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.

Recently I interviewed Reed Davis, and we chatted about functional lab testing. If you would prefer to listen the interview you can access it by Clicking Here.

I’m excited to chat with Reed Davis about functional lab testing and why we should go beyond the blood test. Reed is a Board-certified holistic health practitioner and certified nutritional therapist. He is an expert in functional lab testing and holistic lifestyle medicine. Reed is the founder of Functional Diagnostic Nutrition and the FDN certification course with over 4,000 graduates in 50 countries. Reed served as the health director at a wellness center in southern California for over 10 years. With over 10,000 clients, he is known as one of the most experienced clinicians in his field. Reed serves on the advisory board of the American Natural Wellness Coaches Board and the American Association of Natural Wellness Coaches. Thank you so much for joining us, Reed.

Reed Davis:

Thanks, Dr. Eric. Real pleasure to be here with you. Hope we can help them out a little bit.

Dr. Eric:

I’m sure we will. Why don’t we dive into your background? How did you develop the FDN program certification course?

Reed:

I worked in a clinic for 10 years, as you mentioned in the bio. My job there was to look at lab work on people and figure out what’s really wrong with them. That’s why I started working there.

I had actually been in environmental law saving the whole planet. I decided to work with people. “Hey, the planet is getting worse and worse. Saving the planet’s great: air, earth, water, trees, bees. What about people?” I was getting older. I was perfectly healthy. I had never been to a doctor except for sports injuries. What about people? What about me? I don’t want something sneaking up on me. When I went there, I’m sure your listeners would identify with this, everyone that came in the door, I started interviewing them. It was amazing the number of people who had been to several practitioners and weren’t better yet. I thought to myself, Wow, what a rip-off. What do you mean you have been to eight people, ten people, more, and spent a lot of money trying to figure out what’s really wrong? Some doctors had told them, “There is nothing wrong with you. Everything looks normal in your lab work,” which I questioned.

It was really remarkable how they were all, with different health problems, caught in a cycle of trial and error. It wasn’t one demographic. Most were in pain. You find out what else is going on. They have hormone problems. Their immune system’s shot. Their digestion isn’t working. Their detoxification systems aren’t working. On and on. Again, I came from another field. I didn’t have medical training. I had a lot to learn, but I had nothing to unlearn. I had to open my mind to what was really going on, if I could figure it out.

I started running lab work by the thousands.  Over 10 years, I ran thousands of labs on thousands of people. I had great mentorship from the labs and some doctors. I also made my own observations. That’s what started FDN. It just grew out of that practice. I developed a system of investigation, looking for causal factors upstream. I never wanted to diagnose or treat anything. I wasn’t licensed to do that. I had no interest in that. People already were doing that. I thought they’d been getting ripped off.

I also wondered why they were putting their health in someone else’s hands instead of taking charge themselves, as I had always tried to do for myself. I hadn’t been to a doctor for anything chronic or downward spiraling or degenerative, just some injuries. I didn’t know what the health system was like. I found out through these poor people.

One day, I was riding my motorcycle, and I thought, you know what? I am going to be the last damn person that these people need to see, which is naïve. I had a lot to learn but nothing to unlearn. I was just open to the data. I became an expert in the data that you can collect from these alternative labs: saliva, urine, blood. Not your CBC panel that physicians can say there is nothing wrong. People know there is something wrong. They go down the street and try a bunch of stuff. Some of it might be helpful. Some of it is not helpful at all, that rip-off thing.

10 years later, I find myself teaching the system I created of investigation into the healing causal factors, the healing opportunities. Of course, our protocols, which are known around the world now, the DRESS protocol. Diet, Rest, Exercise, Stress reduction, Supplementation. Well known and practiced. You have hired one of our graduates, so you know what it’s all about.

Dr. Eric:

Yeah. Speaking of acronyms, can you jump into the HIDDEN stressors? I did my research as I usually do before these interviews, and I watched your videos talking about the acronym HIDDEN.

Reed:

I started mostly just testing women’s hormones. I was ina wellness center, so there are some practitioners in there. I was a lead marketer in the beginning before I became a practitioner. I went to school and did nutrition classes and all the other things I did. I was out there getting business through bone density testing. I would go out in the world to different locations. I had a whole route. Every couple months, I’d be back to that location. Bones and hormones, really important. I tested hundreds and hundreds of women in the beginning just for hormones only. I could help them and do some balancing. I wasn’t ever prescribing. You have to balance your hormones. You have to reduce stress.

Guess what? I ended up having to test them for other things. Their digestion, they were eating well but had poor digestion. It took me a while, but I came up with HIDDEN: Hormones, Immune System, Digestion, Detoxification, Energy production, and Nervous system. There is a way to assess each one of those areas in a person. When you do, you are going to find healing opportunities, things that need to be fixed, so to speak, and things they can do themselves to do the fixing.

HIDDEN, a lot of people aren’t looking in these areas in the same way that I or any of my practitioners would do. Not wanting to diagnose and treat anything specifically, but looking for the hidden imbalances and dysfunction. A lot of it is really far upstream; it’s hard to find some of it. We figured out a way, and now we do the HIDDEN stressors and dysfunctions on every person. Doesn’t matter what your main complaint is. These are the areas that have to be looked into to correct chronic, stress-related, downward spiraling conditions, which is what people suffer from today. Everything from Hashimoto’s to IBS to foggy thinking to chronic fatigue.

It’s truly remarkable that assessment and the number of opportunities for healing, you will find in those areas. I call it the entire constellation of healing opportunities. It just works. When you look there and explain it to a person, teach them, then guess what? They will understand. They will really appreciate the information. It’s really intelligence gathering. Then they are much more likely to follow your recommendations for the lifestyle medicine.

Dr. Eric:

I agree. I like testing, trying to find the answers. What are some of the concerns with just addressing symptoms? If someone was having digestive symptoms, instead of doing a test, just taking some supplements, assuming they have parasites or SIBO. Same thing with adrenals. Some people might say, “I know I’m stressed out, so why should I do testing?” What are some of the concerns with taking that approach of not doing the testing and just jumping into the treatment?

Reed:

The main concern is that you are not addressing the causal factors. Your problem will just get worse. I need to back up a bit. There is nothing wrong with getting relief care. If you have migraines or debilitating hot flashes and night sweats, there is nothing wrong with getting some relief. Doctors are great at that. They have all kinds of lotions, potions, powders, and pills. So do alternative practitioners. They are big on their supplements and modalities and things that will get you out of pain and suffering. That’s okay.

But if you only address that level, then you’re not working at the causal level. We look upstream. Having said that, you look for the root cause. Yeah, we look, but there isn’t enough tests. Surely, there is no one test. But there are enough tests out there that you can get close enough to the root cause to have an effect on it. Especially when you use the multiple causal factor that constantly gives healing opportunities.

Realize this: Causal factors, no matter how far upstream they are, no matter how hard they are to find, are also having an effect upon each other. A lot of that is not singly measurable. You have hormone, immune, digestion, detoxification, energy production, and nervous system imbalances. All of these causal factors are having an effect upon each other. How will you figure out the one that is causing the thyroiditis? It’s almost impossible.

That’s why I call it metabolic chaos. I gave up a root cause. We look, and what we find is metabolic chaos. Let’s just call it that. The only way to fix things is to treat every cell, tissue, organ, and system at once. A person has to live. Lifestyle medicine is about living yourself out of the problems you lived yourself into. It’s really a non-specific treatment, but it works on every cell, tissue, and organ there is. It’s a very interesting, non-medical way for people to handle the problems.

I would start with that. It’s okay to treat the symptoms. If you stop there, you will probably need more of the same medicine. Thyroid is a good example. I know you’re an authority on that. You deal mostly with hyperthyroidism, which is a more difficult and often autoimmune condition. There are a lot of factors going on. The more common thyroid problem is hypothyroidism. There might be absolutely nothing wrong with the thyroid.

If you go in with a certain set of complaints, by the way, this is where I like to explain the “sounds like” method. You named it. You mentioned this approach. You go into a practitioner and say, “I’m tired, fatigued. I’m a little overweight. I can’t seem to lose it. Sometimes, I’m sad. I’m constipated. My extremities are often cold. My hair is thinning.” That sounds like thyroid. The typical practitioner would check the thyroid. Don’t break your wrist patting yourself on the back. All you found was one thing that is hypoactive. It’s not producing enough of the right thyroid hormone. You can replace that. That’s going to get that person some symptom relief. They may have a little bit less hair thinning or cold or numb extremities and constipation along with some other things that might clear up. It isn’t addressing why the thyroid is underactive.

