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.

 

If you have hyperthyroidism or Hashimoto’s, what you need to keep in mind is that in order to restore your health you need to go beyond the thyroid. Even Hippocrates himself said that “all disease begins in the gut”.

Having optimal gut health is especially important for autoimmune conditions such as Graves’ disease and Hashimoto’s thyroiditis. The reason for this is because most of the immune cells are located in the gastrointestinal tract.

But a disrupted gut microbiome can also be a big factor in those who have a non-autoimmune thyroid condition. For example, if someone has toxic multinodular goiter, problems with estrogen metabolism is a common cause, and having a healthy gut is necessary for the proper metabolism of estrogen.

During this 7-day bootcamp you will…

• ​The relationship between the gut and the thyroid
• ​6 factors that can cause a leaky gut
• ​Which foods can have a negative effect on gut healing
• ​What you need to know about prebiotics and probiotics
• ​The negative impact of gut infections, including H. pylori and parasites
• ​The most important gut support supplements
• ​And much, much more!!!

The Free 7-day bootcamp will include the following…

Component #1: Daily “Healthy Gut Healthy Thyroid” Video Lesson

During this daily 15-30 minute recorded lesson I will focus on a different topic that is essential to healing your gut and thyroid. There will be one lesson every day for 7 consecutive days (although one of the lessons includes multiple videos).

Component #2: Daily priority action step

I want people to take action, but I want the action steps to be attainable, which is why there will be a single priority action step each day, although at times there will be one or two additional action steps.

Component #3: Bonus Live calls with Q & A

During the bootcamp there will be 5 live bonus calls with some time for Q & A. I will rotate the times of the live events to accommodate those in different time zones, as the calls will take place at either noon or 8:30pm Eastern time.

Component #4: Engage with others in a members-only group

We want you to build relationships with one another and enjoy this bootcamp together. Although you can still watch the daily video lessons and attend the bonus live calls without participating in the Facebook group, if you want to connect with others and be eligible for the prizes (discussed below) then you’ll want to join the Facebook group.

Component #5: Prizes for Participation!!!

There will be a daily prize for those who answer the daily question, and then at the end of the 7 days there will be a grand prize!!!

You Get All of This For FREE!!!

For more information on the Free 7-day Healthy Gut Healthy Thyroid bootcamp check out the link below:

www.ThyroidHealing2023.com

 

Recently I interviewed Tracy Farrell, and we chatted about testing for thyroid triggers. If you would prefer to listen the interview you can access it by Clicking Here.

I am very excited to interview today’s guest, who happens to be one of my staff. Her name is Tracy Farrell. We are going to be chatting about testing for triggers. Let me go ahead and dive into Tracy’s bio.

Tracy has more than 20 years of experience in health care, starting on the administration side, working as director of children’s hospitals with a think tank on women’s and children’s health. Then as a Functional Diagnostic Nutrition practitioner and integrative health and nutrition coach at Natural Endocrine Solutions. She did her undergraduate at St. John’s University. She also received a post-graduate research certificate from Adelphi University. Thank you so much for joining us, Tracy.

Tracy Farrell:

Thank you for having me. I’m looking forward to this.

Dr. Eric:

Very excited to chat with you. Tracy does an amazing job going over tests. She has also done health coaching. We are going to focus here on the testing side. Why don’t we start off by you talking about your background? Why did you decide to become a health coach and then go on and become a FDN practitioner?

Tracy:

Like many people who do what we do, it’s usually a health event for ourselves or our family. For me, it probably started really young. A lot of my parents’ friends were activists and health-focused people. My oldest had a diagnosis of we didn’t know. They wanted to give him medication. I am happy to do what we need to do, but why not find out what’s wrong with him? It turned out he had a little bit of ADHD and a little bit of dyslexia, not necessarily an appropriate use of pharmaceuticals in my opinion for a kid under 10. I started at that point focusing on what can I do in a natural healthy way to support him and our family? That started me on my journey.

Years later, I finally pulled the trigger of going back and getting my degrees and certificates in functional health. Since then, it’s made a huge difference in my family’s health from my oldest to my parents to myself. That’s how I got in here.

Dr. Eric:

Wonderful. As far as testing, we’ll of course talk about the difference as we do. I know there is overlap when it comes to the ones you learned about. Can you talk about what they taught you, as far as what tests they covered during your FDN training?

Tracy:

Yeah. It’s a little bit different today; they have updated their tests. I know you interviewed Reed, so he will probably update those tests for you. On myself, since I did it a little while ago, I did a comprehensive stool panel test; a saliva adrenal test, which is the adrenal stress test; hair and mineral analysis; organic acids; and MRT testing, which is a food sensitivity test.

Post-graduate, I have since added the dried urine test, the Dutch test; functional blood chemistry analysis certificate; an advanced gut health course; a SIBO certificate and update just this year; neurotransmitter testing and remediation; Zoomer for both the gluten and histamine. I like to be as updated as possible. Then I took the DNA course on sensitivities and other testing, just in the middle of that right now. I clearly like school.

