Recently I interviewed Elizabeth Yarnell, and we chatted about redefining autoimmune conditions and how to address them naturally”. If you would prefer to listen the interview you can access it by Clicking Here.

With me, I have a return guest: Elizabeth Yarnell. Excited to speak with Elizabeth again. We will be talking about her upcoming book. The title of this episode is “Redefining Autoimmune Conditions and How to Address Them Naturally.” While I have read her bio before, I am going to read it again. I think it’s been a year since I interviewed you, so I will read it again for those who haven’t listened to the first interview.

Since being diagnosed with multiple sclerosis way back in 1999, Elizabeth Yarnell has been on a mission to redefine MS and autoimmunity naturally. As a traditional naturopath and certified LEAP therapist, she has worked with hundreds of MS and other autoimmune sufferers in her nationwide clinic, using unique, personalized, non-pharmaceutical therapies to empower them to reclaim her health. She is a TEDx speaker; award-winning author, whose cookbook has sold more than 70,000 copies; a patented inventor; and has been featured on CBS, NBC, ABC, and PBS as well as in Good Housekeeping, Health, Martha Stewart Living Radio, and many other outlets.

Her next book, which will be about redefining multiple sclerosis, will come out in March 2023. We will chat more about that later.

Thanks again for joining us, Elizabeth.

Elizabeth Yarnell:

Thanks for having me back! I feel so special that I get to do a repeat podcast with you. The first one was so much fun, so informative. I heard from a lot of people afterwards that they learned a lot of good and new information. I assume this one will be the same, so I’m excited.

Dr. Eric:                        

I got a lot of feedback as well, which is a big reason why I’m having you back. There will be some overlap here, but there will also be some different things that we touch upon.

Why don’t you briefly talk about your background, for those who maybe didn’t listen to the first one? How did you get started doing what you’re doing now? What led up to you writing your future book?

Elizabeth:

For me, this journey began one night in 1998 when I was working on an article for a newspaper, The Denver Post. I was a freelance journalist. I had been really wrangling this article about cross-country skiing that I had been working on for a couple weeks. I’d gotten it to a place where I thought it was a pretty good draft. I printed it out. As I was brushing my teeth to get ready for bed, I was looking over the pages, and I thought, well, I see three places where I want to make small edits. Other than that, I feel it’s pretty good. I’ll do it in the morning. I went to sleep.

When I woke up the next morning, it was almost like goblins had stolen into my apartment, taken an eraser, and erased huge chunks of my printout. I couldn’t see the words. I couldn’t make out or understand the words that I could see. I wasn’t sure what was going on. In due course, I went to an eye doctor, and he diagnosed me with optic neuritis, or inflammation of the optic nerve. That was impeding my vision and clouding my thinking. Almost immediately after that, I went in for an MRI, and that is where I received a diagnosis of multiple sclerosis. That really sent me down this path.

Multiple sclerosis is a disease that affects a million Americans every year. It is a degenerative, autoimmune disease that affects the nervous system. The biggest thing that I learned after my diagnosis was that 80% of MS patients experience significant disability within 10 years of diagnosis. Here I was about to turn 30 years old, learning that by the time I turned 40, I could be in a wheelchair.

Dr. Eric:

That’s really scary. Obviously, that didn’t happen, which is wonderful, not just for you, but just like myself, diagnosed with Graves’ and able to help people with Graves’ and Hashimoto’s, same thing with you. Your experience has helped you help others with MS and other autoimmune conditions.

Speaking of which, as you know, most of my audience consists of people with thyroid or autoimmune thyroid conditions. There is a lot of overlap with different autoimmune conditions. For those who are thinking, “Your story is about MS. What does that have to do with Graves’ or Hashimoto’s?” What you will discuss here really relates to any autoimmune condition. Is that correct?

Elizabeth:

That is correct. In fact, I like to say the term “autoimmune” is really an oxymoron. If we take it apart and look at the root, “auto” means “self,” and “immune” means “allergic.” Allergic to self. If we really think about this, evolution will say, “Nay, nay, not possible to be allergic to yourself. Your species would die out pretty quickly.”

I think that the key to understand about being diagnosed with an autoimmune condition, any of them, is that what it means is you have chronic inflammation. The secret to understanding how to work with these types of conditions is that they are all about inflammation. If we focus on the inflammation rather than where in the body it might be manifesting, the thyroid or the eye or the joints, we have to remember that any condition that ends in “it is” means “inflamed.” I had optic neuritis, inflammation of the optic nerve. You could be diagnosed with gastritis, inflammation of the gastric cavity. You could be diagnosed with appendicitis, inflammation of the appendix. Anything that has to do with inflammation can respond to anti-inflammatory strategies, regardless of where it is manifesting in the body.

I love that you brought up in the beginning, we’re talking about MS. Will somebody with Graves’ or hyperthyroidism or any other thyroid issue benefit from this information? Yeah, it’s all inflammation.

Dr. Eric:

Let’s dive into inflammation. What are some of the factors that cause inflammation, some of the potential triggers?

Elizabeth:

One of the big things that causes inflammation that I see so often in my clinic is these additives and preservatives and toxins and chemicals that have been added and filtrated in our food supply. I gave a TED Talk about this in 2014 called “Poisons in our Everyday Foods.” Our processed and packaged food industry has become so dependent on adding these artificial flavors, artificial colors, artificial sweeteners, not to mention the whole masquerade of “natural flavors” that is going on in our world. All these things are derived from non-food-based sources.

To go back to evolution, we evolved on this planet to eat, thrive, and use the materials into our bodies to create life that evolved on this planet with us: the plants, the animals that eat the plants, they transfer the energy to us. What we did not evolve to deal with were substances that were mined from two miles underneath the earth’s surface, like petroleum. Food dyes and chemicals are petroleum-based. A lot of additives and preservatives, a lot of artificial sweeteners, a lot of pharmaceuticals, based in petroleum. That’s hard for our body to synthesize and process and excrete the toxins afterwards.

Part of being diagnosed and tipping into autoimmunity is that overload of toxins in your body. Everybody has a unique tolerance threshold as to how many toxins they can manage and still maintain a healthy appearance and healthy lifestyle. Once you fill up that toxin bucket inside your body and tip over into autoimmunity, where you’re now having chronic inflammation, which is the body’s defense against what it considers to be foreign invaders, then it takes a lot of sustained effort to bring yourself back below that threshold.

Dr. Eric:

You mentioned tolerance. Everybody is also different. I know your experience with certain food dyes, I forget which food dye. We will get into the foods as well, but the food dye, is it yellow food dye?

Elizabeth:

Yellow food dye is a big one for me. I call it the limoncello incident.

Dr. Eric:

Elizabeth sent me a manuscript of her future book, and I have been going through and reading about the different incidents that she had with the yellow dye. It explains a lot.

I’ll go back to last year. Elizabeth and I met at a conference last year in Tampa that involved different health care practitioners. I remember they also served meals there. I don’t know if Elizabeth remembers this, but one day, they had these cupcakes, and the cupcakes were gluten free. All these health care practitioners, a lot of them alternative practitioners, were eating the cupcakes. I’ll admit, I had a cupcake, too. I’m not going to lie. Elizabeth was inspecting those cupcakes because the topping, she was like, “I don’t know if it has the dye.” I’m pretty sure you did not have the cupcake. You did refrain. They also had these natural beverages, and I remember you were looking at the bottle and the natural flavors.

I am bringing this up because Elizabeth does walk the talk, like she is not just saying this. I saw her in action at the time, not really knowing the backstory. After reading the manuscript, I realized, “That’s why she was carefully inspecting it. The negative reactions that she has.”

A lot of people, like if I eat things with food dyes, I typically don’t feel bad, which is kind of good and bad. You might think it’s good. For years, I thought it was good. In a way, it’s bad because either way, it’s having a negative effect, maybe not as bad as someone who is having overt symptoms, such as Elizabeth. Sometimes, it’s nice when your body tells you that you’re reacting. Regardless of whether you’re reacting or not, certain foods are bad for you. I’m sorry to go on a rant here. After I was reading your manuscript, I was like, “Wow, that’s why you were super careful compared to everyone else there.”

Elizabeth:

That’s a great thing to notice. One of the things to remember is that you may not notice that things like food dyes are creating small amounts of inflammation in your body, or that you might be reacting to them until you bring down the level of inflammation far enough to where you can feel it and recognize it.

Most people are walking around 50-80% inflamed every day. That’s just how it is for them. They feel fine. They pretty much eat whatever they want. But they are walking around with a pretty high level of inflammation. In fact, I have an inflammation quiz we can talk about later that has questions that might make you look at different ways your body is functioning and recognize that it’s actually due to inflammation, even though it might not affect your daily life in the way that for me eating yellow food dye does, when I can no longer walk when I eat it. Until you bring that level of inflammation in your body down to maybe 10-20%, and then you eat something that jumps it up to 80-90%, now you’re going to notice.

You have to do that work to bring the regular level of inflammation, your baseline level, down far enough to be able to recognize clearly if you are having a reaction to something like food dyes.

Dr. Eric:

Another lesson: You need to be an expert in reading ingredients. In a situation, getting back to Tampa, there were no ingredients because the cupcakes were out. If you don’t know, better to avoid, especially if you’re inclined to have negative reactions to these things. Again, even if not, I probably shouldn’t have had the cupcake, but everyone else was having the cupcake, except Elizabeth. I’m going to have it.

Elizabeth:

I believe in treats. I also try to err on the side of caution because the results can be pretty devastating for me. I certainly didn’t want to miss out on the last half of the event that we were at because I couldn’t function.

Dr. Eric:

Obviously, eating whole, healthy foods is a way to avoid food dyes. Sounds like you do indulge every now and then. You’re just very careful. If you do purchase something that is not a whole food, you make sure you carefully read the ingredients. We’ll talk more about the MRT, other ways people can know they are reacting to things. You know your body, but you also are very cautious when buying things. I guess we’ll leave it at that.

Let’s talk more about food triggers. It’s not just about the dyes. With your experience, one of the foods you reacted to was lettuce. We spoke about that last year during the last time we interviewed. For some people, that might be surprising because I and a lot of other health care practitioners are focusing on gluten and dairy. Those cupcakes were dairy free, too.

Elizabeth:

They were.

Dr. Eric:

Gluten and dairy free. Corn, soy, some of the more common allergens. Even eggs in some cases. You don’t hear about being allergic or having a sensitivity to healthier foods, like lettuce, broccoli, or avocado. Why don’t you talk a little bit about that? How did you find out that you had a problem with lettuce?

Elizabeth:

That whole part of my journey really started when my oldest child was born. He was sick from the get-go. He had terrible constipation, even as an infant. He would have this projectile vomiting that would happen, sometimes three times a day. It continued beyond infancy and into his preschool years. He was still vomiting all the time. Finally, by the time he was six, he had fallen off the height and weight charts.

He loved to eat. He was a huge, voracious eater with a really diverse appetite. But every time he would eat, he would just vomit it back up. He is a professional vomiter in our household. I was really concerned about him because between the vomiting and the constipation, this poor child is going to die young. He is not releasing any of the toxins that are supposed to be coming out in your poop. The way that your body processes them.

We took him to the pediatric clinic at Children’s Hospital. We took him to get his DNA mapped. We did abdominal X-rays to see if maybe there was something structural wrong with him. All of those things came up empty-handed. We could not figure out what was going on with this poor kid that he could not really stop vomiting, and he could not poop.

Finally, I took him to a naturopath. This is when I was still just beginning my own studies. She said, “I think this sounds like food sensitivities.” I said, “Well, he doesn’t have hives or anaphylaxis.” She says, “Those are food allergies.” She explained that what she was talking about were food hypersensitivity reactions that caused inflammation in the body.

This was like 2006 or something. I thought she was kind of crazy. I’d never even heard of this. My parents were doctors. Nobody had ever talked about anything like this. We’ve tried going gluten-free, dairy-free, soy-free. We have tried all these things, and nothing has worked. It’s been a huge waste of time to restrict his diet that way. Whether or not we take out these things, he is still vomiting all the time, and he is still terribly constipated.

That is when she told me about the Mediator Release Test. This is a single blood draw. It’s only offered by one labin the entire country. They are based out of Florida. Most doctors don’t know about this. Most rheumatologists don’t know about this. Most medical doctors are not familiar with this.

The reason is because the company, instead of hiring a sales force to go out and treat doctors for lunches and do junkets to try to get them to encourage them to prescribe their test, and then the doctor would receive the test results back and not understand how to work with the patients because as you know, Dr. Eric, there is not really a lot of nutrition education in medical school. You had to learn this outside of that. Instead of that, they devoted their resources to designing a 40-hour certification course for registered dieticians and other nutrition professionals like myself.

As soon as we tested my son, I now have done a thousand of these tests, just about. His is still the worst I’ve ever seen. Fully 1/3 of the items on the test, he was hypersensitive to. Even though we had taken out all these common culprits, there were still so many other things that were keeping him in this state of constant constipation, constant inflammation. Some of the things we thought were healthiest for him, like broccoli, garlic, and lemon, turned out to be things that were making him constipated.

Once we figured this out, the change was amazing. Within two months of changing his diet, he had grown an inch and a half. He had gained 15 pounds. He was now back on the charts, thank goodness. He started sleeping through the night for the first time in his entire life. He’d always had such terrible acid reflux that it would wake him up constantly through the night. He stopped wetting the bed at six years old. Overnight, it was not a behavioral modification thing; it was an inflammation issue. Inflammation had been pushing against his ureter and prohibiting him from feeling like he had to pee before.

All of these things changed. The biggest, most impactful, for me as a mom, came one day when I was passing by his room, and the door was open. I heard him singing to himself. Now, children don’t sing to themselves when they’re miserable. He had never been happy enough to sing to himself. That’s really when I decided to focus my naturopathic practice around the MRT and this food sensitivity testing as a foundational piece to tracking down inflammatory triggers inside people who are suffering.

Dr. Eric:

Your son is the one that did the MRT initially before you found out that you were reacting to lettuce on MRT, correct?

Elizabeth:

Yes. Once I discovered how he was reacting, and while going through the certification course, one of the tasks involved going into the Johns Hopkins Medical School websites and watching animations of what actually happens at the cellular level during hypersensitivity reactions. That is when I heard the narrator of this animation start to say that it’s the T cells that make the assessment. You eat the food, and it goes into your stomach. The food is presented by some presenting cells to the T cells, a subset of white blood cells in your immune system.

I literally almost smacked the computer screen and started yelling at it, “Do you understand that T cells are what are implicated in MS?” Any MS doctor will tell you, “MS happens when the T cells go rogue, and they start reacting for no reason against your own body.” That’s why they say you’re allergic to your own body.

I realized at that minute, oh my gosh, the T cells in my body for MS are not reacting for no reason. They are reacting to triggers that we haven’t been looking for. We haven’t been looking in the right places. First of all, no doctor ever asked me how my diet was or how my bowels were functioning. None of that. Of course, I can’t imagine any doctor asking anyone, “Do you eat lettuce? Maybe that’s your problem.”

Dr. Eric:

A lot of practitioners do food sensitivity testing. It seems most do IGG food sensitivity testing. How does MRT differ from IGG?

Elizabeth:

You’re correct. Most do IGG testing. The way I like to explain this is we just came through this whole COVID vaccine development process. The purpose of the COVID vaccines is to stimulate the creation of the antibodies in your own body, to protect you against exposure to COVID. Now, that’s what antibodies are for. They are there to protect you against exposure. They can only be created after you have once been exposed to something.

The MRT on the other hand doesn’t look for antibody creation. It looks for mediator release. Mediators, the most famous one we all know is histamine. We know that if we have a bee sting or a poison ivy encounter, and we take some Benadryl, which is an antihistamine, we can get relief from the swelling that is so painful with those encounters. Histamine is only one of 80 or more mediators that the bloodstream can release upon exposure to what it deems to be a threat. Every mediator that is released into the blood triggers or causes inflammatory activity.

Now we are going beyond antibodies, which are unreliable markers and really should be protecting us against, say if I have antibodies to mangos, I should be protected when I eat a mango and not experience inflammation. Instead of that, we are going further back, before antibodies even get created because they only get created in hypersensitivity reactions, not all of them. When mediators are released, they always cause inflammation.

The MRT looks at 150 foods and 20 or so chemicals and additives in our food supply and tests those against the whole blood to see which ones incite the blood cells to release those mediators which cause inflammation in the body.

Dr. Eric:

With IGG testing, I know in order for that to be “accurate-” I’m like you. I have been skeptical about IGG testing for years. I can’t say I’ve never done it, but there are practitioners who do it on all their patients. If I do it, before I found out about MRT, it would be usually toward the end of, well, nothing else seems to be helping.

One of the things with IGG food sensitivity testing, you have to be eating the food in order to test for the food. If you have been avoiding any food, whether it’s gluten or eggs, and then you do an IGG test, you would expect it to be negative because your body is not going to be developing the antibodies. With MRT, looking at the mediators, it doesn’t work that way, from what I understand. Even if you were avoiding the foods, you could still do MRT, and it would be accurate.

Elizabeth:

You are absolutely correct. When we tested my son, he was six years old. He tested red, reactive, to coffee. He had never had coffee. He was six years old. I could be pretty sure about that. That never would have come up on an IGG test because he had never had coffee.

If you are looking to get a Celiac test, same thing. They are going to ask you to start eating bread for the two weeks leading up to that test so that your body is accustomed to seeing it again. How painful would that be if you already know that eating bread causes you problems? Now you are forced to put yourself in misery for two weeks to get a positive test result.

Dr. Eric:

It’s funny because last year, when I interviewed you, we didn’t spend too much time on MRT. We spoke a little bit about it. After the interview, I had a few other people I interviewed who mentioned MRT, which is funny because prior to that, I don’t think I had anybody bring it up. It’s not as well-known as IGG, but it is out there. I have noticed more and more practitioners are using it.

I can’t say I use it on all patients. I probably do need to use it more. Again, maybe this interview will encourage me to have more of my patients use it. You did introduce me to it. Even though I’d heard about it, I never signed up and started using it until speaking with you. I’m grateful for that.

When you do the test, and you test positive—you don’t have to go into great detail about the test—but you could either be red, yellow, or green. If you’re red, you have to avoid the food for a longer period of time. If it’s yellow, you should still avoid it, but not as long. If you’re green, then you’re good to go. Is that a summary of the test?

Elizabeth:

That is a pretty good summary although that’s a basic approach to working with the MRT. What you learn in the certification course is how to apply the test results and develop and design something called LEAP Dietary Therapy. LEAP: Lifestyle, Eating, and Performance. It is a trademarked name. I didn’t invent it. Very scientifically designed.

This is kind of the polar opposite of an elimination diet. If you were doing the IGG test or the IGE test, and you were to get the test results back, they would say to eliminate the things that turned up. You can eat everything else. You’re fine. Just eliminate these problem foods. That’s not very helpful because maybe now you’re eating foods that are also inflammatory for you but maybe not as inflammatory for you. It’s just really not that effective and not that helpful. I look at it as an antiquated way. 300 years ago, we might put you on an elimination diet. Just stop eating this one thing, and let’s see if that helps. That didn’t help, so stop eating that other thing. Now you are in this years-long cycle of trying to figure out what’s causing you problems.

The MRT speeds this up. With LEAP Dietary Therapy, instead of looking at the test and saying, “A, B, and C turned up high on the test. Avoid those things,” we are going to look at the test results and say, “X, Y, and Z turned up low on the test. You should be focusing on creating a diet out of these items that we know to be non-inflammatory for you.” If it’s implemented correctly, inflammation starts moving out of your body within the first week or two. Symptoms start to decrease so rapidly. The entire LEAP Dietary Therapy is six weeks to get you on the right course because it takes six weeks to move inflammation out of your body. As you finish, you understand how to move forward and keep that inflammation out.

Most importantly, how do you recover when you’ve been accidentally triggered? This happens even to me, as much as I try to be aware and stay away from what I know to be triggers. There are also times where either I was unaware, or I even sometimes, and I tell this to my clients, you just make an informed decision. “Well, I’m going to choose to eat this even though I know it’s going to make me not feel good.” After you get through this LEAP Dietary Therapy, you have an idea of how that’s not going to make you feel good. You can choose. You’re not flying blind anymore.

It might be even as simple as saying, “Am I going to choose the chicken or the steak at this meal?” You understand which one will keep you in an uninflamed place, and which one might trigger inflammation in your body.

Dr. Eric:

With those foods that you react to, the ones that show up positive, most of them, would you be able to reintroduce in the future? I don’t know if you can eat lettuce now, or if it’s a food that you have to permanently avoid.