I hope you’ll agree with me that this is a natural adaptive response to stress. If you’re under a lot of stress from a lot of different angles, emotional, physical aches and pains, chemical stressors, there is a lot of different types of stress out there that would put you into hibernation. Your body will go, “Whoa. We better not use up all our resources.” The hypothyroid is an adaptive in most of the cases we have seen. If there is less thyroid hormone, do you want to just replace it, or do you want to find out why? What are all the stressors involved that are causing your body to shut down like that? I hope you agree.

Dr. Eric:

I definitely agree that stress is a big factor. You mentioned digestion. Most of these conditions, both hypo and hyperthyroidism, most of them are autoimmune, and most of the immune system cells are in the gut. You need to have a healthy gut, healthy digestion in order to have a healthy immune system.

I agree, it would be crazy to do what most medical doctors do, and just give thyroid hormone replacement if the thyroid hormone is low. Similar with hyperthyroidism, with Graves’ or even non-autoimmune hyperthyroidism, just to say, “Okay, let’s give you antithyroid medication, which blocks the thyroid hormone.” You want to find out the underlying cause, whether it’s stress or some of the other imbalances that you mentioned, imbalances in the nervous system and other things to consider. Unfortunately, most conventional medicine ignores that and just puts a Band-Aid on the problem.

Reed:

I knew we were like-minded enough because you had me on this show, so we are probably very much like-minded in our approaches, too. Mine is not a medical approach. You being licensed have other options that I don’t have and never had. Working in the office, you can’t write a prescription.

The labs that the physicians had already run on these people weren’t revealing much data that was useful. That’s why we got into the alternative labs: the saliva, urine, stool, dried urine, finger stick tests, hair, tissue. I don’t have much hair to get any samples from.

Dr. Eric:

You can use other hair.

Reed:

Facial hair is okay. It will tell you something. Each one of these types of testing gives us a data point. Then our job isn’t to diagnose and change the numbers on the paper. It’s to get the person to do something to change the numbers on the paper. Those numbers aren’t the problem. They are the results of the problem.

Same thing with symptoms. I don’t know if I fully finished discussing chasing symptoms. It’s never bad to try to get out of pain. I totally understand. But you can’t stop there. The thyroid was a good example of why we don’t stop there. The reason we don’t test symptoms is we know they are the result of the real problem, just like the lab work. I’m a guy who teaches a course in lab work, yet I am saying those numbers aren’t the problem. They are just a result of your genetics and how you’ve lived, the signals going to the teams. It’s called epigenetics. That’s really where our DRESS program comes from. It’s an epigenetic program; it’s a lifestyle and environment-based program.

Dr. Eric:

I’d like to discuss some of the different tests that you commonly recommend. For example, with adrenals, you mentioned saliva testing. Is that what you use to evaluate adrenals? Do you like dried urine testing? Now there is the Dutch test.

Reed:

The adrenal part of the Dutch test is saliva, so it’s a combination. The urine part of that test is more about the sex hormones or their metabolites. That’s a good test.

The one we are using has been specially developed for us now that we have been doing this for 23 years. I have a lot of students and a lot of graduates doing this. I have some ability to maneuver in the labs space. I know a lot about labs.

We are using the Circadian rhythm along with the cortisol to DHEA ration ad the sex hormones. We have added to that saliva test melatonin because that is a finger pointing for some healing opportunities, especially if it’s low, or if it’s high when it’s supposed to be low. Also, secretory IgA. We get a window into the immune system all from a saliva test. Cortisol and DHEA are your catabolic and anabolic hormones. You want to have balance. You don’t want to be too catabolic or anabolic. They need to be in balance, cortisol and DHEA. The same test also gives us cortisol morning, noon, afternoon, nighttime. We can check out the Circadian rhythm. We see a lot of rollercoaster. It explains why people feel like they are on a rollercoaster. Their hormones are following along with that.

Again, we always look at the sex hormones. Same thing. These are the bioavailable levels. There is only a very small amount of hormones in your saliva. It has to be a really good test. These tests are very advanced now after decades and decades of work in trying to get accuracy. Specificity and sensitivity is critical.

You don’t have a lot of hormones in your saliva. What shows up is the bioavailable levels. Those are the levels that are actually working for you in your body. Through urine, you are looking at metabolites. They may not be exactly 100% representative, or it’s a good guesstimate. It’s not the bioavailable level. It’s gone through all those metabolic processes, and being excreted in the urine.

It’s also very time-specific. You can’t get time specificity with urine. It’s an average of the last several hours. We want to know what is my cortisol in the morning? What is it four hours later at noon? Then afternoon, nighttime, middle of the night. It’s very important to have time specificity. The sensitivity and specificity for these tests are proven to be very high.

There are over 300 white papers written on saliva testing now. When I first started, there was only a couple that we could refer to. It was considered alternative, crackery, whatever you want to call it. It’s come a long way.

Adding the melatonin at noon, melatonin should be very low at noon. It’s the middle of the day. Why would you have high melatonin? Only if something is wrong would you have high melatonin, and we can explore that.

Secretory IGA is the main indicator of how well your immune system is. It is the main component of the mucosal barrier in the gut that protects you from everything. The gut is most of your immune system. Secretory IGA is huge. It should be hovering all the time, just waiting for anything bad to come along that it can kill or at least sequester and be excreted from the body. You don’t want that stuff getting inside you. You have that mucosal barrier. That’s on the same test.

With one morning sample of saliva, you get the CA; melatonin at noon; the Circadian rhythm throughout the day; and the sex hormones, including progesterone, estrogen, and testosterone (the main ones). You can look at other ones if you want to. We don’t bother much with some of the metabolites.

Anyway, that’s a hell of a test. Great place to start. You can see how stressed out someone is, whether they are catabolic or too anabolic. It’s a way the body adapts. You could do a lot with that data to correct someone’s behavior. Just show them.

By the way, if they went to a physician and were told nothing is wrong with them, you can look at these test results and go, “Wow, look at all of this stuff that is off a little bit that you can improve.” versus “Nothing is wrong with you.”

Dr. Eric:

I know some saliva panels can collect samples of women cycling; this way, they are not looking at a single sample.

Reed:

Of course. In certain cases, like fertility cases, or if women are having extreme difficulty as they cycle with headaches or pain or cramping, all these symptoms that occur on a cyclical basis, you can map out the entire cycle. You have to take a saliva sample. You could do it every day, every three days. Sometimes, it is a matter of convenience and expense that you would do less testing. We have tests that cover the entire cycle.

It’s really interesting to look at the numbers. Some 35-year-olds are under so much stress that they are not ovulating. You can tell by the hormones that nothing is happening here. They don’t have enough estrogen to ripen an egg to be released. Then the progesterone may or may not be kicking in at the right time. It’s very interesting to map out.

Otherwise, with post-menopausal, you can take it any day. Just take it one time. That’s all we need. For the stress part of that, for women who are still cycling, we would just do it mid-cycle. That way, we get a window into whether your estrogen or progesterone are at the right levels at that time when they should be the highest. There is a timing with some of these saliva tests.

That’s another indicator that you’re getting real, usable information. It’s very time-specific. Time of the month-specific, too. How much better can you get?

Dr. Eric:

True. You can obviously collect the saliva sample any day, in the convenience of your home. You don’t have to worry about going to a lab. Sometimes, the timing of the lab during a certain day of your cycle, if you were going to do it through a blood test. Much more convenient to do it through saliva.

I’m glad you mentioned secretory IGA. Part of the HIDDEN acronym is Immune. Are there other markers besides secretory IGA that you look at? Or is that the main one for the immune system?

Reed:

It’s the main one. We are looking at other markers that can indicate there are issues going on. Obviously, the stool testing for pathogens and microbiome imbalances, your microbiome is also part of your immune system. It defends the good bacteria versus bad bacteria. It’s there for a reason. That can get way out of balance. I think that’s one of the other main areas I would look to.

Is it very diverse? You want diversity in your gut. You have to eat lots of different foods. Some people only eat 10 different foods, and their microbiome gets overpopulated. They are not unfriendly, but there is not enough diversity. That is a big part of the immune system.

Physicians run tests, too. Immunoglobulins and things. There are other tests that we would look at. You can look at the secretory IGA. You can look at IGM, IGE, IGG, and others. There are lots of immunoglobulins. Overall immunoglobulin is a good test. You can look at white blood cells. But for your standard FDN practitioner, they will use secretory IGA, which should be hovering, and it shouldn’t be too high. If it’s too high, you probably have some infection. If it’s too low, maybe you’ve had the infection so long that you stopped producing. You ended up with a chronicity of low CA, especially in stressed out people. Everyone knows that if you’re stressed out, you’re more likely to catch even just a common cold. When you get stressed out is when you get sick. Your immune system has gone down.