Dr. Eric:

If you had to pick two, three, four tests, which do you enjoy looking at?

Tracy:

As you know, I love gut health. That’s one of my favorite things. I didn’t start off as being a big testing person. I thought to myself as long as we change food. But the more I dig in, and the more I do FDN, I have to say the gut health I really love. I do it way too much from a personal standpoint. I love to see it in patients just because I find the field of microbiome and how it affects people and how it has so many different gut/brain, gut/thyroid effects.

I recently have fallen in love with the Dutch test, probably because I am slightly middle-aged, and I like to check my hormones. I can see how valuable it is for our patients.

Organic acids is nice. I have to admit, I used to roll my eyes at food sensitivity testing because I felt our immune patients are so sensitive to everything that everything shows up.

The MRT testing, I’m starting to really enjoy and see how it works. Seeing a value for our patients in that more, just from a this is where you’re at now standpoint. That new test is starting to become something that I am looking at a little bit more for our patients.

Dr. Eric:

What I like to do is go down the list of some of the different tests that we do in our practice. If you could talk about some of the things you’re looking for, and I can jump in as well. We can go back and forth. I’m sure there are some listening to this who are familiar with these tests, but there are others who have no idea what’s included. What do I look for when I am doing an adrenal saliva test or a Dutch test or a hair and mineral analysis, etc.

If you’re okay with it, why don’t we start with the adrenal saliva test? What are some of the things that you look for when we do an adrenal saliva test?

Tracy:

I’ll tell you a quick thing about what is an adrenal saliva test. It’s done during the course of the day. It’s a saliva test, as the name suggests. It’s looking at your adrenals. We call it an adrenal stress index because that’s what we use. It measures the Circadian rhythm of your cortisol levels. You begin in the morning when you wake up, and you go all the way through the evening.

The challenge for me when doing this test was not having coffee, I will admit that. Make sure you read the directions. No exercising. Those are a few things to be aware of when you get it.

I am looking at this as I particularly like this for the Circadian rhythm of your cortisol levels. Frequently as our thyroid patients can tell you, I am always talking about the HPA axis and how things are tied together, sort of like teenage lemmings following each other and how our hormones are interconnected.

What I like about it is you measure this, so we can see a snapshot of the stress in your life and how it’saffecting you. It’s looking at everything throughout the day. Versus a blood test, which is just a snapshot of that moment in time and can be affected by what’s known as medical office stress. I particularly like the adrenal salvia test for that. It’s a nice snapshot into it. You can detect food infections, where your possible triggers are, why you’re having trouble sleeping. I like that.

Dr. Eric:

I agree. As Tracy mentioned, there are different companies out there. The company we use not only looks at the Circadian rhythm of cortisol. Cortisol should be at the highest in the morning and should gradually decrease throughout the day.

Tracy:

On a ski slope.

Dr. Eric:

Exactly. It also looks at DHEA, 17-Hydroxyprogesterone, secretory IGA. It lines the mucosal surfaces of the body, including the gastrointestinal tract as well as the respiratory system. It’s a form of protection. It has a few other markers, like insulin. I don’t do that test for that purpose. Really, it’s the Circadian rhythm of cortisol and DHEA.

When I dealt with Graves’, my cortisol was flatlined, at least the first two morning cortisol levels. You want those to be the highest, especially that first one. The third and fourth one should be on the lower side. But my first one and the second one was low. Some people have the opposite, where their cortisol is high, and we are doing things to calm down the adrenals.

Tracy mentioned the HPA axis, which is the hypothalamic pituitary adrenal axis. Hypothalamus communicates with the pituitary that communicates to the adrenal. The adrenals tend to get dysregulated, so we are doing things like stress management, mind/body medicine, adaptogenic herbs to support HPA axis. I have been in remission since 2009, so since then, I have been recommending it to patients.

In some cases, we will recommend Dutch testing, which is the next test I want to discuss because the Dutch test also looks at adrenals. It looks at a lot of other things as well. What are you looking at when we do a Dutch test, Tracy?

Tracy:

A little bit about the Dutch test. It’s dried urine testing. I feel like I say this about all the tests, but it’s easy to do. Not our tests are easy inthe sense that you are doing it at home, so it’s easy to do on the road. I did mine between travels recently. It’s another take anywhere test. You don’t have to go somewhere special. You just order it, and it comes, which is nice.

This test utilizes urine to analyze your sex and adrenal hormones and their metabolites. You will get little strips with it and pee on them several times a day. For some people, this test is easier than the adrenal stress index. Some people can’t produce enough saliva. In my house, saliva is a little difficult for my husband, as I am more salivay than he is.

I found it a little bit harder for me because I hydrate a lot. One of the things I mentioned with the ASI that you will have to be aware of is they like to have you a little restricted on your water. I think it’s 44 ounces a day you will be limited to. For somebody who is hydrating more, that’s annoying. That’s the worst thing I have to say about it. It’s a good thing to be aware of. It’s easy to use. I really enjoyed getting it back because I was right under his nose when I tried it. I also don’t like the adrenal stress of avoiding caffeine, another hard thing, and exercise.

