Recently I interviewed Dr. Wendie Trubow, and we talked about heavy metals and how you can start going in the right direction regarding thyroid autoimmunity. If you would prefer to listen the interview you can access it by Clicking Here.

Dr. Eric Osansky:

With me, I have a return guest, Dr. Wendie Trubow. We are going to be chatting about heavy metals, and we will be tying that into thyroid health, thyroid autoimmunity.

Let me dive into Dr. Wendie’s bio. Dr. Wendie Trubow is passionate about helping women optimize their health and lives as a functional medicine gynecologist. Through her struggles with mold and metal toxicity, Celiac disease, and other health issues, Dr. Trubow has developed a deep sense of compassion and expertise for what her patients are facing. She is a co-author of the amazing book Dirty Girl: Ditch the Toxins, Look Great, and Feel Freaking Amazing! and has been regularly featured in mindbodygreen and Huffington Post. She is an accomplished speaker and previously had her own television show. She is on the faculty of A4M and is a speaker at their conferences as well as other societies. She and her partner will be releasing their next book in mid-2023. Thank you again for joining us, Dr. Wendie.

Dr. Wendie Trubow:

Call me Wendie. Thank you. Happy to be here. So near and dear to my heart, everything we talk about.

Dr. Eric:

Even though you’re a repeat guest, I’m sure there are people who aren’t familiar with your background. You had some struggles with mold and toxicity, and I’m guessing that’s what led up to you writing your book and getting into the environmental toxin field.

Dr. Wendie:

100%. I was a hot mess, anincludeame my message because when I finally got diagnosed with heavy metals, which included lead and mercury as well as microtoxins, which are the toxins that mold puts out when it’s hanging out in you. Super creepy. I had five strains of those. Plus, a whole host of other environmental toxicants, like gasoline fumes, plastics, nail polish toxins, beauty products, phthalates, parabens, flame retardants. I had a list of those, too.

I looked at my husband and said, “I’m such a dirty girl. We’re writing that book because I’m a poster child for healthy living. I have all this stuff, so what does everyone else have, who may not be as far into the functional medicine lifestyle as I am?” So it was pretty personal.

Dr. Eric:

We’re all impacted by these environmental toxins. Not everybody exhibits symptoms. Obviously, your book is bringing awareness to those who are not experiencing symptoms and of course many who are and are not associating them with environmental toxins. I didn’t realize you’re coming out with another book as well?

Dr. Wendie:

Like any good construction project, it’s been delayed. It’s called Sweaty and Bitchy: From Sex to Brain Function. Master Menopause, and Feel Freaking Amazing! However, we have so much going on that we are going to push that further back. We pushed it to January or February of next year.

Dr. Eric:

I’m glad I asked you.

Dr. Wendie:

Good construction project. We’re delayed.

Dr. Eric:

Now it’s early 2024. That’s fine. I’m sure it will be just an awesome a book as the first one, but you don’t want to rush it. Looking forward to that.

We’re going to focus on heavy metals. Our last talk, we focused on a lot of things. But plenty to talk about with heavy metals alone. Why don’t you start out by talking about why they’re such a concern?

Dr. Wendie:

This is so important. I’m so grateful to be able to discuss this. Heavy metals are all throughout our environment. A lot of times, they’re not really present in large enough quantities to do much to us. However, a big caveat: Because we started to use lead and mercury, and because thallium is in the soil of a lot of organically grown vegetables, and because cadmium is found in cigarettes and West Coast oysters, we now get exposed to heavy metals at a much higher frequency and amount than perhaps 300 years ago.

Because we are all by definition born to someone who’s female, we get 50% of what that person had. You get 50% of your mother’s heavy metals and other toxins. You’re born in life, and you’re behind the 8 ball. This matters because what we’re seeing is, for example, you and I both have teenagers. In theory, when you set aside what you get from your mother, teenagers shouldn’t have any of this stuff. There is no lead in their pipes. For everyone except for 10 million Americans, there is no lead in the pipes. Or mercury in the fillings.

Except these kids still come up with positive results. They are getting from their mother what they have. Even if you weren’t born in the ‘70s, you were born to someone who was born in that time frame. You were exposed to lead in the gasoline, lead in the paint, lead in the pipes, mercury in food processing, mercury in those silver fillings, which are 50% mercury by weight.

They never stop off-gassing. This is all about saving your thyroid. The thyroid is particularly sensitive to mercury. Your teeth and thyroid are very close together. Anything off-gassing gives the thyroid a good kick on its way into the rest of your system. We are having these constant exposures. Even though we don’t have some of the things we had, we still have the exposures. Think of it like it used to be.

Dr. Eric:

That’s a good point. Just being born already with so many toxins, and it’s getting worse and worse from an overall toxin standpoint. You mentioned heavy metals. Thankfully, not as many dentists do mercury amalgams and silver fillings, but there still are some unfortunately. There are other sources, too. Most people are already at a disadvantage when they’re born because they are picking up half the toxins their mother has.

Can you go over some of the most common heavy metals you see in practice and also some of the main sources of these heavy metals?

Dr. Wendie:

The top two I see that catch my attention are lead and mercury. Then cadmium and thallium are the next two. There are others. We test for about 15 of them. Those are the ones we narrow in on. We do occasionally see arsenic because it’s a huge source in rice. The majority that I go crazy over are those top four.

The sources for lead are living in a home built before 1978. 1978 was the watershed year because the government outlawed lead being in paint then. If you live in a house built before then, or if you are a DIY human and like to do construction projects on those homes, you’re increasing your exposure. If you were born to someone who was born before 1978, you got half of what they had. Lead pipes is still a concern for about 10 million Americans.

For mercury, you’re looking at those silver fillings and high mercury fish. There is this subtle or sinister one, which is if you’re eating food that was made with mercury to process it, like high fructose corn syrup, has to use mercury to get from corn to high fructose corn syrup. You get a dose of mercury in that syrup, along with glyphosate, because you have concentrated the pesticide in that.

For cadmium, it’s West Coast oysters and smoking. Those are the big sources.

Thallium is largely from the soil in California. If you’re eating organic vegetables, this is a no good deed goes unpunished. You will often have higher levels of thallium in your bloodstream. It’s hard to get away from it honestly.

Dr. Eric:

It’s hard if not impossible. Everybody is different. I’m sure you see high thallium in some people, and in others, not so much. Same with other heavy metals. Is it rare you see low levels of heavy metals across the board?

Dr. Wendie:

The people who come to our clinic are self-selected. If you test the general population, you will certainly see more people who have nothing because you’re making the pool so much bigger. The people who wind up with us, probably at least 50% of them have notable levels of metals, if not higher. Depends on their age range, detox, genetics, food, and gut. At least 50% have notable metals I recommend treating.

Dr. Eric:

You mentioned mercury and lead are the top two. I don’t think anybody would deny how toxic they are. Same with cadmium. We don’t hear as much about thallium, so why is thallium so bad compared to these others?

Dr. Wendie:

It’s not necessarily that it’s so bad. When you compare it to lead and mercury, I’m much more worried about those two. If you were to have a big exposure to thallium long-term, because it is a heavy metal, it could make you sick. It does contribute to inflammation, and it can lead to degenerative and autoimmune diseases. We include it because often, people are doing a good job by eating organic foods. You should not walk away thinking that you shouldn’t eat organic. It’s something we need to monitor if you are eating a lot of organic foods, particularly cruciferous vegetables like broccoli and other ones from California. Your levels may be high, so we need to keep it in the back of our heads.

Dr. Eric:

You mentioned the potential impact mercury could have on the thyroid, particularly because of the teeth’s proximity to the thyroid. It’s always off-gassing. Does it also have an effect on the immune system?

Dr. Wendie:

The downside to all of these metals is that they act as an inflammatory force, not just like a little drop in the bucket, but they are innately inflammatory. The big picture thing is you don’t have a lot of it floating around your bloodstream. Your body knows it’s toxic, so you’re going to put it away. Where do you put it away? Your bones, your organs, your fat. Lead is particularly loving of the bones. When people have osteoporosis, my first response is, “You have a lead issue until proven otherwise because it hangs out in the bones.” Or Celiac. Those are the top two for us.

The next things I would be looking at for people would be mercury loves the thyroid, or the thyroid hates mercury, whichever way. Autoimmune diseases are increased when you have high body burdens from metals. Degenerative diseases like Alzheimer’s, dementia, multiple sclerosis. All autoimmune like Hashimoto’s, rheumatoid arthritis, Celiac.

When you look at all of the things people struggle and suffer with, metals and toxins are implicated in pretty much all of that: heart disease, metabolic disease, diabetes, PCOS, bad periods, infertility, both male and female. Toxins are implicated in all of these at every level. It seems innocuous, like I don’t live in an old house or drink from lead pipes or have a mercury filling, but you still have it in your body because of where you came from. It can still cause issues even without active exposure.

Dr. Eric:

We’ll talk more about testing, but there are some tests out there that look at immune reactions to heavy metals. The point I bring up with this is it’s not all about the levels. You do provoke urine testing. Nobody wants to see really high levels. Even if someone sees low levels, it doesn’t mean there’s not a problem.

Dr. Wendie:

Part of the reason we get into this challenge is your innate detox systems are suboptimal, so that is one reason you store it instead of getting rid of it. When you have that, then sometimes, it’s hard to show what’s happening until you improve the detox mechanisms, so that when you actually do test again, you can see the true scope of it. It can be reassuring or horrifying. Depends on where you’re sitting.

Dr. Eric:

Our focus is on the thyroid, but it’s not just the impact of the thyroid. It affects so many different areas. When we talk about autoimmune thyroid conditions such as Graves’ or Hashimoto’s, mercury can have an impact, but so can other autoimmune conditions. If not a trigger, it can at least be a contributing factor.

Dr. Wendie:

It’s an inflammatory agent. When you look at autoimmune disease, you need to have leaky gut, inflammation, and a trigger. These can either act as inflammatory events or trigger if you have a big exposure.

For example, I have a patient who lives in a house before 1978; it’s an old Victorian. She is very handy and loves to do projects on her house. I saw her the other day, so it’s fresh in my head. She said, “I’m not doing well. I’ve gained a bunch of weight. My knees hurt. My brain is not working as well.” I know her. She had a lead level of 95 one day, which for the record is crazy high. We look for it well under eight.

Knowing her, I asked, “Did you do any projects on your house in the last few months?” She thought for a minute and said, “I ripped out my closet.” Don’t be a DIYer on your old, lead-laden house because you’ll get another exposure. She tested. She got rid of things over Thanksgiving. She did her construction. She stopped feeling well and happened to retest in January because she was due for a retest, and the protocols were on, and it had gone up. What happened? It’s often very subtle because you don’t see it. It does act as an autoimmune triggering event for a lot of people.

Dr. Eric:

Let’s dive into the testing. As far as detecting heavy metals, you use provoked urine testing. That involves a baseline urine test. Then you give a single chelating agent- I’ll let you take over.

Dr. Wendie:

We always do a baseline test on people just in case you’ve had an acute exposure. We want to catch and recognize that. The baseline urine test is getting up in the morning and peeing. That tells us if you had an acute exposure sometime over the past 4-6 weeks that you haven’t yet fully put away and stored in your bones or organs or fat.

Then we do a provoked test. We often do it on the same day. You empty your bladder and take these provoked agents. It’s a chelating agent called DMSA. I don’t see kids, but you’re going to give a kid a lower dose than you will give an adult. It’s loosely based on weight. We do a six-hour urine collection. Same test, but now provoked. It causes metals to come out of their storage depot and binds to them, and then you pee it out, and it’s measured. We look at the relative amount. We look at the baseline. What is the standard? Where are you?

Keep in mind, if you have high body burdens, you often won’t show the full extent of it. You’ll show something. I say to people after you do a removal protocol, your numbers will often go up. You have improved your liver and your gut and the whole system’s ability to get rid of it. Don’t freak out. It will go up. They always like to be prepped because it inevitably goes up, except for the people who started crazy high. They almost always go down. We often doing that type of testing.

Then we treat and test again. I’m a big fan of test, don’t guess. Whenever we are doing a treatment, we are testing to see what’s the impact been. Do you need another role? Do you need to focus on daily detox behaviors instead of ramped up detox? Depends what people need.

Dr. Eric:

How frequently do you retest?

Dr. Wendie:

Depends. For the person who had that 95 level who lives in that old lead-laden house, we treated for six months before we retested because her levels were ridiculous. Most people, after three months of treatment, I will retest.

Once you’re doing the program regularly, it’s about every eight weeks. We get more efficient with the treatment. With the first treatment, we want to make sure you’re tolerating it. Do you do okay when we raise the levels? It’s a bell curve. Most people do really well. Some people love how they feel. Some people take a while to get used to it. They had increased fatigue, gut irritability, or headaches.

We treat everyone based on the standard that maybe you’re the person who’s going to react, so everyone gets a lower dose for the first month. Then it ramps up second month and third month. By the time you have tolerated the whole program and do it again, we start at the highest dose, so you can have maximum efficiency for it.

Dr. Eric:

You don’t want to go too quickly. It almost takes time. A common question is how long it takes. Some people are surprised to learn that it takes a good amount of time, not just a month or two to get rid of all the heavy metals you have accumulated your entire life. We are born with them in the first place.

Dr. Wendie:

You didn’t get it in a year, so you won’t get rid of it in a year. It takes a lot longer than you would expect or even hope. Think of construction projects. They cost more money and take more time than you think. Constructing an ideally healthy human takes a lot more time than you would think.

I’ll speak for myself. I am particularly loyal to my toxins and my metals. I am coming up on about 3.5 years of working on getting rid of them. The issue is when we go back to the testing, which is not an exact science. When you get a number of 14, it’s not exact. That’s how much metal you have in your body. What it is is a guidepost of saying I have a body burden.

When you compare a reading of 14 to 40 to 95, I am pretty comfortable saying the person at 95 had a much higher body burden than the person at 14, but there is still a body burden. If it’s stored in your organs, fat, and bones, and you’re pulling it out, it’s a really painstaking process, so it’s not overnight.

There are a lot of ways to do it. We custom tailor treatment for what will work for you. What is your life like? What are your finances like? Are you getting exposed still? There are a lot of factors that go into it. It takes longer, especially if you are being exposed ongoing, especially if you have silver fillings in your mouth.

Dr. Eric:

Speaking of ongoing exposure or acute exposure, that’s what blood testing is used for. You mentioned a baseline test might pick it up, too. I’m sure you’ve had people go into your practice, like patients who already did blood testing, and everything was negative. Some know, and some do their own research to know it’s more acute exposure. The blood testing, just because everything is negative, does not rule out problems with heavy metals.

Dr. Wendie:

I have never had a patient in my practice who was positive on the blood test. If you go to your primary care doctor, it’s good to rule out there is no acute exposure. Let’s do a lead or mercury blood spot, and it should be negative. Unless you live in Flint, Michigan, it should be negative, but if it’s positive, that’s very worrisome because you got an acute big exposure that’s going on in your body. Most of the time, it won’t be positive because it’s stored away. It shouldn’t be in your blood. Your body goes, “This is toxic,” so you get rid of it as fast as possible.

Dr. Eric:

Makes sense. You didn’t mention aluminum. Is it something you don’t see a lot on testing?

Dr. Wendie:

I don’t see a lot of it actually. I don’t know why. It’s not tremendous.  

Dr. Eric:

I don’t use chelating agents in my practice, but I wonder is there just not a great chelator for that when you use oral chelators to mobilize the heavy metals? I think you’d agree that aluminum is widespread. A lot of people still use aluminum pots and pans and deodorants and cans.

Dr. Wendie:

It is pretty widespread. I don’t really see that that often. I’ll have to look that up, Eric. I don’t pay attention to aluminum that much.  

Dr. Eric:

Just curious. Not to get into the vaccine talk, but some vaccines use it as an adjuvant. It’s also an immune stimulator as well. The other heavy metals have an impact when it comes to the immune system and autoimmunity. Maybe we could both research it and see why it doesn’t show up as far as if it is related to the different chelating agents. I was just curious about that.

Supporting detoxification. What are some of the things that you do to support detoxification? I’m guessing maybe there is one or two things that you mainly focus on, but there is a lot of different things that could be done.

Dr. Wendie:

This is my favorite part of the conversation. The first part of the conversation is about how bad things are and how depressing it is, how you get all this exposure. But this part of the conversation is what agency do you have? How do you take control of the narrative? How do you alter your future and your health? I love this part.

Think of it in a couple of different ways. When you think about, let’s go big picture, toxins in general. You can eat them in your food and water and alcohol and juice. You could put them on your body with products and lotions and clothing. They could be around you, like living near a golf course or a power plant, or your air and water quality. There is some overlap with what you’re drinking and environmental things.

When you look at how you’re going to take control of this narrative, first, let’s stop getting exposed in as many ways as possible. When we’re talking specifically about metals, if you have lead pipes, obviously do not drink from your water. Lead gets absorbed in your skin, too, so you want to filter your water to get the lead out so that you’re not bathing in it and absorbing it and not drinking it and not cooking with it. That’s a special case. If you have lead pipes, you really want to address that.

The next level would be if you own a home that was built before 1978, try not to do DIY projects on it yourself. Every time you cut into the wall, remove a wall, change something, you’re disrupting what’s already there. You make the particles airborne. You breathe them in, they absorb through your skin, and you could eat them, not on purpose. Try not to do that.

If you have mercury fillings, get them safely taken out with a biologic dentist because they continue to expose you to mercury. I wish I knew this 40 years ago. I had mercury fillings for over 40 years. I never knew that it was implicated in hearing loss until I had hearing loss. If you have mercury fillings, get them taken out. They’re nasty for you.

Then we go to how do you actually optimize the body? Here’s the unpopular part: minimize alcohol. Alcohol is a direct poison. It’s literally poison. When you drink alcohol, you stop all of your typical detox work because the body knows if you have to deal with alcohol, it’s so much higher on the priority list than dealing with the toxins stored in your fat or the toxins nailing your thyroid. You’re going to want to minimize your alcohol so that you’re not distracting the liver off of doing routine and regular maintenance and detox on your body.

Then you want to optimize your liver: N-acetyl cysteine, alpha-lipoic acid, phytonutrients, antioxidants. Supporting phases one and two in the liver. Eating meat and flesh is particularly politicized, but there are benefits to eating flesh that support phase two in the detox process. If you’re someone who eats meat, just make sure you’re eating grass-fed, grass-finished meat and organic chicken.

Fish is really tough because it all has plastic in it. I’m not sure what to say in terms of fish, but try to go for cold water fish. Do not eat the high mercury fish because those are another huge source. Ahi tuna, that yummy tuna belly you get with sushi; Chilean seabass, which used to be my favorite form of fish; mahi mahi; swordfish. All the big predator fish have aggregated all the mercury from all the fish they have eaten. They can’t get rid of it any better we can. So when you eat it, you take what they have and start storing it for them.

You want to make sure your gut is optimized. If you don’t have a functioning gut with good bacteria in it and poop every day in a nice long pipe, then what happens is your body has dysfunctional detox, and you’re more likely to reabsorb all of the things you’re trying to get rid of.

Make sure your gut is optimized. That’s a whole conversation unto itself, so let’s go big picture. Don’t eat processed food. Avoid alcohol because it increases leaky gut, and it throws off the biota, the bacteria in your gut. Eat probiotic foods. Eat fermented foods. Eat foods that look like themselves, that didn’t come from a package. Minimize your sugar. Minimize your stress. Make sure you poop regularly with magnesium or things that help you move, like fiber, which also helps clean up the gut. Those are some practical things.

For magnesium, you cannot harm yourself. The only thing you will do, if you take too much, is have diarrhea. For people who are constipated, they are probably psyched. You’ll know you have taken too much mag when you have diarrhea; take less. That’s the line in the sand.

Dr. Eric:

Getting back to fish, do you put a limit on even eating smaller fish or having wild salmon or sardines? Do you say, “I only want you to eat fish two or three times a week?”

Dr. Wendie:

I don’t tell people to limit fish. What we’re living in now is what I would call death by a thousand cuts. There is a lot of ways to zero in on “oh my god, this.” If you pay attention to what’s happening in our food supply, it’s horrifying. Generally, the benefits to fish outweigh the problems with fish as long as you continue to work on optimizing your body. It’s not a perfect science. I would say it’s better for you than eating pasta. When you put it in the scale of things, if fish is a staple of your diet, you’re getting great omegas with it, and that’s healing unto itself. It’s also a good source of protein.

