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!

Recently I interviewed Dr. Ami Kapadia, and we talked about the gut microbiome and discussed the foundations of good gut health, testing, and treatment for fungi, protozoa, and biofilms, common nutrient deficiencies and their impact on overall healing. 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 Dr. Ami Kapadia, as we are going to do a deep dive into the gut microbiome. We’ll be chatting about the foundations of the gut microbiome, including fungi, protozoa, biofilm. We’ll talk about testing as well as treatment options.

I’m going to start off by giving Dr. Ami’s bio. Dr. Ami Kapadia has practiced as a family medication and holistic medicine physician since 2005. She completed her residency at Thomas Jefferson University Hospital in Philadelphia and went on to work in varied settings, including an inner-city urban clinic, VA hospitals around the country, and urgent care clinics in the Portland area. She has been practicing in Portland, Oregon since 2015. Her practice focuses on digestive health and metabolic health. She pays particular attention to the role of nutrition, lifestyle, and food and environmental sensitivities in helping patients reach their health goals. Thank you so much for joining us, Dr. Ami.

Dr. Ami Kapadia:

Thanks, Eric. Good to be here.

Dr. Eric:

Let’s start out. I gave your bio, but if you go into a bit more of your background, how you started focusing on the gut microbiome.

Dr. Ami:

Sure. My family’s from India. I have informally been exposed to ayurvedic medicine for many years. Formally, I have been doing some education in that as well. The gut is the root of a lot of our problems. I shouldn’t say all, but most of our problems historically, some of the more ancient forms of healing as well as we are learning more and more with integrative, functional medicine and even in regular medicine about how so much of our immune system is dependent on our gut health, the gut/brain connection, the gut/skin connection. Basically, any issue you have, there is a gut connection component with autoimmune illness as well. It’s one of the areas that we find is foundational in helping anyone who’s dealing with any sort of health condition help to improve their health. Even though they might have a thyroid issue or autoimmune issue or mood issue, we’re always going to think about gut health as part of how we can help them.

Dr. Eric:

I agree. Most natural health care practitioners, holistic practitioners, functional medicine practitioners, we agree that you need a healthy gut for optimal health. There is that saying, “All health starts in the gut.”

You mentioned foundations. Can you talk about some of the foundations, and expand into dietary recommendations that you give to your patients?

Dr. Ami:

Sounds good. Something that we sometimes forget to do if someone has seen a lot of other practitioners is make sure that we aren’t skipping over foundational aspects of what we all need to do for health. When I meet someone, I try to make sure we’re not missing any of those really basic things, getting stuck on fancy testing and other things where we miss the boat.

Some of the things I try to make sure we touch on with everyone: dietary practices. The standard anti-inflammatory diet. That could mean different things for different people. At least doing organic, non-GMO. Removing added sugars is important.

Meal timing is important. Just not eating continuously all day and into the night. Having some spacing with meals, which is a tradition in ayurvedic medicine, as we learn about more with our migrating motor complex. It’s important to give our digestion time to work in between eating. Those are some of the foundational nutritional things that we go over.

Of course, stress in whatever management we can do. Everyone is under way too much stress. Not forgetting about the effects of that. Outdoor light exposure, exercise, sleep, all of those foundational things are really important to make sure we’re going to get the most bang for our buck in any digestive protocols that we’re doing. That’s where we start with a lot of patients, making sure we’re not having artificial sweeteners and chemicals and all of those things as best we can.

Dr. Eric:

Can you talk more about meal spacing? You mentioned the migrating motor complex. If someone has SIBO, I know a lot of practitioners recommend going four hours between meals. When you sleep, you will hopefully go at least 8-10 hours. Do you think in general, even if someone doesn’t have a condition like SIBO, they should go a number of hours between meals?  

Dr. Ami:

I think it makes sense. We did disservice to patients. There was this trend of telling people to eat snacks all day. It’s one thing if they have hypoglycemia. They need a different type of dietary intervention.

For anyone who doesn’t have that, or having low blood sugar symptoms frequently, ideally, they’re having a couple main meals, maybe a snack if needed, and trying not to eat overnight for at least 12 hours is what’s been found, even with Dr. Bredesen’s work with dementia. Giving our system a break overnight helps with things like autophagy and these processes we are learning more and more about. Historically, we recommend people would do that. Now we have more science about intermittent fasting.

I try to keep it simple. A 12-hour overnight fast is great. We just don’t want to be eating up until the minute we go to bed and then eating first thing in the morning. If you stop a couple hours before bedtime, that can get you a 12-hour overnight fast. Then trying to have a couple of regular meals and not just snacking throughout the day is good for everyone in general if you don’t have things like SIBO and overgrowth.

Dr. Eric:

Even if someone is incorporating a 16/8 fast, for those who are not familiar with it, going 16 hours fasting and having an eight-hour eating window, you wouldn’t recommend continuously eating during those eight hours. You would still space it out, have a couple of meals.

Dr. Ami:

I think that would be better. Traditionally, what’s worked well for our digestion as well as some of the newer information we’re finding. They will still get that overnight fast benefit. It makes more sense to have a couple regular balanced meals than just to be eating continuously ideally.

Dr. Eric:

Sticking with the diet but talking more about elimination diet. I could be wrong, but do you do both elimination diet and incorporate food sensitivity testing? Do you essentially start everybody off with an elimination diet?

Dr. Ami:

I do both. For everyone, I do the normal gluten antibodies that you can get through Quest or LabCorps because it’s an easy screen. For some patients, I do advanced gluten sensitivity testing, but not everyone.

Beyond that, outside of removing added sugars, I give patients the option. Elimination diet is the gold standard, but it is hard to implement. It’s challenging with the busy lives everyone has. My favorite book for that is The Elimination Diet by Tom Malterre. He and his wife put together that book. It’s a good, at least one time in your life thing to do to get a sense of how food might be affecting you, if that’s possible with your lifestyle.

If someone can’t do that, ideally, we’ll do the gluten sensitivity testing, and then we will try to remove one or two of the more inflammatory foods, specifically cow dairy along with sugar, at least those couple things, to see if we can reduce inflammation.

The food sensitivity testing can be a useful tool if someone isn’t ready to go into an elimination diet. It’s certainly not 100% accurate. It has false positives and false negatives. But it is a tool. We can use that sometimes to help motivate someone to potentially try the elimination diet. Gluten, dairy, soy, eggs are some of the most common food sensitivities we see. Usually, someone does not need to avoid all of those long-term. We can find a couple that are irritating their system.

Dr. Eric:

I agree with the flaws. There is no perfect test. Even stool testing, someone could test negative for parasites but still have parasites. With food sensitivity testing, it is not exactly the same, but as you said, you can have false positives or false negatives. That being said, when you recommend food sensitivity testing, is it IGG?

Dr. Ami:

It’s IgG. I don’t have any affiliations.

Dr. Eric:

You can name the lab.

Dr. Ami:

It’s cost effective through Alcat. It’s a $95 IGG food panel for $100-$120. It’s quite affordable. It’s good overall. For some people, they might have a lot of food sensitivities, and I am getting a completely negative panel, so it does help me, kind of. Even though we might still explore that, because it’s not 100% accurate, it does lend itself some information to the overall picture of what we’re dealing with.

I know we’re going to dive into this, but this whole mast cell/histamine reactivity in the gut can look like food sensitivities when it’s not. That’s another topic that we could tackle if we get to it.

Dr. Eric:

Sounds good. How about nutrient deficiencies? Can you talk about some of the common nutrient deficiencies you find?  

Dr. Ami:

Through routine lab work, through Quest or LabCorps, I routinely will check zinc, copper, ferritin for iron stores, and B12. I frequently find low or low normal levels for zinc, B12, and ferritin for a lot of my patients. That’s another easy screening to look for nutrient deficiencies.

Some people, even though they have been to lots of practitioners and have tried lots of things, surprisingly will have some benefit from simple nutrient repletion, moreso for B12 or iron. With zinc, I don’t have people notice immediate improvement, but it’s one of the things we replete to help in their overall healing. With the other ones, sometimes people do have a noticeable improvement in their symptoms.

Dr. Eric:

For B12, do you recommend serum B12 or methylmalonic acid?

Dr. Ami:

I’ve had good luck with checking a regular serum B12. If it’s less than 400, certainly consider repletion. If it’s less than 600, we sometimes will still consider improving optimizing levels. I often find low or normal levels with that, so I don’t always do the methylmalonic acid unless I am digging further.

Dr. Eric:

For zinc, is it serum zinc or RBC zinc?

Dr. Ami:

Plasma zinc/serum copper. There is a reason that intracellular zinc is not as accurate. One of the founders of functional medicine had given a talk many years ago, and I never fully remember all the details, but it has to do with an intracellular enzyme. Intracellular zinc, I have been taught is not as accurate, so I don’t go with the blood levels. Plasma zinc/serum copper.

That being said, when we order it through Quest, I can’t always get the one that I want. It still seems generally accurate with whatever they’re running for us, so I order as such. It’s been a helpful guide.

Dr. Eric:

I’m sure you do a comprehensive metabolic panel on the basics, the CBC. Some will say that if alkaline phosphatase is low, less than 60, that could indicate a zinc deficiency.

Dr. Ami:

Yeah, I’ve learned that, too. I can’t say I’ve always seen it correlate though. I do usually have a hepatic functioning panel and a zinc level. I typically do both because I don’t always see it correlate.

Dr. Eric:

That makes sense. Can we talk about microbes now?

Dr. Ami:

Sounds good.

Dr. Eric:

You know I want to talk to you about fungi and protozoa, maybe even H-pylori if we have time. Can you talk about opportunistic bacteria? I guess I should ask you first, do you do test for the gut? Do you do a comprehensive stool test?

Dr. Ami:

When I’m doing stool testing, we’ll talk about blood markers I use for candida. For stool testing, specifically I’m looking for protozoa. I’m not fully convinced that the technology we have for stool testing is giving me the best picture of bacterial imbalance, if and when it’s there. I assume everyone has some bacterial imbalance. Part of the treatments we use are broad spectrum botanicals that hopefully will be helping to resolve yeast imbalance and bacterial imbalance when it’s there.

I think the stool testing we have could be helpful. My go-to is Parawellness stool testing, which looks at identifying protozoa because it’s one organism which I feel like we can treat and move past, whereas these yeast and bacterial imbalances can sometimes be a longer treatment plan to help rebalance over time.

Dr. Eric:

I will add that I don’t do stool testing on every single person. When I do a comprehensive stool test, almost always we are going to find some type of dysbiosis, imbalance in the gut flora. Very common to see Streptococcus and Staphylococcus and sometimes Klebsiella pseudomonas. Even if we put someone on a treatment protocol, it’s not like their gut is going to look perfect. There will still be imbalances. I think that’s a good approach, not to go crazy and do testing on everybody and treating everybody for opportunistic bacteria. I just wanted to pick your brain.