Elizabeth:

You know, that’s a good question. I haven’t challenged myself on lettuce because I can eat arugula, spinach, kale. I just can’t eat anything that’s called lettuce, like red leaf lettuce, iceberg lettuce, Romaine lettuce. At that same test, when lettuce turned up reactive for me, also avocado turned up reactive for me. That was very surprising because I always advocate avocado as one of the best foods for people with MS and other nervous system conditions because it has very healthy fats in it. It’s also one of the first foods I fed my babies when they moved to solid foods because I think avocadoes are so wonderful.

As it turned out, avocadoes were definitely inflammatory for me. When I would have avocado and lettuce together in a salad, double whammy, that would throw me out of commission for days.

But that test was maybe 2012. Every couple of years, I would challenge myself on avocado because I missed it so much. For the first couple of years, I would react and react and react. Now, 10 years later, I’m fine eating avocadoes. They don’t cause any inflammation for me.

Dr. Eric:

Interesting. For a few years, you weren’t able to eat them. It just took a certain amount of time for you to get below that threshold with regards to the avocado then?

Elizabeth:

A lot of that has to do with that toxin threshold. Also, the immune system’s memory, how long it might take for that memory to clear those T cells to forget that they were offended by avocadoes and to be able to accept them again. That’s all part of the healing journey and part of the process that I teach and people learn after taking the MRT.

Dr. Eric:

I do want to touch a little bit on parasites, but I didn’t know if there was anything else you wanted to mention about MRT.

Elizabeth:

I think I’m good with the MRT. Let’s move to parasites.

Dr. Eric:

Parasites are something else you focus on. Why are parasites a problem for everybody?

Elizabeth:

Unfortunately, it is super easy to pick up a parasite in this world. We don’t have to have had foreign travel although if you have, that could be a clue. You can get them from eating sushi, playing with your dog, swimming in a lake or a river or even a public pool. Every summer, I watch on the news as they find Giardia in water parks around the country. You can get them from eating vegetables that haven’t been washed well or well enough, produce, things like that. You can get them from cleaning out your kitty litter box. In 2018, there were a dozen McDonald’s around the country that they found cyclospora in the salads. In the ‘90s, the entire town of Milwaukee was infected with Cryptosporidium through their municipal water supply. It’s just really easy to pick up parasites.

Those same T cells are the sentries in our body’s immune system. They go through the whole body looking for foreign invaders. Most foreign invaders in the human body, up until the last couple hundred years maybe, have been virus or bacteria, or maybe mold, too. That could be one. Now, there are just so many things that the T cells can find to react to. One of them is parasites because parasites are foreign invaders.

Typically, when the T cells find those foreign invaders, they trigger that inflammatory process and start sending inflammation and heat and antibodies. Those work pretty well against bacteria and viruses but not at all against parasites. If you have parasites living in your body—let’s be clear, the goal of the parasite is to find a host, move in, and reproduce forever more—the T cells see foreign invaders, and they sound the alarm constantly in this vicious cycle. They send out the inflammatory cascade, and the inflammation goes. But the parasites don’t care at all about that, so they’re still there. Then the T cells come back and say, “The foreign invaders are still there. We need to send out more inflammation.” You just end up in this vicious cycle.

The longer I work in my clinic, the more and more convinced I am that hidden parasitic infection is at the root of most, if not all, chronic inflammatory conditions.

Dr. Eric:

You take an herbal approach when it comes to parasites.

Elizabeth:

I do. Myself personally, I have done the pharmaceutical approach, too. In 1998, my then-fiancé and I did a two-week horseback trip across the Eastern Tibetan Plateau. When we came back into Chengdu, China, we had a huge feast at a five-star restaurant. We will all meet there at 6pm. It was such a great celebratory atmosphere. By midnight, 12 out of 15 of us were worshipping the porcelain gods. That is a very clear indication that something was wrong.

For people who are listening, you might have had an experience similar to this. You might have called it food poisoning. You might have called it a 24-hour flu bug, or something didn’t agree with you. That could be the genesis of your infection. It’s called the acute phase of parasitic infection.

When I came back from Asia and submitted my stool sample to my GI doctor, it made its way to the CDC. They actually picked up the phone and called me and said, “Where have you been? We have identified five parasites in your stool.” But that is unusual, as you probably know. Parasite testing is notorious for false negatives.

At that time, this was 1998, I didn’t know anything about the natural health world. The doctor put me on Flagyl, which is a very potent antiparasitic. Still one of the first line antiparasitic pharmaceutical medications that we have. First of all, antibiotics don’t work against parasites.

Flagyl wipes out every bit of flora and fauna in your system. One GI doc said to me, “Using Flagyl to kill Giardia is like using a shotgun to hit a mosquito. You might hit it, but you’re going to have a lot of collateral damage from all that buckshot that is going everywhere else, too.” That’s kind of what Flagyl does. It leaves you this empty shell that you now have to rebuild your whole microbiome from the inside out and recover from it. And you might have gotten the adult parasites, but you probably didn’t get the eggs. Some parasites lay 2,000 eggs a day. You might not have gotten the larvae, which are teenage parasites.

Yes, I prefer an herbal approach. I have a formulation or a protocol that I have developed that is a 30-day protocol that is very effective and super gentle. I use it with babies when their moms find worms in their diapers. I have done it myself six or seven times. I did it most recently at the beginning of the pandemic when I felt like I was having inflammation that was out of control. My kids have done it. It is just very gentle, very well tolerated. Most people don’t feel anything while they go through it unless they are in a fairly recent infection, and then they might feel remarkably different within the first week.

Dr. Eric:

Since parasites are so widespread, when someone follows the protocol, there is a chance they could always get reinfected, I imagine. I don’t know if you personally do cleans every so often, like follow your protocol a few times a year. Do you just base it on symptoms? I think the approach you take with all clients is you treat them as parasites. How do you know if six months later the parasites haven’t come back? Or do you just do something from a preventative standpoint?

Elizabeth:

If you treat for parasites, and that person gets better, then you should have a pretty clear causality. Oh, well, I gave you the parasite protocol, and you got better. You probably had a parasite. Then they start going downhill again after a certain point. Usually, I will say six months, sometimes a year or two years or three years even. That is when I recommend, they do another parasite protocol.

Some people have to do more than just the 30-day protocol. I have a client right now who is in the Bahamas, still seeing parasite eggs coming out in her stool. Sometimes, I add in another protocol. When we added in this other protocol, she started seeing more worms come out, even though she’d already been doing parasite protocols for at that point three months, something like that. There are so many kinds of parasites, and some are harder to evict than others. The 30-day protocol I like to start with is a very gentle way to start.

Dr. Eric:

I know some practitioners, before having someone follow a parasite protocol, they will do things like support lymphatics, so they will almost have a pre-protocol before parasites. Do you find that to be necessary, or do you just put them on the herbs?

Elizabeth:

I usually just put them on the herbs because for a lot of people, it is enough to have to remember to take the herbs and follow the dosing calendar three times a day for 30 days. If I were to add in more things that they had to do, they might throw the whole towel in and feel too overwhelmed. Overwhelm is a big part of it. You can do other things, like you can do hydro colon therapy or colonics, but you don’t have to. It will work itself through your body pretty efficiently, whatever needs to come out.

Dr. Eric:

Obviously, you’re still doing what you’re doing because it works. Different practitioners have different methods, so I wanted to ask because I have been asked that, too. There are four-month protocols out there involving parasites. The first month or two are really preparing the person for the parasite protocol. When I spoke with you last year, I got the impression you didn’t do that. A lot of practitioners just jump into the parasites. I wanted to see what you do. It sounds like that’s pretty much what you do.

Elizabeth:

It is what I do. Just recently, I had a consultation with a 16-year-old girl who has been suffering from debilitating migraines and nausea and constipation, all kinds of systemic issues. It was affecting her, keeping her out of school, missing a lot of work. She was very distressed.

When we started speaking, and I mentioned that I would want her to begin with the parasite protocol, her mother remembered that when she was eight or nine, she had been on the beach in Mexico. When they came back, they had noticed a red line moving up her leg. It kept moving up, up, up her leg. They took her to many doctors who didn’t know what it was and thought itwas just a rash or something. Then they found a doctor who said, “This is a parasite.” They had put her on a pharmaceutical; probably anti-worming would be my guess. Maybe Ivermectin. It resolved that particular trail that was moving up her leg.

As we know, there are probably eggs still in there. Now, 10 years later, she is having really debilitating symptoms. I believe that the origin is that Strongyloides infection that she received.

Dr. Eric:

It’s amazing how healthier foods, let alone foods we know are inflammatory and things like food dyes. It’s also sad because most conventional medical doctors will just completely dismiss this. If someone were to ask to do a parasite test, unless they are having diarrhea and the traditional parasite symptoms, but obviously people don’t have to have diarrhea and gastrointestinal symptoms to have parasites, but most of them will dismiss that. Same thing with MRT. Most of them probably have never even heard of that. Fascinating.

If someone is interested in MRT, or they found this conversation fascinating with regards to parasites, where can they learn more about you? Also, I want to briefly talk about your upcoming book.

Elizabeth:

I am on all of the socials. Please don’t DM me there because it might be months before I actually see that DM. If you are interested in learning more about this, the best place to go is my website, ElizabethYarnell.com. You can get on my newsletter. You can start following me on the socials because I do post on the socials; I just don’t always get the DMs very easily.

Anyone who is listening, if this is resonating with you, and you want to explore further, at the bottom of every page of my website, there is a link to schedule a complementary naturopathic health assessment with me. Happy to do that with anyone.

Lots and lots of information out there. I have been doing a mad circuit of podcasts and summits lately. If you get on my email list, you will start to learn about all of that stuff as well.

Dr. Eric:

Can you take a minute or two and talk about your future book? What can people expect?

Elizabeth:

Yes, I’m so excited about this book. In 2011 or 2012, I spoke with my literary agent because you can see my first book is up on the wall behind me, Glorious One Pot Meals. That’s my cookbook. I was speaking with her, and I said, “I’m ready to write another book. I want to write it on inflammation.” She said, “Nobody wants to read about inflammation. They want another cookbook.” I didn’t want to write another cookbook.

Here I am, 12 years later or so, and I have finally written my book on inflammation. It will be coming out to coincide with MS Awareness Month, which is March 2023. I am super excited about this book.

As you mentioned at the top of the show, Eric, even though my focus is on MS, my history is with MS, inflammation is the common root of most if not all chronic disease. If we focus on the inflammation, that is what I talk about in the book. That is where I want to point and shine the light on. Inflammation is the common root of all of this. Even though the inflammation may manifest differently in different conditions, it has inflammation at the bottom. There are triggers, and we need to be looking in the right places to identify those triggers in order to reduce inflammation and eliminate the symptoms.

Dr. Eric:

By the time this episode is live, the book will be out. Thank you so much, Elizabeth. Again, this was a great second interview. Like I said at the top of the hour, I expected there to be some overlap, but I also wanted to ask you some follow-up questions, which I did. The first call was more on parasites and a little bit on MRT. This was the reverse, where we focused more on MRT and did a little bit on parasites. Thank you for getting together. Also really looking forward to your book.

Elizabeth:

Me, too. I wish I could announce the title and have everyone look for it, but I have changed the title, I don’t even know, 30 times so far. I don’t even want to venture an idea of what the title will end up being.

Dr. Eric:

You’ll come up with it soon because it will be out in a few months.

Elizabeth:

The clock is ticking!

Dr. Eric:

Good luck with that. I’m sure it will be a great title when it’s out. Like I said, I look forward to reading it. I know a lot of listeners will look forward to reading it as well.

Elizabeth:

Thank you for having me on. I really appreciate it.

Recently I interviewed Dr. Vincent Pedre, and we chatted about his new book “The GutSMART Protocol”. If you would prefer to listen the interview you can access it by Clicking Here.

With me, I have Dr. Vincent Pedre, and we are going to be chatting about his new book The GutSMART Protocol. Dr. Pedre is the medical director of Pedre Integrative Health, founder of Dr. Pedre Wellness, and CEO and founder of Happy Gut Life. He has worked as a nutraceutical consultant and spokesperson for NatureM.D. and is a functional medicine certified practitioner with a concierge practice in New York City since 2004. Dr. Pedre believes that the gut is the gateway to excellent wellness. His newest book The GutSMART Protocol, featuring a 14-day personalized gut healing plan based on the GutSMART Quiz, is the culmination of years of research and clinical experience as a functional gut health expert. Thank you so much for joining us, Dr. Pedre.

Dr. Vincent Pedre:

Thanks for having me. I’m excited to have this conversation with you.

Dr. Eric:                                      

Same here. Excited to talk about your new book. Before we start that, can you give a little bit of your background? How did you start doing what you’re doing? You wrote a first book. What led you to write this newer book?

Dr. Vincent:

For one, the research that has come out on the gut and the gut microbiome has just exploded in the last couple of years since I finished my first book, which was over seven or eight years ago. I really wanted to consolidate all the new knowledge that we have but also take everything that I’ve learned, the feedback I’ve gotten, and write a new protocol for gut health that really puts together all of my experience with dealing with gut patients and realizing that there is no one size fits all when it comes to gut health. The approach to healing the gut, especially when it comes to nutrition, has to be personalized.

The biggest distinguishing factor between the books, aside from the GutSMART protocol being a 14-day program versus a 28-day program in Happy Gut, is the GutSMART protocol is powered by the GutSMART quiz, which personalizes the program to the individual based on the score that they receive on the quiz. The quiz is not just looking at gut health issues but also what I call gut related health issues. I talk about that in the book, the difference between a gut centric issue and a gut related health issue, which can happen in all different parts of the body, like the brain, the skin, the lungs, the airway. I wanted to educate people on the interconnectedness of how gut health is really the foundation of the rest of your health.

The update in the research, some of the most recent science, and a personalized protocol not only distinguishes this book from Happy Gut, but also distinguishes it from the majority of the books out there that come out with a prescriptive plan that is a one size fits all. I don’t think that’s right for everyone, especially when dealing with gut health issues, from my experience treating patients now for over a decade with gut health issues using a functional medicine approach.

Dr. Eric:

I agree. It’s funny because one of the questions I have prepared is is there an ideal diet for optimal gut health? I guess you already answered that. No, there is no perfect diet.

Dr. Vincent:

There is more that we can dive into. There are several things we can look at. There was a study done as I was writing the book that was published at Stanford University, where they took a small group of women and divided them into two groups. It was about 16 women per arm. They did it for 10 weeks. They looked at a high fiber diet versus a high fermented foods diet.

They were looking at some important markers, like immune function. We know that 70% of the immune system is all along the gut lining and is very much controlled by what’s happening in the gut. We learned that during the world pandemic, how important the gut was in determining whether people ended up being hospitalized with COVID and how severe COVID they got. They looked at the differences between them, and they also looked at 19 inflammatory markers. Very objective measures you can take from a blood test. They also looked at the stool microbiome. They looked at the diversity of bacteria in the gut. They tested before, and they tested at the end of the program.

Even within the personalization, we can make some general assumptions. What was surprising is if you hear people talk about gut health, you will hear fiber, fiber, fiber. It’s so important. It’s important for the health of the colon. That’s true. What they found was that fiber was a very powerful immune modulator. What does immune modulation mean? It means that your immune system is in balance. It’s not working too much, but it’s also not underactive.

What was surprising though is you would think by everything we have learned about fiber and how it gets gobbled up by the bacteria in the gut, and then they produce all of these incredible post-biotic nutrients. We know short chain fatty acids have effects all over the body, including the brain. You would think that that’s what creates microbial diversity, feeding the microbiome fiber. It didn’t.

What increased diversity was a high fermented foods diet. That was about 2-4 servings of ferments per day. And I think even more importantly, what they found is when you increase diversity, you also lower 19 inflammatory markers. It lowered inflammation. That was a very surprising finding from the study. It’s a small study. It’s not a big group of people. It has to be repeated in a bigger cohort to see if it remains true. But I think it does lead us in a certain direction.

If you take my GutSMART quiz, and you score Severe as your score, what you will find is when you go into the food list, you’re not allowed to eat fermented foods. When you have severe gut dysfunction, you won’t be able to tolerate ferments. I always think of it like the old days when we use transparencies in school. You put one transparency on top of another. You have to interlay, okay, we understand, yes, eating a good amount of fermented foods on a weekly basis is good to lower inflammation and to improve microbial diversity.

For anyone who is listening, microbial diversity is the holy grail. The more diverse your microbiome is, the less inflammation, the better your gut barrier is. It’s what you want. The problem is that in our modern world, we are losing diversity, starting from a very early age. Kids are exposed to too many rounds of antibiotics unnecessarily for viral infections.

Even for ear infections, a number of years ago, the standard used to be if a child has an ear infection, you automatically give them an antibiotic. Then they found that you actually don’t need to do that unless it’s a severe ear infection. The problem is that we are already getting exposed to antibiotics from an early age, and it’s damaging the diversity of the gut microbiome. There is a theory that the diversity never fully recovers.

For me, I was on 20+ rounds of antibiotics from the age of 10 through my late teenage years. That is extraordinary. It destroyed my gut microbiome; it led to leaky gut and food sensitivities, and my immune system was shot. I just kept getting sick. I was a hypochondriac. Part of the reason I went to medical school was I wanted to biohack how not to get sick. I wanted to understand my body. Little did I know that was going to lead me down this rabbit hole of gut health, gut microbiome, fixing my gut, working with hundreds of people on their gut health issues, seeing whole hosts of health issues improve and get to this point.

Just to circle back, we can say fermented foods are good, but it depends on your gut type, which is what I determine using the GutSMART quiz. You can figure out is it okay to incorporate ferments? Do you have to wait for some gut healing to happen, and then you can start incorporating them?

Dr. Eric:

From what I understand, at least according to the study, which like you said, a smaller study, probably needs to be repeated in a larger setting. But it sounds like fermented foods are superior to fiber when it comes to diversifying the gut microbiome. But if you have certain gastrointestinal disorders, such as maybe SIBO, which a lot of those people have issues with fermented foods, then they should avoid fermented foods. The good thing is it sounds like your quiz will guide them in a direction to tell them, “Now is not the time for fermented foods.”

Dr. Vincent:

Exactly. What happens sometimes is the nuances get oversimplified. You might read an article that says ferments are good for your health, but maybe you have an underlying SIBO or SIFO (fungal overgrowth, candida). You start eating ferments, and you feel horrible. You get more bloated. You get inflamed. You don’t feel well because it’s not the right time. What I did with my book is try to get through those nuances to help people understand when is the right time to eat those foods? What are the right foods, depending on your gut type or GutSMART score, as I call it?

Dr. Eric:

You mentioned candida. Different trains of thought when it comes to fermented foods. If someone has candida overgrowth, do you typically recommend those folks to avoid fermented foods completely?

Dr. Vincent:

It depends on the person. Sometimes, what I find is they can have such a powerful die-off from incorporating a fermented food that it’s overwhelming, and it makes them feel horrible. That’s where you really need to be working with a functional doctor/naturopath who understands how to match things together. If you have one of those issues, you might just start with a quarter teaspoon of a ferment and test it out. Then slowly increase from there.

I talk about that because I think in our magic bullet philosophy in America, with pharmaceutical-driven medicine, you hear something, and you think, “Well, if a little is good, then a lot is even better.” But that’s not the case. I talk about that in my book. It’s really important to start slow. Test the water. Then slowly increase over time.

Now candida treatments can get more complex. When you’re killing off candida or yeast, you’re going to release toxin. It’s helpful when you’re doing that type of treatment to use binders that will help bind the toxin and keep it from entering your body. You can use things like activated charcoal, bentonite clay, but also, I personally like, if the person has no objection to them, using SBIs (serum-derived bovine immunoglobulins) because they bind those toxins.

SBIs have been shown to bind endotoxins released by bacteria in the gut, which protects the gut lining and can help the gut lining start to heal. Inevitably, if you have SIBO or candida overgrowth or dysbiosis, you’re also going to have leaky gut. That’s where the problem is. The leaky gut is like having a leaky border that is allowing all these inflammatory substances to get into the bloodstream. They have done tests where they have shown bacteria and bacterial DNA gets into the bloodstream. We know that endotoxin, which is released by bacteria, causes a whole host of inflammatory cascades in the immune system, the brain, the liver, muscle tissue. It increases insulin resistance and leads to weight gain.

Dr. Eric:

Very interesting what you said about the SBIs. If someone were to use SBIs, they wouldn’t need activated charcoal or bentonite clay? Do you usually recommend a combination?

