Recently I interviewed Dr. Neil Paulvin, as we chatted about low dose naltrexone and peptides.  If you would prefer to listen the interview you can access it by Clicking Here.

With me, I have Dr. Neil Paulvin, who is an innovative physician in the study of functional medicine, integrative sports medicine, regenerative medicine, osteopathic manipulation, and craniosacral therapy. He works with patients not only to treat but to find the root causes of autoimmune issues, thyroid and hormone imbalances, digestive and gut disorders, as well as a number of inflammatory-based conditions, uniquely combining osteopathic manipulation and functional medicine to fast-track healing, recovery, and biomechanics to progress athleticism. Thank you so much for joining us, Dr. Paulvin.

Dr. Neil Paulvin: Thanks, great to be here. Should be fun.

Dr. Eric: Look forward to chatting with you about low-dose naltrexone (LDN) as well as peptides. Before we do this, can you give a little bit of background? How did you get started maybe doing functional medicine and prescribing LDN to some patients as well as peptides?

Dr. Neil: Sure. I got into a lot of this initially because I was dealing with a lot of chronic illness patients, Lyme, fibromyalgia, autoimmune issues. There wasn’t a lot of traditional medicine that always worked that didn’t have a lot of side effects associated with it. I went down the rabbit hole of some more alternative treatment that had some good data behind it. That’s how I found out about LDN, which has been studied in a lot of conditions as well as peptides, which I learned over the last two or three years have incredible benefits for multiple conditions.

Dr. Eric: Why don’t you start out by, for those who are not familiar with LDN, explaining what that is?

Dr. Neil: Sure. LDN is a derivative or breakdown product. It’s a medicine that has been used for years in patients with opioid abuse or alcohol use disorder. That is usually a much higher dose, 250mg. They found even at those doses, there were some other benefits that come along, like with so many other medicines, found by accident, serendipity. What they found was that those medicines would potentially help with immune issues, weight loss, and inflammation. They didn’t want the side effects that those higher doses could achieve. Doctors went lower and lower and lower to find out where that happy place was, where we could “microdose” it but still get the benefits that naltrexone can provide. It can be given via pill or dropper. There are some nose sprays, but mostly common in a pill form, and taken at bedtime. That is when it works the best. Via the mechanism that it works. That’s where it comes from.

The one thing that people need to know is you can’t take it if you are on some type of narcotic medication like Percocet or oxycodone because it will put you into withdrawal. That is the one downside. Otherwise, minimal side effects. It works over a broad swath of conditions.

Dr. Eric: Can I ask how long you have been using it in your practice approximately?

Dr. Neil: Good question. Probably close to 10 years or so. 8-10 years.

Dr. Eric: Wow. You have been using it for quite a while then.

Dosing. As you mentioned, you start with low doses. How low do you start? 1mg or .5mg?

Dr. Neil: The preface for all of this is low dose is kind of an art. It’s not that everybody takes the exact same dose. We start at a low dose, anywhere between .25mg-1.5mg usually. A little bit lower in patients who have autoimmune issues, especially things like Hashimoto’s because as part of resetting the immune system, it can affect the thyroid hormone. You may need to change their medications around. You don’t want them crashing or going hyper on you, one or the other. You want to take some baby steps with it.

If you are doing it for pain or weight loss, you usually are a bit more aggressive with it because there aren’t as many side effects. That is usually the sweet spot in terms of where we start the dosing at.

Dr. Eric: Do you gradually increase the dosing with everybody? If they start on 1mg, and they are doing okay, would you keep them on that?

Dr. Neil: It depends on the symptoms. Usually, I will keep pushing for a little bit to find out where they will get the max benefit with minimal side effects. Very few people I just keep on the maintenance dose, less than 5%.

Dr. Eric: Okay. How frequently would you on average increase the dose? Would it be something like every two weeks, or every month or two?

Dr. Neil: It’s usually 1-2 weeks. Depends on the patient. Patients who are more sensitive or we are more worried about, you would go slower, every 2-3 weeks. Patients who you are progressing quickly and don’t have side effects, you’d do every week to 10 days.

Dr. Eric: Okay. What is the highest dose that would really be considered LDN still?

Dr. Neil: That keeps going up and up. There are no rules now on it. Other doctors hit low double digits. You want to make sure you are working with someone who is experienced at handling it, and they are doing it for the right reasons. There is prescription medication out there called Contrave, which is LDN, 8.5mg, twice a day. That’s 17mg a day. For the weight loss, you are pushing higher. I am all about what I call the delta. If I put someone on 7mg, are they going to get a much bigger benefit from me putting them on 12-13mg? Usually, it’s not a huge difference. You will get more side effects than benefit usually. My top is right around double digits, like 10mg. A couple patients might be higher, but that’s not common, at least for me.

Dr. Eric: How about a typical autoimmune patient? I know it will vary. Would they at times exceed 5mg?

Dr. Neil: Not usually. If it’s just an autoimmune patient, usually lower is better. With them, it’s such a domino effect of so many other things going on that I don’t see much benefit beyond that, unless I am trying to treat something else.

Dr. Eric: The reason I ask is because I have been used to, over the years, when other practitioners have recommended LDN, probably the max dose would be 4.5-5mg. Recently, I had a patient who was taking 7.5mg, which was the highest I’ve seen for one of my patients. I hear you saying that in some cases, maybe not autoimmune, but other cases, they might take in double digits. You mentioned the 8.5mg twice a day in that certain situation. It sounds like autoimmunity, you tend to keep them on the lower end.

Dr. Neil: Yeah. We tend to keep them on the lower end to limit side effects. We also have the buffer where we know we’re giving it 6-10x the dose. There are not many issues with it. Now that the prescription meds are out there, and that’s given without many side effects, we have a pretty broad swath to go for.

Dr. Eric: Have you seen any difference with different types of autoimmune conditions? I am guessing you probably see a good amount of Hashimoto’s patients. Do you see similar effects with people with rheumatoid arthritis (RA) or multiple sclerosis (MS)? Are there some autoimmune conditions where it doesn’t seem to be as effective?

Dr. Neil: No. Everybody is different. Some people could have inflammation. Some people may have a mast cell issue. Some people may have brain fog or cognitive issues. Everybody is different. It is very hard to compare A to B. I have seen improvement throughout the spectrum in all of my autoimmune patients. I have adopted what I branded the Safety Deposit Box method, meaning you have to turn all the keys at one time on all of these patients. It’s not just about regulating the immune system, but you also have to deal with inflammation or cognitive issues. It works better that way and keeps you on lower doses of certain medications. It’s definitely worked in pretty much all of them.

Luckily, Hashimoto’s usually has less systemic complaints than MS or RA does. RA is much more noticeable. At least half of my Hashimoto’s patients don’t even know they have it until I tell them. Most patients with RA or MS unfortunately know there is something going on. Those symptoms are usually unfortunately more life-altering than Hashimoto’s, at least from what I have seen. I have patients all over the world who come to see me for these things. Hashimoto’s is usually by itself a little bit simpler to treat than MS. That is the broad category. It can help any of them, and they will all usually see some improvement.

Dr. Eric: I’m glad you mentioned that you don’t just give LDN. It sounds like you do a lot more. If the person has a leaky gut or other gut issues, or if they have cognitive issues. You pretty much do what a functional medicine practitioner is supposed to do, which is try to address the triggers and underlying imbalances.

Dr. Neil: Exactly. We are looking at their labs, hormones, lifestyle, sleep, exercise. We’re doing all of those things. It’s definitely not just one thing in most patients. It’s doing a bunch of different things, working from the ground up. Start at the foundation, and they have one or two things, then you take it step by step. If you try to do 100 different things, it doesn’t work.

Dr. Eric: Do you put pretty much all your autoimmune patients on LDN? Does it depend on the person?

Dr. Neil: I would say a majority are on it, just because I find that it works. What I like to do is find things that work on a lot of their complaints. It will help their immune system, their pain. We know it can help heal the gut. It does so many things with minimal side effects. I love it because it checks all those boxes.

Some people don’t like the side effects. Some people are on narcotic pain medications and can’t take it. Ketamine has become more prevalent in my area, so that makes it a bit of a contraindication. Most patients who can use it do.

Dr. Eric: You said some people don’t like the side effects. From what I understand, there are not a lot of side effects. One of them is sleep issues. If they are taking it at night, they may have to take it during the day. Can you talk about any side effects people should be aware of?

Dr. Neil: The main three are problems with sleeping the first day or two. That is because of the way it affects the cytokines in the brain and the other hormones it works on. It may affect sleep. But some patients say, “I slept the best I’ve ever slept.”

There is occasionally some nausea. If you dose it the right way, I very rarely see that.

The other one I’ve gotten a decent amount of times, probably 1-3%, is you get dreams like you are on some type of psychedelic. That tends to go away over the first day or two as the brain adapts to it. I have had one patient have to stop it just because the dreams didn’t go away. That’s out of thousands of patients on it.

Dr. Eric: How about headaches? Are they a common symptom of LDN? I think I have had a couple patients who said headaches. I can’t say it’s common, even though I can’t also say that I have a lot of patients on LDN since I don’t personally prescribe it.

Dr. Neil: I’ve seen it. It’s not- Chicken or the egg is not the right expression. Is that from the medicine? Is that something else? I don’t know. I’ve had less than two handfuls of patients have that symptom. If you look at the side effectsof anything, you can get one person who gets this, but I don’t really see it.

Dr. Eric: The big one is sleep, but not everybody experiences sleep issues. Some people take it, and they actually sleep better.

Dr. Neil: The other one I have seen occasionally, and I know it’s reported in groups, and it’s usually because of other reasons, is weight gain, even though it’s used for weight loss. What is happening in those patients is it’s regulating the hormones and immune system. The other doctors are not getting on top of the hormone part, so there is some weight gain associated with it. That’s the other side effect I have seen sometimes, but that’s it.

Dr. Eric: For your Hashimoto’s patients, I know you mentioned earlier where they might be able to lower their dose because the effects of LDN on the immune system. Do you have people who are able to completely get off of thyroid hormone replacement by taking LDN?

Dr. Neil: The answer would be yes, I guess. In a lot of cases, I am not as aggressive with the thyroid medicine initially unless their numbers are horrible. The majority of patients that I see, their antibodies are worse than the thyroid hormone is. If you look at their thyroid numbers specifically, they are not bad. I tend not to have them on thyroid hormone.

If there is a double there, where they are both on LDN and thyroid hormones, it’s a mixed effect. Maybe 25% come off their meds. Is there something else going on? The patients that are just Hashimoto’s can sometimes come off the medicines because it’s not a hormone problem specifically, it’s an autoimmune issue. If we fix the autoimmune issue, they can regulate themselves.

Dr. Eric: I know that LDN can also help with Graves’ just like it can with other autoimmune conditions. Have you seen other Graves’ patients who are on LDN?

Dr. Neil: I have a couple. It’s kind of its own beast. I tend to be more delicate with that because you can crash really quickly or have a thyroid crisis with it. It depends. Are they on some type of prescription med that will help them calm down their thyroid storm, or symptoms they are having? I use it, but I go really small doses with them. I also make sure that if they are seeing an endocrinologist, that their endocrinologist knows what they’re doing because otherwise, that could get sticky. It’s the one thing I have seen the least success with, but it does help. I use other tools in my toolbox more than LDN, at least initially.

Dr. Eric: When someone is on LDN, can most people eventually get off of it? Is the goal for you to work on other areas and then for them to get off the LDN like six months or a year later? Is that something where it’s part of your wellness plan? On average, I know it differs.

Dr. Neil: In the big picture, what happens? I would say it’s almost 50/50. Patients are like, “I feel so much better on it. I have no side effects. It’s not expensive. I might as well stay on it.” It’s 50/50 for a patient to come off of it.

I have patients usually on it for 3-6 months. I tell them from the get-go that they should expect to be on it for six months; otherwise, there is no point in doing it. I literally have a ton of patients who I see them every six months. They are feeling great, so why make them get rid of it? Now there are some other studies coming out on LDN in terms of anti-aging and longevity and other things. It will probably switch more to that as the studies come out.

Dr. Eric: I think I heard you say earlier Lyme disease. Do you give it to Lyme patients? Or did you say you work with Lyme patients? Is LDN something you would recommend for someone with Lyme or bartonella?

Dr. Neil: Yeah, Lyme is an autoimmune issue. It helps with pain and brain fog and resets the microglia, which any patient with Lyme who has cognitive issues works with. I use a lot of it with Lyme. I use it with any type of chronic illness patient, just because it hits so many broad stroke things. It makes it so useful. With Lyme patients, it’s part of an overall program. I have Hashimoto’s patients who are just on LDN, and they get better. Most Lyme patients, it’s not going to work that way.

Dr. Eric: Before we move on to peptides, is there anything else that I should have asked you about LDN? Is there anything else you want to say that you think is urgent for people to know?

Dr. Neil: The main thing I would say is understanding that most patients are going to ask when they will notice benefits. It’s 4-6 weeks for most patients. Some of the data will say three months.

The other thing I want people to know is I am pretty aggressive with it and comfortable with it. I have been dealing with it for many years now. If you are on steroids long-term, not just acutely or on some type of autoimmune medication, like Methotrexate or Remicade, you do want to let the doctors prescribing it know about it because some people who want to be aware of that will want to stop it or at least will talk to me and ask, “What’s the deal? I’ll monitor that, and you monitor this. We’ll go from there.” It used to be a lot more restrictive on what you want to use it for, but now we keep pushing the boundaries to see that there is not a huge issue.

Dr. Eric: Thanks for sharing that about LDN. Let’s move on to peptides. Can you explain what peptides are and when you use them in your practice?