Avoid the heavy metal fish. Avoid predator fish. I live in Boston. There is a song written about “love those dirty waters.” Don’t eat fish from the Charles River because it’s dirty. Make sure the sources of your fish are clean, to the best of your ability. It’s a little challenging, but do your best.

Dr. Eric:

Good advice. Your thoughts on sauna therapy?

Dr. Wendie:

Oh, you said the magic word. I love saunas. We have a sunlight sauna in our basement. That was my 50^th birthday present. I turned 50 during COVID, and we were not traveling. Well, instead of a trip to somewhere cool, how about a sauna? We got a sauna. I’m a huge proponent of them. I’m a huge proponent of near, mid, far infrared because it gets to all the levels, especially deep, intracellularly, to help move things along.

What it does is it helps you move toxins out of your body through your sweat. It continues to act for about a half hour after you leave the sauna. I am also a huge proponent of dry brushing; Epsom salt baths; exercise. Obviously not to the level of sauna, but exercise will get you sweating and also help you with detox.

Back to your question. Yes, huge proponent. As often as you can. I do an hour. I know they recommend a half hour. I just like the relaxation of sitting in my sauna, and nobody talks to me. It’s probably a bit of going back to basics and having some downtime, so I spend an hour sitting and relaxing.

Dr. Eric:

Do you dry brush while you’re in the sauna, or do you wait until you’re in the shower?

Dr. Wendie:

I had a couple patients who said to me they didn’t get a sweat going while they’re in the sauna. I told them to try dry brushing before going in, so they can wake up the lymph. They found it did help them with sweating in the sauna.

I would say to dry brush before. It’s gross when you’re in the sauna and wet, and you’re already sweaty, to start. It’s not dry brushing at that point if you’re already sweating and moving the toxins. Dry brush before, get in the sauna, sweat, wait 30 minutes, and then shower.

Dr. Eric:

How about colonics, colon hydrotherapy?

Dr. Wendie:

Love them. There are so many things about colon hydrotherapy. I could go on and on about one. Everybody’s constipated. There are only two speeds: constipation or diarrhea. People tend toward constipation more than diarrhea. It’s fantastic for retraining the gut muscle to contract properly. Love it.

Then for detox purposes, if you’re impaired at moving your toxins along, it can retrain the gut to start to move properly. Some of the colonics, depending on what’s in them, can also support you with detoxing in the moment. People do coffee enemas. That sounded pretty unpleasant to me, so I never did it. I’ve done colon hydrotherapy with therapists who measure the pressure in your gut, and it’s amazing.

Dr. Eric:

I’ve gotten colon hydrotherapy. I do sauna regularly like you do. Have you heard of Dr. Walter Crinnion?

Dr. Wendie:

Maybe?

Dr. Eric:

He unfortunately passed away a few years ago. He was a naturopath who did a lot of research in the world of environmental toxins. He was actually one of my instructors when I went for my master’s in nutrition. We had a detoxification and biotransformation course. I’m not saying I agree with this, but he is also an expert. He said if there was one thing he would recommend to support detoxification (I don’t think it was specific for heavy metals), it would be colon hydrotherapy. It was interesting that he mentioned that over sauna and all the other modalities that are available.

Dr. Wendie:

I have to think about that. Here’s the issue. I think everything’s great. For certain people, things work better and are more accessible. I’m reluctant to say that one thing is the holy grail because it depends where you are in life and what works for you and what your finances allow for. Anybody healthy enough can get a good sweat on. You don’t need a sauna for that. I think it’s up there in the top five, I’ll put it that way.

Dr. Eric:

How about supplements, such as NAC, alpha-lipoic acid, liposomal glutathione? What are some of your favorites?

Dr. Wendie:

I take liposomal glutathione, Vitamin C, NAC, alpha-lipoic acid, and fiber every day myself. Remember, I’m still trying to get rid of my toxins. I take it every day as an ongoing support.

It’s really important before we talk about specific supplements to preface by saying think of healing as a platform, a foundation. The base of the pyramid for healing does not include binding toxins. The reason is if you haven’t handled your food, gut health, sleep, stress management, relationships with others, which could cause or help your stress. If you haven’t handled what I call the foundational behaviors of your life, you cannot detox.

If you improve your liver, but your gut’s dysfunctional, you’re not going to remove those toxins. You’re simply going to recycle them. Then you’re doing even more work and not understanding why your body is so fatigued. If you have a dysfunctional gut that’s not absorbing your supplements, then it doesn’t matter how much you take. They won’t be effective.

Any time we’re talking about this, you have to deal with the foundations first. Then you can deal with what I call higher order behaviors of detox, which is the removal process. You have to heal your gut first. You have to sleep. You can’t be a stress ball. You have to eat food that supports your body. Don’t bother detoxing until you have gotten that stuff pretty well handled. Then we can go to supplements. I had to put that in.

Dr. Eric:

That’s good to know. You focus initially more on gut healing, making sure the gut is healed. Then not just supplementation, but even sauna therapy or colon hydrotherapy. It’s still first focus on the gut.  

Dr. Wendie:

Well, I think colon hydrotherapy has a great way for healing the gut in general. That, I would not put later. Sauna is fine because you’re using your skin to mobilize the toxins. It’s when you’re talking about binding the toxins. Let’s take things that support the liver’s ability to mobilize and process toxins. You don’t want to do that until you’ve fixed the gut. Gut first, and then you can layer on improving your liver with the things we were talking about, like N-acetyl cysteine and alpha-lipoic acid, which are the precursors for glutathione, which helps the liver to process, bind, and remove toxins.

Dr. Eric:

As far as alpha-lipoic acid, NAC, and liposomal glutathione, you are actively trying to detox, reduce your toxic burden. You’re not suggesting everybody should do that on a wellness basis.

Dr. Wendie:

Maybe, maybe not. Almost everyone could use Vitamin D. It’s an immune modulator and regulates the gut and the immune system and the tight junctions in your gut. It helps fight off disease. Everybody could use Vitamin D. Check your levels with your provider.

The B vitamins, most people do really well with them. Those support general health, energy, and detox. It’s a mix.

Fiber, most people could take a fiber and be okay with that.

Dr. Eric:

I take Vitamin D. I definitely need to take it, and a lot of other people do. I agree with fiber. I was specifically talking about those three: NAC, liposomal glutathione, and alpha-lipoic acid. Are those wellness supplements? Should someone just take NAC on a regular basis, or is it just like just rely on food for detox once someone has reached a point where their toxic burden has greatly decreased?

Dr. Wendie:

I would say this is the part of healing that really deserves a consultation with a functional medicine provider. It’s hard to make a blanket do this, don’t do that. I don’t know who’s on the other end of listening. I love NAC, alpha-lipoic acid, glutathione, fiber. I think they’re fantastic. I use them myself. And it’s hard to design a plan for you without knowing you. You can’t go wrong focusing on the foundations of your health and making sure your gut is optimized. Then when you really want to drill into the nuances of detox, do it with a provider.

Dr. Eric:

Awesome advice. Anything else that you want to cover when it comes to heavy metals? I think we covered a lot. Any last words you want to say with heavy metals?

Dr. Wendie:

Love last words. For heavy metals, you might not be able to get away from what you were exposed to at birth. You might live in a home that was built before 1978, so you can’t get away from ongoing exposure. But you do have the ability to heal from this, especially with regards to autoimmune disease. You can absolutely heal. Don’t give up because you have control of this narrative. There is hope.

Dr. Eric:

Thank you so much, Dr. Wendie. Where can people find out more about you? There is your current book Dirty Girl.

Dr. Wendie:

It’s cheaper on Amazon. Don’t type in “Dirty Girl.” You will be sent off into a rabbit hole. Type in “Dirty Girl detox book” or “Dirty Girl Trubow,” my name. My website is FiveJourneys.com. That also has our supplements and our podcast, which is Five Journeys Podcast.

I’m also on Instagram and Facebook at WendieTrubowMD. Our new Dirty Girl brand is now live, DirtyGirlDetox, on Facebook and Instagram.

Dr. Eric:

Thank you, Wendie. You said not to call you Dr. Wendie. Wendie, thank you again for getting together. It was great to do a deep dive into heavy metals.

Dr. Wendie:

You, too. Thank you, Eric.

Recently I interviewed Andrea Nakayama, and we talked about the functional nutrition and tying this into thyroid autoimmunity. 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, Andrea Nakayama. We are going to be chatting about functional nutrition and tying this into thyroid autoimmunity. Andrea is a functional medicine nutritionist and educator who has led thousands of clients and now teaches even more coaches and clinicians around the world in a revolution reclaiming ownership of both their own and their clients’ health.

As the host of The 15-MinuteMatrixpodcastand the founder and former CEO of Functional Nutrition Alliance, Andrea draws on systems biology, mental models, root cause methodology, and the therapeutic partnership to offer long-awaited solutions for the rapidly growing chronic illness epidemic.

After losing her young husband to a brain tumor in 2002, she discovered a passion for using food as personalized medicine and is now regularly consulted as a nutrition expert for the toughest clinical cases and the practices of many world-renowned doctors. She trains nearly 4,000 practitioners each year in her methodology, so they can, too, be the last stop for their clients and patients as well as a trusted referral partner for doctors in their area. Andrea, thank you so much for joining us.

Andrea Nakayama:

I am so excited to have this conversation with you.

Dr. Eric:

Let’s go ahead and dive into your background. I know that you have a history of Hashimoto’s. If you could talk a little bit about that, and how you started getting into functional nutrition, which I gave a little bit of that during your bio. If you could expand on that?

Andrea:

As you said in the bio, my husband was diagnosed with a brain tumor when I was seven weeks pregnant back in April 2000. That really catapulted an awareness of what was happening in the medical space. Prior to that, in our early 30s, we hadn’t really ever been in the medical system. Maybe we had gone to a doctor for a thing or two, but we hadn’t been in the system. That really became a wake-up call for me in terms of where the system excels and where there are some gaps in the system, and what we can do to fill those gaps.

I think of that time with my late husband, Isamu, as my boot camp in nutrition and in all integrative practices. It wasn’t until many years after he died that I decided to change my own career, put myself back through school, many years of training, and then really create a practice, and a practice that was actually doing so well that other practitioners were asking me what I was doing. I realized how I had to take off the model that I was practicing and be able to teach it to others.

During that time, as you said, I myself realized I had autoimmune thyroid issues. I had Hashimoto’s. It took along time to get that diagnosis. In retrospect, with all I know now, it’s no surprise because there was a lot of stress for me going on during one of the biggest triggers for an autoimmune condition, which is pregnancy. I wasn’t only pregnant, but I was pregnant with a lot of stress, given my husband’s diagnosis and illness. That was quite a journey that both led to my own health issues and discovery simultaneous to reshaping my own career and aiming to fill these gaps that I had identified in the medical system.

Dr. Eric:

You were diagnosed with Hashimoto’s during your pregnancy or after?

Andrea:

Years after the pregnancy. While I was pregnant, we changed our diet for the brain tumor, so I was in my “skinny jeans” two weeks after I gave birth because there was a lot, I was doing to support my body. I also look back and can see the underpinnings of an autoimmune condition brewing, not just during that time, but prior to that. It took years for things to manifest in a more obvious way and even more years to actually get the diagnosis that I already knew was true.

Dr. Eric:

Unfortunately, that’s pretty typical with autoimmune conditions, especially Hashimoto’s. It will be underlying for quite a long time. Even when someone experiences symptoms, a lot of times, they will just look at TSH, which might be within the lab range, so a doctor will dismiss it. Again, that’s why you’re doing what you’re doing now, helping other practitioners as well. Based on the unfortunate experience that you had with your husband. You’ve turned that into helping thousands of practitioners.

Can you talk about functional nutrition, what exactly that is? People listening to this are likely familiar with functional medicine. There are different terms out there. If you can compare the different terms, even the difference between functional nutrition and functional medicine.

Andrea:

I’d love to. It’s a word that’s gotten away from us in a lot of ways, so I will bring us back to the foundations. You mentioned some of them in the bio as well.

The three primary tenets of a functional practice are a therapeutic partnership; looking for the root causes, which means we ask why, not what; and a systems-based approach, which embraces systems biology. I always like to say as well as a systematic way of working. How do we work in systems, so we know how to approach each person as an individual?

Those three tenets are at the basis of what was designed as functional medicine back in the ‘90s with Dr. Jeffrey Bland and many others understanding the basis of systems biology. When I say that, I mean as we know now, the gut’s connected to the brain, and the gut’s connected to the liver, which is connected to detoxification, which is connected to our hormones. Understanding that internal terrain, I like to say everything is connected. Understanding that is the premise at the core of a functional practice.

If we look at the differences between functional medicine and functional nutrition, it’s really about what the tools in our toolbox are. With functional medicine, doctors are still prescribing, which is within their scope of practice, and there is an awareness of diet and lifestyle modification, but I think it’s run away from itself a little bit in terms of scope of practice.

What we do in functional nutrition is we double click on the realities of diet and lifestyle modification. I like to say that nutrition is about growth, metabolism, and repair. It’s not just about the food we eat or don’t eat. It’s also about sleep and relaxation, exercise and movement, hydration as well as nutrition, stress and resilience, relationships and networks. All of those things feed our growth, metabolism, and repair, and impact what we can or can’t do with the food we eat.

For me, the nutrition piece is a double click, meaning we are opening that Pandora’s box of what it actually means to make this kind of change. I always like to say that nutrition isn’t a handout. Dietary change isn’t a handout, especially when we’re talking about women, especially when we’re talking about this time in history with anti-diet culture and body positivity. There is an intersection of where we have to look at the role that diet plays and what’s going on with your health and your health outcomes that takes a level of counseling, which is the role of a functional nutrition counselor.

I want to say, which should be the role of a functional nutrition counselor because I’m seeing the word “functional” thrown out a lot to mean testing. To me, that’s not what functional nutrition is. I’m not anti-testing, but there is a lot of other work that we can be doing that makes the practice of functional nutrition much more accessible to every and all individuals as opposed to a concierge, high cost practice, where we get lots of tests, treat to a test, take lots of supplements, and shop at Whole Foods. That’s not what functional nutrition is to me.

I hope that explains the difference between functional medicine and functional nutrition. I think there is a real need for more functional nutrition counselors who can think in these ways.

Dr. Eric:

It sounds like ideally, functional nutrition should fall under that functional medicine paradigm, but many practitioners overdo it with the testing and diagnoses. They focus more on that and don’t dive deeper into the health history and diet and lifestyle, as they should be. Am I understanding that correctly?

Andrea:

Yes, really understanding what does it mean to get to the root? What are the roots? What are our influencers with those roots? As opposed to looking for the root in a test. That’s not where the root lives. The root lives in the history, like you’re saying, into the timeline, into the matrix. Who are you? You are an expert in you. I’m going to learn way more about you by spending time with you than by looking at a piece of paper or any other scale or measure of who you are. They both might be needed, but we’re bypassing the most important evidence in the room.

Dr. Eric:

I admit I do testing in my practice, but I really consider myself to be more on the conservative side. There are some practitioners who will recommend a few thousand dollars’ worth of testing to pretty much every one of their patients. I know some practitioners say if they don’t go through all the testing, they can’t become a patient. With me, even if a person can’t afford the conservative testing, I would never say the person can’t become a patient. I also want to look at the health history and dive into diet and lifestyle, too. That’s great that you’re saying that. I appreciate that honesty. It’s great that you’re teaching your practitioners for so many years as well.

We met at an IFM conference. IFM, Institute for Functional Medicine. They talk about antecedents, triggers, and mediators. I wanted you to dive into those and maybe tie that into thyroid autoimmunity. I know you had your history of Hashimoto’s. Also, a lot of people who listen to this have Graves’. Of course, those apply to any chronic condition, not just thyroid autoimmunity, or regular autoimmunity for that matter.

Andrea:

Absolutely. I just want to say to your last point about the labs. I also love labs. I love them when I need more information. A lot of times, we have enough information to work with before we need that added information. That’s where I think there is a mistake. I also use and love labs. I think it’s just how they’re being used and where we’re bypassing the regular labs we can get from our doctors.

What’s coming in there? There is a lot of information there that sometimes point out to the instance of hydration and where we could be focusing on hydration. Change everything else just by changing how much water somebody consumes. All those other test results are going to change. I just wanted to point out, yes to the labs, when we need more information. At least from a functional nutrition perspective.

Back to our ATMs or antecedents, triggers, and mediators. What I’m going to talk about is two models that I think into. When I think about a case, I’m always looking through three different tools that I’ve created that are based on IFM tools to begin with.

One is the functional nutrition matrix. It’s an offshoot of the functional medicine matrix. In that matrix, there is three sections. They relate to everything is connected. We are all unique. All things matter. Everything is connected is that systems biology. We are all unique are those ATMs. That’s related to who we are and what’s individual about us.

Our antecedents are our genes, yes, but we don’t need to get genetic testing. We can talk about our family history. We can talk about who we are, where we’ve come from. It’s also when we were born, where we were born, how we were born, what order we were born in. There is a lot of good information in those antecedents that tell us where did you come from? What did you not affect in your life? It was just a part of what came with you. That’s what we’re gathering with our antecedents. It could be your genes. It could be your polymorphisms. We could capture that, but it doesn’t necessarily have to be those types of genes that people are looking for right now. It could be just what you know about your genes.

Our triggers are things that have happened throughout our life, positive and negative, that have impacted where we are today. For me, the ATMs are really about our timeline. There is gold in a patient’s timeline. If somebody says to you, “I’ve always had trouble sleeping,” my question to them is, “Tell me about your first memory of having trouble sleeping.” I’m not just making them a recommendation or putting them in a sleep study because actual information and triggers that we can identify from their childhood could be a part of the story. Our triggers are things that have happened in our life. It could be food poisoning, or traveling out of the country, or a virus, or taking antibiotics. It’s what we can look at and say, “I think there was a before and an after this point.”

When you were asking me my story, I told you that pregnancy is often a trigger for autoimmunity, such as Hashimoto’s or Graves’. It’s because of the shifts that are happening in our immune system during that time. I had other triggers, huge stressors on top of that trigger. Those for me are part of my story and my triggers.

Our mediators are my favorite part of the matrix. They are related to what I call the skills. They’re what we know what makes us feel better and what makes us feel worse. We get to put a plus or a minus next to the things that we know about ourselves.

My goal as a functional nutritionist is to help people know more of their mediators. Once we know more of our mediators, we have more agency over our own health because we’re making a risk/reward decision each and every day with each and every choice that we make as opposed to being in the big unknown and relying on a provider to tell us what we should or shouldn’t do.

ATMs are the antecedents, triggers, and mediators. I love spending time there. In fact, all my work going forward in the book I’m writing, it’s about the ATMs. The ATMs are our story. I really love the opportunity to bring people into that story. It’s a little corny, but I like to think of it as the “Oh me” instead of the “Why me?” which is a lot of the place we tend to be in with autoimmunity because it’s so confusing.

Dr. Eric:

You mentioned in some cases—obviously not in all cases—as far as pregnancy being a trigger. Would you agree that the antecedents could be the reason why in some cases it could be a trigger? Not only the genetics, but if someone is born via C-section, and they weren’t breast-fed as a baby, had a history in childhood of antibiotics, accumulation led to the point where it wasn’t in a way not the pregnancy itself, but everything leading up to the pregnancy that caused that to be the trigger.

Andrea:

Correct. There is never one trigger, just like there is never one root. The model I’ve created is what I call Three Roots, Many Branches (TRMB). This is based on the work of Dr. Alessio Fasano, who created the three-legged stool of autoimmunity.

My TRMB allows patients to think into any sign, symptom, or diagnosis as a branch. If we can visualize a tree, we can think of any sign, symptom, or diagnosis: Hashimoto’s, Graves’, bloating, migraines, restless leg, whatever it is. That’s a branch on our tree. We can address that branch, and that’s often what we’re going to our medical doctors for. In functional nutrition, we’re not only going deeper into the trunk and deep down to the roots. We’re focusing on the soil that the roots exist in or live in.

For me, the three roots for any chronic condition, which encompasses all autoimmune conditions, are the genes or the genetic predisposition; digestion; and inflammation. Those are the roots. If we have an autoimmune condition, I’m going to tell everybody we have to look at all three roots. But we can’t do anything about the roots.

