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.

Recently I interviewed Dr. Kirk Gair, and we talked about the laser therapy and relating it to thyroid health. 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, Dr. Kirk Gair, as we are going to be chatting about laser therapy and relating it to thyroid health. Let me go ahead and give a bit of Dr. Gair’s background: He is an international laser expert who has been using lasers for 19 years and teaching laser therapy to doctors since 2017. His research recently led to the first FDA clearance for a green and violet laser for chronic neck and shoulder pain. He has been trained in functional medicine and neurology by his long-time friend, Dr. Datis Kharrazian and has been featured in Dr. Izabella Wentz’s The Thyroid Pharmacist documentary, The Thyroid Secret, and her New York Times best-selling book The Thyroid Protocol. Thank you for joining us, Dr. Gair.

Dr. Kirk Gair:

Thank you, Dr. Osansky. It’s great to be here. I’m happy to share this information with people because I know a lot of people don’t know what lasers can do to help them. It’s great to spread this out there. You said I’ve been using them for 19 years. It’s just now popping into people’s consciousness, so it’s cool to see this awareness happening.

Dr. Eric:

I’m a big fan of lasers. As we were chatting before I pressed record, I haven’t used a laser, especially when it comes to the thyroid. I’m sure a lot of people are tuning in and wondering how can laser therapy benefit thyroid? Very excited to talk to you about that and dive into the research because there is research behind that as well, which I know you’ll get into.

If you could expand a little bit on your background. How did you actually get into lasers?

Dr. Kirk:

Sure. I graduated in 1999 with Dr. Kharrazian. We were classmates. He was so far ahead of his time that he was already doing functional medicine. He did a functional medicine workup on me in 1996, which is great stuff. We were all kind of looking toward the future of things.

About five years after I graduated, what I noticed was that as my skills were getting better, it seemed like patients were taking longer to get better. They needed more interventions, more things to be done.

I started looking at what was working to get top tier athletes back into their game as quickly as possible. I found this doctor, Dr. Jeff Spencer, who was working with at the time the top athlete in the world, Lance Armstrong. Lance did whatever he could to win, both legal and illegal. Dr. Spencer was part of the legal side of it, where he was using these Erchonia lasers on Lance every day before he would participate in the Tour de France. Lance said they helped to enhance his performance, helped him to recover quicker. That’s what got me into it at first, to work with athletes to enhance sport performance and recover from concussions and injuries faster. That’s what I was doing at first, starting in 2004.

Things took a change with a couple of things happening to family members. The first thing was with my cat, Poopsie, in 2008. We came home from a great evening out; we live in Southern California wine country in Temecula. We went to the local Indian casino, Pechanga, and we come back home and find Poopsie on the floor unresponsive. I don’t know about you, if you have pets, but my pets always manage to get sick during not vet business hours but after hours when you have to go to the emergency vet.

It was a Saturday night, like 1am, and Poopsie is unresponsive. We rush him to the emergency vet. They check him out. They tell us he has acute necrotizing pancreatitis. His immune system started an autoimmune attack, just like Hashimoto’s or Graves’, on the pancreas and started destroying the tissue. They don’t have a treatment for this; he has destroyed 90% of his pancreas. He is 11 years old. They recommended putting him to sleep.

Poopsie was our fur baby. He helped my wife and me get through the stress of me going through chiropractic school and her getting her master’s in clinical psychology. I wasn’t willing to give up. “Hey, listen, I want to take my cat home and use my lasers on him.” At this time, I was using this violet and red laser. The vet rolled his eyes at me and said, “You’re not going to be able to do anything with a laser. You have to put him to sleep.” I told him, “What do I have to lose? Let me take him home and try.” He said, “Fine. Today is Sunday. By Wednesday, he will probably be yowling and in a lot of pain. You’re going to need to do the humane thing at that point and bring him back in and put him to sleep.” Fair enough.

I took him home and started using the laser. I placed it over his kitty pancreas, right here near the abdomen. I did that twice a day for five minutes at a time. By Wednesday, instead of yowling and being in a lot of pain, Poopsie was doing really well. He was more energetic. He was eating. Each day, he got better.

Saturday, I take him back to the vet and set him down. The vet says, “Wow, your cat looks surprisingly good. Don’t get your hopes up. He’s probably going to be worse. We’ll do another ultrasound of his pancreas. He had 90% destruction. If it’s worse, you have to put him to sleep. This autoimmune attack on the pancreas is destroying things. We don’t have a treatment for it.” I said, “All right, fair enough.”

He does the ultrasound on Poopsie. He is scratching his head, calls over another vet. They are both looking at the ultrasound. They are both scratching their head. They call me into the back of the office and ask me, “What the hell did you do?” I said, “Why? What’s wrong?” They said, “No, nothing’s wrong. We have never seen this before. Here’s his pancreas last week. It was 90% destruction. Here it is this week. We had to make sure we had the right film to make sure it was the right cat. You just regenerated 80% of his pancreas in a week. He now has a 90% normal pancreas,” which he said for an 11-year-old cat is normal for this age. “What did you do?”

I told him I used lasers. The interesting thing about veterinarians is they jump on technology. They are not slow to adopt, like human doctors are. The vets jumped into it and started doing all the treatments with lasers. “Listen, I have never seen this before. You just halted this pancreatitis that is necrotizing and regenerated the pancreas.” This sparked my curiosity here of how does this happen?

It got even better that he said Poopsie was going to be diabetic from then on. Insulin would work for one or two years. Then it wouldn’t work anymore, and he would need to be put to sleep. He’s going to need four units, twice a day. I kept doing the laser over his pancreas, and he got better with that, too. Instead of four units, twice a day, it was three units, then two units, then one, then ¾ of a unit, then ¾ of a unit every other day. He lived not just one or two years, but he lived six more years. The vet was always amazed. He’d never seen a cat get better from pancreatitis and more improved with their diabetes as well because it was the autoimmune one.

That’s when the lightbulb went off for me. What’s going on here? I looked at the research. The Russians were already doing this back in the ‘60s and ‘70s. They were so far ahead of us. That was what kicked me off with the lasers.

Then the second thing that happened was my wife got really sick when she was given an iodine contrast with some imaging. That created her whole thyroid storm. She almost died from it. She was bedridden. No one could help. She was seeing doctors at Harvard UCLA and Loma Linda, just as the thyroid was going crazy.

It was going to see Dr. Kharrazian. I went to Dr. Kharrazian, and he did a long exam on her. He said, “You have this massive amount of iodine contrast.” She would have had underlying Hashimoto’s hypothyroid antibodies. The iodine kicked it off, and it started an attack not against the thyroid but also against the cerebellum, which affects the autonomic nervous system pathways.

As he is talking to me about this and telling me about how these things, especially once it starts the attack on the brain, how it gets really ramped up, you have to calm it down, a light bulb went off. I was thinking about Poopsie. I asked him about using the lasers—this was 2011—on her brain and her thyroid. He said, “I don’t know. Let me do some research.” He also has a Ph. D in clinical research from Harvard.

That night, he gets back to me and sends me these studies on lasers in the brain and neurodegeneration and autoimmunity. He says, “Dude, laser the crap out of her brain. I didn’t realize this was out here.” It was showing how the lasers can reverse neurodegeneration and affect autoimmune pathways within the brain. That’s where everything kicked off, necessity being the mode of invention here. I took a deep dive into the research 12 years ago, and it hasn’t stopped since then.

Dr. Eric:

Some pretty cool stories. Amazing with your cat. It sounds like your wife was your first thyroid patient, the first person you used cold laser on.

Dr. Kirk:

Yeah. It went from her being bedridden to a year later, we were playing tennis together. Dr. Kharrazian said you don’t really see that with just nutrition and supplements alone. To have that huge of a change, the coordination of your brain in these different neurological pathways.

Dr. Eric:

With your cat, I think you said you used laser every single day until she passed away, correct?

Dr. Kirk:

I used them in that first week every day twice a day. When he was first acutely diabetic, I used it about daily or every other day basis. Ongoing, it was once a week or a few times a month that we used it for the next six years. It wasn’t daily. It was initially more intense.

Often, what we do with my human patients is laser rentals in the office. The patient can rent one of these handheld devices when they are in an acute crisis and take it home. They can laser the gut, the thyroid, the brain, these different pathways, to work on it at your home a few times a day to try to stabilize the condition. For maintenance things, they can do it on a less frequent basis. Patients can even buy these things to use at home, too.

Dr. Eric:

That’s what I was getting at. I wasn’t sure if your wife was still using it on her thyroid every single day. It sounds like she’s not. If anything, maybe doing it once a month or a few times a month.

Dr. Kirk:

Probably more frequently than that. She likes to do it two or three times a week. When we travel, we’ll take it with us. It fits in her purse or luggage. With autoimmunity, there is stress in travel, and it can ramp you up. You might get exposed to different foods or other things. You can use this to dampen the inflammation and calm things down. It’s really handy with that.

Dr. Eric:

Can you talk about the research? There is research behind this. It’s not just you have this experience with your wife.

Dr. Kirk:

After these two things with family members, I did a deep dive. Patients can look it up themselves on PubMed. By 1974, in the former USSR, low level laser was used as state sponsored standard medical care for everything, not just autoimmune things, but for neurology and even oncology, cancer patients. They have been doing that.

There is a study that Izabella Wentz and I have discussed a lot called the Höfling study out of Brazil. Höfling and his colleagues took patients and followed up with them for six years. They were lasering with low level, non-thermal lasers.

This is a key thing. This does not include high-powered Class 4 lasers that are thermal. You don’t want to use those over the thyroid. Those thermal lasers, you can’t use them on heat-sensitive tissues. Even though some doctors try to use them on the brain, research shows a high power, high dose could be problematic for those with brain fog.

Höfling was using low-powered, low-level lasers. In the groups he followed, 47% of the people in the study didn’t need any additional medication at all. They were able to go off of their thyroid meds. All of the patients in the study showed a decrease in the TPO antibodies. We know that’s significant because that’s how you can set up the thyroid for destruction. These cross-reacting with the cerebellum can cause destruction, too.

Similar to my cat. He showed in the study when they did an ultrasound of the thyroid, the thyroid gland appeared healthier, and blood flow to the thyroid gland was also healthier. That was one of the big research studies specific to the thyroid.

When we look at autoimmunity in general with low powered lasers, non-thermal lasers especially, they can provide support to autoimmune conditions. When I take let’s say this laser here, and put it on the body, be it the brain, this is a green laser and a violet laser. This one is a red and violet laser. As you can see, it’s hard to see the violet because it’s so low on the body.

As we get that on there, it will trigger you to make some things that are beneficial for autoimmune patients, like glutathione and nitric oxide. You will stimulate the production of interleukin 10, which helps to regulate inflammatory cytokines. It will help to downregulate inflammatory ones, like interleukin 6. You will also stimulate stem cell production and favorably modulate inflammation and immune markers in the body. It’s really cool what we’re doing on a cellular level to support the body.

The violet lasers also provide immune support against microorganisms, like viruses and bacteria. A lot of patients with autoimmunity have chronic infections. The wavelength particularly supports the immune system against those. There is also research showing that the laser can help, even though it doesn’t directly penetrate to the gut, repair a leaky gut barrier, a leaky brain barrier, and also help to support the microbiome.

It starts to sound like snake oil when you say all of these things. There are actual research studies that supports what the laser does for all of these conditions. It’s not specific to Hashimoto’s, MS, or Graves’. We’re looking at it supporting all those pathways that are involved with immunomodulation and immunoregulation.

When we get the laser on the body, it supports your T regulatory cells, which helps to downregulate autoimmunity. When you have those T reg cells being supported, you can help tame the fires of an autoimmune reaction.

Dr. Eric:

One of the questions I was going to ask you, and still will ask you, is the potential benefits for hyperthyroidism, including Graves’. With Hashimoto’s, you get the damage to the thyroid gland, so that could help regenerate the thyroid tissue potentially. With Graves’, it’s a little bit different. From what you just said, it’s also modulating the immune system and helping with regulatory T cells. It sounds like it could help people with Graves’, as well as other autoimmune conditions. You mentioned MS as well.

Dr. Kirk:

The first thing I will say is no laser is FDA cleared to treat those conditions. This is being used just like you would nutrition and supplementation; these are supplementary things. If you are looking at any autoimmune condition, whether it’s Graves’ or Hashimoto’s or MS or rheumatoid arthritis, you try to remove the offending foods and triggers from the environment. You work on supporting anti-inflammation. That’s how laser works in supporting these different pathways.

When we get the laser on the body, it even helps with TH1, TH2, and TH3 balance. The body is going to absorb the energy from the laser and use it as it needs it. That’s one of the cool things. When you get the laser on the sick cell, it will respond to the laser differently than a healthy cell. The cells have that innate wisdom in a sense, of saying, “Hey, this energy is coming in. This is how we’re going to use this.”

A key thing I want to point out here is when we are looking at these autoimmunities, we know there is commonly problems with mitochondrial dysfunction. When I have these red, violet, and green lasers, these actually support the entire mitochondrial respiratory chain, the electron transport chain. They support all the phases of it. You might have an autoimmunity problem with complex 4, 3, 2, or 1. Historically, red lasers and infrared lasers will only impact complex 4 for making the end product of ATP, which is the energy the patient needs. Complex 3 is affected by green lasers, and complex 1 and 2 by violet lasers. That’s why on all my autoimmune patients, and all my patients really, I use all three wavelengths. We are getting entire support for the electron transport chain, which is generating the energy needed for everything in the body. That’s where you can still help a patient with Graves’ or other conditions.

Dr. Eric:

You’re answering questions before I ask them. Another question I have, which I know the answer: Are all lasers created the same? Someone could just go online and purchase their own laser. You just mentioned that there are different types of lasers: the violet, the green, the red. They have different types of effects, it sounds like.

Dr. Kirk:

They do. Some people will say an LED is just as effective as a laser. They will even try to- There is one study by Hamlin that tried to say LED and lasers were shown to be the same. In head-to-head research, it’s not the same. Erchonia, the company I use, has the most FDA clearances of any laser that’s out there. We do rigorous level 1 testing.

When we do our studies, we compare them head-to-head with LED devices that have the identical wavelength, power, and parameters. When we compare them head-to-head, LED are great for patients to use at home, but you get roughly about a 10-17% effectiveness compared to a laser.

In the studies that are out there where they try to say LEDs are just as effective as a laser, many times, they are poorly designed studies where they will use a laser of one particular wavelength that is not as effective or of a power or a dose that is not as effective versus an LED that is on a more effective setting. They might compare a red versus an infrared. They set it up for failure in a sense. Sometimes, they will use one that specifically doesn’t work at all.

Those LEDs are good for use at home. Not so great to use in the clinic. The problem is right now, a lot of these devices are coming in from China that are very cheaply made. Some of the LED bulbs cost as little as six cents a bulb on there. You are not getting the same kind of effect that you do with a laser.

When it comes to different wavelengths, the easiest way to get people to understand the difference, whether it’s violet, green, red, or infrared, is let’s give the example of let’s put a person in an ultraviolet tanning bed, and let’s put someone under an infrared heat lamp. In the tanning bed, that particular wavelength of ultraviolet light is going to trigger things like melanin production for a suntan. You will also stimulate Vitamin D production that is not going to just be in the skin, but it will go throughout the whole body to strengthen the bones and support the immune system.

When you are under an infrared bed, you won’t get those impacts, but you will get thermal heating, relief from pain, improved blood flow. We get different effects with different wavelengths.

Devices that are on there each have their different uses. When we have an infrared device, they are lower energy devices that work through mechanical activity on the tissues by causing vibrations, oscillations, and a thermal impact. When we are doing things on the brain and thyroid, we have to be careful about how powerful they are in watts.

Some people think that more power is better. As we know with autoimmunity, you have to be careful about how much you load a person up, whether that’s exercise or a dose of a supplement. You have to do the same thing with the energy coming in from lasers. Upping the power can overload an autoimmune patient.

In the visible wavelength, we do have higher energy per photon in there, but we use lower power on there, so there is not a thermal impact. That way, the dose comes in slower. This way, we can not overstimulate an autoimmune patient. That is particularly important for the brain. If a patient is getting a very high wattage laser on the brain, in a matter of a few seconds, it can potentially overstimulate an autoimmune patient or someone who has been concussed, which could flare them up.

The lower power of lasers and lower wattage, we have slower time, so we can start to see how the patient is responding to it. If they start to feel like they are getting overstimulated, it’s easier to stop before you pass what’s called the hermetic threshold.

Dr. Eric:

It sounds like more is not better. You are not saying anything bad about red light therapy, but if someone has their own red light therapy unit, it won’t have the same impact as a cold laser, like the one you have from Erchonia.

Dr. Kirk:

It will be different. You will have a lot of well-known influencers online who will say that’s completely wrong. I challenge anyone to look at the studies. Don’t listen to me or the influencer or the salesperson. Go and read the actual studies. Look at if it was head-to-head. Did they use the same parameters or not?

I got into a discussion with a doctor on this the other day. He said, “Everybody knows you have to ramp up the power way higher with the LEDs to get the same effect as a laser.” I said, “That tells you they’re not equal. They’re different.” If you ramp up power, you will also have more of a thermal impact, which can cause problems. The head-to-head studies are not showing quite as much.