Dr. Eric:

Comprehensive stool testing, do you recommend- Let’s say, everyone with a chronic health condition. Everyone with Hashimoto’s or Graves’. Do you at least teach the FDNs where they should order a comprehensive stool test for everyone? Or does it depend on the person?

Reed:

We automatically run them on every client. Every client has something usually that is healable or needs balancing in that area. I got tired of doing piecemeal testing 20 years ago. The first thing was I brought a lot of new patients into the office by going out into the community. I was lecturing and doing bone density testing all over the place. I had a portable DEXA machine. I started selling hormone test kits. Women with bone problems needed to check their hormones. It led into this whole system.

Otherwise, when I had a client at the beginning, I would start with the stress and hormone panel that we just talked a lot about, and another one called the metabolic wellness panel that looked at digestion and detoxification and oxidative stress. Those two were foundational. I’d run those. Then I’d say, “We need to check for mucosal barrier or pathology and food sensitivities.” Sometimes, it would stretch a person out for two or three months by the time we got all the labs done, maybe even longer. I finally just had clients going, “Why didn’t you run all these tests at once? You could have fixed me a long time ago.” Not that I am doing any of the fixing, but you know what I’m saying. So I just made that the policy.

Everyone needs to do it. You will see this downward spiral as very observable by going through the labs. You might as well just do them all up front. That’s now my policy. That’s what I teach in my course. You don’t have to, but it’s the best way.

Dr. Eric:

What is the metabolic wellness panel?

Reed:

This is another thing we have worked with labs to change over the years. Labs come and go, in and out of business. Operations change. Science itself changes.

We have our metabolic wellness panel that is a dried urine test, which is very convenient. We can ship that all over the world and send out kits. You collect urine and put it on these papers and let them dry, and it’s cheap. We are looking at an old test for dysbiosis and leaky gut. By the way, it tells you that you are not breaking down protein very well. If you are not breaking down protein very well, because you don’t have enough of the good bacteria that breaks it down- Remember all this bacteria is not just sitting there for no reason. It’s part of your digestive system and your immune system and more.

So that test measures bacterial breakdown of protein. If it isn’t working very well, you are in a dysbiotic condition. You don’t have enough of the good versus bad, so you are already dysbiotic. Depending on one’s presentation or symptoms, it could right there point the finger at leaky gut.

We want to test further. If you are not breaking down your proteins, guess what? Amino acids are really important. Protein in a sense is amino acids. They break down into neurotransmitters. I have people with all kinds of mood disorders, who are usually not digesting food very well. It’s amazing how much food dictates health and other things people present with. If you are malnourished because you have dysbiosis, you can fix that easily. Take total control over that.

Another marker is oxidative stress. Right now, we are using the 8-OHdG, deoxyguanosine. That is a great measurement for breakdown of material inside cells. There is always oxidative balance. You have pro-oxidation and anti-oxidation. Inside a cell, it’s important to have a good balance there. If you are over oxidative because you have too much oxidative stress, your cells won’t even work right. They can’t respirate properly and do the job. The DNA can get damaged. That can lead to serious problems, mutations even, things like cancer.

We used to do lipid peroxides. Talks about oxidative stress on the membranes of the cell.

Another marker onthat test is urinary bio acids. They indicate congestion of the liver. Physicians look at liver, too. They will look at certain markers that they would observe if they were elevated for a few months. It might go up and down. They would check for a disease, like hepatitis.

Our test is more sensitive, more subtle. It’s much more of an anti-aging, detoxification marker. Your liver is not filtering as well as it should. When it’s like that, it’s full of antigens and immunocomplexes and dirt and weeds because of the leaky gut. It will spill excessive bio acids into the bloodstream, which can be picked up in the urine. The kidney filters out and excretes in the urine.

Bio acids, there is always a normal amount, but it shouldn’t be a high amount. If there is, we have seen liver detoxification programs do miracles for those people. It’s not diagnosing anything. It’s saying, “Hey, look, your liver looks a little congested.” Every one of your listeners probably- Hopefully they are of an age that remembers bags inside vacuum cleaners. A lot of people don’t today, but you know when your vacuum isn’t working well, you change the bag, and it works like a brand new vacuum cleaner. That is how your liver is supposed to work, like a brand new filter.

Dr. Eric:

Food sensitivity testing, do you use IGG?

Reed:

The test is not IGG or IGE or any other immunoglobulin. It’s a measurement of the release of mediators. It’s counting white blood cells basically, leukocytes and granulocytes. They are going to affect volumetric changes in the blood. From one blood draw, you can test up to 176 foods. No one eats that many foods. It will show up whether you eat the food or not that you are sensitive to it, so don’t eat it. It’s creating inflammation. It’s the Oxford Biomedical Mediator Release test, or MRT. You can follow a diet that is less inflammatory. People get better.

Looking backwards, I couldn’t imagine not running that test on someone, Eric, because miracles have occurred. To the degree that those foods are contributing to metabolic chaos is a degree to which you are probably going to improve by getting rid of those foods. For diet, we use metabolic typing system, but we also do food elimination, and we test, we don’t guess. You’d be amazed at what foods you might-

As a matter of fact, I have right now taped to my computer the little list of foods that I am sensitive to. It’s normally color coded. I just printed it in black and white. It gives you a list of foods to avoid and food additives and other things that are in your diet. It’s an oral intolerance test. It also gives you the good list. Out of 176 foods you’re testing for now, there will be a whole lot you aren’t reactive at all to. That’s your shopping list. It tells you what not to eat. You have given them a shopping list of what you can eat, delicious food. Have you tried this lately? No, I don’t eat that. It’s amazing how many foods you never eat that are on the good food list. It’s remarkable.

My wife and I spend time every week doing food preparation. We grow our own vegetables. We order our meats online. We have other groceries and items delivered. You can really get good at your food selection, especially when you run the test. Again, I got my most recent bad list here. Everyone needs it. If you have a health problem, those foods could be contributing to it. They may not contribute that much, in which case that test didn’t help you that much. But again, looking backwards, I have had people have miraculous results. Looking forward, can’t tell if it’s going to help the most. Looking backwards, would never have gotten anywhere close to the results we got without running that test.

Dr. Eric:

That is another test that you recommend for everyone to get. Obviously, it’s up to the person whether or not they want to get it. That is something you would tell everybody to get.

Reed:

Sorry to cut you off, but no, this is our program. This is how it works. If you’re going to work with me, I need to gather some intelligence on you. You want to tell me the same story you told the last practitioner, who guessed at what your problem is? “It sounds like this. Maybe run one test.” No, we are going to run our five labs: the stress and hormone panel; the metabolic wellness panel, three markers, and uric acid; the mucosal barrier assessment. We look at zonulin, a family of peptides, and also histamine and diamine oxidase. We get the histamine to diamine oxidase ratio. It’s very important. It’s a measurement of gut health.

That’s three tests. Those three alone would tell you a lot about a person. Then we give you all these healing opportunities. Their hormones are out of balance. Their immune system is under or overactive. Their digestion, detoxification, oxidative stress. There are all these healing opportunities, but you are not good. You want to do those, so you have an assessment of a person. You might as well just run the stool test for microbiome and pathology because it’s involved. There are some functional markers on that test as well. Then the food sensitivity test. How could I not run that?

If you listen to my podcasts, I tell this story a lot because everyone identifies with this poor lady, who is coming in the office. She was getting chiropractic. She is on her eighth visit or so. I am triaging. I am walking her back to the office. I say, “Hey, what’s wrong?” She is obviously not herself. “Oh, Reed, I am so upset. I am carrying around 40 pounds extra. I gained it in the last two years because I’m on medication for hives. I can’t stop taking the medication.” Before I get any words out, she was like, “And you know, Reed, I went to the doctor the other day for a check-up, and I told him how frustrating this 40 pounds is.” According to her, the doctor said, “Well, you can be fat, or you can have the hives. Take your pick.” She said, “That’s really depressing.” The physician said, “I’d be happy to write you a prescription for antidepressants if you want.”

I knew then why she looked so sad. She is staring at the ground. I asked, “Did you ever try to find out why you get the hives?” Seems like a logical thing to me and you. Her head snapped around so hard I thought she wouldn’t need her chiropractic that day. “What do you mean?”

Moving forward, I ran a test or two, got her off some foods she was sensitive to, and it only took nine days to quit her medication. She didn’t need it anymore because she found what was causing the hives. Within another couple weeks, she was working out to a sweat, taking hot showers, things she hadn’t done in two years because even on the meds, she couldn’t work out or take hot showers. You talk about life-changing. A couple weeks after that, she’d already lost 13 pounds of her 40. That would never have happened without running a food sensitivity test.