Dr. Ami:

It’s tricky because if we see it, we know it’s there, but we still don’t know if it’s causing the person’s symptoms. Is it worth doing an intervention for that? We’ll get into protozoa, but even for example, patients with Giardia, some of the studies show a significant number of people just have Giardia, and they don’t have any symptoms. Other people are incredibly symptomatic from it. It’s this weight of are we going to test? If we are going to test, are we ready to do a treatment? What are the risks and benefits of subjecting someone to that treatment?

Dr. Eric:

It’s funny you mention that. I had someone test positive for Giardia. I was asking about gastrointestinal symptoms. She didn’t have anything that would indicate she has Giardia infections. I forgot where I heard it, but you can be a carrier for Giardia or salmonella.

Dr. Ami:

Right. With Giardia, again, it’s tricky because if someone’s had it for a long time, some of those patients I’ve had had much more chronic constipation. We of course learn about it as causing acute diarrhea. It’s tricky to know exactly what’s doing what sometimes.

Dr. Eric:

Let’s talk about fungi. What are the consequences of fungal overgrowth? Fungi by itself isn’t bad. We want to have yeast. We don’t want to have too much of it. If you can dive into that.

Dr. Ami:

The way I typically explain it with patients is with our microbiome, there is protozoa, bacteria, yeast, and some of these other archaea and such, but those are the primary three organisms we are working on. There is usually some combination of those being out of balance.

The consequences of if yeast is out of balance, it can cause quite a bit of digestive symptoms and systemic symptoms due to the breach of the leaky gut and causing symptoms in other organ systems, such as symptoms that sound like allergy or skin reactivity, brain fog, as well as common IBS symptoms.

The symptoms that patients can get are very similar to SIBO. It’s tricky to sort out is this from bacterial overgrowth or yeast overgrowth or a chronic protozoa infection? We talk about trying to work with whichever of those is the most easily identified and goes along with that person’s history, and reevaluating to see where we are with that.

I do test for that frequently with the standard blood markers through Quest. I check a candida immune complex and antibodies. While you can’t prove that someone has an overgrowth, it gives me clues and puzzle pieces. If those, particularly the IgG or candida or the immune complex are elevated, and they are having gut symptoms or a lot of systemic reactivity that we talked about. It may be worth doing a trial of anti-yeast medication or botanicals.

The advantage of using botanicals like we talked about is they can work on other organisms as well. We can see where we are after that. I know we will talk about protozoa as well. If I find both, I typically will treat protozoa first just because I find a higher success rate of treating that over the short term with pharmaceuticals usually. We can get that treated. Again, the yeast imbalance, bacterial imbalance can be a longer-term proposition. We usually have to spend more time with that.

Dr. Eric:

Protozoa you treat first. Then it sounds like for that, you don’t use botanicals. Usually, you go to pharmaceuticals like metronidazole, for example?

Dr. Ami:

For example, the most common ones we find are Giardia and Cryptosporidium. If someone has one of those, it is always important to remember I have them filter their water to make sure we are not having reexposure.

For treatment, I typically use pharmaceuticals unless they prefer botanicals just because it’s usually a couple-day treatment. I use tinidazole more than metronidazole. It seems to be better tolerated. It has quite good efficacy for Giardia as well.

For Cryptosporidium, there is no perfect medication. Nitazoxanide can work well for that in conjunction. For that one, I use botanicals as well because there is no pharmaceutical that is anywhere close to 100% at eradicating that as far as I know. I will sometimes do nitazoxanide pulsed with some botanicals, and then a second round of nitazoxanide and then more botanicals for that one.

For Giardia, it has a pretty good success rate with standard pharmaceuticals, either metronidazole, tinidazole, nitazoxanide. I would say tinidazole is my go-to that I start with based on my preference.

Dr. Eric:

I want to get back to the fungi, but what are your thoughts on Blastocystis hominis?

Dr. Ami:

That’s a good question. I have wavered over the years. On my website, there is a section on protozoal and parasitic infections, where I list some of the studies looking at what we can use for eradication.

The first question is should we be trying to eradicate this? Is it causing problems? There are studies showing that if someone is symptomatic with IBS, eradication of Blastocystis hominis can improve symptoms. It’s not my first priority to go after that.

If we have done other treatments, and they’re still symptomatic, it’s worth a trial of treatment. I used to do a longer course of nitazoxanide for that because there was studies on that. Then I found that shorter courses had almost the same eradication rate.

I don’t love putting someone on pharmaceuticals for any longer than we have to. My standard Cryptosporidium three-day treatment of nitazoxanide, now repeated two weeks later if we are going to use pharmaceuticals.

There are also botanicals that can work for that. Some of the standard ones that we use for protozoa: artemisia, berberine, things like that can be helpful. Sometimes, I’ll do a combination treatment like I do for Cryptosporidium.

I’m not convinced it’s causing problems for everyone. It’s so ubiquitous. Again, if they have been treated a lot of other things, we will talk about treating this and seeing if they get symptomatic improvement.

Dr. Eric:

In a situation where you’re just focusing on the protozoa, and the person just wants the botanicals, how long on average? You mentioned the advantage of medications knocking it out in a few days. Are we typically looking at a few weeks or a few months when it comes to protozoa and botanicals?

Dr. Ami:

It is rare that I just use botanicals for protozoa. If I do, I’ll usually do at least a month or so, and then we’ll see where we are with treatment. Again, I don’t have any affiliations, but I use a lot of Supreme Nutrition products. They have artemisia supreme, mimosa supreme, melia, which is neem, and a berberine, which is coptis supreme. I don’t use all of those by any means. I’ll pick one or two.

Beyond Balance also has some really nice protozoal treatments that are very safe for kids and adults.

I’ll typically pick one or two, do a bottle of that, and see how they feel. I don’t like to continue it for longer than that. We usually will pause if they are doing better and see if we need longer treatment. We gauge their symptoms before proceeding with more than a month or so of treatment.

Dr. Eric:

Great. Getting back to the fungi.  Have you seen where someone has a yeast overgrowth, yet the antibodies are negative?

Dr. Ami:

Yes. There is no perfect test for it. Often, patients will come in with a stool test or these blood markers that I’m talking about, and I try to remind them that we still don’t know if this is causing your symptoms. We want to stop and reevaluate each time. Whatever yeast overgrowth someone has is not going to be sensitive to all of the botanicals or pharmaceuticals. Just because we treat it and it doesn’t improve, we could either be using the wrong agent for what they have, or we could be on the wrong track. I will typically try two or three different things if we don’t get a response with the first intervention that we do before giving up on yeast overgrowth as a piece of what’s going on for that person.

Dr. Eric:

What do you think about organic acids testing? Looking at arabinose and other yeast markers.

Dr. Ami:

Some of my mentors used a lot of that, and I like it. I couldn’t find a lot of research backing up that usage outside of the companies that offer it. I think it’s another helpful tool. If someone has done it, I can use that information. If those are elevated, and I have elevated immune complex, and it’s showing up on a stool test, again, while none of those are definitive, because we all have yeast in our stool, and there is no concentration level that indicates an overgrowth, putting those pieces together gives us more clues as to it might be worth going after this.

Dr. Eric:

When it comes to focusing on the gut, how about other types of fungi? If someone has toenail fungus, would you treat the toenail directly? Is the root cause still the gut in this example?

Dr. Ami:

I’ve seen that be its own thing a lot of times. When I’ve worked with veterans, for example, if they had to wear boots a lot and were sweating a lot, the conditions of external moisture can be there. Other people, there has been shown to be a genetic component for your body having what I generically say is trouble controlling yeast and fungi.

I don’t see toenail fungus to be necessarily correlated to any sort of internal issue. Of course, it could be. But I tend to treat that specifically, usually with pharmaceuticals. The standard protocols as well as some compounded topical antifungal prescriptions that we can get from our compounding pharmacy. That’s worked well for a lot of our patients.

Dr. Eric:

How about vaginal candidiasis?

Dr. Ami:

I do see that often having the person also has a gut imbalance. There has also been some studies showing some women are genetically prone to getting that because we’ve had some patients where they have been on so many antibiotics, and they never get a yeast infection. Other people go on one course and get this recurrent problem. With those patients, I do often see a GU component and a GI component. We are working on this full spectrum treatment that we’re talking about.

Dr. Eric:

With the treatments, again, you’re more likely to use botanicals with the fungi than protozoa, but there are times when you recommend the antifungal meds. Could you talk about when you would use nystatin versus diflucan?

Dr. Ami:

If someone hasn’t responded to botanicals, and I’m still wondering if they have fungal imbalance in the gut, I will typically start with nystatin. It’s not systemically absorbed. It’s very safe. The benefit is it acts on the mucus membranes that it hits, so if they have an oral or esophageal issue, you can get compounded nystatin capsules and empty that in water. It doesn’t taste good, but you can swish and swallow that. If you’re doing the commercial tablets or capsules, that will act in the gut where it’s hitting. It’s not systemically absorbed, and it’s concentrated in the gut imbalance area we are trying to treat. That is usually where I start.

If I’ve done that and am still not sure if they have a problem, because we haven’t had a clear response, it’s possible that the overgrowth they have is not susceptible to nystatin. Sometimes, I will do a couple weeks of fluconazole. I don’t like to do that long-term. It has a lot of drug interactions. I think using it on a broad scale for a lot of patients with digestive disorders isn’t a great idea, given we don’t have a lot of good antifungals, and this whole resistance issue. I will sometimes do a couple-week trial, and if we get a really good response, I will try to find some other agents that can be helpful for them. But it can help us decide if we are on the right track or not.

Dr. Eric:

That sounds good. I know you’ve mentioned botanicals for parasites. Did you mention what you like for yeast?

Dr. Ami:

For yeast, the good part is that some of them overlap. I find berberine or coptis to be really helpful for bacterial overgrowth, yeast overgrowth, and protozoa, depending on the person.

The other ones I will frequently try are neem, which can have an effect on all of those. undecylenic acid is another one. Thorne makes a compound that’s been around for a long time. I will use that one for yeast a lot.

Beyond Balance makes MYCOREGEN, which I’ll also use for yeast a lot, as trials of more yeast specific therapy. Those are some of my favorites I use. Olive leaf can also be really helpful.

Dr. Eric:

I was going to ask you about olive leaf, which I know can help with viruses and other things, too. How about oregano?

Dr. Ami:

One of my mentors was not a fan of oregano, just because it’s so strong. I’ve had patients where they’ve told me it’s been quite helpful. If it’s helped them in the past, we will consider using it again.

My personal bias is I don’t use it as much because of personal teachings from one of my mentors. I don’t think it’s wrong to use it. It is very strong, so I would not use it for a prolonged period of time.

Dr. Eric:

Yeah, I agree. It’s good to at least briefly mention that some of these could have a potential negative- Just because it’s natural doesn’t mean it’s completely harmless. Arguably, it’s better than taking an antibiotic. Still, like you said, you wouldn’t want to be on oregano oil for six months.