Dr. Neil: Let me try to summarize it in a paragraph here. It’s really hard. Peptides are small groups of amino acids. They exert their effect at a specific hormone, a specific enzyme system, a specific location, which makes them very efficient because it’s more specific than taking an Ibuprofen. They can be used now for almost anything. We use them now for anything from brain fog to erectile dysfunction to fatigue to rotator cuff tendonitis. They have a broad scope of what you can use them for. Now they are pretty much available in any form, everything from hair gel to injection to IV to creams to nose sprays. It used to be injection or nothing a couple years ago.

Dr. Eric: How do you typically administer them? Do you administer them in both ways, or is it usually mostly oral or injection?

Dr. Neil: it depends on what they’re talking and what they’re taking it for. Some of them are only available in injection or orally. If there is multiple choices, we usually recommend injection, as it’s more absorbable but passes the gut. There is a group of them that are available both orally and injection-wise. We will help people do the injection if they feel comfortable doing that. Two, three years ago, most patients didn’t love doing injections. Now, patients are like, “I inject myself all the time. I feel comfortable doing it here, here, here.” The field has definitely changed in terms of patients self-administering meds, which wasn’t common a couple years ago.

Dr. Eric: You answered one of the questions I was going to ask you, which is do you administer the injections in your office, or do they self-inject? It sounds like maybe initially they go to your office, and you show them how to inject them. Then from that point on, they can do it on their own.

Dr. Neil: I have maybe two patients who come to the office and get injected. I have patients all over the world, so it doesn’t make sense for them to come here. It’s not that hard; it’s just an insulin syringe. So most patients will inject themselves. We have a couple that are needle-phobic. There are other forms, like creams or pills. You can pivot now. Otherwise, I have patients injecting 3, 4, 5 a day. It’s gone the other way from what it used to be.

Dr. Eric: They are fairly safe, I assume? Are there any side effects that people should be aware of?

Dr. Neil: That is the elephant in the room at this point, not in the sense that some are known to be safer than others. If you took LDN or prescription medications or supplements, there are some good studies out there. There aren’t as many studies on peptides long-term.

The ones that we get a little bit concerned about because there is the theory of cancer are the ones that boost growth hormone, even though there is no specific study that shows it. We know that any time growth hormone gets increased, there is a chance for increasing risk for any type of cancer you may have. We will discuss that with the patient. We will often do a max of three months at a time with those peptides, which is called a cycle. You are not doing almost any of the peptides in perpetuity to limit that risk.

There are also ones that work on the thymus. It’s never been proven. It used to be prescription medication. We do it for three months. That is called thymogenalpha-1, which doesn’t exist anymore because it hasn’t been approved by the FDA, not because of side effects, but because of false promises. People were promising the world with it, and it wasn’t true.

This is another issue. People on social media tend to say that things can do things they can’t, so they get everybody in trouble. The bad kid in school. There is also one called TBC and TB-500, which is for inflammation mostly. That is mostly a Reddit thing. It’s amazing watching the Reddit groups and Facebook groups. Some people find some study done on some rare animal that showed one thing, which has nothing to do with humans, and they will put it out there. There is the supposition that it may happen. There is no human data or mouse data, which is a step below that we tend to look at, that it may cause cancer. It’s out there, and people will find that one Reddit group, and they will show it to me.

We are doing those for three months, and that’s it. Patients are aware of those side effects. That sounds scary, but there is no evidence with any of those peptides that it happens. I have prescribed them for years with thousands of doctors prescribing them, and there is not really a reported case of it. Unfortunately now a lot of people do the Dr. Google thing, and they find things. We have to explain to them, or they just move on, and we do other things.

That’s a long-winded answer. Most of the other ones are pretty safe with minimal side effects. The main thing we are concerned about is the reaction that you can have to anything. You can have a histamine reaction to something. You may feel a little nauseous when you get an injection, but that can happen with LDN, supplements, and prescriptions. That is usually the big question that we get. Somebody will see it on a podcast or a Reddit or Facebook group. The paradigm has flipped, where most patients are doing their own research, and they are coming to you and saying they want to do this or that, as opposed to asking what they should do. It’s been interesting over the last couple years.

Dr. Eric: Are peptides similar to LDN in that you’re not just giving the person peptides, but you’re also doing other things from a functional medicine perspective?

Dr. Neil: It depends. Are we doing functional medicine? I also do a lot of sports medicine, as you mentioned in the intro. If I have somebody who has a rotator cuff tear that hasn’t improved, I may just do the peptide and some physical therapy. If I am doing a peptide series in a Lyme patient, in that case, I am doing the whole package deal, not just one thing. It depends. What’s great about the peptides is they treat so many different things. If it’s a chronic illness patient, yes. If it’s somebody who just has hair loss, we’re not doing as much, which is what makes them really great.

Dr. Eric: That makes sense. Most people listening to this have a thyroid or autoimmune thyroid condition. What would be two or three of the top peptides you would give someone with Hashimoto’s or Graves’ or a non-autoimmune thyroid condition?

Dr. Neil: In terms of autoimmune, a Hashimoto’s patient, we are going to work on the immune system first. That will be thymulin, which is related to the thymosin that doesn’t exist anymore. Thymulin is its cousin that we use that works pretty well.

Beyond that, we’d use a peptide called BPC-157 since a lot of gut and immune issues overlap. Many autoimmune issues connect with gut infections. I’m sure you’ve dealt with that. That is probably our second goal with it.

We use a peptide called KPV, which will help heal the gut but also has been shown to help with mast cell issues, for patients who don’t do well with histamine. Sometimes that overlaps on all autoimmune conditions depending on what school of thought you are. More and more studies are coming out about the mast cell giants. There is a huge connection between the mast cell and the immune system and autoimmune issues.

Those are probably the two or three I tend to use if there are no other complaints. Then we will go from there if there are other overlying issues.

Dr. Eric: Just like I asked you with LDN, with peptides, is it something that people will continuously take on average? For someone with hair loss, for example, will someone only take it for three months or six months, and their hair grows back? For autoimmunity, is it temporary or more of a long-term thing?

Dr. Neil: Like I mentioned earlier, usually, we do what are two terms of a use for it. One is we are doing cycles, usually 3-4 months of any peptide. Then we also do stacks, which means we are combining more than one peptide together to get a better benefit than we would with each one individually.

We are also cycling through. For the first two months, I may do BPC and thymulin, and then I may stop that and switch to KPV for the next two or three months. In most cases, patients are not on peptides in perpetuity. They are taking breaks for the reasons I described. You can get in theory what we call tachyphylaxis, meaning you won’t respond as well in the fifth month as you are the first month. That benefit is slim.

They are not cheap. LDN, depending where you are, you can get for $40-$60. Some peptides could be $800-$900 a month. Unless you’re not seeing a big benefit, most patients are spending $800-$3,000 a month on medicine that isn’t helping them.

Usually, it’s two or three months. The only things that I will tend to do longer for is patients who have complaints, and we are trying to clean things up. The rotator cuff, you are treating to the end, and it’s a finite end. Some of these autoimmune things, you’re going on and off.

Dr. Eric: It sounds like LDN is more longer-term. Part of that is the cost, but also autoimmunity, it’s not something that will be resolved within two or three months, whereas peptides, a combination of the cost, and even besides the cost, you said it’s three or four-month cycles. You usually won’t have someone on peptides for six consecutive months or longer, but that wouldn’t be uncommon with LDN.

Dr. Neil: Also, in a functional kind of method, the one I use is sometimes If you have a little back pain, and you take Ibuprofen for a month every year just because it acts up when you are shoveling snow or raking leaves, if your shoulder pain comes back or your bloating comes back, you can hop back on for two or three months and then go on with your daily lifestyle regimen.

LDN is usually a longer-term medication. LDN is like Vitamin D or testosterone. It doesn’t save up. If you stop it, it’s gone, and you have to start all over again. The peptides are usually causing more of a result, and that may be more life lasting. I guess I can put it that way.

Dr. Eric: That makes sense with any medication. Typically, if you stop taking it, you will lose the benefits. Some things like antibiotics, you take for an infection for hopefully a short amount of time, although that can be a longer time for something like chronic Lyme. Thanks for explaining.

Is there anything that you didn’t mention on peptides that you think is important for the listeners to know?

Dr. Neil: I think we hit almost everything. Two or three things I would mention. First of all, be careful about ordering peptides. There are so many sites out there that are not regulated by anybody. They may be cheaper, but buyer beware. They are getting product that is out of the country. If you are getting it from a pharmacy, you know it’s regulated by a state or local government. They are being screened. You know what you’re getting. It has to have certification with it. That’s the first thing I would mention. Especially everything in the supplement community, things become the wild wild West. you want to get products from a quality source.

You want to work with someone who is experienced because there is a lot of nuance to a lot of this stuff. I have a lot of patients who come in and say, “I’m on these five peptides at this dose.” These doses make no sense. Whoever prescribed them had no idea what they were doing. For LDN, it’s pretty hard to mess up. Peptides have more of an art to them of knowing how to implement them.

The last thing I would say is when you talk to the doctor about them, make sure you answer these few questions. What is your goal with the peptides? They will have a dramatic effect. Make sure if you are willing to do only one or two, that the doctor knows. I have some patients who come on five or six different ones, and they feel horrible because they are on too many.

Make sure you understand the cost and you will be on them for multiple months. If the patient can’t afford them every month, they need to try something else. The peptides aren’t going to work for you in two weeks usually. It’s something you will usually do for two or three months. If you can’t embark on that journey, let me know now. I have 700 things in my toolbox. We may switch you to LDN, which is cheaper and can do a lot of the same things and get the benefits you want without you having to worry about a needle and stuff like that.

Dr. Eric: That was very helpful. Before we wrap things up, I have a question about craniosacral therapy. I know you do that in your practice. I have been fascinated by it. They have some techniques in chiropractic that are related to craniosacral. Who in your experience would be a good fit for craniosacral? This might be a broad category. If someone is having brain fog or cognitive symptoms in general, or is it more like specific conditions?

Dr. Neil: I’m trying to think how to answer that. When I started doing it 15-17 years ago, there was no LDN or peptides. There was no hyperbaric chambers or gut chambers or discussions about gut health. It wasn’t there. The paradigm has totally changed.

It definitely is a much slower and steadier progress. It’s not something where in most cases, you’re like, “Oh my god, this is better.” What it still has a really good niche to is someone who had a concussion, a head or neck injury, who have EDS. That is an A to B situation. If I hit my head on the car door, I was a little dizzy. I was treated, and I felt 100% better. It’s great for an injury situation.

In terms of brain fog or fatigue, it’s definitely a help, but it’s not going to be a home run usually for most patients. It’s a nice add-on. It’s gotten harder and harder to find good providers, at least in Manhattan, where I am. It’s something to look into. It’s much gentler. There is no medication involved. Something it’s really good for, because there are allergy issues where I am, are sinus issues. Those are really where it has a good niche for it.

Dr. Eric: That’s good to know. A lot of people do have sinus issues, so that’s great. Thank you for sharing this, Dr. Neil.

Where can people find out more about you? You have a practice in Manhattan, but you also work with people throughout the world. Can you share your website and anything else?

Dr. Neil: The simplest way to find out about me now is the website, DoctorPaulvin.com. I have a lot of information on there. We are redoing it to get some newer things on there. The YouTube channel is Dr. Paulvin, as is the Instagram channel. Those are the easiest ways. We have a newsletter. Depending how much of a deep dive you want, we have a lot of information on there. It may take a while. That is a good way to reach out to me in terms of what we do and if you have any questions about seeing me virtually or in the Manhattan office.

Dr. Eric: Thanks again, Dr. Paulvin. Appreciate you sharing your knowledge when it comes to LDN and peptides and a little bit on craniosacral.

Dr. Neil: Thanks for having me.

 

Recently I interviewed Dr. Angela Mazza, as we chatted about radiofrequency ablation.  If you would prefer to listen the interview you can access it by Clicking Here.

I’m really excited about this interview here. I have Dr. Angela Mazza, who is a triple Board-certified doctor in endocrinology, diabetes, and metabolism as well as internal medicine, anti-aging, and regenerative medicine. Dr. Mazza’s broad medical background includes significant research in both basic and clinical realms of endocrinology. Dr. Mazza is the founder of Metabolic Center of Wellness in Oviedo, Florida, where she spends a great majority of her time caring for persons with autoimmune thyroid disease, thyroid nodules, and thyroid cancer.

Highly regarded for her individualized approach to patient care, Dr. Mazza empowers each person to achieve their unique goals by providing education, lifestyle management, and support. Dr. Mazza believes that hormonal changes that happen in men and women as they age play a huge role in their overall health, longevity, and quality of life. Her passion is helping her patients achieve metabolic and hormonal balance. We are going to be chatting about radiofrequency ablation (RFA). I’m really excited. Thank you for joining us, Dr. Mazza.

Dr. Angela Mazza:

Thanks so much for inviting me. I’m happy to be here.

Dr. Eric:

I gave your background, but how did you start helping people with radiofrequency ablation? There still aren’t a lot of doctors that do this in the United States. I know you are currently the only one in Central Florida who does this procedure. If you could talk about how long you’ve been doing it and how you started incorporating this into your practice.

Dr. Angela:

I have been taking care of patients with thyroid nodules for years. Up until a few years ago, this therapy of RFA wasn’t even available or FDA-approved in the United States. Before that time, I was having to send patients to surgery for nodules that couldn’t otherwise be treated. Unfortunately, going into surgery, oftentimes they’d end up on thyroid hormone replacement for something that should have been so easy to treat.

RFA has been used for years even here in the United States for different tumors like liver, lung, kidney, or even in the heart and varicose veins. It wasn’t until 2012 that it started to be used for thyroid nodules in South Korea by Dr. Baek, who is the father of RFA for thyroid nodules. It took that long with all of the data that was happening, all the proven benefits that were going on, for the United States toapprove it.