I’ll give you an example. We did a study on autistic kids in Cuba. We used a true laser, green waves, and we used an LED device with identical parameters. Laser had fantastic results. The LEDs showed no changes in behavior or mood. On the functional MRIs, the laser showed that it changed blood flow and the neural activity to the frontal lobe and the cerebellum, whereas the LED showed no changes. Then we took those kids who were in the LED group and crossed them over, and they became their own control. They received the laser. They got the same benefits, the same changes on the functional MRI and in behavior that they didn’t get with the LED. Those are the kinds of studies I am talking about when I say I can cite specific research showing the differences in head-to-head studies.

Again, good for use at home. If I am going to race a car, I am not going to bring my old V6 Mustang. I love that car. It’s a sports car technically. But if I am going to try to race in a race against actual sports cars on it, there will be a difference in the effects.

Dr. Eric:

After someone goes in for treatment with the laser, and if they want to do wellness treatments at home and get their own laser, is there still a difference between the portable lasers and the red-light therapy, the LED?

Dr. Kirk:

Yes. When we look at these handheld devices, when we got the FDA clearances for these devices for chronic neck and shoulder pain, chronic low back pain, chronic foot and heel pain, post-operative and preoperative supports, body contouring, etc., these have the same effect.

I actually use these in my office. These are the devices I use. These will still outperform a red-light therapy device or LED therapy device. Patients can use these at home. When I have a patient in a family with a lot of autoimmune patients, neurodegenerative patients, I actually encourage them to buy their own device, so they can all use it on each other at home. This is something you’re going to need for life. The more frequently you can use it, the better it will be.

These are Class 2 lasers, so they are the safest ones out there. They won’t damage the eyes if you flash it. They are not going to damage the thyroid or the brain because they don’t have that high power to them. Patients can use these and have the same kind of effectiveness in their home than they would in a clinic.

The difference is when I am in the clinic, I am doing some different brain-based therapies. Hashimoto’s, we see brain fog, different kinds of issues neurologically. Graves’, the same kind of things happen. With any of the autoimmunities, we tend to see some brain involvement. I tend to stack brain therapies, gut support, and adrenal support as well.

Dr. Eric:

When it comes to the actual procedure, are you taking the laser and putting it directly on the thyroid?

Dr. Kirk:

When I have it in the office, this is a non-thermal device. We can safely do this. When it’s a thermal device, the manufacturers even say it’s contra-indicated there because these are heat-sensitive tissues. We will go on there for a few minutes, and that will stimulate stem cell production, nitric oxide, and glutathione, which Dr. Kharrazian says helps to take the bullet in the autoimmune attack and tame it. It modulates TH1, TH2, and TH3. We will help to stimulate the production of ATP. I use all three waves together, the green, the violet, and the red, because we get this synergistic effect of each wavelength doing some different kinds of stimulation on there. There are wavelength-specific reactions in the body.

With Hashimoto’s patients, I will get it up there on the brain as well. With an autoimmune thyroid patient who is having issues with dysautonomia, we can laser the brain stem and do vagal nerve exercises at the same time, like gargling, gagging, or using a little vagus nerve stimulation device near the ear, so we get that vagus nerve activation while we have the laser going on at the same time. We activate those neural networks, which helps to drive the laser energy toward the particular regions involved with it and help to repair those neural networks. We create some neurogenesis, some new nerve tissue and new synapses. That helps with the overall functioning of the patient.

Dr. Eric:

Here’s a question you might not be able to answer. A lot of patients with Graves’ have thyroid eye disease, which I don’t know if you’re familiar with. It’s more of an immune system condition.

Dr. Kirk:

Correct.

Dr. Eric:

From an immune system standpoint, it sounds like it could help. Also, a number of people have cosmetic changes like proptosis, bulging of the eyes. You mentioned that at least the home laser is safe for the eyes. As far as treating the actual eyes, is that an option, or is that something you would say don’t do on your own? Even if someone wants to see you in person, is that something you’d feel comfortable doing? I know it’s not FDA cleared for that. Do you have any experience with eye conditions?

Dr. Kirk:

We do. One of my patients has Graves’, and he came in with what his endocrinologist said was eye conditions related to it. He was having some different issues with some irritation and blurry vision. What we do with him is as he was getting issues with focusing, and with the blurry eyes, we put the laser first on the brain stem. Then we did eye exercises. We did cardinal fields of gaze stimulation, so he is activating those neural networks and having him focus in on a finger coming in close here. When we are getting a laser on them, it’s improving their focus on there.

Then what we did was had him close his eyes and do the laser right along here. This is completely safe to do. Let’s say if I’m flashing it, that’s considered safe because the blink reflex with a visible laser will protect the eye. Also, as you see how the beam diverges there, how it’s spread out. That spreads the energy over a larger area, so it’s not focused enough to create damage. If you’re doing a laser pointer, that’s pin light. All of the energy is focused on one spot, so that could be damaging. As this is spread out here, we can do these wisping techniques.

What I do is have him close the eyes. We do the laser like this. Then the energy gets spread out over the eyelids but still will trickle down to the eye and help with inflammation. Patients with chromosomal conditions we have done this on, who were losing their vision. We comanaged them with their ophthalmologist and optometrist, and it’s been really wonderful.

I had these patients who were getting steroid injections in their eyes once a month. We started doing laser on a weekly basis, and they didn’t need steroid injections anymore. The ophthalmologist was pretty supportive of what we were doing. In the case of my Graves’ patient, the endocrinologist supported what we were doing, and we saw improvements in that eye condition.

Yes, we have seen it. It’s in the research. The crazy Russians have been doing this since the 1970s. Why don’t Europe and the U.S. do these things? One of the problems in Europe and the U.S. is we think Tim the Toolman Taylor, “Oh, this thing needs more power.” They said that when you ramp those things up, you can’t really do that here on the eyes or the thyroid. When you do that, it changes the way that the laser works. It can limit some of the conditions you can treat. It can be great for musculoskeletal conditions, but for some sensitive ones, it doesn’t quite work as well.

Dr. Eric:

How about thyroid nodules and larger goiters? Have you seen success with those?

Dr. Kirk:

Yeah. It’s interesting. I had one patient who scared the crap out of me. She came in and was one of these patients, who come in and are not fans of chiropractic. They don’t like the adjustments, but they use the laser. She said, “I don’t want you to adjust me. I don’t like being cracked. I heard great things about your laser for neck pain, so I want to do this.”

I have this device called the FX635 that has three lasers that rotate. We are using this on her neck. We get great results. She works as a court translator, so she is always looking down and typing. A lot of neck pain. We have been doing this on her once a week for six months. She is getting great results.

Six months later, she tells me, “By the way, I didn’t tell you that I have thyroid cancer. I was scheduled for a complete thyroidectomy.” Great. I was using a laser literally right around her thyroid. I had asked her if she had any issues, and she said no. I said, “Why didn’t you tell me about this?” She said, “I didn’t think you needed to know because it’s not in your scope or specialties. I was handling it with my endocrinologist and my oncologist, and I didn’t think it was a big deal.” I said, “All right. What’s going on?”

She said, “I have to tell you. Six months ago, before I started, the cancerous nodule was 2.5 centimeters in size, and I was scheduled to have it taken out next month.” I said, “Okay. What’s going on now?” I’m thinking it’s worse, or it’s spread. She said, “Six months later, it’s shrunk to 7mm.” She had a 74% reduction in the size of a cancerous nodule in that time.

She said, “I know it’s the laser. This thing has been slowly growing for years. Now I add in a laser, and it shrinks. My oncologist was shocked. He said he had never seen a change like that, where it reversed. He has now cancelled my surgery, and he is just going to monitor it at this point.” I am not saying to treat cancer with lasers. A caveat in there. This is what we saw with this patient with the worst kind of nodule you can think of, that we saw this improvement.

I got curious again about the research. Again, the Russians by the 1970s were doing things with lasers with cancer. Here in the U.S., we still consider it taboo to do that. If you take cancer cells and put them in a Petri dish and laser them, they grow like crazy. If you put them in a Petri dish and put immune cells around them, there are a lot of studies out of Kyoto, Japan showing this: The immune cells will surround the cancer cells and kill them, destroy them. One of the things the Russians were saying is if you support the immune system, it can fight off the cancer cells.

I have some patients who have come in and are undergoing chemo. We will use it on another area of the body because these lasers have what’s called an abscopal effect or global effect. If I laser a person’s legs, they are going to get a global benefit of increased energy, immune support, stem cell production, etc. We have seen that in cases like this. We have seen that in patients with benign nodules as well, too. I haven’t seen any studies on nodules and the thyroid, but these are the small ones I’ve had in my office, which is pretty darn cool.

Dr. Eric:

That is cool. From what I understand, a cold laser can potentially regenerate thyroid tissue. It can help modulate the immune system. it can help with thyroid nodules, thyroid eye disease. Everybody is different. You are not claiming every single person can be helped. Still, a lot of people will just be on thyroid hormone for the rest of their lives and not do anything.

Dr. Kirk:

No dietary changes, nothing at all.

Dr. Eric:

Exactly. Same thing with these other health conditions. They will just follow the recommendation of their doctor. It’s great to hear there are other options. Like you said earlier, it’s not just about the cold laser. You also recommend dietary changes, stress management, doing things to remove triggers and correct underlying imbalances.

Dr. Kirk:

Stress is an important one. I know Dr. Kharrazian teaches in his functional medicine courses that stress is a dealbreaker for autoimmunity. He used the example of he had this patient, who I believe was a Hashimoto’s patient. He was a Wall Street broker. He did everything perfectly. He ate a perfect diet. He removed all the offending materials in his house, like the carpet, and put in tile. He changed all the furniture. But he still was a mess because of the stress of being on Wall Street.

Dr. Kharrazian said, “Nothing’s going to change unless you deal with your stress.” The guy actually quit his job as a Wall Street broker, moved to Mexico, and now tends bar at a resort. Everything went into remission because he dealt with his stress. It completely changed things. Not to say that everybody has the ability to leave a job and go tend bar in Mexico.

Another cool thing about the lasers is the lasers help with stress management. Especially when we can put these on a setting of a specific pulse frequency. I use these delta frequencies that are 1hz per second. This has a calming impact on the brain.

We will have patients coming in who might be ramped up from Graves’ or Hashimoto’s when they get into that hyper phase, when they have that anxiety and are going through that storm. We put on these delta settings, and we also use a vagus nerve stimulator, and have them do some breathing exercises. That can have a calming impact on them to tame the brain, calm down the nervous system, and help them manage their stress levels better. We will do that sometimes.

Or we will stack laser with the Muse headband. I don’t know if you’re familiar with the Muse headband at all. It does EEG scanning. It’s a couple hundred bucks. Patients can buy it with their own. It interfaces with an app on their phone, and it will give them biofeedback as to what their frontal lobe is doing, if they’re controlling their brain waves. If they’re controlling it, it will sound calm with little birds coming out. If it’s scattered and all over the place, they will hear wind and rain and loud sounds on there. We’ll stack the laser with the Muse headband or the vagus nerve exercises, so we can help the autoimmune patients to deal with their stress.

Dr. Eric:

That is pretty cool. I know we spoke a lot about lasers, which that was the purpose of this chat. Is there anything I should have asked you about lasers that I didn’t ask you that you’d like to chat about?

Dr. Kirk:

Yeah. A big component on here is that sometimes, patients will have autoimmunity. They will think things will get worse, or they can just maintain. Lasers can really help to enhance a person’s performance. If they are already starting to do well, you can improve their overall performances.

Let’s say I have this patient coming in with Hashimoto’s, and their brain is not functioning very well. As we get a laser on the brain, we will stimulate things that will enhance them to function better than they did in the past. Some of these autoimmune patients will have things like motion sickness, which is one of the most common things I see. They have a history of being ticklish when they were a kid. They can’t watch an IMAX movie. We will get the laser on the brain and do balance exercises or eye exercises with them. We see some of these old symptoms disappear. That’s part of the brain rewiring itself and improving longevity.

We get the lasers here. We will stimulate those stem cells to make new, healthy tissue. We will generate brain-derived neurotrophic factor, which I call the MIracleGro for brain cells, so you can make new neurons and synapses. You are also stimulating lymphatic drainage to drain the inflammation off of the brain.

I am mentioning this because as you may know, and as your listeners may not know, once there is one autoimmunity, many times, others pop up, too. There is a lot of autoimmunity in the brain. We are looking at Alzheimer’s and other forms of dementia have autoimmune components and related to diabetes type 3 as well. If you have a patient with these things going on, we can tame those things in the brain. If they have these proteins folding in the brain, as has been shown in Alzheimer’s, dementia, or Parkinson’s, 40hz has been shown to be able to stimulate these resonant waves in the brain to break apart the protein foldings that are occurring in there. Current research is showing you can not just prevent further neurodegeneration, but you can actually reverse it if you catch these things early enough.

Patients should pay attention to this. What’s going on with them? What are these symptoms happening? You can reverse a lot of these things when you combine diet, meditation, stress management, and lasers. If you have a patient with RA, where they are just on immunosuppressant drugs, and your joints are going to degenerate over time, you put the lasers on there and stimulate regeneration of the joints. New bone formation, new cartilage formation. That is the exciting thing about that.

These are the way of the future. This is the Star Trek of the future. While most of the medical model is 20^th century, we’re looking into the future of how you use these different wavelengths and light frequencies to signal the body to repair and direct what’s going on there. That’s where the current research is. We talked about things that were just released on PubMed, using targeted biophotons to stimulate your body to communicate via biophotons to make these changes, which is really exciting stuff.

Dr. Eric:

That does sound really cool. You’re right about how people with one autoimmune condition are more likely to develop other autoimmune conditions in the future. With the RA, it serves a few different benefits. A) It can help with the immune system since RA is autoimmune, and B) it could directly help with regeneration of the joints, which won’t happen if someone just goes to rheumatologists.

Dr. Kirk:

No, won’t happen. I think this is particularly important now. We look at this post-COVID world. I encourage your listeners to go on PubMed, type in “Kharrazian COVID study.” Have you checked out his study on COVID and its impact on autoimmunity, Eric?

Dr. Eric:

I have not. I have done some research though. I have had a lot of patients with thyroid autoimmunity that apparently was triggered by COVID. There is a lot in the research, especially with Graves’, studies showing a correlation although a correlation doesn’t always mean causation. It seems pretty obvious that getting a dose of COVID led to their Graves’ condition.

Dr. Kirk:

You have to read this study. Anybody who is listening needs to check this out. I have seen an explosion in autoimmunity in general since COVID hit. I started seeing it in May 2020. At that point, I interviewed another speaker for Erchonia, Dr. Trevor Berry, who is in Arizona and is a neurological expert. He was already seeing neuro autoimmunities popping up, things like MS. I interviewed him on my YouTube channel about that.

By the fall of 2020, Kharrazian and Vojdani, who is a world-renowned immunologist, they were doing research on the spike protein’s impact on the immune system. They released a preliminary study in fall 2020. In January 2021, the journal Frontiers in Immunology released this study on COVID spike protein impacts on autoimmunity. The spike protein can trigger autoimmune reactions in 26 human proteins in the body. They said this can be spike protein either from infection or from mRNA vaccination. They weren’t pro or anti vax. They are just doing the data.

If a patient with the right genetics is exposed to this spike protein, it can turn on autoimmunity against the thyroid, either Hashimoto’s or Graves’. It can turn on neurological autoimmunity, gut autoimmunity. Once we know that gut barrier breaks down, that opens the Pandora’s box for all other forms of autoimmunity. It can trigger and break down the brain barrier. It can trigger rheumatoid autoimmunities, diabetic ones, a whole host of them. That’s what we’re seeing now.

I’m seeing patients who didn’t have autoimmunity beforehand who said, “It was only my 90-year-old grandmother who had autoimmunity. No regular adults had it. I’m now 35, and I have it. My 12-year-old kid also has it.” This is important information for everybody to know.

It’s great that you’re talking about this stuff. It’s making people aware of they may feel completely different from then on after having had COVID or an mRNA vaccination. They might have had autoimmune activation. They have to learn these steps of what to do with your nutrition, your stress, and what we can do with technology to assist that.

We have people coming in who already had something, and then they got COVID or the mRNA vaccination, and now they have gone haywire. They can’t control their heart rate or blood pressure. They are seeing these dysautonomias as being common. As well as a loss of smell and taste.

We will use lasers on these patients. We will hit the brain stem. If they have lost their smell and taste, we will do smell stimulation and taste stimulation to try to regenerate those neurons. If they are having issues with heart rate and blood pressure, we will have them use the pulse ox and heart rate monitor while they are doing breathing exercises and vagus nerve exercises while under the laser. If it’s attacking the gut, we will hit the laser over the gut to try to stimulate zonulin to be more balanced to try to heal up the gut. We will try to do it over the brain as well, too.

People will see this and learn more, especially young kids, who are already being impacted from their different diets compared to previous generations. COVID has been a gamechanger in ramping up these autoimmune processes in the body.

Dr. Eric:

I agree. I will need to check out Dr. K’s study. You said it was released this past fall?

Dr. Kirk:

No, 2020. He is always ahead of the curve. He put out preliminary research about COVID in fall 2020. They did the release of the study in Frontiers in Immunology in January 2021. That shows you how far ahead. He is talking about COVID and spike proteins in the vaccine triggering autoimmunity.

In their conclusion, they said they were concerned that a vaccine could trigger autoimmunity. What do we say now in the news two years later? Finally, they are saying it looks like long COVID is autoimmune. Oh yeah, we do see some patients who get the mRNA vaccinations and now have autoimmunity. This is not anti-vaccine. The reality is some people are going to have an impact from either the vaccine or an infection that will generate long COVID. It looks like it’s autoimmune. He and Vojdani were already saying that in 2020 when COVID had only been around for less than a year.