A couple of foods. You can look at that list. It’s just a good thing to know. I like what this test looks at: your sex hormones, estrogens, testosterone, androgens, and their metabolites. Your adrenal hormones, oxidative stress bio marker, and your organic acids, which is on an expanded test of this. Depending on which ones you order, you could add cortisol morning with the spit. It’s a little bit about the test.

As a middle-aged woman, I kind of love the test for myself personally to get a snapshot. For our patients, I love it for the metabolites. What I mean by metabolites is the usable hormones that are excreted in your urine. This is the only test that does that. As I mentioned earlier, our HPA axis is tied to it.

In our Graves’ female patients, we see frequently hormone dysregulation. Men, too, but women are grander in our hormones. We are more showy. I love the fact that this gives us those metabolites and what we can see in them. It forces us to see them, and they are important for helping us diagnose certain conditions.

A good example of what kind of condition they can help us, for women, phase one and phase two with progesterone can show us fertility issues, confirm autoimmune issues. I can see where PMS is at. On the male side, we can use some androgen metabolites, some prostate issues. Both sides, acne issues, we can check in on that. It helps tie it in to how we approach the treatment and how we deal with it.

When I was a health coach, I didn’t have as much knowledge of diet and lifestyle. What am I going to do for that? Here, it might be making suggestions on estrogen regulation. Some of our patients are younger, and they are looking to have children. How can we get that together and help them achieve their goals? I really like that about the test.

Dr. Eric:

I agree. I like the Dutch test a lot. As Tracy mentioned, it also looks at the Circadian rhythm of cortisol, just like the ASI test does.

When it comes to triggers, because I didn’t mention with the saliva test, stress is a potential trigger. Stress without question affects the adrenals. You need to have healthy adrenals to have healthy sex hormones.

Arguably, not everybody needs to test the sex hormones, which is why I don’t recommend Dutch testing to every single person. It’s not going to hurt for everyone to get it, but it is more expensive than the saliva testing. If we are just focusing on adrenals, saliva testing is sufficient. If you do want to look deeper into the sex hormones, you could also do blood testing for sex hormones.

As Tracy mentioned, the big advantage of Dutch testing is that it looks at the metabolites of the hormones, which you can’t look at through the blood or the saliva. The different metabolites, cortisol, the androgens, but the main ones I focus on are the estrogen metabolites. There are three estrogen metabolites it looks at. When I talk about estrogen dominance, that you could have high estrogen levels, or you could have normal estrogen levels and low progesterone. You could do saliva testing for sex hormones as well, but you can’t look at the metabolism of the hormones.

I have seen people with lower estrogen levels, yet they have higher 4-hydroxy or 16-hydroxy metabolites, which are the so-called bad metabolites. Nothing is really good and bad. You want everything to be within a healthy range. Again, this could be estrogen dominance or problems with estrogen metabolism. It could be a potential trigger or contributing factor. If someone has thyroid nodules or uterine fibroids or ovarian cysts, that could also be a factor.

I don’t think everybody necessarily needs to do this test, but for those willing to do it, it is very valuable. A lot of people have thyroid nodules, so I can’t say I have everybody with nodules do a Dutch test. If they have other conditions related to estrogen metabolism issues, so nodules, fibroids, ovarian cysts, endometriosis, that might be an indication to do the Dutch test. As Tracy mentioned, if they are having fertility problems, that is another good reason to do the Dutch test. If there is a family history of estrogen dependent cancers or a personal history of, like breast cancer, then it’s probably a good idea to consider doing the Dutch test.

She also mentioned it has a section where it looks at organic acids. More on the basic side, we are going to talk about a more comprehensive organic acids test later. It is kind of cool that it looks at some of the organic acids related to glutathione and some of the B vitamins, like B12 and B6, and some other oxidative stress markers. You do get a lot of information with the Dutch test. Melatonin also. I can’t say enough good things about the Dutch test.

Tracy:

I also like the oxidative stress marker, which I didn’t appreciate as much until more recently, coming from the nutrition end of it. I like to look at OHDG as the marker. I like that one because we talked about triggers, and it seems like a lot of them are stress, stress, some estrogen. This is a nice marker to show patients oxidative stress. It gives a fuller picture to see how stress affects them on a cellular level. You have heard about DNA damage generationally. This is showing you on your body. I didn’t appreciate that as much as I have recently, where I have been reading up on oxidative stress and how to combat it for things. I thought that was interesting.

Dr. Eric:

I agree. It’s also probably a good idea to let people know that for women who are cycling, who are menstruating, you can do a cycle mapping, a cycling hormone panel. You can collect samples throughout your cycle, which is arguably more accurate than just doing a single sample, which most cycling women would do in the second half, the luteal phase. That is better than nothing. A lot of doctors use that. You can look at it through your whole cycle.