Once I started hearing about this exciting research that was ongoing all over the world, I knew that once this was FDA-approved, I totally wanted to be able to provide it for my patients. I was doing thyroid biopsies, thyroid ultrasounds. Unfortunately, I didn’t have any choice for some nodules but to go to surgery. Once it was available, I was like, “Yes, I have to provide this.”

Dr. Eric:

I’m sure a lot of people listening are familiar with thyroid nodules, but I’m still going to ask you if you could explain what they are, how common they are, some of the common causes.

Dr. Angela:

Sure. Thyroid nodules are super common. About one in three persons sometime in their life span will have some sort of thyroid nodule. That is how common theyare. There are nodules that have different characteristics. Some nodules are more cystic; they become fluid-filled. Some nodules are more solid, and they are hard. Some are a mix of both; we call them complex. There are nodules that are more concerning or cancerous.

That is agood question. What causes thyroid nodules? Up until recently, we threw it off to iodine deficiency. That is an unfair blanket statement to say that all nodules are caused by iodine deficiency because they are all a little bit different. That doesn’t make sense. What we are finding is the thyroid is so sensitive to inflammation. Sometimes, these nodules can be a result of inflammation in the body and can in turn cause inflammation in our thyroid.

Different nodules behave differently. These cystic nodules sometimes keep filling up with fluid, and they become a problem. Sometimes, nodules are small and don’t cause any issue, and we leave them alone and watch. Every nodule, it’s important to be able to characterize and say, “These are ones we can watch. These ones are causing issues. These ones are suspicious.” I hate to say thyroid nodules are like snowflakes, but they kind of are. They are all a little bit different. It’s a tough question to answer.

Dr. Eric:

When you do an ultrasound, and you detect thyroid nodules, it sounds like maybe not all of them require follow-up. It depends on the characteristics.

Dr. Angela:

That’s a good point. If some are tiny cysts with just fluid, and they have certain characteristics that we can see on the ultrasound, they may not be worth following up on because they are so benign. There is a grading system that has been developed to look at the concerning characteristics. What are ones we have to follow more closely? What are ones we have to biopsy? What are the ones that need to be addressed as far as surgical removal or some sort of more proactive therapy?

Dr. Eric:

In my practice, I see a lot of people with both Graves’ and Hashimoto’s, but I focus more on the hyperthyroid side. Other than Graves’, we do see some cases of toxic multinodular goiter. Can you talk a little bit about toxic nodules? We will get into RFA. Can it help with it? What are they? Also, for those who are unfamiliar with the term “hot nodule” versus “cold nodule.”

Dr. Angela:

Toxic nodules are essentially overactive nodules. These are nodules that are starting to make their own thyroid hormone and not listening to the signals to stop making thyroid hormone.

Toxic nodules have a distinctive look on the ultrasound. They are really hypervascular. That is what feeds into these nodules to make them keep being overactive. In certain cases, they can be quite large.

The difference between hot and cold nodules is hot nodules are considered toxic because-There is certain imaging we can order. I don’t usethis imaging as much anymore. It’s not needed. There used to be these scans called radioactive iodine uptake scans for toxic nodules. If someone shows up with a nodule, we are not really sure what it is, so before biopsy was around, we would send them for these radioactive iodine uptakes. If it was a hot nodule, it would glow, so they would call it “hot.”

They used to say that nodules that didn’t take up anything were cold, and they were suspicious. They might be cancer. We got away from calling non-functioning nodules suspicious for anything because we know that’s not true. You do a biopsy, and most of the time, they come back fine. Hot nodules light up, so we can use that term still. It also means toxic or hyperfunctioning.

Up until recently, the only treatments we had for hot nodules werewe could put people on antithyroid medicine. To cool off that overactive nodule, especially if it’s causing problems like symptoms of hyperthyroidism. If someone is feeling hyperthyroid, they are feeling hot, shaky, are having trouble sleeping, palpitations, all the symptoms that go along with overactivity. The medicine can cool that off.

But when we are talking about toxic nodules, sometimes we can get people off antithyroid medicine, as they don’t tend to shut down on their own with that type of medicine.

The second treatment is radioactive iodine. Just like that radioactive iodine uptake scan, a different amount of radioactive iodine is used to be taken up by that nodule and shut it down or essentially turn off its machinery. Sometimes that works, and sometimes it causes a whole thyroid to become underactive, which is the downside. Sometimes, these people need another dose of radioactive iodine, but it is radioactive iodine, so that carries with it its own concern.

Surgery would be the other option, to take out that side of the thyroid or the whole thyroid. Until recently, radiofrequency ablation has been a treatment option available for persons with overactive thyroid nodules. It’s a new tool in our toolbox for hot nodules.

Dr. Eric:

Which is awesome. We are going to dive into that. One thing I want to ask you, you mentioned the radioactive iodine uptake test. I still notice a lot of endocrinologists use that. It sounds like you stopped using it in your practice.

Dr. Angela:

I can’t even tell you the last time I ordered one. It’s been almost 10 years, I think. That’s why ultrasound is so great. I have an ultrasound in my office. You have nodules; let’s take a look at the ultrasound. If I am looking at the thyroid gland, and I see a nodule with super vascularity going on, it’s a toxic nodule. End of story. You don’t even really need to biopsy a toxic nodule because they are 99.9% benign.

Dr. Eric:

I’m glad you mentioned the ultrasound and biopsy. Some will justify using the radioactive iodine uptake test to give hints if it’s cancerous. Like you said, even if it’s a cold nodule, it doesn’t mean that it’s cancerous. Most of the time, it won’t be. Why not just do the ultrasound, and then depending on the characteristics of the ultrasound, determine if someone needs a biopsy? It sounds like that’s the approach you take in your practice.

Dr. Angela:

As a skilled ultrasonographer, you just get used to seeing these nodules. You can see different characteristics. Those radioactive iodine uptake scans are a pain for the patient, and they are oftentimes not accurate. It’s not worth the time and energy.

Dr. Eric:

I’m glad you mentioned that. I have been saying that for years.

Dr. Angela:

You were right.

Dr. Eric:

I try not to knock other endocrinologists who use it, but I’m not a big fan. I just don’t understand why. Another reason some will use it is to diagnose Graves’. If someone has hyperthyroidism in the presence of elevated TSI, we know they have Graves’. They don’t need the uptake for that. There are different reasons they give for doing the uptake test. To me, it just has never made sense.

Dr. Angela:

You have a case for thyroiditis versus Graves’. Even then, you will see different shades on the ultrasound. You don’t need the uptake scan.

Dr. Eric:

Let’s get into RFA. If you could describe what it is, when is it indicated.

Dr. Angela:

Sure. I mentioned that RFA has been used for years for other things. RFA is great for benign and toxic nodules, or hot nodules. Essentially, it’s using an electric current to go directly into the nodule, causingtissue- I don’t want to say damage. Essentially, it’s agitating the tissue, and it causes long-term ablation in the nodule itself. It’s great because it leaves the rest of the thyroid completely intact. You’re only working on the nodule itself.

Surgery is great for some things, but this is done in the office. There is no anesthesia. There is no downtime from work. There is no thyroidectomy scar. It’s a nice alternative that we never had until recently here in the States.

Dr. Eric:

You mentioned just before that it could help with toxic nodules, which is great.

Dr. Angela:

Right. Some nodules are more challenging than others for RFA and may require more sessions. Toxicnodules, depending on the size, because they are so vascular, oftentimes require more than one session. Still, it beats surgery and all that goes along with possible risks of surgery.

Dr. Eric:

Like a single toxic nodule will sometimes need multiple treatments.

Dr. Angela:

Depending on the size of nodules in general. I have been seeing some very large nodules and really can only ablate for a certain amount of time. You want to keep them in safe time periods because you are dealing with electric current within the nodule. You don’t want to overablate. Most nodules can be taken care of in one session.

Dr. Eric:

One of the questions I had, which I think you kind of answered, but I’ll ask it anyway: If someone comes in with not a toxic nodule but larger, benign nodules, maybe like 2-3cm or greater, and they are currently seeing an endocrinologist that is saying, “You have to take the thyroid out,” if they need to get more than one nodule removed, typically, it would be like one nodule per visit per session? Would that be fair to say?

Dr. Angela:

It depends upon the size of the nodule and the positioning of the nodule. If they are on one side, you can try to do more than one at a time. if they are on both sides or bilateral, generally, depending upon the size of the nodule, I will do one side, then the other. It’s a procedure.

We are trying to be cautious of the patient’s comfortability. The patient is awake during the surgery. I usually give a little bit of anxiolytic beforehand just because it’s nerve-wracking. You hear the generator going.

We talk to the patient during the procedure. That serves two purposes. It lets me know they are doing okay. Plus it also helps me monitor their voice during the procedure. Surgery as well, one of the things is there is a risk of damage. Very low compared to surgery. As long as we monitor the voice, it’s a good gauge of how things are going. Plus it gives me an idea of how comfortable they are.

Dr. Eric:

Should someone who goes through the procedure expect to experience any discomfort at all?

Dr. Angela:

Well, it’s kind of like the biopsy but a lot longer. If you have ever been through a biopsy, your neck is extended. Unlike a biopsy, there is a lot of numbing medicine to the area. We give about 10ml of lidocaine. That serves a number of purposes. The thyroid itself doesn’t have nerves, but the thyroid capsule has nerves. Its surrounding tissues have nerves. We inject the lidocaine. The lidocaine not only numbs the capsule, but it also separates the structure from the neck out. It separates out the carotid artery, protects the laryngeal nerve. It serves multiple purposes.

To answer your question, the patient should not have discomfort during the surgery. Pressure is normal. I am leaning on your neck with an ultrasound for up to 30-40 minutes. We take breaks. I’ll ask if they are all right, if they want a break.

Patients often comment on this. We are using a probe, not unlike aneedle that is done for a biopsy. The probe, as I am using it, I am going systematically to different parts of the nodule and ablating each area. Sometimes, they will feel a pop. That is the thyroid tissue being ablated. It’s a weird feeling. It’s not a pain, but it’s unexpected if you’re not aware of it.

Dr. Eric:

On average, how long does the procedure take? I’m sure it varies depending on the person.

Dr. Angela:

In whole, from the start, when we do a baseline ultrasound, to the end of the ablation, an hour to an hour and a half.

Dr. Eric:

Okay, that’s not too bad. Once the ablation is done, and they have just a single nodule, and they only needed that single visit, do they typically need follow-up visits after that to monitor it?

Dr. Angela:

Yes. Right after the procedure, the patient doesn’t usually have restrictions. They don’t want to do heavy lifting for a day. As far as follow-up, I recommend doing an ultrasound about two months after with some repeat thyroid function tests, at six months, then at least at 12 months.

We have a lot of patients who come from out of town for this procedure. I rely upon other ultrasound reports and ultrasound images to do follow-up on those cases. It’s nicer when I can do my own ultrasounds for follow-up. Since this is a new procedure, a lot of the radiologists aren’t used to reading what a nodule looks like after it’s ablated. It can look actually suspicious to them because some of the markers that go along with suspicious nodules can look similar to where areas have been ablated within the thyroid. That can cause a little confusion. That’s why I like to do my own if I can. As long as I have the discs to look at the images, that’s part of the follow-up.

We tend to see the best results right around six months to 12 months. Even though we’ve ablated tissue during the procedure, that can be tough to see if you are continuing to ablate tissue within the nodule up until that time period. The two-month follow-up is just so I can make sure everything looks like it’s going in the right direction.

Dr. Eric:

Makes sense. Speaking of suspicious nodules, I don’t think yet RFA is indicated for suspicious or malignant nodules. We were chatting about this a little bit earlier. I have done my research. I am sure there are a lot of studies I haven’t read. I’m pretty sure I came across one or two studies that showed it can potentially help with malignant nodules as well, at least in the research studies.

Dr. Angela:

Right. The ongoing studies are super promising. They are just looking at low risk papillary cancer. Papillary cancer is the most common type of thyroid cancer. They are looking at smaller, 1.5cm or less nodules in RFA. It’s been found to be as safe, if not safer, than surgery. A potential therapeutic option. The results thus far have beenreally good.

Dr. Eric:

Is there any chance or risk of the nodule growing back years later after removing it with RFA?

Dr. Angela:

Yes, there is a potential risk. We are trying to get everything within that nodule. Success defined as far as the research study is a volume reduction of 75% at 6-12 months. That is considered success of the RFA. That holds with it, if there is a little bit of thyroid tissue left, especially if it’s one of those more vascular nodules, there ispotential for the nodule to grow back and require another session downthe line. That’s the good thing of doing serial ultrasounds. Even doing an ultrasound once a year, you can stay ahead of this. It will be less of an RFA procedure down the line.

Ideally, that’s not the goal. I always let my patients know there is potential for some of it to grow back, especially the toxic nodules, as theyare the most challenging.

Dr. Eric:

Everything comes down to risk versus benefits. I know if I was facing thyroid surgery due to nodules, I am pretty confident I would go the RFA route. I am not saying that just because I am interviewing you. The name of my podcast is Save My Thyroid, so that’s my goal. Just like you, you try to save thyroids.

If I happen to have a nodule removed, I would hope it wouldn’t grow back, but still, if it did, I guess I would consider having it again. You have to consider the potential consequences of thyroid surgery. A lot of people who have thyroid surgery, they do okay. As you said, there is the risk of the damage to the laryngeal nerve, the parathyroid glands. Not that there is absolutely zero risk with RFA, but in comparison to surgery.

I still think in many cases, I don’t know if I should use the word “no-brainer” because I know it’s not an easy decision when choosing for some people between RFA and surgery. We were also chatting about where currently in most cases, insurance doesn’t cover it, so they might have to pay out of pocket for it. In the day of high deductibles and being on thyroid hormone replacement permanently after getting surgery, you have to look at the long picture. Even if someone’s thyroid surgery is completely covered by insurance, it’s easy to say that. I’m not in that situation, but still, I am pretty sure I wouldn’t go for surgery even if it was 100% covered, and I had to pay out of pocket for the RFA, just because of potential consequences surgery can have.