Dr. Eric:

There are other studies not just with COVID. But yes, there are studies- I don’t know if I have seen Hashimoto’s in PubMed. With Graves’, there are studies that show that not only COVID can be a trigger, but also the mRNA vaccine as well. I haven’t done much research with other autoimmune conditions, but it wouldn’t be surprising if the research was out there for other ones as well.

Dr. Kirk:

What he showed in there was that the spike proteins shared similarity in its protein structure with these 26 different proteins in the body. You get that molecular mimicry. The immune system gets confused. Now, it starts to think that the thyroid or the brain tissue or cartilage or the pancreas looks like spike protein. It starts to mistakenly attack it. That’s what they were able to show in that study. They had tested it in the lab showing these reactions.

On these patients, when they come in like that, I use the laser because I am trying to support T reg cells and interleukin 10 and dampen the inflammatory cytokines. There are studies that show that violet lasers benefit even against active COVID infection. They are showing the COVID virus can set up shop and be smoldering in the brain, even in the ovaries or the testes, throughout the tissues. This helps to support the immune system against it.

This is where we can tie in all things together, along with the person’s diet and supplementation. Now they do stress management.

Dr. Eric:

Thank you for sharing all this. Where can people learn more about laser? Where can they find out about you, your practice, if they want to work with you directly?

Dr. Kirk:

They can go to LaserChiropractic.net. If they Google me, they will see I have been on so many podcasts and summits. They can hear all kinds of lectures I have done. I also have a Facebook group, Dr. Gair’s Health Performance Secrets. They are welcome to join that even if they are not a patient of mine. That’s where I talk about all things laser, nutrition, things to try to enhance a person to have them be better and have some hope.

If they are looking for a practitioner near them, they can go to Erchonia.com. They can click on the Find a Provider link and put in their zip code. Or they could message me. I have a group of almost 1,000 doctors I have trained. I do between 18-40 seminars a year, teaching other doctors, both in the U.S. and internationally. In Spanish as well in Latin America. They can message me, and I can see if I can put them in contact with someone.

Not all the doctors will know how to support autoimmune patients. They may have a laser, but they may not be well versed in it. You do want to be careful with that. Whatever laser you use, you want to make sure the doctor has an idea of what they are doing. Ideally, they have some training in functional medicine and functional neurology as well, so they know how to handle autoimmune patients as well.

We were not taught that in school. I’m just gonna say it. When we were in chiropractic school, we were not taught how to manage these kinds of things. At least in mine, we weren’t.

Dr. Eric:

Without question. I definitely wasn’t taught in chiropractic school. I don’t know anybody else who learned this.

Dr. Kirk:

Our education started when we graduated.

Dr. Eric:

Exactly. You’re right. Thanks, Dr. Kirk. Appreciate your time. Definitely visit Dr. Gair’s website. Thank you so much for taking the time to chat about lasers.

Dr. Kirk:

Thanks for having me on. I’m happy to share this information. This is my 20^th year of using lasers. I remember when I got started, I thought I was late in the game because the doc who trained me had been using them since the ‘90s. I saw the Russians had been using them since the ‘60s and ‘70s. I thought we were going to get to this point a lot sooner. It’s just now, people are getting their awareness, like it’s a brand new thing. It’s kind of cool to say it. I feel like the old veteran in the laser world because I have been fighting down in the trenches for the last 20 years.

Dr. Eric:

Thanks for everything you do. Now, there are other practitioners, chiropractors included, who are doing what you do because of you. Appreciate the time and research you have put into this.

Dr. Kirk:

Thank you. Thanks for that.

Recently I interviewed Dr. Nirala Jacobi, and we talked about SIBO and the Biphasic Diet. 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. Nirala Jacobi about SIBO, as I have been following her on her podcast for a number of years. Previously, I interviewed Shivan Sarna, and we covered some of the basics of SIBO, including the symptoms, causes, the low FODMAP diet, prokinetics. Here, we will go in a little different direction.

First, I want to share Dr. Jacobi’s impressive bio. Dr. Nirala Jacobi is a naturopathic doctor and internationally recognized expert on small intestinal bacterial overgrowth (SIBO). She is the creator of the SIBO Bi-Phasic Diet, a resource that has helped tens of thousands of SIBO sufferers around the world. Dr. Jacobi is the host of The SIBO Doctor podcast and the founder of The SIBO Doctor, which is an online educational platform that includes a practitioner certification program. She is the medical director of SIBO Tests, providing innovative testing options for SIBO and IBS. Dr. Jacobi is known for her systematic and effective approach to diagnosing and treating SIBO and other functional digestive disorders.

Having received her naturopathic doctorate in 1998 from the esteemed Bastyr University in Seattle, she brings more than two decades of clinical experience and expertise to her clinic, The Biome Clinic. Thank you so much for joining us, Dr. Jacobi.

Dr. Nirala Jacobi:

It’s a pleasure to be here. Thanks for the invite.

Dr. Eric:

You are very welcome. I’d like to start off, Nirala, by just chatting and getting a little bit of your background. How did you start focusing on SIBO?

Dr. Nirala:

It’s an interesting story. When I first found out about SIBO, I had been in practice for about 15 years. I found out about SIBO in 2010 or 2011. I went to a conference, the American Association of Naturopathic Physicians, and heard Drs. Allison Siebecker and Steven Sandberg-Lewis talk about SIBO.

It was like a thunderbolt because it was like the missing link that I found that many of my patients seemed to have, where very well-intentioned protocols that we usually use for digestive disorders and dysbiosis and things like that were not working for these patients. It was really an aha moment for me. Wow, this is actually a really big deal, and it’s going to be a really big deal for many people.

Up to that point, as you may remember, there wasn’t a whole lot out there for the treatment and even the diagnosis of IBS. What we now know is that a large percentage of these IBS cases are actually SIBO. Because it’s a diagnosable condition with a breath test and a very treatable condition, all of a sudden, we have all this good news for IBS sufferers that were always told to eat more fiber and learn to live with it.

Dr. Eric:

You’re right about SIBO being a bigger deal than some practitioners, including myself- It was probably 2016 when I really started getting into SIBO and was surprised to see at summits- NUNM.

Dr. Nirala:

Yes.

Dr. Eric:

I guess it’s more of a conference. Anyway, since then, and before then, there has been so many conferences and summits. There is a lot of information out there because it isn’t easy to get rid of SIBO and address it. You can’t completely get rid of it sometimes. Can you talk about the different types of bacterial overgrowth? What is the difference between having an overgrowth in the small intestine compared to the large intestine?

Dr. Nirala:

Let’s talk about what the normal physiology is, and maybe that’s helpful to your listeners to get an idea of what’s going wrong then with the normal physiology and the normal terrain of the digestive tract.

When you’re eating, you’re starting to secrete a lot of digestive juices that are meant to keep a lot of food-borne bacteria at bay and kill bacteria on contact. Because of that effect, there is a very low level of bacterial growth in the small intestine.

The other reason is because it needs to be bacteria-free more or less, or very low bacteria levels in the small intestine because that is where you break down your food and absorb your food. Too much bacteria in that area is not very helpful for absorption and so forth. That’s one thing is where digestion is really impaired, for example. You’re not secreting enough digestive juices, and that can lead to local bacterial overgrowth in the small intestine.

The large intestine is where you’re meant to have a lot of bacteria, something to the order of three billion per mil of stool. There is a lot of bacterial activity in the large intestine.

We have these two places that are very different from each other. It’s like the rainforest in the colon and the desert in the small intestine. When you have different reasons for SIBO, either digestive deficits or motility problems or structural issues, then you can end up with a local bacterial population. These are normal in small amounts, but when they overgrow, they cause a lot of problems. We know so much more about SIBO now than we did when we first started to learn about it. We’re down to understanding what bacteria produces which gas and treatments. It’s been a long road, but we are understanding a lot more now.

Dr. Eric:

When a practitioner does a comprehensive stool panel, and we see a lot of opportunistic bacteria, that is completely different than SIBO. You can’t conclude that that person has a lot of opportunistic bacteria in the large intestine, so they might have SIBO. The only way to know is by doing a breath test, correct?

Dr. Nirala:

Yeah. A stool test will give you no information about the state of the small intestine in terms of bacterial overgrowth. It simply is not equipped for that. A lot of practitioners try to deduce that there is SIBO because potentially either E. coli or Klebsiella or Desulfovibrio are overgrown in the colon, which is not normal but is often the case, as we know. Those happen to be bacteria that cause SIBO. Just because they are high on a stool test is in no way the implication that they are also high in the small intestine.

Dr. Eric:

Can you talk about some of the hidden causes of SIBO? I heard you talk about this in your SIBO course or your podcast. I have been following you for quite some time.

Dr. Nirala:

Sure. That’s where my sweet spot is in terms of practice and education. I think we owe it to our patients to find the underlying cause. I always tell people, “Look, the bacteria are not that hard to treat, but it is a very frequently relapsing condition. We have to understand why is it relapsing?” The causes of relapse are different for different people.

As I mentioned, the one, what I would say, category of issues is you have a problem with digestion, or you have a problem with motility of the small intestine, or you have some structural issues like scar tissue from an abdominal surgery or endometriosis or anything that increases scar tissue formation in the abdominal cavity that then can disrupt the way the body moves through the entire digestive tract.

If you think about the causes in those three categories, it gets a little easier. By far, the biggest is the motility problem. Let’s talk about that for a moment. The small intestine is equipped with something called the migrating motor complex, which is a part of the enteric nervous system that sweeps the contents of the small intestine toward the colon. Different conditions can damage or hinder or impede the migrating motor complex. That is one thing.

Then the other aspect of this motility might be conditions like hypothyroidism or issues with vagal tone, where we have vagal tone dysfunction with extreme stress or mold toxicity or chronic viral infections that affect the vagal output.

Under this umbrella of causes, you have three categories. Under each category, you have the actual problem, if you know what I mean. It’s a bit complex. It’s certainly not a one size fits all. I think the more we understand about what causes SIBO for an individual patient, the more we can actually resolve this issue for them once and for all.

Dr. Eric:

It’s not as simple as just following a low FODMAP diet or treatments such as antimicrobial herbs or Rifaximin. Either way, you want to address the underlying cause, or you could and very well probably would relapse if you don’t address the cause.

Dr. Nirala:

In many cases, that’s what I see. Some people have relapse rates of every 2-3 months. Some people have relapse rates of once every year or two years. That also differs depending on what the cause is. Because the biggest issue is motility, that’s where I often find the people that do the most relapse.

When you have digestive issues, like let’s say a typical case of digestive issues would be somebody who has had extreme stress for a few years potentially due to their job or their relationship, whatever that may be, or trauma. We have all experienced different degrees of trauma. It’s been heightened. I don’t know if you have experienced that as well. Their whole baseline of anxiety is way higher after COVID seemingly than it was before. This chronic stress can tell the body it’s not time to digest anything. It’s time to deal with the stressor. People just are walking around with chronic stress and are not digesting their food properly. That’s a real thing. That’s relatively simple to correct because we have supplements and herbs that aim to support digestive processes: hydrochloric acid, bitters, enzymes, etc. We know how to do that as practitioners.

Let me finish up with that other category. The hardest thing about those cases is really inducing a parasympathetic nervous system response. I often refer to modalities like hypnotherapy and trauma work and different kinds of vagal toning and brain retraining. That is a little bit more involved if it involves the central nervous system and the vagus system.

Dr. Eric:

Just out of curiosity, have you noticed over the last few years increased incidence of SIBO with all the stress post-pandemic?

Dr. Nirala:

I definitely saw more relapses after COVID. I thought that was stress-related. Generally, there is so many changes and worries that people are carrying these days. It isn’t just COVID and lockdowns, but the state of the world is very frightening for a lot of people, understandably so. Learning how to downregulate or ground yourself and learning how to work with your nervous system is one of the biggest skills that people can develop.

Dr. Eric:

I agree. I’m glad you mentioned this. There are some people who think it’s all about diet and don’t relate stress management with SIBO.

Dr. Nirala:

It’s not like I’m over it. I just find that stuff not difficult. Occasionally, I do have patients who fail treatment, and they fail every single one of the treatments. I can count those cases on one hand over the last 15 years or so.

The majority of people will respond well to the treatment. It’s about treating the cause of the problem.

Dr. Eric:

Let’s talk a little bit about the Bi-Phasic Diet. When I spoke with Shivan, we spoke more about low FODMAP. There’s also Dr. Siebecker’s SIBO specific diet. I forgot exactly what we chatted about. We definitely didn’t get into the Bi-Phasic diet. If you could talk about why you created the Bi-Phasic Diet. I know you have a few different variations like a histamine one that relates to histamine, a vegetarian version, etc.

Dr. Nirala:

The Bi-Phasic Diet came about because there were just too many instructions and too much confusion about low FODMAP. I put people on low FODMAP, and they would still be symptomatic. I had to come up with a way to structure my treatment because I found that when a patient came to me, I would give them a breath test to take home. The first point of contact where we are just assessing whether or not it is SIBO.

I found that just supporting their digestion and putting them on a very restrictive diet, so this would be phase one of the Bi-Phasic Diet, which is stricter than a low FODMAP. It’s virtually grain-free and free of all the main allergens—dairy, gluten, and so forth. Egg is still allowed. It’s very strict, low FODMAP, but beyond that. I do a lot of supportive therapies during that phase.

Then people would come back and feel so much better. The test would come in, and we found that yes indeed, it’s SIBO. Then we could immediately move to phase two, which is more the antimicrobial phase, where you are introducing again a few of the FODMAP foods. You can expand on the diet also, so you can have a little bit of bacterial growth. You want them to be active when you’re blasting them with antimicrobials.

I found this approach really helpful, especially for sensitive people that often have an issue with die off, that condition where you’re feeling the effects of bacterial death and absorption of the endotoxin LPS that triggers so much inflammation in the body. When you already reduce their fuel source, you are getting some bacterial downregulation. I found that approach really helpful.

Now that has expanded. I just recently released an e-book that incorporates both the vegetarian and the regular SIBO Bi-Phasic Diet. The purpose of that was why are only vegetarians learning how to sprout their legumes and not having all these other foods available to them? I’m a big fan of plant foods. I think plant foods are ultimately, as we know from many different studies, where we get our fibers and nutrition from that are important for the microbiome in general. Anyway, it was a labor of love to put this e-book out. It incorporated both the diets with a lot of updates. That recently happened.

The histamine diet, I did with Heidi Turner, who is an excellent dietician who works a lot with mast cell activation syndrome. I found that often is a comorbid condition in people that are really extremely sensitive and have SIBO. We needed something for those patients, but also people who have histamine intolerance, which is actually quite common in people with SIBO or IBS. That is the history of the Bi-Phasic Diet.

It’s a structured approach that allowed me to have people do this in a stepwise fashion without having them leave with 10 different supplements on day one. I really didn’t want to do that. I wanted to navigate it a little bit gentler.

Dr. Eric:

Each phase is 4-6 weeks?

Dr. Nirala:

That’s adjustable by the practitioner. I’ve had people just do a two-week phase one depending on how they’re responding, and then move straight to phase two. You can do it as long as you’re improving in phase one. It starts with a very restrictive part, which is the restrictive phase one. Then it’s semi-restrictive, which is a self-guided process. As soon as people feel better, they can go to the second part of phase one and incorporate some more vegetables.

Whenever you start antimicrobials, you do want to move to phase two. A lot of people find the Bi-Phasic Diet really helpful when they have acute flareups, or they have had Christmas or one of those holidays that involves a lot of food. They have a bit of symptom control to do. They do a couple weeks of Bi-Phasic. That’s also a useful tool for that.

Dr. Eric:

The first phase kind of sounds like a combined paleo and low FODMAP diet. You said eggs are allowed, but you’re avoiding grains.

Dr. Nirala:

And specific carbohydrates. It’s sort of all of that. You’re reducing inflammation. You’re wanting to start that process. I find that really helpful when you focus on just supporting digestion and reducing inflammation before you go in there with harsh herbal medicines. Some of these essential oils can be quite full-on for people. That’s been super successful for me and for many of the practitioners that have completed the program and are recommending this diet to their patients.

Dr. Eric:

The second half is when you are starting the antimicrobials. It depends on how the person is responding. Someone might be on the antimicrobials for potentially a few months?

Dr. Nirala:

Each round is about six weeks. If you have very high gas levels, you may have to do two rounds, so it’s three months. The second round, you might want to add in some biofilm if you retest after the first round, and you have not made significant progress. If you have made no progress, I would change antimicrobials.

It really is case by case. I am always very hesitant to give absolute numbers for how long you have to do it because it’s adjustable. Some people need more carbs for example from the get-go because they have blood sugar regulation issues. That’s also possible.

In the e-book, I mention all these different things you can adjust and make it a little bit more manageable for yourself. I do have a self-help SIBO success plan, which is a self-guided SIBO treatment for patients. I really want them through the Bi-Phasic Diet very meticulously.

Dr. Eric:

There is also SIFO, small intestinal fungal overgrowth. Does the Bi-Phasic Diet benefit people with SIFO as well?

Dr. Nirala:

SIFO is also very common. It is often morbid and exists with SIBO. It has exactly the same symptoms, I’d say. It is a diet that lends itself very well to the treatment of candida and other fungi. Phase two of the Bi-Phasic Diet, you can introduce honey and maple syrup. I usually say don’t do that yet if I know somebody has SIFO.

Dr. Eric:

That’s one reason you like the herbs because the herbs can help with both, whereas the Rifaximin would just help SIBO.