Tracy:

It is. I did not do that one. I couldn’t give up exercise.

Dr. Eric:

Let’s talk a little bit about hair mineral analysis testing. If you want to dive into that, what is it? What do you look for when you do that test?

Tracy:

This test can be a little more challenging in the sense of it’s an easy at-home test. We have to cut our hair and not color it for a month. Some of us have more hair than others. I always suggest to patients, “Hey, grow out your hair for a month. Do the test. Bring it to your barber or hairdresser, and let them take a patch in the back, so you’re not having some spouse, family member, friend take too much or too little.” That is my tip of the day. It is actually easier than it sounds.

I have found this test valuable with patients because it gives us a snapshot of heavy metal exposure, which I love. It’s not perfect. Part of the reason why that is good is because our body is an extraordinarily efficient machine, even when we are sick. It detoxifies and pulls out all the things we are not supposed to have in our body, and it stores it in our tissues, hair, bones. This can give us a non-invasive way of seeing how you are absorbing nutrients. Do you have any heavy metal exposure? Things like mercury, copper, aluminum, along with some trace minerals like zinc, selenium, magnesium, calcium, and others. It’s a nice snapshot.

If you’re telling me you’re taking vitamins, and I’m not seeing them being deposited in your hair, hmm, what kind of gut issues are you having or not? Things like thyroid health. We can confirm or eliminate copper toxicity, which is definitely a possible trigger. I am sure Eric has seen this, but I have not personally seen this: I know that copper toxicity is related to estrogen production, and zinc and copper are levers for each other.

Speaking of heavy metals, it had a significant impact two challenges ago. There were two patients. One was a jeweler. When I looked at her test, oh my god, this person had lead poisoning. It was really concerning. We were doing a group call, and I emailed them separately because it was the highest numbers both of us had ever seen. I asked you about it. It turns out she was soldering jewelry without protection. Not only was she infected, but her whole family was infected with lead poisoning. There you go. There’s another thing. That’s just one example.

Somebody worked at a mechanic shop, and she had some poisoning/toxicity. She ended up remediating her whole shop. That is just two extremes, but it does show up.

I did mention copper toxicity. Things that can cause it are pipes, cookware, industrial stuff, hormone replacement, copper IUDs. That is another subject that I am sure one day you will cover. Vegan diets, smoking.

It’s a nice test to find those things. Thyroid and hormonal imbalances and mood and depression and weight gain and everything is all connected to this one simple, small amount of hair test. I didn’t know that I liked it as much as I did until we did this talk.

Dr. Eric:

I like the hair test. I have been doing it for years. It’s not a perfect test. Some practitioners will criticize the hair test being that it’s not perfect, and I admit that, too. You could have heavy metals deeply embedded in the tissues and not showing up. Same thing with urine testing. Some practitioners use urine testing for heavy metals. Same thing. It’s not perfect either. Some practitioners use provoked testing, especially in the urine. They’ll do a baseline urine test and give a provocation agent or key later to mobilize the metals and then do another urine test. There is controversy over that as well.

When we see the metals, then we know that there is a problem. When we don’t see the metals, it doesn’t completely rule out a problem. Sometimes, we see a few things high initially. Someone goes through a detoxification and retests a few months later. Some things that weren’t high the first time are now high. The reason for that is because by detoxifying, a lot of times, we will release metals that were more deeply embedded in the tissues. It’s not necessarily a bad thing. Ultimately, of course, you want to see everything start decreasing. You will never see zero across the board because we are always being exposed to heavy metals.

I like that test. As far as minerals go, it’s definitely not perfect with the minerals. Some of them, I definitely pay attention to. Others like iron, I usually don’t pay as much attention to. I don’t rely on iron for the hair test; I recommend a full iron panel through the blood. If someone has hard water, it will spike up the calcium levels. You have to keep that in mind. If someone is using anti-dandruff shampoo, usually it has selenium, so you might see elevated selenium. Again, you need to understand that there are certain variables that can affect minerals in that way and cause elevations. As Tracy said, if there are other minerals where you see a lot of them that are low, you might be suspecting a gut issue.

It’s a good test. It’s inexpensive, affordable for most people to do not only initially. The challenge with testing in general is that when you find something, not everybody can afford to retest. As a result, not everybody retests.

When I did my adrenal saliva test, everything was low. A few months later, I did another test because I wanted to make sure that what I was doing was helping the adrenals. You can go by symptoms improving or maybe your thyroid test. I wanted to do another saliva test.

Some people want to do another saliva test or Dutch test or comprehensive stool panel. I’m not saying everybody has to do an initial test and then do a retest. In some cases, you would want to consider doing that. With hair, it’s usually not a problem just because it is so cost-effective.

Tracy:

Exactly.