Dr. Ami:

Before I learned about mast cell activation and histamine reactivity, I was treating some patients with botanicals over and over, and it was helping. It didn’t seem like that was the root cause. If we’re treating someone over and over, and they tend to improve but not fully, and it keeps coming back, we can talk about how to go after the biofilm issue because sometimes, that’s the issue.

Sometimes, it’s this mast cell reactivity in the gut which can mimic the symptoms of any of these abnormal gut flora issues with diarrhea, constipation, bloating. Sometimes, it’s worth a trial of very simple H1/H2 blockers to see if that helps. Sometimes, that’s helped a lot more than any of the dysbiosis protocols that I’ve done. We just have to remember to think about it as part of our differential. If someone is having ongoing gut or other symptoms, that might be another avenue to think about, in addition to biofilms causing resistance.

Dr. Eric:

With mast cell activation syndrome, you mentioned earlier how someone might not have food sensitivities but mast cell activation syndrome or histamine intolerance. They’re not exactly the same. Is that what you were talking about just now as well?

Dr. Ami:

It’s this spectrum of disorders, specifically for gut health but also allergic and skin conditions and all sorts of issues where it wasn’t in my differential until the last five/six years. I was missing it.

There are mast cells throughout our body, and they contain histamine and all of these other mediators. It’s been found in patients with IBS that mast cell reactivity is higher in the gut compared to other patients. It may be that there is this overall sensitization and reactivity as opposed to “I’m reacting to egg or dairy or soy.” It might be just whatever they’re eating, their gut is hyperreactive, so calming that down can help prevent having to restrict their diet as much. It’s something to think about.

Some of the most effective treatments, if it works for the patients, like cromolyn. For some patients, it doesn’t do anything, and for some, it’s reduced 75% reactivity to foods. Not because they were reacting to all of those foods, but because their histamine reactivity was up.

The tricky part is what is causing the histamine reactivity and mast cell reactivity? That is all of those things we’re talking about. These gut bugs can do it. Food sensitivities can do it. Stress can do it. We still have to go digging. But it can certainly help stabilize symptoms. We can buy ourselves some time and improve quality of life.

Dr. Eric:

Definitely agree you want to address the cause of the problem. You said H1/H2 blockers. As you just mentioned, you don’t want to just give these blockers; you want to do things to address what we’re talking about. Also incorporate diet and lifestyle factors.

I’m sure there might be some people listening who are wondering about quercetin. Can I just take quercetin instead of these blockers? I’m guessing it’s probably not strong enough in many cases of mast cell activation syndrome.

Dr. Ami:

A lot of us do prefer natural botanical, food-based interventions. In my community, what we’ve found is that the natural agents, we can circle back around to them, but we’re not getting as clear or definitive of a response. If we’re really trying to figure out if this person is suffering from mast cell reactivity, we’ve just had a lot more success using pharmaceuticals, at least for a 3-6-month trial. Then we can say, “This is helping or not.” If the person prefers botanicals, we can try to regroup and go that route. I haven’t seen those same results with quercetin, for example.

Dr. Eric:

Great, thanks. Before we get into biofilm, I do want to ask you: Getting back to how we spoke about oregano being a little bit harsh on the gut microbiome, what are your thoughts on berberine? You have mentioned it. I interviewed one specific practitioner who wasn’t too high on using berberine, but the more recent research seems to show a beneficial effect with berberine on the gut microbiome.

Dr. Ami:

I know. That’s gone around and around. We have some patients where we are using botanicals more long-term. I would love to know if there are any studies showing that it’s causing disruption of the microbiome.

I remember one of my first integrative medicine conferences like 15-20 years ago, I asked the speaker who was talking about berberine for blood sugar, “Are you worried about using this long-term with patients?” He was one of the most well-known senior doctors, and he said, “We monitor, but we haven’t seen it.”

It is strong. I don’t like to use it indefinitely. I haven’t seen studies showing it has a negative effect on the microbiome, and there have been studies showing it has a positive effect on the microbiome, and it helps with blood sugar.

Maybe we wouldn’t use coptis long-term. That has stronger activity than some of the other berberine-containing herbs, I believe. I have not seen data showing that we’re causing a disruption. Clinically, from my Chinese medicine colleagues, I learned it is a cold-forming herb. I would be cautious about using it with a certain constitution of patients. I haven’t seen data on negative effects.

Dr. Eric:

Okay. Let’s talk about biofilm. When do you use biofilm? What are some of your favorite biofilm disruptors?

Dr. Ami:

Some of my mentors have had very drastically different views on biofilm. Dating back 15-20 years ago, some of them said, “Don’t mess with biofilms. They’re there for a reason. It’s our body’s way of walling off things.” Other mentors have had the opposite view. I’m in the middle.

I don’t start with biofilm treatment. I think we do have to be cautious, especially with someone who has had symptoms for a long time. That being said, I don’t give it with the first round of treatment. If someone is having non-responsive symptoms or recurrent symptoms, it’s definitely one of the things we think about. Do they have biofilms? That may be why the agents we’re giving them, be they pharmaceutical or botanical, are not getting where we want them to go.

I will introduce biofilm treatment cautiously. We usually use it. Dr. Paul Anderson has some really good information on some of the products he’s formulated. There are some over the counter and some prescription ones. I typically start with over the counter. Some of the ones I’ve used moreso are some of the enzymes, like lumbrokinase and nattokinase as well as Priority One—I have no affiliation. They have a biofilm phase one or something like that. They have a product I’ve found helpful. Those are some of the ones I’ll start with.

If we are still not getting to where we want to be, and it seems like the patient is tolerating those, but we didn’t get anywhere, and I want a yes or no answer if biofilm is part of what is going on, then we will use a prescription compounded version that Dr. Anderson has formulated. Various compounding pharmacies use it. It’s a bithionol complex that is quite strong. That will give me an answer. If someone has an exacerbation of symptoms or improves, then we know that biofilms are part of why they haven’t responded.

You want to start them on that complex, and then have botanical support on board because if we are opening up these biofilms, we want to make sure we’re helping to treat whatever is in there, whether it’s protozoa or yeast or bacteria or whatever else might be part of that biofilm community.

Typically, we’re looking for some sort of response. Did they get worse or better on the biofilm treatment? As opposed to “I took it for a month and didn’t feel any different,” then there probably isn’t a biofilm component to why they’re not responding.

Dr. Eric:

You mentioned Dr. Anderson. A number of years ago, he spoke about taking a biofilm disruptor 7-10 days before doing a stool test, just to reduce the chances of getting false negatives. I’m thinking you’re probably not doing that with the Parawellness, but I don’t know if you heard him talk about that.

Dr. Ami:

I haven’t. I used to do that with certain stool tests. With Parawellness, I get so many positives as is, so I haven’t needed it. If I have a patient who prefers a different type of stool test, I do think it’s a good idea. They probably are not looking themselves under the microscope, like the director of Parawellness is looking microscopically. There are different technologies being used with other stool tests. I think it’s a good idea.

It’s a 7-10-day protocol, and then you collect your stool after that, unless you have an aggravation of symptoms. Then you stop it and collect your sample.

Dr. Eric:

What do you think of NAC as a biofilm disruptor? It’s not just for that purpose. A lot of people take it, including myself. I recommend it for supporting glutathione as a precursor. In some cases, it can be used as a biofilm disruptor.

Dr. Ami:

I think it can be useful. I would say it’s not strong enough to give me a yes or no answer. If you’re using it as one of those initial ones to gently get into biofilms, it’s a good idea. I still hesitate to use it long-term because there are healthy biofilm communities. I do find it is useful for if someone is having a respiratory infection, and we are trying to thin secretions. As a precursor, it can have a role. I tend to avoid it longer-term for theoretical risk of disrupting healthy biofilm communities.

Dr. Eric:

I’m glad we’re having this conversation. I do commonly recommend NAC. If you’re trying to support detoxification, would you tend to go more toward a liposomal glutathione because of what you just mentioned?

Dr. Ami:

Yeah. Detoxification, I used to do very complex protocols. I’ve gone back to more simple things again. Some people feel amazing on acetyl glutathione or liposomal glutathione. I’ve had an equal number of patients who don’t feel good on them. I don’t think it’s essential to use. I think it can be helpful. We’ll try it, if we’re doing a very targeted detoxification treatment.

I’ve gone back toward trying to ensure someone is having good elimination, using food forms of fiber, like cilium, chia, flax to get bile binding that way. Sauna therapy, if they tolerate it. Outdoor exposure.

If I am going to do a targeted detox protocol, I think what you’re doing sounds really good. Trials of NAC or glutathione, maybe just not using it as longer-term. With the glutathione, letting patients know some people feel better, and some people feel worse. Let’s see how you do. I start with those more minimalistic interventions, and then I see, do we still need more detoxification support after that, particularly if someone can’t sweat or do a lot of movement? Everything you’re talking about definitely can be part of the toolbox.

Dr. Eric:

Great. A few questions getting back to yeast when talking about fungi. A lot of people want to know, if someone has candida overgrowth, should all sugar be avoided? Should they avoid fruit? Or is it just minimizing sugar consumption?

Dr. Ami:

I use the protocol that one of my mentors, Dr. Leibowitz, came up with in the ‘80s. We remove added sugars. We allow fresh or frozen fruit. Stevia is fine. Sugar alcohol tends to aggravate GI symptoms, but it doesn’t feed yeast per se. I tell them to remove all added sugars, but fresh and frozen fruit are fine. Carbohydrates are fine. The healthy forms, if they tolerate them. That tends to work well. Patients would always ask about honey or maple syrup.

I have an FAQ list. All of those can still make dysbiosis in any form worse and can negatively affect our health. Part of it is a teaching tool of reading labels.

I tell them not to drive yourself crazy. If you’re eating out, there might be some sugar in the dressing. Don’t worry about it. When you’re preparing your food, you don’t want to add sugar. That’s a long-term lifestyle change. I tell people if you tolerate dark chocolate, the higher the percentage, the less the sugar. That’s fine.

A couple grams of sugar here and there, once we have gotten through the protocol. While we’re doing our first couple weeks, it’s helpful for patients to see how they feel when they’re not doing any processed added sugars outside of fresh or frozen fruit.

Dr. Eric:

Do you minimize fresh and frozen fruits? Like a couple of servings. Or not necessarily?

Dr. Ami:

I tell them to use reasonable judgment. Don’t eat 10 bananas a day. A couple servings of fruit is generally tolerated and fine. Unless they’re doing something unusual, they’re not eating that much fruit. A couple of servings a day if they ask is totally fine for most people.

Dr. Eric:

How about fermented foods for yeast overgrowth?