Dr. Nirala:

Yeah. Mainly for hydrogen SIBO. Hydrogen or hydrogen sulfide. It’s a good antibiotic, and it’s really specific to small intestinal problems. It doesn’t get absorbed. It has a minimal impact on the large intestine unless you repeatedly use it. It’s obviously a popular antibiotic for a reason. It works really well for hydrogen dominant SIBO. It’s still an antibiotic.

Ultimately, the problem with SIBO is you have a dysbiotic microbiome of the small intestine because the bacteria that cause these problems are not pathogens per se. We know that. Were they the kind of pathogens that don’t cause food poisoning, like salmonella, Campylobacter, E. coli. You have normal amounts of E. coli in your gut that are important players of the microbiome. When you have bacteria that are meant to be in small amounts that all of a sudden overgrow because of the reasons I mentioned before, then we run into issues. They are normal players of the microbiome. For that reason, we really need to focus on rebalancing a normal microbiome of the small intestine.

Dr. Eric:

One question I have. You mentioned that Rifaximin is mainly for hydrogen dominant SIBO. Then I learned years ago when I first started learning about SIBO that if someone has methane dominant, they could take Rifaximin or Metronidazole. Can someone mix the antibiotics and herbs? Can they take allicin with the Rifaximin if they have methane dominant?

Dr. Nirala:

Absolutely. I actually prefer that. My usual routine with mixed SIBO where you have both hydrogen and methane dominance, if they opt for Rifaximin, is to do that two-week course, but more like a six-week course of the Allimed, or high content allicin, not just the garlic extract. They are not all made the same way. Methane does take a little bit longer. Maybe add in a biofilm buster and potentially also something like Nystatin or maybe even oregano oil. A little bit more involved. You can absolutely mix and match.

Dr. Eric:

With the biofilm busters, do you recommend it just for methane dominant SIBO or also hydrogen dominant?

Dr. Nirala:

With just the first round, I don’t. I want to see how they respond and what their relapse rate is. Usually in those cases, where they’re relapsing right away, within a few weeks or so, then I will do it. I will add in whatever SIBO that is. If it’s hydrogen dominant, I will also add that in sometimes.

Dr. Eric:

What are your thoughts on elemental diet? Is that something you sometimes recommend?

Dr. Nirala:

Yes. It’s a great tool. What people don’t realize is it is an actual antimicrobial. Don’t be fooled by the word “diet.” It’s not that you’re adding this to your diet, or you’re doing this while you’re doing other antimicrobials. It is a standalone antimicrobial treatment. The idea here is that those ingredients are so predigested that they basically get absorbed as soon as they hit your small intestine. When you drink it, it gets absorbed really rapidly. There is no food left over for bacteria. When I first heard about it, I was quite skeptical. It is actually quite dramatic, the degree of reduction of gas.

The problem is you have to do it for two weeks minimum. A lot of people at that point are over the sweet taste. It’s quite sweet. There are different versions. Some people are great with it. It is a great treatment, don’t get me wrong. Talking somebody into doing it, sometimes repeatedly, is hard.

Dr. Eric:

I guess it also depends on the severity of the SIBO and if the person has tried other things. Have they taken antimicrobials, and it hasn’t worked?  

Dr. Nirala:

I often give the option. Here are your options: Here is your conventional recommendation. Here is what I would do, the herbs I can give you. Here is the elemental diet. These are the three options we have. Sometimes, the second time around, people will opt for that, with minimal movement of the gas levels.

Dr. Eric:

Bloating is pretty common, as is gas. It could take time for the Bi-Phasic Diet, the antimicrobials to kick in. Do you have any quick solutions? If someone is really dealing with a lot of bloating, something they could do to get some relief sooner than later.

Dr. Nirala:

There is lots of different causes for bloating. Sometimes, it is the gas that is produced by bacterial fermentation. With SIBO, there is no doubt about that. But sometimes it isn’t that.

You may be really deficient in these digestive juices that help you break down food. I’ve seen that a lot. I see a lot of people with suboptimal hydrochloric acid production, bile production, bile flow, pancreatic enzyme output, brush border enzyme output. There are all these different substances your body produces in response to food. When they are really deficient, and you are not breaking down these bigger particles, then you have all of this food actually arriving in the colon. Colonic fermentation can also give the sensation of bloating. Then the treatment is different than SIBO.

Sometimes, it is the neurological wiring that is basically in this fight or flight, where nerves aren’t communicating very well. Things like hypnotherapy we know in research in certain cases can dramatically improve symptomatic relief for IBS sufferers. These studies use gut-centered hypnotherapy to improve IBS symptom scores. It’s just amazing. If that’s the case, I would really recommend doing things like working on that vagal toning and nervous system downregulation.

If it’s digestive stuff, then I would start with something like a bitter tonic to help with the production of these digestive juices.

If it’s just you’re bloated, and you’re going to a wedding, and you have to fit into a tight dress situation, then I’d probably use something like a charcoal binder. Charcoal is pretty good because it’s simple, easy to get, and does tend to bind gas. Also doing certain exercises like wind relieving exercises, yoga poses, things like that.

Oh, and I have a tea. I forgot about this. I have a video about how to create your own carminative tea. Carminative is a word that we use in herbal medicine that means “wind-relieving,” actually reducing gas. It’s three seeds: caraway, anise, and fennel. You mix them in equal portions. You put them in a jar. You take one teaspoon and put it in a mortar and pestle. You grind them up, bruise them, and put them in a cup. You put hot water on it, steep it for 5-10 minutes, and drink that after a meal.

That’s an easy thing to do if you go to a bulk seed store. You can just buy them. We have bulk stores where I can get my flour and different seeds and different spices and herbs and put them in a paper bag, take them home. You mix them up and make yourself a cup of tea.

Dr. Eric:

Obviously, start with one cup. Will some people need multiple cups?

Dr. Nirala:

You can even brew it properly for like 10 minutes in a teapot. You make yourself a big teapot and drink one cup after each meal. It doesn’t have to be hot. You can drink it cool as well. It’s pretty pleasant tasting. It can really help with the reduction of bloating.

Dr. Eric:

You mentioned bitter herbs. Would something like apple cider vinegar work to stimulate the body’s own production of stomach acid?

Dr. Nirala:

When I think about different degrees of increasing stomach acid. Let me just back up. Your normal stomach pH, when you’re at normal resting state, is supposed to be the acidity of car battery acid, which is around 1 on the pH scale. If I were to stick my finger into your stomach, it should get digested all the way down to the bone. It should get broken down. That’s a normal, healthy stomach acid.

Now all of a sudden, if you’re not putting out enough, your pH starts to go up, meaning more alkaline. We have certain things like lemon juice and apple cider vinegar to help with the pH of that, but it doesn’t do much to stimulate your own parietal cells of the stomach to produce hydrochloric acid. Herbs like ginseng and all the bitter stuff—dandelion leaves, berberine, Oregon grapes. It’s a great bitter, but it’s also a mucosal tonifier, and it has some antimicrobial activity. I would use that because it directly stimulates the parietal cells to increase their stomach acid output.

The next level from there would be actual hydrochloric acid supplementation. Different things do different stuff. Apple cider vinegar, while it’s fantastic for some people, it really helps with improving the stomach feel. Some people are sensitive to the histamine levels of fermented foods.

Dr. Eric:

That’s a good point. Thank you for explaining the differences. I know berberine is used as a treatment for hydrogen dominant SIBO and has benefits for the gut microbiome. You mentioned it also stimulates the body’s own production of stomach acid as well.  

Dr. Nirala:

Berberine is the ingredient or constituent, as we call it in herbal medicine, that is present in many different plants. There is a berberine-containing plant family. Some of them are big trees, like calodendrum, and some are brushes, like the Oregon grape root is basically a bush. Different plants, but they can be extracted. Berberine is then the active ingredient that has these antimicrobial activities. If you use the whole plant, like Oregon grape, which has traditionally been used as a bitter, a stimulant, and a mucosal tonifier, you get all this added benefit of good effects on digestion in general.

Dr. Eric:

I have a couple of quick, true/false questions for you. You could feel free to expand on them. I don’t think we mentioned that you’re in Australia, so this question might differ based on the location. I’m not sure. True or false: Most gastroenterologists, GI doctors, are familiar with SIBO.

Dr. Nirala:

I think that’s false. Or they often dismiss it. It’s a tough one because I see pretty extreme cases, so they have gone to different gastroenterologists. Some do the breath test. I think that adage of any new discovery in medicine takes at least 20-30 years to filter down into the actual offices of medical doctors. It takes a long time. We’re only 15 years in or so at this point.

A lot of functional doctors are familiar with it at this point. Some medical doctors and some gastroenterologists, we have some absolute superstars like Lenny Weinstock or Dr. Bulsiewicz, who wrote Fiber Fueled. They are more into microbiome restoration rather than SIBO, but at least awareness of microbial issues is starting to take hold, I should say, in some of these modern or conventional minds.

Often, I see patients that say, “I was told this is not my problem.” Then we do a breath test, and lo and behold, it’s a problem. When we treat it, their problems go away. Some people are very upset by that because they should have been told it is a thing.

That was not a true/false question. That was a very long-winded answer to a short question.  

Dr. Eric:

I expected you to expand and not just say false. I brought it up because some people might go to the GI doctor hearing SIBO, and the doctor might dismiss it and say, “No, you don’t have SIBO,” but they didn’t do a breath test. Maybe they did an endoscopy, or they didn’t do anything at all. They just dismissed it because they are not familiar with it.

True or false: It’s okay to randomly treat someone with SIBO rather than do testing.

Dr. Nirala:

100% false. Well, okay, nothing is ever 100%. Here’s my pitch for testing: First of all, you need to know that it’s SIBO. Now that you know you have these three different categories of causes, it’s important to know if it’s actually SIBO so that you can then explore the reason why SIBO is there to begin with.

Second reason is you need to know which gases are dominant, so you know what you’re actually treating because the treatment varies with different gas types.

Those are my two main arguments for testing. Testing is super accessible. It can be done at home. It’s available on all major continents. It’s a do at home test. It couldn’t be easier.

Dr. Eric:

They do offer some testing for hydrogen sulfide. If someone is experiencing more constipation, would it be okay to just do the traditional SIBO test?

Dr. Nirala:

Absolutely. Unfortunately, there is only one lab right now in the world that does hydrogen sulfide testing. That’s always a bit limiting in all ways. Also, I’d like to have more labs that then corroborate the fact that this is a valid test. I’m not saying the test is not good. I would just say that not everyone needs this particular test that checks for hydrogen sulfide simply because what we can expect in terms of symptom-wise for hydrogen sulfide is a diarrhea dominant type of SIBO.

Somebody that is constipated may have hydrogen sulfide production in the colon because it causes constipation when the solvent-reducing bacteria (which is confusing because they are not reducing, they are just biochemically reducing sulfur) are present and overgrown, they can cause constipation in the colon. But a breath test for hydrogen sulfide will not pick up that level. Or very rarely. It’s really the cases that are not positive or maybe barely positive on a normal lactulose breath test, and they have diarrhea and some other symptoms that maybe give you a suspicion of hydrogen sulfide, such as sulfur sensitivity, burning type symptoms, that kind of stuff.

Dr. Eric:

I brought it up just because I kind of expected you to say that. I wanted others to hear it because I’ve had a few people bring up the test. Just because it sounds great. Now you have the new test that tests for three different types of SIBO. I have also mentioned where not everybody needs to do that test.

Dr. Nirala:

No.

Dr. Eric:

I wanted to hear it from the expert, someone who is dealing with SIBO on a day-to-day basis.

I got one more true/false question. I know the answer to this, but it’s another area of controversy. It doesn’t specifically have to do with SIBO, but it does have to do with the gut. True/false: Everyone should be treated for parasites.

Dr. Nirala:

No, that’s false. Two of the most common things are D fragilis and blastocystis, right? We see them not too infrequently on stool tests. It’s actually not, depending on what subtype you have, associated with an unhealthy microbiome. Certain subtypes can be a great benefit to have on board.

I have blastocystis. I don’t have any symptoms. This overfocus of the bug as the cause of all of your problems is a reductionistic and conventional approach. “Oh, it’s the bug that’s the cause of all of this issue.” It’s really not. It’s the terrain. I’m not saying that nobody has parasitic issues, but I think it’s been popularized by the online wellness industry to some extent.

I do a lot of testing. I don’t see parasites too often. When I see blastocystis, let’s see what else is there, really learning how to interpret not just the stool test, but a shotgun genomics test, which is really a true measure of the microbiome. That’s where it becomes much more interesting and takes a bit more finesse and understanding of the microbiome.

Dr. Eric:

I asked you this because I heard you say this on one of your courses about the parasites. I knew the answer was going to be no. There are some practitioners, some who I have interviewed for this podcast, and I don’t treat everybody for parasites either. I like to get different perspectives. Someone might hear a podcast episode where I interview someone who says, “Yes, everyone needs to be treated for parasites.”

Dr. Nirala:

That’s just a foreign concept to me. First of all, it’s interesting. There is a study that shows African immigrants came to America and started an American diet. I can’t remember now, it’s been a while since I read that study. What stood out to me was that when they started having digestive symptoms, and they went to the doctor and did the fecal multiplex PCR that looks for the parasites and the food poisoning bacteria, and they had parasites, they were given antibiotics, and everything went to hell in these people.

Some of the parasites are actually ancient organisms that have coevolved with us. The problem is that the terrain of the gut has been so mismanaged or is in such poor shape with such low microbial diversity for example and overproduction of different toxic metabolites that the environment that leads to the growth of some parasites. I’m certainly not trying to make the blanket statement for all parasites. It’s more the thought process that leads to why do we need to find the one bug that’s causing this, and all the problems are over? I just don’t subscribe to that idea.

Dr. Eric:

I agree. I appreciate you taking a few minutes to address the true or false questions. I know there is so much we could cover, but anything that we didn’t cover that you really wanted to bring up? Any last words that you wanted to mention before you tell everybody where they can find you?

Dr. Nirala:

Well, I think you did a pretty good job with the questions, especially if you have other episodes of your podcast that go into more symptoms and causes. I would invite people that have SIBO that are struggling with it to start focusing on finding the underlying cause. There is a free handout they can get from TheSIBODoctor.com about what caused my SIBO. It’s a very rudimentary questionnaire that you can complete and give to your practitioner. They can at least get some idea about what the problem is, because that’s really where true healing is. It’s not always about chasing bacteria. That being said, some people who have a damaged enteric nervous system or migrating motor complex may need repeated doses of antimicrobials. At least you know then what the problem is, and you can address it correctly.

Dr. Eric:

Definitely check out her website and her podcast. Amazing podcast. I have taken a few of her courses, including the histamine master class with Heidi Turner. That was a good class as well. Also, you’re in practice, too. TheBiomeClinic.com. You are still seeing SIBO patients.

Dr. Nirala:

Yes. I am planning on going on a sabbatical at the end of this year. That’s been a recent decision I’ve made. I have been in practice for a long time, and I need to take some time off to rejuvenate my enthusiasm for everything and also focus on other courses that I want to update. I am in the process of updating the SIBO mastery course for practitioners. I still have a lot of juice for the topic because I have four different businesses and things I have my fingers in. I need to downsize a little and not see patients. Patients, as you know, are often complicated and time-consuming. It’s wonderful. It’s very rewarding. I have decided to take a little bit of a break.

People can find me on TheSIBODoctor.com. That’s where a lot of the courses and free resources are. The Bi-Phasic Diet e-book now has a charge to it because it’s expanded, and I have put a lot of effort into it. That’s available. There are some other free resources you can find.

The SIBO Success Plan is a course for patients that I have put a lot of energy into, so people get a good education. I expand on a lot of things we talked about here today.

Dr. Eric:

Thank you so much, Nirala, for sharing your knowledge with regards to SIBO, the Bi-Phasic Diet, putting up with my true/false questions. I appreciate your time. As usual, I always learn a lot from chatting with people here. Definitely learned a lot from our conversation here.

Dr. Nirala:

Thanks for the invite, Eric.

Recently I interviewed Dr. Izabella Wentz, and we talked about the adrenal transformation protocol. If you would prefer to listen the interview you can access it by Clicking Here.

I am beyond excited to interview today’s guest, Dr. Izabella Wentz. If you have Hashimoto’s, then there is a very good chance you’ve heard of Dr. Izabella. Just in case you haven’t, I will dive into her bio. Dr. Izabella Wentz is a compassionate, innovative, solution-focused integrative pharmacist dedicated to finding the root causes of chronic health conditions. Her passion stems from her own diagnosis of Hashimoto’s in 2009, following a decade of debilitating symptoms. She is a New York Times best-selling author of three books on Hashimoto’s. Her newest book focuses on adrenal health, The Adrenal Transformation Protocol: A Four-Week Plan to Release Stress Symptoms and Go from Surviving to Thriving. Thank you for joining us, Dr. Izabella.

Dr. Izabella Wentz:

Thank you so much for having me. It’s such an honor to be here with you. It’s so great to see you again.

Dr. Eric:

I agree. So great to catch up and chat with you about adrenals. As we were talking prior to the recording, years ago, we swapped interviews, and we were focusing on thyroid. We’ll integrate thyroid into today’s talk as well. Really doing a deep dive into adrenals.

People know about your background with Hashimoto’s. If you could maybe elaborate a little bit more, tie in your experience with adrenals, and why you decided to write the new book.