Dr. Eric:

Next, maybe your favorite test. I know you mentioned earlier how much you liked the stool test. Let’s talk about the comprehensive stool panel. In our practice, we use the GI Map. There are other really good stool tests, like GI Effects from Genova Diagnostics. We have been using the GI Map from Diagnostic Solutions. There are other companies as well. I am mentioning the name because she is going to go over certain markers that might just apply to GI Map. I will let you talk about it and what you look for. Then I will fill in the gaps.

Tracy:

There will be gaps. A comprehensive stool panel, exactly what it sounds like. Sometimes I tell people my tip of the day is I learned from my youngest who said she spreads out something on the floor when she does it. When you come to my house, I am a nutritionist, and I do functional diagnostic testing. Instead of a mint on your pillow, there might be some testing on your pillow. If you’re a family member, at-home testing and experimentation is a real thing in my house.

I have trained on the GI Map and Genova, Cyrex, Nordic. What most people will be able to recognize about it would be it’s DNA-based, quantitative PCR testing. You are most familiar with it by hearing the Cologuard, the colorectal, instead of getting your colonoscopy if you don’t have a risk. I lovingly call it “poop in a box.” The alternative colon cancer test, the camera thing.  Instead of doing a long DNA test, it’s a faster test that extrapolates more information, which we love. Until recently, in gut health, we could only see what was the aerobic, the oxygen-breathing bacteria that survived when you poop it out. This test was a gamechanger in gut health in that you can now get the DNA from the anaerobic, the non-oxygen-breathing that are committing suicide the minute they get out of your body. That has opened up a whole field of the microbiome.

I tell people I have been interested in poop for far longer than has been exciting. As we know in recent studies, we are seeing deficiencies in kids on the spectrum; in people with colitis and SIBO and SIFO and thyroid health; all immune and inflammatory diseases. Everybody is inflamed. Obviously, I have a lot to say about this test.

I like the ranges in the test that we use. Instead of just a positive or negative, we are getting an entire range of numbers. I can see your secretory IGA, which we also get in the ASI. What’s interesting is a tremendous correlation for us between the two. Saliva in my upper tract is good, but in my lower tract, it’s not. The tying in of the tests help.

I love to look at all the markers. I probably first became familiar with it here. I like to look at the H-pylori portion of it. If it’s too high or too low. It’s the most comprehensive. It gives a range and virulent factors and lets us know is it anti-bacterial resistant or not?

There are parasite markers, which I have seen but I don’t see very often. We had a patient who claimed never to have gone outside of the country. She was a florist and picked up a parasite from her floral deliveries from overseas. We had to help treat her. It’s fascinating.

I can also tell what you’re eating by what your poop tells me. If you’re telling me you’re being good and you’re not, I can see it in your artigesic trigger markers, your zonulin portion, your cow protein. It’s a nice snapshot if you can do it.

There are other tests that will tell us more from a thyroid perspective. I happen to like it from an overall health perspective. I probably do it too much in my household. We had H-pylori. An interesting factoid about the H-pylori was how you react. The highest marker individual in my household did not have any symptoms. The lowest marker individual in my household, Bertie had some gastric markers from GERD. They were already having some erosion in their stomach from possible ulcerations. This helped us treat it. Your symptoms and how you are feeling are going to base on what your markers are and let you know how your snapshot is.

I don’t know if I answered all the interesting things about it, but I clearly like the GI Map.

Dr. Eric:

You covered most of the highlights. As you said, it’s a quantitative PCR. For example, you mentioned H-pylori. If you go to a regular lab, it will just say if you’re positive or negative. They will put a number on it, unless it’s below detectable limits. Otherwise, they will put a number. If someone is elevated, so clearly positive, and then they follow either a natural protocol or antibiotics, and then let’s say they test after that protocol, if the H-pylori is still high, which would be a bummer, but it does happen, then you can see if it got lower at least. If you went to a regular lab, you would see it still positive maybe.

Another advantage is being that it’s PCR, it does seem to be more sensitive than regular labs. Some labs won’t pick it up, whether it’s a stool antigen or a breath test. This will pick it up. I like this test.

It also gives virulence factors. Most of the time, these are negative. The other day, I had someone who had two positive virulence factors. With these there is an increased susceptibility to developing—it depends on the virulence factors, but some of them are developing ulcers, which sometimes correlates with H-pylori; or some gastric carcinoma, which is not good. It doesn’t mean that if you have positive virulence factors, you will develop ulcers or gastric carcinoma. It’s just an increased susceptibility.

I like the H-pylori part of this test. Some other tests, like the one from Genova, you have to add on the H-pylori. I am pretty sure it’s just the stool antigen, positive or negative, through that test.

You mentioned parasites. I will say Genova does have a little bit more in the parasite department on their test. They give more information. But with parasites, it’s definitely not perfect. There is no perfect test out there with any of the tests we discussed. It does get tricky because if someone is negative for parasites, it doesn’t always rule out parasites. That’s why there are some practitioners, including some I have interviewed, who don’t do stool testing for parasites. They will just treat for parasites. There is definitely controversy over that. Obviously, if you see a parasite, if someone tests positive for blastocystis hominis, then it’s nice that you know you have it. You can choose to retest if you want to retest.