What I’ve done is create a circle of influence that surrounds each of those roots that gives us a little bit more agency. Around the genes, there is a circle of influence, which are epigenetic factors. Around the digestion, there is a circle of influence. Around inflammation, there is a circle of influence. That gives us a little bit more of an idea of where do I go? What do I do?

To your point, Eric, yes, it’s never one trigger. You are never to blame. It’s again understanding, “Oh, this is what set me up for this. This is just the tipping point” versus “I did that, and therefore, it’s my fault.”

Dr. Eric:

I agree. There is usually, if not always, multiple factors, multiple triggers. Getting back to functional nutrition, how big of a role does that play in your opinion, when it comes to, I don’t know if you use the word “reverse” autoimmunity, or have someone regain their health? Obviously, it plays a big role. To reword it another way, can just nutrition alone help to alter the course of Hashimoto’s, Graves’, all these other chronic conditions?

Andrea:

I’m going to give you the answer I give most of my students, and then I’ll talk into it. When I say to my students, “What’s my favorite answer?” they will answer, “It depends.” Of course, because I’m a functional medicine nutritionist, I believe in the powers of food. Yet from a functional nutrition perspective, food is this object outside of our bodies. Coffee is coffee. Wine is wine. Bread is bread. It’s the intersection or the symbiosis of where food meets physiology when it comes to functional nutrition. I’m looking at how does this food or the elimination of this food impact your body and your brain?

For instance, we can talk about specific foods. Is it ideal for the healing of the internal system to eliminate a food? Yes. If that elimination causes a tremendous amount of stress, is that stress also detrimental to your health? Yes. I’m looking at the whole picture, but I always believe that there is a place for dietary interventions in addition to the powers of internal healing.

Dr. Eric:

That’s a good response. I’m glad you said it depends because I see it all the time, too. There are people where all they’ll do is eliminate gluten, and that seems like that’s enough to get into remission and to feel great again. Then there are people who follow whatever type of diet, whether it’s paleo or AIP, and they’ll still feel lousy. Maybe that’s not the right diet for them since there isn’t a perfect diet that fits everyone. But there could also be other factors, whether it’s the chronic stress they’re dealing with or infections. I’m glad you mentioned that.

I wanted to ask you: Do you have a favorite diet? Speaking of paleo, there is ketogenic, carnivore, AIP. Do you have one that you recommend to most people with autoimmunity? Does it really depend on the person, as far as what you’re going to recommend?

Andrea:

For me, it really depends. What I do for myself is not what I recommend to others. I don’t think dietary intervention is a prescription. I’ll tell you my principles for what we could be looking at, but my goal is for people to eat the most diverse diet that is possible for them at any one point in time. All of those factors are going to change over time, if we’re really looking at nutrition.

When I think about those areas of influence, that soil I was talking about that surrounds the roots, if we look at the root of genes and our epigenetic factors, the influence, the expression of our genes, that includes food, movement, environment, and mindset. Each of those, I can look at their circle of influence.

For food, I’m going to think about quality, quantity, diversity, and timing. All of those are going to be different depending on the individual. If I were to say, “Intermittent fasting, it’s the bomb,” but I’m talking to somebody who has blood sugar issues and dysregulation and is up in the night, intermittent fasting is going to be problematic. If we say, “Ketogenic diets are the way to lose weight,” and everybody is going on ketogenic diets, but they have problems digesting fats, or they don’t have a gallbladder, we are causing more issues based on these theories versus looking at the individual. That is not functional to me.

The principles that I’d rather invite people into around how they eat are three. I always talk in three’s if you haven’t noticed. Lots of three’s, sometimes four’s. Every meal should include fat, fiber, and protein. Of course, there is deeper conversations around what that means. How does that feel? But that will help with our balancing of our blood sugar, our metabolism. We have to start at least playing like that, bringing to awareness not how am I eating in accordance to a theory or a prescription, because that’s a diet. Nobody will stick to it, or barely anybody will stick to it. If we start to bring awareness to, “Wait, I’m actually choosing this not because it was listed on a piece of paper of what I should be eating and buying, but because I’m bringing awareness to what I’m eating.” Fat, fiber, protein.

The second one is to eat the rainbow. This is just something to have fun with. How many colors did I get in my day? I don’t care if it’s three blueberries, and it goes in blue or purple. Just start to have fun with your food. That will crowd out some of the other foods as you start to play around with that.

The third principle is to have your yes, no, maybe list. This relates to those mediators we were talking about, but it also brings people into awareness of what they know works for them, what they know doesn’t work for them, because I guarantee they know some of those things. Start to ask questions. “Every time I eat broccoli, it feels different. Sometimes, it feels like this. Sometimes, it feels like that. I don’t know. Should I be eliminating broccoli?” Put it on your maybe list. Focus where you do know for a minute, and then you start to experiment.

What I’m trying to introduce is more of an ownership and a relationship versus a set of principles that put people in a healing diet protocol, many of which should not be done for long periods of time but are because people don’t know how else to live.

Dr. Eric:

I agree as far as diversity, definitely important. It also sounds like certain foods you recommend avoiding, like things that can be mediators such as gluten. I imagine you advise people with Hashimoto’s and other autoimmune conditions to avoid it. Are you saying that just by introducing all the other healthy foods, it will push out those common allergens, without saying specifically “avoid gluten or dairy?”

Andrea:

I’ll tell you how it works. As you and I both know, and I’m sure our audience knows, there are certain foods, like gluten and others, that have the potential to act as molecular mimics in the body that can exacerbate our immune system.

For me, it’s a non-negotiable personally to eliminate gluten. What I’ve done in the last few years is work with more populations of people who have chronic illness but also have really troubled relationships with histories of diets and dieting or body or dysmorphia. I’ve worked with a group of transgender practitioners. I’ve worked with military practitioners who don’t have options to make changes that we would think of as ideal. That’s really informed the way I talk about diet.

If you and I were talking as practitioners, and if I have the opportunity to educate about gluten, yes, there is an entire class in my digestive intensive about the interactions of gluten in the body. I want people to understand those connections, so they’re in that risk/reward relationship.

However, I am cautious about starting with dietary eliminations for people who may have more complicated relationships with food, dieting, and their bodies. I’ve certainly worked with people with Hashimoto’s and Graves’ where the conversation about diet or food tracking is off the table for a little bit, and we have to think about other ways to enter while we warm up to the situation of talking about gluten.

I like to think of this as the ideal versus the heal. Ideally, with Graves’ or Hashimoto’s or any autoimmune condition, because of those three roots, we are not eating gluten because gluten can impact our gut lining and our ability to receive things in our bloodstream that we don’t need that impact our immune system.

Yes, yes, yes, and there are certain ways in which food elimination is so triggering for people, I have learned. A lot of people who have Hashimoto’s because they have been on extreme diets that make me really want to rewrite the story about how we usher into conversations that are about being able to take agency for our own health. I know that it’s complicated.

Yes to the elimination of gluten for Hashimoto’s and Graves’ ideally. And these are complicated conversations. I just want to note that because there is so much anchoring on these quick diet changes these days that I think are putting a lot of pressure and shame on too many people who also have these conditions.

Dr. Eric:

I agree. I think it makes sense. Ideally, gluten should be a non-negotiable, but depends on the person. If someone is used to eating gluten all the time, depending on how the health history and conversation goes, you still might encourage them to avoid gluten. If they’re in a position where that is stressing them out, you might take it slow and gradually, even with the gluten, and try to work on incorporating healthier foods rather than focusing on elimination.

I think it sounds like also, there is less non-negotiables, like for example, AIP, not to pick on it because I like it, but eggs are not allowed for AIP. It sounds like you wouldn’t tell every autoimmune patient that they can’t have eggs because even though it’s not part of AIP for certain reasons, it’s not the same as gluten, whereas gluten arguably causes an increase in intestinal permeability and inflammation in everybody. But eggs are nutrient-dense, and a lot of people do really well on eggs. I think I understand where you’re going. It makes sense.

You’re right in that really strict diets do tend to stress out a good number of people. That defeats the purpose of the diet in the first place, if they are going to follow a strict diet but really stressing every day on “When am I going to introduce the next food?” or “I can’t do this more than a week or two.”

Andrea:

I was going to add two things and one actual case study because it’s often helpful to think through that lens. I’m working with a case study group from the book I’m writing, which is focused on the timeline. I’m not their clinician because that’s not a book. I can’t be one-on-one.

We’re working through some more principles. There is one person who has Hashimoto’s. There is more than one person with Hashimoto’s in this group, but this one particular person has been to all the doctors. In fact, all of them have been to all the doctors and on all the protocols, and they are still not better. That leads me to what I love about the work. What’s happening that that’s the case? What’s going on? Where is there a lack of understanding? How do we get out of “I know what to do, but I’m not doing it” to the reality that if you knew what to do, and you really knew it, you would do it? There is something missing in the education or in the implementation.

For this one person in particular, she had been on an AIP diet. It had felt better, but it had triggered all of her disordered eating and her control of every single thing she had to include. Even when I was saying “we’re going to food track,” she couldn’t track her food. When I was saying “eat the rainbow,” she would go to eight cups a day. She couldn’t be in the in-between, in the small steps because every step was a big step, a huge step. That allowed her to be either in the all or nothing arena.

That all or nothing, neither were working for her, and neither were helping her get to her full expression of health because one helped her feel better physiologically but was a lot of stress psychologically, and the other one was maybe psychologically feeling a little bit better but was not physiologically working for her.

She had to have a rock bottom moment, and I had to allow her to have a rock bottom moment, where she was actually on the floor, vomiting, coming out both ends. Her husband, up and worried. Her daughter, up and worried. For her to say something has to shift. She kept saying to me, “Gluten doesn’t impact me. I don’t have any digestive issues.”

She wrote me a week off of gluten and said, “I don’t know what I was thinking, that gluten wasn’t impacting me. I can finally put my wedding ring back on my finger, and I haven’t been able to in three years.” That had to be her journey of ownership, so that she is not feeling shame or guilt around what she was doing and not doing. She was having a deeper sense of awareness. That is a more interesting, sustainable path for me for people forward than what is essentially becoming a diet.

The other thing I want to say with some of these healing diets, whether they’re low histamine or AIP or low oxalate or low lectin, these usually point to the fact that there is more healing that needs to be done internally so that the body can tolerate more foods. None of those diets are meant to be done for long-term. Once we do those diets for long-term, you are usually introducing other nutrient deficiencies by what we are not including in the diet that can manifest as signs, symptoms, and even diagnoses.

Eliminating gluten isn’t going to lead to any nutrient deficiencies. That’s the difference between a sustainable way of living versus some of these very restrictive diets, which are not designed for long-term living. People are getting narrower and narrower. In our clinic, we work with people who are eating three foods for three years when they come in. They just don’t know what’s going on, and they haven’t done the internal healing.

You can tell I’m passionate about this. I think we’re doing nutrition all wrong. I feel like there is a lot more we could be doing to move in with each individual to their reality, their story around food, and their body, and around making change to make it a sustainable change.

Dr. Eric:

I agree. There is actually some research now. With ketogenic, I think there’s one, if not multiple, studies on the long-term effects on the gut microbiome since you are not eating a diverse diet. I can imagine it’s the same with some of these other diets, not to pick on any specific diet. With ketogenic, it’s in the research, so I can pick on that, even though I’m not anti-ketogenic.

With these diets, if you’re going to do them, they’re not meant to be permanent diets or even really long-term diets. You make a good point.

Getting back to the gluten, you’re not going to have any nutrient deficiencies with giving up gluten or unhealthy oils or some other foods or categories of foods, whereas if you start restricting too many things, then you fall into that trap. Like you said, the psychological effects that it has on the person, we can’t overlook.

Andrea:

Those psychological effects have a physiological impact. That is the truth of functional practice. I always say I’m not a therapist. I’m into physiology. For me, it’s what’s going on in the body, and how there are so many things that can happen that impact what’s going on in our body. Our gut isn’t just impacted by our food and probiotics; it’s impacted by our sleep and our stress and our hydration and so many other things. I just worry that we’re missing those realities of the truth of systems biology when it comes to food and diet.

Dr. Eric:

Hydration, as you mentioned, that’s big as well. A lot of people don’t drink enough water, so they might focus on avoiding gluten, avoiding other common allergens, doing what they feel is everything right from a dietary standpoint, but maybe not drinking enough water.

One time was actually yesterday in a patient consultation, where I asked someone, “Are you drinking enough water?” They were honest and said, “No, I’m pretty sure I’m not drinking enough water.” A lot of people say they are not staying well hydrated.

Andrea:

Even before I might know that, this is a place where I love serum labs. We can look at people’s red blood function and see if they’re potentially dehydrated and point that out and make the connection. I’ll have a lot of people who are complaining to me about fatigue. If you look at a red blood cell function that is not functional, and they’re not hydrated, we’re not pumping enough blood, and we’re going to feel our energy depleted.

Making those simple connections for people, I like tothink of itas the simplicity on the other side of complexity. We think that the conversation about hydration or sleep, maybe that’s a little too basic. I talk about the complex stuff, but I can talk to you about your hydration in relation to your energy and your oxidative stress. I can talk to you about your sleep and your microbiome. It’s understanding the complexity of systems biology and yet understanding the realities of the core basics, which for me are on the right side of the matrix, which is why I keep using my hands. Those ATMs and those core basics.

Dr. Eric:

That’s a great point about what’s considered to be basic testing, like a CBC with differential or comprehensive metabolic panel. Unfortunately, a lot of doctors spend a few seconds looking and seeing if everything is in the lab range. When it comes to the RBC, they’re concerned if it’s low. If someone has anemia, the low hemoglobin, the low hematocrit. If it’s elevated or on the higher side, they may not pay attention to that, which as you could suggest, means someone has problems with hydration. I definitely recommend all those basic tests.

Here’s a question when it comes to the non-negotiables. I’ll put you on the spot as far as dairy. Would you consider dairy to be a non-negotiable when it comes to autoimmunity?

Andrea:

I’ll tell you my non-negotiables because I have three tiers of nutrition mastery. Tier one is your non-negotiables, which are sleep, poop, and blood sugar balance. If dairy is impacting something, then we have to look at dairy as a non-negotiable, your yes/no/maybe list.

I do think people have different tolerances for dairy. I have some Hashi sisters, one which we were talking about earlier, who can’t tolerate dairy at all. I can tolerate minimal dairy, and it feels fine. I didn’t tolerate dairy at all times. I’m careful about what I choose. I don’t eat cow dairy. I will eat goat and sheep dairy. I choose to ideally eat raw goat or sheep dairy. I can’t eat it regularly; I can put it in what I call my bike lane, for those of you on the east coast, that’s the shoulder. I’m on the west coast, so it’s a bike lane. We have our path. We have our poison ivy. There’s a place where we need a little wiggle room, so that we’re living.

For me, it depends where we are in our healing journey. It depends who we are, and it depends what we’re able to track and determine as working for us, like you said with eggs. I’m about the same with eggs as I am with dairy. It’s not an everyday. It’s on occasion. I’m selective about my source or quality that I’m using when I do consume that food. I’m pretty tight about how I eat, but it allows me the wiggle room to at least take a whole food and make it an include in moderation as opposed to some notion of can’t.

Dr. Eric:

Just to repeat your non-negotiables: sleeping, pooping, and balancing blood sugar. Dairy, depends on the person. Gluten, obviously falls in that non-negotiable, as you mentioned. Definitely want to get sleep. That’s another big problem.

As far as regular bowel movements, what do you consider? Two per day, three per day?

Andrea:

So many of us with autoimmunity are perfectionists. We’re type A. I don’t want anybody worrying about the perfect poop now. Yes, I like to think about form, function, and frequency when it comes to poop. 1-3 times a day is nice. Well formed, easy to pass, no straining but not urgent, brownish in color, not too light, not too dark. That’s our best diagnostic test for a person. Look in the bowl. What do you got? How does it feel?

Then how can you begin to see what makes a difference? If I eat more protein, does that impact my poop? If I eat more fiber, does it impact my poop? If I eat more fiber and increase my hydration, does that impact my poop? This is how we develop true sustainable relationships with our food and our dietary plan. Just paying attention. I think poop is our best diagnostic tool, but not through stool testing, through what’s in the bowl.

Dr. Eric:

Observe your poop.

Andrea:

Heavily.

Dr. Eric:

Not to say there is not a time and place for a comprehensive stool panel. Again, before you do that, make sure to observe your poop. It’s a good point. There is a lot you can tell by observing not just the poop, but looking at your tongue. Paying close attention.

There are people who say, “Should I do testing for candida?” I’m not saying I never do that, but do you have strong sugar cravings? Do you have a thick white coating on the tongue? Other symptoms that might suggest that? You might be able to find out without doing the testing.

Andrea:

Exactly.

Dr. Eric:

Glad we’re having this conversation. One of the questions I wanted to ask you since I know you work with a lot of practitioners is some of the more important functional nutrition tips that you give to practitioners. I don’t know if what we already covered would be some of those tips, or if there is anything else for any practitioners who might be listening to this that we didn’t cover yet.

Andrea:

I want to highlight the understanding of what’s going on in the body. I train thousands of practitioners, and they may be surprised that I’m teaching physiology. I’m just teaching it through the lens of where food and lifestyle meet physiology. Even our nurses and doctors and chiropractors who come through my training will ask, “Is this going to be a repeat of what I already know?” They come in and are like, “I knew the physiology, but I never thought of it like this.”

The biggest thing I’m teaching people is what I call “What’s going on in there?” When we understand how the body should function, we can see the clues to where we might need to move to make our recommendations.

Then the top tools I’m going to use are the functional nutrition matrix, which again, remind us everything is connected, we are all unique, and all things matter; the TRMB, to help us think through, where do I go now; and what I call the three tiers to nutrition mastery, which starts with tier one, the non-negotiables. It goes to tier two, deficiency to sufficiency, and then tier three is dismantling the diagnosis. That tends to be where we want to go. If we work on tiers one and two, that soil, we actually influence tier three without having to play target practice.

Dr. Eric:

All right. You covered a lot. You gave a lot of wonderful information. Is there anything I didn’t ask you that I should have asked you? If not, perhaps you could summarize what steps people should take if they are interested in taking that functional nutrition approach.

Andrea:

I think we had a great conversation, so I feel like we did covera lot of basics. I do want to say that oftentimes, we’re overcomplicating the situation. For patients listening, I just want to remind patients that you actually have influence in the decisions that you make every day. If you’re struggling with a decision, that’s where you can seek help.

I invite you to think about your non-negotiables, and they may be not eating gluten or saying, “Oh, she said sleep, poop, and blood sugar balance. I don’t know how to do those, so that’s what I’m going to get help with as opposed to my diagnosis because I know this impacts the expression of my diagnosis.”

Also, I invite people to think about what are your personal non-negotiables that you know? For me, it’s reading, spending time with my partner and my son, being out in nature, being in awe. I went to Iceland last summer, and I’m going again this summer because wow, the healing power of awe was just astounding to me.

I invite people to think about their personal non-negotiables. Might be playing music or having more laughter or being with family more often. There is a lot of healing in that that we’re bypassing as we’re stuck in this sympathetic dominant state, seeking the answer, when in fact it’s multi-factorial. It’s all the things. There’s stuff you can do while you’re on that quest.

Dr. Eric:

Well said. Where can people find out more about you, Andrea?

Andrea:

You can head over to AndreaNakayama.com. Lots of A’s. That will lead you to all the places, to the Functional Nutritional Alliance, where I teach practitioners; to any writing and opportunities I have now; and to The 15-Minute Matrix podcast and other podcasts like this one.

Dr. Eric:

Thank you so much, Andrea. Appreciate your time and sharing all your wonderful knowledge when it comes to functional nutrition.

Andrea:

Thank you so much.

Recently I interviewed Dr. Jason Hawrelak, and we talked about the adrenal transformation protocol. 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. Jason Hawrelak, as he was actually my instructor when I went through my master’s in nutrition at the University of Western States. I’m not sure why I haven’t invited him to the podcast sooner because I have been following him for so long. I keep mentioning his name when I’m doing my own courses and talking to patients. It’s an honor to have Dr. Jason here. We’re going to be chatting about prebiotics, probiotics, and the gut microbiome as a whole.