Dr. Izabella:

Sure. I was diagnosed with Hashimoto’s in my 20s after almost a decade of some debilitating symptoms. I was never really interested in thyroid gland and thyroid medications during pharmacy school. I just thought they were boring. I really came to appreciate the condition. All of that was going on with Hashimoto’s.

When I was diagnosed myself, I started taking thyroid meds. I felt a little bit better but not fully better. I realized there were a lot of dysfunctional patterns that were in my body. Some of them were causing me to have Hashimoto’s. Other parts of that were consequences of having hypothyroidism for a while or were worsened by the hypothyroidism. I wanted to figure out if there was anything I could do to make myself feel better and feel human again.

I really focused on looking at the research and patient forums and trying to figure out if I could find out a plan to get myself better. I did, thankfully. I then wrote a book about it in 2013 called Hashimoto’s: The Root Cause. Throughout that process, part of what was really fundamental to my healing journey was changing my nutrition. I went gluten-free and dairy-free, which helped me tremendously. I was able to eliminate acid reflux, joint pain, carpel tunnel, and IBS that I had had for many years prior that was barely responding to medications. This resolved the acid reflux and the IBS and bloating within three days. Holy cow.

Then I still struggled with brain fog and fatigue, especially morning fatigue. I was a night owl, where I had a hard time falling asleep at night. I felt anxious and wired but tired throughout the day. I was always wearing sunglasses and would step outside. Man, I feel like a vampire right now, being outside with these bright lights. I had seasonal affective disorder. If I would stand up too quickly, I would feel faint. Always startled and always anxious in that fight or flight state.

Somebody brought up adrenal fatigue to me. Okay, that’s interesting. What are the adrenals? What’s going on? I go to Google it 10+ years ago. Some reputable medical sites said, “Adrenal fatigue doesn’t exist. It’s a quack diagnosis.” I was a skeptical pharmacist, not going to go down that road because that’s a fake thing.

Finally, it probably took the 15^th person who happened to be my local compounding pharmacist, Mr. Carter Black. He said to me, “Hey, have you looked into adrenal fatigue?” Maybe I had a moment of weakness when I was like, “Fine, I will look at that.” Sure enough, I had all the symptoms. I tried the recommendations. I got better. I talk about adrenals in my Hashimoto’s book, in all of my work on Hashimoto’s. That is part of the healing plan: to support the health of your adrenals.

I have worked with thousands of people with Hashimoto’s and hypothyroidism at this point. 90% of them had some degree of adrenal dysfunction when I tested their levels. I had a pretty straightforward protocol for the adrenals. I thought it was straightforward and made a lot of sense. It helped me get better. I was trained through functional medicine.

Then this all came to a big moment when I was a new mom of an eight-month-old baby, who was still waking up a lot throughout the night and needed to eat at night. I was his main source of food. I found my adrenals were dysfunctional again, but I couldn’t utilize the hormones that I had normally recommended for others because I was nursing. I didn’t feel comfortable taking a lot of supplements. I wasn’t going to sleep. That was one of the big things people recommend to heal adrenals. Yes, but I’m not sleeping, so I need something else. People also recommend cutting out coffee. I was like, “But coffee is the reason I function during the day.” I had to come up with a new way to heal and resolve brain fog, energy issues, and sleep issues for myself.

Being a guinea pig, I stood out to my community. It’s now helped over 3,500 people resolve all these symptoms in just 3-4 weeks. That’s how I began to talk about adrenals. I’m not changing my name to the adrenal pharmacist or anything, but addressing that adrenal dysfunction is a key component to healing when you do have thyroid issues.

Dr. Eric:

I agree. When I dealt with Graves’, the stress and adrenal issues played a role in the development of my condition. Over the years, I have worked with both hyperthyroidism and Hashimoto’s. As you know, I have more of a focus on those with hyperthyroidism and Graves’. Like you see most people with Hashimoto’s having adrenal problems, I would say the same thing with those who have hyperthyroidism or Graves’. It’s even in the literature. If you do some research, I wouldn’t say adrenals are in the literature with Graves’, but stress and Graves’, there is a number of journal articles. If someone is dealing with chronic stress, it’s almost definitely going to affect the adrenals. Your book, your protocol, is definitely well needed.

Let’s talk about why many people have compromised adrenals. I mentioned chronic stress. I’m guessing that’s a big reason why a lot of people have adrenal imbalances.

Dr. Izabella:

Absolutely. Current stressors can cause a whole host of issues. I typically will ask people that I work with: What was going on in your life before you got sick? Most of them will say something very stressful was happening in their lives. Maybe they were going through a divorce. Maybe there was a death in the family. Maybe they were fired from a job or had a major terrible life change.

There was a study that was super interesting talking about a woman who was thrown down the stairs and developed Graves’ shortly thereafter because of that traumatic, stressful experience she had had. That is a big connection for a lot of people: something bad happens that overwhelms your ability to cope and handle it.

There are also good stressors. You have a baby. Yes, bundle of joy, but yes, it’s stressful for your body. Growing a baby takes up nutrients. Then the life change is big. Not sleeping, being nutrient depleted. That is a happy life change for a lot of people, but also stressful. Getting married, getting a new job, getting a job promotion, going to graduate school. All of these things can be incredibly stressful.

We were just talking about the medical profession. How many times doctors have to do 80+ hour weeks at the hospital. I personally had to do two or three exams every week when I had to wake up at 5am and get to those exams. I loved going to graduate school, but I wouldn’t say it wasn’t stressful because it was stressful, right? All the deadlines and all that pressure you can have from creating very positive change in your life, from the personal growth that you can experience, starting a new business or starting a family, moving across the country or going to graduate school.

There are also stressors that happened to us a long time ago that we may not even remember. History of childhood trauma. Something happened when you were three. You may not even have a clear recollection of it, but it stayed with you. It’s this unprocessed stress that could also be present in our bodies and lead to low levels of inflammation. There are a ton of studies that have connected childhood trauma to autoimmunity later on in our adult life.

Then we have physical stressors, things that are in our lifestyle. Sleep deprivation. One of the fastest ways to wreck your adrenals is if you don’t get sleep. I have been there, done that. I have written the book. This is a key component to getting back in balance. If that’s an issue for you, you need to address that.

There are things like overexercising, undereating, being nutritionally deficient, having blood sugar imbalances. Some of these habits of hustling. You have your job, and you have your side hustle, and you have your side hustle. That can be incredibly draining on a person.

There are some of these stressors that I feel like unless you’re working in functional medicine or with a functional medicine doc like yourself, you’re not even aware that they’re present. These could be infections like H-pylori. Such an important trigger for Hashimoto’s and Graves’ and for all kinds of digestive issues. This leads to inflammation and stress in your body. There are protozoal parasites that can be an issue for some people. There are toxic exposures, like people don’t even know they might be exposed to mold or another type of toxin that is sending these stress signals to the body.

Really anything that overwhelms our ability to cope is going to be what I consider a stressor and can get us into that adrenal dysfunction state, where we’re stuck in that stress response rather than going through a stressful time, shaking it off, and then you move on with your life. You feel good again, and you feel normal. Instead, you get stuck in that fight or flight mode. Your body is not really repairing itself, and then you end up having really low levels of energy, fatigue, anxiety, sleep issues, all the things.

Dr. Eric:

I agree. One factor that resonates with me is overexercising. That was also me prior to my Graves’ diagnosis. Emotional stress definitely played a part in my adrenal imbalances, but I was overtraining. With my background, I should have known better, but I didn’t. Looking back, that was a big tax on my adrenals, so I’m glad you mentioned that.

You’re correct about everything you said: the infections potentially could be a factor when it comes to adrenals. We live in a toxic world, so we tend to overlook the impact that these toxins have on our adrenals as well as other areas of the body.

When you dealt with Hashimoto’s, you felt like you had some of the classic symptoms of having compromised adrenals. When it comes to finding out whether someone has an adrenal imbalance, would you recommend relying more on symptoms, do you recommend testing, or a combination of both? The question I’m asking is how does someone know if they have an adrenal imbalance?

Dr. Izabella:

I personally love testing. If I could have my little way, I would have everybody take every single test. Let’s collect all this data. I force my husband and my son to do all kinds of tests. We do stool tests. We don’t do a lot of blood tests with my son because he is little. Let’s test your urine, let’s test your stool, let’s test this, and see what’s going on in your body and how we can optimize it. That testing can be incredibly helpful to figure out if you have adrenal dysfunction.

I love the ZRT adrenal saliva test. I love the Dutch urine test. For the 10 years I have been talking about people getting tested, people oftentimes will go to their endocrinologist and ask them to test for adrenal issues. They test them for Addison’s, and they say they don’t have adrenal issues. There is a disconnect between integrative, functional, natural medicine and conventional medicine, where conventional medicine doesn’t recognize this adrenal dysfunction as a real thing. They are not testing for it.

People get the runaround from their conventional docs, so I’ll be like, “No, you need to find an integrative doctor.” The integrative doctor is too expensive, or they have to pay out of pocket for them, and for these tests because they are not covered on insurance because they are experimental. That’s another barrier to people getting that test and getting the help that they need.

Another part would be they do see the doctors. They get the tests. The tests would be sitting at their house for however long because you have to get off of caffeine and all of that to get an accurate test. They just can’t do it. They don’t have the energy not to have caffeine for a day.

Then you have the test results. Great. They took a few weeks to get back, or sometimes a few months because the person didn’t do the test right away, or the lab had a backlog. Then you are sitting on six months to a few years from the time that you knew you had these symptoms to when you get the plan.

Then you get the plan. For whatever reason, you react to the hormones, or you react to something else. You can’t comply with the plan. Part of the traditional plan is to get off of caffeine, get lots of sleep, take hormones, and take glandulars. Some people took glandulars and had palpitations, or the hormones gave them back-ne, or they are now estrogen dominant because they took too much of the hormones, or there is no way you are taking coffee out of their cold, dead hands. They won’t do it. There is a lot of barriers to it.

The beauty of my program is that it focuses on symptoms. If you have these symptoms, there is a chance your adrenal stress response is off. Here is the good news. Let’s rewire that stress response so that you feel good. I don’t necessarily focus on adrenal testing throughout the program. That’s not a requirement for you to feel better. I hope that eliminates the barrier for people to feeling better.

People can absolutely do tests, and they will be incredibly helpful if they are working with a practitioner. I want to eliminate that one barrier because there are so many people who are suffering, but they don’t have the ability to access these things.

Dr. Eric:

I have been using saliva testing in my practice to look at the Circadian rhythm of cortisol. You mentioned Dutch testing; I also like that test. But you’re right. There are some people who either can’t afford to do the test, or they can afford it, but it sits on their shelf for a few months before they send the test in. It’s nice to know that there is a way where they can just read your book and look at all the symptoms and get a good idea if they have an adrenal problem by looking at the book and bypassing the testing.

If you go to a conventional doctor, they are not going to do anything unless you have Addison’s or Cushing syndrome. They will just do blood testing or ACTH stimulation. When it comes to looking at Circadian rhythm, they won’t go there.

I used to use adrenal fatigue all the time years ago. It kind of gets a bad rap, adrenal fatigue. It’s not really adrenal fatigue; it’s dysregulation of the hypothalamic pituitary axis. We are going back and forth. We’re not saying adrenal fatigue, but we’re saying adrenal dysfunction. What are your thoughts on if adrenal fatigue really exists, or if it’s just a term that was used in the past, and now it’s adrenal dysfunction, or HPA axis dysregulation?

Dr. Izabella:

I think adrenal fatigue has been cancelled. Is that what happened? When I was trained in functional medicine, I understood—this was over 10 years ago—adrenal fatigue as you are fatigued because your adrenals are not functioning properly and because your HPA axis has a disconnect. Your adrenals are capable of making the right amount of hormones at the right time, but they’re not doing it, so we need to reconnect that wiring between your brain and your adrenals.

What I now understand as the original definition and intent of the term “adrenal fatigue” is that the adrenals were actually fatigued and unable to produce adrenal hormones. That’s what people used to think back in the day. Now the endocrinologists are like, “Adrenal fatigue doesn’t exist. Only Addison’s is a thing. We test these people, and their body is capable of producing cortisol.” I do agree with that, that in people with this HPA axis dysregulation, they can produce cortisol in the right amounts at the right time of day, but their body is just not doing it.

I scratch my head because doctors will say, “Adrenal fatigue doesn’t exist,” and they will call it HPA axis dysregulation, where that doesn’t necessarily roll off the tongue. But that is where all of the evidence base is. If you do a search on PubMed, which is the largest database of medical journals, you will be able to find HPA axis dysfunction, but it doesn’t necessarily roll off the tongue, does it?

I call it “adrenal dysfunction.” The symptoms of adrenal dysfunction are the same as symptoms of adrenal fatigue and burnout. It is how the body responds to stress. They are not the same as Addison’s. Addison’s, you would have all of the symptoms of adrenal fatigue, and then some. Addison’s is a different kind of condition. It just happens to be tied in with our stress hormones.

I hope that clarifies it. It’s one of those things where I feel like 10 years ago, people were like, “Leaky gut doesn’t exist.” You would search for “intestinal permeability,” and there is all this research behind it. For a while, I didn’t say “leaky gut.” I said, “intestinal permeability.” People were like, “Okay.” But if I said, “Leaky gut,” they would be like, “Quack! I don’t know what you’re talking about.” Now you have to say, “adrenal dysfunction,” even though we all know it’s the same as adrenal fatigue or burnout. What our bodies do for a prolonged period of stress, that’s how it adapts to stress.

Dr. Eric:

I agree. Definitely easier to say “adrenal fatigue” or “adrenal dysfunction” instead of “HPA axis dysregulation.” Thank you for clarifying that. Can we get into the different components of your adrenal transformation protocol?

Dr. Izabella:

I really focus on figuring out why your body is in this fight or flight mode. What are the signals you’re sending to your body that is telling you that you’re in danger right now? Things like sleep deprivation over exercising, over- and under-eating. These three things that are part of modern culture of “Lose weight, and exercise, and burn the bridge at both ends.”

Oftentimes, if you were thinking of caveman/cavewoman times, the cavewomen, if they were doing this, they would be like, “Okay, I’m not eating enough because there’s a famine. I’m overexercising because I’m being chased by bears. I’m keeping watch because there is some tribe trying to attack me. That’s why I’m not sleeping at night.” They would get shifted into this high alert, fight or flight response. There are things we’re doing in our modern life that are kind of doing the same because we have our ancient genes and ancient wiring that isn’t necessarily tuned into an abundance of food. I’m under immediate threat right now, and I’m not sleeping because there are deadlines. Our body shifts into this survival state.

Part of what I do is I focus on what are the safety signals we can send your body in a language that it understands that we are safe, and we do not need to be in that survival mode. How to shift the body into thriving. When we are in that survival mode, our body is not repairing itself. Our body is essentially breaking itself down. That can be very problematic when you have antibodies because it’s not balancing the immune system or the inflammation. It’s not repairing itself. We want to shift into that repair mode.

What I focus on is replenishing. First, we focus on replenishing any kind of nutrients. We focus on micronutrients. We focus on B vitamins and vitamin C, which are incredibly helpful when people have been under stress for a long period of time, as are magnesium and electrolytes. They help us come back from all that stress.

Then we focus on making sure we get enough protein and fat. Part of what’s happening with the adrenal dysfunction is we’re utilizing amino acids to fuel the stress response. Amino acids are like the little bricks our body uses to fix itself. By eating more protein, we’re getting more amino acids into our system. Protein is made up of amino acids. That’s a big part of the beginning part of the program.

You focus on nutrition safety signals. Nutrient dense foods, not starving yourself, eating frequently every two to three hours for some people to start yourself that way.

Then we go through additional safety signals, which focus on reenergizing. Part of that is you get connected with the Circadian rhythm. You figure out how to give your body more energy throughout the day and less energy at nighttime, so you can sleep and replenish and really heal and save your body another part of that safety signal.

Then we get into revitalizing. This is probably a favorite part and a little bit of what makes my book a bit unique from some of the others out there. We really focus on pleasurable activities that tell us that it’s safe. We focus on things like a lot of us have goals. If you’re an ambitious person, sometimes it feels like you’re just knocking things off of your to-do list. You have your family and your work and your parents who are getting older to take care of. All of these adult responsibilities, where that can make us shift us into that survival fight or flight mode.

Taking some time throughout our day to focus on pleasurable activities. Maybe you like painting, and that brings you a lot of joy, but you haven’t done that for a long time. Maybe scrapbooking is your thing, putting a bunch of stuff on the floor and making some cute scrapbooks. Maybe that brings you a sense of joy, but you haven’t done it for 10 years because you have been on the stress rollercoaster. I give people a prescription for pleasure, just to do the things you love and enjoy. That is such a powerful way for them to shift out of that survival mode into more of a thriving state.

Then we also focus on rebuilding resilience, which is figuring out what weighs you down and how to get rid of those things. A lot of times, it’s past trauma. We focus on giving people trigger tools. If there are things that are really setting off your fight or flight response, like annoying people being one example, then you would focus on that. What do you do if somebody really drives you nuts and annoys you? Here is a list of ideas. Let’s develop a trigger toolkit, so you don’t get into that angry survival state. You figure out how to work with that.

Then we focus on how to build up your body and how to be more resilient to stress. Even though we all have stress in our lives, you can’t always get rid of it, but you have to cope with it and let it bounce off of you rather than absorb into our system and overwhelm us.