Dr. Ami:

I have people do this old protocol that Sidney Baker came up. It’s a five-day yeast/mold elimination challenge diet. I tell patients these foods are not bad for you; they don’t feed yeast, but you may react to them, either because you’re reactive to high histamine foods, or because they are moldy. You can remove them for five days and then eat whatever of those you frequently eat. The most common are fermented vegetables, vinegar, nutritional yeast. See how you feel. If you don’t react, you need to remove them. If you do react, we keep them out for the first few weeks of the protocol.

The other way I do it is for some people, it’s just easier to remove them for the first 2-3 weeks of our protocol, and then add them back.

We have a more comprehensive list. The main ones are fermented vegetables, vinegar, dried fruit, alcohol, sugar, and yeast. The sugar, we keep out for everyone. The other ones, we only keep out if they’re reacting, or if we want to keep them out for the first couple weeks because it’s easier than doing the elimination challenge.

Dr. Eric:

I don’t know if you know this off the top of your head. What percentage would you say of your patient population have protozoa, on Parawellness? Same thing with fungi. I don’t know if you want to include mold.

Dr. Ami:

It’s always tricky because we have such a biased patient population. Everyone has symptoms. I would love to have 100 of these test kits to test 100 people in my community and see. I’m sure my results are not representative of the general population.

I would say of my patients, 80% have a protozoal infection. Of the candida blood testing I do, at least 50% will show up positive for one of those I mentioned. Those aren’t definitive, but they are puzzle pieces. It’s a very high percentage. A lot of them have had SIBO testing done already. That’s often a piece of our overall landscape, but it’s been done already. Probably at least 50% of them have had that imbalance.

I try to reorient what we’re doing. These are the three main pathogens or organisms that can be out of balance in the gut. Our overall goal is to help make your system less likely to be having an overgrowth or infection of any of these, as well as eradicating protozoa and rebalancing those other micro-organisms as part of our whole approach. It’s a very high percentage of patients that I test that have those.

Dr. Eric:

I know you have no affiliation with Parawellness. Is it just because that’s what they focus on is parasites, and they have been doing it for a long time, that makes it superior to other stool tests?

Dr. Ami:

From what I’ve been told, talking about standard labs, even our specialty labs, the training is not necessarily there as far as literally making the stool samples to look at under a microscope. The director at Parawellness must have looked at tens of thousands by now of stool samples under the microscope, so it’s a subjective skill in some ways, to be able to pick out these organisms.

It’s the way it used to be done. There were many lab changes over the last couple decades, where that’s not the way most labs are looking for protozoa anymore. They don’t have a technician that’s been trained for years on how to do this. It’s an antigen test. It’s an objective measure, which doesn’t always correlate with the subjective looking under the microscope and having that skillset. That’s my understanding of why the prevalence is so much higher with that actual microscopy skill.

Dr. Eric:

Very interesting. Is it just that one technician there? Has he trained others?

Dr. Ami:

I don’t know. It seems like a large volume of specimens to look at. I don’t know if there is a whole staff. At some point, I want to observe, as I have the same questions. It’s panning out in the patient resolution of symptoms. I know there are practitioners who question it. Clinically, it’s made sense.

I have had patients have completely negative specimens, especially when I’ve had patients who say they’re not having a lot of symptoms. What else can we do? “I have this autoimmune condition or this or that, and I just want to make sure.” I have had fully negative test results at times, typically in patients who aren’t manifesting any symptoms.

Dr. Eric:

You’ve seen autoimmune cases where you address the protozoa. If they have fungi, you address that. And then they get into remission by doing that?

Dr. Ami:

Autoimmune is usually not just those things. It’s this whole thing we’re talking about. It’s stress, lifestyle, all of the things that we talk about in integrative and functional medicine. It’s rare that I have someone who has- It’s so hard to dial in those other factors for all of us, even us as practitioners, that “just fixing the microbiome” is a huge feat in itself. It can’t get fully rebalanced without addressing all those areas.

Yes, I have had patients with autoimmune conditions go into remission. I can’t recall a case when it was easy.

Dr. Eric:

It’s not just follow this parasite protocol. I get it. It’s definitely complex.

Dr. Ami:

I’ve had patients with alopecia arietta where it did go into remission, but it goes into remission on its own sometimes. My patient and I thought it was from everything we did. Would it have gone into remission anyway? I don’t know. But it did go into remission after we treated her protozoa. She was someone who didn’t have a lot of lifestyle factors that were impeding our progress. It was a lot of gut stuff. It was great to see her hair growth come back. We were both super excited. Was it what we did? Who knows?

Dr. Eric:

Can I ask you one last question? H-pylori. You knew I wanted to ask you about this, too. What is your approach? Do you test for it? If someone is positive, do you treat it?

Dr. Ami:

The first thing to remember is I only want to test for it if someone has symptoms of H-pylori. I don’t want to test for it just because they’re having, for example, typical IBS symptoms. So many people are colonized with it worldwide, and the treatment protocols can be pretty aggressive. I only test for it if someone is having typical symptoms like reflux, gastric pain, low stomach acid, and we are trying to dig into that particular symptom picture.

Typically, we use a stool antigen test although there is urea breath testing. If someone has had an endoscopy, they will have had biopsies for it. If it is positive, we will typically treat it because we have usually done the test because they are symptomatic.

I will have patients often ask about botanical options. The pharmaceutical options are aggressive. It’s a proton pump inhibitor with a couple of antibiotics and bismuth sometimes. I give patients both options.

If we’re going to use a botanical option, it’s definitely really important to retest and make sure we’ve eradicated it. There are potential long-term consequences of untreated H-pylori in someone where it’s causing symptoms. There is a Thorne product I’ve used that has some of the things we’ve talked about, like berberine and bismuth. It’s called Pepti-Guard. Most of the companies we use have some sort of H-pylori life formula.

I think that option is totally fine as long as we’re retesting to make sure we’ve treated. I do have patients where we’ve done the botanical program, and it has been eradicated on retesting. I definitely think it works for the right patient.

Dr. Eric:

All right. I know there is so much more we could talk about, but I do want to ask: Is there anything I should have asked you that I didn’t ask you? Anything else you want to talk about?

Dr. Ami:

I feel like you touched on everything, Eric. In 15-20 years of seeing patients now, if we’re getting into all of these details of that supplement or this supplement or why isn’t this working, I find it helpful to take a step back and make sure we’re looking at those foundational pieces we talked about as well as this histamine/mast cell component and biofilm component. If we’re getting stuck and spinning our wheels, there is usually something in those three areas that we’ve missed the boat on. When I revisit those, that’s where we can often find something that will work when we’re getting stuck in the older paradigm of treating these bugs over and over again.

Dr. Eric:

Dr. Ami, thank you so much for your time. Can you let the audience know where they can learn more about you?

Dr. Ami:

My website is AmiKapadia.com. I have a resource tab that has a lot of the handouts I’ve made for patients and resources on there. I see patients in Oregon, so if you live in Oregon or southwest Washington, feel free to reach out to our clinic if you do need help. Thank you for having me.

Dr. Eric:

Thank you so much. It was a great conversation. I’m sure the listeners learned a lot. As usual, I learned a lot, too.

Dr. Ami:

Thanks, Eric. It was nice talking with you.

Recently I interviewed Katie Wells, and we talked about why we need to be aware of environmental toxins, plastic alternatives, how to identify safe cookware and personal care products, practical tips to move away from plastics. 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 my guest today, Katie Wells, who is known also as the Wellness Mama. I’m going to dive into Katie’s impressive bio, and then we will be talking about plastic alternatives, cookware, personal products, so it will be a very valuable episode that applies to pretty much anybody listening to this.

Without further ado, let’s get into Katie’s bio here. Katie, the Wellness Mama, is a mom of six as well as an award-winning blogger, author, podcaster, and real food crusader. Her mission with WellnessMama.com is to provide simple answers for healthier families through practical tips, real food recipes, natural beauty and cleaning tutorials, natural remedies, and more.

As a mom of six, Katie has developed systems and tips for leading a wellness lifestyle with a family and on a budget. She was named by Greatest.com as one of the 100 Most Influential People in Health and Wellness along with Dr. Oz, Dr. Mercola, Food Babe, and Tim Ferriss. She writes at WellnessMama.com and can be found on Facebook, Twitter, Instagram, and Pinterest.

She is also the creator behind Wellnesse, the first line of commercially available personal care products based on the DIY creation she had been making in her kitchen for years. Her popular Wellness Mama podcast can be found at WellnessMama.FM. Thank you so much for joining us, Katie.

Katie Wells:

Thanks so much for having me. I’m excited to chat.

Dr. Eric:

Same here. If we could just dive into your background a little bit. Before we started this, you said your podcast started in 2014, so it’s been almost 10 years that it’s been out. What motivated you to start your podcast and your website?

Katie:

The website started first. Two things lined up perfectly after I had my first son. It’s easy to look back and see. For instance, I tell people now if you want to create autoimmune disease, all you have to do is be really stressed out, eat a terrible diet, and not get enough sleep all throughout college, which is pretty much what I did.

I was doing okay until I got pregnant with my first child. Post-partum, I had some really weird symptoms. My background up to that point was in journalism, which is what I went to school for and had been working in until I had him. I was having these weird symptoms myself.

Sitting in my six-week follow-up appointment with my doctor, I read in TIME Magazine that for the first time in two centuries, the current generation of American children would have a shorter life expectancy than their parents. This article went on to talk about the drastic rise in heart disease, diabetes, cancer, and autoimmune disease. I vowed in that moment that I wanted to help change that somehow. I had no idea how I would do that, but I didn’t think that was good enough for my son or anybody’s child. We needed to figure out why this was happening and how we could change that curve that was happening so drastically and quickly.

That lining up with my own health struggles that ended up taking about eight years and a whole series of doctors to get answers. I had Hashimoto’s, which is now fully in remission. That led to a really intense passion of researching those topics. I took my background in journalism and my loves of reading and research and writing and started trying to find my own answers when I wasn’t getting them through conventional medicine.

I was also trying to figure out what I could do to give my son and eventual other five children a solid foundation in life to not face those statistics I was reading about at the time. I have always been one to process by writing. As I started writing, I realized there were many other women and families in similar situations.

At the time, there wasn’t as much information available as there is now. I’m really grateful so much of this information is very mainstream. You can go on social media and see people talking about things like morning sunlight or sourcing food from clean sources or avoiding common toxins. This is so much more well-known now than it was 15 years ago when I started. That’s been encouraging to see.

But I also very much fundamentally believe that moms are an absolute force of nature. When you can help moms who are making the daily food choices for their families or who are influencing the habits of their children, you can create ripples that impact society at a larger level. That’s been my passion with Wellness Mama since day one, one I am extremely grateful to still get to do every day.

Dr. Eric:

When did your website come out? 2014 was the podcast. The website was prior to the podcast.

Katie:

I started writing in 2006 when he was born. I officially got the name Wellness Mama in 2009. It’s been mostly daily blogs since then. I don’t write as much as I used to with the podcast; I podcast more than I write. It’s been consistent since then.