Make sure everyone does it. Kids with ADD. I had a principal call me and track me down through a mom. He said, “This kid is so different. He was poking the other kids, not paying attention, failing.” By the way, he is only nine years old. I got him turned around. Model student, smart kid. The principal tracked me down and said, “What’d you put him on?” What we put him on was a diet that works for him and a better sleep schedule. There is no magic pill. That was just doing the right test.

I can go on and on. I have countless stories like that. That’s looking backwards. Boy did it help. Can’t imagine not running that test.

Looking forward, I can’t really tell because I don’t know. You are going to have some sensitivities. To what degree are they creating that metabolic chaos or contributing to the chaos that is resulting in your specific symptoms, I can’t tell that. We just run the test.

Dr. Eric:

Do you know Elizabeth Yarnell?

Reed:

Yeah, the name is really familiar. Why do I know her?

Dr. Eric:

She is also part of Mindshare. She is really big into the Mediator Release Testing. I interviewed her on my podcast last year or the year before. I heard of it before I chatted with her, but she really convinced me to set up an account and start doing it. Honestly, I can’t say I have been doing it regularly, but I interviewed her again recently because she is coming out with a new book. I interviewed her before you, but your interview on the podcast will be coming out before hers. The point is, between speaking with her a couple times and then speaking with you, and I’ve had a few other practitioners, such as Cynthia Thurlow and Dr. Anshul Gupta, who recommend it. There are a lot more practitioners than I realized. Now it makes me realize I probably should be recommending it.

The reason why I have been hesitant is for years, as you know, IGG testing is a lot more common. I just didn’t find that to be as accurate. I don’t want to recommend a test for the sake of recommending it. Obviously, I want to find answers. By speaking with Elizabeth and now you and a few others, it’s something I probably need to be a little bit more stern about as far as saying this is a test that is going to benefit you.

Reed:

It may benefit you. We have to be realistic about that. You don’t know the degree to which these foods are contributing to the chaos that is resulting in the symptom. With IGG, I find it’s less common. In other words, the IGG reactions just aren’t as involved in the chaos as producing the symptoms. Not to the same degree as the MRT. I have run them both, and I have run them both on the same people over the years, especially with kids.

Sometimes, you want to remove every food that is possibly reactive in creating the symptoms because kids can’t think. They just don’t have the experience. They have nothing to go on. They might think that not paying attention and poking your friends and outbursts are normal. They don’t know why you’re yelling at them and sending them out in the hallway. I used to get sent in the hallway alot. Kinda proud of that now. The janitor would come along and say, “What are you doing out here again?” Anyway. Leave that for another conversation.

These food sensitivity tests, top of the line is the MRT. I know Cynthia and Gupta real well. I just looked up Yarnell, and I do recognize her picture from Mindshare. Good people doing good work. That’s what it’s all about.

Dr. Eric:

Well, thank you. Thank you so much. You shared a lot of great information. Anything else? I want to respect your time, but is there anything else you’d like to share? Anything else I should have asked that I didn’t ask you?

Reed:

I always have time for you, Dr. Eric, and to help people. It’s what I do. I get up every day, joyful because I do have a career like this and a job. If you love your work, it’s not work. That’s where I would end.

I always like to say the science is great. Gathering intelligence through lab work is all great. It can lead to magnificent, miraculous outcomes for the people. That is who we’re here for. We want to put control back in the hands of the people. It starts with that getting up in the morning. A lot of our job is to uncover obstacles to healing. The body wants to be fully functional. Every cell knows its job. You don’t have to teach your cells that they are an adrenal cell or brain cell or muscle cell or bone cell. They know what kind of cell they are.  They know how to do their job. Our job is to uncover obstacles to that natural state of being.

Sometimes, those obstacles- I find them on lab work. They are in the minds and emotions of the person. That’s another big part of FDN. We study coaching skills. We study motivation. Getting to the obstacles to healing, it has nothing to do with their saliva or blood or stool. It’s in their head. Getting into people’s heads is very important. Our system fully includes stress reduction, the mental and emotional states of mind that people might be in. We are not psychologists. We are not diagnosing anything like psychiatrists. We are not providing any happy pills. Although supplements are part of our program, they are not happy pills. You get what I’m saying.

That’s where I start a lot of conversations. Other podcasts I have been on, that’s pretty much all we talked about, is what’s in their head. How do you separate these things out? I’ll just add that’s also part of healing: your state of mind, your attitude, if you will, and figuring out why it’s a bad attitude, if you have one.

Dr. Eric:

I definitely agree with what you just said. Where can people find out more about you?

Reed:

What I do is I am the founder of FDN, Functional Diagnostic Nutrition. You can go to FDNTraining.com/SaveMyThyroid in honor of this podcast.

Dr. Eric:

Thank you so much for sharing your expertise and knowledge with regard to lab testing and going beyond that. I learned some things. I always love when I learn things from my guests. I’m sure the listeners will learn a lot, too.

Reed:

Thank you very much. I hope people get something out of it that’s useful. I’m glad you did, Dr. Eric. Thank you.

Recently I interviewed Dr. Stephanie Gray, and we chatted about sex hormones. If you would prefer to listen the interview you can access it by Clicking Here.

I am very excited to interview Dr. Stephanie Gray, who is a functional medicine provider. She helps men and women build sustainable and optimal health and longevity so that they can focus on what matters most to them. She is arguably one of the Midwest’s most credentialed female health care providers, combining many certifications and trainings. I’ll include all these certifications and credentials in the show notes. Specifically, she helps women in midlife who feel their bodies have betrayed them step back into their bodies by restoring optimal hormone levels so they can regain their sleep, figure, mood, and feel amazing once again. She is known for keeping hormone replacement therapy sexy, safe, and effective.

Dr. Stephanie is also the Amazon best-selling author of her book Your Longevity Blueprint; host of Your Longevity Blueprint podcast; and co-founder of Your Longevity Blueprint Nutraceuticals with her husband Eric. They enjoy spending time outside with their son William. They founded the Integrative Health and Hormone Clinic in Hiawatha, Iowa. Thank you so much for joining us, Dr. Stephanie.

Dr. Stephanie Gray:

Good morning. Thanks for having me on. Excited to be here!

Dr. Eric:

What I’d like you to do is give a little bit of your backstory. How did you become interested in learning more about functional medicine and doing what you do today?

Dr. Stephanie:

Sure. I think everyone in our field has our own personal health crisis, which I can get to. I also feel pretty blessed that I was raised in the Midwest in Iowa in a healthy family. We always had home-cooked meals. We were always engaged in physical activity, went to the chiropractor. Our parents were self-employed, so they wanted to keep us healthy because we didn’t always have great insurance. High deductible plan, even back then. We were taking vitamins. My parents were growing wheatgrass juice on the countertop. They weren’t hippies, but they were ahead of their time.

I feel very blessed that I was raised in a family that valued health. A lot of our neighbors had great insurance. Any time they were sick, their parents took them to the doctor, and they were given antibiotics. Back then, I almost envied they had great health insurance, so they could go to the doctor. I now appreciate the fact that my parents were helping to prevent me from ever needing to go to the doctor. I was raised with that mentality.

Secondly, I had my own personal health crisis which fueled my passion for functional medicine. I was already in functional medicine when this happened. One day, sitting at my desk, after seeing patients in the morning, my heart took off to the races. I had what was called medical tachycardia, very fast heart rate. You probably deal with this with hyperthyroidism. I did not have that. I was very stressed out. I had a very fast heart rate. In that moment, I tried to push the button on my phone to intercom my husband, who is our office manager. I was so disoriented, dizzy, lightheaded. I didn’t know what was happening. I thought I was having a stroke. I walked down the hallway of my clinic. I was very pale.

Long story short, my nurse found me. Went to the emergency room. I was sent to cardiology, who referred me to Mayo Clinic. They told me I could take a medication to control my heart rate. I already knew, practicing functional medicine, taking a medication wasn’t going to tell me why this was happening to me. That was only a Band-Aid approach. That wouldn’t really get to the root cause of the problem.

There are times and places for medication. Maybe I should have taken a medication at some point because my heart rate was so fast. But I knew in that moment that I had tools with functional medicine. My husband said, “It’s time. You will have to apply these principles that for years you have been teaching your patients to yourself.” That’s when I created the Longevity Blueprint because I really had to regain my health.

I was already in functional medicine when my health crisis started, but functional medicine helped me regain my health.

The other piece of my personal story was I was also struggling with infertility, which makes sense. My body was in a stress state, with a fast heart rate. I wasn’t in the place where I could grow a human. My body unfortunately had very low progesterone. We can talk about hormone levels. The stress I was under in that time of my life was robbing me of progesterone, which is needed to achieve and maintain a pregnancy. I had a lot going on. Thankfully, I had some tools that really helped me rebuild my health.