I’m going to dive into Dr. Jason’s bio. Dr. Jason Hawrelak is a researcher, educator, western herbalist, and naturopathic physician with over 20 years of clinical experience. He did his Ph. D examining the capacity of probiotics, prebiotics, and herbal medicines to modify the gastrointestinal tract microbiota and teaches worldwide on the topics of microbiota modification and gastrointestinal health. He has published extensively in these areas, including 20 textbook chapters.

Dr. Hawrelak is on the Medical Nutrition council of the American Society of Nutrition. He is a fellow of both the American College of Nutrition and the Naturopaths and Herbalists Association of Australia. Dr. Hawrelak maintains a busy clinical practice in Hobart, Tasmania, Australia, where he consults with patients from all over the world.

Additionally, Dr. Hawrelak is chief research officer at ProbioticAdvisor.com. I must say it’s amazing. That offers a searchable database that enables easy, evidence-based prescribing of probiotic products and online resources for clinicians to learn more about the human microbiome and how they can positively influence these ecosystems. Thank you so much for joining us, Dr. Jason.

Dr. JasonHawrelak:

You’re welcome, Eric. I’m trying to remember how long ago it was that you were a student of mine.

Dr. Eric:

Quite a while. I believe I specifically took your course in the fall of 2013.

Dr. Jason:

Goodness, okay. You were definitely one of the early ones, weren’t you?

Dr. Eric:

Yeah. You no longer teach in Western States, do you?

Dr. Jason:

I’m still there.

Dr. Eric:

Maybe that was in the bio, and I just wasn’t paying attention. I should know this. I have attended your online courses and listened to your podcast. You’re still teaching there.

Dr. Jason:

That’s one of my passions. I thoroughly love teaching. I love nothing more than teaching stuff to practitioners because I love the ripple effects that go out when you can improve the way practitioners are engaging with their patients, improving outcomes, actively changing lives. An honor and privilege but also great joy to teach. Coming onto a podcast like this, too, because you have a chance to reach so many people you otherwise wouldn’t, hopefully improving their lives with information they may have been waiting for, but now is the time to hear it, changing the direction of their health. That’s what we’re hoping for.

Dr. Eric:

Can you give us some of your background? How did you start becoming an expert when it comes to gut microbiome and probiotics? What motivated you to create the website ProbioticAdvisor.com?

Dr. Jason:

Some of it was probably almost chance. In my final year of naturopathic training, there was a lecture around dysbiosis and leaky gut, how it drove so many other chronic diseases. This was back in 1999. That lecture stirred something in me. This stuff is amazing. I really want to delve into the topic and dig into it.

I finished off my naturopathic training and did an honors degree. It’s a research-based project. I folded that into the Ph. D. I did a clinical trial of looking at prebiotics and probiotics in IBS. Changed the gut microbiome. That was 2000. Followed that up with my Ph. D. If I had not showed up to class that day and missed that lecture, my life would have taken a different path. Who knows? Exciting area. I find it immensely exciting still.

How do we change the microbiome in patients with IBS using prebiotics? Probiotics? I started teaching clinical applications in pre and probiotics, essentially back in the latter end of my honors degree, back in 2002, to naturopathic students to share what I learned from spending a year devoted solely to that topic. I learned a lot more than what I was taught in my training. We did a fair amount of stuff, but it was scratching the surface.

There are certain things around strain specificity that was not touched upon in my training. When you delve into the research, some probiotics are good for certain patients, and some strains are good for other applications. It blows your mind and changes the way you look at using probiotics from what I tend to call the old paradigm, which is you do a stool test. You’re low on Bifidobacteria; take some Bifidobacteria. That was the old paradigm.

Versus the new paradigm. Doing clinical trials showing that Bifidobacterium strain P1009 speeds up colon transit time and softens stools; therefore, you use it for people who are constipated who have slow transit time. You wouldn’t use that strain for someone who has diarrhea or an H-pylori infection. The research has built up around probiotics, and you get to see how much differences there are between different strains even within the same species. How important that is around choices we use therapeutically as tools. Making sure we have the ones with the actions required to treat the condition of the patient we are trying to help.

Dr. Eric:

I found that fascinating because I learned that from you. Before that, I didn’t know about how you should use probiotic supplements with specific strains, just like a lot of other practitioners still do. I was just recommending probiotics without knowing anything about them. A lot of practitioners neglect prebiotics as well. Definitely want to look at the strain. You’re looking at a probiotic supplement, and it has Lactobacillus acidophilus. It’s not actually giving the strain. Then you don’t really know the therapeutic benefits that it has.

Dr. Jason:

No, you don’t. In this day and age, it’s unforgivable for a supplement company to only be providing species-level information. 20 years ago, when I first started, it was a bit more forgivable because the concept around strain was newer. It had been known for a while, but it was a newish idea that we could have marked differences within the same species by the strain designations.

Now, if there is any company that doesn’t list the strain and just has species name, I will not use it as a tool. You just don’t know what it’s useful for until you do research. We don’t know if it survives stomach acid or bile salt exposure, whether it adheres to the gut, whether it produces an antimicrobial compound that is helpful or detrimental in the gut, whether it has any therapeutic effect at all, unless we do research on that specific strain to see what it does in reality.

I can’t help but think of a relatively new psychobiotic, which is a probiotic that has been shown to help with mental illness, that has hit the marketplace in the last couple years. Lactobacillus plantarum PS128. That was originally isolated from a traditional Taiwanese ferment, cabbage mustard green ferment, which is 500 different types of lactic acid, using those bacteria naturally found in the ferment. Through a lot of testing, they isolated that one strain that had psychobiotic effects. When you give it to animals, it changes the amount of serotonin and dopamine in their brain. The animal studies were pretty consistent.

Let’s change it to humans. They gave it to kids on the autism spectrum. Lo and behold, it decreased defiance, repetitive behaviors, and anxiety. They used the same strain in Parkinson’s disease and other conditions like that. It’s phenomenal. You can’t expect any random strain in that fermented food to have the same effect. They isolated that one strain that had the characteristics they were after. A bunch of strains did not. It puts that in perspective.

Scientists do that well, and companies do this well. We have this well-researched, well-characterized agent that has definitive efficacy in these conditions. Versus you can go, “Okay, well, this is a random L-plantarum, and let’s hope it has some impact,” which is where I think a lot of practitioners practice because they are unaware of this strain stuff. “Let’s give some probiotics and see if they help.” It’s hit and miss.

I think they will be missing a lot more, and their patients will be suffering as a consequence of not prescribing things based on the best scientific evidence, and with the way the information has evolved in the last 20-30 years.

Dr. Eric:

According to what you mentioned, having specific strains is more important than having a higher potency, like the colony forming unit (CFU). Not saying it doesn’t make a difference. You want to have at least one billion CFUs for most probiotic strains. Just because something has 100 billion CFUs doesn’t make a difference if it doesn’t have specific, well-researched strains.

Dr. Jason:

No. I like giving this example of antibiotic-associated diarrhea. There is one study that gave Lactobacillus reuteri DFM 17938, which is sold around the world as BioGaia to these elderly people taking antibiotics. They did give 200 million CFUs per day.

Another study looking at elderly people taking antibiotics in hospital settings. The same population. Gave 60 billion Lactobacilli and Bifidobacteria strains.

Fast forward. Two different results. The 60 billion did nothing. Didn’t stop diarrhea at all. Yet the 200 million of that one specific strain worked amazingly well. That is such a clear example of choosing the right strain with the right actions versus billions of the stuff that we don’t know if it works or not, and it turns out it didn’t work.

That same strain combination that didn’t work for antibiotic-associated diarrhea does have some positive research for improving quality of life in IBS patients. It’s not as useful for any condition; it’s not useful definitively for antibiotic-associated diarrhea. The L. reuteri strain that we use in that study, even if we are giving 300x less dosage, does work.

Dr. Eric:

When it comes to specific strains, a question I get from people time to time is fermented foods. Can’t I just take fermented foods instead of taking a probiotic supplement? If it’s for therapeutic purposes, it might be also hit or miss since you don’t know what strains are in the fermented foods.

Dr. Jason:

They are generally wild ferments. You can be very directive with your ferments and use a probiotic strain with well-defined characteristics as your starter. If there is a way of guaranteeing that’s the end product, which you can sometimes do with different microbiome analysis labs. You can send your ferment there and see what’s actually there. It is possible you could make a ferment based on the right strain to make sure you’re getting that strain in a food base, sure.

In terms of what most people are having, they’re wild ferments. Sauerkraut, kimchi, we are just letting the natural bugs found on there ferment that cabbage. You don’t know what you’re going to get. You know the species stuff, fine. It’s most likely Lactobacillus plantarum, some strain within that species. It doesn’t necessarily mean it will have any therapeutic quality to it. Doesn’t mean it will survive transit to the stomach or bile acid exposure or attach to the gut or produce any selectively acting antimicrobial compound, or it might increase an antimicrobial compound that might kill beneficial bacteria. You don’t know any of those things in a wild ferment.

I drink kombucha and eat kimchi and sauerkraut daily. I think they taste great, but I think it’s a way of enhancing your immune reactivity by interaction with different microbes in the environment, which I think is always a part of what humans have done and part of what we should still be doing. Increasing the diversity of our ecosystem by introducing these microbes that are generally temporary visitors.

While you’re eating them, you’re adding another 20, 25, 30 species, depending on how diverse that ferment is, that are in your gut for these temporary time periods. There is no way I would rely on it in the same way that I would the PS128 strain to the kid on the autism spectrum that we know changes neurotransmitters in the brain because other strains of L. plantarum cannot. We know they don’t have that capacity.

You may luck out on the sauerkraut lottery and have a psychobiotic strain in there, but there is a decent chance you have not. If you take the sauerkraut and feel really happy after, maybe you have won the sauerkraut lottery, and you can use it as a starter culture. With wild ferments, they’re just that. They’re wild. They’re diverse. There is a strength to that. There is a place for that in healing journeys. It’s not really trying to target specific issues.

Dr. Eric:

One thing you also mentioned is with fermented foods in the species or strains that come with them, you’re not sure if it’s going to survive stomach acid. When it comes to commercial probiotics, are typically all of them resistant to stomach acid? That is a concern for some people. If I take it, will it actually reach the desired?

Dr. Jason:

I think this area has probably been overfocused on by companies selling other probiotic preparations to try to make you wary about using Lactobacilli or Bifidobacteria-based ones. “They don’t survive stomach acid anyway, so there’s no point.” It’s been a selling point for other types in the market and has taken hold sadly.

If you went back 30-40 years ago, you’d probably say there is a decent chance that a number in the market would not meet the criteria of survival to the upper gut. Fast forward to now: any preparation that has well-characterized strains like L. rhamnosus GG or DSM17938 or L. plantarum 229B, we know that they survive stomach acid and bile salt exposure. They can show up in your poo after. They did these studies before they brought them to the marketplace.

These days, scientists are generally doing these preliminary studies, taking these 500 strains of Lactobacilli from this fermented Taiwanese traditional food, and we will put them through an obstacle course. Does it survive bile acid exposure, stomach acid exposure? Does it adhere to the gut? Looking at all these different characteristics. They might find 5-10 that do. Those ones, they will take into animal models, and then eventually human studies. You want to see what they do beyond survival. The ones that are well-defined strains, yes. They will survive everything easily.

There is a risk if you’re using probiotics that do not define the strain. You have no idea what you’re getting. The reality is a supplement company can buy well-characterized, well-researched strains that have all the background data done on them at a high price point. Or they can buy at a low price point, where some microbiologist said, “I isolated 500 strains from this sauerkraut and will sell it because it’s cheap.” We have no idea if they have the basic characteristics required. There is always a risk in numerous ways in buying supplements that do not define the strain characteristics.

If we buy the ones that do have the strains and have positive clinical trials showing they work, then we don’t need to worry about whether they will survive in the upper gut or not. We know they work. We have clinical trials showing they work.

Dr. Eric:

I learned that you’re supposed to take probiotics with food because some sources will say not to take it with food.

Dr. Jason:

Yeah. That’s one of those myths I have been trying to bust for 23 years now, Eric. The data was relatively clear back then, and it’s even clearer now. We have better survival with immune. This matters far more now for Lactobacilli or Bifidobacteria-based probiotics. Saccharomyces, doesn’t really matter. Bacillus, doesn’t really matter.

With the new generation of probiotics, like those based on Akkermansia, I reckon they will be better with food, too. They are often impacted by a really low pH. When your stomach is empty, the pH is around 2, 2.5. When you are putting bacteria in there, it’s really acidic. It’s designed to kill bacteria. It does that pretty well. When you have food, the pH goes to 4 or 4.5. It’s closer to neutral. It’s still acidic, but it’s a far cry from pH of 2, 2.5. We have better survival from the bacteria that go through with a pH of 4, 4.5. The bigger the meal, the more buffer the pH has.

There is research that shows that dairy food actually works as a better medium to transport bacteria through. The buffer in pH is even more so. It provides a more neutralish environment for microbes to pass through the stomach intact.

Dr. Eric:

Lactobacillus, Bifido-based bacteria probiotics, take with food. The newer probiotics as well. You mentioned Saccharomycesboulardii, not necessary. If you are taking Bacillus-based, like spore-based probiotics-

Dr. Jason:

The spore-based ones don’t matter. That’s one of their strengths. You can buy some spore-based stuff that is mixed into baking kits that you buy and bake in the oven. Other ones, you add boiling water to herbal tea, and that doesn’t kill them. They are quite resilient and release in the gut. That’s one of their strengths, is their capacity to survive in a wide variety of environmental conditions that would otherwise kill. If you pour boiling water on the Bifido bacteria, they won’t survive. The Bacillus spores will survive and release into your gut at a later time.

Dr. Eric:

Sticking to the topic of spore-based probiotics, I knew a few years ago, not that you weren’t in favor of them, but the research was still behind the Lactobacillus and Bifidobacterium. Do you still feel that way, where there is still a lot of research to be done?

Dr. Jason:

Yes. There are clinical trials showing they do something. For me, that’s the indicator. If there is evidence showing that something is safe and efficacious, a spore-based probiotic will work for this condition. We are seeing that evidence grow. There has been some Enterogermina strain of Bacillus on the Italian market since the 1950s that has a fair bit of research on it. It is an exception that has a higher research base.

In other areas, the products have been overhyped before the research was there. That is the thing that triggered me a bit. If we have these Bifidobacteria and Lactobacilli ones with clinical trials showing they work, and then someone selling the products says, “Don’t use them. Use mine that has no data for it,” it doesn’t feel right to me.

I have been happy to see that the evidence base has been growing on those. You get ones like the Bacillus coagulan GBI-30 6086. There is some interesting research that is useful for rheumatoid arthritis and functional abdominal pain. A couple of conditions with less research data on other probiotic strains. If you were still to compare the total amount of research on Lactobacilli-based bacteria versus Bacilli, the research on the traditional ones far exceeds what we currently have on the Bacillus-based ones.

Dr. Eric:

Let’s dive into prebiotics. Can you discuss why prebiotics are so important and perhaps some of the best food and supplement sources of prebiotics?

Dr. Jason:

I think prebiotics, as you alluded to before, are an underutilized tool in most people’s clinical toolkit. Not for me. I was enamored by prebiotics when I started doing my honors degree in 2000. I wasn’t taught anything about them in my naturopathic training. I started reading the studies. There are these things that dramatically change the microbiome, in selective ways, far beyond what we’re going to get by taking a probiotic and eating fermented foods. There is a dramatic impact, and selective.

Let’s look at what a prebiotic is. It’s a selectively fermented compound that encourages the growth of one or more beneficial species of bacteria in the gut to produce health benefits. That’s how it is defined. We only have a limited number of compounds that currently meet that criterion. That would be inulin-type fructans, which we would typically call fructooligosaccharides. Then we have galacto-saccharides.

We have lactulose, which would probably surprise many North Americans because lactulose is one of those things that has now been earmarked as a breath test substrate more than anything else versus as a prebiotic since the 1960s. It was in infant formula as a way of making it more like breast milk. It was pigeonholed in the U.S. with some negative connotation.

When you look at the science behind it, its capacity to alter the ecosystem is fantastic. Its capacity to decrease levels of proteal bacteria like E.coli or Klebsiella in the gut is paralleled as a prebiotic. It works amazingly well. That overgrowth of Bacteroides populations, it will bring down very well.

There is a study published in 1997 which was one that really blew my mind. It was recent when I first started my honors degree. It showed we had a 1,000-fold decrease in Bacteroidespopulations and 100-fold decrease in E.coli populations in the gut when people took lactulose as a bacteria. For every 100 E. coli, there was now one. For every 1,000 Bacteroidi, there was now one. Dramatic impact. 100-fold increase in Bifidabacteria and 10-fold increase in Lactobacilli. These massive shifts.

That got me excited. Clinically, if you see results like that in patients, you see these dramatic shifts in ecosystem composition as a result. We get that in supplemental form for sure. I tend to use them primarily that way. However, we can also get food sources that contain Galacto-oligosaccharides, which is primarily in legumes. We do get some in things like beets for example. It’s scattered in other vegetables, but the amount is tiny. Versus legumes. All legumes have a good amount. That’s what makes legumes give you gas. You get gas because there is indigestible compound called Galacto-oligosaccharides. They reach the colon, feed specific beneficial members of your gut, but you do get some flatulence that comes with that.

Inulin-type fructans, we find more broadly across different foods, like onions and garlic are really rich sources that we have commonly. Also, wheat, rye, barley are decent sources as well. Particularly when people eat a ton of it, which they often do with wheat products.

There are some foods that are less commonly eaten by us as westerners now than our ancestors would have eaten that are quite high, like burdock root. It’s like 10% inulin-type. Jicama root. Yacon tubors have 15%. That’s a South American vegetable. There are a number of traditionally consumed vegetable crops throughout North, Central, and South America that are high in inulin-type fructans. A high part of people’s diets who are traditionally from those areas. Chicory roots, dandelion roots, people with European backgrounds used to go and collect those things to consume. No longer because they taste bitter. We have lost our capacity to deal with bitter flavors as a culture. There are large amounts within those foods. Even dandelion leaves have large amounts as well.

Dr. Eric:

Do you personally take prebiotics in supplement form, or do you rely more on food sources?

Dr. Jason:

I do both. I definitely take my inulin-type fructans daily, and almost partially hydrolyzed guar gum, which is one we haven’t talked about much. It is somewhat unique because it is very good at feeding butyrate-producing bacteria in the gut. Lactulose, galacto-saccharides, they tend to feed Bifidabacterium pretty consistently across the board. They will also increase another group called the Calibacterium as well as having decrease in pathogenic bacteria as well.

Partially hydrolyzedguar gum feeds an array of species in the gut. It doesn’t really lower the levels of potentially pathogenic microbes, so that’s not a strong point. Feeding butyrate producers, which is such an amazing substance. I chose my diet to nurture my microbiome. I choose my foods to nurture my butyrate in the gut. I also supplement with hydrolyzedguar gumin my daily regime.

Dr. Eric:

You mentioned that prebiotics could lower opportunistic or potentially pathogenic microbes. Is there concern that it could do the opposite? Maybe prebiotics would feed the different opportunistic bacteria.

Dr. Jason:

Some of this comes from a study published in the early 2000s that suggested, let’s look at fructosetriglycerides. In this particular study, if you took Klebsiella out of the ecosystem context and put it in a petri dish with some phoss in there, it could grow on that phoss. People got freaked out by this. FOS feeds Klebsiella.

What they didn’t do was look at the other components of that study. Klebsiella in the ecosystem of poop, when phoss was added to the fecal slurry, Klebsiella went down, not up. There are no human studies showing that Klebsiella goes up when we give phoss. It’s like taking research out of context, going, “Oh my god, there is this in vitro study, but we will show all the human studies that shows it does the opposite,” which I find strange.

Phoss can cause gas and bloating and dysfunction. I might fart or bloat more if I take it. Bloating in dissension is a sign that your gut is not working well, and you need to do something to look at what’s going on there, whether it’s slow transit time or SIBO that is driving that that you need to address. It’s not that the phoss is feeding the bad bacteria. That’s where people sometimes go, “We have this in vitro study. I eat this, and I get bloated. I’m in pain. Therefore, it must be feeding Klebsiella. That’s why I’m in pain.” That is ignoring the human studies that don’t show that.