Dr. Vincent:

Sometimes, I might use the SBI by itself. It depends. If you’re working with a practitioner, you might incorporate different types of binders because they all have different binding properties, depending on what you want to bind. Also, SBIs tend to constipate. If you are working with a patient who is already constipated, then you have to be really careful with an SBI because you could really stop them up. You need to make sure you are going to give them some sort of support so that they are going to the bathroom regularly. Again, it depends on what type of SIBO they have. You want to make sure they are getting the right amount of fiber, but you have to be careful not to give too much fiber. It will get fermented, and they will get really gassy, bloated, and uncomfortable.

Dr. Eric:

Makes sense. Going back to the fermented foods. I have two hopefully quick questions. Would you recommend a diversity of different types of fermented foods rather than someone eating sauerkraut every day? Do you recommend on top of that a probiotic supplement, or if someone is eating fermented foods daily, would that be sufficient?

Dr. Vincent:

In this study, for example, the participants were not taking a probiotic supplement. They just added ferment, and it did improve the diversity of the gut. In my clinical practice, when I’ve worked with patients with severe dysbiosis, with candida overgrowth, sometimes you really need to use a high potency probiotic as well to get in there and help reset the microbiome.

There are different types of probiotics, like soil-based organisms that are spore-based that actually produce their own antimicrobial peptides. It’s like having little, tiny, antibiotic-creating factories that are delivered specifically to where they’re needed, but they’re actually not going to kill off your good bacteria. They will increase the diversity of your gut microbiome. There is a place for that as well. That’s really important.

In terms of the types of ferments, I think diversity is kind of like the key to happiness in life. If you start doing the same thing over and over, you will get bored with it. Maybe your body will get bored with it. I really think rotating the types, so sauerkraut, pickles, yogurts. I think for a lot of people, because dairy sensitivity is very high in the population, and even just lactose intolerance is super high, it’s probably better to go with a coconut yogurt or non-dairy yogurt. Sometimes, it can be helpful to use a kefir that is made from organic milk, grass-fed cows. Or even goat milk kefir. It depends on your sensitivities and what’s going on in your body at the time.

I’ve personally used kefir as a way to help my gut recover from having had a parasite. During the pandemic, I went to Guatemala, and I ended up getting giardia. I was really, really sick to the point that it became really hard to eat. The two things that helped me recover were kefir and bone broth. It seems strange, and I can’t explain why I thought. Of course, I also took a probiotic. Intuitively, it felt like that’s what my gut needed at the time. That’s something that I know is hard. How do you doctor yourself?

I talk about intuitive eating and really understanding before-meal intuition, during-meal intuition, and after-meal intuition. It’s important to understand before you eat, how hungry are you? Intuitively, what is your body craving? There is an intelligence there. Your body is going to let you know. Over the last 20 years, as a doctor, I’ve had for example women come in who eat very little red meat and then might say, “My body is craving red meat for some reason.” If you’re going to eat red meat, eat grass-fed beef or bison or lamb. Very humanely sourced meats. There is a wisdom there. Usually, if that’s happening, there is iron deficiency, and the body knows.

It could be that you’re craving a big bowl of vegetables. If you have severe gut dysfunction, then it’s going to be hard for you to digest non-cooked vegetables. Raw vegetables are going to be really hard, especially if you have leaky gut. You might have pancreatic insufficiency, so it will be hard to break down vegetables. If you see a salad green in your poop, automatically you can assume you’ve got some element of leaky gut. You’re not digesting your vegetables properly. You’re probably not making enough enzyme, so you have to revamp your diet.

I took your question and went on a whole tangent on intuitive eating. I think it’s important because even when you’re incorporating ferments, start at a quarter teaspoon, then go to half. A lot of it is dependent on the person listening to their body. The one thing I learned over the years from working with patients is that for some reason, people don’t know how to listen to their bodies. They just are not listening to the signals. Sometimes, I used to think, “I’m just a body whisperer. I’m just telling people what their bodies are telling them and helping them learn how to listen to their body.” That’s why it’s so important to have that after-meal intuition where you’re tuning into your body and seeing, “I ate this meal. I now feel really sleepy and tired and bloated. I’m not feeling so great.”

I had a professor I listened to give a lecture, and he said, “We should be eating for our microbiome.” I also like to think that I eat based on how I want to feel and the time of day. There is a Circadian rhythm to what your gut is doing and how your body will respond to different types of food.

Dr. Eric:

You mentioned leaky gut a couple of times. I want to cover this. Especially when it comes to testing, I used to do testing all the time for leaky gut. Then I just saw most people were positive, so I assumed people have a leaky gut, and that’s what I do these days. A lot of practitioners do testing. Maybe your quiz points them in the direction of whether they have a leaky gut. I wanted to get your approach.

Dr. Vincent:

If you end up with moderate or severe dysfunction, you pretty much can confirm you have a leaky gut in the background. I agree with you. The testing for leaky gut is not foolproof. The lactulose mannitol test that can be used for leaky gut is really only picking up leaky gut in the small intestine. If the gut is leaky in the large intestine, it won’t pick that up. It’s much harder to pick up. For example, patients with Parkinson’s tend to have increased intestinal permeability or leaky gut more in the large intestine than in the small intestine.

I did the testing for a while. Sometimes, I do food sensitivity testing. If someone lights up across the board, lots of high sensitivity, moderate sensitivity reactions, you can assume they have leaky gut. If I do wheat metabolite testing, looking at different wheat breakdown proteins in metabolites, and look at antibodies to zonulin as well as antibodies to actin or vinculin, which are basically cytoskeletal structures that hold the cell together and help create those tight junctions between the cells, you can assume that if you have developed antibodies to those structures, you have leaky gut.

We are working like Plato. We are looking at the shadows against the wall. We can’t exactly measure it directly. You could put somebody under an ultrasonic endoscopy, where they can do micro ultrasound and look at the gut lining. We’re not going to do an invasive procedure on every patient that we suspect has leaky gut.

Just like you, after testing for a while and seeing how people even just react to putting them on a leaky gut protocol, I decided that I am going to go by the clinical because it’s very obvious who has leaky gut and who doesn’t have leaky gut and how they respond to these interventions.

Dr. Eric:

It sounds like the test you use is similar to- I’m sure you’re familiar with Cyrex Labs. I used to use the Array #2.

Dr. Vincent:

Yeah, Cyrex does that. Vibrant America also looks at wheat metabolites, food sensitivities, dairy metabolites. The thing is that it’s like you’re building the evidence, and it’s nice to have data. I’m very much into collecting data on patients, but there is a point where the data is not perfect anymore. I know there are labs that are looking at stool PCR patterns, so microbial patterns that might be indicative of increased intestinal permeability or leaky gut. Even that I think we still don’t 100% know. We are just making assumptions. As we get more pooled data from more stool analysis and start seeing what patients with leaky gut microbial makeup look like, maybe we will start seeing a microbial signature that identifies leaky gut. We also know that there are different microbial signatures even depending on what part of the world you live in and what your diet is like.

Dr. Eric:

Another flaw of the test is they don’t tell you what is causing the leaky gut. Are you eating gluten on a daily basis? Do you have a gut infection? Is there another factor?

Dr. Vincent:

Absolutely. I know you had a question about gut pathogens and infections. The thing is that when you find them, depending on the pathogen, you always have to line up the test result with the story of the patient. If we’re interlaying those transparencies, I hate medicine where you just treat the test result, and you’re not taking into account the person. You’ve got to overlay that we have this test result. Does it make sense with what’s happening with the person, with the story, with the symptoms, with how they’re presenting? If it does, then you treat. We have to be really careful about being trigger happy and treating everything that appears on a piece of paper. Sometimes, it doesn’t quite honestly correlate with what’s going on with the person. Some people may be able to tolerate having certain imbalances better than others.

Dr. Eric:

I don’t know what your answer to this question will be, but I kind of think I do based on what you just said. There are some practitioners out there who will treat everybody for parasites. I have interviewed people who do that. It sounds like that wouldn’t be your approach because that’s-

Dr. Vincent:

It depends on the parasite. For example, Blastocystis hominis, one of the most common parasites worldwide. Very common in India, but I’ve seen it in patients in the United States many times. If you do a Google search, you will find literature saying it’s a benign parasite. You don’t need to treat it; ignore it. If you dig a little deeper, you will find research studies connecting Blastocystis hominis with leaky gut. We know leaky gut is the first step down a chain reaction that increases inflammation, overactivates the immune system, can eventually lead to autoimmune disease and other chronic degenerative disease in the body.

Always putting it in context of that, who the patient is, and figuring out what is the right thing for that person? If they have amoeba in their stool, of course I’m going to treat that. It’s incredibly inflammatory. It’s invasive. If they have any other sorts of parasites, yeah. I tend to err unless there is evidence that the person is not showing any signs of any issues, including blood markers, having elevated C reactive protein and other things that are important.

Something like H-pylori is a great example of a “pathogen” that infects the majority of the people in the world. When they first found it, they connected it to peptic ulcer disease and said, “If someone has H-pylori, we need to treat it.” Of course, the pharmaceutical industry is on top of that, coming out with all sorts of regimens including Clindamycin, which is one of the worst antibiotics you could ever take because it increases your risk for C. diff diarrhea, which is a very bad diarrhea that can even lead to what we call mega colon and, in the worst case scenario, death or ruptured colon. You’re increasing the risk of that by going on these antibiotics for H-pylori. We know there is also increasing antibiotic resistance.

The fact is that’s an example where say you find H-pylori in a person. Could be just a colonizer. Is it an active infection? It depends on the way that it was tested. Is the patient symptomatic? If you do an endoscopy, do they have an ulcer, or do they have metaplasia, like signs of precancerous changes in the stomach, which can be caused by H-pylori? If they don’t have that, probably shouldn’t treat the H-pylori because it may be serving a certain purpose in there. Taking into account the risk/benefit ratio of putting the person on this crazy two antibiotic regimen plus a proton pump inhibitor, which can then lead to SIBO and all sorts of other problems that I have seen. Yeast overgrowth, it depends on the situation, the person’s particular individual case. What they might be at risk for or the other underlying issues they have at the same time.

Dr. Eric:

That’s pretty interesting. H-pylori doesn’t always cause symptoms. If they have ulcers or reflux, that might be an indication to treat H-pylori. How about if they have an autoimmune condition in the presence of H-pylori, but no symptoms? It sounds like even in that case, you might not decide to treat them just because they have an autoimmune condition.

Dr. Vincent:

Yes. You have to think the treatment itself is putting them at risk for developing a severe dysbiosis, leaky gut, which is only going to aggravate the immune system and possibly make their autoimmune condition worse.

Dr. Eric:

I agree with the antibiotics. I should have mentioned taking an herbal approach for example for H-pylori.

Dr. Vincent:

I’ve seen and used different herbal approaches. They’re not incredibly successful. I say the phrase “50% successful” with people. If a person has it, then I think you have to be judicious about deciding is this something that we should treat, or is it “Okay, we found it”? Instead of treating it, because you have no symptoms, let’s work on improving your microbial diversity through the diet. Let’s improve gut permeability, so let’s reduce leaky gut. Let’s reduce inflammation in the body. Let’s work on it from a different angle. Rather than attacking, we want to rebuild the gut and the immune system.

Dr. Eric:

Just one more thing with parasites. There are a lot of practitioners who will treat parasites. No stool tests, no symptoms, they just assume everybody has parasites, and they treat for it. It sounds like similar to H-pylori, you wouldn’t treat for parasites unless they have a finding on a stool test. There is a possibility of false negatives. Maybe they have a false negative, but they have symptoms that are indicating they have a parasite.

Dr. Vincent:

It’s a bit of a rabbit hole. If you start investigating, most of us have some sort of parasite. We could have a worm parasite. Parasites might actually serve an immunomodulatory purpose in the body. If you look at India, where people are colonized with parasites, before they started introducing more antibiotics and more of a Westernized processed foods diet, India had very low rates of autoimmune disease. If you track what’s happening in India throughout the 1900s, as antibiotics are introduced, more of a Westernized sugar, processed foods type diet, you start seeing autoimmune disease rising in India. That might be an example where having some level of parasites in the gut actually serves a favorable purpose. It’s part of microbial diversity.

The other thing I would say about it is if you don’t know what the parasite is, how do you know that you’re treating it correctly? To make it even more complicated, we have all these tests, the stool PCR, stool culture. Some of these tests are really poor at detecting parasites, especially if it’s a culture. PCR maybe will detect the parasite. Not always. I think it’s great when you find one. Whenever I’ve found a very specific parasite, and I can do a targeted treatment for that patient, patients always improved in some way, whether it’s their energy or joint aches that other doctors thought were due to an autoimmune disease. When you find a parasite and can do a targeted treatment, where you know you are treating exactly what you have, that’s very helpful.

I have a doctor friend who sends stool samples to Africa in a lab in Nigeria, where it gets analyzed under a microscopy. They find parasites that are missed by other labs. The question is are we using the right testing to look for these parasites? Do the patient’s symptoms correlate with a parasitic illness?

On one side, you could say you can assume people have parasites. It might not be a bad thing to do a parasite cleanse. It might clear you up. If you do that, and you don’t feel better, then maybe the treatment didn’t kill off the parasite. Maybe it was the wrong parasite. Maybe it was the wrong treatment. Maybe it wasn’t for long enough. Like anything in medicine, there is never a black and white, “Yeah, do this. Don’t do that.” It’s a matter of understanding each individual case.

Dr. Eric:

On a stool test, if you see some opportunistic bacteria, like commonly you will see Staphylococcus, Streptococcus, Klebsiella, Pseudomonas, are those usually not a concern? Is that something you usually address?

Dr. Vincent:

It totally depends on the full clinical scenario of what’s going on with a patient. Let me qualify it by saying that over the years that I have been taking care of gut patients, I went from being much more aggressive to being much gentler in my approach. Now, if I see that, I might say, “Okay, let’s build up the gut. Let’s work on leaky gut. Let’s work on microbial diversity. Let’s use a spore-based organism that is going to go in there and fight and claim territory away from these pathogens. Let’s approach it from a different direction.” That’s where I’m at now. Being gentler with people and having an approach that maybe is a little bit slower, but long-term, it actually works better for them.

Dr. Eric:

Makes sense. I agree. You don’t want to be aggressive with everybody. There is a time and place. Treating everybody who has increased Staphylococcus or Streptococcus, especially if they aren’t having symptoms, is probably not a good idea.

Dr. Vincent:

Certain things we do understand. Say you have an E.coli infection, and you have campylobacter. That will give you massive diarrhea, and you will feel horrible. Because of those situations, sometimes we apply that reductionist thinking to all of these fancy stool tests that we can get. Whole genome sequencing.

What we don’t understand is when you find that in a patient who is not having acute diarrhea or any other acute findings, what is it actually doing in the balance of the entire microbiome? Is its presence pathological, or is its presence part of the normal background? All you need to do is a little tweaking to improve it.

I think that’s kind of where I’m at more now: restoring gut microbiome diversity and letting the gut rebalance itself rather than thinking. I just see people treat people with strep or staff, and sometimes it goes well, and sometimes it creates more problems.

Dr. Eric:

I have one more question. I can’t let you go without asking about gluten. I assume you have people avoid gluten, but I also heard on another podcast you were talking about why some people avoid gluten. They might have not had issues with gluten, but then they avoid it and reintroduce it. All of a sudden, they are reacting to gluten. Or maybe it’s a different food. If you could expand on that?

Dr. Vincent:

Totally. Gluten is one of the most inflammatory substances. It’s been found to trigger a molecule called zonulin that is found inside the cells that line the intestine. It controls gut permeability like a dimmer switch. They have looked at gluten and its effect on people with Celiac, non-Celiac gluten sensitivity, and normal individuals. They found that depending on the degree of disease, gluten is going to have increasing effects on the person, but it is not neutral for a normal person. Even for someone who is normal, it will cause a slight increase in gut permeability.

What might be going on because- I don’t know if you have gotten into this in other podcasts, but how wheat has been hybridized. The gluten content in the wheat, especially here in the U.S., is 30-50% greater than it was 50 years ago. We are being exposed to gluten at a much higher rate than our digestive system can handle. It’s a very different molecule to digest and break down.

If you have leaky gut, and you have partially digested gluten molecules that didn’t get bound to an enzyme called tissue transglutaminase, then you get these chimeric molecules that your immune system will look at and say, “This is foreign.” Then it has molecular mimicry that can cause your body to attack things like your thyroid for example.

I think it’s a stepwise hit problem. Maybe you start off normal, but then you go on antibiotics. Your gut permeability increases a bit. You’re eating a lot of bread, pastries, things like that. Your diet is not perfect. There is an accumulation over life issue that eventually you can reach that threshold, where it causes disease in the body. That’s the same theory for all disease in the body. We need to apply that also to gluten.

Why is it that maybe during your 40s, you were not gluten sensitive, but in your 50s, now you are starting to find that you don’t feel so good when you eat gluten? You get achy and mental fog. I think it’s that multi-hit hypothesis over time. It could be genetics, genetic expression that changes over time. Our genes are controlled epigenetically by the foods that we eat. I think that’s a dynamic process. It’s not something that is just set in stone.

We used to learn that Celiac disease was a disease that was diagnosed early in life in pediatrics. We learned about Celiac in medical school. This was only 20+ years ago for me in our pediatric rotation. Now, we know that Celiac disease can evolve later in life. You might have the predisposing genetics, but it’s a multi-hit exposure after exposure after exposure to gluten that eventually just cracks the camel’s back, and then you get Celiac disease.

My oldest patient with Celiac disease who also had Hashimoto’s, which is very much linked to Celiac, I diagnosed her with Celiac at age 52. She had positive markers. No other doctor had picked it up. I think also it’s because I asked the question, and I thought, this is not what I learned in medical school, but what if she has Celiac disease? She would get sick whenever she ate anything that had wheat, gluten. She would get nauseous.

I think we have to have a really broader understanding of how disease evolves over a lifetime. Even if you were fine when you were younger, what I like to tell people is that your body is like a board game that changes the rules, but it doesn’t tell you that the rules have changed. You have to find out that the rules have changed by playing the game. You have to figure it out. If you can be astute to that and understand that your body, your blueprint is slightly changing as you get older, your body is going to get a stronger read of what’s going on.

Say we find that you’re gluten sensitive, and you take gluten out of your diet. You create this blank slate. When you were eating a lot of gluten, it was overwhelming your immune system and causing immune complexes that maybe weren’t allowing for the full expression of the effects that gluten was having in the body.

For example, you mentioned that one patient where she had taken gluten out. She was feeling great. A month in, she went out for a pasta dinner or something, and she broke out in full body hives. She was upset. She was wondering what happened. Did I make myself gluten sensitive by taking gluten out of the diet? That’s not what happened. What happened was you create a blank slate. When you reintroduce gluten, now your body is going to give you a very clear read of what that gluten is doing to you. It causes this massive activation of the immune system that led to hives in this person. I think that’s something important for people to understand.

If you follow my GutSMART protocol and do the protocol for14 days, then retest, do the quiz, and see if you can progress, or if you are still on the same level. Say you progress from severe to moderate, and you can start to introduce new foods into the diet. I tell people there is still a powerful individuality that goes into what your body can tolerate. Even though I have determined these are the foods that are okay under the moderate, I still want you to be intuitive and listen to your body. What might be right for one person might not be right for everyone.

Dr. Eric:

Thank you for talking about that. Definitely agree. Where can people find out more about you? I know you have a free gift as well.

Dr. Vincent:

I’d love to share a free chapter and some special surprise bonuses from my book. If you go to GutSmartProtocol.com/gift. If you want to learn more, go to GutSmartProtocol.com. You can learn more about the protocol and the benefits of doing it and what people have found from following it.

Dr. Eric:

Awesome. Thank you so much for your time, Dr. Pedre. Appreciate it. Learned a lot. I’m sure the listeners did as well.

Dr. Vincent:

Thank you. It was great being here.

Recently I interviewed Dr. Deb Matthew, and we chatted about testosterone. If you would prefer to listen the interview you can access it by Clicking Here.

With me, I have Dr. Deb Matthew. We are going to chat about testosterone. I am really excited because I haven’t had an episode yet where I focused on just testosterone. Dr. Deb is an expert when it comes to this topic. I am going to dive into her bio, and then we will get into it.

Dr. Deb Matthew is known as the Happy Hormones doctor. She is a best-selling author, international speaker, educator, wife, and mom of four boys. After suffering for years from fatigue and irritability due to hormone imbalances, her quest to solve her personal health led her to change everything about the practice of medicine. She has been featured on national podcasts, radio, and broadcast shows, including NBC, ABC, CBS, and FOX. Thank you so much for joining us, Dr. Deb.