Dr. Angela:

Replacing your own thyroid with thyroid hormone replacement is tricky. Not everybody feels great on the same thing. It’s a quality of life thing after. Sometimes, people make the decision to do the surgery and get rid of the nodule and take thyroid medicine for the rest of their life. They don’t think about the long-term consequences. You know what I mean? Even the best thyroid combination, not everybody feels great afterwards.

Dr. Eric:

A question that just came up: experience. If someone does undergo thyroid surgery, they probably want to choose a surgeon who has a lot of experience. You have now been doing RFA for a while. Do you think that plays a role, too? The longer someone has been doing it, the better.

Dr. Angela:

It’s definitely a learning curve. Even from when I first started doing biopsies in fellowship, it takes a while to get good at it. Fellowship was a long time ago. The more you do them, you know what to look out for. You know potential issues during the procedure, whether it’s the generator issue or something else. There are so many steps involved that to say you are an expert right out the gate is very naïve. We have been doing them here in my office since 2019. It definitely is a learning curve, like with anything.

Dr. Eric:

I understand. Any other risks or side effects that people should be aware of with RFA?

Dr. Angela:

The most common side effects right after the procedure include tenderness. We have been working on an area of your neck up to 30-45 minutes. It is going to be a little tender. Some temporary hoarseness is not uncommon. I am not talking voice loss. Some bruising in that area. It shouldn’t be bruising all over your neck. Just some localized bruising that may extend up and down the length of your thyroid area. Sometimes, patients have a little bit of a burn mark there because of the electro going into the thyroid itself. Those are the most common side effects.

Very rare side effects include the laryngeal nerve injury. Also rare is something called capsule rupture. That happens where people are overablating a nodule for too long. The capsule gets disrupted. That is why we don’t keep the ablation time above a certain time period.

Dr. Eric:

In your office, do you do ethanol ablation?

Dr. Angela:

Yes.

Dr. Eric:

There is ethanol ablation. There is laser ablation. Can you compare the different types? Ethanol ablation is more for cysts, I think. Is that correct?

Dr. Angela:

Percutaneous ethanol injection, or PEI, those are mostly cystic nodules. Those are nodules that mainly are filled with fluid. Essentially, with the PEI, we drain out the fluid. Oftentimes, people who have had cystic nodules know that these nodules will fill up. They will have been through this before. They will have been through a biopsy, where they aspirated everything, and it grew right back. These are people who work really well for PEI or even just fluid-filled nodules.

With the PEI, we also use the ultrasound for guidance. We drain out the fluid as much as you can. Oftentimes, I will leave a little pocket because that is where I am going to put the alcohol in.We use a special kind of dehydrated alcohol. What that does is it fibroses the inside of that nodule down so it does not fill up with fluid again. That is a pretty quick procedure. That one probably is closer to the time, even less than a biopsy. Plus it’s super simple.

We might need to do another PEI if it does fill up a little bit. Some of these really large nodules, you think you got as much as you could out as far as aspiration. They find a way to fill up a little bit more. Sometimes, you have to redo it. It can sometimes burn a little bit, depending upon where the nodule is at. That’s about it.

As far as laser, laser is great for larger nodules. It’s a little more cumbersome than RFA. RFA, we are using a probe. It’s a fine needle tip that can go right into each and every section of the nodule. Laser is more like diodes. There are a few diodes that go into the nodule. You don’t have as much control.

I don’t do laser. Some people do really well with laser. When we look at head-to-head studies, RFA is still superior in efficacy than laser.

Dr. Eric:

I don’t see a lot of research, at least compared to RFA. It seems there is a lot more with RFA and thyroid nodules.

Dr. Angela:

Not as much. There are practitioners who do laser, and they have good results. At our clinic, we only do PEI or RFA.

Dr. Eric:

With the PEI, that is just for cystic nodules. If someone has a solid nodule-

Dr. Angela:

It doesn’t work as well. There are studies on more heterogeneous or complex nodules. It’s just not as good. You can instill as much alcohol into those nodules, but it’s just going to laugh at it. Nah.

Dr. Eric:

All right. Is there anything else that you’d like to discuss, or anything I didn’t ask you that I should have asked you?

Dr. Angela:

Probably some people ask, “Who is a good candidate for RFA? Who would not be a good candidate?” Candidates that are really good are people who have a nodule that’s bothersome, whether it’s cosmetic, you see it from the outside; whether it’s compressing. Sometimes, people can have large nodules that can press on the windpipe and can make breathing or swallowing difficult. Some of those nodules, when they are very large, when you are lying flat, you can’t breathe or have trouble exercising because they are pressing on the windpipe. These people are great candidates for RFA.

People who have pervious thyroidectomies, they don’t want to damage or lose the remaining function of the thyroid they still have. This is being looked at for recurrence of thyroid cancer. That is something to consider.

There are people who are really afraid of surgery or just don’t want to have surgery. These are people who are good for RFA.

That’s the list of potential good candidates.

People who aren’t ideal candidates are people who have pacemakers or defibrillators or have severe heart disease. People who are on blood thinners that can’t be stopped for a couple days before the procedure. Patients who are pregnant. As of right now, those are probably not the best candidates.

Dr. Eric:

It sounds like if someone has a partial thyroidectomy, and they have some nodules on the thyroid that’s left, they can undergo RFA rather than get the other half of the thyroid removed.

Dr. Angela:

Yeah. That thyroid is working well, so you want to preserve what you have and save the rest of your thyroid.

Dr. Eric:

This was wonderful. I was really excited to chat with you about RFA. I’m sure we will hear more about it in the future. Now, it’s a really good option for a lot of people who are potentially facing thyroid surgery just because there are still a lot of endocrinologists who aren’t aware of it. Is it safe to say that the average endocrinologist is not aware of it, or maybe they are aware of it but aren’t too familiar with it, so that’s why they are still going to recommend the surgery route?

Dr. Angela:

It’s kind of mixed. I honestly think that a lot of endocrinologists don’t know about it. I think some endocrinologists are waiting for more data although there is a lot of data already, but they are not convinced because they haven’t seen enough patients go through it to say, “I had this patient do RFA. They did great.” The more we get the word out about it, the more we educate other providers about it, I think it’s going to be more acceptable because they will see the results are really good. If patients themselves had an option, I think they would prefer not to have surgery rather than have it if at all feasible.

Dr. Eric:

I agree. I hate mentioning it here, but I think I feel the need. You would hope that in many cases, endocrinologists are going to do what is best for the patient. My guess is also surgery is a lot more profitable than RFA. You would hope that’s not why they are recommending surgery. As RFA becomes more popular, you will see more and more endocrinologists incorporating it or referring out. Still, I’msure there are some who- I don’t know how much the average surgery is, but compared to RFA- Anyway, I wanted to bring that up to say that most endocrinologists have that motive to make money off the surgery. That’s why they recommend radioactive iodine-Radioactive iodine probably isn’t that profitable. Surgery, I imagine, is.

Dr. Angela:

If you’re in a hospital-based practice, maybe they don’t do referrals. If you are coming to an endocrinologist, we should be able to give all the options. If you are going to an ENT or surgeon, they will recommend surgery.

Dr. Eric:

That’s what they do.

Dr. Angela:

Yeah. As I mentioned, too, when we were speaking earlier, right now, this is all very patient-driven. Patients who are being proactive about their health and wanting other options, these are the patients that are going for the RFA. They know that surgery is not what they want. They want other options. Even when their doctors are telling them to get the surgery, they are finding more research.

Dr. Eric:

Thank you so much, Dr. Mazza. Where can people find out more about you? I know you also have your own podcast.

Dr. Angela:

Our website is MetabolicCenterForWellness.com. We do have a podcast once a month. It’s me and my friend Dawn, who is a friend as well as a patient. She gives a patient’s perspective. It’s called Thyroid Talk with Dr. Angela Mazza. We try and make it fun, as fun as certain topics can be.

Dr. Eric:

I’ve listened to a few episodes. I enjoyed it.

Dr. Angela:

It’s a little silly sometimes. What are you gonna do? I have a YouTube channel. It’s just Dr. Angela Mazza.

Dr. Eric:

It really was a pleasure chatting with you about RFA.

Dr. Angela:

Thank you so much. I really appreciate the invite.

Recently I interviewed Dr. Aimie Apigian, and we chatted about stored trauma and thyroid autoimmunity.  If you would prefer to listen the interview you can access it by Clicking Here.

Recently, I did an interview with Josie Warren, who personally dealt with multiple autoimmune conditions. She mentioned that chronic stress was the single most important factor in regaining her health. In this interview, Dr. Aimie will differentiate between stress and trauma. Even though I did the interviews about a month apart, I relistened to the episodes on my own back-to-back. While I always bring up stress to my patients, Dr. Amie made me realize that it’s not just about dealing with the fight or flight response and blocking out time for meditation, as it goes well beyond this.

I am very excited because I am going to chat with Dr. Aimie Apigian about stored trauma and thyroid health. Dr. Aimie is the leading medical expert on how life experiences get stored in the body and restore the body to its best state of health through her signature model and methodology, The Biology of Trauma. She is a double Board-certified medical physician in preventative medicine and addiction medicine. She has a Master’s in biochemistry and a Master’s in public health. In addition to her medical training, she is also a functional medicine physician. Dr. Aimie has trainings and certifications specifically in neuroautoimmunity; nutrition; genetics for addictions, mental health, and mood; and behavioral disorders. She has several certifications in various trauma therapies, including the instinctual trauma response model; somatic experiencing, which was developed by Dr. Peter Levine; and NeuroAffective Touch by Dr. Aline LaPierre. Thank you so much for joining us, Dr. Aimie.

Dr. Aimie Apigian:

Absolutely. I am really excited for this conversation. Such an important conversation. Thank you for the invitation.

Dr. Eric:

You’re welcome. I agree. Definitely a very important conversation we’re about to have. Can you start out by giving your background? How did you start helping people with trauma? Getting into how you developed your signature model and methodology, The Biology of Trauma.

Dr. Aimie:

When you were reading my introduction, it takes me down memory lane of all the different trainings I’ve had, yet at the end of the day, this was actually just for me to save my own life and to try to help my son Miguel, who I had adopted. It was while I was in medical school at Loma Linda University. 2008 was when Miguel came into my life. He was a foster child at the time, four years old, landed in my home. I thought I knew what to do. I thought that my love was strong enough to heal him of all of his prior wounds that he had had up until that point. I had so much to learn. He was really the one that opened that door up for me. I made a commitment to him to figure out what he needed in order to help him be happy. I wanted him to have some happy years in his childhood.

What I saw happening was that he was bringing his past with him as if it were still happening. My love continued to actually be a trigger for him, and he would be very reactive and not want to connect with me because that did not feel safe to him. When I saw that not changing with time, I got very worried about his future. I started diving into trauma at that time. It was specifically around attachment because that’s what I recognized was his core issue.

Then I went on to general surgery residency after medical school. I was finishing up my third year of general surgery residency. I am on transplant surgery rotation of all things. My body broke. I got so sick that I could not even get out of bed for a period of time. I saw my conventional medicine doctor and found from my lab results that I had high autoimmune markers, that my thyroid levels were off, but not yet to the point where they would diagnose me with anything. They did diagnose me with chronic fatigue because they couldn’t figure out why I was so fatigued that I could not get out of bed. I actually ended up having to take a medical leave; that’s how sick I got.

In the process, what I realized through my studies on trauma was that all of the health symptoms and conditions that I was having, or at least that I was on the pathway to having, all of them were related to adverse childhood experiences. I had no idea why because that was not me, or at least I thought. That was my son. My son had had a lot of childhood trauma. I had not. Why was I having the same health issues as one of them?

It started me on this pathway of asking questions around, well, what exactly is trauma? What exactly are those things that happen in childhood that create these adult-onset diseases? Through that process, I started learning and tracking my own system, experimenting with my own system, then started all of my trauma therapy trainings, all to help me better understand what was happening in my own body and how to get my life back. What I was experiencing was not what I wanted my future to be.

That is how I developed all this. That is how this started. This was never intended initially to go out and help other people, and certainly not to start a professional training program, where I am training professionals around the world in my methodology. This started with me having to figure it out for myself, not knowing if it could be done, not knowing if as an adult, we could actually rewire these trauma and stress patterns that have been in our system since childhood. I was willing to figure it out and do everything that I could in order to see if it could be done, just to get my life back.

Dr. Eric:

That is some story. Thanks for sharing. When working with any chronic health condition, most listeners have a thyroid or autoimmune thyroid condition, be it hypothyroidism or hyperthyroidism. A decent number of people will respond just to diet and lifestyle, stress management, getting proper sleep, taking supplementation. There will be people who just don’t respond, not to say that with all of these people, it’s adverse childhood experiences. Is it still safe to say that at least in some of these people, that is playing a role in them not getting the results they or I are expecting to get?

Dr. Aimie:

I may say something really controversial here. Many people might not want to hear me say this. This is what I have found: When it comes to these chronic diseases, especially autoimmune, all autoimmune conditions fall under the category of being trauma-related, not stress-related. That opens up this whole can of worms to be like, well, then when would you have experienced trauma? We need to redefine trauma because just like me, you may look back on your life and be like, “Me? I haven’t had trauma. I relate to being stressed, but not traumatized.” I had to relook at what is trauma? That’s why I call it the Biology of Trauma. There is a whole biology of trauma. Autoimmune conditions are squarely in the freeze response or trauma response category.

Dr. Eric:

That brings us to the question: What is the difference between stress and trauma? Why don’t we dive into that right now?

Dr. Aimie:

Let’s do it. This is a really important distinction. Most people aren’t aware of this distinction. Most professionals, even practitioners, you will still hear them say, “fight, flight, or freeze,” as if all three of those are the same. They’re not. Many people are being diagnosed with stress or even chronic stress when they should be diagnosed with trauma. You are in a trauma response. Your body is chronically in a trauma response, not a stress response. Here is the difference.

