that there is oxidative stress in the retina. There are waste products that develop. Those waste products trigger inflammation that leads to the leaking of blood vessels.

You may have heard of two types of macular degeneration, dry and wet. Dry is not leaky eye. When it converts into wet, that is basically leaky eye syndrome. Blood leaks out, and people can lose a tremendous amount of vision, particularly their central vision. They can have a big blind spot right in the middle of their vision where they can’t see faces or read or drive. It’s because of leaking blood, protein and fluids.

Another example of leaky eye syndrome is diabetic retinopathy. A similar process happens in diabetes, where the very small capillaries in the retina become damaged from high glucose levels. There are advanced glycation end products. Damage is caused to the blood vessels, and they start to leak, and people can lose vision. These are some examples of leaky eye syndrome. It’s not just a single type of eye issue; it’s a category of multiple eye issues due to oxidative stress and inflammation.

Dr. Eric:

If someone has wet macular degeneration, then it sounds like they almost definitely have leaky eye syndrome. That’s worse than dry?

Dr. Rani:

My definition is leaky eye because it’s progressed into that state where blood is leaking where it should not be leaking. It’s leaking right under the central part of our vision, which causes vision loss and blindness. It’s an interesting concept. We’ll see how my colleagues in ophthalmology and optometry respond to it.

I did think it was important to point out because in the similar vein of leaky gut, if you have damage to the lining of structures, whether it be your gut lining or blood vessel lining, then you’re going to have other compounds that leak into areas where they’re not supposed to be, which triggers inflammation.

Dr. Eric:

Are there any other nutrients that you have a burning desire to talk about when it comes to eye health?

Dr. Rani:

Yeah, I would say omegas are another important class of nutrients aside from the macular carotenoids. Why are omegas so important? Our retina, the light sensing tissue in the back of our eye, the majority of our retina is made out of an omega-3 called DHA. Much of the brain is made out of DHA. The highest concentrations of DHA in the body are in the brain and the eye. In the eye, we need a constant supply of this omega-3 DHA because our retinal cells are constantly churning over. There is a high turnover, a high metabolic rate. Whenever our cells capture light, they basically lose their cell membranes and have to remake them. DHA is the critical structural component of the cell membrane.

Have enough omega-3s in your diet, preferably a combination of DHA and EPA. If you’re vegan or vegetarian, you can do ALA, which is a precursor. Unfortunately, much of it does not get converted. You can take a supplement.

There is an omega-6 that’s also been shown to be beneficial for eye health. We typically think of omega-6s as the not good omegas, the proinflammatory omegas. There is a type of omega-6 called GLA, gamma-linolenic acid, which has been shown to be anti-inflammatory and can help conditions like dry eyes.

Relating it back to thyroid, if you do have thyroid eye disease, one of the most common symptoms is dry eye. Think about increasing your intake of omega-3s and perhaps take an omega-6 as a supplement for GLA to help with your dry eye.

Dr. Eric:

If someone is going to take it in supplement form, like borage oil or evening primrose oil for example.

Dr. Rani:

Exactly. It’s hard to get it from diet. I don’t think that many foods have a lot of GLA. Maybe small amounts in some nuts. If you’re suffering from dry eye, I would suggest taking a supplement.

Now, there are great combination supplements that you can take, where it’s a combination of omega-3 and 6, and sometimes even 7 and 9 can also be beneficial. Always check with your doctor first before you decide to take a supplement.

Dr. Eric:

Getting back to omega-3s, if someone is eating fish once a week, do you think—everybody of course is different, —but in that case, would you say that should be sufficient for enough EPA and DHA? Or is it not sufficient, and you should take a supplement? Do you recommend a fatty acid profile to see if they’re deficient?

Dr. Rani:

I’ll reference the Women’s Health Initiative, which looked at thousands of women and their incidence of dry eye. What the study found was that the women who had regular fish intake of 2-3 times a week had much lower frequency of their dry eye symptoms. 2-3 times a week is the overall recommendation that we make for conditions like dry eye as well as macular degeneration.