Dr. Deb Matthew:           

I’m so glad to be back.

Dr. Eric:

I’m glad as well. This is the first time I have you on the podcast. We actually interviewed you before my podcast on the YouTube channel. The first interview Dr. Deb and I had on YouTube was more general, talking about sex hormones. I really wanted to have an episode that focuses on testosterone. For those who didn’t watch the first interview, can you give a little bit of your background, how you started focusing on hormones?

Dr. Deb:

I used to be tired all the time. Napping was my favorite hobby. I used to be cold all the time. Even in July in North Carolina, I would take a sweater with me everywhere I went because when I went into air-conditioned movie theaters and restaurants, I would shiver uncontrollably. The refrigeration section at the grocery store was the worst.

I was also really irritable. I would fly off the handle at my kids over the silliest little things, and then I felt so guilty for being such a horrible mom. My husband didn’t know what the heck to do with me. He started saying things like, “Why are you always in such a bad mood?” The reality is that I didn’t know what the heck was wrong with me. It was really confusing because nothing in my medical school training helped me understand what was happening to me.

When it finally changed was when my husband found a book that he thought I ought to read. It was a book about hormones written by Suzanne Somers. I remembered her as Chrissy Snow from Three’s Company, the ditzy blonde, and the Thigh Master. I looked at this book, and I looked at him and said, “You’ve got to be kidding me.” Medical doctors don’t want to get our advice from celebrities. He looked at me and said, “Well, honey, we have got to do something.” So I read the book.

Truthfully, that book changed my whole life. That was the first time I got introduced to this idea that our hormones impact how we feel, who we are on the inside, how we relate to other people and react to the world around us. I learned that there are actually places where practitioners can go to learn about this stuff. It’s not woo-woo medicine; there is real science behind it.

When I really learned what was going on and got my hormones in balance, I got my energy back. My kids got their mom back. My husband got his wife back. I got my life back. I couldn’t go back to just writing prescriptions all day long. That didn’t make any sense to me anymore. So I retired from my old practice. For the last 16 years, I have been helping men and women get their hormones back in balance, so they can get well, get off a lot of those prescription drugs, and love the way they feel.

Dr. Eric:

That’s awesome. Many listening to this know that I am in the Charlotte area in Mathews, North Carolina. Dr. Deb, that’s where your practice is, in the Charlotte area, too. She is not too far away. Thanks for getting deeper with your background.

The focus is going to be on testosterone. Before focusing on testosterone, can you give a brief breakdown of the different sex hormones?

Dr. Deb:

For women, for sex hormones especially, we think about estrogen, progesterone, and testosterone. Those are the ones that come from our ovaries. Estrogen and progesterone are the ones that go up and down over our menstrual cycle. All the changes that happen cyclically, like PMS, menstrual changes, menopause, those are all tied up with estrogen and progesterone. Birth control pills have synthetic forms of estrogen and progesterone in them.

Testosterone is another really important hormone for women. We usually think of it as the male hormone. Of course, it’s really important for men, too. Men even have some estrogen, but men have way more testosterone than women do. They have 10 times more testosterone than women. Women have 10 times more testosterone than estrogen. We think a lot about estrogen, but we can’t forget about testosterone, too.

Dr. Eric:

That’s good to know. You’re right. A lot of women focus more on progesterone and estrogen and don’t really think about testosterone.

Dr. Deb:

And their doctors, too. Their doctors are frequently not thinking about testosterone.

Dr. Eric:

That’s a good point. We’re going to focus on testosterone now. Why is it so important in both sexes?

Dr. Deb:

Testosterone has a lot of really important roles that it plays. Estrogen and progesterone also have a lot of important roles, but testosterone is very important for our physical body. Testosterone helps to keep our bones strong. Estrogen helps to prevent bone loss as we age. Progesterone actually stimulates new bone growth. Testosterone gives strength to our bones, so that if we trip and fall down, we won’t snap like a twig.

Testosterone also helps to maintain our muscle mass. Naturally, with age, our muscle mass declines. Our skin and hair and muscles get thinner, and testosterone helps to keep all of those things more robust. Technically, what testosterone is doing is helping to prevent frailty as we get older. It’s really important for our physical body and our strength and stamina.

It’s also really important for everything to do with sex. It’s important for us to think about it and care about it in the first place, to become aroused. It’s important for vaginal lubrication, arousal and orgasm. For men, it’s important for all those same things, for erections. When women don’t have the right amount of testosterone, it can impact our sexual function.

Testosterone also is really important for how we feel on the inside. All these hormones are important for that. Estrogen is like a natural antidepressant. Progesterone is a calming hormone, so it’s like a natural anti-anxiety hormone. It’s good for sleep. Testosterone is what gives us our motivation, our confidence, self-esteem, decisiveness, get up and go and get things accomplished.

When testosterone levels go down, sex drive goes out the window. We start to age at an accelerated rate. We just feel more blah. How women describe feeling is they are just putting one foot in front of the other, making their way through the day. If things really have to happen today, we’ll make it happen. If it doesn’t really have to happen today, we’ll just push it to the side because we’re not really feeling it.

When I say that to women who come in to see me, when they are sitting across the table from me, and I talk about feeling flat, kind of blah, putting one foot in front of the other, I can just see their eyes nodding. A lot of women really resonate with that. Testosterone is a really important hormone for our physical health, and it’s really important for our mood and how we feel.

All this is true for men, too: confidence, motivation, stamina, muscle strength, sexual health. If a person were to walk into their doctor’s office and try to put this into words, “I just don’t feel like myself. I don’t really get excited about things anymore. I’ve lost my motivation. I just feel kind of tired.” What’s their doctor going to do? Prozac, sleeping pills. That’s really what we are trained to do at medical school, to prescribe medicines to fix whatever things you’re complaining about. In this case, antidepressants don’t really work well because they’re not fixing the right problem.

Dr. Eric:

The next question I was going to ask you are common symptoms of a testosterone deficiency, but you just answered it. There might be others. If someone is having low libido, low mood, low stamina, those are some of the signs and symptoms of a possible testosterone deficiency.

Dr. Deb:

Because you talk a lot about thyroid, one of the things we should mention is there is a lot of overlap between thyroid symptoms and testosterone symptoms. More so with the low thyroid, but the fatigue, the low libido, the mood changes, etc., there is a lot of overlap there. Testosterone symptoms can sometimes make women go to their doctor thinking, “Gosh, it’s got to be a thyroid problem.” Their thyroid gets measured, and they are told, “No, everything’s fine.” Nobody thought to look at their testosterone.

Dr. Eric:

Good to know. If they go to a conventional medical doctor, sometimes they won’t even look at the thyroid. If they do, they will often just look at TSH. As you mentioned, they will neglect looking at the sex hormones, including testosterone.

Dr. Deb:

Just like you can have low thyroid, or you can have hyperthyroidism and too much thyroid, the same thing is true with testosterone. You can have low testosterone, which is very common in women probably over 35. Testosterone levels start to go down as our ovaries are inching their way toward menopause. We can talk about some of the things that cause low testosterone.

Women can also have high testosterone. There is a very common condition called PCOS (polycystic ovarian syndrome), which results in high levels of testosterone. There are some other hormones that act like testosterone; we call this group of hormones androgens. They are the male hormones. Women can have too much of these.

These symptoms are totally different. If you have too much of these hormones, you can have acne, especially along the chin and jawline; hair growing in the places where you don’t want it; thinning hair on your head; irregular periods, either no periods at all or periods come randomly or heavy periods that never want to go away. A lot of women who have this problem struggle with their weight. Often, they end up having blood sugar problems and prediabetes. Cysts on the ovaries, which is where the name comes from.

If somebody has all of those symptoms, and they are pretty notable, then probably what will happen is at some point along the way, they will be diagnosed with PCOS. This is a very common problem. We find it in 1/10 women; 10% of women have PCOS. The majority of them have not been diagnosed. Often, what happens is when they’re teenagers, they never really get regular periods, so they just get put on birth control pills.

Now they are on birth control pills, which shut down our natural hormones and replace them with the synthetic chemicals in the birth control pills that mimic our hormones, but they are not the same thing. That regulates periods. It does help with some of the symptoms, but it’s not really fixing the underlying problem. Then at some point, this woman is going to want to start a family. She is going to come off birth control pills but not have regular periods and have problems with fertility because one of the things that this testosterone does is it interferes with fertility.

It’s important for women to have a proper diagnosis. If you don’t have all the symptoms, or if you just have some of the symptoms, sometimes it slides through the cracks. Too much testosterone is not a good thing either.

Dr. Eric:

What I’ve learned, what I’ve researched, is when someone has elevated testosterone, especially in the presence of PCOS, a lot of times it’s insulin resistance related. Is that true?

Dr. Deb:

Exactly. The underlying problem is an insulin problem. There is too much insulin, so that’s what’s going on with type 2 diabetes. You don’t have to have type 2 diabetes; it doesn’t have to be that severe. There is a problem with insulin that affects the ovaries to trigger more testosterone production. This testosterone causes symptoms, and the testosterone interferes with the regular ovulation and ovarian function, which messes up periods and causes problems with fertility. We can cover it up with birth control pills. If we can go backwards and get down to working on the insulin resistance and some of the other factors here, we can actually get the hormones much better balanced.

Dr. Eric:

If someone has elevated testosterone, so PCOS, would you still suspect insulin resistance?

Dr. Deb:

When somebody has insulin resistance, whether they have a diagnosis of PCOS or not, it can trigger more testosterone production. Even if a woman doesn’t have the label of PCOS, we would still want to think about working on insulin levels.

Dr. Eric:

I’m just saying, because you mentioned a lot of women with PCOS are not diagnosed. Even if they were evaluated, and they don’t have cysts, and their cycle is fine, is it possible that it hasn’t reached that point yet, where they are at the beginning stages? If nothing was taken care of, if it wasn’t addressed, eventually, they might have developed PCOS?

Dr. Deb:

Exactly. While we are talking about this, let me talk about another hormone that causes testosterone levels. 50% of a woman’s testosterone comes from her ovaries, and the other 50% comes from the adrenal glands. The adrenal glands make adrenaline, cortisol, and one called DHEA (dehydroepiandrosterone). You can understand why we call it DHEA. It can be used to make testosterone. 50% of the testosterone comes from here.

When you are stressed, your adrenal glands will start getting stimulated to deal with the stress. They will make more cortisol, and they can make more DHEA. That can result in more testosterone. Sometimes, it can be from stress, but usually, there is a limit to how high the testosterone will go.

For some women who have PCOS, their testosterone levels aren’t that bad, but their DHEA levels are quite elevated. If their doctor only measured their testosterone, they might miss it. They can still have acne or hair growing or whatever the symptoms are. We would also want to make sure to look at the DHEA. We can talk about lab testing in a minute, but that’s another important one to think about. Addressing stress is an important way to try to help get testosterone levels normalized.

Dr. Eric:

A follow-up question for men: I don’t know if you ever see elevated testosterone in men. Obviously, men can’t have PCOS. Would you say it’s in most cases stress-related if they have that elevated testosterone?

Dr. Deb:

I have never had a man walk in my door and say, “Somebody help me. I have too much testosterone in my system.” Those guys aren’t coming in complaining. They’re out taking over companies and driving sports cars. I don’t know what they’re doing, but I’ve never seen them.

Dr. Eric:

Good to know. Makes sense. Most of the men probably are on the lower side.

Dr. Deb:

Most of the men who come in have low testosterone, yeah.

Dr. Eric:

Before we get into testing, what causes the decrease in testosterone?

Dr. Deb:

Low testosterone, there are a few really important things that women need to know. One of them is birth control pills. When you are on birth control pills, it’s not hormones; it’s synthetic, man-made chemicals that are never found in your body but are made to try to mimic the hormones. What happens is they shut off your natural hormones, which get replaced with the synthetic chemicals, but your brain feels like it’s got the hormones in the system, so the message to your ovaries gets turned off. Okay, we don’t want you to ovulate and get pregnant, so that part is okay. But the message to make testosterone also gets turned down.

Plus when you take birth control pills, your liver reacts by making more of a hormone called sex hormone binding globulin (SHBG). When you have more SHBG, it binds to testosterone and inactivates it. First of all, your testosterone level goes down a bit. What you’ve got gets inactivated. Now you feel like you have low testosterone, and your body could be making it. It’s just a side effect of the birth control pill. That’s one really important thing that women need to know.

When they go on birth control pills, libido may go down. They could have vaginal dryness. They may just not feel as good. There is a bajillion birth control pills that all have different types of these chemicals in them that all act a little bit differently. Birth control pills is one that’s important to know.

Another thing that can lower testosterone is stress. We talked about how stress can cause more of this DHEA that can make more testosterone. What often happens is your adrenal glands pump out a lot of cortisol to help you cope with stress. They can only maintain that for a while, and then your system starts to shut down inappropriately. Now you don’t make enough DHEA. If you don’t have enough DHEA, then you don’t make as much testosterone. Stress is an important cause of low testosterone for women and for men. Coping with stress in healthy ways is one of the ways to help normalize testosterone levels when it’s low.

A really big cause of low testosterone is just the aging process. For men, testosterone levels very gradually go down over time. We’re seeing low testosterone in younger and younger and younger men.

For women, over the age of 35, as our ovaries are inching toward menopause, the testosterone levels start to go down. It’s super common for us to see low testosterone levels in perimenopausal women in their 40s and certainly in women who have gone through menopause.

Dr. Eric:

I’m glad you mentioned stress because stress can not only lead to low testosterone but also other sex hormones, like testosterone converts into estradiol. We can see that low. Definitely has a dramatic impact on all the sex hormones.

You mentioned SHBG, where birth control can increase that, and then the testosterone binds to it, so you have less free testosterone in the bloodstream, correct?

Dr. Deb:

That’s right. Also, hyperthyroidism-

Dr. Eric:

I was about to have a segue into the hyperthyroidism increasing SHBG.

Dr. Deb:

Hyperthyroidism can increase SHBG. When studies have looked at this, they have actually found that because hyperthyroidism increases your metabolism in many different ways, sometimes women end up with higher testosterone production because their system is just revved. Then they make more of this binding protein that inactivates it. At the end of the day, it comes out as a wash, which is interesting. We definitely see more SHBG, which definitely inactivates testosterone. You could be at risk for having low testosterone, and maybe the negative impact of the hyperthyroidism might boost the testosterone and negate that. You just need to test, and then you’ll know.

Dr. Eric:

That is interesting. You mentioned you’re seeing younger men with low testosterone. Would you say most of the time, if you have to guess, that’s more due to chronic stress compared to years ago?

Dr. Deb:

Part of it is due to stress. Part of it is due to lifestyle habits. If you’re not eating the right foods, if you become more inflamed, if you’re overweight, especially if guys are carrying weight on their belly, that causes a lot more testosterone to flip over into estrogen. Testosterone gets converted into estrogen. If that’s happening too much, then your estrogen goes up, and your testosterone goes down. That doesn’t feel good if you’re a guy.

Lifestyle habits. Alcohol causes more estrogen production. Too much marijuana isn’t good for testosterone levels. If you are not doing exercise, resistance exercise, like lifting weights, helps to boost testosterone.

Another thing that we really need to mention that is so important is the effect of toxins in our environment. I’m sure you talk about how toxins trigger autoimmunity. A lot of the toxins that we’re exposed to on a regular basis in our environment are hormone disruptors. They mess up how our hormones work. They mess up your thyroid, and they mess up testosterone. There are a lot of examples of toxins in the environment that lower testosterone in men. The problem is they are so hard to test.

For example, atrazine is an herbicide that gets sprayed on crops in order to kill the weeds. It rains, and the atrazine gets washed into rivers, lakes, and streams. Atrazine can turn a boy frog into a girl frog. Apparently, according to one study, there is enough atrazine in the urine of a typical American man to turn a boy frog into a girl frog. The real question is what does it do to a male human? We can’t really properly test that. What are we going to do? Get a bunch of men to drink a bunch of atrazine or roll in it? Who is signing up for that study? That would be completely unethical. We don’t really know. That is one example.

Another example is triclosan, which was an ingredient in antibacterial soap. They are no longer allowed to use it, but it was in our soap for a really long time. What we know from that one is when they took, I forget it was hamsters or gerbils, some type of cute fuzzy animal, and they exposed them to triclosan, it caused their testes to go from pink to blue. What does it do to male human testes? We don’t know. Thankfully, they have taken that one off the market now.

There are tens of thousands of these chemicals. Most of them have never been tested, so we have no idea. But we do know that is a really important factor in why we’re seeing a lot of hormone imbalances in women and men.

Dr. Eric:

That’s definitely important to know. That’s why we want to do everything you can to reduce your toxic load. Even though triclosan is not part of the hand sanitizers and soaps anymore, there are still other exposures.

Dr. Deb:

Your thyroid is one of those canaries in the coal mine, where your thyroid is one of the first things to be damaged when we’re exposed to a lot of these chemicals.

Dr. Eric:

I know in the research with thyroid, the xenoestrogens, like BPA, I don’t know if you’ve seen anything in the research that shows that could potentially affect testosterone.

Dr. Deb:

A lot of the chemicals do. A lot of what they do is because they act like estrogen, they throw off the estrogen/testosterone balance. Indirectly, they do definitely affect all of these. The way that these hormones work is a lot of times, they have equal and opposite actions. If one of the hormones is high/normal, and one of them is low/normal, even if technically the level of each hormone is in the normal range according to the lab, if they are out of balance, you still can have symptoms. If you actually could get your doctor to measure your hormone levels for you, which is sometimes difficult, sometimes they just look at it, and everything lands within the lab range. They say, “Everything’s normal, congratulations.” You’re sitting there, going, “I feel so crappy. How could it be normal?”

Thyroid is the worst, right? I was on Synthroid for 10 years. It probably took me 10 years to get diagnosed with hypothyroidism. I was on Synthroid for10 years. I felt no better. It took me 20 years to learn this stuff and get my thyroid in balance. We are talking about testosterone today, and that’s important, too. When we are talking about these toxins and getting these labs, thyroid is just the worst.

Dr. Eric:

You make a good point. These hormones are all inter-related. Even if it’s not directly affecting testosterone by affecting estrogen or other hormones, it could indirectly affect testosterone.

Dr. Deb:

We still don’t feel good.

Dr. Eric:

Let’s talk a little bit about testing. I imagine blood is probably the most common method you use for testosterone.

Dr. Deb:

For hormones, we can do saliva testing, urine testing, but blood testing actually works really well for testosterone. We do want to do more than just a testosterone level because we have the total testosterone, and we also have free testosterone. You want to know both. Testosterone circulates around in your bloodstream, but you also have this SHBG. SHBG is going to grab hold of testosterone and inactivate it. Whatever is left over that hasn’t been inactivated, that’s your free testosterone. That’s what you feel. If you have more or less testosterone, or more or less SHBG, it’s going to impact how much free testosterone you have. I like to look at the total testosterone, free testosterone, and SHBG to understand really what’s going on.

We also want to look at DHEA because that is the precursor hormone. For men and women, if we are going to order the blood test, we want to order DHEAS, which stands for DHEA sulfate. That is how DHEA is carried through the bloodstream. If we just order straight DHEA, it fluctuates a lot. The level goes up and down over the day. The DHEAS is the one for us to order.

For men, DHEA is made into testosterone, but it’s not enough. It’s just a small amount. For women though, 50% comes from DHEA. If the DHEA level is not very good, if it’s kind of low, if we actually give women some DHEA, we can actually raise their testosterone level naturally. Knowing what the DHEA level is is important. If your DHEA level is kind of high to start with, we wouldn’t want to give you more; otherwise, we will cause you to have side effects. It’s important to measure DHEA.

I also think that we should be measuring cortisol levels. That one is not the best one to measure in a blood test. For cortisol, we prefer to measure in a saliva test or urine test because we can measure multiple times in a day. Cortisol has a Circadian rhythm, where it changes over the 24 hours. What we’re really looking for is is it going up when it’s supposed to go up, and is it going down when it’s supposed to go down? If the pattern is off, that’s a problem.

Testosterone and cortisol are opposites. Testosterone is a build and repair hormone. It makes you strong, and it’s an anti-aging hormone. Cortisol is a wear and tear hormone. It breaks things down, like your bones and muscle. It’s an aging hormone. They are kind of opposites. High cortisol can be a cause of low testosterone, so we would want to know that.

We are trying to look for as many potential underlying causes as we can, so we can fix them. All these things are often going on at the same time: too much stress, not enough DHEA, toxins in the environment, birth control pills. You get all of these all at once, and then you feel really bad. You go to your doctor and walk out with a Prozac prescription that kills your sex drive and makes you gain weight, and you still don’t feel good.