Dr. Eric:

With the tachycardia, you were able to avoid medication, which I assume was a beta blocker. Was that what they recommended?

Dr. Stephanie:

Yep. It was really sad. I feel like I had a very thorough workup. Having a high deductible, you pay $7,000-10,000 to get this huge workup to rule out big, bad things, which I didn’t have. They said I had atrial tachycardia. Where it was happening, they couldn’t offer me an ablation. Medication was what they had recommended.  I just didn’t feel like that was what I needed.

In hindsight, it wasn’t. I really needed to change my lifestyle. I will say gluten was a huge trigger for me. Pretty much any time I have cross contamination with gluten—I finally figured this out— but I would have very fast heart rate after certain meals. I tested myself for Celiac, and I remember when my nurse brought me the results, she just handed them over to me. I looked at them and thought, Oh crap. I’m one of those people. I have to go gluten-free. This was a decade ago. I had been preaching the importance of removing inflammatory foods to my patients. I was already 80% gluten-free, but I needed to be 100% gluten-free, which I have been for the past decade. That was a huge game-changer for me.

I also had SIBO (small intestinal bacterial overgrowth). I had so much gas, bloating, and pressure. Sounds silly, but I would have palpitations and fast heart rate until I could burp and alleviate some of that pressure and air. That wasn’t something that conventional medicine was putting the pieces together. I had to figure that out myself. I was low on magnesium, low on progesterone, super stressed out. Once I got my minerals up, my hormones balanced. Stress is a lifelong thing. I still have some stress in my life. Once I set some healthy boundaries, all of those things together really helped to calm my body down. I didn’t need to take medication.

Dr. Eric:

Stress for most people is a work in progress. Being a functional medicine practitioner myself, we are both aware of the impact of stress. It’s something that obviously never goes away. It’s always something you have to work on. I’m with you on that.

I talk a lot about functional medicine. I don’t know if any of my guests actually have spoken about what functional medicine is. Can you briefly, for those who are not familiar with functional medicine, differentiate between functional medicine and conventional medicine?

Dr. Stephanie:

You bet. I like to use the analogy I share in my book to explain this, which is the fire department versus the carpenter approach. Think of conventional medicine as being the fire department. That’s what I sought out. I went to the emergency room. The fireman has two tools, an ax and a hose, which I consider medications and surgery. For me at least, they weren’t offering surgery. For some other ailments, they would. Conventional medicine is great for acute care in that regard. Their tools are drugs and surgery.

When we think of chronic disease management, and me trying to get to the root cause of my problem, I needed a carpenter or contractor, who tries to rebuild the body. That’s where functional medicine comes in. Think of functional medicine as being that carpenter. They will ask how and why an illness occurs. They will try to discover the root cause, the dysfunction in the body, so you can fix it and prevent future fires, so you don’t need the fire department.

I would say that I do think from an acute care standpoint, if you get hit by a car, if you have a heart attack, we do need conventional medicine. We do need the fire department. I think the fire department isn’t great when it comes to chronic conditions and preventing those.

Dr. Eric:

Thanks for the explanation. This relates to the house blueprint concept as well that you talk about in your book?

Dr. Stephanie:

Yeah. We are so immersed in functional medicine. I don’t want to speak for you, but we just assume people know what we do. It is actually rather complex. When I was going through my health crisis, my husband said, “You need to make a blueprint, an outline as far as all we offer to help patients. They may just come to our clinic for fixing a gut issue or optimizing hormones, but we offer so much more.” I thought, okay, what’s a relatable analogy for patients to learn functional medicine? I created this Longevity Blueprint. I’ll try to describe that.

I’m comparing your home and how you maintain it to your body. Most of us know: mow the lawn, keep hair out of the drains so they don’t get clogged, change your furnace filters. There are innate things we do to maintain our home, so our home lasts a long time. We don’t always know what to do for our body and specifically each organ system in the body.

Throughout the book, I am comparing one aspect of the home to an organ system in the body. For instance, chapter one, which is probably most important, I talk about gut health. I am comparing the foundation of our home—you have a strong foundation upon which to build your house—to the gastrointestinal system in the body. We have to have a strong gastrointestinal system upon which to build great, long-lasting health.

That is just one example. Within each chapter, I am going through all of the available, complex functional medicine testing options for each organ system. I really talk about your human fingerprints being a detailed, unique marker of human identity, as are your test results. Your test results will differ from your neighbor’s. Those test results help your functional medicine provider personalize a plan to rebuild your health.

I can keep going if you want me to explain some of the other parallels I am drawing with the house and the organ systems if you want.

Dr. Eric:

Sure. Let’s go for it.

Dr. Stephanie:

I didn’t mention this yet, but something else that really helped me reduce stress was getting chiropractic adjustments. I don’t know what your thoughts are on chiropractic care, but I wanted to include it in the book. I would feel so tight and stressed. I would have a fast heart rate. Then I would get adjusted, and everything would lessen. I wanted to include the importance of maintaining the framework of the home, aka the spine, our musculoskeletal system in the body. That’s chapter two.

Chapter three is all about the electrical work in the home. I am comparing that to genetics in the body. Some lights, you want turned on. Some lights, you want turned off. There are certain genes we want expressed and other genes we don’t.

Chapter four is all about having the correct keys to unlock certain doorways in the home. This is a stretch, but I was comparing that to having the proper nutrients in the body, repleting nutritional deficiencies. You want that correct key to fit that lock to open the doorway or to bind to a receptor. You want to have the certain cofactors for enzymatic reactions in the body.

Chapter five, I am comparing the importance of tackling the laundry. We have a constant influx of dirty clothes needing washing and drying and folding and putting away. That is an ongoing problem, at least in my house. I am comparing that to the detoxification systems in the body, your liver, gallbladder, and bladder working appropriately so you can eliminate toxins.

Chapter six is my favorite. Maybe we can spend some time here. I am comparing the heating system and cooling system in the home to the endocrine system in the body, optimizing your hormones.

In chapter seven, I am comparing the plumbing system in the home, because you want clog-free plumbing, to the cardiovascular system.

Chapter eight, I am comparing the importance of having good roof integrity, aka treating and strengthening the immune system. You don’t want to have chronic infections. You want to make sure you have that protective barrier, your immune system in the home or the roof in the house.

Chapter nine, I am encouraging patients to find a contractor, aka a functional medicine provider, to help them work through all of this because again, it is complex. It’s not easy. You do need to run some advanced tests and be able to interpret those results as well.

Dr. Eric:

Those are some pretty neat analogies. Thank you for sharing. I definitely want to get more into the hormones. Before doing that, as far as my thoughts on chiropractic, being that my background is a chiropractor-

Dr. Stephanie:

I didn’t know that!

Dr. Eric:

Definitely in favor of regular chiropractic adjustments. I am a little bit overdue, I’ll admit, for my wellness adjustment. I do try to go in regularly. I don’t really practice chiropractic like I did years ago. It’s more functional medicine, focusing on helping people with thyroid/autoimmune thyroid conditions. Still, I definitely recommend chiropractic. Can’t say enough about chiropractic.

Let’s talk about hormones and where they fit into this analogy. I really want to dive a little bit deeper into the hormones.

Dr. Stephanie:

Here I am discussing how important the heating and cooling system is in your home, comparing that to the function of your thyroid, your ovaries or testes, adrenals, all of those organs that help produce hormones. You don’t want to have cold intolerance, your fingers and toes to be cold. You don’t want to have hot flashes or night sweats either. You want to have a favorable body temperature.

In this chapter, I am discussing ways for patients who are younger to produce hormones naturally. We can certainly go there. But I also talk about ways to replace hormones. I do have a heavy natural hormone replacement therapy practice. I’ve had lots of patients who’ve had hysterectomies who need replacement.

Here, I am dispelling a lot of myths: Hormones aren’t safe; they cause cancer; women don’t need testosterone. We can dive into as much as you would like.

Lastly, I also discuss the importance of optimizing estrogen metabolism. That’s what my doctor focused on, looking at urine hormone, metabolism testing to help reduce risk for estrogen-related cancers.

Dr. Eric:

We’ll talk more about the estrogen metabolism. It sounds like you recommend hormone replacement to a lot of women, especially if they have a hysterectomy, but maybe younger women, not as much. Is that correct?

Dr. Stephanie:

It really depends. Back to my story. Sadly, I was in my 20s when I first started checking my hormones and was struggling with infertility. I had my son at 35, a little later in the game, but it took me years. I was on progesterone. I had to take progesterone injections through my pregnancy because my levels were so low.