Dr. Eric:

I came out with my website in 2010, and my podcast hasn’t been around as long as you. Ever since coming out with a podcast, I’m definitely podcasting more than writing. I really do enjoy it. With the blog, it’s just my perspective, whereas with the podcast, when you have guests, you’re getting someone else’s perspective, so they are not just learning from me.

Katie:

What an amazing honor to chat with incredible people, like you do, as my actual job. We’re in this very cool time in history where thanks to conversations like this and the availability of all this information on the internet, people are stepping into the driver’s seat of their own health, with the understanding that hasn’t always existed.

I say often on my podcast we each are our own primary healthcare provider. We can work with amazing practitioners, but what really impacts our health are our own daily choices and habits and the inputs we are putting into our own bodies. I really encourage and am excited to see this huge wave of people who are willing to step in and take responsibility for their own health. That’s how we will see the best outcomes: when we have informed patients who are well-researched and have a vested interest in their own health working with all these amazing practitioners now who are specialized in certain areas and have specific knowledge that can help people. Those are the best outcomes.

Dr. Eric:

I noticed that the patients who are more compliant are those who are educated and already are familiar with things that we’re going to talk about today: trying to minimize exposure to plastics and cookware. If someone is brand new, not to say they’re not open to it, but sometimes it’s more challenging to get them to comply.

I agree. Having podcasts like yours and mine and others out there will lead to more compliance and better outcomes. I completely agree with that.

I want to start off by talking about plastic. I think that’s where I found you first, even though your podcast is so popular. I have been fascinated by all the articles you have on your website about alternatives for plastic and safe cookware. If you could tell people in your words what are the main concerns with using plastic on a regular basis?

Katie:

Like anything, in some ways, the dose makes the poison. We’re also talking about compounds that are relatively extremely new to human interaction. These are things that did not exist on a wide scale 100 years ago even. The last few generations are the first to deal with plastic exposure. We’re very much still learning just how drastically that can impact not just human health but the health of our planet.

I know a lot of people talk about this. There have been great documentaries on this. How much that plastic exposure is now far reaching throughout the entire earth. We have found plastic chemicals under 30 feet of ice in the Arctic. It’s in the water and the ice in both poles at this point. Plastic has essentially saturated the planet. This of course has impact as well, but it really impacts human health for a lot of reasons

Things like BPA get the most airtime. That was one of the first ones people started talking about. It’s a compound that’s added to plastic to make it more durable and bendable, all the things that make it convenient for packaging, which I would argue also has some problems. This availability of ultra-processed foods at all times doesn’t line up with how humans have eaten through our history up to this point.

BPA was originally given to livestock and chickens to help them gain weight for slaughter. We know it has this effect. BPA is present in a lot of plastic compounds we interact with on a daily basis. It causes that weight gain through a disruption of hormones. The same effect happens in humans.

I do also think because we found out about BPA first, and it gets the most airtime, we have also not talked enough about the other compounds present in plastics. There is a whole family of bisphenols, like BPS, BPF. There is a lot of them. There is a lot of other compounds beyond that.

This problem is really widespread. We know 92% of people tested had pretty high measurable levels of these compounds in their bodies. We know babies are born with hundreds of chemicals in their core blood. The scary part about that is a baby in utero is in the safest environment on Earth because everything is so tightly controlled by the mother’s body. The fact that we’re seeing hundreds of chemicals, and these are just the ones that can pass through the placenta because the mom’s body is going to do everything in its power to get a lot of that stuff out. This has become a really widespread problem.

A lot of these are estrogenic compounds. They’re not the only factor by any means, but I do think they’re somewhat contributing to the rise in hormone-related problems and those often-quoted statistics about men having 1/3 of the testosterone that their grandfathers did at the same age. There have now been some really daunting reports about how even as early as 2050, we might be seeing things like total infertility in a lot of people, or a sperm count of zero in a lot of men. Part of this is these estrogenic compounds that mimic hormones in the body and disrupt or replace the natural hormone processes that are happening that we literally depend on for our survival.

There are also things like phthalates and all kinds of other compounds that we’re interacting with through these plastics. They’re not just in our food packaging, but in our home environment. Parts of construction are built with plastic. They’re in clothing. Not only are we ingesting these, but maybe people have read we consume about a credit card’s worth of plastic per week on average. These things are sitting on our skin all day every day. These things are connected to our food and in our food and water supply. It’s become a widespread process, and honestly, one that would be an uphill battle to undo because it’s saturated our lifestyle at this point.

Dr. Eric:

I agree with everything you said. The hormone disrupting effects of these plastics are well known and in the research. You also mentioned other compounds, not just BPA, but BPF and BPS. The problem when someone just thinks they can use like a BPA-free container. Whether it’s a water bottle or another source of plastic doesn’t mean it’s completely devoid of endocrine-disrupting chemicals.

Katie:

There are floating islands the size of Texas in the ocean that are almost completely plastic waste that is just floating in the ocean. We run into additional problems with UV light breaking those down. Then you get these microparticles that get emitted, including things like DDT and PCB that are in the ocean and in the seafood supply and the water system in general. These things are all contributing to disruption.

Statistically, we are amping up our exposure and use of plastic. Over a trillion plastic bags per year are used worldwide. Those don’t break down in landfills. They are now entering the groundwater. Estimates are now up to a thousand years to start breaking down. That’s a million plastic bags per minute. More than 3.5 million tons of plastic each year. It’s a pretty massive problem that we’re facing.

Dr. Eric:

Before we get into plastic alternatives, I want to circle back to the water. There was an episode, I forget the name of the practitioner you interviewed, but she was talking about the microplastics in fish. What is your perspective on that? It’s a little bit of a catch-22. When it comes to seafood, nutrient dense, a lot of health benefits. Because of the plastics, is it something that you and your family try to minimize? Or is it risks versus benefits, and the benefits of the nutrients outweigh the risks of plastics in seafood?

Katie:

That is a consideration we have to weigh. There is the very real consideration about stress. It would be very easy to fall into the mindset of thinking everything will kill us at this point. You probably echoed this, but stress is one of the more harmful things we can introduce to our environment as human animals. It’s figuring out that balance of not getting to a point where everything is stressing you out, but making good choices as to what is available from a budget perspective, an availability perspective, and a health perspective to make the best choices possible, whenever possible.

Much like with heavy metals, there is an element with plastic in seafood that you want to aim for smaller seafood. The larger fish have eaten other fish that also have plastic contamination. The higher up the food chain you go, the more exposure you are potentially getting to both plastics and heavy metals.

I choose things like sardines or small fish that have a high nutrient density that are also inexpensive compared to other forms of seafood. They are like nature’s multivitamin of sorts because they also have minerals and calcium. You’re getting the whole fish in that sense. It’s good to make easier choices that way when it comes to choosing the type of seafood. It’s not like plant foods don’t have their own set of problems.

We know we need fat soluble vitamins and Omega-3s and compounds that are present in seafood or other animal products. It’s just being aware as consumers and making the best choices we can. You also have to realize that unfortunately, the reality of our time in history right now is that we are going to face these compounds in some way, just like we are going to be exposed to EMFs in some way. How can we just apply the 80/20 rule and minimize, when possible, but not in a way that will be a source of stress and lead to health problems in other areas?

Dr. Eric:

That’s a good point. You can make a good excuse for not eating anything. No matter what the food, it seems like there is a drawback. I completely agree about if you’re going to eat fish, just try to avoid swordfish, king mackerel, and tuna, and stick with smaller fish, like sardines.

Let’s dive into some of the alternatives to plastic. For those who are like, “Well, what am I going to use instead of plastic bags?” Those Ziploc bags or other brands and plastic-fee storage container. I listened to your podcast, so I know storing meat it sounds like is a bit of a challenge when it comes to avoiding plastic. If you could talk about that, but especially for other sources, and then going into the grocery stores, those produce plastic bags. What do you do in your household to minimize your exposure to plastic?

Katie:

There are some easy swaps in categories I will talk about. The gold standard is not doable at scale for all of us. To any degree we can have a direct relationship with where our food is coming from, whether it be growing our food or shopping from local sources. I live in an area near the ocean, so people can fish. If you can buy fish straight from the ocean that are not frozen and packaged in plastic for weeks or months, that’s a great step. There is a convenience aspect, and that’s not going to be feasible for most of us at scale.

There are some easy swaps from the categories of bringing your own cloth bags to the grocery store, not just for the bags I carry the groceries home in, but also produce bags. They have some great mesh bags that you can use. Those are some easy ones.

When it comes to food storage, there is amazing options for both glass and metal storage containers. Also remember that our grandmothers or great grandmothers managed to do all of this without plastic. It is possible, but it is a big job in a world where it is so much more convenient to use plastic. I try to apply that 80/20 rule in my house as much as possible, so it isn’t a source of stress.

Things like metal water bottles or glass water bottles is an easy swap. The packaging you’re using when you store food that you’ve made in your own home is an easy swap.

There are a lot of canned goods that are specifically free of plastic chemicals. Most people don’t realize that a lot of cans are lined with BPA or plasticizers to extend the shelf life of those things. You can get plastic-free versions. Making those easy swaps when possible.

In my home, I focus with my kids on the fibers of our clothing. When possible, choosing more natural fibers. I’m really encouraged by this upcoming generation in how aware they are of a lot of this. My older kids for instance pretty much exclusively shop at secondhand stores because they prefer it, not just from a budget perspective, but because they like the environmental impact of not having to buy new clothes and being able to buy secondhand. When you do that, you can look for cotton or more natural fibers in the clothing you’re buying.

The main one to be aware of there is a lot of the athletic wear that we see is extremely high in different plastic-based chemicals. Making choices there can be really impactful as well.

Like I said, it’s in everything. It’s in the cords of our lamps, the construction of our homes. It’s not realistic to completely avoid it unless we are willing to live off grid and build everything from scratch. Some of those easy swaps can make a big difference in our day-to-day exposure and reduce it enough, so we don’t have to be as stressed about it.

Dr. Eric:

You said glass and steel. I’m going to be up front here. I have a stainless-steel water bottle. It’s sitting in the stainless steel, but the spout is plastic. I don’t know if you’re familiar with Lifefactory water bottles, which are pretty much glass. I don’t like the spout, so I copped out and used the stainless steel even though it has a plastic spout. It’s not sitting in plastic, and the plastic is hard. Would you still recommend not using a water bottle like this? I want you to be up front with me. Would you not touch this water bottle because it has the plastic spout?

Katie:

My take personally is that I have both options at my house. Most of the time, I’ll use a metal one that has a metal lid that screws on. The parts touching the water are metal. I also have a gallon-sized one where the water bottle is metal, and it does have a silicone spout and a plastic cap. The part touching the water is silicone. That one is much more convenient for when I’m at track meets with the kids or traveling, and I need to have enough water for the whole day.