Dr. Eric:

Do you also test for estradiol to see if the testosterone is overconverting?

Dr. Deb:

Yes although it does depend. For men, absolutely, because that’s an important cause of the low testosterone, if too much is converting. For women, typically, I am measuring all the hormones. If somebody is on birth control pills, the birth control pills shut down estrogen, so the lab test won’t be valid. It is very important for women who are having menstrual cycles, we have to do the tests at the right time in the cycle. Otherwise, the estrogen and progesterone levels won’t be valid. We would expect completely different estrogen numbers when you are on your period versus when you are ovulating versus the week after you’ve ovulated. The timing matters a lot. You can’t just march into your doctor on any random Thursday afternoon and ask for an estrogen level on the spot and be able to properly interpret it.

Dr. Eric:

Glad you mentioned that. How about optimal levels? Can you talk about both free and total testosterone? I know it differs between men and women. What do you look for? What do you ideally want to see?

Dr. Deb:

That’s a really loaded question. It should be obvious. This is the lab range, and this is the optimal level. But nobody can decide. Every lab sets what they consider to be the normal range. It varies so much.

If we start with women and just talk about blood testing, for the longest time, LabCorp had 40 as the upper limit as normal and 4 as the lower. You could be 4-40; that was the normal range. Other labs said that the normal range went from 15-85. You could have twice as much testosterone at the other lab, and that was considered normal.

For free testosterone, typically, the upper level for women goes up to about 2.5 or something like that. But the lower end is 0. You can have 0 free testosterone as a woman and be considered completely normal, which is just stupid. The problem is we can’t decide what’s too high, and we can’t decide what’s too low. We just let it go all the way down to the bottom without really caring about it.

For me, one of the most important things that I look for is do you have symptoms? Do you have symptoms of low testosterone or high testosterone? What I see in practice is for example, the women who have PCOS, etc., where they are having symptoms of acne, hair growing, etc., they very frequently have testosterone levels above 35. In the high 30s, 40s, 50s, 60s. They are not on any kind of testosterone replacement therapy. That’s a whole different ballpark of what number we look for.

When we see women with symptoms of low testosterone, I very commonly see the total testosterone is below 20.

For the high testosterone, often, those women have free testosterone at the upper end of what the lab says is normal, or a little bit over. For low testosterone, what I see women is under 20 typically have symptoms, even though the lab says that normal goes all the way down to 4. Sometimes, even in the mid-20s, etc., women will still have symptoms and not feel good.

The challenge that we have is for free testosterone, when we are measuring low levels, the lab tests become inaccurate. The machines that they use at the lab can’t properly count the number of molecules of testosterone when it gets really low, so it’s hard to put a number on what would be too low because it’s inaccurate, and it’s allowed to go down to 0.

For me personally, assuming somebody has symptoms, I would say that something below 20 would be where I would look at somebody and say, “I think your testosterone is too low. Maybe we need to help you naturally make more, or whatever we need to do to get your testosterone better.”

For men, they have much more testosterone than women, but we still have the same problem. Nobody can decide what’s normal. Nobody worries too much about where the upper limit is. I gotta tell you, LabCorp used to say 900 for men was the top. Then they pushed it and said you can go all the way up to 1,200. That’s normal. After a few years, they came back to 900.

For lower, there is even more disagreement. Some labs will say anything below 200 is low. Some labs will say anything below 300. Some labs, they have to be below 350 to be counted as low. Even the free testosterone, we have the same problem. The labsare different.

For me, I am starting by looking for symptoms again. If a man has symptoms of low testosterone, and his total testosterone level is below 400, or if the free testosterone is low, even if the total testosterone is normal, those are men where I would look at them and say, “Your testosterone is too low, and we need to do something about it.” Even if it’s a little bit above that, it depends on the symptoms and all their circumstances, they could still use a little more sometimes.

If you were a man who lived your whole life with a testosterone level at 850, and now, over time, because of all those various things, now you have gone down to 450. That still might be considered normal, but that’s a big change from where you used to be. You probably won’t feel as good as how you used to. It’s not like we want to make you 18 again, but it’s not healthy to have low testosterone.

Dr. Eric:

One question I had based on a patient I saw recently, and you might have already kind of answered this. I had a female patient who had free testosterone levels, but her total testosterone was out of range. I was going to ask you how would you approach that? It sounds like the first thing you would do is evaluate the symptoms.

Dr. Deb:

Are you talking out of range high or low?

Dr. Eric:

I think it was high. I think it was a little bit on the higher end, the total testosterone. Free was normal.

Dr. Deb:

Even so, if the total testosterone was high, I would still be looking for what’s driving it high, and what we could do to calm it down. Look at the insulin resistance. I would be looking for symptoms especially. A woman whose testosterone level is a little bit high is probably stronger. She is probably an athlete. She is probably competitive. She might be the vice president at the bank or running her own company or a doctor or lawyer. Testosterone gives us drive and motivation and confidence and assertiveness and self-esteem. Women who naturally have had a pretty decent amount of testosterone their whole life tend to be confident. They are in corporate America or are competitive athletes, whether they are amateur competitive athletes or professionals.

Women who have always had low testosterone are more likely to choose a different life path. Maybe they are a florist or kindergarten teacher, something that requires, I was going to say less assertiveness, but goodness knows if you’re a teacher, you need assertiveness to get all of those kids to sit down and behave. I am not trying to stereotype. But these hormones affect who we are. They affect our behavior and a lot of things about us. Sometimes, a little bit of extra testosterone can actually be an advantage in certain circumstances. It’s not always bad.

Dr. Eric:

That’s good to know. One last question I had with the testing: What are your thoughts on saliva testing for testosterone? Earlier, you mentioned urine testing for adrenals, Dutch testing for testosterone.

Dr. Deb:

When I am picking which test I am going to order for somebody, because I do all of these (saliva, urine, blood), usually the decision of which test I’m going to make depends on the other hormones. If for whatever reason the only thing I’m going to measure today, which doesn’t happen very often, is testosterone, I will just do it in a blood test. I think it’s perfectly fine.

When we are looking at the other hormones though, there is more information we can get. In the saliva test, we can do the cortisol four different times, and you’re not going to the lab to get your blood drawn four different times, especially not at midnight.

In the urine test, we can look more at how the different hormones, including testosterone, are broken down and how your body processes them. Depending on how you process them, that has implications for how they work and how you feel and what kind of health conditions you could be at risk for. If I’m interested in those pathways, if a woman has fibroids or fibrocystic breasts or ovarian cysts or problems like that, I might be really interested to know how she is processing her estrogen, so I would pick that test.

Testosterone can be measured in any of these tests. The gold standard at this point is still in a blood test. What I would say for women is first of all, you have to find the right practitioner to even order the test in the first place. Not all doctors are going to be able to do that. You’re probably best letting the practitioner choose the test that they are the most confident and comfortable with interpreting. Any of these tests would be okay.

Dr. Eric:

I will add that I don’t do Dutch testing on everybody, but when I have done Dutch testing, it’s common to see testosterone really low. Oftentimes, the report will red flag that and say, “Test it in the blood.” It will admit that it’s not completely accurate.

Dr. Deb:

The blood test is the gold standard for testosterone definitely. It’s important to know that in the urine test, you’re measuring the testosterone that your body used and you peed out. In the blood test, you are measuring how much is going around and around. It’s not quite apples to apples. You’re getting different information. Sometimes, one piece of information is really helpful.

Dr. Eric:

The final topic is increasing testosterone. I think you mentioned earlier weightlifting, resistance exercise. Let’s get into that. Bioidentical hormones, you don’t have to go into great detail with that. I’ll let you talk.

Dr. Deb:

Resistance exercise, lifting weights with heavier weights, is one of the things that boosts testosterone in men more so than in women. Women still need to do that resistance exercise. Men get a bigger boost in testosterone than women do.

Sometimes, you can’t avoid all the stress. Doing things to help balance the stress in your life, whether that’s yoga, breathing exercises, writing in a gratitude journal, doing what you can to manage stress in a healthy way is so important for hormones.

There are other things we can do. If your adrenal glands aren’t making the right amount of cortisol and DHEA, there are certain herbs we can use, adaptogenic herbs, things like ashwagandha, holy basil, ginseng, etc. Those can be helpful, too.

For women who have low testosterone and low DHEA on the test, we can give a nutritional supplement of DHEA to help naturally raise the levels. That doesn’t have to be permanent either. If you’re all stressed out, burned out, overwhelmed, sometimes we can give you some of these herbs and DHEA, and then you get better. Things can go back to normal. The younger you are, the more often things can just go back to normal. You won’t have to keep taking them.

There are other herbs that specifically help to boost testosterone levels. There is one called tongkatali. There is a number of herbs that can be used. The younger you are, the more likely it is that it would be helpful.

When men and women get to a certain age, and testosterone production is just low and not really coming back because of age- These days, age is not 96 anymore. For women, it means you have gone through menopause. In men, it’s somewhere in mid-life or lower if you have a lot of toxins in your system. We can give testosterone replacement. Almost all of testosterone is bioidentical, meaning it’s the natural form of testosterone. It’s exactly what your body used to make, which is so important.

There is still one pill on the market called Estratest, which is a synthetic drug form of estrogen and a synthetic drug form of testosterone. I don’t recommend it. It’s not the same thing as testosterone. It’s not good for your liver. You wouldn’t eat a drug version of a tomato, so I don’t know why you would want a synthetic version of testosterone.

But we can give testosterone. It’s important to have your level measured first to see if you even need it. We don’t want to give it to you if that’s not the appropriate thing. You want to be monitored for side effects. You want to have your level rechecked to make sure you are on the right amount.

You want to make sure you are working with a practitioner who is taking the whole person into account. It’s important to put any type of hormone replacement therapy into a healthy body because we want the benefits of the hormones, not the risks and side effects. Fortunately, the risks and side effects of testosterone are more nuisances. They can cause oily skin, oily hair, acne, hair growing where you don’t want it. All of these things are annoying, but they are not like heart attacks, strokes, breast cancer, or things like that.

But there are some practitioners out there who are so confident in the idea that testosterone makes people feel better that they have the mindset that more is better. Sometimes, they are giving pretty hefty doses of testosterone. Or they are not looking at the whole person and dealing with inflammation, nutritional levels, stress, and other things. If someone is not feeling good still, they just keep trying to go up and up and up on the testosterone to try to fix all of their symptoms. That’s not really the best approach either.

If we can get the person healthier, you don’t need such a big dose of testosterone because your body just works better. It is important to make sure that whomever you’re working with, if you end up to the point of talking about hormone replacement therapy, is using a functional medicine approach, where they are looking at you in a holistic way.

Dr. Eric:

How typically is testosterone administered in both women and men? Is it orally or cream?

Dr. Deb:

Typically, not orally. We can do it as a topical cream. We can do it as a lozenge that dissolves under your tongue. We can do it as injections. We can do it as pellets, which look like little Tic-Tacs that get inserted under your skin.

Dr. Eric:

That’s for both men and women?

Dr. Deb:

For both men and women, yes. We have lots of options.

Dr. Eric:

One other question when it comes to overconverting testosterone to estradiol: Do you ever recommend either natural or prescription aromatase inhibitors?

Dr. Deb:

Yes. We don’t usually need that for women. We can work with women without needing aromatase inhibitors.

For men though, if the main problem is that a man is able to make testosterone, but he is converting too much to estrogen, first of all, we want to work on the underlying causes. Insulin resistance, inflammation, belly fat, these are some of the primary drivers. We want to improve lifestyle habits and help lose weight. There are lots of toxins that act like estrogen, so we want to clear those out.

If we just gave more testosterone, they are just going to flip it into more estrogen, and they won’t feel better or get the results. I see that all the time. Men go into their primary care doctor. Sometimes, they have to ask for it. If somebody measures their testosterone level eventually, then they get a prescription for a testosterone gel. They put this gel on, and it just flips over into estrogen. They don’t feel better. Either they just give up on it, or they keep taking this gel because it was prescribed to them. But they don’t get that much progress because regular doctors are only looking at testosterone, not estrogen.

If a man came to me with these risk factors, and I could see the estrogen is relatively high compared with the testosterone, I would definitely give aromatase inhibitors, which prevent this conversion. We can use an herb called chrysin, which works a little bit. Sometimes, we have to use a medicine; a common one is called anastrozole. We don’t like to use medicines, but we can use half a pill twice a week. Sometimes, that’s enough to stop that conversion. The testosterone comes up. Then a man feels like himself again. He is much more likely to have the motivation to go to the gym and eat healthy and do the right things to lose the weight and get the inflammation down. Sometimes, things can reset themselves, and he doesn’t need to take it anymore.

Dr. Eric:

Thanks for sharing that. I think we covered a lot, but is there anything I didn’t ask you that I should have asked you? Anything else you’d like to talk about?

Dr. Deb:

One thing I’d like to say is that hormones are really important in how we feel. It’s something that you can’t see and touch. If your right elbow is swollen up double its size, when you walk into your doctor’s office, everybody will scramble around to figure out what to do to help you. When you walk in and say, “I don’t feel like myself. My career is stalling because I can’t get myself going to get stuff done,” they don’t have anything for that. You’re left to feel like you lack self-discipline; it’s like a personality flaw.

Please know that hormones are really important. It’s so common for women and men to have hormone imbalances. You can’t wait for your doctor to fix you. Your doctor doesn’t have a pill that’s going to fix you. We all need to take charge of our own health. I really believe that living well is the best medicine.

Dr. Eric:

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

Dr. Deb:

The website for my practice is SignatureWellness.org. You can follow me on Facebook or Instagram @DrDebMatthew.

Dr. Eric:

Did you want to mention your book as well?

Dr. Deb:

Sure. I wrote a book. When people come in to see me, women will often say, “I’m feeling like this, this, and this. I wonder if it could be my hormones.” When men see me, “I’m feeling this, this, and this. Maybe it’s just my age.” That’s what I hear. Women think it’s their hormones, and men just think it’s their age.

I wrote this book to help women understand whether their symptoms could be from a hormone problem. It’s called This is Not Normal: A Busy Woman’s Guide to Symptoms of a Hormone Imbalance. It has a bunch of quizzes, so you could check the list of symptoms to see if it could be your testosterone, estrogen, cortisol, or anything else. It’s got tips for how to naturally start getting your hormones back in balance. It has some tips on how to talk to your doctor to try to get the right help. If your doctor is not the right person to get you help, there are some tips on resources for where you can go to find the right kind of doctor to help you. You can get a free copy at IsItYourHormones.com.

I have a book for men, too. It’s called Why Can’t I Keep Up Anymore? It’s a guide to regaining peak mental, physical performance over the age of 40. That one is available on our website and on Amazon.

Dr. Eric:

Thank you so much, Dr. Deb for your time and for sharing your knowledge about testosterone. I’m sure the listeners learned a lot, and I did as well.

Dr. Deb:

Thanks so much for having me.

 

Recently I interviewed Dr. Sarah Ballantyne, and we chatted about nutrient density and Nutrivore principles. If you would prefer to listen the interview you can access it by Clicking Here.

An award-winning public speaker, New York Times best-selling author, and world-renowned health expert, Dr. Sarah Ballantyne, PhD believes the key to improving public health is scientific literacy. She creates educational resources to help people improve their day-to-day diet and lifestyle choices empowered and informed by the most current evidence-based scientific research.

Dr. Sarah began her career as a science communicator and health educator when she launched her original website ThePaleoMom.com in 2011. On this platform, Dr. Sarah combined her background in medical research with her experience of using diet and lifestyle to mitigate a dozen diagnosed health conditions to create a wealth of educational resources and amass an audience of millions.

Since then, Dr. Sarah has continued to follow the science, diving deep into immune health, metabolic health, gut microbiome health, nutritional sciences, and the compelling evidence for help at any size while also observing the harm of healthism, diet culture, dogmatic misinformation, predatory marketing. With Nutrivore, which we will chat about, Dr. Sarah seeks to create a positive and inclusive approach to dietary guidance based in science and devoid of dogma using nutrient density and sufficiency as its basic principles.

Thank you so much for joining us, Dr. Sarah. If you couldn’t tell, I am so excited to have this conversation with you.

Dr. Sarah Ballantyne:

Thank you so much for having me. I’m excited, too.

Dr. Eric:

A lot of my audience is familiar with your Paleo Mom website, which is just amazing. Now you are making the transition to a wonderful Nutrivore website as well. Can you talk about that transition?

Dr. Sarah:

It’s a transition that began probably six or seven years ago. It really started with observing a problem in not just the paleo community but the health and wellness community more broadly, where we continue to define diets based on the foods we avoid. Most of the diets that are popular now—I might venture so far as to say all of the diets that are popular right now, when you are learning about that diet, you have a list of restrictions, things that you are going to cut out completely or avoid or things you have in very measured quantities. Most diets boil down to a list of roles, the good foods and the bad foods.

The problem with this is first of all, psychology studies show that dichotomist approaches to diet, where you have rules, yes foods and no foods, or good foods and bad foods, actually increases the risk of regaining lost weight and increases the chance of developing disordered eating patterns. My observation in this community is that I think this is very human nature. I think what happens is we have some kind of reason why we go on a diet. I think it’s very common for that reason to be weight loss. We go on a diet that you avoid these 10 foods or 100 foods.

What happens is our bodies fight weight loss. Our bodies do not want to lose weight. As we lose weight, our basal metabolic rate slows down, and our hunger hormone, ghrelin, increases. It becomes harder and harder to keep losing weight, and it becomes harder and harder to maintain that weight loss. When we define a diet based on “I cut out these things. I lost weight initially. I am not losing weight anymore. What is the next thing to do? I am going to cut out more things.” Then we repeat that cycle of an ever more restrictive eating pattern.

This goes back to the ‘70s with low fat. Defining diets based on the thing that you cut out creates a mindset where when we want more results, whatever that is, the natural next step is, “I have these results by cutting stuff out. I will cut out more stuff to get that next step of results that I want.” What’s happening in my observation, and certainly the scientific evidence would back this up, is that we are actually magnifying a problem that already exists, which is the rampant prevalence of nutrient deficiencies and insufficiencies.

Our food supply is abundant in calories. Doesn’t actually contain that many foods that are really dense in vitamins and minerals and phytonutrients, unless you are eating a very whole foods and very varied diet. Unless you are in that privileged space to be able to afford food like that, you have nutrient deficiencies.

When you get on this diet train yo-yo, what ends up happening is the more things you learn through diet culture, the more restrictive your eating becomes, the more you’re exaggerating nutrient deficiencies, which are driving your health problems, which are then driving that guilt/blame cycle, and the yo-yo continues. In observing this as a thought leader and health educator, and dare I say influencer (it’s not my favorite word), I have really been searching for the solution to this problem.

I have done a lot of communication around nutrient density since my very earliest days blogging in 2011/2012. That to me was the missing piece. The missing piece of education that people don’t have, which is very basically what do nutrients do in the body? What foods contain them? How much do I need? That’s not integrated into most dietary approaches. It’s obviously integrated into the autoimmune protocol because of my work.

That’s what Nutrivore is. It’s very much understanding outside of any particular dietary structure, outside of labeling foods as good or bad, getting away from those dogmatic approaches to food. It’s about understanding what foods contain what nutrients. How do we choose foods to make sure we are getting all of the nutrients that we need?

What I think is so powerful about Nutrivore is you can apply Nutrivore principles to a diet that you resonate with. If you love the paleo diet, you can apply it to paleo, but you can also apply it to no dietary structure in particular. You can apply it to anti-diet, the 10^th principle of intuitive eating, and you can use it for your primary guiding principle for a diet. It lives in between the worlds of diet culture and anti-diet, pushing back on diet culture by providing this simple and logical solution. Let’s just get all the nutrients that our bodies need from the foods we eat.

Dr. Eric:

Makes sense. You kind of answered a question that I had while you were talking. You mentioned someone could follow a paleo diet but still incorporate Nutrivore. You talk a lot about the autoimmune protocol with Paleo Mom. Just because you follow AIP doesn’t mean it still has to be a restrictive diet where you are not getting necessary nutrients. You can and should probably incorporate Nutrivore concepts.

Dr. Sarah:

I would argue that the AIP was my test case for Nutrivore principles because the AIP has had nutrient density as one of its five pillars. AIP has three lifestyle pillars: sleep, activity, stress management. And then two diet pillars: the elimination challenge, the phases of the AIP where you discover your own food triggers, and nutrient density. Nutrient density is synonymous with Nutrivore. We are choosing foods that have a lot of nutrients per calorie.