I can say from giving phoss to thousands of patients, and doing pre and post sampling, microbiome analysis, you do not see these things go up on phosssupplementation. It’s not reality.

Dr. Eric:

If a practitioner was to do a stool test, and it showed a few opportunistic bacteria, which is common. Let’s say there is Streptococcus, Staphylococcus, Klebsiella. Some practitioners might say to give antimicrobials such as oregano. Would a better approach be to give them some prebiotics, or even probiotics, to do things to increase stomach acid? Or is there justification for antimicrobials, even if they are just opportunistic and not necessarily pathogenic?

Dr. Jason:

Good question. I think it depends on what’s there and how far off normal it is. I do see some people look at the results. Streptococcus is in the red, but it’s a tiny bit above the normal range. That’s not problematic really. Sometimes, you might have E.coli tenfold higher than normal range. That’s problematic, and I might use a combination effect. I might use saccharomyces cerevisiae or DSM 17393 or a compound called Reuterin to target E.coli, and I will use lactulose, which will bring E.coli down. I might use an herb, too. I’m very selective.

This came out of my Ph. D research. We were curious about what impact different herbal antimicrobials might have on the gut ecosystem. This is back in 2001/2002. We did some in vitro research at that time. Grab some bacteria that are representative of the keystone species we knew about at that time that we could grow in petri dishes. We will expose them to different herbal antimicrobials and see if they only kill pathogens and leave good guys intact, or if they kill everything, or if they lower good guys in lower concentrations. We were really curious.

It turns out that some of those ones did do that. Citrus seed extract killed everything; if anything, it was more effective at killing the good bacteria than it was the pathogens. We used Clindamycin as our positive control, which is a pretty full-on antibiotic. It wiped out Clindamycin as the concentration. It killed everything.

We had things like garlic that only targeted things like candida, E.coli, and left Lactobacilli and Bifidobacteria alone. We had oregano essential oil that was good at killing Bifidobacteria, but sadly Lactobacilli was fine. It did kill some pathogens, too. Berberine-containing herbs were also good at killing Bifidobacteria. Lactobacilli were a bit more tolerable to it, and it killed some of the pathogens.

It was an interesting project. It became integral to my choice of herbs. Antibiotics cause damage, but herbs are fine. No. Hold on, that’s not true. Depending on what herb we use, what form we use, what concentration we give it in, what dose, we can kill lots of beneficial bacteria with our herbs. That really changed the way I practice from that point on. I can choose things that work selectively as much as I can, which thankfully is most of the time. We can choose something that will target the E.coli but leave Bifidobacteria and butyrate producers alone.

There is more research that has come out in that vein in the past 20 years around how herbs are more selective and certain ones are not. You shouldn’t underestimate the impact of the right prebiotic and probiotic for shifting things in the gut, too. If it’s only a minor imbalance, I will often use dietary changes, prebiotics, and probiotics to shift things.

I had some patients with Crohn’s, and 50% of their ecosystem was E. coli. Some context here: Normally, E. coli are 0.01%, or 0.1%. That’s the normal range. I had two people where it was 50%. In that case, I am not just using prebiotics and probiotics. I am also adding herbal medicines. One of the benefits is that it targets Klebsiella, Streptococci, E. coli, but leave butyrate producers alone. They go up if we utilize it. Some herbs are just amazing in their selectivity. When you get on board with targeting things and doing things in a selective way, putting the microbiome first, we end up with better results long-term for our patients.

You can look at things like berberine, which we know does kill a different range of pathogens. Some interesting research has come out about longer-term use of berberine, where it causes decreases in the diversity of the ecosystem. It produces butyrate-producing species in longer-term use. It reduces Bifidobacteria populations with longer use. Importantly, it increases levels of E.coli, Klebsiella, and other nasty bacteria, which is one thing that should be on clinicians’ radar when talking about.

Berberine is a new “let’s use it for everything” supplement. When there is research done on the impact to the microbiome, there are definitely some negative impacts with long-term use that should be on our radar. If you are using it or cholesterol or metabolic health, where you are giving it daily for long periods of time, you need to be aware of the significant dysbiotic effects it has on the gut.

Dr. Eric:

That’s interesting. I know oregano oil can be harsh, as can citrus seed extract. Maybe I need to dive deeper into berberine. If you do a search on PubMed with berberine and gut microbiome, a lot of it seems to be positive. But I guess you can’t argue with the research in terms of it does affect some of the good bacteria like Bifido.

Dr. Jason:

More surprising is look at the research of long-term use on humans. I think that’s a short-term thing, which might be one thing. I don’t mind using berberine for short periods of time. A couple weeks, no issue. But if you start giving it daily for months, that’s where you start seeing more substantive negative impacts of its use.

Also, it’s important to respect traditional wisdom, in that berberine-containing herbs were never given to people long-term in any traditional medicine system. They are always seen in short-term use, like Coptis chinensis, traditional Chinese medicine, really high in berberine. Always short-term use, don’t use long-term. Goldenseal was always seen as a short-term use. Don’t use it long-term. That is more from the North American/Western medicine.

This wisdom that was there around these things, and we have pulled out this potent antimicrobial compound, thinking it improves luxury control. Let’s give it to everybody long-term for years. Let’s fix this diet or lifestyle. Don’t do that. Let’s just give them this one magic pill. We’ll see there are negative consequences to the magic pill, whether it comes from the herb or the pharmaceutical lab, if we are not treating the underlying diet and lifestyle factors that led to that occurring.

Again, I think berberine in the short term is fine, but I think the data is clearly showing there are long-term negative consequences from the microbiota perspective. And unexpected, like the growth of E. coli/Klebsiella strains and blooms with long-term berberine use. Maybe you get this initial suppression, but then the bacteria become resistant to it, and then they end up growing as a consequence of continued use.

Dr. Eric:

Very interesting. Speaking of randomly killing antimicrobials, what do you think of practitioners who treat everybody for parasites? As you know, I interviewed Dr. Nerala Jacobi and asked her the same question. I’m sure I know what your answer will be as well. If you could talk about putting everybody on an antiparasitic protocol, even if it’s without berberine. Let’s take berberine out of the equation and other antimicrobials. Also, if you could expand on Blastocystis hominis, is it more commensal or pathogenic? There is also some controversy on that as well.

Dr. Jason:

There is definitely controversy around it. How the evidence has changed over 20 years. If you had asked me this 20 years ago, as a clinician, if I had someone who presented with gut symptoms and took a stool test that said Blastocystis, I would have said to treat it. Fast forward 20 years ago, no. I will work this patient up really thoroughly. 95% or even higher of the time, we find something else that is causing their symptoms. Generally, it’s SIBO. They haven’t been adequately breath tested for SIBO. They took a stool test, and they have symptoms, and they see Blasto and presume it’s the cause, stopping their diagnostic workup there. That’s the biggest mistake. All that focus is on this microbe.

If you start looking at recent data, it’s being viewed in a different light. It’s being associated with better, higher quality, more diverse gut ecosystems. People are now arguing it has an apex predator role in the gut. Just like wolves in Yellowstone National Park or great white sharks out in the ocean, they actually are the apex predator, and their job is to keep other populations in check. If we wipe out that population, there are consequences to the ecosystem, allowing other bacterial species to dominate.

Blastocystis is a bacteria eater. Some argue it keeps certain types from overwhelming, which is what we tend to see in Western culture. The lack of Blastocystis might be the reason why. I think the crappy Western diet is probably the reason, but it’s also the connection with the lack of species. Enough people in North America take antibiotics, and it’s not there anymore.

A billion people worldwide have Blastocystis in the gut. There are a lot of super-duper healthy people with Blasto in the gut. I’m putting my hand up here. I was doing stool test experiments, and it turns out I have Blastocystis in my gut. Do I have gut symptoms? No. Do I have fatigue or brain fog? All the things people attribute to that, I don’t have. If you subtest me, there are other people who have this in the gut, and it’s not a problem. Sometimes, the issue is if we stop our diagnostic workup as “You have this stool test, and you have these symptoms; therefore, that must be the cause,” that is the issue.

I do think that there is enough data out there to suggest to me there will be in rare cases a potential for Blastocystis to be a problem for a patient. I think we have to rule out everything first. After you do that, you rule out SIBO and everything else, but you do have this bug. Maybe it came from a case of travelers’ diarrhea. You didn’t have the bug before. Now you have symptoms. There is some stuff in the history that might make us think this is the likely cause. I would still focus on microbiome optimization, improving the health of the gut, and then seeing how symptoms go from that point over trying to kill this thing.

If it was as simple as pulling one of them out, there wouldn’t be this discussion. Here in Australia, there are people who run centers that do triple antibiotic cocktails, three different antibiotics poorly, sometimes at the same time as doing three antibiotics sprayed by colonoscopy as a way of trying to get rid of this bug because it’s been blamed as the cause of this person’s brain fog, fatigue, or gut symptoms. Then I am stuck with trying to mop up these people’s Blasto being gone, but now they are a hell of a lot worse than they were before because their ecosystems have been decimated trying to get rid of this. It’s a massive loss of diversity.

Weighing out the potential risks versus benefits with treatment. When there is lack of definitive evidence showing this as a problem, then I think we have to be very cautious about using big guns to target. Let’s make you healthier and see how you feel. It’s a different way of looking at it.

Can we potentially induce better behavior? We know with certain microbes—not with Blastocystis yet—if we make the environment more acidic, by adding more fiber or prebiotics, we actually bring out better behavior in potentially pathogenic microbes. We can turn different genes off and on. They can produce beta-glucuronidase, or toxic metabolites goes down. Candida, we can change the pH, which doesn’t grow hyphae that can burrow in your tissue but instead stays in bud form. We have enough data that if we can change the environment to a healthier one, we can bring out the best behavior in certain microbes and suppress negative behavior. The bug might still be there, but it’s not a problem in terms of the context of the environment.

Dr. Eric:

Do you take a similar approach with H-pylori?If someone has it in the absence of symptoms, would you also say to leave it alone?

Dr. Jason:

It would depend on the test I did. When I am testing for H-pylori, I am specifically doing it because I think it’s causing symptoms in that patient. I think there are a couple of stool tests out there that test it in everybody, that find it in 80% of tests, which isn’t correlated with any follow-up analysis in most of those cases. I am more cautious to run those things. If you have H-pylori that shows up on a random stool test that isn’t backed up by other tests and technologies, like breath testing or scoping or blood tests for antibodies or normal fecal antigen. If those show up clear, then no, I would not treat it based on that.

If I do have patients who show up with a positive urine or breath test, then they would be doing that because they have symptoms consistent with H-pylori causing a problem. I would treat it.

You bring up a point in that there are people who argue, and I agree, that there are likely benign strains of H-pylori that are not problematic, and then there are some that are problematic. There are certain things we can test for, like CAG, and some of those other things that are virulence factors that we know about now. We don’t know about all virulence factors, so we can’t say, “It doesn’t have these two virulence factors; therefore, it must be benign.” I don’t think we’re at that point yet. In another 15-20 years, we will have a better picture about when it’s appropriate to treat it and when it’s not.

I do think when people have upper gut symptoms consistent with this, and it’s present, then I will treat. But I am also able to use herbal medicines and dietary interventions to target it without causing major microbiome damage. To me, that puts it in a different perspective. If every patient had to take a triple cocktail and quadruple therapy to get rid of it, I would want more distinctive evidence that it was harmful. Versus you take this herbal medicine for six weeks, eat some broccoli sprouts and drink some cranberry juice, and take this probiotic, and we get 90% efficacy rate doing that.

I have less qualms about taking out the H-pylori and leaving everything else intact. That to me is close, selective tweezering of pulling out the microbe and leaving everything else in a good state, that we can get with some things like H-pylori.

Dr. Eric:

The final question I have for you is leaky gut testing. I attended one of your online courses where you discuss some of the different testing. I don’t want to put words in your mouth, but I think you mentioned zonulin is not completely accurate as a marker.

Dr. Jason:

It’s been interesting watching the research in this area. Some people will pooh-pooh the lactulose mannitol tests because it’s old technology. It’s accurate technology. We’ve been using it for a long time. It’s still considered the gold standard by people who are specialized in this area who don’t work for a lab trying to promote something else. When you start looking at the data around, taking bloodstream sampling for zonulin does not correlate with the gold standard. Most research suggests it does not.

More importantly, there is research looking at what the test is even looking for. It turns out the tests looking for zonulin aren’t finding zonulin; they’re finding something else. Some studies show it might be haptoglobin or complement C3 or another zonulin-like compound, but it’s not finding zonulin anyway. The correlation between that and the gold standard is pretty consistently poor. It’s not even finding what it’s purported to find, which is zonulin.

Some people think that we should be tossing out every single study that’s done using bloodstream testing of zonulin because of its poor accuracy. Never mind the fact that maybe 10% of people don’t produce zonulin, so they will always not have zonulin show up, but will have a leaky gut. It’s a problematic thing.

Are we always finding zonulin or a similar compound to zonulin that we can make an assumption with?  It doesn’t always correlate with bloodstream zonulin or lactulose mannitol. The occasional study with fecal zonulin suggests it may correlate. It’s usually mixed but mostly negative with fecal zonulin. Blood zonulin is questionable as a marker, and I won’t rely on it as a way of assessing leaky gut.

It’s pushed more in the States because lactulose is a prescription item. It means that nutritionists, dieticians, etc., can’t prescribe lactulose mannitol test because it has a drug in it. In Australia and pretty much every other country in the world, lactulose is common over the counter. It’s a thing everyone has access to, and we can all prescribe this test really easily. Over there, you can’t. You can if you are a medical practitioner or naturopath in certain states. But it means there is more of a push to go, “Okay, well, we can’t use this test, so let’s see if we can find something else.” People have jumped on it way before the data supported it as being accurate. I think the tests were developed- They can’t find zonulin. The test is supposed to find it, and it’s not. It’s finding something else.

Dr. Eric:

That’s good to know. I’m glad I asked you that question. I know I said that was my last one. In 2018, when I took one of your courses, I think you said you used to use uBiome for biome testing, but since then, they have gone out of business. Do you currently use any companies for gut microbiome testing?

Dr. Jason:

Yeah. My patient base is spread around the world, which means I have different labs in different continents I work with, all using different technologies. Broadly speaking, there is probably two types of tests that I would use in practice, tests that use 16S RNA technology to look at the microbiome.

In the States, Ombre does that. They were called Thrive. There are limitations with it, but you do get a beautiful snapshot of the whole ecosystem at a low price point of around $100, which I think is fantastic. You can track changers in the key species, Bifidobacteria, Lactobacilli, butyrate-producing species. You can target that there and see the impact of your dietary changes and prebiotics relatively quickly and inexpensively for follow-up.

There is a test in the UK called Biomesight that also uses 16S RNA, which has a better microbe library and fills in some of the gaps we currently have with Thrive. It’s not particularly good at telling us bacteria populations, so each of those tests has its strong and weak points. Ombre is not good with proteobacteria for example. Can’t see Bilophila, which is a bile-loving organism that produces hydrogen sulfide gas. If we take their data and put it through the Biomesight library, we can see proteobacteria and Bilophila. There are ways of working around that issue.

There are labs that use shotgun metagenomic sequencing, which is really cool because you can go down the species level accurately and down to the strain level. You can tell people are taking L. Rhamnosus GG, the probiotic, because I can see it show up in their poo. It’s pretty cool. The cool thing about shotgun metagenomics is you get to see fungi and protozoa bugs and bacteria, and even genetic pathways, too, for the production of certain compounds, like hydrogen sulfide gas or methane.

There is a labhere in Australia called Microba that uses shotgun that I do a lot of. The major downside is the cost point; it’s $300-350 per test, which is a lot more than the $100 for Ombre. I also use NirvanaBiome or CosmosID in the States, who also does shotgun. The price point is a bit higher. But we do get more data to work with.

One of the biggest issues with 16S, which is uBiome and Biomesight, is their species level differentiation is not so good. We can’t go which Bifidobacteria species are in there. We can when we’re using shotgun techniques; we can get that species level detail in fine, nuanced ways.

Dr. Eric:

Does Viome use 16S?

Dr. Jason:

Viome uses shotgun. They use arguably the best technology to look at the ecosystem. But as a clinician, I don’t get much out of the reports. They’re more designed for the general public. Eat more of this food, eat less of that food. As far as telling you what the ecosystem looks like, so I can advise that patient how to modify it, I don’t get the data I need from Viome. But the technology they’re using is good.

Dr. Eric:

All right. Thank you so much for sharing your knowledge, Dr. Jason. I’m sure there is a lot more you could talk about. Is there anything I didn’t ask you that you have a burning desire to share? If not, can you give a brief summary as to what direction they can go as far as looking more into taking care of their gut microbiome?

Dr. Jason:

I think we covered a lot of good topics. I can’t overestimate the importance of looking after your microbiome. Changing the way you look at it as being a custodian. It is a custodian of this ecosystem, not just for yourself, but for future generations. Particularly if you haven’t had kids yet, you will be passing on the microbes to the next generation, so you want the ecosystem to be as diverse as possible.

It is not always straightforward to eat the way I’m going to mention here because sometimes you have SIBO or IBS or other things that may complicate things. But in general, you want to eat predominantly plants. Not completely plants necessarily. You can if you want. Predominantly plants. Whole foods. High fiber. Avoiding all processed foods. Anything with weird food chemicals, emulsifiers, completely avoid. Olive oil, bright colors, purple potatoes, purple sweet potatoes, choosing lots of bright berries. A wide variety of as many rainbow colors as you can in your diet. The widest diversity of different plant foods in your diet. Spices, like cumin and coriander. A mixture of different things. The key is diversity of different foods, particularly plant foods and whole foods.

It would be poor of me to neglect lifestyle stuff, too. Get out in nature. Go bush walking, hiking out in natural environments. Garden. People who do organic gardening pick up more microbes and have a diverse ecosystem. People who have the widest variety of plants growing in their garden have a more diverse ecosystems in their gut, which is also a fascinating correlation. Since I read that study, I have been planting out in my garden like mad with a wide variety of different species as possible, so I can interact with different plants and get different microbes.

Dr. Eric:

I think you once said 40 different types of plant-based foods per week. Do you still recommend that?

Dr. Jason:

Yes, I still recommend that. Not that 40 is a magical number because I think 50 is arguably better, but I think 40 is achievable for most people. How many different types of plant foods are you having that week?

To make this easier, Granny Smith apple, Red Delicious apple, Fuji apple are three different foods. Red quinoa, black quinoa, white quinoa, three different foods. When you look at it that way, it becomes easier to achieve that 40. By doing so, we do see the improving of diversity in the ecosystem. The richness of the ecosystem will improve when we are able to eat that way.

Dr. Eric:

Not just fruits and vegetables, but nuts and seeds. Would those also count?

Dr. Jason:

Nuts, seeds, legumes. Legumes have been demonized more recently, but they are fantastic for feeding the microbiome. They really are. They contain lactulosesaccharides. If you eat Suzuki beans or black beans, you are getting beautiful polyphenols, which feed other beneficial bacteria. Soluble fibers, which feed butyrate-producing species. As a food group, that provides a lot of nurture and nourishment for beneficial members of your gut microbiome. Legumes are fantastic. They have been unfairly demonized in the last 10 years sadly.

Dr. Eric:

Where can people find out more about you? ProbioticAdvisor.com?

Dr. Jason:

That’s where my probiotic database is, which is trying to make evidence-based prescribing of probiotics easy for clinicians and people who don’t have access to them. I have a range of courses on there, too, mostly geared for practitioners because probably my main passion is educating clinicians to reach more patients.

There are some courses there for the general public who are up on health, which is a decent proportion of people these days. That is one thing that has changed a lot in the last 20 years, is people’s general knowledge in health, which is way beyond where it was 20 years ago. We have courses for those people, too.

Dr. Eric:

Thank you again for your time. I appreciate you sharing your knowledge on probiotics, prebiotics, and the gut microbiome.

Dr. Jason:

You’re welcome. Nice chatting with you, Eric.

Recently I interviewed Hope Pedraza, and we talked about hair tissue mineral analysis (HTMA) and tying it into thyroid health. If you would prefer to listen the interview you can access it by Clicking Here.