There are three ways you can tell the difference between stress response and a trauma response. One is your body’s sensations. One is the thoughts you’re having. The other one is the physical health conditions or symptoms you are experiencing.

Let’s go with body sensations first. When you are in a stress response, it is that state when you are actively running or facing and fighting the danger in your life, whatever that danger is, whatever that problem is. It is when you are running from that dog who is going to bite you. It is when you are racing towards your meeting in order to get there on time. It is a very high energy state. Your senses are very alert and tuned into the problem. What are all the different factors contributing to that problem? What do I need to do to face that problem? Stress response is when you don’t want to go to bed because you actively have a problem, and you want to solve it. You’re taking action to solve it.

The trauma response is when it feels like things have been too much, and all you want to do is go to bed. In fact, you don’t want to get out of bed. You want to pull the covers over your head. There is a problem in your life, but it feels like you don’t have the energy to face the problem. There is this sensation of a collapse of energy, a low energy. In fact, when you feel into your body, it’s when you want to curl up into a ball.

A fight response is, “No, I am going to fight you.” The trauma response is, “I’m done fighting. I don’t have the energy to fight anymore. I may still go through the motions because I still have responsibilities. I still have a job, I still have kids, I still have a partner, I still have life.” That is what it feels like. “I’m just going through the motions” rather than experiencing the aliveness and energy and joy and feeling like you’re actually present and engaged.

The trauma response will have you feeling like you’re distanced, like things are a little foggy. Things are a little numb. You don’t feel like you belong. You feel like you’re on the outside looking in, sometimes at your own life, let alone at a group of people. You can be surrounded by a group of people yet still feel very alone. That is the trauma response. That is the difference between trauma and stress.

Dr. Eric:

If someone is dealing with chronic stress, oftentimes, you will hear practitioners, and that includes myself, talk about blocking out time for stress management and incorporating mind/body medicine, whether it’s meditation or yoga or biofeedback or tai chi, or anything else. Is it safe to say then that with trauma, that is not the solution? Let me ask this differently; Does mind-body medicine play any role when it comes to trauma? Is it for those who are chronically stressed?

Dr. Aimie:

Like you say, there is a lot of different modalities. Rather than focusing on which modality, I teach the principles of what the trauma response needs in order to come out of the trauma response. What does the stress response need? Those are two very different things. When we think that it’s stress, and we apply tools for stress, but it’s actually trauma response, those tools aren’t going to work.

That’s when people can get stuck, or they experience resolution of those physical health symptoms, but then other physical health symptoms appear. I have seen this quite often in people who do some of these different modalities that maybe their gut issues resolve, their thyroid issues resolve, but then it shows up as something else, like chronic pain or inflammation somewhere else. It always shows up somewhere until we actually work with and resolve the true underlying and root cause.

What the trauma response needs is three things. The trauma response has to have a felt sense of safety. I’ll come back to that because it can be tricky for some people. The other things are time and energy. The trauma response is an energy problem, so that’s where the biology factors come in. We need to look at all of the things that are draining our energy that are contributing to us continuing to go into the trauma response. It’s become this conditioned pattern. Now we just go automatically into it without really even needing a trigger because that’s what we’re conditioned to do. It needs time.

There are two triggers for the trauma response. One would be when things happen too much too fast. The body hasn’t had time to process what’s happened. it hasn’t had time to integrate what’s happened. It overwhelms it. it goes into the trauma response. The trauma response is in a sense our protective adaptation to buy us some time.

Then it needs a felt sense of safety. If you were a turtle, and you had danger approaching, you’d pull your head back into your shell. That’s like a trauma response. We close up. We retreat within ourselves. We’re not sticking our head out until it’s safe outside. We don’t want to get our head bitten off. That’s the same thing with the trauma response. We’re not going to come out of that trauma response until we have a felt sense of safety.

Here’s the problem: So many people live in their heads. They are used to thinking about things and talking about things and analyzing things. They have no idea that they actually don’t feel safe in their own body. They tell themselves that they should feel safe. They maybe even say affirmations and mantras and do mind/body medicine that tells them. Is it a felt sense? Do they actually feel safe in their body? Until that is in place, the body itself will stay in its trauma patterns. Doesn’t matter what the mind does.

When we look at the different modalities that are out there that can help us, that is the question we want to ask: Does this help me create a felt sense of safety, time, and energy? If so, then it’s the right tool for the trauma response. If it doesn’t, it still maybe the right tool, but it’s not the right time to use this tool.

The stress response needs different tools. Those may be better tools for the stress response. We are not in the stress response yet; we are still dealing with the trauma response. Anybody with active thyroid issues, especially autoimmune, is in the trauma response. Unless you have a thyroid storm, and then you are clearly in the sympathetic stress response, but otherwise, if you have any version of hypothyroidism, the fatigue, the heaviness, the low metabolism, those are all symptoms of the trauma response. It doesn’t need to be emotional. It can be our biology that pulls us into that trauma response.

Dr. Eric:

You’re explaining that connection between the physical trauma and emotional trauma. That’s one of the things I wanted to ask you about.

Dr. Aimie:

It can be both. When we look at adverse childhood experience studies, for those who may not be familiar with those studies yet, I encourage you to look at those. They came out of the work of Dr. Vincent Felitti in San Diego at Kaiser, working with obese women and noticing that a high percentage of them had had sexual trauma in their childhood. It opened up this question for him: Is there a connection here? He was willing to ask the questions that no one else wanted to ask, let alone talk about.

Since then, it’s opened up all these other questions of if that’s the association with obesity, what about with autoimmune thyroiditis? What about Hashimoto’s? Yes, there are clear connections between adverse childhood experiences and autoimmune thyroid conditions. There is a great paper that came out in 2009 by SR Dube. If you search “adverse childhood experiences, thyroid, 2009, Dube,” you will find the article. There is a very clear association. What they also found in that is it’s not only the association with the thyroid issues, but it’s also the severity of symptoms that you are likely to experience. The more stress or the more adverse childhood experiences you had as a child, the more that predicts you will even be hospitalized for the severity of your thyroid symptoms.

There is another article that was published in 2018. This was looking at subclinical hypothyroidism in pregnancy. What they found is that the childhood stressor or abuse is associated with increased risk of mothers experiencing subclinical hypothyroidism when they are pregnant. This was published in the journal Psychoneuroendocrinology in 2017.

There is another article on post-traumatic stress disorder and the incidence of thyroid dysfunction in women, which was published in 2018 by Cambridge University Press. They found there is this association between the diagnosis of PTSD having a higher risk of hypothyroidism. Of course, it does. Hypothyroidism by itself puts us into a trauma response. We see these connections that the earlier in life, and the more times in life that you have experienced overwhelm, that is what actually promotes the nervous system changes that cause the immune system changes that cause autoimmune. Stress does not cause autoimmune. The trauma response is what causes autoimmune. The autoimmune causes the trauma response. It goes both ways.

Dr. Eric:

Obviously, you brought up these examples because you know my audience consists of people with thyroid and autoimmune thyroid conditions. If you did the same studies on multiple sclerosis or lupus or rheumatoid arthritis-

Dr. Aimie:

All autoimmune. You can’t ignore the facts. That’s why when my autoimmune markers came back high, and my doctors wanted to make it insignificant, “Well, you haven’t had any of the clear symptoms yet. Once you have those symptoms, come back, and we will diagnose you with lupus.” How do I get off of this path? I don’t want an autoimmune condition for the rest of my life, but I am clearly on this path. That’s what my studies led me to, “Aimie, you can’t ignore the facts.” This is related to what I thought at the time was stress, and I have since learned it’s trauma response. That became my focus of how do I work with my trauma response so that it is no longer driving my health?

Dr. Eric:

Can you talk about some of the things you do? Some of the therapy modalities or methods you use to regulate the nervous system.

Dr. Aimie:

In the approach I have created, which is The Biology of Trauma, there are three arms to this approach. One arm is what I call somatic work or body work. This is where I use my mind to put attention on different sensations on my body so that I can be aware of what’s happening and provide it a felt sense of safety, which is what the trauma response needs; provide it a felt sense of support, which is what the stress response needs; and provide it with a safe experience of growth and expansion and joy and healthy anger and boundaries and all of these other things that autoimmune people need to work on as well. The somatic work, which is working with the body and body’s sensations, using the mind to put attention on the body.

The second arm is our thoughts and belief systems. I classify this as parts work. Anyone who is familiar with internal family systems, this is how I frame this. There are different parts of us. There is the part that experienced a situation in life. What were the belief systems that we made coming out of that? What were the stories we told ourselves about ourselves coming out of that experience? Those now have continued to drive our belief systems about ourselves, our views of ourselves. I actually incorporate parts work in our belief systems with the body work so that they are actually done together.

Then I bring in the biology piece. As we can see, whether we’re talking about stress or trauma, but especially trauma, it has chronic effects on our biology. Now it’s no longer enough to go back and process the trauma, which I will mention that we can’t process trauma until we have some tools in place. We can’t process that trauma and expect everything to be resolved because now we have had this downstream effect. It’s our biology that will keep us stuck.

We also do need to address how our biology has been affected by the trauma. The tools that we have to use include what we call regulation. Regulation, you can think of as stabilizing the body.  I did 3.5 years of general surgery residency. When a person goes into surgery, surgery can be thought of as processing trauma. We are going to fix the problem. We are going to rewire the nervous system. We are going to do this big release, or whatever it is that we’re processing. That is what happens in surgery. You just don’t take anybody to surgery at any time. You have to do a pre-surgery assessment. Are you ready for surgery? Are you ready for processing that level of trauma, that depth of trauma? Are we actually going to retraumatize you by trying to help you?

That is what a lot of therapies do. They try to help people process when they are not yet ready to process. We haven’t stabilized the system yet. The body has to be stabilized to go into surgery. You wouldn’t go into surgery without anesthesia. You would create more harm than good. That’s what we do with therapy. We are trying to do good, but actually putting them in a place where we are asking the body to do more than what it’s prepared to do at that time. It’s not yet stabilized. Doesn’t have the tools yet.

Those tools are called regulation skills. The short of it is, the regulation skills are the body work. Our being able to shift my own states of my nervous system to be able to recognize when my system has gone into the stress response, the trauma response, and have the tools in the moment to create a felt sense of safety or a felt sense of support or to bring my system back into parasympathetic.

So many times, we have relied on other people to do that for us, whether it’s a therapist, our partner, our friends. We have relied on other people to help manage our emotions, to help stabilize us, to help bring us back down to a place of settling and feeling okay. We go to therapy in order to help us feel safe in an area of life that we don’t feel safe. That is why the therapy doesn’t work, no matter what modality you use, because a person needs to go into therapy feeling safe for their body to be ready and open and able to process what happens in that therapy session. Otherwise, we can retraumatize people by even a good thing causing too much too fast.

There was one other trigger for the trauma response other than too much, too fast, which is too little for too long. Too little of something that you need for too long, be it too little of support, love, touch, whatever it is. Too little for too long is the other trigger for the trauma response in our life.

Dr. Eric:

Wow, this is quite a process. You said the reason why therapy doesn’t work, or if someone goes to a psychologist, is they need to feel safe prior to seeing a therapist or psychologist. On top of that, they are not dealing with the biology. They are just dealing with the psychology. That’s why someone might be seeing a therapist or psychologist for months or years. Maybe they are getting a little bit of progress, but not where they could be by seeing someone like you, who focuses on the whole picture.

Dr. Aimie:

Yeah. One thing I discovered that I’d love to share is how to know when the therapy that you are doing is actually retraumatizing you. Sometimes, we are not aware enough of our own bodies yet to be able to recognize that. It shows up in our health. If you are experiencing a flare-up of your physical health conditions, of your chronic health conditions, for me, I would experience a flare-up of my autoimmune stuff. I would wake up and feel inflamed, and my gut issues would flare up. Those are signs that what you are doing is too much for your body. You are actually retraumatizing yourself. That is how it’s manifesting. That’s how it’s expressing. That’s how it’s trying to talk to you and get your attention of, “This is not the right thing at this time. This is too much too fast for us.”

We can use our physical health as a measure, as a monitor for how we are doing any therapy process, and whether it’s helpful, and maybe it’s a good thing, but not just the right thing at the right time.

Dr. Eric:

After or while someone is working with you, a lot of people don’t know this, but my bachelor’s degree is in psychology. If someone works with you, is it completely unnecessary to see a therapist or psychologist? In some cases, is it still beneficial to see someone in addition?

Dr. Aimie:

Great question. I’m not going to say that no other process is going to be helpful. I don’t call what I do therapy because what I’m doing is teaching you how to give your body what it needs to heal itself. That’s very different than going to somebody else and saying, “Will you please fix me?” This is a natural part of the trauma response. We lose our own sense of power. We feel powerless. We feel like it’s too big for us. It’s a very important principle in my methodology to empower people and teach them so much of what they can do for themselves.

It is my belief in my experience and certainly with the thousands of people who have come through my courses that when they have the skills to do a lot of this themselves, the rest becomes clear. For some of them, they’re good. Their health conditions are better. We have had some come through with their thyroid levels off. Then they regulate their nervous system and provide a felt sense of safety and support, and their thyroid levels come back to normal. It’s been phenomenal the health changes that happen.

For some people, it becomes clear to them that “This over here is another piece I’m missing. This is a piece that is the next best piece for me.” It changes the feeling of being lost. “I don’t know what to do, so I’m going to randomly pick something and hope that they know what they’re doing.” This process changes that, where now they are making decisions that are coming from a place of clarity. “I can tell what my body needs. I know what my body needs. Let me go find someone who will fit that piece and be able to do that for me.”