Nutrivore provides an amazing tool for AIPers by using the Nutrivore Score, which is a profiling method that I developed as part of the foundational content for Nutrivore, to help identify those nutrient dense foods. It gives additional tools to people following the AIP to actually increase the nutrient density of their diets, which is important for immune health.

Dr. Eric:

I love the Nutrivore Score. I was fascinated. For example, I am pretty sure you mentioned that collard greens had a higher Nutrivore score than kale, which I had no idea.

Dr. Sarah:

Yes.

Dr. Eric:

We will talk about Brazil nuts, how they had the highest score for nuts. That being said, can you talk about some of the foods, especially vegetables, with the highest scores?

Dr. Sarah:

I pulled some scores and brought notes, so I had some scores to share. I think this is such a fun intellectual exercise. Taking a step backwards, the Nutrivore score is a profiling method. When I started to build Nutrivore, my first intention was to go through the science of nutrient profiling, find a nutrient density score I liked, and use that. What happened after reading nothing but nutrient profiling papers for three months was I decided I didn’t like any of them. None of them made sense.

One thing that is happening in nutrient profiling right now is this effort to retrofit a nutrient density score to what’s called the Healthy Eating Index, a measurement of how well someone fits USDA dietary guidelines. They are trying to figure out what nutrients to include in the score, so a high score would match a high healthy eating index. I think it’s completely backwards. I think we should be just doing the math, whatever makes the most sense, to represent the food, and using that to better understand diet. That is what I have done with the Nutrivore Score.

It’s algorithmically very similar to the Nutrient Rich Foods Index, but it uses 33 nutrients in the calculation, basically every nutrient we have complete enough data that it’s fair to include it. Very carefully making sure not to overweight plant food nutrients or animal food nutrients. You really just get total nutrients per calorie.

The insight that the Nutrivore Score has given me into different foods has just been fascinating. For me, it was like, “Let’s do this math. Let’s do the math on 8,000 foods. Then let’s look at the numbers and see what they tell us.” That’s the scientific method, right? It really shows for example just how important leafy vegetables are, how important the cruciferous vegetable family, the cabbage family are, how important mushrooms are. It really shows you why organ meat is so fantastic. Shellfish and fish are just crazy high as well.

The #1 top food in the entire database is canned clam liquid, which has a Nutrivore Score of 14,744. I would have never, ever guessed in a million years that the liquid you drain from canned clams, or clam juice, would have the most nutrients per calorie. It just so happens you have a lot of dissolved minerals and vitamins in that liquid. There is a lot of protein. It’s like bone broth on steroids.

Watercress is one of the highest vegetables that most of us could find in a grocery store. There’s lots of obscure ones that are higher. It has a Nutrivore score of 6,989.

Turnip greens have a Nutrivore score of 6,370.

Swiss and rainbow chard are up in that range. Rainbow chard is 6,573, and Swiss chard is 6,198.

Radishes are a surprising super nutrient dense food. They have a score of 5,863.

Garlic is 5,622.

Kale, which I feel like is the pinnacle example of a superfood, is 4,233.

All of these are crazy high.

The lowest is 0. White sugar has a Nutrivore score of 1. It shows you this math really does bear out if you have foods that are 0 and foods that are 14,000. If you were to get 100% of everything in your diet, and only 100%, on a 2,000-calorie day diet, you would be looking at an average Nutrivore score of 165. We typically say anything over 150ish because 2,000 calories is not a super accurate way to determine how many calories someone needs. Over 150ish is going to give you more nutrients than energy.

The great thing about the super high score foods is the more of them you eat, the more room you are earning for quality-of-life foods, to round out with foods that aren’t nutritionally impressive but still can be very valuable foods. Something like white rice has a Nutrivore score of 66, I believe. It’s not nutritionally impressive, but it is a great source of resistant starch if you tolerate rice. There are studies showing that people who eat more rice, especially men, have lower rates of cardiovascular disease, likely due to the impact on the gut microbiome, which studies show are very favorable. The more of these kale and collard greens and mustard greens and turnip greens and seafood and organ meat that we eat, the more having something with a low Nutrivore score won’t impact the overall quality of our whole diet. We get to enjoy these foods to round out our meals.

Dr. Eric:

It sounds like diversity is still important, not just to focus on the high Nutrivore score. As an example, I believe you said during one of the videos I was watching that strawberries is the #1 berry when it comes to Nutrivore Score, followed by blackberries. A lot of people think blueberries would be the highest. Cranberries weren’t too high. This is not saying you can’t eat blueberries or cranberries, and you should just focus on strawberries and blackberries, correct?

Dr. Sarah:

Correct. This is getting into the challenges of scientific communication and attention spans in our modern age. One of the things I am building out on the Nutrivore website is a better understanding of what I call nutritionally distinct food families. Instead of thinking of our four or five food groups, which are typically based on how a food is grown and/or maybe one nutrient, we have protein foods and fiber foods. We have calcium foods. That’s how we think of food groups, at least in terms of USDA dietary guidelines and my plate.

With Nutrivore, we are taking a broader look at what nutrients food contain. There is a collection of food families that offer something very special. Seafood in general, some of our most nutrient dense animal foods. The long chain Omega 3 fats are incredibly important. Plus they are very good sources of vitamins and minerals. They are nutritionally distinct because of those long chain Omega 3 fats.

Vegetable families that are nutritionally distinct include cruciferous vegetables. They contain glutamates, which we can’t get from other vegetables. They are very important phytonutrients that reduce cancer risk most strongly as well as cardiovascular disease risk.

Alliums, the onion family, are a nutritionally distinct food because they have thiosulfinates, which are very important for reducing cardiovascular disease risk and cancer risk and also type two diabetes risk.

Leafy vegetables, we are talking about fiber types that are particularly important for the gut microbiome, and some of our most nutrient dense foods.

Mushrooms have a lot of different things going on. They have a few classes of really unique phytonutrients. They have also unique fiber types we can’t get anywhere else. They contain an amino acid that is not part of the 20 our bodies use to make proteins but has an important role in our body. It’s found in almost every tissue. It’s called ergothioneine. It has this potent antioxidant effect that has been nicknamed the longevity vitamin in scientific studies because it’s so cool. Not a vitamin at all, but an amino acid. Mushrooms are important.

Root vegetables have a functionally distinct collection of fibers for the gut microbiome. Those are the most important families.

From there, we would say avocadoes and olives, that little group, would be important as healthy fat sources.

Fruit, we really see the biggest benefits to our health from the berry family and citrus.

Each one of these has something nutritionally distinct to offer. The Nutrivore Score can help us identify the most nutrient dense within each of these families. It’s important to understand we are not adapted to one food or one food group. We really need this collection of foods in order to meet our nutritional needs, in order to get all of the different nutrients that our body needs. We can use the Nutrivore Score on top of identifying these important food families to help up the ante in terms of how much nutritional benefit we are getting from every bite.

Dr. Eric:

You mentioned citrus and berries. I also saw a video on bananas, raving about them. I’ll admit, that’s one of the fruits that I usually tell people not to eat too much because of the sugar. I’d like to get your thoughts on fruit and sugar. Maybe I shouldn’t be advising people to avoid bananas on a regular basis, or maybe they should stick with small bananas.

Dr. Sarah:

I should have come with a visual aid for this one. There is a variety of studies that do dose responses and all-cause mortality. That’s a measurement of general health and longevity. It’s basically a way of scientific studies telling us whether or not something is good or bad for us. There is a variety of studies, including these huge meta-analyses, that look at the level of intake of food or food groups has what effect on all-cause mortality.

There are certain foods that the more of them you eat, the better you are. Vegetables are like that. The more vegetables you eat, the healthier you’ll be on average. Almost a straight line. I eat more vegetables and reduce my all-cause mortality. Interestingly, legumes are more similar. I eat more legumes and reduce all-cause mortality.

There are other foods that are the other way around. The more of them I eat, the more I increase all-cause mortality. We see this in sugar-sweetened beverages like soda. We see this in processed meats. The more processed meats on average, the higher our all-cause mortality rates.

Then there are foods that have non-linear relationships. Nuts and seeds, for example, have a benefit up to—it’s a steep little slope on this graph—about an ounce a day, and then it levels off. There is no additional benefit above an ounce a day, but it’s not erasing the benefits that you were getting from that 0-1 ounce.

Fruit has almost a J-shaped curve. It’s not quite E-shaped. We see a really steep decline in all-cause mortality from 0-300g per day of fruit. That is 2-3 servings, depending on the fruit, per day. We see pretty impressive declines in all-cause mortality. Then it levels out, and it starts to creep back. At about 600g daily, you’ve lost about half of the benefits. It’s approximately a 10-12% decrease in all-cause mortality at 300g, and only 5-6% decrease at 600g.

What’s really important, especially when we are trying to make healthy changes sustainable, is to emphasize that 600g of fruit daily, so that’s 5 or 6 servings of fruit, is still better than no fruit. 300g, getting into that sweet spot, that would obviously be the best. 2-3 servings of fruit per day would be awesome. High fruit consumption is still better than no fruit consumption. That really helps us get over that fear of fruit as nature’s candy, which I think has done us a disservice, to label fruit as the same as refined sugars.

What is actually really interesting: Because fruit has fiber and so many antioxidants, phytonutrients, Vitamin C, there are studies that have compared high fructose corn syrup, a lot of fructose, versus the same amount, 100g of fructose a day, which is very much above the toxicity levels for fructose, and compared that from whole fruit. They have shown that whole fruit is not as detrimental for the same amount of fructose as drinking a glass of corn syrup sweetened liquid, which is what they kind of do in those studies. The metabolic impact is not as high. It would still be able to have a water fructose intake of less than 45g per day. Even getting up to 100g per day, if that fructose is coming from fruit, it is not as harmful as that fructose coming from a refined source.

We look at all of the science together. Fruit in moderation, and it really doesn’t matter what fruit that is. The fruit you like is great. Fruit in moderation is actually incredibly beneficial. Fruit in excess is still not as harmful as avoiding fruit.

Dr. Eric:

Good to know. When I was younger, a child, teenager, even a young adult, I honestly didn’t eat any vegetables. It was all fruits. Now, it’s the opposite, where I am eating plenty of vegetables and a little bit of fruit. It sounds like it’s not a big deal if someone is eating, not that you are encouraging them to eat 4-6 servings per day, but it’s not harmful to do that. The next question: If they are eating that many servings of fruit, should they up the ante when it comes to vegetables? Or does it not make a difference?

Dr. Sarah:

Especially for bitter supertasters, for people who detect that very strong bitter flavor from especially cabbage family vegetables, these people often don’t like any vegetables. It tastes different to them than it tastes to us. It tastes bitter and gross. Some people learn to love the bitter, but most people don’t. They tend to gravitate toward special treats. For someone like that, if fruit is your way into eating more fresh fruits and vegetables, I think that’s an amazing trade. That’s a great compromise.

I don’t work with clients, but if I had clients, the conversation I would want to have would be: Can we start trading some of that fruit for a little more vegetables? We are eating 5-6 servings of fruit per day and 1-2 servings of vegetables. Can we even keep fruit where it is, and just add a serving or two of vegetables? Can we ease into a little bit more vegetable? There is some really fantastic recipes that actually combine fruits and vegetables. l think about how fruit can really offset the bitter flavor of something like kale in a salad. Looking at how can we combine this fruit with some vegetables to make those vegetables taste better? We are talking about a person who loves their fruit.

Gently encouraging a shift in balance ideally, we would have about eight servings of fruits and vegetables. About two of those would be fruit, and six would be vegetables. That is the ideal ratio. Can we slowly shift that ratio?

It’s also really important when we are trying to make dietary changes to make those give and take compromises to keep things in a sustainable level. When we get into that “I have to use all my willpower to keep doing this thing. I hate what I’m eating,” we are setting somebody up to fall off the wagon again. Being able to ease into a habit where we just eat more vegetables, and it’s really natural, is a more sustainable approach than how am I going to force myself to eat more vegetables?

Dr. Eric:

Yep, that makes a lot of sense. What are some of the more common nutrient deficiencies that you see? Most people listening to this have a thyroid or autoimmune thyroid condition. If there are any nutrients more common in those with hypothyroidism or hyperthyroidism.

Dr. Sarah:

That’s a really good question. Studies that have just looked at typically NHANES status, so it’s nutritional surveys of what Americans are eating, are- Actually, it’s really surprising how common nutrient shortfalls are. I will use the words “shortfall” or “insufficiency” instead of “deficiency.”

Studies show that about 1/3 of Americans are at risk for nutrient deficiency. Deficiency is when we are going to have a disease of malnutrition, like scurvy from Vitamin C deficiency or Rickets from Vitamin D deficiency or beriberi from VitaminB1 deficiency or anemia from iron deficiency.

Insufficiency is where we are not getting enough of those nutrients, but it’s not so bad that we are going to have a disease of malnutrition. What’s really important to understand is not getting enough nutrients, those nutrient shortfalls increase our risk for every single chronic disease and infectious disease. That is because our body uses nutrients. It’s the raw materials of all the chemical reactions happening in our body all the time. When you don’t supply the raw materials that a cell needs to perform its function, it can’t perform its function as well. That string builds up over time to impact that biological system in a negative way, an increased risk for chronic disease.

Nutrient insufficiencies are a big deal, but they are technically something different than a deficiency. A deficiency is like “Your gums are bleeding. You have scurvy.” An insufficiency, you might not have any overt symptoms. You might feel fine, but your risk for some kind of chronic illness is increased over time.

The most common nutrient insufficiency is Vitamin D. Basically 100% of us don’t get enough Vitamin D from our diet. I don’t know if we count that one as much because we are obviously making more Vitamin D from sun exposure. Also, if you are deficient or insufficient, it’s very hard to build your serum levels back up from diet and sunshine. This is definitely an exception to the Nutrivore philosophy. Go get tested, figure out what your Vitamin D is, talk to your healthcare provider, supplement accordingly, and retest to make sure you are supplementing enough and not overshooting the mark. Vitamin D, we will put to the side. I thought it’s worth noting: Nobody gets enough vitamin D from their diet.

Potassium is the next most common nutrient insufficiency. 97.8% of Americans don’t get enough potassium in their diet, which is crazy. Not only that, but the USDA Dietary Guidelines, the brand new 2020-2025 ones, they have a paragraph about the nutrients that if you followed USDA dietary guidelines perfectly, here is the nutrients you wouldn’t get enough of. Potassium is on that list. I think it’s a flaw in the USDA dietary guidelines if they can list six essential nutrients you won’t get enough of, even if you follow the guidelines perfectly, which only 7% of people even try to do. That’s a tangent.

Vitamin E is next. 96.2% of people don’t get enough Vitamin E in their diets.

Folate is next. 90.2% of people don’t get enough folate in their diet.

80.1% of people don’t get enough Vitamin A in their diet.

72.4% of people don’t get enough Vitamin K in their diet.

66.3% of people don’t get enough magnesium in their diet.

56.3% of people don’t get enough Vitamin B1 in their diet.

54.9% of people don’t get enough calcium in their diet.

52% of people don’t get enough Vitamin C in their diet.

Those are 10 nutrient deficiencies that over half of the population are not getting enough from their regular foods, which is just the most shocking statistics. Everyone is walking around with nutrient shortfalls, and that is increasing our risk for chronic disease. No wonder we have so much chronic disease in Western countries.

Dr. Eric:

Have you done any research when it comes to thyroid health to see if any of those nutrients are more deficient in people with hypo and/or hyperthyroidism?

Dr. Sarah:

Certainly, there is research showing that there are four nutrients important for thyroid health. People with especially hypothyroidism or hyperthyroidism are more likely to have these deficiencies: iodine, selenium, zinc, and iron.

Iodine is really interesting because of course, too little iodine can cause hypothyroidism. Too much can cause hypothyroidism. Iodine is part of the structure of thyroid hormone. The enzymes that are making thyroid hormone are seleno-enzymes; they are based on selenium. Iron and zinc are important cofactors. Those nutrients are the most important from a thyroid health perspective, or at least the nutrients where there is pretty good science with people with hypothyroidism, where supplementing with those nutrients can improve thyroid hormone production.

Dr. Eric:

You mentioned iodine. I wanted to ask you about sea vegetables because sea vegetables are higher in iodine. A lot of people I work with are concerned about iodine and do everything they can to avoid it. I don’t recommend avoiding all food sources of iodine. How about seaweed and kelp and other sea vegetables? Is it safe for people with Hashimoto’s and Graves’ to consume sea vegetables in your opinion?

Dr. Sarah:

I would definitely say first of all, talk with your doctor. This is where a food journal where you are evaluating what iodine sources are in your diet already would be really important. You can do blood tests for iodine levels. Looking at what your regular iodine intake is, most people are getting iodine from iodized table salt. That is the fortified food in Western countries that is supplying the most iodine. When you decide to switch to Kosher salt or sea salt or Himalayan pink salt, you are now using a salt that has very little iodine. There is some, especially in Himalayan pink salt, that has such high mineral content. It’s nowhere the same concentration as you are getting from iodized table sat.

If you are eating a predominantly whole foods diet, and you are using these unrefined salts, chances are you are not getting enough iodine, unless you happen to eat a lot of seafood. We can get iodine from different foods. Eggs have a good amount of iodine. The dominant food source of iodine is things that were in the ocean. Sea vegetables are some of our richest sources of iodine.

Really interestingly, studies show that about a serving or two per day of sea vegetables has some pretty big impacts on health, especially cardiovascular disease risk. That may be because not just iodine, but sea vegetables tend to have a lot of trace minerals. They also have some really unique carotenoids. Fucoxanthin, which we can’t get in other foods, that have some really impressive health beneficial properties. But we do want to be careful about the iodine.

Kelp sequesters iodine. It’s a very high iodine sea vegetable. Most of the other sea vegetables you will get in the store have a tenth the amount of iodine as kelp. Our daily value is 150mcg. The tolerable upper limit is 1100mcg. 1-2 servings of sea vegetables other than kelp will hit your iodine daily value, and you won’t get close to that upper limit. You will be in a good range. With kelp, you would want to keep to one serving or less on a daily basis. A serving is 5g dried. It’s not huge. It’s like one nori sheet.

Nori itself, I feel like that’s the most common sea vegetable that most people are eating. Nori is a lower iodine option. With nori, you can have several sheets a day, and you won’t be anywhere close to that tolerable upper limit for iodine. The one to be aware of is kelp. Kombu is a type of kelp. Knowing your sea vegetables and which ones are kelp. Most ones like arame, wakame, nori are all low enough in iodine that you can definitely have a serving or two every single day, get the benefits of sea vegetables, and not have to worry about the iodine in it.

Dr. Eric:

All right, wonderful. Earlier, I mentioned that Brazil nuts have the highest Nutrivore score with regards to nuts. A lot of people know that Brazil nuts are high in selenium, so a lot of people will eat Brazil nuts. One question I had, which I don’t know if you have the answer, but is selenium toxicity a concern if someone eats too many Brazil nuts? Or since it’s a food-based source, it’s not a concern if someone were to eat a cup of Brazil nuts, for example.

Dr. Sarah:

Let’s differentiate between acute toxicity and chronic toxicity. Acute toxicity is if you had a dose of something in one dose that is so much that it was a health problem. For selenium, that’s not very well defined. Chronic toxicity is. That’s where you have that same amount every single day for months. Chronic toxicity for selenium is around 900mcg. The tolerable upper limit is 400mcg, but there is a lot of studies showing intake, and that in between 400-900 being totally fine. There are obviously some people who are more sensitive. That’s why they set tolerable upper limits very conservatively.

The daily value is 155mcg. You can get the daily value of selenium from like two Brazil nuts, which is phenomenal. They are such a rich source of selenium. That is what pushes their Nutrivore Score up to 700, which is way higher than just about any other nut and seed. That’s because of their incredible selenium content. 10-12 Brazil nuts would hit that chronic toxicity level, but you would have to eat that many every single day for months in order for chronic selenium toxicity to show.

Our bodies are pretty good for most nutrients of getting rid of excess. Sitting down and eating a cup one day is unlikely to be harmful. Not going to say guaranteed not to be harmful because different people are differently sensitive. Having a look through the literature, the case studies I can find on selenium toxicity are all from supplements, not from Brazil nuts.

Dr. Eric:

All right. I know you encourage people to eat organ meat. I don’t know if off the top of your head, you know the Nutrivore scores for different types of organ meat. We could talk about organ meats. A question I had is if someone absolutely does not want to eat organ meat, would having organ meat capsules be a substitute?