Similar to dry eye, other studies have shown that people who have higher fish intake per week have less prevalence of macular degeneration as well. You can benefit multiple things in terms of your eye health.

I would be cautious: if you’re eating fish a couple times a week, make sure that it’s wild caught, and it has a low mercury profile. You have to be cautious with that because you don’t want to have high mercury fish and have mercury toxicity.

Let’s say you don’t know if you’re getting enough omegas. What should you do? Should you supplement? You can do an omega quant test. It’s basically a dried spot blood test that will tell you what your omega profile is. You can adjust your dietary intake or supplement intake based off of that omega quant test. It’s very easy to do.

Dr. Eric:

I’m familiar with that test and have done it myself. I find it to be helpful.

Dr. Rani:

Going back to the omega-6, not all omega-6s are harmful. We need omega-6 in our body. It’s the ratio that you’re looking for. If you have a really high intake of 6 and very little 3, that’s going to push your body into a proinflammatory state. If you have a higher level of 3 more equal to the 6, that will be a better balance for your body. Try to strive for that balance. You don’t want to completely eliminate omega-6, so try to get that balance.

Dr. Eric:

Getting back to thyroid eye disease, we spoke about selenium. Are there any other nutrients you find to be beneficial? Omegas can benefit overall eye health, but anything else?

Dr. Rani:

There are a couple of other nutrients to think about and maybe test for and see if you’re deficient and supplement if you need to. Vitamin D is the one that I have noticed most in my thyroid patients, both hyperthyroid and hypothyroid. I’ve found that Vitamin D levels tend to be very low, and I always test for it because I would like to know where my patients are, to see if I do need to prescribe them a supplement, which one I should prescribe.

The normal range that is reported in labs will be somewhere between 30-50. I would say that if you’re on the low end, you want to boost your Vitamin D level. Vitamin D is not just a vitamin; it functions like a hormone. It’s important for so many processes in the body, including thyroid health. It’s also anti-inflammatory. You want to boost those levels. Try to get them into the 50-70 range. I wouldn’t go above 70 because it may cause other issues. 50-70 is what I tend to target my patients for.

You want to eat foods that are fortified with Vitamin D. Perhaps take a Vitamin D supplement. In my book, I talk about all the different sources of some of these nutrients. Something a lot of people don’t realize is that mushrooms are a great source of Vitamin D. If you enjoy mushrooms, they have other health benefits as well, like anti-cancer properties. You can also help boost your Vitamin D through them.

Another nutrient I would say is really important is iron. You want to get your iron levels checked. If your iron levels are low, consider eating more foods rich in iron but also perhaps taking a supplement. We do need iron in the process of thyroid hormone formation and overall thyroid health.

Dr. Eric:

Kind of like selenium. You don’t want to be too low or too high. You don’t want iron overload. I recommend testing or doing an iron panel. Some medical doctors rely on just a CBC, complete blood count. Others will just look at ferritin. I do recommend looking at serum iron, ferritin, iron saturation, total iron binding capacity.  

Dr. Rani:

Absolutely. Get the full panel. If you are low and decide to increase your intake of foods that are iron-rich or take a supplement, maybe get it rechecked in six months. That will guide you. Should you continue with what you’re doing? Should you adjust? Definitely don’t do it once. Do it again.

You really have to advocate. I have come across the same issue, where a lot of doctors, even if it’s for thyroid, will check a TSH and say, “Oh, everything’s fine.” You need to go beyond that. To pick up a lot of these conditions, even if they’re subclinical, you need to do the full thyroid panel, including the auto antibodies. If your doctor is a little bit hesitant or resistant to order it, really advocate for yourself. Try to get these labs done.

Dr. Eric:

Definitely agree with you on that.