Tracy mentioned some other markers like cow protein, which is an inflammatory marker. Especially if someone has ulcerative colitis, that type of inflammatory bowel disease, you will often see that elevated. Pancreatic elastase is another marker that we see on this test. Those markers, we see those usually on other comprehensive stool panels. We should probably differentiate. Maybe I will have you do the difference between comprehensive and going to a regular lab.

Before you do that, you mentioned zonulin, which is a leaky gut marker. If you test for zonulin, and it’s elevated, then it typically confirms that you have that increase in intestinal permeability, which is the medical term for a leaky gut. The thing is, I usually don’t recommend that. It is an add-on test. I just see false negatives a lot with that marker. It’s not a perfect marker. If someone wants to do it, that’s fine. I just assume that most of the people we are working with have a leaky gut.

I used to do a lot of leaky gut testing using Cyrex Labs, their Array #2. There are other tests like the lactulose mannitol test. I and a lot of practitioners I know just assume people have a leaky gut. There are so many different tests that you have to prioritize. Some people want to do everything, but most people have a budget.

The flaws with leaky gut testing is it doesn’t tell you what is causing the leaky gut. If you are doing zonulin as part of the GI Map, the rest of it can tell you what might be causing that leaky gut and what potential triggers, like H-pylori could be a trigger for Graves’ or Hashimoto’s, or parasites.

Feel free to expand on anything I just mentioned. If someone wants to get a stool panel, like a regular lab, what is the difference between this and the test we are discussing?

Tracy:

First, I would say about the leaky gut: We assume that everybody has one because they have an inflammatory disease. If you are inflamed, your entire body is inflamed from your blood vessels to your heart. As I always tell our patients, if you have an inflammatory disease, you have an immune disease. You may agree or disagree on that. We are treating you for inflammation. With food testing, everything is going to irritate you. It’s like being locked in a closet with somebody who irritates you particularly well, and you are not getting it out. They may not make it out. Part of it is you are in a heightened state of inflammation, so we are treating it as thus.

There is another marker that I recently started looking at more, the methyl bacteria marker that we see sometimes elevated in people with SIBO. Even though you can’t get into your small intestine either way, when people have it really bad, I have noticed we have started to see that more when it’s coming down into the marker.

I don’t know how you feel about that because I didn’t ask you how you felt about that. I have noticed we have seen more of it, and when they do do SIBO Testing, they test on SIBO. I threw you under the bus there, so sorry about that. I tend to think about people having more SIBO with Graves’ or thyroid issues. They are off because of our SAD diet.

I will talk about the comprehensive stool panel. I digress. If you go to LabCorp and their stool panel, it’s just collecting and testing a small amount of markers. What they are picking up, they are not doing the full DNA. They are not running it. They are not doing the PCR test. It’s basically like what are they seeing or not seeing?

With the GI Map, they do both the DNA and then on parasites, they do a visual scan on most of them. It’s less comprehensive. It’s testing fewer things. It’s looking at fewer markers. It’s not burning the full DNA on all of them.

I’ll be honest. I think part of it is that the companies that specialize in this have larger data sets because they have a larger amount of people coming in. They have more of a background and more training on what they are doing versus a LabCorp. I’m not saying that LabCorp isn’t good; it’s good. It’s not giving you the full amount for it. It’s just limited. If you are going to pay for a test, you might as well get the whole test.

Dr. Eric:

I agree with what you said. There is a time and place for a basic stool panel. If someone is having diarrhea for example, especially if it’s covered by insurance, you go to your primary care doctor and get that test because that’s what it’s testing for. If you look at the GI Map report, there are four main pages. That basic test is looking at what’s on page one of the GI Map, which are parasites, bacteria, and viruses that cause gastroenteritis and commonly diarrhea. If you are having chronic diarrhea, experiencing it for a number of days, then it’s not a bad idea to get that test. Arguably, maybe even a better idea than the GI Map because the GI Map will take some time to get the report back. You might want to go for that basic test.

As far as looking for triggers and parasites, it’s definitely flawed. It will look at maybe a few parasites that relate to diarrhea. If you are relying on that to look at parasites, you could be missing out. I mentioned even with the GI Map or Genova or other panels, those are not perfect for parasites. Arguably, the one that you get through a regular lab is going to be the bare basics, as Tracy mentioned.

You mentioned SIBO. The comprehensive stool panel is looking at the large intestine. Yeah, there are markers. Some of the opportunistic bacteria, if they are high, it might give a hint that maybe someone might have SIBO. If I am highly suspecting SIBO, typically I would recommend the SIBO breath test. That is specific for the small intestine, looking at the methane and hydrogen. Now there is one lab that looks at hydrogen sulfide as well. Good point as far as that you could maybe get an idea of if someone has SIBO. Again, it’s not-

Tracy:

It’s not perfect. Sometimes if it’s really raging, the patient knows. There are a few markers that we see down there that occasionally tip us off. It’s just an added bonus there.