That is part of the 80/20. I’m not going to use single-use plastic bottles that are sitting in the sun, which also drastically increases the amount of plastic you’re exposed to. But I’m also not willing to get dehydrated not to touch plastic as well. That’s one of those balancing acts.

Dr. Eric:

I love to have a glass of water here, but I am cautious with the technology and the computer. I’m a little bit on the clumsy side, so that’s why. It’s a convenience. My wife has the stainless steel with the metal top. Every time she wants to drink out of it, she has to open it. It’s copping out because of the convenience, so I figured I’d ask your opinion.

Just besides the water, the same thing with food as well. Food, you try to store it in metal and glass in the refrigerator.

Katie:

Yeah, I can be clumsy as well. They have these great metal containers that have latch-on lids, which is convenient with young kids. Since they will inevitably drop them at some point, they bounce instead of break, and the lid doesn’t come off. I have those in varying sizes all the way from single serve meal size for food prep to one that can hold two gallons of soup if I put it back in the fridge. Those are easy swaps and are entirely plastic-free. There is a brand called Life Without Plastic that makes a lot of these.

I also do some meal prep in glass containers with latch-on lids that are either silicone or wood. I am doing a lot of strength training, so if I am prepping my own food for the week, so breakfasts and lunches, I’ll do those.

To circle back on the hydration, one tip I give people from a habit stacking perspective and a hydration perspective is if you sleep with a glass quart-sized mason jar of water on your nightstand, and I also recommend putting trace minerals and silica and a bunch of stuff I know I need to get more of in that water. One habit is as soon as I wake up, I will drink that water before I drink anything else because we lose a lot of our hydration while we’re sleeping. We can lose quite a bit of water through respiration while we’re sleeping. Getting that water in our bodies first thing in the morning from a glass container ideally with minerals added in is an easy way to keep hydration on point for the whole day.

There has been a lot of research around hydration early in the day versus hydration later in the day, not just from a sleep impact perspective. We don’t want to drink a ton of water before bed and be up all night going to the bathroom. That early morning hydration, because we do get a mild dehydration during sleep, can be really impactful from an energy level perspective and help our detox pathways. Those are important to be aware of and support if you are trying to get out plastics that exist in the body. I’m a big fan of that as well as sauna use for getting out residual plastic in the body.

Dr. Eric:

Good tips. Definitely want to stay hydrated. I love sauna. You want to especially stay hydrated if you are going to the sauna regularly. Take electrolytes. Do you do sauna daily or a few times a week?

Katie:

A few times a week for sure. I go through phases of doing it regularly. When everything shut down for COVID, I actually used that time to do an actual experiment in my neighborhood. We were all locked down together, so I recruited this group. We did lab tests before and after.

People may have heard of the studies on sauna, especially the Finnish study that is most quoted. That is the one that makes a strong case for sauna use. I say if sauna were a pill, everyone would take it because the effects are profound. We know sauna use in the range of 4-7 times per week can reduce all-cause mortality by up to 40%. It can reduce risk of dementia, stroke, heart attack pretty drastically because sauna is an exercise mimetic. You won’t get the same strength benefits that you would from exercise from doing sauna, but you get a lot of the cardiovascular and mental benefits you would get from exercise. You’re sweating, your heart rate increases, and you’re moving your lymph system.

If people are able, hitting that 4-7x a week is the gold standard window. There is evidence of excretion of BPA and plastic chemicals from the body with regular sauna use, with the caveat being the studies that currently exist have looked at mostly the heat as the mechanism. People talk about infrared saunas, which I think are awesome. Make sure you’re hitting that minimum heat threshold and time threshold to get the benefits. Use whatever kind of sauna you have available.

Dr. Eric:

Do you know what that heat threshold is?

Katie:

There is a little bit of variation in what the studies say. I personally aim for 170 degrees or above, Fahrenheit. Some people say 150s and above. There is a time-dependent threshold there. I aim for 170 degrees and up for a minimum of 19 minutes without getting up. Uninterrupted heat exposure for 19 minutes. Sometimes, I’ll do several cycles of that. If I’m short on time, that’s the minimum I aim for.

Dr. Eric:

Just curious. Do you follow with a cold shower after that?

Katie:

Sometimes. The interesting thing about that is I think of them as three separate categories with separate benefits. Sauna use on its own has this whole host of benefits. So does cold exposure.

Since we have an audience that is potentially thyroid-specific, be careful with cold exposure at first if you’re working on rehabbing your thyroid. It can be stressful to the body if you are in a state of thyroid disruption.

Heat and cold together has its own set of benefits. They call that contrast therapy, where you’re going back and forth. Going from the heat to the cold makes it much easier to do the cold, and it’s a great relief from the heat.

I try not to do cold exposure every time I sauna because I think the isolated benefits of heat and staying in that heat exposure for longer can be beneficial. I have also lately been experimenting with doing the growth hormone protocol, where you do 30 minutes of sauna, cool down a little bit, and then do that four times, which is shown to drastically increase human growth hormone. If you’re trying to recover from something, that can be a beneficial tool as well. I think sauna on its own is really profoundly beneficial, even if you’re just doing sauna.

Dr. Eric:

Wonderful. Didn’t expect to talk about sauna here, but I always love talking about sauna.

Before we move on to cookware, is there anything else that needs to be mentioned about plastics?

Katie:

I think those are the big categories. I think of a lot of things in my life along the lines of the 80/20 rule, which is the idea that 80% of results come from 20% of inputs in both positive and negative contexts. Any time we can find those 20% of things that are actually causing 80% of our exposure, that’s a great starting point. Even if that’s the only point we ever get to, that’s a drastic change for our health. Same with stress. If you can find the 20% that’s causing 80% of your stress and work on those.

Side note: Since I didn’t say the results of the sauna study, we lab tested before and after. Only in a two-month period, there was a drastic reduction of inflammatory markers in the body. There was beneficial movement in all the labs related to inflammation, hormones, and sleep. Sauna can be really profound there.

I also don’t think sauna is necessary for health either. I know sauna is not always budget-friendly. I don’t want people to think they can’t be healthy without sauna.

Applying that 80/20 rule to plastic exposure and health exposure. I know we will talk about the personal care side as well, but that was my driving force with creating those particular products. What are the 20% of products that are giving us 80% of exposure to toxic compounds in the personal care products we’re interacting with?

I look at that with dietary approach in general. We don’t have to be 100% perfect. If we can be dialed in in the things that are making the biggest impact, we have a lot more leeway in the other areas.

Dr. Eric:

I tell my patients that if you’re getting exposed to plastic water bottles on an occasional basis, if you’re on vacation or on an airplane where you can’t bring your own water bottle, if it’s every now and then, not a big deal. You don’t want to be buying water by the case and drinking that every single day. Same argument with tap water.

Same thing with cookware. If someone goes out to eat, you don’t know what cookware they’re using. You could ask, I guess. Chances are you probably won’t ask. As long as you’re not going out to eat every single day, not a big deal, it sounds like.

Katie:

Exactly. You touched on something so valuable. The more of our food we can prepare at home, that makes a huge impact. It doesn’t have to be 100%. If we can make that a habit as much as possible, which is also great psychologically from a family perspective. There are a lot of studies looking at outcomes of kids in different areas of life. Just from having dinner together as a family every night, which is a great bonding experience. Hopefully, we’re cooking together, so our kids are learning those foundational skills. We have a lot more awareness and control over where our food came from and more of a connection with our food. Steps like that make such a big difference.

I know you would echo these steps as well, but staying in that point of not being stressed out and thinking everything is out to get us. Dialing in the stuff that’s free first. Getting morning sunlight in the morning because we are so light-dependent, as is the thyroid. There is a lot of light-dependent aspects going into that.

Getting outside for 10 minutes in the morning, not through the window. You don’t have to stare in the sun; please don’t. Just being outside, it’s a great time to hydrate or get some gentle movement or spend time with your family. That can make a huge difference in your cortisol, melatonin production, sleep quality, and other hormones as well because they all are dependent on those cortisol rhythms.

Same thing if we can dial in our sleep. Anything we can do that improves our sleep has ripples into our wakefulness as well. We know stress is a big epidemic. Anything we can do with our stress levels will have positive ripples. There is a conversation about health, especially related to thyroid, because that is so personal to me as well.

I also like to remind people that the body’s natural state wants to move toward good health and healing. I know with autoimmune disease, for a while, I felt like my body was out to get me. I had to realize, Dr. Cassie Huckabee says this so beautifully, “If your body wanted to kill you, it could do it in less than a second, instantly.” Your body is always on your side. It’s adapting, trying to do the best thing for you.

If we can approach it with that mindset, even if there are symptoms of something we don’t like going on in the body, our body is still always on our side. If we can approach it from the perspective of how do I best support my body in moving toward health, where it already wants to go and is trying to do, what steps can I do to help it get there, we will come at it from a much more positive mindset than thinking everything is out to kill us.

Dr. Eric:

I agree with that. Thank you for bringing up sunlight in morning as well as sleep. I think everybody knows the importance of sleep. Even sunlight is something I have been working on over the years. Morning sunlight and in the middle of the day.

You live in sunny Florida, so it’s probably not difficult. If someone lives up north, or in a rainy area like Seattle, are you okay with them using a light box to get that exposure?

Katie:

Absolutely. In the hierarchy, I put light as a very high priority as far as things we can do for health. I am grateful to live in an area now that gets a lot of sun and good UV throughout the year. It’s something I can integrate pretty easily here.

Before I lived here, I did have a 10,000 lux light I used in the morning. When I started using it, I noticed a difference in my energy levels. We are so light-dependent. There are receptors in our eyes that start the whole Circadian clock toward sleep, and it’s dependent on that early morning light exposure. My general rule was as soon as possible after waking, I would ideally get natural light exposure. If not possible, I would get exposure from the robust light boxes that hit those receptors in the eyes that start that clock for melatonin production at night.

Because I have done a lot of lab testing over the years as I was recovering, they really do make a measurable difference in our stress hormone levels. Stress hormones are a big issue for a lot of people in today’s society, but they often do overlap with thyroid issues as well because all hormones are connected, and they don’t exist in isolation. If you are only addressing thyroid but not the others as well with some of those free steps, like getting light, you will be fighting a more uphill battle. I love any time there is an inexpensive or free step we can do that has far-reaching impact on our health, and light is one of those.

It’s a little bit controversial, but we have done ourselves a disservice in the last few decades with our fear of light exposure and things like our fear of salt exposure. Both of those have had pretty negative impacts for health in general. Those are two things our bodies are dependent on.

From a mineral perspective, we need enough sodium for our sodium potassium pump activity to work correctly, and our electrical communication within the body. Especially those of us who eat a more natural diet, we are not exposed to as much salt from processed foods, which is overall a good thing. If we are not replacing those minerals from other sources, that can actually have your energy levels take a dip. That’s another easy one.