Dr. Sarah:

Liver is the most nutrient dense organ meat, depending on which animal you are talking about. The Nutrivore scores range from about 2,500 (chicken livers) to 4,000 (beef liver). Lamb liver is around 6,000. That is the range. They are incredibly nutritionally impressive foods.

Kidney is a little bit lower on average. Heart is quite a bit lower on average. Interestingly enough, there is not too many other organs that I have a really complete data set on. The most complete nutritional data I have is for these three that are the easiest for us to find generally.

If you look at the nutrients in liver, and you hate liver, but you know it’s a nutritionally valuable food. The first thing to emphasize is that you can get a very similar nutrient profile from mollusks. That is the group of shellfish that includes mussels, clams, and oysters. With about half the nutrient density. You’d have to eat twice as much mollusks per serving of liver to get the same nutrients. If you love clams and oysters and can afford them and can’t stand liver, that is one solution. Swap it out for another food that is nutritionally similar.

Organ meat capsules are a phenomenal option, especially these high quality freeze-dried capsules. I love Smidge brand for example. They are super convenient because you’re not tasting anything. It’s the liver, just freeze dried, which preserves the nutrients, is the best way to encapsulate it. They are just gelatin capsules.

The thing you need to know though is your fresh equivalent. Typically, the dose on the bottle, depending on the brand, is 4-6 capsules. That typically translates to, if you have that every single day, about two ounces of liver over the course of the full week. If you follow what’s on the bottle, you’re getting half a serving of liver over seven days. That’s just something to know. If that’s your only source of liver, it’s better to get a full serving a week. You might want to talk to your doctor because I can’t recommend any supplements. Talk to your doctor about doubling the number of capsules.

Dr. Eric:

That’s good to know. Fatty acid deficiencies, can you quickly talk about how common they are, especially if people don’t eat fish? I know you advocate eating seafood on a regular basis, including fish. If someone isn’t a seafood lover, there is fish oils and all that, but not exactly the same. I’ll let you take over.

Dr. Sarah:

True fatty acid deficiency is very rare. What we see is that the balance of Omega 3 fats and Omega 6 fats that we consume is very important. It’s not so much about exactly how much we get, but that we don’t want to have way too many Omega 6s and not enough Omega 3s.

Unfortunately, most of the foods in the modern food supply have quite a lot of Omega 6s. Where we are getting Omega 3s are mainly from seafood. We get the long chain Omega 3s from seafood and sea vegetables and algaes. For example, we can get short chain Omega 3s from plant foods, especially things like chia seeds, walnuts, sacha inchi seeds. We do convert some of that into longer chain Omega 3 fats in our body.

They do different things. They are both really good for us, but they do different things physiologically. Those long chain Omega 3 fats, the more of them we eat, they reduce risk of mental health conditions, neurodegenerative disease. They are important for preventing cardiovascular disease. They are really important for immune health and gut health in general.

Again, it’s not about how much we are eating, but the balance. We can typically not worry about how much Omega 6s we are getting as long as our diet isn’t super high fat and super high vegetable oil. As long as we are getting 3-4 servings of an oily fish per week, that is typically the amount that we would need to eat to balance Omega 6s in our diet.

For someone who is allergic to fish or shellfish, there are algae oil supplements that can provide those long chain Omega 3s. Or a vegan option if anyone was looking for a vegan way to get those long chain Omega 3s.

The most affordable option is to eat fish. Canned fish is a fantastic way to go. It’s very affordable. I feel like canned foods have been super maligned. One of the big insights I’ve had doing all of these calculations for the Nutrivore score is canned foods didn’t get this bad rap. They are nutritionally extremely similar to the fresh, raw food. There are examples of canned foods that are more nutrient dense than the fresh, raw version, including Eastern oysters. They are more nutrient dense canned than fresh. Don’t ask me why because I don’t fully understand why. That’s just the way the math works out.

One of the best things we can do to prevent problems with immune health, cardiovascular health, gut health, and brain health is to make sure we are consuming enough of those fatty fish. That’s where we are getting the most Omega 3 fats.

Dr. Eric:

I know we’re running out of time, but I wanted to ask you one more question as far as some of your favorite non-dairy sources of calcium. I do recommend especially when people follow AIP, they will be avoiding dairy. A lot of people are like, “If I can’t have dairy, where am I getting my calcium?”

Dr. Sarah:

On the AIP specifically, I will back up. Nuts and seeds are a great source of calcium. That is obviously not AIP friendly. On the AIP, green vegetables, especially dark green, leafy vegetables, are typically very good sources of calcium that is highly bioavailable. Mushrooms have a good amount of calcium. Oranges have a good amount of calcium.

One of my favorite sources though is blackstrap molasses. A tablespoon of blackstrap molasses only has 42 calories, so it’s not a high sugar sweetener. It has more calcium per calorie than cheese and more iron per calorie than steak. It actually has 20% of the daily value of both calcium and iron. It has some other minerals and lots of B vitamins. It has a Nutrivore score of 340, which is quite impressive. It’s in its own ballpark. It doesn’t even share a space with other sugars in terms of nutrient density. That’s a great option. Yes, permission to eat something sweet is always appreciated on the AIP.

Another great option for AIPers is mineral drops for water. Typically, natural water sources have a lot of dissolved mineral content. Tap water and most bottled water do not. One of the easiest ways to increase mineral content if you are not going for a spring water. Gerolsteiner Spring Water has a huge amount of calcium. That would be my go-to recommendation. Plus it’s delicious.

There are lots of different options of mineral drops out there. There are lots of unflavored options. It’s just for the minerals in water. It’s another way to up calcium intake on the AIP without having to reach for a calcium supplement because those are associated with higher risk of kidney stones and potentially increased risk of cancer over the long term in the scientific literature. There is always a time and place for supplements. Talk to your doctor. If they recommend it, completely different situation. But as a general rule, we usually only want to take calcium supplements if those are our only options.

Dr. Eric:

You mentioned fish. Sardines with the bones. Other fish as well.

Dr. Sarah:

Canned fish with the bones is as much calcium as a glass of milk. Sardines, canned salmon. If you are eating the bones, yes. Not only are you getting the calcium, but you are getting all of the minerals that our bones need.

The other thing that’s really important about calcium is Vitamin K and Vitamin D are really important for calcium metabolism. Vitamin D affects how much calcium we are absorbing, so you don’t want to be Vitamin D deficient because you can’t even absorb the calcium from your food. Vitamin K is important for shuttling calcium around to the right spot in our body, so you want to make sure you are getting enough of those as well. Seafood is a great source of Vitamin D. Those leafy vegetables are great sources of Vitamin K. Salmon and kale was the top recommendation there.

Dr. Eric:

Dr. Sarah, where can people learn more about Nutrivore? Feel free to share any other resources you’d like to.

Dr. Sarah:

Come on over to the new site: Nutrivore.com. We launched with 250 articles. We’re adding several articles every single week. We are continuing to build out the site. There is so much there to explore. You can search the entire Nutrivore Score database of 8,000 foods. You can see detailed nutritional information on a whole messload of foods. You can learn about different nutrients. There are detailed articles of what nutrients do in the body. Those detailed articles have links to the foods that are top sources. If you are really interested in food sources of calcium, you can go to the calcium article and click into the foods that are great sources of calcium. We are continuing to build out this resource. I think we will be for years. I have so many plans.

From there, make sure that you go up to the top menu and click Join. That’s where you can find links to my social media. I am @DrSarahBallantyne just about anywhere online that you can think of. That’s where you can find links to join my newsletter. I have five free Nutrivore guides I would love to send to your inbox. I have some awesome resources to share with you. That’s where you can link to things like my Patreon and my community in general.

Dr. Eric:

Thank you so much, Dr. Sarah, for sharing your knowledge about nutrient density and Nutrivore. I’m sure a lot of people will be visiting your website as well as your other social media platforms. Can’t say enough good things about what I have seen so far. I’m also excited about what’s to come in the future. Thank you for your time.

Dr. Sarah:

Thanks again for having me. I really enjoyed this.

 

Recently I interviewed Dr. Darin Ingels, and we chatted about allergies, asthma, and Lyme disease. If you would prefer to listen the interview you can access it by Clicking Here.

I’m very excited to chat with today’s guest, Dr. Darin Ingels. We are going to be talking about asthma, allergies, and Lyme Disease. Let me dive into Dr. Darin’s bio.

Dr. Darin Ingels is a licensed naturopathic doctor, author, international speaker, and leading authority on Lyme Disease. He is a former Lyme patient who overcame his own three-year battle after having failed conventional treatment and became progressively debilitated. Dr. Ingels found that proper diet, lifestyle management, and natural therapies worked with his body to heal instead of against it. He then applied what he learned about his own healing journey to his own Lyme patients and found they recovered faster and with fewer side effects. Dr. Ingels has treated more than 8,000 Lyme patients using his novel approach, many of whom have gone on to live healthy, symptom-free lives.

Dr. Ingels has been featured on WebMD, MindBodyGreen, Be Well, Thrive Global, Motherly, and Dr. Ron Hoffman’s Intelligent Medicine podcast. He is the author of The Lyme Solution: A Five-Part Plan to Fight the Inflammatory Autoimmune Response and Beat Lyme Disease, which I read while I was dealing with Lyme personally. Excellent book. Highly recommend. Thanks, Dr. Darin. Appreciate you joining us here.

Dr. Darin Ingels:                 

Pleasure to be here, Eric. Appreciate it.

Dr. Eric:

Let’s dive into your background. You dealt with Lyme, and that motivated you to write your book and led you to helping over 8,000 people with Lyme Disease. Can you get a little bit deeper as to how you developed the practice you have today?

Dr. Darin:

Sure. I am a naturopathic doctor by training. When I came out of medical school, I was really interested in environmental medicine, so I studied with the American Academy of Environmental Medicine. That is dealing with all these things in your world that get you sick and keep you sick. It deals a lot with allergies, asthma, and eczema. We also look at pollution, chemicals, mercury, heavy metal toxicity, and other things. That was really a big chunk of my practice.

In 2002, literally two weeks before I was set to open my own practice, I got Lyme Disease. I had classic Lyme. I am one of the few people I have ever seen that had all the textbook symptoms you get with Lyme. I had the bull’s eye rash, 105 fever, headache, joint pain, neuropathy, the whole gamut. I knew I had Lyme. I saw the rash. I got treated with Doxycycline right away. Within four days, all my symptoms completely went away. I felt fine.

If anyone has ever opened their own business, they know what it’s like, so I couldn’t afford staff. I was doing everything myself: scheduling patients, seeing patients, managing the books. I was working six/seven days a week, 10-12-14 hours a day. I got eight months into that schedule, and I started to relapse, having symptoms again. I recognize that this happens with Lyme. I took Doxycycline again for a month, and it did not work. I switched to Azithromycin for another month, and it did nothing. I started working with a local Lyme doctor I knew, and I started different oral antibiotic regimens and got worse and worse. This went on for eight or nine months.

I lost 30 pounds. My gut was a mess. I felt terrible. I had learned of a doctor in New York City named Dr. Zhang. He is a Chinese medical doctor and works as an acupuncturist and Chinese herbalist. I went to see him, and he gave me an acupuncture treatment and started me on a regimen of Chinese herbs. It was just a wake-up call that you’re not really taking care of yourself, dummy. You have to sleep more and eat better, all the things I tell my patients all the time.

Once I took stock of that and started on this regimen, within a month, I felt 80-85% better. From there, I took another two years to feel like I completely got my life back. I got to a point where I was 100% symptom-free.

I started applying what I did to myself to my patients, and I found that people got better faster. It’s looking at the whole person, not just the infection itself. Your diet, lifestyle, stress, all of these things, really play a huge role in your ability to get well. It’s not just about taking a bunch of pills. That then led me to see lots and lots of Lyme patients over the years.

So many people who deal with Lyme at some point end up having some element of allergy or hypersensitivity. We know the persistent infection has this capacity to offset your immune system in a way that it can make you more sensitive to your world. I see people that never had an allergy or sensitivity in their life, but after they get Lyme or some other chronic infection, now they don’t tolerate certain foods or can’t be in a moldy environment, or pollen bothers them, or they can’t pet their dog anymore. There is something in this underlying infection that is upsetting the balance in your immune system that can dispose towards allergies, asthma, or any type of mast cell activation problems.

I took what I learned as an environmental medicine doctor and kept doing it through my practice, even with Lyme patients, because it’s still applicable. Of course, your environment plays a role in everything. Whether you have heart disease, diabetes, obesity, there is often this element of immune dysfunction. A big part of my practice today is still dealing with all these underlying immune issues. We do a lot of immunotherapy in our practice to help modulate the way the immune system responds to these different allergens. We will talk about that later.

Dr. Eric:

Definitely. You mentioned the classic bull’s eye rash. With me, it was the opposite. I had no evidence of a tick bite, no bull’s eye rash. I wasn’t having migrating muscle and joint pain; it was more neurological symptoms. When I went to a primary care doctor, he didn’t want to do a Lyme test. The only reason I suspected Lyme was my experience with other patients who had Lyme. It was neurological symptoms, but everything was moving around. It wasn’t consistent. I went to see a Lyme literate doctor, and sure enough, it was chronic Lyme.

Interesting that you mentioned the connection between Lyme and other infections and allergies. Before we dive deeper into allergies, can you give a brief definition of what an allergy is?

Dr. Darin:

An allergy is an overreaction of your immune system to something that’s part of your world. To this day, we still don’t fully understand what makes people sensitive to cat dander or certain foods. Why is it in the United States, do we have this ridiculous rate of peanut allergy, where in Thailand, where peanut oil is used in everything, and their incidence is extraordinarily low? It’s a complicated issue, and we don’t understand what sensitizes people.

The bottom line is that your immune system is reacting to these things that are in your everyday life. Overreaction creates this collection of symptoms that can range anywhere from pollen allergy, which is typical hay fever, itchy eyes, itchy ears, runny nose, scratchy throat, head pressure, cough.

To things like mold allergy, which can be thick mucus in the back of your throat, chest pressure, headaches, insomnia. Mold for a lot of people can create psychiatric symptoms. Some get horribly depressed.

Some people get skin reactions. Eczema is a classic allergy reaction. Other types of skin rashes, too.

A lot of stomach and bowel problems. Chronic abdominal pain, constipation, diarrhea, gas, bloating.

Joint pain, muscle pain.

Mast cells in particular are scattered all throughout your body, and these kinds of cells can trigger various allergic reactions.

It’s interesting. In the United States, allergy has a very strict definition, and it refers specifically to IGE reactions, or immunoglobulin E. For people to have a classic allergy, pollen or hay fever, people get anaphylactic reactions to certain foods, where your face swells, you can’t breathe, or you get hives. All of that is classic allergy mediated by IGE.

If you read European journals on allergy, their definition is much broader. Some allergy is IGE; some might be IGG. Some might be T cell mediated. There is a lot of immune mechanisms that can create allergic symptoms.

If you go see an allergist, they have a very strict definition of allergy. They will scratch test you. They will do blood testing, looking at that IGE reaction. If that comes back negative, they will say you don’t have allergy. I think it’s a view of what allergy really is. The fact that it’s multi-systemic, can affect any body part, it’s important to understand. If you have these chronic ongoing issues, and your doctor can’t figure out why, I would be very suspicious that there is some element of allergy that may be causing it.

Dr. Eric:

One of the questions I was going to ask you is what do you think about the different types of allergy testing with regard to IGE? You mentioned the skin prick testing and blood testing. It sounded like you might not be a big fan of those. If they are negative, they don’t necessarily rule out allergies. Would that be correct?

Dr. Darin:

They have their place. It looks for a type of allergic reaction. If someone comes in, and they have had a true anaphylactic reaction and are not quite sure what it is, we can do skin prick testing or blood testing, looking at this IGE reaction to help identify if it was peanuts or something else. For those kinds of reactions, they are helpful.

For the reactions like mold, mold is notorious for not being IGE mediated. I have seen numerous people over the years where they go to an allergist, get skin prick or blood testing for molds, and it comes back negative. But every time it rains, or it’s humid, or they walk into a damp basement, they feel the symptoms. You are telling me clinically that mold is bothering you because it’s those moldy environments that precipitates your symptoms.

Often, we are doing different types of testing to look at the broad scope. Sometimes we do blood testing for IGG antibodies. I had one girl in my practice who had terrible hives. We did different IGE tests, and nothing came back. Mom was suspicious, “I know every time she eats oatmeal, she gets hives.” We did an IGG test, and the IGG was sky high. She pulled oatmeal out of her diet, and the hives completely went away. Her IGG level dropped down. That’s an example there are other immune mechanisms.

A lot of these probably involve T cells. Unfortunately, we don’t have great testing for T cell mediated reactions. If anyone is old enough to remember when you used to get a TB test, they would poke you in the arm. You would come back two days later to read it because it’s a delayed reaction. That was a T cell reaction. Because those are delayed, it could be hours to days after the exposure for the immune system to react.

With food reactions, this is an area that gets grossly overlooked. You go to the allergist, they test you for food allergies, and everything comes back looking normal. “You don’t have food allergies.” Their definition, that might be true. You don’t have a food “allergy.” That doesn’t mean you don’t have food sensitivity or intolerance. Both of those can create symptoms.

Then we have to look at other types of testing. Some people do IGG blood testing. Some people do skin patch testing. Some people do more esoteric testing, like muscle testing. There are a lot of different ways you can try and help glean that information about what you’re reacting to. Again, I think when you are talking about testing, at least in our world, often we are doing more than one type of testing because we want to understand the broad scope of what kind of immune reactions are happening.

Dr. Eric:

Do you tend to lean toward IGG testing for delayed reactions for more food sensitivities? There is also ALCAT. There is Mediator Release Testing. Did you have a preference?

Dr. Darin:

We actually do our own in-house testing. We do skin testing for some people. We use types of esoteric testing. We still do some IGE testing. I don’t use ALCAT or MRT or IGG testing. The problems with food, with IGG testing, it tends to show what you’re eating and not necessarily what bothers you.

I did this early in my career. We would do the blood test, get a list of all these IGG antibodies. What was weird to me is that sometimes it would come back with IGG high to lettuce, high to cucumber. This is water and cellulose. If you are reacting to this, you would react to every plant you eat. These are foods that are not generally known to be allergenic. Clinically, I really never saw people react to these kinds of foods. People would tell me, “I have salad three times a day.” Is it just showing what you’re eating and not necessarily what bothers you?

We would change people’s diets based on those results and repeat the test. All the foods they eliminated, the antibodies would go down or away. Now they have incorporated new foods, and we are seeing antibodies to the new foods. I would do this a third time and see it change again. It became very clear that it seemed to be showing what you’re eating and not necessarily what bothers you.

I think the benefit of IGG testing for food sensitivities probably not so much showing what you’re reacting to, but if you have a lot of IGG reactions, it’s a pretty good indicator you probably have leaky gut. If you are trying to help understand if you have leaky gut, because we don’t have great tests for that, if someone has all these high antibodies, the more antibodies you have. If it is reflecting what you’re eating, the fact that all these food substances are getting through the gut to stimulate at least an IGG reaction is pretty telling that the gut may not be as tight as we want it to be. For me, that is the benefit of IGG testing.

A food elimination diet is the gold standard for food sensitivities or intolerances. You eat a very limited diet, pull out all the common food allergies, remove all the dyes and artificial stuff for three weeks. You slowly reintroduce the foods one at a time and see how you clinically feel. That has been the gold standard for food intolerance for years. It’s a very inexpensive, easy way to determine which foods might bother people.

Dr. Eric:

I agree. I have been recommending elimination diets for years for patients. With IGG testing, I know there are a lot of practitioners who use them, and they get good results. The reproducibility of the test is a question. Different labs are different. Some arguably are better than others. I also have looked into MRT and found that interesting.

I agree, the elimination diet- I don’t know if you’d use the word “easy” because it’s less expensive, but some people find it difficult. They could get the blood test and find out what they are sensitive to. But that’s not that easy. You also have to be eating the food when it comes to IGG food sensitivity testing. If you are not eating the food, then you are not forming the antibodies. There are a lot of flaws in my opinion.

Dr. Darin:

When I say “easy,” I mean not complicated. It can be very difficult. When I was a med student, my nutrition teacher was Dr. Alan Gaby, who literally wrote the textbook on nutritional medicine. He had people go on lamb, rice, and pear for three weeks. It sucks. It’s so boring. People don’t like it at all. These are all foods that are considered to be very hypoallergenic. If you wanted to eliminate any other food that might possibly react to you. Then we would slowly reintroduce foods. People had a hard time doing that.

I don’t do that anymore when I do elimination diet. We incorporate more foods than that. You have to pull out all the common allergens and remove all the dyes and artificial sweeteners.