Eye health supplements. There are a lot of them out there these days. I know you’re encouraging people to try to get the nutrients you can through food and not rely on supplementation. When should people consider taking a supplement for eye health? Or should they? Maybe you don’t think they should. Maybe they should just rely on food or take individual nutrients like resveratrol or some of the other ones you mentioned.

Dr. Rani:

If we lived in a perfect world, I wish I could say you don’t have to take an eye health supplement. Unfortunately, we don’t live in a perfect world. Studies have shown that even people on the healthiest of diets are simply not getting enough of these really important eye health nutrients.

I was talking about macular carotenoids like lutein. It’s estimated that we need about 6.5mg of lutein a day. Unfortunately, most adults probably only get 1-2mg a day. Many of us are deficient in these key nutrients. Our macular carotenoid levels decrease as we get older, so it’s even more important to supplement when you get into mid-adulthood and later adulthood to prevent conditions like macular degeneration. I strongly believe it is important to supplement, even if you think you’re eating enough.

The other reason to supplement, and you may be aware of this, Dr. Eric, is our soil is not as nutrient-rich as it used to be. There are studies comparing soil samples from the 1930s or 1940s to more recent years, like 1990s/2000s. Our nutrient levels have significantly been depleted because of agricultural practices, tilling, fertilizer use. Let’s take magnesium or Vitamin C levels. Back in the 1930s/’40s/’50s, the levels used to be much higher than what those levels are in today’s soil. This means that our food is also depleted in these micronutrients. That’s another reason why I think we should supplement.

I’m glad you brought this up because I’m doing a webinar on eye health supplements later today, breaking down the science behind supplementation and what to look for in your ingredients for an eye health supplement. There are so many brands on the market. If anyone is interested, you can watch the video on YouTube at a later date.

In terms of getting a complete supplement, I actually recommend taking a multivitamin that has all the regular components of a multivitamin, like B vitamins, C, E, D; minerals like magnesium, selenium, iron, manganese, etc. Also, look at the label and make sure that in your multi, there is the bioflavonoids. Not all multis will have them. Look for them. Then you know you’re getting quercetin, resveratrol, and other potent antioxidant nutrients through your multi.

Then consider taking a separate eye health supplement that has macular carotenoids.

There is another carotenoid that we didn’t talk about, astaxanthin. That is gaining a lot of recognition recently because astaxanthin is considered the king of all antioxidants. It comes from this red algae. Astaxanthin is red as well. It has been shown to help promote skin health, brain health, and also eye health. In your eye health nutrient, if you are taking one, look for the macular carotenoids like lutein, zeaxanthin, and meso-zeaxanthin, but also look for astaxanthin.

There are some other things you can look for as well. For example, there is a form of Vitamin E. Most Vitamin E is tocopherol, but there is a specific form called tocotrienol, which is considered to be more potent in terms of its antioxidant capability. If you are getting an eye health supplement, find one that has that tocotrienol formulation that is really potent and anti-inflammatory.

Dr. Eric:

Just to summarize: You recommend pretty much everyone to eat a whole healthy diet, and to take a multivitamin with bioflavonoids and a separate eye supplement with the ingredients you just mentioned.

Dr. Rani:

Yes. Also, because we spend so much time on screens, our retinas get a lot of light toxicity from them, a lot of blue light exposure. It’s even more important to supplement with these macular carotenoids.

I even tell parents of my pediatric patients to try to increase your child’s intake of some of these foods with carotenoids, but maybe consider giving them an eye health supplement that has lutein, zeaxanthin, and meso-zeaxanthin. These have been shown to reduce eye strain, digital eye strain, light sensitivity, and help with dry eye.

You have to think about it in the context of what we’re doing in today’s age. Most of us spend the majority of our day in front of the screen, so you want to be proactive and protect your eyes from any potential adverse effects of screen time. Multiple benefits there, long-term as well as short-term.

Dr. Eric:

I’m glad you mentioned that. One of the questions I meant to ask you also is sunlight. How important is it getting sunlight, not just for Vitamin D, but also for eye health? Obviously, you don’t want to stare into the sun, but getting some of those outside rays.