Not that everybody is as low as me, but I see a lot of high performers. They are just driven individuals, entrepreneurs, busy bodies, Type A, have higher stress. Unfortunately, when they are not supporting their bodies with nutrition and detoxification, they can end up with lower sex hormone levels earlier in life.

Progesterone is the first hormone I do start replacing. Many times, I have to replace that for women in their 20s. It’s not just a hormone I wait until someone is 50 to replace. If they are having PMS, heavy periods, anxiety, premenstrual headaches, infertility, they may need progesterone much earlier in life. That’s really determined based on a combination of symptoms and testing to confirm that they are low.

Dr. Eric:

That was my next question: How does someone know if they have a hormone imbalance? You don’t just randomly recommend bioidentical hormones. You do test your patients.

Dr. Stephanie:

No, no. I love testing. I don’t know about you, but I love it because I have seen so many patients, even menopausal patients, go see their gynecologist. They are put on estrogen without having any hormone tests run when they never needed estrogen in the first place. They come to me. I test their levels. They are sky high. Maybe they needed progesterone or testosterone, not estrogen. That is a big pet peeve of mine, when providers are willy nilly prescribing hormones without comprehensive testing.

There are various ways to test hormones: saliva, blood, and urine. There is blood spot testing as well; I don’t do a ton of that. Depending on the age of the patient, their cyclical status, the symptoms they have, that helps me determine what is the best means of testing their hormones.

Sometimes, for younger women, I will do a month-long saliva hormone test, where they will spit into a tube every couple days for the full month, so we can gauge-If they are having a symptom like a headache with ovulation day 14, or maybe day 26, they are having a headache, we can correlate symptoms with labs when we can see both together. I do like the month-long saliva hormone test for those sorts of patients.

For patients who aren’t cycling, we really don’t need to do a full month-long test because their levels are pretty stable. For perimenopausal patients who maybe are cycling every 2-3 months, or menopausal patients, I’ll just do blood testing on them.

You can still do blood testing on cycling women, but you need to test them a week after ovulation. That is when progesterone will peak. If patients don’t want to do saliva testing, I’ll try to have them target that window to do the blood testing.

For post-menopausal women, I just test them any day. It doesn’t matter.

We will test estrogen, progesterone, testosterone, sometimes DHEA, prednisone. A full thyroid panel, which I’m sure you talk about a lot on here. Many times, we will test cortisol as well. I can do that in saliva, or we can do cortisol in urine testing.

That leads me to the next form of testing we can run on patients, which is the Dutch test, dried urine comprehensive hormone test. We also just test one day, but that specific day, we can run cortisol multiple times throughout the day. Cortisol is supposed to be high in the morning, so patients are full of energy. It is supposed to gently reduce throughout the day, being lowest at night so they can sleep. We can see their Circadian rhythm, which many times is disrupted in the perimenopausal stage. We can also see their hormone levels. Plus we can see hormone metabolites. We can see how they are eliminating estrogen, which is really important, especially if I am going to be prescribing them estrogen.

I think your question was how does someone know if they have hormone imbalances? A) We test them. B) I have them fill out a symptom questionnaire. Many patients who have low estrogen have vaginal dryness, hot flashes, night sweats, urinary incontinence, memory fog. If they have low progesterone, they may have PMS, anxiety, heavy cycles, poor sleep. If they have low testosterone, which I am seeing a lot of that these days, they may have poor mood, motivation, drive, libido, energy, muscle mass. Many patients can have poor mineral bone density with any of the hormones being low.

We combine symptoms with labs to determine what is the best course of action for this patient. Do we want to try to boost hormones naturally and use supplements and herbs? Are they at a point where they are not producing anything? Maybe they have had a hysterectomy, so they just need hormone replacement therapy. If so, we can go there as well.

Dr. Eric:

A few questions. When looking at cortisol, it sounds like you lean more toward the Dutch test for looking at adrenals when compared to saliva testing?

Dr. Stephanie:

I do both. Let’s say I want to test their sex hormones. If we are going to do a Dutch test, to be clear, you can do it with or without the cortisol. It’s an extra $100 to do it with cortisol. For many people, it’s convenient to add that portion on. If we are not running sex hormones, let’s say they come to me, and we are focusing more on thyroid or gut health or other things, and we are not doing urine hormone testing, I will do saliva cortisol testing. It depends on what I am running for that patient to decide the best combination of tests. How do we make it the most cost-effective for the patient, too?

Dr. Eric:

I take a similar approach. When I dealt with Graves’, I did saliva testing, back in 2008. I wasn’t familiar with the Dutch test. I don’t know it existed back then.

Dr. Stephanie:

I don’t think it did, not through that company.

Dr. Eric:

I did saliva testing for adrenals. These days, similar to you, if I am just going to focus on adrenals, usually I will have someone do a saliva test. If we are doing the hormones, looking at the hormone metabolites, I usually recommend the Dutch test. We’re similar there.

Another question I had: In the past, I would do the cycling hormone test through saliva. Then the Dutch test also offers-

Dr. Stephanie:

They have it, too.

Dr. Eric:

I don’t know why I got away from doing the saliva test. Now, if I recommend a cycling hormone panel, it’s more the Dutch test than the saliva test. I don’t know if you use that.

Dr. Stephanie:

I failed to mention that. There are so many testing options these days. Yeah, I offer that to patients, too. It’s based on patient preference. Some people just don’t want to dip their urine. Some people think it’s easy and convenient to do the urine dipped test. Others like doing the saliva test.

It comes down to cost, too. The saliva test for some people ends up being cheaper if their insurance- We won’t go off on a big tangent. Do it through Genova, and they might get some insurance coverage. Precision is urine. I try to explain all the options to patients. Both can be accurate and very clinically useful.

Dr. Eric:

I’m glad you mentioned the blood test because some people, even if they are cycling, it might be cost-prohibitive for them to do. They would do the blood test one week after ovulation, correct?

Dr. Stephanie:

Yep, which is easy in a 28-day cycle. I have patients go to the lab on days 19, 20, or 21. If their cycle is 35 days or 21 days, then it becomes a little more difficult to determine when the best testing window is for that patient. I always ask if they have any ovulation symptoms, kind of twitching, cramping. Some patients get headaches with ovulation. Cervical mucus changes. If they are having any of that, I make sure we do labs after symptoms suggestive of ovulation. We don’t want to test before.

If someone is having a short cycle, 21 days, we may need to test them very early based on that. They may be ovulating day seven or 10. That becomes trickier. That’s where you need a functional medicine provider to help you know when to test in those situations.

Dr. Eric:

When testing in the blood, can I ask what you test for? Is it just estradiol, estrone, and estriol?

Dr. Stephanie:

Good question. Another one of my pet peeves is providers not looking at estrone. We know in the post-menopausal phase, estrone is way more predominant than estradiol. Many times, estradiol will look normal, but estrone could be very high. I have seen a lot of patients get mistreated with their provider thinking, “You have low estrogen levels. Let’s give you estrogen,” when they really weren’t low. Their estrone was high, but that was never detected. I think I learned that the hard way a long time ago.

I do test estrone in men and women. And estradiol, pretty much every single time I am doing blood work. If I am giving men and women testosterone, I also want to make sure that’s not aromatizing or converting over to their estrogens. Some patients convert over to estradiol. Some we see it in estrone. I think it’s important to test both.

Dr. Eric:

Do you ever test for total estrogens?

Dr. Stephanie:

I don’t. If I don’t order it, it comes back like that sometimes. They give me total estrogens. Maybe we should have this discussion another time, but I don’t know clinically how to use that. I do want to know what portion of that is estradiol versus estrone. You can give me your opinion on that, too.

Dr. Eric:

Good point. When I test for sex hormones in the blood, I’ll commonly test for estradiol and total estrogens. If it’s high, like if estradiol is looking okay, and total estrogens are high, I guess it could be either estriol or estrone. A lot of times, I’ll assume it’s the estrone. I guess you don’t know unless you test for estrone.

Dr. Stephanie:

I would say you’re still doing what’s better. You’re testing for all of the estrogens versus just estradiol. That’s when I think providers miss things, when they are just testing that portion. I guess it’s a good thing to test for total estrogens. We just don’t know the breakdown in that.

Dr. Eric:

Do you look at FSH, LH in everybody? Or just post-menopause?

Dr. Stephanie:

In younger women and men, yes. Totally depends on why they are coming to see me, if it’s fertility-related or not.

Post-menopausally in women, I really like testing FSH. That is telling us how unhappy the brain is with circulating estrogen. Sometimes, I like to explain to patients that when their FSH is very high, like over 100, their body is screaming for estrogen. They need it; they want it. That’s another confirming marker that we need to do something to boost estrogen or give them estrogen replacement. I do test those often. I will say I don’t test them in every single situation though.