Dr. Eric Osansky:

I’m excited to chat with Hope Pedraza, as we will be talking about hair tissue mineral analysis (HTMA) and tying it into thyroid health. I’m going to give Hope’s bio. She is a certified holistic nutritionist, nutrition coach, Functional Diagnostic Nutrition practitioner, a hair tissue mineral analysis expert, and a comprehensively certified Pilates instructor and founder of inBalance Studio. Hope helps women heal their body from chronic gut, hormone, thyroid, and autoimmune issues; balance the mind; and live in alignment. Hope is also the host of the fast-growing podcast Hopeful and Wholesome. Thank you so much for joining us, Hope.

Hope Pedraza:

Thanks so much for having me.

Dr. Eric:

Appreciate you being here. Excited to chat with you about the hair tissue mineral analysis. Why don’t you start out with your journey? How did you get started helping people with hair tissue mineral analysis and doing everything that you do today?

Hope:

I think we all have our own health journey that leads us into this space. I initially got into wellness from my love of dance. That got me into Pilates. I opened my own Pilates studio. With my Pilates studio, I wanted to create this comprehensive experience for people, where they could get their movement and nutrition and everything all in one spot. That led me into the nutrition space.

Initially, it was me doing nutrition coaching. Then it was me realizing that a lot of the women coming to me wanted to “lose weight.” They wanted to lose weight, or they wanted to tone up, or whatever. Working with these women, I’m realizing there are so many deeper things at play than just the weight. There are hormone issues they have been dealing with for years. Thyroid things they have never dealt with. Inflammation. All these things that are the real problem. The weight is just a side effect.

That led me down the path of Functional Diagnostic Nutrition, really being able to reach people where they need to be reached, which is at a much deeper level than just talking about calories and weight loss. It’s a much more complex equation than that.

Through my work in FDN, I got into HTMA, realizing what a huge piece mineral balancing plays in the wellness equation. I realized that we talk about vitamins and minerals all the time. We hear about them all the time. I don’t think we really understand the role that minerals play. You have probably heard of the term “the spark plugs in the body,” which sounds great. But what does that mean? They are literally starting the reactions in your body. Without minerals, nothing is functioning.

Understanding that piece at a deep level, understanding that minerals are the building block for everything else. This is a piece that is missing in most practitioners’ work. Most practitioners aren’t looking at minerals in a deep way. You may do a blood panel, and that’s the extent of it. Also, giving them a valuable protocol to know what to do with it. “My magnesium is low. Now, what do I do?”

Dr. Eric:

Why not just test for minerals in the blood? What’s the difference between hair testing and testing for minerals in the blood? You can test for nutrients in urine. If you could dive a little more into the significance of the hair mineral analysis.

Hope:

For sure. It’s a good question. This is the piece that sets this specific test apart from other labs and what makes it such a great functional lab. When you are getting a general blood panel, testing there is a very acute measure. It’s a small window of what’s going on with your mineral levels. Not only that, but a lot of our minerals are intracellular, meaning they are in your cells. When you are measuring the blood, it’s not an accurate picture of what’s going on, especially at a cellular level.

When you are doing the HTMA, you’re submitting some of your hair, which is a tissue. You are seeing what’s being pushed out into your tissues, which gives you a look at what’s going on chronically, over time with your mineral levels. It’s much more accurate because it is what’s going on at a cellular level. You get more detailed information at what’s going on.

I have had so many clients I’ve worked with get a blood panel, and their potassium is too high. Potassium is an intracellular mineral. It’s supposed to be in your cells. If it is that high in your blood, it actually means you’re deficient because it’s not in the cells being used. There are a lot of things you can see with the HTMA that gives you a more accurate picture of what’s going on and can help correct the imbalances and chronic symptoms people are dealing with.

Dr. Eric:

Is what you see always what you get on the hair test? If you see low minerals, is it always low? If you see high minerals, does that always mean you have too much of a mineral?

Hope:

Good question. No is the short answer to that. It’s not always that simple. Typically, if it’s low, it’s low. Often, when it’s high, that doesn’t mean it’s high. For example, I feel like magnesium and calcium are two of the big ones there. A lot of times, the magnesium is high in the HTMA. That actually means it’s being pushed into your tissues, so it’s not bioavailable, which means deficiency.

With calcium, same thing. Calcium is a structural mineral. 98% of it is supposed to be in our teeth and bones. When it’s coming out in your hair and tissues, that means it’s being pulled from our bones and teeth and pushed out into the soft tissue. That’s a problem.

It’s not always straightforward, which is why you don’t want to just treat the lab. You want to treat the person. We are looking at symptoms, comparing symptomology and looking at the labs, connecting pieces with other labs we have done to connect dots and see correlations.

Dr. Eric:

Pretty much just to summarize: In the case of calcium, magnesium, if it’s elevated, it could mean not that it’s too much, but the opposite, where you are actually deficient.

Follow-up question: Can other factors influence it? If someone has hard water, could that also be a reason why the calcium is high?

Hope:

Not typically. There are other things that could show up from hard water. There are some other trace elements that the HTMA measures. I’ve had some clients where their uranium is through the roof, but they are drinking and bathing in well water, or they are in a place where granite is in the water. It can happen that way.

If calcium is that high, it’s not from the water. It’s from a calcium build-up in the body. This is veering off subject here. Elevated calcium is indicative of other more serious things. One of those could be copper toxicity, which I know we’ll talk about. Really what it means when the calcium is that high, especially when it’s off the charts literally (it can’t measure it)—I have had clients all the time with that—we are looking at what’s called a calcium shell. We have this calcium build-up in the soft tissue, and it starts to affect cellular permeability. This calcium shell builds up around the nerves and cells in the body. It starts to prevent things from going in and out of the cells.

Often, I have clients with hypothyroidism, and that’s a big thing. The hormone has to get in your cells, so if you have this calcium build-up, it’s not having an easy time going in and out of the cell. The high calcium is a big deal because that will affect all of your other minerals. It’s affecting what’s going in and out, and it’s affecting all the other levels.

Dr. Eric:

Before we get to copper, can you talk about magnesium, sodium, and potassium? They’re all important, but those are the macro minerals.

Hope:

We have the big four: calcium, magnesium, sodium, potassium, the ones we need the most of and you hear the most about. In my experience, typically, more people have excess than deficiency in calcium.

With magnesium, most people have a deficiency. I’ve never to this day had someone who had excess magnesium in their body. It’s always a deficiency. Magnesium is one of those that it’s used in so many reactions in the body, 500-600 reactions. Because it’s used so much, it’s so easily depleted, especially by stress. The adrenals zap your magnesium supply really quick. Magnesium is easily depleted when your body is stressed. I’d say 99% of my clients, there is a deficiency there. That is one I always look at.

Potassium is similar. More deficiency than excess. Excess is not really a thing from the labs I do. I don’t ever see an excess. Deficiency is usually a thing. I have a lot of clients who deal with thyroid issues. That is a big one connected to the thyroid. Potassium helps with the sensitivity of the cells to the thyroid hormone. Most clients I work with who have hypothyroidism have totally tanked potassium. That’s a big one we have to look at and build those supplies back up.

Sodium, actually similar. Typically, 99% of the time, that is more deficient than it is in excess. This is a weird one. It’s a hard one for people to wrap their heads around. Sodium is one of those carbs. It has a bad rap over the past, more than carbs. Are there issues caused from high sodium? 100%. When you look at it deeper, it’s really not the sodium. It’s where you’re getting the sodium from. Our bodies have to have sodium to survive. It’s what helps things cross through cellular membrane.

The issue with sodium that we hear, high blood pressure, stroke, etc. You can go down a rabbit hole like I have in the studies about sodium. If you go really far down the rabbit hole, you’ll see that most of the studies out there actually do not pinpoint sodium as the true underlying cause of high blood pressure and stroke. The studies that have been done that look at different cultures that are high in sodium, they do not deal with high blood pressure. It’s not a thing.

What causes high blood pressure is where you are getting the sodium from. You know what causes high blood pressure? The Standard American Diet. It’s the processed food, and it’s getting sodium from refined salt. That’s the real piece. Refined salt, like table salt, is the equivalent of white sugar. It had all these chemicals put on it and stripped everything away, so it’s just sodium chloride. There are no other minerals in it.

If you look at an unrefined salt, like a Celtic salt, which is always my recommendation because it has the most trace minerals in it, or a pink Himalayan salt, it has 84-95 other trace minerals in it. When you are eating that salt, it has these other trace minerals in it that help push the sodium where it needs to go, so it’s not your body just soaking up sodium chloride and nothing else.

Long story short. I’m answering your question. The sodium piece is a tricky one. Most of the time, my clients have low sodium, the reason being your adrenals use more sodium than any other part of the body. When your adrenals are tired, when they are constantly churning and burning and pushing out cortisol, that’s zapping your sodium supplies. That will cause a lot of issues in the body. That’s one thing I work on with my clients.

My clients are always scared to eat salt because they have been told their whole life all these things about salt. My first recommendation is to add Celtic salt to your water because it supports your adrenals and sodium levels. That feels weird to them, because they have been told not to eat salt. It’s tricky, but it’s always huge in the labs.

Dr. Eric:

I agree with everything you said regarding sodium. My wife and I use Celtic Sea salt on pretty much everything. I think we get plenty of salt. I encourage my patients to also use either Celtic Sea salt or pink Himalayan salt.

As far as the problem with sodium, people are eating a lot of refined foods. Every packaged food pretty much has sodium. If that’s what someone is living off of, they probably are going to get too much of the refined salt. Not that I tell people to have a couple of tablespoons of Celtic Sea salt, but even a half teaspoon or teaspoon per day is perfectly fine.  

Hope:

Totally.  

Dr. Eric:

You said as far as the hair test goes, you never see it high. It’s almost always low. Is that correct?

Hope:

Almost always low. I have never had a client who has it high. Sometimes, people’s potassium is where it needs to be. But for the most part, deficiency is most common.

Dr. Eric:

With magnesium, it sounds like it’s pretty much always low. As we mentioned earlier, even if it’s high on the hair test, it doesn’t mean that it’s elevated. Regardless of whether it’s elevated or low, someone usually is deficient in magnesium.

Hope:

Yep, pretty much.

Dr. Eric:

What’s your favorite source of magnesium, if you do recommend supplementation? I’m guessing you do if people are deficient.

Hope:

Yep, I do. Magnesium glycinate is my go-to. It’s most easily absorbed. It’s easiest on the gut. I sometimes recommend a magnesium chloride, like a good magnesium chloride soak. I have my clients do that sometimes. It’s twofold, too. It gives them a way to get their mindfulness practice in. Let’s sit in the tub or get a foot soak or do meditation. The magnesium chloride is highly absorbable by the body. Glycinate is usually my go-to.

For those who are wondering how much I should take, typically, it’s 5x your body weight is how many mg you want to get. For the average person, it’s usually between 500-700mg, depending on your body weight.

Dr. Eric:

Getting back to potassium, you mentioned that potassium also is important with regard to thyroid health.

Hope:

For sure. That’s a big one that I see. Every client that I have ever had that has hypothyroidism or even Hashimoto’s, potassium is always low. Potassium is responsible for the sensitivity of thyroid hormone in the cells. We need potassium. Your thyroid really needs it.

There are so many things that can affect stores of potassium. I keep going back to copper, but it’s one thing that always pops up because it’s so common. Copper can really hurt potassium supplies. I have quite a few clients who have copper toxicity with hyperthyroidism. It’s a double whammy. It drains your potassium supply, that excess copper. Potassium is a big one we want to look at.

I think it’s important to know how to supplement that one well. There is a tolerance level that your body has to supplementing potassium. It doesn’t absorb it after a point when you are taking it in a vitamin or pill.

My first recommendation is always to get it from food first. Then we can supplement from there. Avocadoes, bananas, and coconut water are the three best sources in my opinion. That’s what I typically recommend to my clients. From there, we’ll supplement. Not fully relying on a supplement to get potassium, as it’s absorbed best through food.

Dr. Eric:

To reinforce what you said, there is a time and place for potassium, but unlike magnesium, where it sounds like most of the time you will offer supplementation, and you will still do things through diet as well. With potassium, it’s more focusing on the diet: avocadoes, bananas, and coconut water.

Let’s chat about copper toxicity. You mentioned it a few times. How does that present on a hair mineral analysis?

Hope:

There is a checklist that I go through. There are 12-13 boxes I’m checking as I’m looking through someone’s HTMA. The big red flags for me are the calcium first and foremost, the really high calcium, the calcium shell. Even if I don’t look at anything else, I already have that going.

Here’s the thing. This is also kind of a weird one. You have to look at the whole lab, not just individual pieces. You also have to look at the client and the symptoms. With copper toxicity, copper can either be super high or super low. If it’s super low, it’s like your body is holding onto it. A deficiency can cause a copper toxicity, which I know sounds completely counterintuitive, but that’s how it works sometimes. It’s not bioavailable. Your body is holding onto it. It accumulates in your tissues. First in your liver. The big issue comes because once the liver is full, then it goes to your brain. That’s when it can become dangerous.

Looking at the HTMA, we are looking at the calcium levels for sure. Calcium is a big thing. We are looking at potassium, sodium, zinc, some ratios. We are going through and checking these boxes off.

Again, we look at exposure. I work mostly with women. I usually know the answer before I ask them these questions. If they have ever been on birth control or have a copper IUD, that is typically where it’s coming from. It’s one of those two. If the answer is no, then we look at if you’re drinking from copper pipes or using copper cookware. I’d say 99% of the time, it’s a birth control thing or an IUD thing. That’s where the toxicity is coming from.

Dr. Eric:

How long does it take to get out of the system? Does it get out of the system on its own? If a woman had a copper IUD 10 years ago, or if she took oral contraceptives 15-20 years ago, can she still have a copper toxicity 15-20 years later?

Hope:

You totally can. I’ve had clients who have that. “I haven’t been on birth control in 15 years.” Some people can totally get it out of their system. I’m not saying everybody who has ever been on birth control, it stays in your body for that long. But it is possible.

The problem comes, especially when there are stressors on the body, when you are considered a slow oxidizer, meaning your body breaks things down really slowly. Your body holds onto things. We look on the HTMA at a fast oxidizer versus a slow oxidizer. It’s your metabolism. When people are slow oxidizers, your body is slow at getting rid of things. This typically means you’re holding onto things.

When there is additional stress on the body, especially when there is that big calcium shell, sometimes it can get built up from stress. It’s a stress response in the body. It’s a protective mechanism. When that calcium shell is in place, it’s almost impossible to get rid of things. There are multiple factors at play. You can’t say just because you have been on a copper IUD you will have copper toxicity. When there are other factors at play and other sources of inflammation and stress, especially other mineral imbalances, there is a really good chance that 15 years later, it could still be built up in your body and cause issues.

Dr. Eric:

How big a role can a zinc deficiency play since zinc and copper go together? As far as balancing copper, I imagine it’s important to make sure you have adequate zinc levels.

Hope:

Exactly. That’s one of the things as I look at on the HTMA. We are looking at zinc levels. If it’s super low or super high, that’s a huge red flag. They do work together. That’s part of the protocol. We are getting rid of the copper. We have to be careful because too much zinc doesn’t sit well in the stomach sometimes. We amp up the zinc a lot. We work our way up to getting a pretty good dosage of that a few times a day with the copper toxicity protocol because it is a huge player there.

Dr. Eric:

I think it’s important to mention there is no good or bad minerals. Everything is important. Even copper.

Hope:

Yeah, your body needs copper.

Dr. Eric:

Exactly. We’re not saying copper is bad in everybody. Obviously, if someone has a copper toxicity issue, you want to address that. How about selenium with the HTMA?

Hope:

Good question. That one is hit or miss with my thyroid clients. Our thyroid needs selenium. I have yet to have some sort of thyroidism that doesn’t have deficiency in selenium. That’s always a big one. It’s easy to pick up right now. Sluggish thyroid, your selenium is waiting. That’s typically what I see in thyroid. A lot of our other clients that don’t have thyroid things going on, their selenium levels are fine, 80% of the time. Selenium is a big one we have to address with my thyroid clients.

Dr. Eric:

Do you usually address it through supplementation, Brazil nuts, or a combination?

Hope:

It’s a combination. Brazil nuts are my go-to because it’s so easy. It’s a combination of both because when I am working with my clients, I work with the lab directly that can customize the mineral protocol to the HTMA. I add the selenium in there, but I like to do both. Food is always first and foremost. When they are specifically on the mineral protocol, we are taking a mineral supplement. I always like to add a little bit in there. But I definitely like to do food first.

Dr. Eric:

Can you talk about the importance of the mineral ratios in the HTMA?

Hope:

An important thing to understand, which is why I like the question you asked earlier about if it is low, does it mean it’s low, and if it’s high, does it mean it’s high? This is why you want someone who is trained to understand the lab. Just looking at the lab, you could interpret it 28 different ways. It’s important to understand this with minerals as well. Yes, we are looking at the individual minerals, but we are also looking at the ratios between minerals. Understanding how the minerals are working together.

For example, you could see that some mineral levels seem okay. They’re not really high or low. They may be trending one way or the other. You can’t really tell until you look at the ratios. Our calcium:potassium ratio is the thyroid ratio. You look at it face value. The calcium levels aren’t off, nor are the potassium. But when you look at the ratio, your ratio is really high. Now, we see the thyroid is functioning a little slow.

It’s important to look at the relationships between the minerals as well, not just each mineral individually, because it will give you a better picture of what’s going on with your thyroid, adrenals, nervous system, vitality, immune system.

Dr. Eric:

In those with hypothyroidism, do you commonly see that calcium:potassium ratio high then?

Hope:

For sure. Their potassium is so depleted. It’s putting that ratio out of whack. Then you add on where so many people have the calcium in excess, so it whacks out the ratio. Almost every single time, we are seeing that ratio being pretty high.

Dr. Eric:

I don’t know if you see any hyperthyroid patients, but would you expect it to be the opposite, a lower calcium:potassium?

Hope:

Yeah. I don’t have a lot, but I’ve had a handful. You have the ones where it’s hypo, then hyper; it fluctuates back and forth. You would see the opposite. For faster thyroid activity, you would see a really low ratio, which is a good indication of hyperthyroidism.

Dr. Eric:

Sometimes, I’ll see the opposite that it should be. Someone is hyper, and the calcium:potassium ratio is high and not low. Same thing you mentioned. Slow oxidizer, fast oxidizer. You would think that most people with hyperthyroidism are fast oxidizers, but a decent number of them are slow oxidizers.

Hope:

Very true. That one trips people up. I am explaining what oxidation means and metabolism. People think metabolism means you’re fat or skinny. No, it’s how your body is breaking things down. It has nothing to do with your weight really. People think they have to be a fast oxidizer, but it doesn’t always work this way. I find the same thing, that I’ve had hyper, and they are slow oxidizers. Tricky one there, looking at the oxidation rate and helping people understand exactly what that means.

Dr. Eric:

How about heavy metals on the HTMA? What is the significance of high and low levels?

Hope:

Depending on which lab you’re looking at, a couple of good ones in my opinion. The one that I use measures quite a few, maybe 15 or so. When you’re looking at, speaking of oxidation rates, a slow oxidizer, I typically expect to see at least some heavy metals show up. Your body isn’t able to get rid of them very fast, or not at all. Your body is holding onto things. The heavy metals are definitely something we have to look at to work on that oxidation rate, to help your body get rid of those heavy metals, because it will start to cause issues with the other mineral levels.

The big ones I see, aluminum is one that almost always shows up. Showing up is one thing because a lot of them will show up, but they are not cause for concern. Yeah, we could do some things to help with the aluminum. If it’s super high, now we need to address it. Aluminum, mercury, those are the two most common that I see.

Mercury is another one of those red flags for copper toxicity. That’s also a reason to look at copper levels. The heavy minerals, we want to address those. I put into the protocol to support bile flow, gallbladder, liver, all those things to help your body get rid of heavy metals and help the oxidation rate, so we are pushing things out.

Dr. Eric:

What are some of the common sources of mercury being high, from what you’ve seen?

Hope:

Eating a lot of fish can be one, especially if you are eating high mercury fish. There are some fish that are lower in mercury. If you’ve ever had tattoos, if you’ve ever had vaccines, using some common cleaning agents. Things like Lysol and Ajax have mercury. There is unfortunately a lot of really common brand soaps for your body, which is scary to think about that they are putting mercury in soap that you use for your body.