Dr. Eric:

That’s amazing. I want to talk a little bit about replenish. In this day and age, intermittent fasting is popular. I’ll admit, I do some intermittent fasting these days. For example, when I dealt with hyperthyroidism, I wanted to do intermittent fasting for a few reasons. I was losing tons of weight due to hyperthyroidism; I lost 42 pounds, so I definitely was not thinking about intermittent fasting back then. A big reason is also now you see it all over the place. Back then, in 2008/2009, it wasn’t as popular. I also mentioned how if someone has compromised adrenals, you do want to be cautious about intermittent fasting. It sounds like we’re on the same page. You’re talking about replenishing, making sure you’re not undereating. Can you talk more about that?

Dr. Izabella:

Of course. I’ve had a lot of ladies go through my program who are struggling with weight issues, so their goal is to lose weight. They are restricting calories, trying intermittent fasting, trying things like the keto diet, doing lots of exercise. They are doing all of these things that are supposed to help them lose weight. I will say these things work really well if you’re a 20-year-old fitness guru. They work so well, and you can get a six-pack that way. But if you have dysfunction in your stress response and your thyroid, these things can actually backfire.

People with flatlined adrenals, where they have this flatlined adrenal curve, where they just don’t produce enough cortisol throughout the day, stressful things will overwhelm them. Doing things like cardio, which is supposed to be really great for most people, when it’s balanced with proper atabolic exercise, like lifting weights, they will do that and be exhausted. “Everybody said if I wanted more energy, I should exercise more. This did not work for me.” Or they will hear things like, “Skip breakfast,” but part of the whole presentation is you will have blood sugar swings. Fasting can actually make you feel worse, and you can crash. Your body is like, “Oh no, we’re in a famine.”

When you have a really balanced response, at this point, you can do fasting because you have worked so much on your health. I can do fasting. I can do aerobic exercises. I can do all the things. But when I was trying to heal my adrenals, and even a few years ago, when I was a new mom and sleep-deprived, a lot of these things were stressors. They were shifting my scale of you have this thriving here, or you’re surviving here, and depending on how many things you put on each side of the scale, your body will shift that way. If you’re a new mom who is sleep-deprived, you already have that stressor. You want to counteract with eating lots of great foods. If you have inflammation, autoimmunity in your body that’s very present right now, that’s a big stressor. We want to reduce that stressor and send more safety signals.

I think it’s simple math. You put a little bit of weight here, and you can do that. If you are overall in a good healthy, balanced state, doing a little bit of intermittent fasting can be game-changing. But if you already have too much stress on your plate, that will cause you further issues. That’s been my experience as well as yours for people with adrenal dysfunction. That’s one of the things I’m trying to raise awareness about for people who beat themselves up. “Well, I must be exercising enough. I must not be fasting enough. Why is everybody else getting results, and I’m not?”

Dr. Eric:

Adrenal imbalances could also be a factor when someone is trying to lose weight. If they are doing everything from a dietary standpoint, they are exercising regularly. Like you said, it could backfire because if they are doing those things. Getting back to exercise, even simple cardio sometimes, but especially these days, you see high intensity interval training. Someone might be doing HIIT along with the intermittent fasting, and that’s just continuously taxing their adrenals, which could make it even more difficult to lose weight. You’re right. It becomes a vicious cycle.

Dr. Izabella:

It does. I’ve had so many women who were so reluctant to take my advice of eating more calories and doing less exercise because they were trying to lose weight. “Is it working?” A lot of times, they’d be like, “No, I’m gaining weight. I do all this exercise,” and it’s further suppressing their metabolism because they’re getting stressed. Part of the plan is you eat more protein, and you get more nutrients, and you focus on destressing your body.

We have had people who have started the program underweight, and we have had people who have started the program overweight. The beauty of adrenals is if your weight issues are caused by adrenal issues, destressing is going to help you get to a healthier weight. We have had 80% of people trying to lose weight, “You know what? I did lose 5-10 pounds on this plan.” 5-10 pounds is a healthy amount of weight to lose over 4-6 weeks. You don’t want to lose 40 pounds in a week or anything like that. The people who were wasting away, we help them shift into gaining more weight.

One of the things I utilize throughout the program is carnitine. People with thyroid issues often get into this state where they’re muscle wasting, and carnitine can be incredibly helpful for that and the resulting brain fog, fatigue, blood sugar issues, supporting their mitochondria. People find they feel better. Weight isn’t a focus on the program, but it tends to normalize as people go through the program.

Dr. Eric:

Do you recommend acetyl-L-carnitine or regular L-carnitine tartrate?

Dr. Izabella:

I recommend a combination, just because L-carnitine is going to be helpful for muscles. Acetyl-L-carnitine can be helpful for the brain to waken people up with that brain fog. I find a combination of one supplement that has both of them in there, and the L-carnitine has more with a little acetyl-L-carnitine. You don’t want to do too much of the acetyl-L-carnitine. That tends to work well for the brain fog. 92% of people in my program have had their brain fog resolved. That’s one of our biggest success symptoms in the program.

Dr. Eric:

You mentioned the Circadian rhythm. How important do you feel it is to get sun exposure to get back on track with the Circadian rhythm? Do you recommend getting morning sun exposure? At night, I imagine you tell people to limit blue light and other things just to get back on track there.

Dr. Izabella:

I have lived everywhere. Maybe not everywhere. I have lived in Europe and many parts of the United States. Right now, I live in sunny Austin, Texas. I was in Los Angeles for a few years. I was also in Chicago; Boulder, Colorado; Poland; and rainy Amsterdam. Bear with me. I know people can roll their eyes when they’re like, “Get morning sunshine. Step outside. Spend time in nature.”

If you can do this, this can be incredibly game-changing. If you can get sunshine first thing into your eyes when you step outside, that’s going to let your body know it’s time to wake up. That will raise your cortisol to healthy levels without needing to rely on caffeine to raise your cortisol to wake up. That also sets the clock for your body, so your body knows that it’s waky waky time now. In this amount of hours, it’s going to be time to unwind and go to sleep.

I know it’s not always possible. I have lived in Chicago and Amsterdam and Colorado. Sometimes, I’ll recommend a dawn simulator or light therapy boxes. I actually have a list of things throughout the book and the program. People are like, “Great. If you live in perfect weather year-round, you can do this.” But it’s not realistic for people living everywhere in the world. There is a way around that. Even if it’s raining and snowing on your doorstep right now, which sometimes in Colorado, it would be end of May, and there would be snow. How is there snow in May?

Dr. Eric:

I’ve seen photos of not just snow but lots of snow in May. There have been a few snowstorms over the last few years. I don’t know about last year specifically, but I have seen at least a couple of different years in May where it was completely covered. I’m sure you’re glad to be in Austin, Texas, so you don’t get the May snow.

Dr. Izabella:

Yes, I miss Colorado. I love Boulder so much. I miss all my friends. We miss Colorado so much. But we are also loving our time in Austin. My husband’s family is here, so we’re excited to be here with our little one. I am one of the people who doesn’t mind the heat. I’m saying that now. Ask me again next summer. It is nice to have access to the morning sunshine and nature because that can be really regulating for our Circadian rhythm.

Dr. Eric:

I’m glad you mentioned the light therapy boxes. You’re right. If someone lives in Seattle or Portland, where it’s rainy a good part of the year, they might not be able to get that sun exposure waking up. That’s an excellent idea. Check out her book for some of those resources.

I promise we will get to the supplements. Before we get to that, we can’t have an episode with a thyroid pharmacist without talking about thyroid and adrenals. What connection have you seen between thyroid and adrenals, whether adrenals are affecting thyroid or thyroid affecting adrenals?

Dr. Izabella:

Our hormones talk to each other. It’s not like we have these individual hormones in a vacuum separated from one another, like naughty children that have to be separated in the backseat.

The first thing that can happen is if a person is hypothyroid, when their thyroid is underactive, cortisol will accommodate for that. When we are low in thyroid hormone, our cortisol clearance decreases, so our body keeps cortisol in our system longer. Typically, people will say, “Oh, I’m kind of tired, but I’m kind of wired.” That wire is coming from that cortisol. It’s trying to help you out and keep you alive and not sloth-like. That’s part of the feedback loop system.

Then as people get onto thyroid medications, their cortisol clearance increases. You get on thyroid medications, and it normalizes your thyroid function, but your cortisol clearance increases. All of a sudden, you’re left with really low cortisol. This can be unmasked. Hyperthyroid states as well. Then you have increased cortisol clearance. It’s one of those feedback loops that occurs with thyroid issues.

Then we focus on what’s happening with people who have too much stress. Sometimes, they will have more production of reverse T3, which can block thyroid hormone receptors. People aren’t able to utilize their active thyroid hormone properly. It’s a feedback loop system. For people listening, you don’t have to memorize this. You won’t be quizzed on it. This is us talking about the nerdy things.

The key to remember is if you have a thyroid problem, your adrenals have probably been compensating. There is some kind of feedback system. Oftentimes, people with thyroid issues, 90% of the time, I’m not sure if that’s your experience as well, with hypothyroidism, we do have to support the adrenals for a person to get rid of all their symptoms.

Dr. Eric:

Yeah. I agree. You mentioned cortisol clearance. I don’t do dried urine testing on everybody. It’s interesting because they look at that cortisol metabolism, so you can see that. If someone has hypothyroidism, typically, you’ll see not only a lot of times cortisol low (not all the time). You almost always will see the low cortisol metabolites.

Opposite with Graves’. If someone has hyperthyroidism, you will see on that test where the cortisol metabolites are elevated. Exactly what you said. You usually do see that pattern with hypothyroidism and hyperthyroidism, increased cortisol metabolites because you are getting the increased cortisol clearance. Also with elevated cortisol, there are a lot of different factors that could affect the conversion of T4 to T3. Also, elevated cortisol could affect that conversion.

One other thing I’ll say: This isn’t really a connection between adrenals and thyroid directly, but just the impact of chronic stress. Chronic stress of course affects adrenals. It could also decrease secretory IGA, which lines the mucosal surfaces of the body, including the gastrointestinal tract, and make someone more susceptible to infections, for example. It serves as a form of protection, which in turn could be a trigger, as you mentioned earlier, talking about H-pylori and parasites. Stress is directly affecting adrenals, but that whole connection between stress affecting adrenals and stress affecting secretory IGA, which can make someone more susceptible to an autoimmune condition such as Graves’ or Hashimoto’s.

So supplements. Let’s talk about some of your favorite supplements. You mentioned L-carnitine, which is a mixture of acetyl-L-carnitine and regular L-carnitine, like L-carnitine tartrate. You mentioned earlier B vitamins. You mentioned Vitamin C. I know there are others, like ashwagandha, rhodiola, licorice root. I’ll shut up and let you talk about supplements.

Dr. Izabella:

We already talked about carnitine. It’s traditionally been used for people with Graves’. People used to think it had antithyroid effects. It’s also been used successfully now for people with hypothyroidism. What we’re learning now is it tends to act as more of a stabilizing effect with thyroid hormones. That’s been really fabulous for thyroid fatigue.

I try not to give too many supplements. I try to pick ones that have multiple uses. The carnitine helps with balancing blood sugar; clearing ammonia in the body, which can cause a lot of the brain fog; muscle strength; brain health; helping our metabolism utilize fatty acids; and a lot of things. I utilize that as part of the protocol. It supports our mitochondria.

Then I focus on saccharomyces boulardii. It helps to raise our secretory IGA levels, even when we’re stressed. Whatever is living in our gut or wants to live in there, we have this extra layer of protection. We talked about how infections can sometimes be a trigger or exacerbating factor for thyroid issues. The saccharomyces boulardii can help you clear out the infections naturally, whether it’s candida or mold or parasites or H-pylori. Sometimes, just the saccharomyces boulardii can do that on its own. Other times, you might need deeper protocols, especially with H-pylori because that pathogen tends to be notorious and can make biofilms and can be something that is resistant to various things. Always having that extra layer of defense will be helpful.

It’s also helpful for preventing infections; preventing some food reactions and making us tolerate more stuff. This is one of the hacks that gives people a little bit of an edge, where they can start recovering a bit faster from the effects of a lot of stress in their bodies.

I focus on utilizing adaptogens. There is a whole host of different herbs, and all of them have different personalities. These herbs can make us a bit more resilient to stress.

Rhodiola is a great herb that I like because it’s helpful for balancing the stress response. It’s been shown to be effective for anxiety, depression. It also helps us grow new mitochondria, which mitochondrial dysfunction is oftentimes a part of the whole fatigue adrenal presentation.

I focus on B vitamins and Vitamin C, which get depleted during a stress response. I will often try to put that in one supplement formulation, but it’s not right for everybody. I have a few options for people.

Licorice is something I really love if you have low cortisol and low blood pressure. If you have high blood pressure, don’t do it because it can make your blood pressure even worse.

I focus on magnesium. Magnesium can be incredibly helpful. It’s a cofactor for hundreds of biological systems in the body. It’s great when people are saying, “I have cramps. I’m anxious. I have trouble sleeping.” This is incredibly helpful for so many people. It gets super depleted when you’re stressed out.

I utilize electrolytes. They have lots of Vitamin C and D ribose. Electrolytes help us with recovery. People with adrenal dysfunction tend not to have enough electrolytes. I use powder. I don’t use Gatorade or anything with junk in it.

The other thing is utilizing myoinositol, which is helpful for blood sugar balance. This is something that many people have found to be very helpful for anxiety and even OCD symptoms.

I have this handful of supplements that people utilize. Of course, not every supplement is right for everybody. I have a section that talks about the pros and cons of each supplement and which ones you might wish to utilize as part of your healing journey.

Dr. Eric:

Wonderful. Thank you for sharing. I like adaptogens as well. I definitely will reinforce what you said about the licorice root. If you have high blood pressure, you don’t want to take it.

Last but not least: stress management. I probably should have brought this up before the supplements. Stress management is not all about taking supplements, like you said. You admitted you don’t want to give people a bunch of supplements to take, but they do help to speed up the recovery process. In some cases, they can be beneficial for adrenal health. But if that’s all you do, it’s not going to fix your adrenals.

You mentioned getting sufficient protein in your diet and fats. You just mentioned myoinositol to help with blood sugar imbalances, so you want to minimize sugar. That’s important. I don’t know if you want to talk about that as well.

Let’s finish up by talking about sugar and stress management, your thoughts on those two things when it comes to adrenal health.

Dr. Izabella:

Most of us need to eat more protein and fat and probably less carbs than we think we need. I don’t recommend necessarily a keto diet for most people, but we focus on whole food sources of carbohydrates. We focus on proteins and fats. The diet template is very similar to a paleo diet, where we don’t eat a ton of grains, just because they can have an impact on blood sugar.

Blood sugar imbalances are part of that adrenal dysfunction. People end up on this blood sugar rollercoaster, and they end up feeling anxious and tired and very off when their blood sugar is out of balance. They end up storing fat instead of burning it. We shift the nutritional safety signals to focus more on that protein, fat, and lower carb intake to help people balance their blood sugar. People feel more calm, steady throughout the day. They don’t get that 3pm crash. They don’t wake up at 3am, like, “Where am I? Who am I? Why am I so hungry?” That 3am wakeup is usually a person going hypoglycemic and cortisol trying to save us. People get that cortisol surge at 3am. We really focus on how you sleep better and how you have more energy throughout the day. That’s balancing your blood sugar.

Yes, we don’t eat candy. I do have people drink orange juice first thing in the morning to help raise their glucose levels. Oftentimes, glucose is low in the morning when we have low cortisol, and blood pressure is low. We combine that with some protein and some fat from coconut milk. We add some sea salt or electrolytes to that, so you slow down the effect of what I call the blood sugar rollercoaster. If you have orange juice by itself, you go up and you crash. When you combine it with all the different proteins and fats, you have a much smoother ride throughout your day. You get the boost of glucose, so your blood sugar improves in the morning, and you feel a little bit better. You have more energy. But you don’t get the crash. That is part of the nutritional program.

I’m so glad you asked about stress management because people are so willing to take supplements and change their diet, and there are free things you can do. Your stress adjusts. That’s the easiest and the hardest thing to do.

I talk a lot about trading coping mechanisms. We talked about the trigger toolkit. If somebody triggers you, how can you respond? What can you do to soothe yourself? We talk about creating the space for healing and figuring out what in your life is making you feel worse and what is making you feel better. Generally, we try to focus on doing more of the things that make you feel better. If there is a way to eliminate the things that make you feel worse or find a way not to impact you so much, that will be huge for the healing journey.

Dr. Eric:

Is there anything else that I didn’t ask you that I should have asked you? Any final words? Any last things you want to chat about?

Dr. Izabella:

I just wanted to mention to people that if they are struggling with brain fog, fatigue, mood issues, anxiety, trouble sleeping, you do not have to feel like this forever. Just because it’s common doesn’t mean it’s normal. A lot of people are stuck in this survival mode. There is a very targeted way to get out of that with sending your body these safety signals, so you can thrive and feel amazing and have lots of energy and sleep really well and have your brain work and feel strong and fit in your body and pain-free. I hope you will take the time to learn more about your health. Thank you for joining us. Hopefully, this will help you on your healing journey.

Dr. Eric:

I’m sure listeners learned a lot, and I’m sure they will learn a lot more by reading your book, The Adrenal Transformation Protocol. Your website is ThyroidPharmacist.com.

Dr. Izabella:

Yes. I have a free guide at ThyroidPharmacist.com/ABCs that talks about the ABCs of Adrenals, B vitamins, and C vitamins, and some of the stress management techniques. My book is available on Amazon and Barnes & Noble and wherever books are sold.