Dr. Eric:

Why are hormones important to the aging process? How do they help with longevity?

Dr. Stephanie:

I have already mentioned today symptoms that hormones can help with: hot flashes, PMS, low libido, etc. At the end of the day, hormones are extremely important from an aging standpoint. Even if you’re listening and have zero symptoms, you feel great, hormones will still help you preserve your memory, bone health, heart health. When we think of the top leading causes of death—heart disease, which can be the silent killer—hormones will really help reduce chances of having cardiovascular events. When we think of estrogen helping with vaginal dryness, it helps with the elasticity of the tissues, and not just in that region. It helps with cardiovascular elasticity, to prevent stiffness and narrowing. You even have estrogen receptors in your eyes, all over your body.

As you age, not to get wrinkles and to look good and feel good, I really do think estrogen, progesterone, testosterone, thyroid, and cortisol all are extremely important. I can keep expanding, but hopefully the heart, bones, and brain, everyone should want to keep their memory as they age, hopefully those benefits were strongly conveyed there.

Dr. Eric:

Can you talk a little bit about synthetic versus natural hormones? There is definitely a difference. I assume most of the time you are recommending bioidentical hormones.

Dr. Stephanie:

Absolutely. In my book, I actually put in picture diagrams of the molecular structures of synthetic testosterone versus natural and synthetic progestins versus progesterone. When you think of synthetic hormones, they have to be tweaked in a lab. They are man-made because they are a profitable drug.

A little different than a hormone that is more bioidentical to what your body is making. Those are usually plant-based. Those are also slightly tweaked in the lab, so they are turning a yam basically into a hormone structure that is biologically identical to what your body is already making, meaning taking natural progesterone should fit like a key fitting in a keyhole. That progesterone should fit into your progesterone receptor exactly.

Synthetic progestins have a totally different molecular structure. They are going to bind partially but not fully as well as natural progesterone would into your hormone receptor. Synthetics are harder for the body to detoxify. They come with greater risks. They were what’s used in the Women Health Initiative study that scared away everybody from using hormones.

The #1 most prescribed drug last year was Prozac. All these women were left with many symptoms that hormones could have helped. Rather than find safer options of the hormones, we just started prescribing antidepressants to these poor ladies. I do think that hormones can be used safely and appropriately. We just need to absolutely be looking at labs, symptoms, using only bioidentical hormones, and given in the safest strata of administration as possible for that patient.

Dr. Eric:

Do you use any natural agents, like chaste tree or maca root, to help with progesterone?

Dr. Stephanie:

Yeah. Maybe I’ll expand on what I think you’re asking, if I use natural agents before we get to hormone replacement therapy to boost hormones. I personally took a blend of ProgestoMend from Douglas Labs, a blend of progesterone-boosting herbs, for my health years ago before I actually went on progesterone.

I actually want to go back and also say before I even get to those things for the younger population, I also talk to them about three things. The first is reducing stress. Stress is your body’s biggest hormone hijacker. There is no pill, potion, or powder that is going to replace lifestyle changes. Even for me, I had to say no to some things. I had to back off. I had to get into yoga and deep breathing. One of the best things you can do to optimize hormones is reduce stress.

The second thing would be to detoxify the body. I used to go to Bath & Body Works and get all these toxic lip glosses and lotions. I had all these chemical hair straighteners. I was essentially self-inflicting myself with all these endocrine-disrupting chemicals that were creating more of an estrogen dominance that led to endometriosis and some infertility. I wish I would have known back then to avoid fragrances and these parabens. I didn’t know, but you can only move forward. You can’t go back. I would encourage listeners to work to eliminate environmental toxins and do a liver cleanse, something like that, to help as well.

The third thing would be to work to fix nutritional deficiencies. Magnesium for instance, everybody needs. It’s important for thyroid hormone production and sex hormone production. It was certainly something I was really low in. That is just one example of a supplement, a nutrient that can help to boost hormones. There are several others.

For many of my patients, I am running nutritional analyses to see what vitamins, minerals, amino acids, antioxidants, Omegas they need. Let’s saturate the body with the nutrition they need first, and then retest hormone levels.

If still, after reducing stress, detoxing the body, fixing nutritional deficiencies, they are still not where we need them to be, then I will pull out the herbs. Yes, I’ll use herbs to boost estrogen, progesterone, testosterone if we need to, or lower testosterone. For patients with PCOS, sometimes we need to lower the androgens. I do use herbs after I get through those first three steps.

Dr. Eric:

Typically, what do you use to lower androgens? Saw palmetto?

Dr. Stephanie:

Saw palmetto is excellent. It specifically will block testosterone’s conversion to DHT. It’s a 5-alpha reductase inhibitor or blocker. We have a different combination of those herbs. Men will use them as well. Pumpkin pygeum horsetail, stinging nettles, saw palmetto. Those are the ones off the top of my head. We have a blend and various products that we’ll use for patients when needed.

Dr. Eric:

With testing for nutrients such as magnesium, you mentioned Omegas, I don’t know what testing you use, but I know you mentioned earlier Genova. Do you use the NutrEval, or do you use some other test? Blood testing?

Dr. Stephanie:

I am privy to Genova’s tests because I think, “I’ll use Great Plains for OAT testing.” We use probably 50 different lab accounts at our clinic. I am privy to Genova because I am privy to how they present their results. They are color coordinated with high needs and low needs. It’s very patient and user friendly. I do like that test. That also looks at nutrient needs. It will also give me a glimpse into gut health because it has some bacteria and yeast markers on there. It has oxalates and toxin markers and a basic heavy metal screening. It’s a really comprehensive glance at one’s health. That can help direct us to know which path we need next to go down. Do we need to focus on gut health? Do we need to focus on detoxification? I think it’s a great test. Everybody should have that test run.

Dr. Eric:

Depending on the answers that the test gives, you mentioned gut health. Do you ever run a comprehensive stool panel? Maybe look at beta-glucuronidase or other markers of dysbiosis?

Dr. Stephanie:

Yep. Many of my patients, which you are probably running as well, are doing food sensitivity testing. Back to chapter one of my book. In that chapter, I discuss literally what you just said. A stool test, a food sensitivity test, maybe SIBO testing. A lot of these patients will have gut infections. An infection is a stress on the body. Stress will rob you of hormones, not just psychological stress, but stress from things like infections. I absolutely run stool tests. I usually start with food testing. Let’s face it, most patients have GI issues as well. If the food testing and changing the diet improves symptoms, we may not need to dig deeper. Sometimes, we do. The stool test is usually the next step there for sure.

Dr. Eric:

Just a quick question with food sensitivity testing. Do you use IGG or MRT?

Dr. Stephanie:

I like IGG. I’m privy to that. I feel like there are different opinions. I think everyone finds what’s clinically most useful for them. I think it varies per lab because some labs’ tests are more repeatable. I do like IGG testing. IGA and IGE, sometimes, too.

Dr. Eric:

Getting back to the hormones. I don’t think you mentioned as far as type of hormones. Do you recommend for example progesterone cream or pellets?

Dr. Stephanie:

We offer everything here. When I started practice, I started with what I felt was the safest: the topicals, the transdermal application. I do think for patients who are very sensitive and have mild symptoms, topicals are great. A couple years into practice, I found out a lot of these patients are having dermal fatigue, where they get receptor resistance. They are applying the cream to the same place over and over, and they quit working. I needed to learn other ways to replace hormones.

I used sublingual dosing, so I do prescribe a lot of compounded sublingual hormones. Like putting B12 under the tongue, we do compound hormones under the tongue. I do prescribe oral progesterone because we can compound a sustained release version to release throughout the night, keeping patients asleep. Sublingual can’t be compounded as a sustained release version. That needs to be in the delayed release capsule. I do prescribe oral progesterone.

We do a lot of pellet procedures. Progesterone has not been invented in that pellet form yet, so the pellets are more for estrogen and testosterone. Estradiol and testosterone for men. Women will need estrogen as well.

I found throughout the last decade+ of practice that a lot of patients who are very symptomatic, or let’s say, they come to me and are not symptomatic but need to build bones. Hormone pellets are the quickest, best way to do that. Using topical hormones can help a little bit. Oral hormones can help a little bit more. I know there are patches as well.

I don’t remember off the top of my head, but I want to say oral and patch replacement therapy helps 1-3% as far as improving bone mineral density. Pellets can help up to 8%. Pellets in the literature really outperform any other form of hormone replacement therapy, which is really cool. I have seen patients come in with osteoporosis and a couple years later have normal bone density, which is amazing. There is no drug out there that is helping to build bones like natural hormone replacement therapy can. That is exciting for me as a clinician but super exciting for patients as well. They get to go back to their other doctor and say, “Look at this. My bones are improving.” Really exciting.