That is the first thing I ask my clients. Let’s look at your cabinets, your cleaning supplies and personal care products first before we look at anything else. That is a place that we can look to limit our toxic exposure to these things. Aluminum is another one that is in antiperspirants. That’s an easy one. We can lower that one easily.

I find that’s the easiest place to start, looking at what you’re using to clean your house and what you’re putting on your body. It can be built up from a lot of those things. Cleaning through those can be a good way to limit your exposure to it.

Dr. Eric:

How about if someone has a lot of mercury amalgams? Can that be a reason?

Hope:

Totally. I forgot to mention that. I have a client who is going to get rid of hers in the next few weeks. That’s a huge one. I hear tons of stories about this from other FDNs’ clients who have gone to get rid of their amalgams, and it changes their life. It’s almost like a switch flips off, and they don’t have migraines anymore.

Dr. Eric:

Getting back to aluminum, because I see aluminum high consistently, too. Some of these people say they are doing everything to avoid aluminum. They are avoiding deodorants, aluminum pans and pots, eating canned foods, or foils. There has to be other sources of aluminum in the environment. Just about everybody has aluminum. It sounds like you see the same thing, where most people are high. As you said, I wouldn’t say not a concern, but like you said, if it’s really high, definitely a concern. It’s always a work in progress, trying to reduce someone’s toxic load.

Sticking on the topic of heavy metals, what do you think about detox therapies such as sauna or colonics or coffee enemas to help reduce one’s toxic load?

Hope:

All those are great. I love a sauna. I love the infrared sauna. I love it for myself. I have my sauna blanket at home.

I have to be careful with saunas for some people. While it’s a really great way for detox, if someone’s adrenals are really struggling, especially if I have clients who have really low sodium. I’ve had some clients where it barely even shows up on the HTMA. If somebody is that deficient in sodium, I won’t recommend sauna to them. If they are what’s called a 4 low, those big four, if they are all low, I won’t recommend a sauna to them. Their body is so depleted, that they will just sweat out what’s left in their body.

I do recommend the sauna strategically, depending on the person. For somebody who can handle it, I love it.

Colonics, same thing. Coffee enemas, same. People who are okay doing all of those things, I think it’s helpful. When we are detoxing, especially when we are looking at the buildup of heavy metals, copper toxicity, I think implementing multiple strategies, helping the body out wherever we can, we are helping increase bile flow and helping the gallbladder. Colonics and enemas and saunas, they are all just helping add to everything else that you’re doing to support the detox process. I’m a huge fan.

Dr. Eric:

I’m a big fan of sauna therapy as well. Even if someone doesn’t have low sodium, you want to make sure that you replenish electrolytes.

Hope:

Totally.

Dr. Eric:

Extremely important.

Can you talk a bit about the hair collection procedure, as far as how much hair is required? If people color their hair, or things they should avoid before collecting the hair sample.

Hope:

The sample itself is a teaspoon of hair. It’s this very archaic scale they send you. You measure out the hair. You’re cutting it as close to the root as possible. You want what’s closest to the root. You measure out a teaspoon of hair.

I encourage my clients to avoid, if you are using an antidandruff shampoo, that before cutting your hair because it will mess up the selenium levels on the reading.

As far as people who color their hair, and I work with many ladies who do, the lab will tell you- Honestly, I think they say two weeks. I don’t think two weeks is long enough. I tell my clients to wait a good 4-6 weeks if possible, so you have some good hair growth from the root that is not colored. I have my clients wait about 4-6 weeks after they have colored their hair to do the sample. I feel better about doing that. If you color your hair, you can still do the sample.

Sometimes, when you get the samples back, some heavy metals will show up a little higher. Unless they have used an all-natural color. Knowing that the heavy metals will be off a little bit for those.

Dr. Eric:

How about if someone wants to do a hair test, but they don’t have any or very little head hair? Can they use other parts of the body?

Hope:

The lab says it takes nails. Things will be skewed a little bit for that, so I don’t love that option.

The pubic hair is an option. There are a couple minerals that you have to look at differently for that one, but it can work. If it’s a man who shaves his head, or I have had women before where they have very thin hair, and they are very scared to cut what little hair they have on their head, which I get. We can work with it.

Dr. Eric:

If someone has a water softener, can that also throw off some of the minerals?

Hope:

Yeah, it can. We were talking about hard water before. Hard and soft water can throw off a few things. Well water. I’ve had one of my more recent clients whose levels were crazy. I asked her, “Do you drink tap water?” “Yeah, every day.” Why? Her levels were so crazy. My recommendation there is to stop drinking tap water. Hard, soft, and tap water all can throw off the levels.

It always goes back to not treating the lab; you’re treating the person. Looking at the lab, but also being able to ask questions, looking at symptomology. Understanding a person’s environment is a good thing to know.

Dr. Eric:

Is there anything I didn’t ask you that I should have asked you? Or anything else you want to chat about? I know there is a lot you can talk about with the hair test. Or did you want to summarize for someone who might be thinking about doing HTMA and is still on the fence?

Hope:

Honestly, I would say if you are thinking about it, when I first started out as an FDN, I wasn’t taking HTMA at first. It wasn’t one of my foundational labs I did with my clients. I have been able to see such a huge shift in how my clients respond to the protocol by doing the HTMA and including that really specific mineral balancing with the protocol. I have had clients where nothing else has worked ever, but we work on the mineral balancing, and that’s the thing.

I have had clients come from other functional practitioners, who have had similar labs done, but they have never done the HTMA, which was the missing piece. For a lot of people, it is the missing piece. It’s not something a lot of practitioners are looking at. It’s not an important piece to address for some. Sometimes, I feel like they need to look at bigger things. They want to look at the gut, the hormones, which are all important obviously, but minerals all affect the gut and hormones. If you don’t get granular enough with how the human body functions. It should be the first place we look. The minerals are the driving force for every reaction in the body. Knowing that for a lot of people, this is the missing piece because they haven’t looked at the mineral levels.

If you haven’t done the HTMA, and you won’t do it in the near future, if you want to look at general practices to balance things out on your own, look at the big four: calcium, magnesium, potassium, and sodium.

I am very hesitant to recommend “Everybody needs a calcium supplement.” So many people have elevated calcium. I don’t give point blank recommendations.

For magnesium, potassium, sodium, that’s an easy recommendation for me. 99% of the time, those are deficient. That’s a good place to start. Food sources of potassium and sodium. Switching your salt out, going to Celtic salt or a more unrefined salt. Adding some salt to your water. Getting a good magnesium supplement.

Tackling those little pieces is a good place to start if you want to work on mineral balancing on your own. If you’re dealing with hyper or hypothyroidism, potassium is a big piece of that. Knowing you want to protect your potassium levels and your thyroid.

Dr. Eric:

You shared some amazing information about the HTMA, Hope. Where can people find out more about you?

Hope:

You can find me on Instagram, @TheHopePedraza. I have a free Facebook group, Live Wholesome and Healthy. It’s all things functional nutrition, functional health. Those are the two best places to find me.

Dr. Eric:

Do you have a website as well?

Hope:

HopefulAndWholesome.com.

Dr. Eric:

That’s the name of your podcast as well?

Hope:

Yeah. My podcast is all things health, wellness, and inspiration. You can learn more there with all the free content on the podcast.

Dr. Eric:

Thank you so much. This was the first deep dive I’ve had on the podcast discussing HTMA.

Hope:

Awesome, I love it.

Dr. Eric:

I was very excited to chat with you. Thank you again for sharing your knowledge.

Hope:

You’re welcome. Thanks for having me.

Recently I interviewed Dr. Jacob Teitelbaum, who is the author of the book from Fatigued to Fantastic and we talked about fatigue. If you would prefer to listen the interview you can access it by Clicking Here.

Dr. Eric Osansky:

I’m very excited to announce today’s guest, who is Dr. Jacob Teitelbaum. He is the author of the book from Fatigued to Fantastic. I read this book in its original version years ago; it’s now on its fourth edition. Very excited and honored to chat with Dr. Jacob. We’re going to be talking about fatigue, no shocker.

Let me get into Dr. Teitelbaum’s bio here, as Dr. Jacob is one of the most frequently quoted integrative pain and fibromyalgiamedical authorities in the world. He is once again the author not only of the bestselling book From Fatigued to Fantastic, but 10 books in total, and lead author of eight studies on effective treatment for fibromyalgia and chronic fatigue syndrome (CFS). Dr. Teitelbaum appears often as a guest on news and talk shows nationwide, including Good Morning America, The Dr. Oz Show, Oprah and Friends, CNN, and Fox News Health. Thank you so much for joining us, Dr. Jacob.

Dr. JacobTeitelbaum:

It’s great to be with you. Those of you who have fatigue, pain, brain fog, or don’t quite feel the vitality you want, we are going to give you a nice, organized approach on how to be feeling fantastic.

Dr. Eric:

Awesome. Can’t wait to chat with you about this. Before we do, let’s go ahead and give your background. How did you start becoming an expert when it comes to helping people overcome their fatigue?

Dr. Jacob:

People ask, “What’s a nice Jewish doctor like you doing in fibromyalgia? Natural medicine, what?” I got into it the old-fashioned way. I was in medical school in 1975 and came down with a nasty viral infection. It basically left me with post-viral chronic fatigue syndrome and fibromyalgia. I was paying my own way through med school, so that meant I was homeless and sleeping in parks. The professors knew there had been a virus, but when I was still sick 6-12 weeks later, they figured, “He’s depressed.”

There I am, as if the university put a holistic homeless medical school student sign on my park bench. Naturopaths came by. Chiropractors came by. Herbalists came by. Energy workers came by. Sometimes, they had pizza, and I even ate. It wasn’t uncommon to go a couple days without eating. They taught me all the bits and pieces I needed to learn how to recover myself. I was able to recover, go back to med school, get my degree in medicine.

I focused on treating the different components of fatigue, especially thyroid, adrenals. We will talk about a whole host of ones that are essential for recovery. It’s complex, but it’s not hard. It just takes an organized approach. For those who want it, there is a lot of stuff; “I have brain fog, I can’t do this.”

There is an energy analysis program if you go to EnergyAnalysisProgram.com. Do a quick 15-minute quiz. Instead of $400, it’s free to everybody, so everybody can get care. It will tell you what’s draining your energy and how to take care of that. Mix and match. There are a lot of options for you to work with your physician. The tools are all here, and we are happy today to try to get an overview, that there is something you can do, and which things resonate with you, so you can start with those.

I’ll talk about 2-3 things that can double your energy in a minute a day. That’s not hard to do. We’ll take it piece by piece.

Dr. Eric:

A lot of people listening to this have a thyroid condition or an autoimmune thyroid condition. When we think about thyroid, especially when we think about fatigue, most of the time arguably we think of hypothyroidism, low thyroid hormone, including Hashimoto’s. I also wanted you to briefly share your experience because from what I understand, you had Graves’, correct?

Dr. Jacob:

After I’d been in practice for many years- It’s funny because I would be on the lecture circuit and talk about the symptoms and signs. Every time I’d look in the mirror, they were gone. Then I would have this period where my weight dropped 20 pounds. I am good at meditating. Otherwise, having high thyroid, and I had Graves’ with some autoimmune, and thyroid was sky high.

The joke is if you have high thyroid, it’s like a country western song. You lose your job, you lose your spouse, your dog runs away, because you’re an emotional train wreck. I was able to get centered and watch it. Oh, this is interesting.

But those of you who find that emotionally, you’re on a rollercoaster, if it’s sugar cravings, you want to look for low adrenals. For those who may be wondering if you’re manic/depressive, you’re kind of hyper and then depressed, it’s not uncommon with the high thyroid. First, we’ll make it high and overdrive, 20 cups of coffee. As it burns out and goes to low thyroid, it’s very common that you’ll see people who will be on a rollercoaster where the thyroid burns out, goes low, and there is another blast of autoimmune activity. The thyroid inflames again and goes high. You get these highs and lows.

As long as you know that can happen and can go to a lab and get a free T4 blood test and see if it’s high or low at the time, the TSH is one of the crappiest tests invented in humanity. But you can adjust things after that free T4 test. Then you are in control again. For those of you who have had high thyroid, that feeling of being in control instead of being spun out is a very good thing.

Dr. Eric:

When it comes to having a thyroid condition, and experiencing fatigue, sometimes it’s not always just related to the thyroid. There could be other causes, too. Can you chat about some of the other common causes of fatigue?

Dr. Jacob:

Absolutely. You know it’s low thyroid whether or not the tests are normal, or you have overt elevated TSH, and the doctors say, “You have a thyroid thing,” but they treat you poorly at least half the time. If you find that despite thyroid being optimized, the thyroid treatment, you’re still feeling crap, then it’s okay to find someone who knows how to adjust thyroid properly.

Most doctors have no clue. Most doctors look at tests, and only the TSH. If it’s in a normal range, you’re fine. Normal range just means you are not the highest or lowest 2.5% of the population. A normal shoe size would be 5-13. Eric, I imagine my size 12 shoe, if I put a size 6 on, a doctor would say, “It’s in the normal range. There is no problem with the shoe.”

Once you have optimized the thyroid hormone to how it feels to you, not to the blood test, and you still have problems, the first question I will ask is: Do you have trouble sleeping? If it’s a “Yes, I’m exhausted, I can’t sleep,” you have fibromyalgia or CFS. Two names, but in most cases, it’s the same thing, although each of them is somewhat different as well. You want to look for another thing.

If you have trouble sleeping, and you have fatigue, you have tripped the circuit breaker called the hypothalamus. That controls sleep hormones on and off. Blood goes to your heart and stays there; it’s called POTS. That’s when things like the Energy Analysis Program help.

If you look at S.H.I.N.E., that will give you a checklist for looking at probable things and how to treat it. You need to address the sleep. A lot of good natural ways. There is Revitalizing Sleep Formula, 10mg Melatonin EP120, all good kinds of natural things to start with.

The hormones. Thyroid, adrenal, reproductive hormones. We will look at each of these as time allows. You want to optimize these. The blood tests being normal means nothing. Seriously. That’s not how you diagnose. That’s one piece of information that helps. It’s about 20% of the information.

80% is the symptoms. Do you get irritable when hungry? You need adrenal support. Weight gain and cold intolerance? Thyroid support. If you are a male in your 40s or 50s and your cholesterol is going up, and your blood sugar is toying with going up, and your blood pressure is going up, you will probably have low testosterone, if your testosterone level is under 500. There are other hormones, too.

There is a 4,000-word information sheet I put together for people with chronic fatigue, fibromyalgia, and long COVID, which is post viral CFS. You can email me about it. My email address is FatigueDoc@gmail.com. Ask for the fatigue, fibromyalgia, POTS, or long COVID information sheet, and I will send it to you.

The other agent is hypertension. You stand up, your blood goes to your legs due to gravity, and it stays there. Don’t go back. Doctors usually miss it. Very treatable.

Infection is nutritional support. B vitamin deficiencies, other deficiencies, B12, iron, a host of infections. Viral antibiotics sensitive, candida. If you have nasal congestion, postnasal drip, gas, bloating, diarrhea, constipation, you probably have candida. Especially if gas doesn’t have smell.

If you have these silent but deadlies, then that’s small intestinal bacterial overgrowth (SIBO). That’s bacteria splitting the gut, sulfur off the amino acids. SIBO is a manifestation of low thyroid. Until you treat the thyroid optimally, the gut will be sluggish, the bacteria will back up from the colon into the small intestine and cause SIBO. In addition to clearing the bacteria, you have to optimize the thyroid, if you want that SIBO to go away.

There are all these different things. We will go through the quick list. But that’s S.H.I.N.E. I’m having trouble sleeping. Hormones. Hypertension. Infections. Nutrition. Look at those four things, and you will get a massive start at recovering.

Dr. Eric:

You didn’t mention the E.

Dr. Jacob:

E is Exercise as able. That’s not so much. If you’re a couch potato, that contributes. But a lot of you who have fibromyalgia can’t walk very much, or you will be wiped out for two days and bedridden. It’s called post-exertional malaise. You’re afraid to do any exercise, so you decondition, which is just as bad.

You want to see how much you can walk, even if it’s 50 steps, whatever it is. You may be wounded. But you want to see how much walking you can do, so you can stay conditioned without crashing after. You want to find that middle path. It’s not harming you to get that crash; it’s just unpleasant. Don’t be afraid of it, but don’t try to get it. You’re not helping yourself by doing it.

Dr. Eric:

I’d like to dive more into the S.H.I.N.E protocol. This protocol alone could make a big difference in someone’s fatigue. S for Sleep. Can you talk about some of the more common reasons that people have difficulty falling asleep and staying asleep? Especially those tough cases. There are some people I consult with, and it seems like they have tried everything. They have taken melatonin and valerian root and all these other supplements.

Dr. Jacob:

They haven’t. People say, “I have tried everything.” “Have you tried this?” “No.” “How about that?” “No.” “How about this?” “No.” I never once have found somebody who has actually tried everything, who has said yes to all of my questions.

Here’s the thing. Many reasons for sleep issues. 1) This is an energy crisis. Our cellular energy production goes down or can’t keep up with demand. When energy drops to a certain level, the area that uses the most energy for its size, which is the hypothalamic circuit breaker in the brain, which controls sleep hormones and autonomic function, goes offline, so you can’t sleep. That paradox of can’t sleep even though you’re exhausted, tells you have hypothalamic dysfunction, which is what fibromyalgia and chronic fatigue syndrome are. Direct low energy causes it.

2) Average weight gain. We have done studies beyond the eight treatment studies. 32.5 pounds is the average weight gain for fibromyalgia. I don’t care if you’re eating like a bird. The metabolism goes up, and you will gain weight. They get sleep apnea, sleep disordered breathing. People often wake up in the middle of the night with sweat from low blood sugar from low adrenals. Their hormones are low, so they will trigger sweats. Or infections will trigger sweat, or acid reflux.

There are a lot of things that can affect sleep. The book goes through an organized way of how to check. If you fall asleep at the TV or the wheel of the car, look for sleep apnea. If you’re waking up hungry, take a nighttime protein snack and some adrenal support at bedtime. It’s not hard. You take a Pepcid for three nights, and if you wake up and the sweat goes away, it’s acid reflux. These are easy things.

How do you fix it? If you do a high enough dose of any one thing to get to sleep all night, you will be hungover until three in the afternoon. Each treatment has its own half-life, which means it gets kicked out of your body at its own schedule regardless of whatever else you’re taking with it. If you take a low dose of several things, it’s not going to be so high as to leave you hungover the next day, but it won’t be high enough to get you sleeping. You take several, and they gang up in the middle of the night, and you’re sleeping like a kitten.

What do I start with? The Revitalizing Sleep Formula, an herbal mix of six things, including Valerian, passionflower leaf, 5-HTP, and more, It’s terrific. It’s easy.
Terrific Zzzz, a mix of four essential oils. The EP120 melatonin, which is a sustained release, which is what you want.

For natural things, the smell of lavender. A heavy blanket called a weighted blanket. Have you ever swaddled a baby, and it calms right down? The heavy blankets swaddle the nervous system. A night mask, $15 each, cheap on Amazon.

Herbals you can find on my website. All of these natural things you can try. There is ANS Rewire. If you can’t tolerate anything by mouth, any pills, or supplements, ANS Rewire by Dan Neuffer or Dynamic Neuroretraining System. No pills. They reset the hypothalamic limbic system, that whole sleep cellar. That by itself can often make this problem go away with no pills. You do it online. The DNR is $250 to get the program online. I’m not sure what Neuffer’s ANS Rewire is. Both are superb.

Medications. Trazodone. Some people need Ambien for sleep. Certainly, it has its issues. For initiating sleep, the Zzz meds are often necessary and helpful. I think the benefits way outweigh the downsides of those who tolerate them.

See how I got my college nickname of Rambling Jack?

Dr. Eric:

I appreciate that. That was great. Some of the other components of S.H.I.N.E could also interfere with sleep. Hormones, high cortisol, infections. Have you seen infections, especially stealth infections, also affect sleep?

Dr. Jacob:

Absolutely. A reflection of a common pattern with adrenal problems is that people will be irritable and hungry. If you have relationship problems, get adrenal support because you get low blood sugar and this irritability. I see people in marriage counseling and divorce because of slow adrenals. Adrenoplex is a nice mix of glycyrrhiza glabra licorice, B5, Vitamin C, all these things that the adrenals need. It will smooth that out along with your energy.