Dr. Eric:

Since we talked about adrenals, focus on Dr. Izabella’s adrenal transformation protocol book. Highly recommend her Hashimoto’s book and her other books. They’re wonderful. I think I have even listened to some of them on audio.

Dr. Izabella:

Yes. One strategy I hadn’t mentioned for people who maybe cleaning their house they find stressful, or driving in the car they find stressful, consider listening to an audiobook when you’re doing these tasks. This can actually take the stress out of that task. That might be a fun way to get all your reading in rather than focusing on the traffic or whatever is frustrating.

Dr. Eric:

I do that all the time. I listen to books these days more than I read them. I read some, too, but I definitely knock out books quicker listening to them. That’s a great point.

Thank you so much, Dr. Izabella. I appreciate you taking the time. Excited about your new book. I definitely recommend all of your books, like I said. Look forward to not only reading but listening to your new book. As of recording this, it hasn’t come out yet, so I preordered it on Audible. Once it comes out, I will be listening to it as I work out and do my chores.

Dr. Izabella:

That’s amazing. Thank you so much for the wonderful work that you’re doing to save thyroids. Really appreciate you. Thank you for having me on.

Recently I interviewed Dr. Krista Coombs, and we chatted about the foundations of thyroid health. If you would prefer to listen the interview you can access it by Clicking Here.

With me, I have today’s guest, Dr. Krista Coombs. We are going to be talking about the foundations. Dr. Krista came up with his headline, and then I will dive into her bio. The headline is “Getting Back to the True Roots of Functional Medicine and How to Apply That Foundational Approach to Better Management of Complex Autoimmune Conditions, Including Hashimoto’s and Graves’ Disease.”

And Krista’s bio: For over two decades and counting, Dr. Krista Coombs has been helping patients learn to manage complex health issues using a foundational approach, integrating Chinese medicine and functional medicine philosophies. Her expertise in autoimmune condition management using easy concepts empowers her patients, giving them hope of mastering helping themselves and increasing their health span. Thank you so much for joining us, Dr. Krista.

Dr. Krista Coombs:

Super awesome to be here. Love talking to fellow colleagues. We can always learn from each other.

Dr. Eric:

Definitely agree. As usual, I love to get the background of the person I’m chatting with. I know you have a history of Hashimoto’s, so if you could dive into your personal journey and how that influenced you becoming an integrative health care practitioner? I know you combine Chinese medicine along with functional medicine.

Dr. Krista:

It’s probably a tale as old as time. Hashimoto’s is pretty common. I didn’t know about it until I was 42. I look back at my life, and I see all of these flares that I was having. I didn’t know what I didn’t know. Nobody told me any different.

When I got into Chinese medicine, I always wanted to be in medicine. I always wanted to be a vet, and I worked with 11 vets in emergency care. I have a degree in science. I have done Chinese medicine for four years. I have been practicing for a couple of decades. I was always really in the thick of it. Then I got into functional medicine. That is when I got diagnosed.

I had to force one of my physicians to test for me because I was starting to suffer so much once I got into perimenopause. I looked back and think, “Gee, maybe I could have saved myself a lot of trauma.” In fact, it’s probably a good thing. Now I have delved heavily into functional. I have become integrative. Got certified by the Institute of Functional Medicine, which was no easy feat.

I have since tried to dial in how to go from really complex ideas. Functional medicine can be pretty complex. You have to know some stuff, and you have to be able to read papers. We are saturated, geeks like us, in this. It’s this deep rabbit hole of information that you never want to leave. How do we make that simpler so that we can actually start living a great life and having a longer health span? I didn’t really come to terms with all that until probably last year.

I was managing Hashimoto’s pretty good but not good enough for what my goals were in life. I am going to be 51 here in a month and a half. I feel like I have de-aged in the last year just by following my own ideas. It’s been quite a journey. Working with hundreds and hundreds of patients like yourself, I have all kinds of complex autoimmune diseases—Hashimoto’s is one of the top ones, especially when I deal with a lot of fertility in my practice or one-on-one.

I just got down to the foundations that were overcomplicated. Now we just try to make it really easy for people to pick those off, figure out how to do that, and empower people to take control of their own selves instead of having to give all their power away to medications, other doctors who don’t believe them, or even to us. They can learn the easy stuff without huge investment, move the needle pretty significantly, drastically really, and heal themselves, even with these complex illnesses. We really get to play and finesse the stuff left over, which is what we’re studying the depths for, so we can help those things instead of teaching them how to drink water.

That’s my story. Man oh man, I can’t imagine not doing integrative care. I can’t imagine. I can’t even imagine retiring. I love it that much. It’s such happy bliss for me. It wasn’t always. Now it’s genuinely happy bliss. I get so much joy out of it because you can make things simple. It’s incredible. That’s my story.

Dr. Eric:

I agree with you. No intentions of retiring in the future. I love what I do. How long have you been dealing with Hashimoto’s for?

Dr. Krista:

Probably most of my adult life when I look back. I have been diagnosed formally since I was 42. I started getting really sick when I was about 41. I look back, and I think, Gosh, how did I not know? But I didn’t. Even with all my education, I still didn’t. Once I started putting the pieces together, it was clear.

I will tell you that the day I got diagnosed, I remember it was May 2016, 8am. I got diagnosed. I sat in my truck and did a little cry because I knew that this was going to be the end, the diagnosis. Then I said, “Okay, next.” I knew I needed to change my diet, so that’s what I started with. Within a week, I was a completely different person. No pain, less inflammation, my brain fog was gone. I could put a sentence together; I used to stumble over words constantly. Then I devoured everything, like you.

I think some of the best practitioners are the ones who go through it. They go through big fire, and they come out the other side going, “Ahh.” I have the fireman’s hose to put out all these fires. I just have to have people learn how to hold the hose and put out their own fires. I will be 51, so almost nine years. This past year, I just learned how to make it so that I think I’ve slowed down the progressions dramatically, even just with easy stuff. I’m a big fan. Now the rest of my life can be awesome.

Dr. Eric:

We’ll definitely talk more about that. Also like myself, you mentioned you went through the Institute for Functional Medicine’s Certified Practitioner Program. It’s not just about functional medicine; you also integrate Chinese medicine. Can you talk about how that has also impacted you?

Dr. Krista:

I think Chinese medicine was pivotal in making me the practitioner I am for sure. I have a really heavy foot and love of Western science. That was my first degree. I love that stuff. However, I have a real desire to learn how to holistically look at us as physical beings and spiritual beings and how that integrates with the environment.

Chinese medicine is very much about that. It’s about looking at systems, biology already, but just not from the Western science point of view, but another way of talking about it and looking at patterns. Everything is about patterns. Instead of just going, “Oh, it’s a liver issue,” it’s not. How do those systems interact with the heart, the lungs, and the rest of the body and the environment?

Learning Chinese medicine was pivotal for me. It made learning functional medicine really simple. It was already the approach I had, looking for patterns and learning how to support where you get the most bang for your buck. It may not be always the gut. It might be something else, some genetic thing that has to do with detoxing the liver for example. You learn how to support that to get massive fallout for the rest of the body. I think that’s where Chinese medicine helped me the most.

I have been an acupuncturist as well, which is one of the tools of Chinese medicine, for 22 years. Starting to age myself. It’s been a passion. I now apply all this integrative knowledge even in my brick-and-mortar one-on-one with acupuncture patients. It’s really changed things. I can’t unthink looking at things as patterns. You must think the same, coming from a chiropractic background. You guys have something fundamentally simple. I think Chinese medicine is a little more patterns oriented. Now you are functional, so you see all the patterns. You can look at somebody and go, “It’s pretty clear,” especially when you have been doing it for decades. It’s easy to help them make some shifts once they get the mindset in play. That’s how it worked for me.

Dr. Eric:

You do acupuncture. I don’t know if you can answer this, or I am curious to see what your answer will be as far as what impact you think acupuncture has on your Hashimoto’s patients, the ones that you see in person. Over the years, I’ve had a good number of people ask me about acupuncture, that they considered going to an acupuncturist. I have been as well. I didn’t go to one when I dealt with Graves’; it was years later. I went through some treatments. I like acupuncture. I have written an article on it. Now that I am chatting with someone who does acupuncture, how can it potentially benefit?

Let me backtrack. Chiropractic can benefit everyone, I think. My guess is you probably think the same with acupuncture. Acupuncture, chiropractic are treatment modalities that can help many people, if not all people. Have you found that it’s an important piece of the puzzle when it comes to improving the health of someone with Hashimoto’s?

Dr. Krista:

Good question. Of course, everybody thinks their profession is good for everyone. I think there is a time and a place. It needs to be a personalized approach. Everything needs to be personalized. It’s not necessary for everyone. Some people can really benefit from it. I do a lot of virtual care in my practice. I am not going to give them acupuncture. If they go to someone else, if they don’t have some of the background, it’s a little easy to coordinate the efforts.

However, that said, acupuncture, I look at it as one of the tools in the toolbox that can help move the needle. Same with chiropractic actually. It’s one of the tools in the toolbox. I do believe a lot of healing can happen if someone is empowered to make better choices for themselves in the day to day. Tools like acupuncture and chiropractic, any kind of body work, can get them to their goals at a faster rate. If they are in a bit of a rush, it can do that.

Where I’ve seen it work the best when it comes to Hashimoto’s management is for people who have a lot of anxiety. They haven’t come to terms with it all, or there are aspects of their physiology that get really agitated when they’re in a flare, and it perpetuates a flare. Acupuncture is good at realigning some of that energetics.

The way I explain it to my patients is I say I’m like a mad scientist. I’m like a mad chemist actually. I’m always playing with people’s chemistry. You do something similar. I am always playing with people’s chemistry. When I look at a body and see these patterns, I go, wow, I have all of these points, almost unlimited, on the body that I can play with in patterns and shift their chemistry. I can turn some stuff down or off or trigger it to go back on. You do that repetitiously, and whammo, they are feeling way better.

I do that a lot with my Hashimoto’s patients who come to visit me. I do acupressure that they can sometimes use in those situations that they can do on their own. I am all about empowering people. There is so much they can do on their own, so they are not spending all their time coming into doctors’ offices. Not all doctors will like me saying that. But it’s the truth. We want to be living our lives, but well. I give them tools on how to do that.

Acupuncture is great like that. It even changes the chemistry. I have even done it on myself. I remember when I first was diagnosed in May 2016. I was like, “Okay, I am going to throw the whole kitchen sink at this.” I would just lay on my own tables and do my own acupuncture, which is not always the easiest thing to do. I’m influencing my own chemistry. I did it twice a week for five weeks, just to get the ball moving and get me feeling a lot better faster. I just thought it’s a beautiful technique. I don’t damage much tissue, just slight microdamage, microtrauma, but it influences the body’s intuitive knowledge of how to clean up those little microtraumas. It really gets things going very quickly. I love it for that.

I’ve coordinated with chiropractors in the past. My clinic was right beside one of the first six years of my practice up in Labrador. They go over to the other side in their bare feet and get an adjustment after getting acupuncture. It used to last longer because we have relaxed the muscles, calmed them down. The energetics were peaceful. They go over there, get their treatments, and hold their adjustments way longer. I’m a huge fan of that. You’re using body work that supports each other.

If they’re doing things to change, uplevel their lifestyle, which is what we could talk about, man, the healing is rapid. It’s like a week, two weeks, and they’re different. I’m always looking for tools like that. But it is one tool in a big toolbox. I think people need to go with what they resonate with. Give it a try.

If you have a great relationship with your chiro or acupuncturist, and you feel comfortable in their presence, and they understand you or at least are trying their best to help you, that’s the person to see. You add that to your toolbox for a little while. If you feel like you might be going into a flare, which is common with autoimmune, you’re anticipating that that could happen because you maybe are getting a root canal done, which you would hope to avoid but gotta happen. Or somebody wants to put you on an antibiotic, or you’re going on a big trip, or you have some tragedy in your life. You can interrupt that and use tools like acupuncture and chiropractic to alleviate that stress and shorten your flare. That’s my experience anyway in the industry.

Dr. Eric:

I agree. You’re right. We’re all probably biased and believe everybody needs our treatment. I will say for the most part, I don’t tell people I work with they need to see a chiropractor. I don’t think it’s essential, like you mentioned with acupuncture. In some cases, maybe it could accelerate the process of healing. I go for regular adjustments even though I admit I’m a little bit overdue. Usually, I try to go for monthly tune-ups.

Dr. Krista:

We’re our worst patients. I’m not anymore though. I have to say I learned my lesson.

Dr. Eric:

That is true. I wanted to switch gears a little bit and talk about the expense of functional medicine, which makes it difficult for a lot of people to work with practitioners such as you and I. How do you approach this in your practice? Regardless of the price, there will be people who say they can’t afford it.

Dr. Krista:

I have been practicing integrative medicine since I was about 42. Just to get the knowledge costs us how many thousands of dollars and time. It’s a pretty remarkable skillset that we have developed. Doing all this tech stuff and teaching, it takes its toll. We already have our autoimmune conditions that we’re managing, and stress is part of that.

In order to offer one-on-one care in a functional medicine paradigm, it costs money. It costs more. Here in Canada, we have subsidized care in the medical industry. People aren’t used to paying for much healthcare. I have really struggled with that: How the heck do I deliver high level care, not necessarily personalized, but teach people how to personalize, get the basics done, and then if stuff is left over, geeks like us can say, “It’s worth investing to work with us because we will take you to the next level. You will get closer to the top of the mountain sooner if you do that.” They are already aware of the power of looking at their body systemically and saying, “Look what I can do.” Then they are really inspired to work one-on-one with us. It costs them a ton less money.

I learned that this year. I have tried to sell one-on-one programs. I have a needle mover membership program where I work with these really complex cases one-on-one. It’s intense for three months, and a lot of them stay. We get a lot of momentum. I am always teaching the foundational stuff. I feel like that’s high cost to teach the foundational stuff. Once they learn it, they can just practice it if they have a good mindset and are not self-sabotaging so much. They have commitment in the game. Then it’s fun for me to add to that and finesse. That’s what I ‘ve learned this year.

I’m saving people a lot of money by offering the foundational stuff. Functional medicine is amazing. However, it’s still in its infancy. It’s still 30-some odd years old. Really catching on the last 10. I don’t know if you agree with me on that. There are a lot of us now in the industry but not enough of us.

I know I hear this all the time: “I’d love to work with you, but you’re too expensive to get that care. The supplements are too expensive. The testing is too expensive.” It is. It’s expensive. I know people say, “Test, don’t guess.” When you have been in it a long time, there is a lot you can see that you don’t have to do the expensive testing for. If they get the basics in line, they don’t even need the testing because it’s really clear. Everything starts to clean up.

I have learned to make it accessible to most people. For those people who still need more of a financial advisor than what I can give, or they are so debilitated that they can’t work, I understand that. You want to have low hanging fruit things they can use to move the needle. They spend their money on quality diet for example. As they get their life back, maybe they can invest in some mini courses or a book that you write. Maybe they will decide to do one of your online programs or challenges. You do a lot of those. Those kinds of things If they are inspired to work for themselves, they haven’t invested a lot of money, but they have learned a lot about the foundational stuff. That’s how I approached it. I think you’re doing something very similar. That’s the way to help people.

This very heavy knowledge-based, information-based world that you and I live in, they don’t have to know all that stuff to make big, massive, beautiful changes to their lives. It doesn’t have to cost a lot. We just have to find ways to teach them how to help themselves at a more reasonable price level. That has been missing in the functional medicine industry for probably the last six years or so, in my humble experience. It’s just been very driven toward really expensive testing.

I know some practitioners who, just to work with them, you have to do three, four, five big tests that are thousands of dollars. Plus an initial visit with them is also thousands of dollars. We probably know as much as they do. I don’t think that they need to do that. It keeps the practices alive, and they can pay all kinds of staff. Maybe that’s wonderful for a certain type of person.

But for the majority of us, when we’re suffering, brain fog, a lot of pain, you can’t focus properly, maybe can’t work, you’re emotional, it’s overwhelming, you’re losing your life, and your experience of it is really poor, concentration is off, you need to start with the foundations. You pick them off, and within a week or two, you’re different. Then you get more inspired to do more for yourself. I don’t think that has to be expensive to learn. But it has been missed.

You go to all these conferences and courses. How many courses do we do a week? I do at least one. People glance over the foundations. They call it basics. “Of course you got to do an elimination diet.” I don’t know, sometimes that needs to be personalized. How do you teach people how to do that? You just assume they understand what the basics are. We understand them because we’re in it all day long teaching it. The average person who is suffering may even forget that water is that essential for example, or sleep is that essential. They don’t have that dialed in. Until they get that dialed in, there is not much you can do for them.

I like lifestyle-focused, lifestyle-first approaches. Get to the very basic foundations, like you’re building a house. Before you start putting in a window or a door and a doorbell with ten supplements or something outside of you, instead of going what can I do, this is my philosophy, Eric. Why is this body having all these symptoms that look like what we call Hashimoto’s, Graves’? This collection of symptoms suggests very strongly that the body you have currently is not in alignment with the environment that it’s in. If you try to change your body, it isn’t going to work. You have to change the environmental inputs.

Once you start seeing your life that way, “I have influence, there is a lot I can do,” it is extremely good, very powerful, I think, from my experience with people, and even myself, when you start gaining confidence that you have say. All of a sudden, your body is going, “Thank you. It’s about time. Thank you for listening.” Some of those symptoms that look like Hashimoto’s start to go away because the body starts to support itself. Then you need less help from geeks like us. Really focused help, then we can move the needle way cheaper.