Not everyone is a candidate for pellets. Those patients who are sensitive to everything, no way am I putting a pellet in them. You can’t take the pellets out once they are in. There are patients who are good fits for the pellet. We just have to strategize with the patient what hormones they are going to take, what form, and what dose. Personalize that approach for them.

Dr. Eric:

Earlier, you mentioned an example of someone having a hysterectomy, and you will recommend hormone replacement. Is that every woman? Or is it just if they have a complete hysterectomy?

Dr. Stephanie:

That was one extreme example, which unfortunately I see a lot. I have a lot of patients in their 30s and 40s who have had hysterectomies because they had heavy bleeding or fibroids. I will also point out sadly, knowing they have had these surgeries, yes, we can replace hormones and help them, but having the surgery never got to the root cause of the problem as far as why they had the heavy bleeding in the first place. Removing the uterus doesn’t get to the root cause of the problem. We still have more work to do with those patients. Tangent there.

I have patients who haven’t had hysterectomies who need hormone replacement therapy. Maybe they had a very stressful decade of their life from mid-20s to mid-30s, and they are burned out. I see men and women with extremely low testosterone. I still replace individuals who haven’t had surgeries like hysterectomy. That was just one sad, common example that I also see.

Dr. Eric:

I’m sure there are some people listening to this who are completely anti-hormone. “I don’t want to take any type of hormone. I just want to do things naturally.” I keep an open mind. If stress and adrenals is the big problem and depleting the hormones, of course, I want to do things to help improve their stress handling skills. You spoke about doing this, too. In the meantime, the person might need to be on progesterone. Maybe not depending on the situation.

For those who have concerns about hormones, there are some who just maybe don’t want to take it. There are others who are concerned about it will maybe cause cancer, especially if you recommend estrogen. Can you talk about that? Maybe alleviate any fears people have about that.

Dr. Stephanie:

Common question I heavily discuss in the book. Hormones don’t cause cancer. If hormones cause cancer, we would have a bunch of 20-year-olds with cancer because they are the ones with high levels of sex hormones, right? We would see patients going through puberty, high hormone levels, getting cancer, and 90-year-olds not getting cancer. That’s not the case. The opposite is true. We don’t see cancers usually in young individuals with high hormone levels; we see it in the elderly with lower hormone levels. I do want to dispel that myth.

Some people need to be more careful with hormone use. If they have significant family history of breast cancer, I am going to be very cautious giving that patient estrogen. That also comes back down to you doing the year-end hormone metabolism testing. If I can assure we have these three major estrogen metabolism pathways working in your favor, and we optimize them, that will increase my confidence with the safety of me prescribing that hormone. In conventional medicine, none of this is done. That totally baffles me. In those cases, I will be more cautious with the use of estrogen, but it doesn’t mean it’s contraindicated. Hormones don’t cause cancer.

I will say hormones can feed an existing cancer. If someone had an estrogen receptor positive breast cancer, I am absolutely not going to give them estrogen. If a man had active aggressive prostate cancer, I am not going to give him testosterone. But hormones don’t cause cancer.

I will say the increased risks that were shown in the Women’s Health Initiative study although that was a very poorly designed study we could talk about. In that study, they were using synthetic, oral, horse urine, basically. The estrogens that were used there were from horse urine, and they were given orally. We think a lot of the risks with estrogen come down to that estrogen being synthetic and taken by mouth. When the hormone is taken by mouth, it has to be metabolized through the gut and liver, and that is where increased clotting can increase the risk of cancer. It’s not the hormone itself, but if we are metabolizing it improperly, bad things can happen like fibroids, cysts, and heavy bleeding.

Dr. Eric:

Let’s talk more about estrogen metabolism. What are some of the things you do to help support estrogen metabolism?

Dr. Stephanie:

Sure. The only way to assess metabolism or detoxification or elimination is in the urine. Genova used to offer this test, which was available back in 2008, but it can’t offer it because they use helium as one of their analytes for androgen. There is a helium shortage. Precision Analyticals is a main lab that offers urine testing for estrogen right now.

Bottom line is in that test, we can look at three pathways. One is the 2-16 ratio, looking at how high your 2s are—this might be over the heads of listeners—as compared to the 16s. If that ratio is unfavorable, there are things we can do like increase consumption of cruciferous vegetables or take a supplement called DIM. DIM is like eight pounds of vegetables a day without the gas. That will improve the 2-16 ratio to reduce breast cancer risk or even just risk of fibroids and cysts.

The next pathway we can look at is methylation. Many times, if I see poor estrogen methylation, I assume they are a poor methylator in general. It’s a phase two detox pathway. If methylation is poor, usually the easiest thing we can recommend to improve that is methylated B vitamins. Not everybody responds well or tolerates them, so sometimes we have to use other strategies. Methylated B vitamins can help there.

Lastly, the most dangerous marker on a urine hormone metabolism test is called 4-hydroxy estrone. If oxidized, that can lead to DNA damage and then cancer. How do we prevent that? We give antioxidants. This is what my doctorate was on, these pathways. Back then, the major antioxidants in the literature that could help that were n-acetyl cysteine and resveratrol. I think n-acetyl cysteine is great for a lot of things in general. A lot of patients take it for immune purposes these days. It boosts glutathione, which is the most powerful antioxidant in the body. I do think glutathione itself is very helpful for protecting you against that elevated 4-hydroxy estrone. There hasn’t been a lot of studies on it, but the ones that exist are more for n-acetyl cysteine because that’s what boosts glutathione.

There are things we can do if we find unfavorable estrogen metabolites to optimize them, to improve them, which is hopefully very encouraging to the listeners.

Dr. Eric:

Thanks for sharing that. Is there anything else that I should have asked you that I didn’t ask you? Anything else you want to expand on?

Dr. Stephanie:

I don’t think so. I will just say don’t fear hormones. Hormones can help you age well. A lot of patients have been burned, maybe because they saw a provider who didn’t quite know what they were doing. If you were going to have brain surgery, you’d want to go to a brain surgeon. If you want to optimize your hormones, go to a hormone specialist. See someone who really knows what they’re doing, so you don’t get burned. What they are giving you is really safe and effective.

Dr. Eric:

One more question that came to mind is how frequently do you retest? If someone is on progesterone or whatever hormone, when is the first follow-up? How frequently? Is it every month, every few months?

Dr. Stephanie:

Variable. I’ll say on average, for a new patient, they come in and see me. We will test hormones after the first visit. We will bring them back to go over those hormones. We will initiate some form of hormone replacement therapy.

Let’s say they know they want hormone pellets. They will get peak pellet labs done six weeks after their first pellet insertion. We will see what range they are in six weeks after the procedure. They will come back again. We will go over those labs. For many patients, if they are smooth sailing, if their labs are good, we have achieved symptom relief, we only test their hormones once a year. Once we know we are smooth.

For sublingual and topical, it’s a little different. I measure those primarily doing the Dutch test. I will get them hopefully smooth sailing within the first 2-3 months. We may have to tweak the doses a bit. Once the Dutch test comes back favorable, if levels are optimal, then I will test them once a year.

Not everybody is just smooth sailing out of the gate. For some of these patients, if we have to tweak their dosages, I am not going to wait a year to retest. We will retest at another three months. Once we’re smooth sailing, then I will test them once annually.

For some patients who have higher risk of breast cancer, they may want to do the Dutch test twice a year. It’s fine, it’s their money. I will test them as often as they want.

For blood testing, if I am just putting someone on progesterone, I may test their level two or three times in the first six months to make sure their dose is appropriate. Again, once they are smooth sailing, it’s usually once a year.

Dr. Eric:

Awesome, thanks. Where can people learn more about you, Dr. Stephanie?

Dr. Stephanie:

I have a couple different websites. YourLongevityBlueprint.com has my book, our podcast, and all of our supplements. There is a free tip sheet on the homepage reviewing some of what we talked about today: three tips to boost your hormones naturally, breaking down reducing stress, fixing nutritional deficiencies, and detoxifying your body.

My clinic website is IHHClinic.com for Integrative Health and Hormone Clinic in Iowa.

You can also find me on Instagram, StephanieGrayDNP, and Facebook. I also have a free e-book, YourLongevityBlueprint.com/Creating-Resilience. That is a step-by-step guide on what stress is and how to minimize its impact on your body and hormones.

Dr. Eric:

Check out Dr. Stephanie’s book, podcast, and other resources. Thank you so much for sharing your knowledge. It was a pleasure chatting with you. That was a lot of valuable information, especially with regards to hormones and touching upon some other great information. Look forward to being on your podcast as well. This was amazing, so thank you so much, Dr. Stephanie.

Dr. Stephanie:

You bet. Love talking about hormones.