We see the adrenal tends to be low during blood tests. Normal is useless. Helpful if you’re an interpreter, but normal means nothing. You have size 12 shoe. A size 6 shoe is normal. I can give anybody a size 6 shoe, and it’s normal, no matter if they’re a 400-pound, 6’10” Texan.

If you look at someone who is irritable and hungry, normal morning cortisol is 18. At nighttime, it has to drop below 2. Otherwise, your mind will be racing at bedtime. The blood test tells me if your mind is wide awake and racing at bedtime, your cortisol is not dropping low enough to sleep. Exhausted all day, mind racing at bedtime. Irritable all day, mind racing at bedtime. Get phosphatidylserine on Amazon. 100-300mg, 90 minutes before bedtime. Start with 100mg. The next night, 200mg. The next night, 300mg. It will drop your cortisol at sleep if that’s a problem.

What happens is cortisol is too low during the day. Doesn’t drop enough at bedtime. But then it plummets in the morning, so you wake up wide awake, hungry for more blood sugar. A simple test and treatment for that is protein. Hard-boiled egg, cheese, meat, fish. Protein, not sugar, not carbs, an hour or two before bedtime. That may cut off the drop in blood sugar until later. That’s why I start with 100mg of phosphatidylserine because it will drop your blood sugar in the middle of the night, too. That’s when your lowest dose keeps you up.

Dr. Eric:

I like phosphatidylserine. I’m glad you mentioned that. How about some other natural agents like ashwagandha or L-theanine? What do you think of those out of curiosity?

Dr. Jacob:

The Revitalizing Sleep Formula has L-theanine in it. I designed that formula. All the money from that goes to charity. I don’t take money from farmers’ international industries.

Ashwagandha, there is a study we just finished, but we haven’t published yet. I’ll talk about it. We gave a mix of ashwagandha, rhodiola, green tea extract, licorice, a couple of other things. It’s called the Smart Energy System. It increased stamina, energy, and sleep. Stamina went up 80%. 60% of people benefited within a month. It was quite dramatic.

The ashwagandha supports adrenals. I give it more in the morning, but you can give it at night along with the phosphatidylserine for what I call Sleep Tonight, for those who have mind awake and racing. The Sleep Tonight is a simple way to get the phosphatidylserine and ashwagandha together to help with nighttime sleep.

The Smart Energy System was awesome. We’ve done four studies in the last two years. If you’re outside of the United States, you can go to RecoveryFactors.com. That’s an immune serum supplement that is quite dramatic. For those in the United States, the Smart Energy System.

The only supplement I keep on my desk if I need an energy fix is HRG80 Red Ginseng. It’s a chewable tablet. I take just half a tablet when I need it. It tastes good. In the studies, it increased energy on average by about 60%. What I like to do is decrease pill count. I don’t like people popping pills. Smart Energy is two capsules that replaces how many pills by using the chewable of the HRG80 Red Ginseng tablets, it’s half a pill to one pill a day. You may want to try it, if you’re having a crazy busy day. I can feel it in seconds, as I’m quite energy sensitive. It’s quite dramatic. That study was published about a year ago.

Dr. Eric:

Might need to give it a try. That’s not something that you would want to take at night. That’s more in the day to help with energy.

Dr. Jacob:

The Smart Energy System is for the morning. It has the ashwagandha you were asking about. It balances adrenal function along with numerous other things.

Brand matters. I use a KSM-66. I use the Europharma ones. Some things like the phosphatidylserine, I don’t think the brand makes a difference. Some things like red ginseng, 95% of ginseng products are useless because the active components are gone. If it’s not wild ginseng, it doesn’t work. I’m picky when it matters.

Dr. Eric:

You should be. You don’t want people to waste their money understandably. How about sex hormones? Can those play a role in fatigue as well?

Dr. Jacob:

Absolutely, and in sleep. Progesterone is the body’s natural Valium, and it’s important to men as well as women. In women, the tests FSH, LH, and others for menopause and perimenopause do not start to become abnormal until 5-12 years of hormone deficiency. You don’t want to wait for that test and then for your periods to stop. If you are in your 40s, and I want to distinguish between irritable around your menses, which is PMS, which is progesterone deficiency. Omega-3s. For Omega-3s, Vectomega, which is one a day. If you have this around your menses, you get headachy, you have trouble sleeping, the insomnia, brain fog, or energy plummets, that’s progesterone deficiency.

I would use a bioidentical progesterone, which you can get over the counter. Those tend to be pretty good. You are looking at 30mg of topical. I will use bioidentical estrogen, not the poison that people tend to use because it’s profitable. Around your menses, you crash and burn. That tells you that you need it. If you take it and feel better, then you know.

The testosterone in men. Men go through perimanopause. Before you drop to a testosterone of 200, which is what you must be abnormal on the labs, you will be normal at levels of about 400 or 500. The way that you tell, cholesterol goes up, blood pressure goes up, spare tire waste, diabetes or prediabetes, those numbers go up. Other things won’t go up.

Libido goes down. That gives you a sign of low testosterone. There was a study on lost libido, where 30% of people say that. It’s not because your spouse is ugly or fat or whatever. That’s just part of the condition. It takes longer to improve, but it does.

Certainly, low testosterone in men, low estrogen, progesterone, and testosterone in women plays a big role in the whole process. Again, you go by symptoms predominantly. You go with bioidentical treatment. If the labs are low normal, or if you have the symptoms, then you treat. Unless there is a reason not to. Then I see how they respond. If they got better, then their hormones were low. To me, that is how the diagnosis is made.

Dr. Eric:

Makes sense. Infections, including long haul COVID, because people don’t have an answer who are suffering from that. People suffering from Lyme, bartonella.

Dr. Jacob:

Long COVID is very treatable. It’s just a lack of physician education. There are no expensive medications. It is very treatable.

Dr. Eric:

It doesn’t take a really long time, it sounds like, to treat either?

Dr. Jacob:

No. It just takes knowing what you’re doing, or having a doctor who does it. Let’s look at infections. There are dozens of infections that can trip the hypothalamic circuit breaker. How many ways are there to blow a fuse or a circuit breaker in your home? Countless. Same in your body.

A lot of antibiotic infections, we talk about Lyme or coinfections. The Lyme tests are grossly unreliable. The holistic tests are positive for virtually everyone. I’ve seen two negative tests in the main Lyme lab that did not have some infection positive in 30 years. To me, a test that is positive on everybody is not a useful test. You can go to the standard labs, the main national labs most doctors use. They are just so wrong that don’t bother with the test. Flip a coin. It will be just as accurate. In terms of whether you have it. So we have no good testing.

So, I go by symptoms. Since a lot of people have a positive Lyme test, whether or not they have it, low dose naltrexone (LDN) helps people even in the absence of infection. It shuts down microneedle activation. You can see brain inflammation, even though it’s a little over vivid. It settles that down. LDN settles that down. When you have the Lyme, and it doesn’t go away completely with the antibiotics and stay gone, you want to go after the S.H.I.N.E. protocol. You want to consider LDN. Your Lyme doctor will know about that. That’s a prescription.

Candida, very important. Nasal congestion, postnasal drip, chronic sinusitis, gas, bloating, diarrhea, constipation, mouth sores. If I get two or three of those symptoms, I am going with the antifungal for 6-8 weeks. I am going with a natural antifungal and a probiotic. There are all kinds of great natural ones out there, like grapefruit seed extract and dozens of others. I am going to give it for a long period.

I am going to stop feeding the yeast. Yeast grows by fermenting sugars, so you are going to have a sugar craving, not an irritable, “get out of my way or I’ll kill you” adrenal fatigue, low blood sugar, but more like a happy Twinkie, something sweet would be nice, so you go into the cabinets looking for it. The yeast is putting out a chemical, saying, “Feed us,” and look for the sugar. You kill the yeast with an antifungal protocol.

Viruses, countless viruses. Some viruses trigger other virus release, like Epstein-Barr. The EB tests are positive in 95% of healthy adults. That doesn’t mean you got it. But if you have current viral symptoms, like flu-like symptoms, when you feel sick, you feel flu-like. I am going to go with antivirals for four months. Celebrex can be helpful.

I will use things like ViraPro, which is elderberry mixed with other things. That’s what I take myself when I’m traveling because I travel quite a bit. I will take ViraPro twice a day if I’mtraveling, or if I have COVID, or if I am sick for a lengthy time. I will be stimulating my immune system, keeping it healthier with ViraPro and a good multivitamin.

There are a lot of infections. The book tells you about if it’s antibiotic sensitive, viral, fungal. They have different symptom patterns. They stand out once you know the patterns. Then I treat them, and the person gets better if they had it.

Dr. Eric:

The LDN, how long do you typically keep people on that? I’m sure it varies depending on the person.

Dr. Jacob:

It takes two months before you see anything. It may mess with your sleep in the beginning, in which case they can go make a starter pack. People don’t expect anything. I started using LDN 35-40 years ago. Take it for a month. Didn’t help anybody. Tossed it. Onto the next thing. I didn’t do it enough times. It takes two months to start.

For most people, once they are feeling better for nine months, I can wean them off almost everything. But I encourage them to stay on the multivitamin, the Clinical Essentials multivitamin tablets, two a day. I will keep them on something for sleep, whether it’s herbals or 25mg of Trazodone long-term because otherwise, they will have stress push them over the cliff again. The LDN, 70 cents a day. Once you have been on it, it’s benign and well tolerated.

When people are feeling back to themselves for nine months, I pop the question: “Are you ready to come off the stuff?” Half of them are like, “Oh yes, what can I get rid of?” The other half is, “The only way you are getting any of this away from me is out of my cold, dead fingers.” I want to see if that matches people who are against gun control. It’s a 50/50 split. It’s fine. You can take this stuff as long as you want. Let me know when you want to come off it.

Dr. Eric:

Makes sense. Getting back to long haul COVID, do you recommend Ivermectin, or is that more for acute COVID?

Dr. Jacob:

Yes, yes, yes. It works. Even for post vaccine. I am not an anti-vaxxer. I think vaccines, used wisely, are one of the four main benefits of modern medicine. People don’t remember polio or smallpox. That crap was nasty. It’s been turned into a major business, where we turn our kids into pincushions. I took the vaccines because I was traveling. I couldn’t get into Berlin to visit my grandkids without it. Otherwise, I probably wouldn’t have bothered because I feel quite comfortable getting my immune system strong enough to handle without.

The studies on Ivermectin show that it decreases death by 30-70% in COVID. Why all of this, there no evidence? Evidence is defined by if there is not a 95% statistical probability, if you have a study that decreases death by 70% but not one with enough people in the study to meet that 95% statistical mark, that’s no evidence.

Using their definition, there is no evidence that parachutes work. I can see Fauci now in the airplane. The captain is saying, “We’re going down. Distribute the parachutes.” Fauci would be like the steward, going, “No, there is no evidence that parachutes work.”

I took it when I had it. I had a very pleasant COVID experience for four days, drinking my iced tea and reading my Kindle. It’s okay not to. There are no bad people here. It’s just the economics. Anything cheap is being suppressed by the pharmaceutical industry. The pharmaceutical industry controls our government. We are the only country in the world where Medicare can’t negotiate drug prices. Whatever they say, we have to pay. I can see them in the board room, pouring shots of expensive tequila, saying, “What’s 3x this? Oh, $1 million.” They say, “The law says they have to pay whatever we charge.” Congress is controlled. That’s not Congress’ fault. We tell Congress they are going to raise 1,000x, pay you in bribes. Then represent us. That’s not going to happen.

The media, once it became legal, only one of two countries in the world where the pharmaceutical industry can advertise to the public, so they own the media now. The media will not publish anything to piss off their advertisers. They’re all good people. There are no bad guys here. It’s just the economics of the situation.

The short answer is yes, Ivermectin works very nicely, including for reasons I can’t even begin to fathom: post vaccine fibromyalgia. In those cases, they have to take repeated courses of it. The dosing is usually about 27mg a day for 4-5 days. It works nicely, but you need proper dosing.

Dr. Eric:

Wonderful. The N, nutrition. I assume whole healthy foods, plenty of vegetables.

Dr. Jacob:

Common sense. Down the sugar. Increase your salt intake. If you do salt restrictions, your system will crash and burn because of the adrenal issues. Everybody is different. Feel what is best for you. High protein is the most common diet that feels best to people.

A good multivitamin. Clinical Essentials, two tablets a day. The capsules are fine, but you need more of those. I like to keep the pill count down. During periods of COVID, I will do ViraPro. But if you use Clinical Essentials, get the Smart Energy System. Go to the home page of EndFatigue.com. I put those three there, the third one being the HRG30 Red Ginseng. Get those for a month. For most people, it doubles their energy. The studies we did with red ginseng and the smart energy, more than doubled. That’s a quick, easy start for people. It gives overall nutritional support.

Australia was founded because Britain sent all their criminals and crooks and hookers to Australia because they didn’t want to pay for prisons. They sent all their Puritans to the United States. “Anything that feels good to you is the Devil.” Australia, even though we call it the stain, they are much more fun. The Puritans were so annoying. Can you imagine, whether you are looking at evolution or a divine being that created people, that either one of them would make people that say, “Whatever feels good and you enjoy is actually bad for you.” Why? That’s insane.

When the food industry gets hold of things, they try to addict you by modulating foods in ways that will feel good but are incredibly unhealthy. If you are getting natural, whole foods, chocolate is a healthy food. You don’t get 140 pounds of sugar in your diet each year if you are eating a whole food diet. You get that from the food processors.

Things that you enjoy. How is it working for you? That’s how you figure out your diet. What leaves you feeling the best? Not just an hour later because sugar will give you a zing, but the pow, crash.

Dr. Eric:

You already touched upon exercise. Some people aren’t able to incorporate exercise right away. They may have to focus on the first four.

Dr. Jacob:

In 10 weeks, their energy will skyrocket, and then you will be able to condition instead of crashing.

Dr. Eric:

CFS, chronic fatigue syndrome, fibromyalgia. Years ago, most doctors thought it was psychological, in people’s heads. Even these days, there isn’t really a great test. I think it comes down to what you said earlier, going by symptoms and how people feel.

Dr. Jacob:

Yeah, you’re exhausted, lasting more than three months. You can’t sleep because you’re exhausted. You have widespread pain and brain fog. I can give you 30 other symptoms. It’s a symptom thing. If you’re not sure if you have it, go on EndFatigue.com. There is a free quiz that will tell you if you meet the criteria for CFS or fibromyalgia. It’s not rocket science. There is a test that is $700, but I wouldn’t waste your money on that. It gives me no more information than doing the free quiz to have diagnostic criteria.

If things are very complex, there is not a test for it, and it affects women. What I have just described are immune and autoimmune illnesses and conditions. Medicine has a habit of saying, “I don’t know what’s wrong with you, so you’re crazy.” That’s abusive. Multiple sclerosis used to be called hysterical paralysis. Rheumatoid arthritis used to be considered neuroses. If you want to understand how the medical profession views women, despite half of doctors being female now, it’s an institutional thing. If you look at the word “hysteria,” it comes from “hystero,” which is Latin for “uterus.” If you walk into a doctor, and they imply to you and your family, “I don’t know what’s wrong with you, so you’re crazy,” say, “I don’t know what’s wrong with you. Let’s find somebody who does.” If you read my book, I don’t do heart surgery. I don’t know it. Doesn’t make me a bad doctor.

But if the doctor implies to you or your family that “I don’t know what’s wrong with you, so you’re crazy,” what I want you to do is stand up, walk over to the doctor, smile, give them a kiss on the head if you want to, and say, “Doc, thank you for letting me know right away what a complete, utter idiot and asshole you are, so I don’t waste my time with you. I will let everybody know that you’re an abusive schmuck who is clueless.” Walk out the door. Slam it. Say, “This doctor is abusive and crazy. I recommend you all leave and go.” You can put enough ratings online. That abusive behavior is no longer acceptable. Can you imagine if you had MS, and a doctor was too lazy to learn about it and just said you’re crazy? You’re paralyzed and can’t see out of one eye. That’s not acceptable. It’s not to be tolerated anymore.

Dr. Eric:

We even see this in the thyroid world. You mentioned earlier the reference ranges. Someone walks in, and their TSH is 4.2, which is within most lab reference ranges. They might not even test the thyroid hormone levels because the TSH is within the range. If the person is experiencing fatigue, brain fog, and coldness-

Dr. Jacob:

It’s insane.

Dr. Eric:

The doctor says, “I don’t know what’s wrong. Everything looks good.”

Dr. Jacob:

Give the doctor a size 6 shoe, and say, “Wear this to your next appointment. This shoe size is within the normal range.” Find a doctor who knows what they’re doing. You may want to go to a holistic doctor.

I was going to go into endocrinology when I was in medical school. I’m a science geek. They used to call me the phantom because at 3am, I would be in the medical library going through the stacks reading stuff. I know God loves me because the most beautiful girl in the world was attracted to science geeks, and she married me. I can’t imagine why she did. Worked for me.

The bottom line is find a doctor who knows thyroid. The testing is ludicrous. I was lecturing in Italy at the Fibromyalgia Conference once a year in different parts of the world. They move from place to place. The world’s leading researcher on hypothalamic thyroid disorders and fibromyalgia, I asked him point blank if the TSH tests are reliable. He said, “Absolutely not.” It’s a useless, piece of crap test. Look up the definition of TSH in the dictionary. It would say “a useless, piece of crap test.” Sorry.

Dr. Eric:

This has been a very entertaining interview as well. You speak the truth. You’re entertaining, but I can’t argue with what you’re saying. I understand many doctors just rely on TSH still to this day. Some will do a free T4 or a total T4.

Dr. Jacob:

Endocrinology is 50 years behind scientific literature and is not likely to change. I realized I could do better endocrinology as an internal medicine doctor, so I took that pathway.

Dr. Eric:

I know we’re running out of time but circling back to thyroid. Let’s say TSH looks within the perfect optimal range even though we’re dismissing it. Free T3 and free T4 within the optimal range. Everything is looking good from a thyroid perspective, but they are still experiencing fatigue. That’s when they need to dive into that S.H.I.N.E. protocol, correct?

Dr. Jacob:

Yes. You can start with red ginseng and the Smart Energy System. Make sure you’re on a good multivitamin with high levels of B complex and magnesium. Easy starting place. Start with the N in Nutrition, and build that up.

For a lot of people, that would make a big difference. After sleep, that’s the next stop. If you have nasal congestion and IBS, then that’s candida. A couple simple stops for most people can make a massive difference.

Dr. Eric:

There’s so much more we could talk about, but I will tell them to read your book. Maybe we’ll do a part two one day.

Dr. Jacob:

We may want to address pain relief in another episode. That’s another horror story in our country. Almost all pain is treatable unless you go to your MD.

Dr. Eric:

It’s treatable, but they will give you drugs. It’s not curable if you go to your MD. But if you want to be on drugs for the rest of your life-

Dr. Jacob:

A third of American adults suffer from chronic pain needlessly. A third of Americans die from ibuprofen-related medications each year. You won’t hear about that research each year because you don’t want to piss off the advertisers, and ibuprofen advertisers and NSAIDs advertise conservatively 50,000 preventable U.S. deaths a year. You have a whole host of things that can be used for pain that are more effective according to studies with fewer side effects.

Thank you for saying it’s entertaining. Sometimes, you have to laugh or cry. It’s a way of teaching.

Dr. Eric:

It was entertaining in a good way. Obviously, you also provided a ton of knowledge. Definitely recommend for everyone to check out your excellent book, the fourth edition of From Fatigued to Fantastic. Where can people find out more about you besides your book? I know you mentioned a few websites along the way.

Dr. Jacob:

Www.Vitality101.com has the information. There will be a four-step program on how to recover. Email me, FatigueDoc@gmail.com for the information sheets. For those with infertility, because you will see that with low thyroid, you can ask for the infertility information sheets also.

For the supplements I mentioned, Amazon has most of them. If you want to support my outreach work, EndFatigue.com.

We have a Facebook page as well. If you email me, I will send you the link.

Dr. Eric:

Thank you so much, Dr. Jacob. Appreciate your time and knowledge. We will get together for another interview on how to talk about pain and how to overcome it.

Dr. Jacob:

Be well, everybody.