It’s a very different place than feeling like you’re spiraling out of control and grappling for something, someone, somewhere that can help you versus “I know my body, I’m an expert on my system, I’m an expert on my trauma, and I know that this is the next piece for me. Let me go find that specific person.” It’s completely different. It’s such meaningful work to see people go from a place of feeling very lost, feeling very broken and being able to see that through this process, they come to their clear path forward.

Dr. Eric:

This is important not just in regaining someone’s health, but in maintaining their health, too. Flare-ups will happen. Obviously, you can’t undo the past, the trauma(s) that people have experienced in the past. If someone is dealing with Hashimoto’s or hyperthyroidism/Graves’, and maybe they just haven’t gotten the results that they expected by changing their diet and doing other things that I teach on the podcast and other functional medicine practitioners teach, what are some next steps that you would recommend they take?

Dr. Aimie:

I would recommend they start to look into the trauma. I know this is scary, and it can be daunting to look at trauma work. Or maybe I have been doing trauma work, but I have been doing it wrong.

I have created a starting place for people, so that can be a helpful place. It’s a starting place for doing this type of body work, trauma work through the lens of what were the overwhelming experiences that I’ve had in my life? Let me start with the superficial layer. Let me do things gently. Let me learn how to build in these felt senses of safety and support rather than what I call jumping off the cliff of the emotions where I hope you have your parachute because that can be a hard landing if you are trying to go process something.

I have starting place retreats, and I do them over a weekend, Friday-Sunday. Very low time commitment. 30 minutes for Friday, an hour and a half on Saturday, and an hour on Sunday. It is a starting place to show people this is what this type of trauma work means, so you don’t have to be afraid of it. You know what it’s like. They can make a decision to continue on with me, or they now have a better sense of what it is that they need. They sometimes go and find that in their local area, someone they can meet with in person. They don’t do an online course with me.

I do a 21-day journey for those people who want to do that journey with me and have me guide them into their own body, their own nervous system, and start to become the experts of their system. There are options, but they need a starting place.

My strong recommendation is get to know what it is that you actually need, what your body needs. From there, things start to become clear. If that is coming to my Starting Place Retreat, come. Experience it. Be able to make a better informed decision of what do you want your next step to be? Do you want it to be one of my longer courses? Do you want it to be something in person, but now you have a better idea and sense of what it is that you’re looking for? How gentle or fast is your body ready to go? That is something that each person needs to know in order to keep it safe and not have it be an experience that retraumatizes them.

Dr. Eric:

The three-day retreats are in person, not virtual? Is that correct?

Dr. Aimie:

Those are all virtual.

Dr. Eric:

Okay. Anywhere, people can do them. You mentioned the 21-day program. Obviously, that’s online. Anybody can do that as well.

Dr. Aimie:

Yes. The 21-day Journey is what I designed. I was taking all of my patients through. At that time, I was still having my own clinical practice. I noticed that if I could teach them these skills first, their health/baseline was at a very different place. We could do so much more and faster with their actual medical care. I started having all of them do just 21 days of some very simple, basic somatic work. These are short exercises. I teach these exercises. They are 10 minutes every day.

The whole first week in that 21-day journey is me teaching them the seven different exercises to create a felt sense of safety. This is where most of them tell me, “I didn’t even know that I didn’t know what it felt like to be safe. I didn’t know.”

The whole second week is me teaching them seven different exercises to create the felt sense of support. When you feel like someone has your back, my goodness, you can do anything. We are able to stay in that stress response and not have our stress turn into trauma because we felt all alone, and no one understood what we were going through.

The third week of that 21-day journey, I teach them different exercises on how to safely step into growth and expansion and joy and healthy anger and boundaries, all of these things that we need to bring into the trauma work, but we also need to bring it in at the right time. That is never at the very beginning. We need to create a felt sense of safety and support first. Then we can move into these more expansive things.

Dr. Eric:

Would you say this is something that everyone can benefit from?

Dr. Aimie:

Every single person.

Dr. Eric:

I’m asking because especially those with an autoimmune thyroid condition, but you said every autoimmune condition, trauma is a factor.

Dr. Aimie:

Who in our life today does not experience stress and overwhelm? Everyone, to some degree. I really do consider this as the manual for our human bodies and knowing what our bodies need to get through life in the most healthy way possible.

Dr. Eric:

I probably need to go through that too, then.

Dr. Aimie:

I would love to have you in it.

Dr. Eric:

I know we covered a lot. Is there anything I didn’t ask you that I should have asked you? Anything else you’d like to share?

Dr. Aimie:

We did cover a lot. I imagine there are some people who already feel overwhelmed with all that I shared. I just want to share hope. There is so much hope, no matter how old you are, no matter how far you are in your disease process. No matter what, no matter how your life experiences have been up until now, there is so much hope. It’s just using the right tools in the right way in the right order. That is what we have not been doing. That is what will give us so much more freedom and change for our future.

Dr. Eric:

Well said. Thank you so much, Dr. Aimie for sharing your knowledge on trauma and relating it to thyroid health and autoimmunity. I am sure the listeners learned a lot. I did as well.

Dr. Aimie:

Thank you so much.

 

Recently I interviewed Josie Warren, who shares how she regained herself after dealing with eight different autoimmune conditions, all by addressing a single trigger. If you would prefer to listen the interview you can access it by Clicking Here.

With me, I have Josie Warren. She will be discussing how she overcame multiple autoimmune conditions. Josie is an autoimmune expert. She used to have Graves’, Hashimoto’s, and six other autoimmune disorders. She completely resolved all of her autoimmune conditions and now takes people down the same path of healing she has traveled. Thank you so much for joining us, Josie.

Josie Warren:

Thank you, Dr. Eric. It’s great to be here. Excited to speak with the Save My Thyroid audience.

Dr. Eric:

Great to have you. Why don’t we go ahead and start off by giving your background? How did you start doing what you’re doing today, which is helping others with autoimmune conditions?

Josie:

That’s a great question. Like all of you listening out there, I also had multiple autoimmune conditions starting in high school. I started with arthritis. Seems like you can’t just have one. They snowballed over the years, as I continued to not deal with my life and stressors.

By the time I was 28, I had to leave my profession. I used to be a licensed professional counselor; I worked at the Betty Ford Center. I loved it, but it was very stressful. I decided to set out on a quest to figure out all my health conditions. I had about eight autoimmune disorders at this point, and some mental health conditions as well.

I found an organization here in Denver who I was told could help me because I was someone that doctors didn’t have any explanation for. I came here and was able to learn a very unique and novel perspective on healing from autoimmune. Within a number of months, all my autoimmune disorders resolved and went away. It so profoundly changed my life and gave me my life back that I knew I had to learn and teach this.

I left my profession as a licensed counselor. I trained for five years. Now, I teach the same educational program that I learned, but we’re always updating it and making it more current. That’s what I do now. I am an autoimmune expert, taking others down this same path.

Dr. Eric:

That’s some story. What autoimmune condition were you diagnosed with first?

Josie:

The first one was rheumatoid arthritis. I believe I was about 17 years old, 16 or 17. I didn’t think much of it. I didn’t see that as a red flag, that there was something not right in my immune system, and I should be noticing there was a dysregulation happening.

Dr. Eric:

As you probably know, I was diagnosed with Graves’. One question I had for you also is family history. When it came to Graves’, I honestly don’t know anybody else in my immediate family or even distant family who had Graves’. There are some hypothyroid cases. I’m not sure if they had Hashimoto’s. Either way, is there a history of autoimmunity in your family?

Josie:

There is. My sister has lupus. My mom had hypothyroidism. Back in the day, I had many great-aunts who had what I now believe to be some autoimmune conditions that they were going more misdiagnosed. My grandmother had autoimmune. Yes, autoimmune definitely runs in my family.

For me, for many out there, if it’s genetic, I thought that I was trapped, and there was no way out of these conditions because of that genetic factor. I always like to teach people and talk about how we are not a prisoner thankfully to our genes. For me, even though I have a history of it, now, not having any autoimmune, I can attest that the genes do not hold us back.

Dr. Eric:

I agree. The reason I ask is because you had so many autoimmune conditions. As you said, regardless of whether someone has one autoimmune condition, like I did in the past, or many conditions, like you dealt with, genetics is still a factor, but it’s not the most important factor. I’m glad you brought that up.

Can you discuss some of the similarities between different autoimmune conditions, what they have in common?

Josie:

Absolutely. I’ll speak for how I was taught back then, and now what I understand. When I had all of these autoimmune conditions, I was taught that they were all separate and to treat them separately. I was seeing different specialists to treat all of these conditions. Different endocrinologists, immunologist, rheumatologist. I was also doing functional medicine and seeing nutritionists and doing herbs. I was trying the whole spectrum for all of these different conditions.

What I have found is not only do they share very similar symptoms, symptoms such as brain fog, fatigue, body pain, but I have also found they are all coming from the same place. That is what I did not understand when I had them for all those years. All of my autoimmune conditions were coming from the very same singular root cause, which we know here is stress and chronic stress. I focused on the one root cause that was causing my immune system to go overactive and to malfunction, all of the autoimmune conditions resolved, and all of the symptoms resolved, just by working on one thing. Before, where I was working on everything separate, treating them all as separate conditions, I actually would never have found for myself a way out of them.

Dr. Eric:

You brought up a great point. In the conventional medical world, you go to different specialists depending on the autoimmune condition. If you have an autoimmune thyroid condition, you will see an endocrinologist. If you have rheumatoid arthritis, chances are you will see a rheumatologist. If you have some kind of gut disorder, you will see a gastroenterologist, even if it’s autoimmune. There is not an autoimmune specialist amongst conventional medical doctors. They are not focusing on that autoimmune component, like you said.

In my experience, you could have multiple triggers when you have different autoimmune conditions, but in your experience, there was one main factor, it sounded like. Once you resolved that, you got everything under control, which was great.

How important was diet when it came to restoring your health? I imagine it had to be at least a piece of the puzzle. I wanted to get your opinion as far as what type of diet you followed then. What type of diet do you follow now, now that you’re in a state of wellness?

Josie:

Great question. Thank you for asking. What I will share is going to be different than what you are hearing out there. Up until I got healthy, those years of autoimmune conditions, I was really focused on restrictive food diets. Like many out there, I went from diet to diet. I did elimination, AIP, the LEAP program, low-FODMAP, gluten-free, sugar-free, the Candida diet, Bulletproof, paleo, just to name a few. I was really on a lot of diets.

By the time I came to the organization I work for now, A New Life Center, I was only eating five foods. That’s all that my body could handle. If I remember right, it was kelp noodles, spinach, garbanzo beans, coconut oil, and something else. That was my daily diet. I could not handle anything else because of the years of restrictive food diets I had been on.

In my body healing and self-repairing, there wasn’t a diet component to that because what I found here was that the reason my digestive system wasn’t working properly, the reason my gut was leaky, and the reason I had all of those digestive issues wasn’t the foods I was eating. It was my immune system. My body was stuck in the sympathetic nervous system due to chronic stress. When I worked on my chronic stress, my body was able to exit out of the sympathetic, enter into the parasympathetic nervous system, and in that, my gut naturally healed and self-repaired. That process happened all without a food diet.

My experience, and the experience of my students that I work with, we don’t work with any diets. I didn’t do any diets to resolve my conditions. Now, to give people hope out there, I’m happy to report that it’s almost been eight years since I’ve had these conditions, and I am not on any restrictive food diets. I eat a normal, healthy diet. I enjoy barbecues, birthday parties. I have a birthday coming up in a few weeks, and I will be getting a cake. I don’t have to worry about foods I eat because I don’t have these conditions anymore.

Dr. Eric:

You mentioned a normal, healthy diet. It sounds like most of the time, you’re still eating healthy. You’re not going to McDonald’s every day.

Josie:

No.

Dr. Eric:

You’re not eating cakes and cookies every day. Maybe for your birthday and special occasions. Maybe more frequently than that. When it comes to working with clients, there is no special diets like AIP or paleo. Do you tell them to restrict anything as far as gluten or dairy or any other foods?

Josie:

Like myself, many of the students I work with who come in with different autoimmune such as Graves’, Hashimoto’s, fibromyalgia, and other chronic illnesses like migraines are often on special food diets. They are coming in severely restricted on foods, oftentimes AIP, gluten-free, dairy-free, etc. I just let them know, “Hey, it’s up to you if you feel like you want to continue this” while they are in my program. Some do. Some choose not to.

I know that at the end of the program and working with me, the immune system will go back to normal; the digestive system heals and self-repairs. Regardless of if they are on a food diet or not, they are then able to start reintroducing foods that they were once maybe sensitive or allergic to back into their diet.

While I don’t work with food diets, and some choose to stay on them and some not, every person I work with who is/was on a food diet, I teach how to reintroduce foods just like I did for myself. They are able to go back to eating those foods that they were once allergic to, even things that they were sensitive to, like gluten. I work with people with Celiac who can now eat gluten. Even people who had anaphylactic experiences to things like nuts are, over time, able to go back to eating those as well. I focus more on the reintroduction versus the taking out.

Dr. Eric:

Very interesting. It sounds like stress was a big factor. I also listened to some of your other podcasts. I try to get acquainted with my guests before I interview them and learn about them. I know you had a journey with regard to stress and mental health. Can you talk about that, as far as how that ties into autoimmunity, not just your condition but your students?

Josie:

Yes, I love talking stress because it’s the thing that I find no one is talking about when it comes to autoimmune, and it is, from my experience, the singular root cause. What I didn’t understand, and this is true for myself and anyone that I have worked with on autoimmune, is that we are not good stress people. We are born into this world not well wired to handle stress. Unfortunately, what happened with myself and everyone with autoimmune is that we unconsciously suppressed stress in our bodies.

If you think about a lifetime from birth on, suppressing the stressors that we have been through, things such as, even at a young age, moving, siblings being born, maybe a parents’ divorce, heartbreaks, graduations, new jobs, marriages, we just suppress that. All of that stress layered into our body until our body reached a tipping point. Physically, it could not handle any more suppressed stress.