I will say it’s more expensive to be sick because you lose so much of your life experience potential, not just money. A little bit of investment, you can learn a ton. If you commit to yourself. You do just a little bit more if you want to move the needle a little faster with people like us. That’s been heavily missed.

There is a movement for people like us coming to that place and helping more people at a lower cost point learn how to navigate this complex stuff. I’m excited by that. I think that’s needed. You can’t just learn from a book either. Books are great, but they’re general. If you really want to learn, you have to learn how to personalize it, and you need guides for that.

I always say I’m not a sage on the stage; I’m a guide on the side. That’s what Joe Polish says, and I love that. He always says, “I don’t want to be the smartest person in the room all the time. I want to be in a room where everybody’s getting smarter.” I think that’s why offering these ideas to people in group environments instead of always one on one, which is super pricy, is where the magic lies. Everybody is getting smarter from a guide on the side. You do the same stuff.

Dr. Eric:

Everything you said I agree with. Obviously, the foundations. Then you mentioned not just changing yourself but focusing on the environment. Actually just yesterday, I chatted with someone who was talking about a moldy environment. There is so much you can do with diet and stress management if you’re not getting rid of the mold. It sounds like she did do something; she is aware of that.

Dr. Krista:

It’s also not having fear around what you don’t know, or not knowing what you don’t know. You probably hear this, too. Dr. Google’s great. I do like Dr. Google. A lot of practitioners complain about it, but I like it. I like people are seeking. I like seekers. They are striving to understand how to help themselves. I love that.

What I hear often is people say, “I was looking at all of these different pages, but it seems like everything’s contradicting each other.” Yeah, because you’re not everyone. You’re unique. You need some of the foundational comprehension in order to piecemeal all of the things you’re reading to make it apply for you.

Instead of getting too saturated with that and having all this fear response, which keeps you sick, let’s go down to the basic stuff, the foundations, and say, “What’s not in alignment? What could I do?” It’s the low hanging fruit. You have the beautiful apples on top that are getting a bit of sunburn. That’s a very expensive program, surgeries, tons of meds. That’s high level, out of reach apples. You need somebody to help you get up there to get those apples.

You have apples that are easy to pick. You don’t need anybody to help you get those.

The ones that are on the ground that are still viable, you can bend over and pick those up. You don’t need anybody to help you with that. That’s my role. That’s what’s been missing. I wasn’t always doing this, but I see that as my role to show them the stuff that’s on the ground. Those are the easy ones. You get those, and you won’t be hungry. You don’t necessarily need the ones that are starting to ripen. You definitely don’t need the sunburnt ones at the top. They’re not better. The ones that are protected are better. They are the foundation.

That is the philosophy I have been developing: start with the low hanging fruit first. Then you have so much left over, and the cost of that is way less.

Dr. Eric:

Agreed. One of the questions I wanted to ask you, which I think I know the answer now, but if you want to expand: What do people with autoimmune conditions need to do to manage their conditions, their symptoms, and overall health? It sounds like start with the foundations.

Dr. Krista:

Yeah, I’m a broken record, right? Anybody who hears this will recognize the truth of it. The truth is where it’s true for everyone. It’s not just true for you; it’s true for everyone. That is look at your life. What’s out of alignment? What can you do to create better alignment? I call it the four EASY pillars. I do everything through this lens. The lenses say easy all the time. Joe Polish says have an ELF life: Easy, Lucrative, and Fun. How do you develop an ELF life, practice, relationship? How do you do that? Focusing on what you can do to make it easy.

For all the autoimmune conditions, I don’t care which one you have, I don’t even care how far along you are with it. If you don’t dial in the foundation part, the easy stuff, you’re always needing to do really hard things. You will always decline at a faster rate. It’s inevitable in my experience. I would think you probably agree.

The four EASY pillars. E: anything to do with eating and your philosophy. That’s your immune system, your microbiome. You can start with the first layer of that. Nail it. That lets you graduate to the next layer. You can add complexity if needed.

A is everything to do with activities: mental, spiritual, physical activities. You don’t want to miss one of those. They are all important. Start with the very basics. You don’t have to chew off everything.

S is sleep and rest. There are seven forms of rest. There are different ways to approach sleep. I could argue that’s probably one of the top things that if you’re not working actively on prioritizing that, it’s pretty hard to heal. There is lots of reasons for that.

Y is saying yes yesterday. I am committed yesterday. I am committed to myself. I am making myself a passion project. If the mindset is not in alignment, and you are not consistently trying to find non-negotiables, where you have wiggle room, giving flexibility to your life, it’s pretty hard to maintain even the easy stuff.

If you do that, that’s so easy. If you do that, all of a sudden, everything goes into place. All the organ systems start to uplevel with support. It’s a very food forward, lifestyle forward, not supplement-based program to think about. It doesn’t mean you can’t try those things. But it’s not needed in most cases to move the needle. Some meds might be of course, like for Graves’, just to control things once you have progressed that far with that much damage. Generally, it’s a pretty lifestyle-focused approach.

I will tell you, in my experience, so far, especially this year, for myself even, I started putting these practices in place. I was perfecting it for myself. I have lost 45 pounds in record time just because the inflammation started to go away. Now, my metabolism is reset, I think. I have more flexibility with my food choices. I never thought that would happen. I thought I was going to have to be white knuckling it forever, just to keep my head afloat and be able to consume research papers and talk with patients and stay at work at a high level of function. It’s just so easy. I don’t have to white knuckle everything anymore.

How do you not share that? How do you not go, “Dr. Eric, teach the people?” This is so good. It would help you help them and help you help yourself. Have an ELF practice. That’s why I wanted to geek out with you here today.

That’s the four EASY pillars. I can’t think of anything to add to that. That’s the foundations. It houses literally layers of possibility to look at. They don’t need to be able to recite the Kreb cycle for energy production. We can because we like that. They don’t need to be able to understand that in order to influence it. It’s all about influencing the physiology they have so that the body systems work in more coordination together, and they start to heal. You see people come off meds, like diabetic medications, in record time because we are resetting metabolism, the relationships with sugars and fats. They are resetting the mitochondria and getting more biogenesis because we are doing some intermittent fasting and learning how to personalize it for each person. It puts the power back in these people’s hands. Then they realize, “Oh my god, I have been giving my power away to the powers that be forever. How indoctrinated I have been. I can do all this stuff myself and then have a great life.”

This is what I have always said. I am trying to help people have a better-quality life experience. I am not trying to fix people because I don’t think that’s possible. I don’t think we’re broken. I am always trying to influence them to have a better life experience. Now I am also trying to say how we increase the life span. I have no control over longevity. What if we have some say on health span? That means your quality of life is automatically better. The only way to do that is to be consistent with the basics. If you’re consistent with the fundamentals, your body declines at a very slow rate.

Dr. Eric:

Just to repeat: E is eating. A is activity. S is for sleep. Y is yes to yesterday.

Dr. Krista:

It’s about saying I am committed. If the mindset piece is not there, if the sleep piece is not there, if the appropriate style of activities aren’t there to help with various organ systems, and if the eating and daily choices to support that physiology aren’t there, the basics, you cannot out supplement that. You cannot out medicate that. No surgery in the world is going to fix that. That’s why I can’t see anything else to add.

I came up with that idea. It was at my 50^th birthday last March. I was at a cabin, which I love to go to. I am an avid kayaker. Anything I can do in nature is bliss for me. I couldn’t go kayaking because there was still ice on the water. Most of the lake was frozen. I was all ticked off because I couldn’t go kayaking in March. I am in Canada. It’s not like I can go kayaking. I was laying on the beach and I was kind of moody. What the heck? How come I can’t make my health get better with all of this information that I have, all of this knowledge? I have helped lots of people. Why am I still struggling? I laid down and did some tapping. Have you heard of tapping? Emotional freedom technique.

Dr. Eric:

Yeah.

Dr. Krista:

I take it most of your listeners have as well. I love that. That’s foundationally built on acupuncture. It’s acupuncture points that we’re tapping. I am tapping and trying to shift my physiology. All of a sudden, I said, “Why can’t I make this easy?” I snapped out of it and thought, “Why can’t I? Of course I can.”

I am always overcomplicating things. I sat right up and was looking at the water and was really calm. I came up with what could EASY stand for? That’s how I came up with the four pillars. I was so excited that I couldn’t even wait to get home and talk about it with patients. What if this was all we looked at? Then I started doing that and setting up a program. We got so many people feeling better really quickly, losing weight, normalizing their metabolism. That’s really all I do now.

Why do I need to complicate something that can be so simple until I need to complicate it? I have the skillset like you. I have the knowledge we can pull from and dial things in for people because that’s what functional is, right?

That’s my little story. I thought that was kind of neat. Mindset work, getting yourself into that cool space where all these beautiful ideas just come from the universe, and they just gel.

Dr. Eric:

That’s wonderful. I love that EASY way. Quick question with the eating part of that. I’m sure some listening to this will wonder if there is a specific diet you recommend. Do you eat whole, healthy foods?

Dr. Krista:

Specifically for autoimmune management, everybody in your listenership is aware of this because you’re preaching to the choir. They understand what you’re talking about. We’re not talking to an ignorant audience.

There are times where there are non-negotiables for foods. If you have developed an autoimmune disease and have cross reactivity with certain proteins or peptides, leaving them out because the immune system has a memory is smart. It’s not an eating disorder. It is smart. There is no fear around that. It’s a choice you make because it serves you, and it helps your body survive.

There are some non-negotiables. Research is pretty clear what those are. I’m sure you talk ad nauseum about them to your people. The top of course is the gluten protein. We know this. Maybe not just the protein itself, but things that are in those particular parts. It doesn’t mean that gluten is bad. It means it’s not so great for you in your life. That’s it.

Same with dairy cross reactivities and the proteins there. If there are any digestive insufficiencies, you will have more insensitivities. Corn, eggs, grains. You can personalize that, absolutely, but you have to start from the basics to be able to do that. Your gut needs a rest. Your immune system needs a rest. That is why we do something like an elimination style diet.

My approach is basically a reset. It’s about resetting the metabolism, resetting how your body handles sugar, which is huge for inflammation and stimulating the immune system; how it deals with fat; and how it deals with trying to help the cells recover function. I call it a metabolism reset. It involves four phases.

We start with a couple days where we are overeating and doing all kinds of things. A goodbye to inflammatory foods party. If you are gluten free or dairy free already, you still do this part and trigger all kinds of cool chemistry in your body to get yourself ready for a reset.

That’s 6-8 weeks where it’s an elimination style diet, but it’s not really AIP. It’s a little different. We can tweak it. I have ideas on how they can individually do that to personalize it for themselves. They know themselves best, right? There is no one diet that fits all. We reset the metabolism.

Then we start bringing some things back. The body learns how to tolerate that and increases tolerance. A lot of healing has already happened. On average, everybody is losing about 25-30 pounds in 6-8 weeks. It’s rapid. People who are already on the thin side lose a little bit, but their brain fog goes away, and their pain goes away. They just learn a better way of structural eating to serve their body. It’s just so easy.

Then we dial in activities for each phase. We dial in how to improve sleep strategically. That’s not an extra added stress on the body. How to work on their why for getting well and making that detailed so that they always have a reason to be committed, not just, I don’t like having pain.” It’s “I want to go kayaking,” or “I want to start a business,” or “I want to walk my kid down the aisle in six months.” That’s the why. It has nothing to do with the autoimmune disease. It’s about putting the body in a better environment by changing the environment you are putting it in.

The body thanks you. That works for the body. You just go, “Oh, wow. Look at the power I have.” That’s what I do. I feel that timing of meals, figuring out what works and doesn’t work for your body, gives you so much power. It really does. Once you realize what it really means, that’s what we know.

I teach people you don’t have the fear anymore. You just know what everything means when stuff happens. Then you can make better choices. You can recover from flares pretty quick. They create their own first aid kit. You anticipate a flare, and you know how to eat for that. You know how to live for that. You know how to recover from that much more rapidly, so you are not causing more decline and developing more autoimmune diseases.

We know that with Hashimoto’s and Graves’, you are probably 5x, if not more, likely to get another autoimmune disease. How many people have you seen who has more than one autoimmune disease if you dig? Probably hundreds. If we do pretty comprehensive testing, you can see if they have elevated antibodies against other organ tissues. They are suffering.

Everything you do fundamentally, the foundations, influence every single one of those autoimmune processes. It’s all related. The immune system is protecting you. It’s pretty wise. When you start resetting your relationship to food, mentally, and your relationship to yourself, everything starts to get better.

I sound like an evangelist. I’m not even selling. It’s so real. It’s so empowering to watch people learn that they can actually help themselves instead of coming to our practices and always saying, “Please help me,” and they are crying and have nowhere to go. I can teach you how to help yourself get somewhere. That’s my passion. That’s bliss.

Dr. Eric:

Thank you for sharing all this great information. Can’t agree with you more about the foundations. A lot of practitioners, including myself, sometimes overlook them. Of course, everyone who comes into my practice, we don’t skip over diet and stress management. Sometimes, we go down a rabbit hole of complexities.

Dr. Krista:

That’s because it’s fun for us. We love it. And you and I are people who really love this stuff. We want people to feel better. We are almost overwhelmed if we can’t do it fast. We’re used to being fee for service. We want things fast so people like it and do well. I’m always trying to do it fast. We feel an innate sense of responsibility to do that. But we also love the science. It’s fun. You don’t have to be a geek to be able to personalize your own care. That is what we sometimes forget.

At least I did in my practice for 20-odd years. I really did. I glanced over. I just assumed people are drinking their water and going for a walk and sleeping. I’m looking for big stuff. We have to over supplement. Green medicine is everything. This herb for that. Adaptogens for stress management. Seriously, get rid of the stressor. What could we do to reduce some of the stressors or learn how to adapt to those stressors a little better with mindset, so you don’t need another supplement or thing that could be maybe even triggering the autoimmune process and spreading things?

Listen, I want to offer your listeners. They are obviously in alignment with you, and you and I are in alignment. I have a mini course called “Building Immune Resilience the EASY Way.” It’s 10 modules. I will give it to your people for free. Would that be okay?

Dr. Eric:

Yeah, that would be wonderful.

Dr. Krista:

I guarantee it would be in alignment with what you teach them.

Dr. Eric:

Thank you so much, Dr. Krista.

Dr. Krista:

If they use the code EASY100, they will get 100% off. Free for them as a complimentary thing because I want your people to get that little boost, so that when they are working with you, it makes even more sense. They can have that. It’s pretty awesome, and it’s easy to consume and apply over time. Everything I do is easy. Give it to your people. You take a look at it and see what you think.

Dr. Eric:

I’ll check it out as well. Anywhere else you want to guide people where they can learn more about you?

Dr. Krista:

Sure. My signature program is affordable, and we have an awesome private group. I am not the sage on the stage; I am the guide on the side. I like coaching in a group. I think it’s something I’ve missed in my whole career. I love it.

We have this private group called The EASY Way with Dr. K. It’s an online course that you get to teach you through those four phases and reset your metabolism and your life pretty dramatically. You’re in a group of like-minded people. All those people are coaching each other. It’s peer coaching. It’s accountability. I have a lifestyle coach in there who is excellent. She also has training in functional medicine. Then there is me. You have a doctor teaching people how to do stuff.

I’d love to have you in there and do a Q&A or a live on some cool thing any time. We have a few people in there with Hashimoto’s and other autoimmune diseases. Everything you talk about would work for them. I’d love to cross-pollinate. They would learn a lot from you. That would be brilliant. I love having those cool conversations with like-minded people. That’s TheEasyWay.ca. They can always reach out to me on Facebook with questions.

Dr. Eric:

Thank you so much, Dr. Krista. Appreciate you joining us here and sharing your knowledge about the foundations.

Dr. Krista:

Thanks for the opportunity. This was brilliant. I love this. How can you not want to do this all the time, Eric? This is awesome. I’m glad you do it. You help a lot of people.

Dr. Eric:

I agree. I definitely love what I do. As you said earlier, definitely don’t have any intentions of stopping anytime soon. I’ll admit, I love doing Facebook Lives. I love doing podcast episodes. But I love the guest interviews because I’m always learning stuff, too. I enjoy these even more than just doing the solo episodes because the solo episodes are honestly more work. I’m doing all the talking and not learning anything.

Dr. Krista:

You know what I find, too? When you get minds like us together, it’s like a hive mind. You come up with these beautiful ideas that you would never maybe have thought of before. It expands your potential to help other people, which is what we’re here for. We love helping people. You learn more through conversation. Thank you for the opportunity.

I wish I’d reached out to you a long time ago and gotten to know you. I bought your book years ago when I was first diagnosed with Hashimoto’s. That really helped dial things in for me. That was part of my evolution in functional medicine. I’m very grateful to you for that. I bought it in 2018.

Dr. Eric:

Which of my books?

Dr. Krista:

The one on Hashimoto’s.  I think you had just posted it on your website. I was following you at the time. I don’t know why we never communicated before.

Dr. Eric:

I don’t know. I’m glad you reached out to me. I’m glad we did this interview.

Dr. Krista:

I’d like to have you in my groups, too. I have a group that’s called Hey Hashi and Healing Inspiration: The Easy Way. That’s all about Hashimoto’s. I have DrKristaCoombs.com as my Hashimoto’s website. But I work with all autoimmune. My practice sees everything. I am not as dialed in as you are even though I deal with Hashimoto’s myself because I think they’re all related.

Dr. Eric:

Thank you again, Dr. Krista.

Dr. Krista:

Thanks for listening.