I say it’s easy in that it isn’t terribly complicated. It does take an element of discipline to do this for three weeks. It is inexpensive, and anyone can do it. In lieu of having other tests that may not be as reliable.

When I was a med student, we did one of the labs that does IGG testing—I won’t name them—we took the same blood sample and split it in four samples. We put different names on it and sent it to the lab, and we got four completely different results. I do wonder at least with some of the labs what their reproducibility is. This is now 25 years ago. Testing has gotten better probably. I know practitioners who do IGG testing and say they get great results.

What I find interesting is that people tend to crave the food they are sensitive to. It’s a weird dynamic. It’s almost like a drug addiction. Your brain and body want that thing. If you are eating a lot of the food you’re sensitive to, and it comes up on IGG and you pull it out, of course you are going to feel better. To some degree, it probably is picking some of that up. People do tend to eat these foods a lot. Elimination diet is still the gold standard.

Dr. Eric:

How does asthma relate to IGE allergies?

Dr. Darin:

Asthma can be triggered by a lot of things. Asthma for a lot of people is really allergy of the lung. You come in contact with some allergic substance because asthma is a combination of inflammation in the lungs and constriction of the bronchials. If you look at that inflammatory part, it can be triggered by dust, mold, pollen. There are other non-allergic triggers. Some people get cold-induced asthma or exercise-induced asthma. That can be different.

My experience in people with asthma is the overwhelming majority of them, if not close to all of them, have some element of allergy. When you reduce the allergic load, their asthma improves. It’s still a function of looking at all these different factors that might trigger asthma. We will go through and test them for pollen and dust and mold and common environmental triggers. We will probably look at food sensitivities.

It’s about total load. We are all born with a barrel, and some people have a huge one, and some people have a shot glass. When it overflows is when you become symptomatic. As much as we control each aspect of these things that are setting off your immune system, we get better control of allergies and asthma.

When I used to live in Connecticut, the dead of winter, it’s cold. We don’t have a lot of outdoor allergens. Pollen isn’t pollinating; it’s so cold. Mold isn’t sporulating. We would deal with people’s food sensitivities in the winter. When spring rolled around and the pollen hit, their pollen allergy wasn’t that bad this year. We never did anything for their pollen allergy. Just by reducing the load of the food sensitivities, their immune tolerance to other things got better. It’s always a function of trying to identify what these triggers are, and as much as we can get control over each aspect of it, your tolerance to the rest of the world gets better.

Dr. Eric:

If someone has multiple food allergies, essentially by cleaning up their diet and avoiding food allergies, that could help with asthma?

Dr. Darin:

Absolutely. I have a lot of people that a big trigger for their asthma is something they are eating. Because a lot of these food reactions are not true food allergies, they don’t happen in seconds or minutes. We know from the research that some of these reactions happen three days after you have ingested the food. If there is a day where you feel tight in the chest, short of breath, write down everything you have eaten over three days. I don’t think any of us would be able to figure that out. It’s important to do that evaluation and try and find out what those triggers are.

I have a lot of people with asthma where food is at least part of it. May not be all of it, but again, it is a function of load. It’s important to look at the whole gamut of things that might be setting you off.

Dr. Eric:

What are some of the more natural treatment options for allergies and asthma? My dad had asthma. I remember growing up, he would always rely on his inhaler if his condition got real bad. A few times, he got cortisone shots. This was before I became a chiropractor and knew what I know now. We were brought up eating fast food and junk food. I am sure diet played a role. I know stress in his case, too. I dealt with allergies, too, years ago, and I got the allergy shots. What are some alternatives? I know you do the low dose immunotherapy, which we’ll talk about. I don’t know if there are other things you want to talk about before getting into LDI.

Dr. Darin:

The low hanging fruit is you have to control your environment. That means get rid of all the toxic chemicals in your home. Stop using Windex and 409 and Glade plugins. All these things are chemicals that you breathe in. I think about something like tile cleaner in your bathroom. A lot of these things leave a residue on your tile. Every time you jump in the shower and turn on that hot water, which is steam, it aerosolizes all those chemicals, and now you are getting a big dose. If you are an asthmatic, that can be really bad. Clean up the environment. Get rid of all the toxic chemicals.

Use good quality air filters in your home. Depending on where you live in the world, I live in southern California where our air quality is bad most of the year. As much as we can filter the indoor air, that really helps a lot. Even simple things like washing your bedding every week, reducing dust in the home, these kinds of things can be very simple.

Beyond that, there is a lot of things you can do nutritionally. I think about things like fish oil, which is anti-inflammatory. It’s great for people with asthma. Helps you with allergies.

Vitamin C is a natural mast cell inhibitor. It helps block this histamine reaction from mast cells.

I have a lot of patients that use glutathione. Glutathione is a very important nutrient for detoxification. Very important for the lungs. A lot of people with asthma have low glutathione levels in the lungs.

Magnesium is the one nutrient you burn through the fastest. When you are deficient in magnesium, particularly if you have asthma, your asthma will get worse. One of the ways we treat acute asthma attacks is we give them IV magnesium because it’s a natural bronchial dilator, and it can open up their lungs quickly. If we can sustain their magnesium levels over time, we can prevent them from getting to a point where we had these asthma attacks.

It is a combination of environmental control, looking at these underlying triggers. We have a lot of natural substances we can use to help control allergies and asthma. Things like stinging nettle are great for people who get seasonal hay fever. Quercetin is another great product I use a lot for people with chronic runny nose, itchy eyes, and itchy ears. There are other natural mast cell inhibitors like luteolin, PEA, rutin.

I was talking with Dr. Kelly McCann, who is a mast cell expert. She did a summit last year on mast cells. In the research, there is over 65 natural products that have been shown to help with basically mast cell activation or allergy. In our world, we have a lot of options.

Again, I don’t really want people to get the idea that if you take a bunch of supplements, that will fix the allergy and asthma. It will help your symptoms. If we really want to get to the root of how to change your immune system long-term and hopefully permanently, that is where immunotherapy does a much better job.

Dr. Eric:

Let’s talk about immunotherapy, LDI. How long have you been using it? How can it benefit people with allergies and asthma?

Dr. Darin:

Just as a primer on immunotherapy. It’s immune therapy. In conventional allergy treatment, they do what is called subcutaneous immunotherapy, aka allergy shots. If they do a skin prick testing, and they find you are allergic to dust and ragweed, you come in every single week, and they inject you with dust and ragweed. They are injecting you with the thing you are allergic to, but at a very specific concentration, it starts to build your immune tolerance. Over time, they increase it incrementally, little by little. They get to a point where you are at a maintenance dose, and you will often stay on that dose for many years. That helps control your allergies. Insurance typically pays for it.

It’s a pain because you have to go to the allergist every week, at least for the first handful of months. Then they start spacing out your appointments. That is conventional allergy.

Beyond that, we have sublingual immunotherapy. This has been around for 100 years. The idea is kind of the same as allergy shots. Instead of getting the injections, these are drops you put underneath your tongue.

The way immunotherapy works is through what are called dendritic cells. These are part of the immune system that basically train other parts of your immune system to know what you should be tolerant to. The mechanism by which immunotherapy works is the same.

A lot of people like sublingual immunotherapy because it’s easy. You don’t have to go to the doctor every week. It’s very safe; we have hundreds of studies. In fact, it’s very widely used throughout Europe. It’s their preferential method over allergy shots because it’s also more cost-effective. Unfortunately, here in the United States, allergists get reimbursed for allergy shots, not drops under the tongue, so there is no financial reason for allergists to switch over. I have been doing sublingual immunotherapy for almost 24 years now. I find clinically it works very well. It’s very well tolerated by the majority of people. it’s incredibly safe.

Beyond that, we have what’s called LDA or LDI. The nomenclature gets sticky. Originally, it was called LDA, low dose allergy therapy. This was developed by a doctor in the UK back in the 1960s named Dr. Leonard McEwen. He was an ENT surgeon. He accidentally discovered that if you gave very low doses of these allergens, and you mix them with an enzyme called beta glucuronidase, you can modulate the way your immune system reacted to whatever you mixed it with.

If you look at what conventional allergists use, they are using 1:100, 1:1,000 dilutions of ragweed or dust. Dr. McEwen started with 1:10 million or 1:100 million. Way more dilute. The idea is still the same.

The nice thing about LDA is unlike other types of allergy treatments, which are much more frequent, allergy shots are once a week, and sublingual is usually done daily. LDA, you only do every seven weeks.

Dr. Shrader, who is an American doctor who has studied with Dr. McEwen, calls it EPD, enzyme potentiated desensitization. They were bringing the extracts over from England, but the FDA got a bug up their rear end and didn’t like it, so they put the kibosh on that. Dr. Shrader recreated it in the U.S. with a pharmacy here and called it LDA. EPD and LDA are really the same thing.

Dr. Ty Vincent though, who had been doing LDA in his practice, realized at some point that the way our body responds to microbes is really quite similar to how it responds to conventional allergies. He developed what was called LDI, low dose immunotherapy. That was really more geared toward microbes. The autoimmune reaction to Lyme or strep or candida or mycoplasma or any other microbe. Since then, Dr. Vincent has veered off and created his own extracts. He has his own food mixes and environmental mixes. He calls everything LDI now. Depending on where you are reading this, LDA, LDI, the concept is the same. It’s really the function of what we are treating.

I use the word LDA because we still buy our mixes from a pharmacy that makes it and calls it LDA. Those are for conventional allergies. There are mixes for food, inhalants (mold, pollen, cat and dog feather), and a chemical mix for people who are chemically sensitive. The nice thing about it is there is no testing involved. It’s just a function of do you have the clinical symptoms to suggest that you have food allergies, food sensitivities, environmental allergies? You give the doses.

The way LDA is typically given is as an intradermal injection. Dr. Shrader has a 35-page pink book (because it has a pink cover on it) that has all these rules. This is what Dr. McEwen did in his practice. It’s lengthy. The long and short of it is there is a specific diet you need to follow the day before, the day of, and the day after you get your injection. There are all these other rules about what you can and cannot take in terms of medication. That is the way it was done for many years. Dr. Vincent is a little bit of a cowboy and a rebel. He said, “I wonder what happens if we just don’t follow the rules. Would it still work?” Behold, he found that it did for the majority of people.

In our practice, we do it mostly sublingual. We do it under the tongue. It’s different than sublingual immunotherapy, but we do still administer it under the tongue. We still do the intradermal injection for some people. Clinically, I find it works quite well. The downside to the intradermal injection is it really hurts. It feels like you are getting stung by 100 bees. It lasts for about 30 seconds and goes away, but it’s pretty uncomfortable.

The nice thing of LDA is it is cost-effective, very safe. I get rare complaints of people who don’t tolerate it. If you are looking for strategies that will modulate your immune system over time and cure the allergies and asthma potentially, some form of immunotherapy is likely to do that.

Dr. Eric:

Guessing you have seen people not only with asthma but with IGE allergies that over time disappear with receiving the LDA/LDI.

Dr. Darin:

Yeah. We can monitor this with blood tests. If they are seeing an allergist, they are doing skin prick testing. We see their reactivity over time go down. Treatment can be anywhere from 18 months to several years. People need to understand: When you get on board with immunotherapy, it’s not a quick fix. You’re in it probably for several years.

The earlier you start, the faster it goes. When I treat kids in my practice, and they come in at six years old with eczema and a runny nose, that process is faster, versus coming in at 56 with a lifelong history of allergies, which might take longer. Clinically, we often see improvement within a fairly short time frame.

One of the big differences between sublingual immunotherapy and LDA is time. I find sublingual immunotherapy works a little faster. People feel the difference faster. LDA might take longer. You are getting it almost every two months. It might be that third or fourth dose before you really feel the difference. Sublingual immunotherapy, you’re doing every single day. That daily dose makes a difference.

We are always sitting down with our folks and trying to evaluate what works best for you, your lifestyle, your budget. Unfortunately, all of the non-allergy shots are out of pocket. Insurance doesn’t reimburse for any of it. If you get into that, you need to be prepared that it will be an out-of-pocket expense. If you are fortunate enough to have a health savings account, you can reimburse yourself that way. Unfortunately, there is no codes in the insurance industry that allows us to submit it for insurance reimbursement.

Dr. Eric:

Let’s say someone has asthma, and then they undergo treatment for two years with LDI. They feel like they have been cured. Do they then continue with maintenance treatments every few months? Are they pretty much done?

Dr. Darin:

Generally, no. I do have a few people where they are very well maintained. If there is a high pollen day, and that can happen, it hasn’t rained in a long time, the pollen count goes high, they may start to feel some irritation. In which case they will do over the counter Zyrtec. You might need medication to control it because it’s an unusual event.

Most people, once they are done, they don’t need to continue it. I have a handful of people who get a dose once or twice a year. Sometimes, it’s at their request. “I feel good. I want to make sure I stay good.” There is no downside to continuing treatment long-term. If you are completely desensitized, it won’t harm you. I try to avoid having people spend money on things I don’t think they need. The goal is to get you to a point where you don’t need the treatment anymore.

Dr. Eric:

Before I pick your brain for a few minutes with regards to Lyme, is there anything else I should have asked you that I didn’t ask you about allergies and asthma?

Dr. Darin:

No. If this is something you have been struggling with, get in the hands of a good environmental medicine doctor who understands differently than what an allergist will do. Everyone has their place in the world. Allergists at least in the U.S. will have a very limited definition of allergy. If you want to look at the broader scope, there is a group in the U.S. called the American Academy of Environmental Medicine, AAEMOnline.org. You can do a search and find someone in your area.

Dr. Eric:

Wonderful. Thanks Dr. Darin for sharing that.

Lyme Disease. I work with people with thyroid and autoimmune thyroid conditions, a lot of folks with Graves’ and Hashimoto’s. One question I had is whether you have seen in your practice Lyme and even other coinfections, like bartonella or babesia. Can those microbes be a potential trigger for autoimmune conditions, including thyroid autoimmunity?

Dr. Darin:

Absolutely. I think this is very common, specifically with Lyme, more than other coinfections. Any microbe has the capacity to trigger autoimmunity. We know from the research on Lyme borrelia that it can cause autoimmune reactions to the gray matter and white matter of your brain. It can cause it to your peripheral nerves and joints. I see a lot of people with Hashimoto’s that it seems to have fallen on the heels of having had Lyme exposure. I have not read any research on Lyme and Hashimoto’s specifically, but my clinical observation is it does seem to be a trigger.

This capacity to trigger autoimmunity is different than we think of lupus or rheumatoid arthritis and more classic autoimmune disease. We know from the research that it can trigger those kind of auto antibodies to your own tissue.

The thyroid is a common problem. I have seen a lot of people who have never had a thyroid issue in their life, and after they have Lyme, a lot of people end up with some sort of underactive thyroid, whether it’s Hashimoto’s or straight up hypothyroidism. There is that effect.

It can affect other hormones. Sometimes, it’s adrenals. Sometimes, it’s reproductive hormones. I have seen women who start having irregular menstrual cycles. I have seen a lot of men who have had Lyme and have extremely low testosterone. These 20-somethings who should have testosterone well over 1,000, and it comes back at 200. There may be other explanations as well, but I think this capacity for Lyme to create destruction in our body is quite high.

The way I always think of it is if you are standing on the lake in the morning, and it’s a nice, quiet lake, and a motorboat blows by, the boat can be long gone, but the waves are still rippling in the wake. I think Lyme is that way. It creates this swath of destruction in your body. Even if you’re effective at eradicating the infection, you’re still left with a mess, the hormone mess, the immune mess, sleep. We still have to correct these other issues.

Dr. Eric:

You mentioned earlier on your experience. You took the Doxycycline, the antibiotics. Initially, it seemed to be effective. The second time around, it wasn’t. It’s not just about treating the Lyme infection; it’s improving the overall health of the body. I look at viruses the same way. I think of Epstein-Barr, cytomegalovirus as more of an immune issue than a virus issue.

Dr. Darin:

Yeah. COVID was a great example of this. Look at how COVID affected people. People had no symptoms, some had mild symptoms, and some died. We saw these extreme reactions. If we say the virus is relatively the same- Obviously, COVID mutated over time. Generally, the population was being exposed in the same time period to the same virus and having these extreme reactions.

Same thing with Epstein-Barr or strep or Lyme. Is it really the bug, or is it the terrain? I am not really a subscriber of germ theory anymore. I was a clinical microbiologist before I was a doctor. I think this idea that germs are harmful- There are some germs like salmonella that do create a toxin. Anybody can get sick from salmonella because of the toxin. Most of the germs are out there in our world. We are exposed to millions of bugs every day that don’t harm us. I think there is better evidence that these bugs are here to protect us. Why our immune system starts reacting to these bugs in a negative way, and why these bugs are allowed to create the kinds of symptoms that they do, that comes down to the terrain.

That is everything we talked about earlier. It’s gut health, diet, lifestyle, sleep, toxicity, emotional trauma, all these things that comprise us as humans. If these aren’t in alignment, that is when these bugs become opportunistic, and they start to take over.

Epstein-Barr is a great example. I never really treat it in my practice. Do antivirals work? Not great. This idea that we are trying to kill something that is part of us. If you get exposed to Epstein-Barr as a child, you will have that virus in your body your whole life. You will never get rid of that virus. If it’s reactivated, and you’re having a higher viral load, can you bring it down? Yeah, you can try. Again, if we’re really looking at root cause medicine, what is it that is allowing that virus to become more active? Is it stress? Did you make radical changes to your sleep pattern or diet? Usually there is other underlying factors disposing you toward these things.

When I think about Lyme treatment, it’s not just about killing the bug. That’s part of it, but we have a deep conversation about all these other factors contributing to your health.

Dr. Eric:

The last question I have for you with regards to Lyme is it like Epstein-Barr? Once you have it, you have it. Or can it be eradicated, where it’s completely gone, and you don’t have to worry about it again?

Dr. Darin:

Great question. I think the truth is we don’t really know. We don’t have tests that measure Lyme directly in your body. We look at antibody tests, which are looking at immune reaction. Antibody tests have numerous flaws with them.

I am of the opinion that I don’t think we ever get rid of it. I have plenty of patients over the years who have long periods of being symptom-free. then on the heels of some sort of stress, it’s almost like shingles. When they get really stressed, then shingles comes out. In this case, their Lyme symptoms come back. It seems too coincidental that it coincided with a new tick bite.

It’s always possible. If you live in an area where ticks are endemic, it’s possible that you could get more than one tick bite. More often than not, when I see flares from people who have been symptom-free for a while, it probably was dormant. Your immune system handled it, it lived with you, you lived with it, you didn’t bother each other, but then the terrain shifted. Now that bacteria becomes opportunistic, and you start to experience symptoms again.

Dr. Eric:

From what I’ve read and researched, I agree. I just wanted to get your opinion. Since I dealt with chronic Lyme in 2018, overall, I feel really good. If I didn’t know I had Lyme in the past, there would be no evidence. Sometimes, I feel like weird things, like tingling. Maybe it’s unrelated to the Lyme. Like I said, it’s one of those things that seems like it’s not exactly the same as a virus, but it is intracellular from what I understand. It’s not the same as having H-pylori or other types of bacterial infections. We could go on and on.

For more information, I definitely recommend Dr. Darin’s book on Lyme Disease. Maybe in the future, we can get you back on to talk more in detail about Lyme because we have a lot to cover between asthma, allergies, and Lyme.

Where can people find out more about you? If you could also mention the upcoming summit.

Dr. Darin:

The best way to find me is on my website, DarinIngelsND.com. We’d love for people to join our community. We provide a lot of great information: videos, podcasts, blogs. We have a lot of great information for people dealing with Lyme or other types of chronic illness.

I am going to be hosting an allergy and asthma summit from March 13-March 19, 2023. This is a free event. All you need to do is sign up for the event. If you go to my website, we will have some information posted very soon about that. Join our email list, and we will be sending a lot of information out.

I brought in 50 experts on different aspects of allergy and asthma. I think it’s a great opportunity to hear from different doctors and practitioners around the world on how they help people manage allergies and asthma. We’d really love you to join the event and share it with your friends and family, who also may be dealing with allergies and asthma. People will find a lot of value in it. It will be a great resource of information.

Dr. Eric:

Your book The Lyme Solution is on Amazon or your website?

Dr. Darin:

You can go to Amazon or any major retailer. I know there is not a lot left anymore. Barnes & Noble still exists.

Dr. Eric:

Thank you so much, Dr. Darin for sharing your knowledge regarding asthma, allergies, and Lyme. It was a pleasure chatting with you.

Dr. Darin:

Great. Thanks, Eric.