That was my experience. I had a lifetime of suppressed stress. I had the health to show it. We all have different kinds of conditions that led up to these autoimmune that we had. They didn’t come out of nowhere. There is actually a term for that, “allostatic load.” That is a term that talks about the accumulative wear and tear of our bodies due to increased stress in our lifetime. If you were to take a timeline of the conditions you had, say, even, strep or sinus infections and things like that, and you layered it over the stressors of your life, you will see them line right up.

For people like us with autoimmune, from my perspective, you have reached that stress tipping point, and we have one stressor that is one too many. It pushes our body over into a nervous system called the sympathetic, which is where fight or flight exists. Our fight or flight kicked on, but it unfortunately stays on due to the chronic stress of our life. It thinks we are under a constant threat. From that point forward, people with autoimmune are stuck in the sympathetic. The immune system goes overactive. People with thyroid conditions, it starts attacking our thyroid. That’s where it all comes from.

For me, stress is everything. The reason we haven’t healed is because we haven’t dealt with our stress. Deal with the root cause: chronic stress. I have found fight or flight will always turn off. Then the body can fully heal and self-repair. The immune system goes back to normal. The body no longer has autoimmune anymore. That’s why I no longer have these autoimmune disorders and why my students don’t either. Love talking stress.

Dr. Eric:

Stress definitely was a big factor in the development of my Graves’ condition. A lot of people are in a sympathetic state, and we need to make the switch more to a parasympathetic state.

I’m sure you’ve spent a lot of time with your clients as far as trying to help them overcome the stressors. We don’t have time to go over everything during this call; that’s why they would see you. Can you go over at least some of the basics? What do you do? Do you do testing to look at their adrenals? Do you just assume everyone has stressed-out adrenals, and you have people do mind/body medicine? If you could give some pointers of what you do to help your students deal with stress or eliminate the stress, whatever approach you take.

Josie:

There is a lot of misconception about stress out there. Our society likes to deal with stress after the fact that we’re stressed. Then we’re told to work out or sleep more or eat healthier. That’s not really getting to the reason of why you are stressed in the first place.

What I do and what we teach here is an educational program. There is no need for any kind of lab testing or bloodwork. We let their doctors do that testing. People I work with have already been diagnosed, so they can do that testing before they work with me and after, or within the program if they feel like it. I know definitively stress is the way out. Everybody I work with, I do the same stress work with, and everybody gets better, regardless of age, what or how many autoimmune conditions or chronic illnesses they have. I know it’s stress. We just have to learn a new perspective on stress.

When we learn a new perspective of life and stress, our experience changes internally, and we are no longer feeling chronically stressed anymore. Fight or flight picks up on that and turns off. You enter into parasympathetic. Autoimmune resolves. The body heals and self-repairs.

I have three tips I can share to give you an idea of what I’ve done and what I teach my students. The first one is we have to normalize stress. We have to realize that our stressors are really not unique. If I think the things that have happened in my life are worse than others and more unique, I make them too big, and I can’t handle them or overcome them. We have to realize that as humans, we all generally have the same kinds of stressors in our lives, give or take. If you wrangled up a group of 100 people, you’d find the same things. I needed to learn that for myself to normalize my stress. We can know and anticipate the stressors we have because that’s what humans have. It’s what our ancestors a couple hundred years ago had. It’s what the people who come after us will have. First, we have to normalize stress.

The second thing is I teach people that stress is an internal experience, meaning it’s not given to us by the things, events, and circumstances. Our stress comes from inside of us. That’s why if you fly on an airplane, you will find five different people with five different experiences or stress responses to the same stimuli. Some people might be relaxed; some people might be taking medication to help them with the stress experience; some people might have the bag out. You don’t know. That’s because stress comes from us. If it comes from us, which it does, the key is there is something you can do about it. Remember, stress, from my perspective, is the root cause of the autoimmune condition in the first place. If there is something you can do about it, that’s wonderful. You will be your own solution.

The third thing that I teach people is that to resolve our experience of stress, we have to activate and grow and build the resolution of chronic stress, which is our natural resilience. I know “resilience” is a buzz word. It’s our ability to be adaptive and bounce back quickly in times of stress. It’s our ability to go out into life to grow and learn. Our ancestors had strong resilience because they had to deal with all these day-to-day events for their survival. We have a very easy life these days. Resilience has gone a little weak.

I teach my students it’s by going back out into life, into the stressors, not hiding from them, willingly, to grow and learn, and to build our own internal strength, that your body and self is able to handle your stress. You grow that resilience. Again, your body picks up on that, and your fight or flight will turn off. That is how you enter into that parasympathetic nervous system.

In a long nutshell, that is my framework of what I teach on stress. It’s not after the fact. It’s prevention and doing it before it happens, by changing our perspective.

Dr. Eric:

It’s not getting rid of the stressors. Many times, that’s not possible. Even if you can eliminate some stressors, we are always going to be faced with stressors in the future. Some of them are unexpected. You are teaching people to deal with their current stressors better as well as from a preventative perspective. Improve stress management skills and their perspective of stress, so that future stress won’t have that same impact on their health.

Josie:

Yes. It’s changing us. You make a great point. Our society teaches, and I did this for some time before I knew better, “Oh, I’m stressed. I have to leave that place. I have to move. I have to leave that job, that relationship, etc.” That is no solution because wherever we go, there we are. Stress is in us. We are the creators of our stress. I was the one who had to change my perspective. Then I could keep the same life I have. It’s no longer feeling chronically or overwhelmingly stressful anymore because I have the resilience and the ability to handle it. From that, our body will heal and self-repair our autoimmune and chronic illness.

Dr. Eric:

You said you don’t do any testing. You leave the testing to the practitioners. Correct?

Josie:

That’s correct.

Dr. Eric:

If someone with Graves’ or Hashimoto’s came to see you, how do you know that they are in remission? Is it based on the tests that they are getting with another practitioner, like they go to an endocrinologist, and their thyroid panel stabilizes, their antibodies normalize? Maybe you don’t look at those. How do you determine if someone has restored their health?

Josie:

Great question. I have two answers to that, but I want to touch on remission. I was taught back before I learned this and healed that remission was the best I could do. That was the top of the pyramid. Everyone is searching for remission. What I have found and what I teach is the step beyond remission, which is the condition is actually no longer present anymore in the body. In remission, we are still in that sympathetic state. The immune system has still malfunctioned. Unfortunately, no one taught me this, but it’s only a matter of time before a flare-up will pull a person out of remission. You don’t know when, but you know it will. That is the problem there. With remission, it doesn’t mean the condition is gone.

What we teach with stress is that when you can get the body out of that sympathetic nervous system state, when you can get it into the parasympathetic state by eliminating the experience of chronic stress, the immune system actually goes back to normal functioning. In the case of Graves’ or Hashimoto’s, that immune system permanently stops attacking the thyroid. When your immune system stops attacking that organ, you no longer have an autoimmune disorder. That is actually beyond remission; that is a permanent elimination of the autoimmune disorder. There is nothing that needs to be done to maintain that. That’s why I don’t have to be on restrictive food diets or take supplements to maintain my health. My immune system is healthy and back to normal.

For testing, it’s very interesting. What we find is that when a body gets into that parasympathetic state, when you eliminate chronic stress, the immune system goes back to normal, the autoimmune disorder resolves permanently, and the symptoms do as well. People don’t always test normal right away. We recommend for people outside of my 10-week program to give themselves six months or a year. Give their body some time to get in that parasympathetic nervous system for all the levels to test normal.

Regardless of levels testing normal right away, it is undeniable when a person no longer has an autoimmune condition. You will feel physically tangibly that internal health of you’re no longer fatigued. I used to have almost no hair up here. Your hair grows back. Your weight stabilizes. You wake up in the morning with energy. Your skin is moisturized again. For hyperthyroidism, you’re not anxious all the time, your heart isn’t palpitating, and you’re not sweating abnormally anymore. You go back to living a normal, healthy life. You can feel that regardless of testing or not.

We don’t do testing because we’re education. People have gotten tested, and I have gotten retested outside of the program. We don’t have anything anymore. Our immune system has gone back to normal.

Dr. Eric:

It’s an interesting perspective. I have written articles like “Remission versus Cure.” I have been in remission since 2009, but everything is normal. I feel like I am cured. I am hesitant to say that because there is that genetic component. Even though it’s not just genetics, obviously environment plays a much greater role. I definitely agree with a lot of people who relapse, it’s just the stressor getting out of that sympathetic state, and not just shifting to the parasympathetic, but staying there.

This leads me to what you’re currently doing to maintain your state of wellness. Diet-wise, you spoke about. You’re not following any specific diet. Are you doing things on a regular basis to stay in that parasympathetic state?

Josie:

Just to answer a little bit from my perspective on what you shared to clarify my understanding, I want all the listeners out there to know, like I shared earlier: What I have found is regardless of if we have it in our genes or not, whether you have the genetic component or markers, it is no factor in the body’s ability to heal itself. It’s a nonfactor. It’s so wonderful because I know for so many of us, like myself, I felt that pulled me back. I couldn’t heal because of that.

Dr. Eric:

I agree with that. The environmental factors definitely are a greater factor. If you have the genetics, I agree, that’s not going to prevent you from getting into that parasympathetic state.

Josie:

It’s a great thing. I was so excited because I felt so trapped by environmental toxins, foods, GMOS and allergens, and when I threw in my genetic background and my family history, I thought there was no way I could ever heal.

What I teach, working on what we know as the singular root cause here, which is chronic stress, that’s all we work on. That’s all I was taught. Move my body from the sympathetic to the parasympathetic, and it’s been in the parasympathetic for almost eight years. I do not need to do any specific maintenance to keep it there. I eat a normal, healthy, all-American diet. Nothing too out of the ordinary. I don’t take any supplements anymore. I used to be on at least 12 a day. All I do is work on dealing with my life, going out into life to grow and learn, continuing to activate and grow my natural resilience and ability to do life. That is what reinforces my body in the parasympathetic. It’s my approach to life that is keeping me healthy.

I have worked with so many people. We have been doing this here for over 15 years. I have seen people who have done this work and resolved their conditions. They have been healthy for 12, 13, 14 years. They are all still in the parasympathetic state. When we really lock in there, it takes a lot of work for someone to get out. You’d have to be intentional, if that makes sense.

Parasympathetic, it’s not challenging whatsoever to stay in there. It really comes from how I’m approaching my life.

Dr. Eric:

No daily yoga or meditation or any type of mind/body medicine? Just your approach to life, your perspective on the stressors.

Josie:

Correct. I did come from a background of doing meditation. I did a lot of yoga leading up to this. I still had all of my autoimmune conditions. Did the supplements. Did all the restrictive food diets, like I shared. What I didn’t realize at the time was that was all symptom management, which was great if we want to manage our symptoms. But I want not to have the autoimmune disorders anymore.

It didn’t click with me that working on a symptom was never going to resolve the actual condition. I was having these symptoms because I was stuck in the sympathetic nervous system. Working on the foods, the supplements, the meditation, or even the yoga, that was me managing my symptoms in the sympathetic. When I got to the real root cause, and worked on stress, all of the symptoms and the autoimmune disorders resolved. I didn’t have to and don’t have to use symptom management because I no longer have the conditions anymore.

Dr. Eric:

You mentioned leaky gut earlier. That also ties into the stressors since the stress is the root cause of everything in your experience and with your students. In order to heal the gut, you found in your experience that it’s not so much the diet or other factors, but just the resiliency, the perspective on the stress, switching from the sympathetic to the parasympathetic nervous system state.

Josie:

Yes. Here is what made so much sense to me, and I wish someone would have told me this earlier. I asked, “Why am I having these autoimmune?” In addition to this, I had food allergies, leaky gut, candida, digestion issues, constipation, all the stuff that we have with autoimmune.

What I did not realize was that trapped in the sympathetic nervous system, not only does our immune system go overactive, and for a thyroid condition, it attacks our thyroid. In the sympathetic, the digestive system becomes compromised as well. In that fight or flight state, the body is turning off what it deems nonessential functioning. The digestive system is one of those. That is actually where the leaky gut is coming from.

Stuck in that sympathetic nervous system, our digestive system isn’t functioning properly, and we get leaky gut and those other digestive conditions. The way to resolve that is to get out of the sympathetic by eliminating chronic stress, so that the digestive system can then go back to normal functioning, which it does in the parasympathetic. It does it naturally all on its own. That leaky gut will naturally heal and self-repair without the need for supplementation, cleanses, and diets.

For me, that was almost a miracle. As stressful as my autoimmune conditions were, dealing with my leaky gut and the symptoms of my leaky gut were just as or more stressful than that as well. Again, parasympathetic heals and repairs on its own. The reason we have leaky gut is we are stuck in sympathetic.

Dr. Eric:

Thanks for sharing that. Are there any questions that I didn’t ask you that I should have asked? Anything else that you’d like to share?

Josie:

What I want to share is I want to give you all hope. I have been in your shoes. I know what it’s like to be trying diet after diet, supplement after supplement, maybe even different medications, changing doctors, and feeling so stressed, like “What is wrong with me? What is wrong with my body? Why did this happen to me?”

I want you all to know that there is nothing wrong with you. I say that with so much love. There is nothing wrong with you. You’re just like I was. Your body is just stuck in the sympathetic, and it’s staying there because you just haven’t been taught how to deal with life’s stressors. When you learn to handle your stress, your body will heal, and it will self-repair. I’ve worked with women who are 74 and have had these conditions for decades, and I have also worked with students as young as eight or nine who have autoimmune conditions. Everybody’s body can heal and self-repair by eliminating chronic stress. You’re not too far gone. You haven’t had these too long. There is nothing wrong with you that will keep your body from going back to the natural state that you were born into and healing and self-repairing on its own.