Dr. Eric:

Thanks for mentioning that.

Organic acids testing, let’s talk about that. There are a few companies that do that. We use more commonly Great Plains Laboratory. Genova also has one called the Organics that is pretty good as well.

Tracy:

The Dutch also has an OAT addition, too.

Dr. Eric:

Exactly. It has some brief organic acids markers. Let’s talk about the one that we use mainly.

Tracy:

Sure. This is another urine test. It’s easy. You will probably want to be slightly dehydrated because we want to concentrate the urine, so we can catch it. It does 74 markers. It’s at home. It’s an easier test because you’re at home or at work, and you can do the collection. The 74 markers are organic acids. They are what your body produces and metabolizes when you are eating food and discarding it. By measuring the amounts of them, we can see if there is pathway clearing, your kidney function, too much, too little. Cellular metabolism. Some gut microbiomes are in it.

The limitation is that it’s showing us what you’ve eaten or what you’ve done within a 12- to 48-hour time period. When we go to the doctor, we will be good before our bloodwork. My tip to patients is I really want you to eat what you normally eat. Do not try to game the test. Don’t try to clean up your diet beforehand because the purpose of this is for us to see what you’re doing all the time, not on your best behavior. Then we can really help you, and we can really find your triggers, some other things going on by behaving in a normal manner. That is a good thing to keep in mind. Don’t do it around the holidays when you are eating cookies. Maybe just do it during your normal diet. It is important that you eat beforehand what you normally eat.

One of the best things about this test is yeast overgrowth is seen here. It shows some of that. A good highlight. Versus seeing it not necessarily in the GI Map.

It shows vitamin deficiencies on a neurotransmitter level. Mold, fungus exposure to a certain extent.

Like other tests, like the coffee and avocadoes for one test, you will avoid certain foods for this one. Look up that list, even if it’s in your normal diet.

It’s a quick and easy snapshot of your cellular health. High oxalates are good to know. Some patients are impacted on it. Eric, you had a high oxalate marker when you first were testing. You did some remediation.

It also indicates your detoxification. What your body is doing and your mitochondrial markers. This is another good snapshot of your health. Again, it’s limited. It’s 12-48 hours. There you go.

I mentioned yeast. Part of it is mitochondrial dysfunction we may see there. That’s a trigger. Every test has a little bit of a piece of the puzzle for what your triggers may be.

Dr. Eric:

OAT is a really good test. Tracy mentioned yeast overgrowth. The stool tests look for yeast, but it doesn’t show up a lot of times. If it shows up on the stool test, you probably have a real bad case of yeast overgrowth. I do prefer the organic acids test if we are going to look for candida overgrowth or other types of yeast.

She mentioned mold markers. It could give an idea if someone has aspergillus. It’s not a comprehensive mold test. Great Plains has their MycoTOX test, which is more comprehensive if someone wants to look into mold. There is also Real Time Labs and a few others that look into mold testing. Two of the more common ones are Great Plains and Real Time.

Tracy mentioned mitochondrial markers. This could be a factor, not just with autoimmunity, but with anybody.

She mentioned yeast particularly being a trigger, affecting that permeability of the gut. Mold also could be a trigger. It looks at some of the neurotransmitter markers.

She mentioned oxalates. When I did the OAT for the first time, it didn’t look too bad. I did have a bit of candida overgrowth as well. I did have the high oxalates. At the time, I was adding spinach regularly to my smoothies, so I cut that out. That is the main change I made. I was eating other sources of oxalates, but I can’t say I made dramatic changes in the other areas. When I retested, the oxalates were normal. It was the spinach in my case that was the main culprit. There could be other higher oxalate foods like Swiss chard and sweet potatoes or even nuts and dark chocolate. It will be difficult to eliminate oxalates completely, so we don’t recommend trying to do that. The spinach is probably the highest source of oxalates. Even if you cook spinach, it doesn’t have much of an impact.

She also mentioned nutrient indicators. It looks at B vitamins and CoQ10 and NAC. Some indicators of detoxification as well.

To me, it could find triggers, but also, it’s a good overall test, just looking at different areas. Some of the tests we spoke about, especially saliva testing, focus more on adrenals; Dutch, adrenals and sex hormones; stool testing, looking at the gut. This test looks at different areas. It’s more of a broad test.

This would be a nice screen for a physical. It probably will never happen, but if you go to a physical, they usually do a CBC, metabolic panel, lipid panel, and that’s it. They might do a Vitamin D. This would be a neat test to do as part of a physical, just to see one’s overall picture. Yeast overgrowth, clostridia, but that could be a factor. The oxalates, mitochondria, neurotransmitters, nutrients, detoxification. It’s a neat test.