We got afraid of the sun, and we got afraid of natural minerals. A lot of people are facing deficiencies in both of those. Light and sun exposure, even though it’s controversial, is extremely high up on the list of priorities for supporting health across the board.

Like you, I get morning sunlight. I also try to get 20-30 minutes of bright midday sun exposure on as much of my skin as possible, with the caveat that we are not trying to burn. If we are burning easily, that can be insight that there is inflammation happening somewhere in the body.

I also noticed when I changed my diet and was much more careful about what I was eating that my sun tolerance went up a lot. My background is Irish/Scottish, so in high school, I would burn if I even thought about looking at the sun. Now that I’m eating a much more nutrient-rich diet and have worked on getting inflammation down, I find that I don’t burn, and I’m very careful not to burn, but I feel great when I get enough sun exposure.

Dr. Eric:

I want to ask you another question about the sun, especially since you have six children. Do you ever use sunscreen? If you do, it’s a more natural brand. Or do you completely avoid sunscreen?

Katie:

For the most part, I completely avoid sunscreen. That’s a controversial viewpoint. I very much take the view that we need more sun exposure, not less, with careful care not to burn. My preference is always to cover the skin or get in the shade if we’ve reached our tolerance of the sun for that day. If they’re at a sporting event, on the track field, with no shade, they will either put on a long-sleeved shirt or a hat, or occasionally they will use a homemade mineral sunscreen on their face.

I also find my kids, who have lived most of their lives in sunny environments, our bodies are so adaptable that they have developed really good sun tolerance from a young age. Kids are so great at noticing almost immediately the positive effects of changes they make. They notice they feel more energetic when they get good sun exposure. It’s so built into our family culture that they are very careful about not burning, but they are also pretty careful about making sure that they’re outside quite a bit during the day, which is great.

Dr. Eric:

Especially in this day and age where a lot of children unfortunately are glued to their electronics and not getting enough sun. It also goes back to what you were saying about plastics. 80-100 years ago, they didn’t have to worry about plastic. It’s not like 100 years ago, everybody was using sunscreen. I don’t know when it was invented. For many years, there was no sunscreen out there. I’m not saying there is never a time and place, but for the most part, as long as you’re careful, not out in the sun for too long, taking the proper precautions when you are, you will probably be okay.

Katie:

We can mimic some of the aspects of the sun, whether it be with red light or the light boxes or even UV lights. Those all get pretty pricey. Another thing you have to add to your to-do list every day. The sun is like the multivitamin of light. It’s free. It’s hopefully available to us in some form every day. At least start there, even if you do for your thyroid for instance red light for a while, or you want to increase your UV exposure if you live in a cloudy area, that’s great. I don’t think that needs to be the starting point, as the sun is free.

Dr. Eric:

Now we’re going to go to cookware. I’m sure everybody has been waiting. I’m sure they have been learning a lot. I didn’t expect to talk about sauna and sunlight, but they’re important. That’s the thing with this podcast. I go in whatever direction if something important comes up. We tend to overlook some of these factors, like getting enough sun and even neglecting sleep. I appreciate you bringing that up.

I want to talk to you about cookware because that also is what I discovered on your website. Your articles talk about safe cookware options. There are problems with aluminum and the different coatings. I don’t know if you want to start off by talking about some of the problems with the nonstick pans and aluminum and other chemicals that are being used.

Katie:

Absolutely. This is another area I think we are seeing a lot more awareness about, which is great. Now we have people stepping into the space that are creating healthier alternatives that are also still convenient. We see that curve happen a lot, where new things are created that make life so much more convenient, so they are easily adopted. Then we learn later about the potential downfalls of those things, which is also the case with nonstick cookware and aluminum.

The nonstick is so much easier to cook with for a lot of people, so it became widely adopted. But people have probably heard of the studies of how the off-gassing from certain cookware can even kill household pets that are birds because they’re so sensitive to it. Humans are not going to die from the fumes of it, but there is an impact on humans as well.

Just to acknowledge the convenience side, I get why people want to use those because it is much more convenient. Cleanup is a lot easier. Now, there is a whole category of products that are within the safe category that are also pretty convenient to cook with. I have experimented with a lot of those over the years.

I know my grandmother was pretty much just using cast iron that she had seasoned for decades that was essentially nonstick at that point because she had taken such good care of it.

There are other options as well. I’m a big fan of ceramic. It’s not nonstick, but if you cook with it correctly, it doesn’t have a high likelihood of sticking, and it’s very easy to clean. You can use metal scrubbers to clean it, which is not the case with a lot of other natural cookware. As long as you’re getting ceramic cookware that doesn’t have heavy metals or anything in the ceramic coating. I have a lot of fully ceramic cookware in my house.

There are also ones like the Always Pan, which is essentially nonstick but free of a lot of the compounds that are in traditional nonstick, like Teflon. There are ones that are emerging.

If the movement is more toward cooking at home as much as possible, then cookware is in that category of the 20% we can change that makes a big difference because it’s interacting with a lot of our food. Any time we can use ceramic or glass or safe metals over the aluminum or nonstick, that’s an easy step. We’re already cooking anyway.

I am a big fan of swaps that can be made without any extra inconvenience, whether that be natural laundry detergent that’s safe because you’re washing clothes anyway; whether that’s cookware that is safe because you’re cooking food anyway; whether that’s deodorant or shampoo or toothpaste that’s safe because you will use those products anyway. I’m a big fan of those swaps that don’t take any extra bandwidth or decision-making once we switch them.

Dr. Eric:

You said the pan was the Always Pan. That is the name of one of the products?

Katie:

The Always Pan. There is also a brand called Xtrema that makes ceramic as well. Caraway is new on the scene. A lot of people like it because they have bakeware as well. I have resources for all of these. There are thankfully a lot of great alternatives.

Stainless steel is a pretty decent alternative if it truly is aluminum-free. That one is widely available and pretty inexpensive. Or cast iron if you are willing to take care of it although some people have concerns about getting too much iron from exclusively using cast iron. That’s the one caveat with that one.

Dr. Eric:

My wife and I don’t use it all the time, but we use cast iron a few times a week for some grilling, like grilled chicken. What do you use if you’re grilling burgers or chicken?

Katie:

Usually cast iron or occasionally stainless steel. Cast iron has a better heat ratio and gives a better cook on those foods.

Dr. Eric:

Do you use glassware as well?

Katie:

I do use glassware. There are even glass pots and pans you can use.

The one thing I run into in my house is because there is so many of us, I also have to find cookware that’s big. I love the Always Pan, but it’s hard to cook for eight people in one skillet. I use a lot of stainless steel or ceramic stockpots for bigger meals, which is the majority of meals at our house.

Dr. Eric:

For those listening who are wondering what’s the big deal with nonstick, there is some research out there, especially with Teflon, and when it comes to the thyroid, there are some disrupting properties. I’m sure it has other health concerns besides that. Just because there are alternatives as Katie has been sharing with us, it makes sense. The answer is convenience. That’s why people go for it.

Again, we use ceramic as well. We use a combination of ceramic, glassware, stainless steel, and cast iron pots and pans. There are definitely alternatives. Like the cast iron pots and pans, I don’t know if you found a good solution, but it is difficult. It is just one of those things where to me, it’s worth the time to scrub to avoid those chemicals.

Katie:

One easy mom tip on that is both of those—stainless steel and cast iron—are very temperature-dependent in the cooking surface and how much they will stick. Often, a lot of the cleaning issues can be resolved by waiting to get to the right temperature before you put any food in the pan.

An easy test for that is to put a couple of drops of water in. If they immediately start dancing, that’s a safer temperature than using a natural oil when you put food in. I can even cook eggs often in either of those without any sticking as long as I have the temperature correct going into it.

Also, seasoning it carefully. Making sure it always has that natural oil barrier. Not using soaps or anything harsh to clean it. We’ll clean with salt or things like that not to break down that natural seasoning.

Dr. Eric:

Do you recommend using salt?

Katie:

Yeah, I use salt and a natural scrub brush. I always hand dry it and then oil it rather than air dry it, so it doesn’t ever get rust. I occasionally also season it in the oven to keep that barrier strong. If you take care of it well, a cast iron pan will get better with age for that reason.

Dr. Eric:

Do you have an air fryer?

Katie:

I do. There is one that has a stainless-steel insert. I don’t use it as often because it’s hard to cook for as many people in an air fryer, so I would have to do multiple batches. I normally use my stainless-steel bakeware in the oven because there are so many of us. But there are a couple good options now for air fryers. I know those have gotten really popular.

Dr. Eric:

The reason I ask is because my older sister was raving about her air fryer, so I looked into them. A lot of people have the nonstick as well. The tray that they use for the air fryer. It sounds like there is one that is stainless steel?

Katie:

Yes. With air fryers, and especially pressure cookers, that’s another one to be very aware of if you’re going to use them. A lot of them do have nonstick coatings. Especially with pressure cookers at pressure, you will see more of the movement of those compounds into the food itself. Heat and pressure both increase that movement, just like they do with heat or light in the ocean with plastics. The higher the temperature, the more careful you want to be.

Dr. Eric:

Before we talk about personal care products, anything else when it comes to cookware that you wanted to mention?

Katie:

I think that pretty much summed it up. There are easy swaps you can find now that are not much less convenient than the nonstick ones you will find everywhere. We are seeing a big move of people making those choices, which is great.

It seems like a battle between smaller companies that will rise up to solve a problem that will eventually get bought by bigger companies. A lot of consumers resist when a natural company is bought by a bigger company. Long-term, that’s a great sign. This means even the big corporations are acknowledging that people want safer products now. To fix the problems at scale, we need the consumers making great choices, and we need these big companies who have economies of scale, and can vote with many more dollars than we do, making those choices as well. I take it overall as a good sign that we are seeing so many of these companies pop up, and big companies are acknowledging the importance of them.

Dr. Eric:

I agree with that. Let’s talk about personal care products because I know that is a huge passion, which is why you developed your own product line. What are some of the concerns? I think people who are listening know the concerns, but I still want to hear the main reasons why you decided-

First of all, before that, you had on your website DIY recipes, so it’s not like a product line is the beginning of it. For years, you have been promoting people making their own products. A lot of people don’t want to do that. They can also make it on their own. If you could talk about some of the concerns with personal care products out there.

Katie:

All of those recipes are still on my site. I’m a huge fan of DIY. People who don’t want to buy natural products, there is now great DIY recipes for everything now.

For me, when I was in the thick of healing from my thyroid issues, I was much more sensitive to essentially everything. I was on a very restrictive clean diet, which thankfully I am not as restrictive as I was then. A lot of things in my environment were also causing problems at that point.

At the time, there were not natural alternatives to most things, so I started making them at home. This was everything from toothpaste to deodorant to hair care. Pretty much anything that came in contact with our bodies, I made from scratch, so I knew what was in it. That was fascinating. I learned that deep dive into chemistry and understanding how those compounds interacted.