Dr. Rani:

It is important especially in the early morning. It helps set our Circadian rhythms, and our eyes are directly connected to our pineal gland, which is the modulator of our Circadian clock. It is important to get early morning sun exposure.

As you mentioned, please don’t look directly at the sun. I know some people practice sungazing, which is not the best thing to do with your eyes open. Do that with your eyes closed. Those UV rays from the sun can do a lot of damage to the retina and even cause burns in the retina, so you need to be very careful about that.

Early morning sun. I would say between 8am-10am is probably best to help set your Circadian clock. Not directly staring at the sun, that’s not a great idea.

Dr. Eric:

If you’re wearing glasses like I do, do you want to take them off? Not to stare into the sun, but is it important to take off your glasses while doing sun exposure?

Dr. Rani:

I would say yes. Some people have tints in their glasses that may block out- Say you have a blue-blocking tint on your glasses. You want to expose your eyes to natural sunlight as our ancestors did for hundreds of thousands of years. That’s probably the best thing to do.

As you mentioned, there are great benefits to Vitamin D production as well. As well as mood. There are plenty of studies that show that people who get regular sun exposure have better regular mood profiles and less risk for depression or seasonal depression if you are getting that morning sunshine.

Dr. Eric:

Can you talk about some of your favorite therapeutic foods for eye health? I know you mention a bunch in your book.

Dr. Rani:

If I had to talk about categories of foods that provide multiple nutrients, the first category would be the leafy greens category. Foods like spinach, kale, collard greens, dandelion greens. These provide high levels of lutein and zeaxanthin. They also provide Vitamin A and C and some minerals and iron. Great source of multiple nutrients.

I know some people are concerned about oxalates if they are having leafy greens. Especially if you have thyroid issues, you don’t want to have too many oxalates in your system. If you’re concerned about oxalates, if you have any symptoms possibly of high oxalate content, and your concentrations in your blood, get your urine tested. That will tell you if you truly have hyperoxaluria, which is the medical term for too many oxalates in your system. Test to make sure that’s what the issue is, and it’s not something else.

Another therapeutic category of foods would be berries, which I talked about earlier. I typically recommend to my patients to have half a cup to one cup of berries a day. Try to rotate through those berries, different colors. You can have them raw or in a smoothie. There is lots of different ways to enjoy berries.

The third category of food I would recommend are spices. We haven’t talked about this yet. Curcumin, which is the active ingredient in turmeric, the yellow spice, is very anti-inflammatory. It’s very potent. It’s been shown in numerous studies to help with autoimmune conditions, like rheumatoid arthritis. There is some very early work with thyroid that is very beneficial. Try to include spices in your diet because it will help your overall health, any inflammatory conditions, and promote your eye health.

Curcumin has been shown to help with conditions like dry eye and inflammation inside the eye, which is called uveitis, and optic nerve function. Lots of great benefits there.

Along with curcumin, you may also want to include paprika, which is a great source of lutein and zeaxanthin.

If you can, you may even want to include some saffron because it’s also been shown to promote macular health. Saffron can get expensive as a spice. If you have a little bit, sprinkle it on a smoothie or in a soup. It adds a lot of flavor as well, so it’s a great addition to your kitchen.

Dr. Eric:

You mentioned oxalates briefly. Is there any concern with oxalates having harmful effects on the eye, including thyroid eye disease patients?

Dr. Rani:

I haven’t seen a major issue. Everyone can have a reaction on an individual basis. I do know that particularly patients who have autoimmune thyroid issues, there is a study that shows that when they have biopsied the thyroid, they’ve found oxalate crystals in the thyroid in individuals with inflammatory autoimmune thyroid conditions.

In terms of whether it shows up in the eye, not that I’m aware of. It can show up in the cornea in primary hyperoxaluria, which is more of a genetic issue rather than a dietary issue. You can see oxalate crystals in the cornea in that condition. It’s very rare to have a genetic condition related to oxalate toxicity. If you think that’s an acquired condition, first, just test. I always go back to that. Know for sure.