It’s a urine test, so it’s easy to collect. Can’t say enough good things about this test. Genova’s test is pretty good, too. At least as of now, I don’t think they test for oxalates. Great Plains Lab is the only one that does. Same with clostridia. Clostridia, which stool tests will look at, but they don’t differentiate between potentially harmful strains of clostridia and commensal, whereas the OAT from Great Plains is looking at more of the problematic clostridia. If you are high in clostridia, you want to address that.

Tracy:

Yeah.

Dr. Eric:

For the most part, we covered what I wanted to. I guess the one thing that I will briefly mention, because you mentioned the MRT food sensitivity testing. I have spoken about it in the past with some practitioners, and there is a follow-up interview with Elizabeth Yarnell, who I interviewed previously. She has a new book coming out, so she will talk more about the MRT.

Mediator Release Testing, I do like it. I probably need to do more of it. I have been opposed to food sensitivity testing, but in the past, I was more familiar with IGG testing. I didn’t find that to be too reliable. Like Tracy said, if someone has a leaky gut, a lot of times, you will get a lot of foods being positive, which is related to the leaky gut. It’s a challenge because a lot of those foods may be healthy foods and foods that are allowed on an AIP or paleo diet.

I can’t say I never did IGG testing. I have done it in the past. It usually wasn’t the first thing I would recommend. If someone wasn’t progressing, then I would go to the food sensitivity testing and rely on the elimination diet initially.

I have heard so many good things about MRT. I have dabbled with it. Had some patients do it. After interviewing Reed Davis and Elizabeth Yarnell and a few others, it’s something that also could be very valuable. Everything does add up, so you need to prioritize and say, “This is the test.” I have had success without the MRT over the years. I am always looking to get even better outcomes than I do now and potentially get people better even quicker. That is definitely something else to consider.

Tracy:

I agree with you. I dislike the IGG test because I found you came back with numerous things that weren’t allergies. They were just sensitivities and other things.

I had to do the MRT test for taking my course. I don’t have food allergies or sensitivities. I am the GOAT of the family. A couple of my kids are allergic to different things and have severe EpiPen allergies to them. I found that was the most accurate test of them because it didn’t come back giving me a list of things that the other tests came back listing. I am not doubting it. For other people, it has been a gamechanger. It was interesting for me to do it because I already knew I wasn’t sensitive. I had already spent time working on my health because it’s my job. I was pleased to see that it did not come back with a lot of false positives and false things. I appreciated that. It turned my view of it.

My youngest is allergic to pecans, and it actually picked it up on one test. As an experiment, because I do love to experiment, I decided to run the IGG test, which didn’t pick it up. It’s an EpiPen sort of situation. It was interesting to see it. I guess we’ll be doing more in the future when we need to because we don’t need to do it all the time.

Dr. Eric:

I will say if it’s a true allergy, like if you had a pecan allergy, the IGG wouldn’t pick it up because that is an IGE mediated response.

Tracy:

Right.

Dr. Eric:

Looking for something different. The IGG, some labs are better than others. Still, I do like the MRT better.

Tracy:

I like to say we are in an inflamed state. When you get those sensitivities, I think in Reed’s interview, he mentioned he gets an updated list because when we are in an inflamed, immune state, sometimes things change because our bodies change. It may be that you are more sensitive or reactive. Our whole diet, our SAD diet, before we change it, is just a crowded room of unhealthy things and environmental toxins. Once you clear out, that little voice that used to bother you is now being able to be heard, so that’s a beauty. My plug for eating healthy and getting healthier is those quiet voices that we can’t hear in our bodies because we are so unhealthy, living in such a toxic environment, we can now hear. It’s a good thing.

Dr. Eric:

Agreed. Any last words before we wrap this up, Tracy? You did great. I think we both went into great detail with the tests. Just want to make sure there is nothing else that you wanted to add.

Tracy:

I look forward to seeing new patients and reading their tests and doing new programs and continuing- I love what I do, so I always joke that I am a skeleton here in this chair by the time I’m done because I love it. Our whole office, we love what we do. I look forward to the future.

Dr. Eric:

Which of course is important. You want to work with someone who enjoys doing what they do. Tracy is definitely passionate about what she does.

Tracy:

I was emailing you on my vacation for my anniversary on something I was reading about an update. I do love what I do.

Dr. Eric:

Every time I do an interview, I usually share the website of the person I am interviewing. In this case, the website is NaturalEndocrineSolutions.com. Tracy is also active in my Graves’ and Hashimoto’s support group on Facebook. You can check that out. I don’t know if you’re on Instagram.

Tracy:

I am not.

Dr. Eric:

I thought I was the only one that wasn’t on Instagram.

Tracy:

It’s the two of us. I can barely keep up with the Facebook group. Join the group and all the programs. It’s a fabulous group of individuals who contribute research and do stuff, so that’s a nice resource for everybody, along withthe podcast.

Dr. Eric:

Thank you so much for this interview, Tracy. It was a pleasure chatting with you. I am sure the listeners learned a lot about testing and the different triggers that go along with the test.

Tracy:

Thank you for having me.