What I learned is people will say our skin is our body’s largest organ. There is a strong case for that. I would argue that if you want to count muscle as an organ system, muscle would be a larger organ. Both are important.

With skin, a lot on our body also enters our body. People think of our skin as a barrier that doesn’t let things in. Our skin is a barrier, a very important one, but it’s also meant to uptake things. Things that do go on the body do eventually make it into the body, which can be used for positive as well as negative.

That was one thing with DIY products. How can I put beneficial ingredients into the things that go on my skin or are going in my kids’ bodies through their skin, and not just avoid the bad stuff? Hopefully avoiding the toxic stuff in skincare should be the baseline. I hope for a world one day where that is the standard for companies, not the exception.

Understanding that our skin is an organ that interacts with anything put on it, we hopefully become more aware of what we’re putting on our bodies or in our mouths, or especially tissue like the armpits, which is very close to our lymphatic system. There are some controversial studies about products put on our armpits from deodorants that might leech in, with a higher incidence of breast cancer.

I started making these at home and realized about 10 years later that a lot of people who were eating organic and making all these healthy choices weren’t willing to put in the effort to do the DIY. They also wanted products to perform a certain way because they were used to an experience with these products. Women essentially weren’t willing to trade how their hair looked or felt, or if their teeth were white, for using more natural products. For these friends who were eating organic but still using Pantene and Crest, the only way they were going to make a change is if there was a convenient, easy swap they could make with no extra effort.

Back to the 80/20 principle. I also realized that 20% of the products we use are responsible for 80% of our chemical exposure. We know statistically, on average, women encounter many more chemicals through personal care products than men do. Anyone who is married and has a bathroom counter can probably tell just from looking at the number of products the guy has versus what the woman has. This is especially a concern for women. Women also have a higher incidence of thyroid issues and all kinds of issues. This is one of the contributing factors, certainly not the only one.

If we could just make swaps in those products that are most impactful, that would go a big part of the way to changing everything. There are also natural makeup brands. You could swap out everything if you wanted to. But if you start with the stuff that is on your skin, or you are getting exposure to all day, that makes a big difference. Just like we talked about with the plastics, the things in our personal care products are getting integrated into our bodies and entering our bloodstream and our tissues. Many of them can store in the body for years. Personal care products, just like a lot of plastics, have endocrine disruptors. Avoiding those products can make a big difference toward health over the long term because our skin is such a large organ and allows so much to go through it.

That was the impetus for creating those products. I also started with what I started with for that exact reason. Obviously, oral care products are in our mouths. People can acknowledge those go into the body pretty rapidly. There is medication you hold under your tongue, which is so effective because the body can so rapidly uptake from the mouth.

I have been fascinated by oral health ever since learning about nutrition and physical degeneration over 10 years ago. I realized that not only do we have an oral microbiome, but there is this amazing living process that is going on in our mouths with remineralization and the interaction of our saliva and fat-soluble vitamins within the body and the constant rebuilding of the enamel of the teeth. Creating products that supported that natural process. Back to that idea of your body is always on your side. If something is going wrong, what does the body need in order for that process to go right?

I started with oral care and hair care because hair is also one where we think if we just wash our hair and wash it out, we’re done. What’s happening is we are getting the direct exposure to those products while we’re washing our hair. Not all of it is removed from the hair follicles. We are getting low-level exposure to whatever that is throughout the whole day through skin contact and respiration. Any of those really strong-smelling scents or perfumes, we’re inhaling those and getting low level SVOC exposure all day long.

It’s a dual exposure, which is also something to be aware of with laundry products. If your laundry products smell like air fresheners, those compounds are sitting on your skin through your clothing. You’re inhaling them all day, every day, even while you’re sleeping, if you are wearing pajamas or have sheets that were washed in those. Making swaps there can be an impactful change as well.

Same thing with deodorant. That being such a tissue where so much lymphatic activity is happening in the armpits. If you have chemicals sitting there, the body is uptaking those, and they can circulate throughout the body.

If I could replace those products that most people use every single day with oral care, hair care, and deodorant, that would go a long way toward removing some of at least the more dangerous and widespread exposures that we all have.

Dr. Eric:

You have your own line of toothpaste, shampoo, deodorant, soap, and hand sanitizer.

Katie:

Soap and hand sanitizer. Now floss as well. Most floss is actually lined with some of the more nasty plastic compounds to make it glide so easily. Those are sitting in the gums. Being especially aware of what goes into our mouth is a big problem.

Fluoride is another controversial topic in and of itself. There is a lot more that goes into oral care than just that. I know you have talked about the fluoride/thyroid connection and how we want to be wary of fluoride because it can interfere with thyroid hormone. Most people, when it comes to toothpaste that are aware of that, just choose fluoride-free alternatives, which is helpful.

When we use one called hydroxyapatite, which is what’s naturally present in tooth enamel to begin with, and what our body is using to rebuild tooth enamel all the time- There is also a diverse microbiome that is the start of the digestive process and is really involved in whether or not we get cavities or gum disease.

There are two kinds of imbalance that can happen within the mouth. In one direction, you will get the Strep mutans bacteria, which is the one that is responsible for cavities. But you also might see other imbalances that lead to gingivitis.

The interesting part is you typically don’t see those happen at the same time. Just like in the gut microbiome, there is an oral microbiome that is always trying to keep the bad bacteria in check. Usually, only one of those opportunistic bacteria at a time will spike. Understanding that, if we can support the oral microbiome, and support our good bacteria in our mouth, not only does that help with things like bad breath, which people are concerned about, and help with remineralization, but also it can help with keeping both of these more opportunistic and dangerous bacteria in check as well.

I love talking about the oral microbiome and how to support it. Just like with the hair care products, my goal was not just to avoid the bad stuff. It was mandatory that all of the products only had EWG-safe ingredients. But also knowing that these things are going to enter the body in a bigger way, how can we put the things that are beneficial to the oral microbiome or to the skin microbiome or to the proper functioning of a hair follicle into the products so that we are getting a beneficial effect all day long versus a negative one?

Dr. Eric:

Is it the same with the soap? Do you have ingredients in the soap that can nourish the skin?

Katie:

Yes. For example, in the hair care for instance, we have ones that naturally increase hair follicle activity. I know hair loss is a big concern for people, especially thyroid. I had hair loss for a while. I was looking at how I can create a multivitamin for the skin, hair, and oral microbiomes that will give it a benefit all day long.

Dr. Eric:

That’s awesome. Getting back to toothpaste, the hydroxyapatite, it’s not only that it’s fluoride-free, but it also helps support the oral microbiome. It also helps with potentially the remineralization of the teeth as well.

Katie:

Exactly. That was the goal with the toothpaste. It’s the one I DIY’d earliest, and it’s been through almost 100 iterations to get to this current version that I love. It uses hydroxyapatite, which is also what makes teeth look white. I know people prefer their teeth to look white and shiny. When you strengthen that tooth enamel naturally over time, it’s also what contributes to your teeth looking white and healthy because it’s supporting that natural remineralization process by providing that hydroxyapatite and the minerals that the body needs to interact with your saliva to constantly replenish your tooth enamel.

Dr. Eric:

Wonderful. You can check out Katie’s line, Wellnesse.com. I highly recommend checking her products out. Anything else we need to cover with regard to personal care products?

Katie:

Yeah. I’m glad we got into so many far-reaching directions. I love the work you’re doing. All of these subjects you’re tackling that are so important for all of us, but especially for moms, which have been my audience and community for so many years. I love that the work you’re doing is supporting families and helping all of us as well.

Dr. Eric:

Thank you so much. Being that you at one time experienced thyroid autoimmunity, Hashimoto’s, if you could just finish by giving some additional tips for those with thyroid autoimmunity, things you have done over the years to maintain your health. You did mention a lot here with the sauna and sunlight and sleep. I don’t know if there is anything else to add, but if there is, I would love to hear it.

Katie:

Thyroid especially is a place where I think we see the best outcomes when we have informed patients who are willing to do the research and make the daily choices and can benefit from the knowledge of amazing practitioners who have specific knowledge that can be helpful.

The thyroid is so far-reaching in its impact in the body, and there are so many inputs that can lead to an imbalance. It’s not that there is ever a single cause and effect, one thing that will fix the thyroid. All hormones are so interconnected that I often think the thyroid having an issue is a symptom of something happening wider in the body. We can’t just try to fix the thyroid, but it’s a great sign from the body that the body wants us to look at all these other things as well. When we take that holistic approach, it’s more impactful and hopefully a quicker healing than if we just try to treat the thyroid in isolation for instance.

It also leads into a little bit of a conversation around mindset, which was much more impactful for me than I expected it to be. For many years, I had that view that my body was out to get me, and it was attacking me and trying to kill me. I eventually realized that that mindset piece and the languaging I was using toward myself made a big difference in how I was approaching healing and how that process was going to look. I don’t think mindset alone will fix the problem, but I do think it’s an important piece to be aware of.

Shifting to that idea that our body is always on our side, coming from the approach of how I can best support my body and be a partner in achieving better health, which also leads to what could be many podcasts all on its own on the stress side and addressing if we have unresolved issues or trauma going on. That was part of it for me.

Shifting that mindset to a positive approach versus a negative approach, not restricting food because it’s bad, but choosing great food because we love and respect and want to nourish our bodies. Taking the positive approach of working with our bodies in the best way possible to nurture ourselves and work toward what the body already wants, which is healing.

I think that mindset piece opens the door and sheds light on a lot of the areas that we can work on in a way that makes it exciting and fun versus restrictive and feel like a prison. I always want to leave people with that. That mindset of working to a place of less stress and more self-love puts us in a better mental state for healing as well.

Dr. Eric:

Thank you for sharing that. I agree. You mentioned mindset alone usually won’t be enough. I agree with that as well. I will say that when I work with people, those who have a more positive mindset do seem to get better results than those with more negative mindsets. Thankfully, most people I work with do seem to have that positive mindset. For those few people who have the negative mindset, it doesn’t mean they can’t heal, but it does seem like it makes a difference.

Can you remind people where they can find out more about you, Katie?  

Katie:

I’m Wellness Mama everywhere online. The website that hosts the podcast is WellnessMama.com. There are links to a lot of resources available on there. If people want more specific information in any of these categories, it’s often easy to google Wellness Mama and cookware or thyroid, whatever it is, and all of the articles on that topic will come up.

Dr. Eric:

That’s how I find you when I want to refer to something. I type in “Wellness Mama cookware” or “Wellness Mama plastic alternatives.” That’s great advice.

If you’re one of the rare people who have not checked out Katie’s website as well as her podcast, please do so. Katie, thank you so much for sharing your knowledge. You covered so much today, and I learned a lot. I really do appreciate it.

Katie:

Thank you so much for having me. This has been such a fun conversation.