Also, there are many foods that have oxalates in them, not just leafy greens. There is a whole range of foods that have high oxalate content. If you’re really worried about whether you may be sensitive to certain foods or not, you can actually do a food sensitivity test. Not an IgE, which is the food allergy test, but a food sensitivity test, where you do a whole panel of different foods, and it measures the IgG response to those foods. That may point out to you which particular foods or food groups you may be sensitive to. Then you can maybe modify your diet based on that type of test rather than guessing. A lot of people think they know, but they’re not 100% sure. It’s always better to do the test and know for sure.

Dr. Eric:

Last thing I want to ask you: Are there any updates when it comes to thyroid eye disease since you were last on the podcast?

Dr. Rani:

The biggest update has to do with the medication TEPEZZA, which is teprotumumab-trbw. Many of you, if you are following thyroid eye disease in the news, they have commercials on TV now for TEPEZZA. I think it’s really changed the landscape of our treatment for patients with thyroid eye disease, particularly patients who have a lot of bulging of their eyes, proptosis; if they have a lot of swelling of their lids or double vision. This drug has really changed how we manage our patients.

Initially, the drug was only studied in patients with acute disease. Let’s say less than nine months. Active proptosis, bulging, a lot of swelling, congestion. It showed benefit. But now, there are studies that show that this drug TEPEZZA can also be used for people with more chronic disease, even up to 10 years in duration. Even after the active phase of the disease calms down, it’s really stable, people can still have benefit.

It’s something that is within our toolbox for treating thyroid eye disease. It’s not something I would rush to immediately, but it’s nice to know there is this option out there. It has been shown to work. It has some side effects, but overall, it’s relatively safe. It’s important to have that discussion with your doctor, particularly your ophthalmologist, your neuroophthalmologist, or your oculoplastic doctor about whether TEPEZZA may be right for you.

As an integrative ophthalmologist, I try to bring both aspects and offer them to patients. Yes, there is that treatment that is a biologic agent. It’s a medical therapy. It’s an infusion. I also combine it with dietary strategies, supplements, lifestyle, so I always try to provide the best of both worlds, not just say, “you’re a great candidate for TEPEZZA, so get this infusion for the next six months.” That’s not ideal. You want to bring more of a holistic approach to thyroid eye disease. Use some of these modalities together to get the best outcomes.

Dr. Eric:

I know you have to run, but is there anything I should have asked you that I didn’t ask you? Anything else you wanted to mention before we wrap things up?

Dr. Rani:

I know we covered a lot, and I know it was a lot to cover in a short amount of time. If anyone is interested, you can get my book on Amazon. It’s available in paperback and Kindle. It will soon be available in hardcover as well. Hopefully, in the future, audiobook as well.

Also, if you want to learn more, I did offer a webinar on my top four tips for eye nutrition. That’s also available on YouTube. You can watch it at your convenience. It’s about a 45-minute webinar.

The webinar I am doing today on eye supplements will also be posted on YouTube.

Dr. Eric:

What’s your website for those who are interested in the NY area who might want to see you in person?

Dr. Rani:

My website is my full name, www.RudraniBanikMD.com. I also offer a lot of information on my social media platforms. I’m on Instagram, @Dr.RaniBanik. I’m also on Facebook with a couple of groups.

Dr. Eric:

Wonderful. Thank you so much, Dr. Rani. This was an amazing conversation. Definitely check out Dr. Rani’s book Beyond Carrots. Thank you for getting together here. Look forward to having you on the podcast again in the future.

Dr. Rani:

It’s my pleasure. Thank you so much. Thank you for sharing all your wisdom with your listeners. It’s really amazing how your podcast has helped so many people, I’m sure. I look forward to watching you grow and expand your reach as well.

Dr. Eric:

Thank you!