Dr. Eric:

If anybody listening would like to get in contact with you, work with you, can you tell them where to find you?

Josie:

Yes, I love hearing from people. I know what I’m sharing here, no one else is talking about. It brings up a lot of questions. If you have any questions, reach out to me on email. My email is Josie@TheHashimotosFix.com. My website is TheHashimotosFix.com.

I want you all to know that while my niche is Hashimoto’s, because it is the most common autoimmune disorder for women, as I’ve spoken about today, the work I do works with almost all autoimmune conditions, whether that’s Graves’, fibromyalgia, Celiac, Lyme, or chronic conditions like chronic pain and migraines, and other chronic conditions, like anxiety and depression. They are all coming from the same root cause from my experience: chronic stress. Reach out to me with questions. I love to hear from all of you.

Dr. Eric:

It was great chatting with you, Josie. I really do appreciate you sharing your knowledge on how you overcame multiple autoimmune conditions. I’m sure they learned a great deal.

Josie:

Appreciate it. It was great to be here. Thank you for having me.

 

Recently I interviewed Dr. Shane Steadman, as we chatted about the brain-gut-thyroid axis.  If you would prefer to listen the interview you can access it by Clicking Here.

With me, I have Dr. Shane Steadman. We are going to discuss the brain/gut/thyroid connection. Dr. Steadman is an expert in treating and supporting tough cases, such as concussions, migraines, vertigo, peripheral neuropathy, autoimmune conditions, thyroid and hormonal disorders, and other health conditions. Dr. Shane became a chiropractic neurologist in 2003 and is one of only a small handful of chiropractic neurologists in the state of Colorado. Dr. Steadman is the owner of Integrative Health Systems in Denver, Colorado. He has completed numerous hours of post-graduate and advanced studies in functional neurology and functional medicine, including functional blood chemistry and thyroid issues as well as neurotransmitters and brain function through the University of Bridgeport. Thank you so much for joining me, Dr. Steadman.

Dr. Shane Steadman:

Thanks for having me. It’s going to be fun. I’m happy to be on.

Dr. Eric:

I’m excited as well. The first question I have, just like many podcasts, hosts ask the person they are interviewing to give their background. My question is can you discuss what a chiropractic neurologist is? Then discuss why you became one. Why do you do what you do today?

Dr. Shane:

Chiropractic neurology is newer to the public but has been around since the early ‘80s. Chiropractic neurology is the idea of understanding the functionality of the brain and trying to identify which areas of the brain are working and are not working as well. To make it easy, it’s so much like a physical therapist. If you hurt your hip, you go to a physical therapist, and they say, “This muscle is not working. This one is overactive. The range of motion is not great.” You are able to identify what is going on with the hip, so you can develop a treatment plan.

That is the goal with chiropractic neurology. Sometimes, people might hear a term, functional neurology, which is the same concept. If you get a head injury or have vertigo, why? Why are you having these symptoms? What areas of the brain are overworking, not working, not communicating? What therapeutic strategies can we prescribe to make it so that those areas are doing what they are supposed to be doing? When everything works together in the brain, that is when you see really cool things happening.

Dr. Eric:

You have been a chiropractic neurologist for almost 20 years now, correct?

Dr. Shane:

Yep, that’s a long time.

Dr. Eric:

You have seen a lot of different cases. Let’s dive in. I don’t know where you want to go, if you first want to focus on brain/thyroid or brain/gut or cover it all.

Dr. Shane:

This is where my practice has evolved over the years, trying to understand- You always hear the brain/body connection. That is so generic. We are trying to understand how these systems interplay with each other. When we look at brain function and something like the thyroid, or the gut. This is a great topic because we can explain to people that everything is so intertwined that you can’t just look at the thyroid.

When you talk to patients who are coming in, people are starting to understand that there is more to the story than just TSH. A lot of people say, “My TSH is high, so I was put on this medication.” What we have to figure out is why is the thyroid not working? Now we start looking at all the pieces.

The brain becomes one of those pieces that is still overlooked to this day. To give the story on brain/thyroid function, what a lot of people don’t realize is that the signal to the thyroid- When we look at TSH, it’s a signal or message that comes from the pituitary down into the thyroid. It tells the thyroid what to do. If that signal is off, then we can actually go look at the brain. What is the pituitary doing? If we take a step back from there and ask, “What tells the pituitary what to do?” it’s the hypothalamus.

The hypothalamus is your big regulator of all sorts of things from temperature to growth to sleep to adrenal stress. Your hypothalamus has to tell the pituitary what to do. But we can’t stop there. We have to take a step back and figure out who tells the hypothalamus what to do. It has all these things that integrate from different areas of the brain and the body that say, “Hey, this is what’s going on.” Everybody reports back to the general or president. This is what the army is doing; this is what the National Guard is doing. This is the economy and the financial economy. All of these pieces come together. Based on all of those signals, the hypothalamus knows what it needs to do to make sure that homeostasis is always there.

Two of the biggest things when we look at hypothalamic function or what activates it are serotonin and dopamine. A lot of people wouldn’t even think about that. Serotonin and dopamine play a role with mood and motivation and joy and happiness and all of these things. If you have imbalances in serotonin, we are going to see imbalances in mood. Does that same imbalance affect the thyroid? The answer is big possibility. That is where we see these brain to thyroid connections. It’s much bigger than just looking at this gland. There are so many factors involved.

That is what we have tried to do over the years is understand that connectivity between brain and body, brain and thyroid. When you throw in the gut, that’s another animal because the brain and the gut have a relationship with each other. If we truly understand that the brain controls the whole body, if we fix the brain, how does that fix the body? If we fix the body, how does that impact the brain? Obviously, I am biased, and this is a passion of mine, but this is how we work in the office.

Dr. Eric:

Amazing. Imbalances in serotonin or dopamine ultimately affect the hypothalamus, which could affect the communication between hypothalamus and pituitary. That can in some cases cause thyroid dysfunction.

Dr. Shane:

It could.

Dr. Eric:

As you know, most thyroid conditions are autoimmune in nature. With hypothyroidism/Hashimoto’s and hyperthyroidism/Graves, the immune system plays a big role. In these cases, the brain could be affected as well. You can’t just assume that the immune system is the problem?

Dr. Shane:

Yes. The brain can come into play. What is even more interesting is that your brain can actually play a role with autoimmunity. Depending on the balance within the brain, looking at right/left, the cerebellum, they have roles in autoimmune conditions as well and controlling the immune system. You can have a brain that is causing an alteration of the immune system, so the immune system is impacting the thyroid.

When you said, “The name of his clinic is Integrative Health,” that’s why we named it that. Everything affects everything. How do we address it? Where do we start? When you go fishing, you throw the line out there, and you reel it in. If for some reason it was tangled- I swear I don’t understand how your line gets tangled in the water, but sometimes it gets so tangled that it looks like a bird’s nest. Where do I start in unraveling it? Sometimes you sit there for 20 minutes and are trying to find the one thread or loop in the fishing line. You think you got it, but it takes a while to figure out where to start.

A lot of these complex cases that patients are struggling with are similar. Where do we start? Brain, thyroid, gut, neurotransmitters, autoimmune, inflammation? Sometimes it’s so messy, and that’s what’s important about learning about all the different pieces.

Dr. Eric:

You’re right. Where do you start? If someone comes in, I assume you go through a comprehensive health history. Is it safe to say in most cases you don’t start with the thyroid? Maybe you start with the brain or the gut. Maybe you do start with the thyroid in some cases.

Dr. Shane:

What I try to do is look at each system. We do a consultation, but that’s to see if we would be a great fit. On the exam, we say, “Let’s do a neuro exam. Let’s see what the brain is doing.” Then we will do a health history. If the health history dictates that somebody is on antidepressant medication, and we have a history of depression and traumas, maybe that is a player. Then we start diving into the history and find out what you’ve taken, what you’ve gone through, what life has been like. Then we look at bloodwork, lab testing, cortisol levels. We look at all of it. By looking at all of it, then I can decipher is this a neurological condition? Is this a thyroid gland dysfunction? Is this an autoimmune condition? Are there other systems like hormones and gut dysfunction that are playing a role? I look at every single system and try to decipher which systems to go after. Sometimes, it’s one. Sometimes, it’s all. That’s where I think everybody is so uniquely different.

Dr. Eric:

If I understood you correctly, before, you said that the brain can actually lead to an autoimmune condition. If someone had a concussion, traumatic brain injury, in some cases, that could be the trigger to an autoimmune condition?

Dr. Shane:

Absolutely. There is fascinating research looking at things like the cerebellum has a pretty significant role with natural killer cells. There is some research that shows the right brain deals more with the B cells, and the left brain deals with the T cells. Some literature out there looks at concussions and what their implications can be in sparking an autoimmune condition. Sometimes in the office, we see when someone has a car accident, and they developed multiple sclerosis or another autoimmune condition. It’s interesting. There is another world of looking at neuroimmunology and how it influences. In the same token, autoimmune conditions can create imbalances in the brain and fire up areas of the brain that don’t need to be activated, but they are being activated because of the autoimmunity.

Dr. Eric:

Very interesting. How about the brain-gut connection? Can you talk about that?

Dr. Shane:

Yes. The gut is a rest and digest system. Everybody is familiar with that term. The opposite of that is fight or flight. The gut, we need to make sure it has motility. It needs to move. It needs to absorb. That is a connection that goes from your frontal lobe or cortex into your brain stem. Your brain stem houses the vagus nerve. That vagus nerve then goes into the gut to help with motility, function, movement, absorption, and digestion. You have this connection from cortex to brain stem to gut.

They have done some really cool studies, where they have this group of mice that they activated the vagus nerve and caused a concussion. Because the vagus nerve was strong and sustained, it kept good gut function in that mouse. Another mouse, they created a concussion, and they found all these gut issues. There is a lot of connectivity from the brain to the vagus nerve into the gut.

It’s fascinating that some of your first signs of Alzheimer’s and Parkinson’s is constipation. Some of the biggest struggles in most kids with special needs is constipation. It tells you how much that brain-gut relationship is there. On the flip side, we see a lot of people with anxiety disorders and PTSD, if you are in constant fight or flight, you get this inhibition of the rest and digest. You start seeing decrease in motility and all sorts of gut issues stemming from that. The brain has strong, powerful connections with the gut.

Dr. Eric:

You mentioned the vagus nerve. Are there tests that you do? Is it part of your neurological exam to determine if someone has dysfunction in the vagus nerve?

Dr. Shane:

Every single patient, we look at vagus nerve function. If someone has gut issues, do they have true gut issues, or is there gut issues because of a neurological condition? Part of our neuro exam is looking at the vagus nerve because it’s an idea of what the brain stem is doing, specifically because that vagus nerve has such a major role in a lot of your visceral function: kidney, gallbladder, stomach, liver. All those things come from the vagus nerve. We want to make sure that the vagus nerve is working and not just assume that you have a liver issue, so you need supplements. That may not be the case. You may have a liver issue because of the brain-gut or brain-body connection through the vagus. We check on that in almost every single patient.

Dr. Eric:

If someone does have problems with the vagus nerve, I know there are different exercises like vigorous gargling or singing loudly. How about plain old mind-body medicine? Is that not typically enough as far as getting someone more in a parasympathetic state?

Dr. Shane:

It can be, but clinically, it takes longer, and it’s harder. We’ll use a lot of those exercises. There are some vagus nerve stimulators that we use in the office. You can put them right along the vagus nerve and activate it. Besides the exercises, we use some equipment that stimulates the vagus nerve. We will do some stimulation through the tongue or the face to drive simulation into the brain. These ways to get into the vagus nerve, back door into the vagus nerve, or hit it directly to try to turn it on, so we can get some activation.

That is where testing comes in. If we test, and it’s not working, then we stimulate it, and now it’s working. We have made a change.

Dr. Eric:

Many listeners are familiar with a leaky gut, increased intestinal permeability. Can you talk about leaky brain, the disruption of the brain-blood barrier? There is some overlap with the two if I understand correctly.

Dr. Shane:

Within leaky gut, the best analogy I have is a picket fence. When you look at gut function, you have the barrier that protects you from the world. It’s like a fence in your backyard. Leaky gut is when those fence pickets are broken. They got bumped into with somebody’s car on accident, or your kids were playing soccer and broke the slats. If you break a slat or are missing one or the wind blows your fence over, like we had a few times in Denver this year, now you have a gap in your fence. Animals can get through, and kids and trash, that shouldn’t be getting into your backyard. Everything in your backyard should stay there, and everything on the street should stay there. That is the best analogy for leaky gut.

What ties the slats together are two different bonds, like shoelaces that hold it all together, called occludin and zonulin bonds. Those same exact bonds are formed in the blood-brain barrier system. You have these things that tie it all in together. It keeps everything in the brain, and everything that should be out is out. When you start affecting those bonds, you don’t only affect the gut, but you also affect the brain. If you have a big cheeseburger with fries and a Coke for lunch, and now you have brain fog, you probably also have gas and bloating. You see this gas, bloating, and brain fog as indication that you have messed up those bonds and broken them down a little bit, so you have some slats missing now.

The symptom of leaky brain is brain fog. If anyone is walking around, saying, “I have gas, bloating, and brain fog,” that tells us your barrier system needs to be fixed, and you need to call a fence repair guy out there quick.

Dr. Eric:

Do you do any testing for leaky gut or leaky brain? I know there is one test out there from Cyrex that relates to the blood-brain barrier. I don’t know if you just assume that someone has a leaky gut. I used to use the Cyrex intestinal permeability test. These days, I just assume that most people have a leaky gut. What approach do you take here?

Dr. Shane:

It’s similar. There are times where I will use those tests that look at blood barrier proteins that includes zonulin bonds. You can measure those in the bloodstream. If you have a lot inf the bloodstream, you are probably breaking those bonds down, and they are floating around in the body. We will look at those markers.

I make assumptions now. Most patients that come in now have some kind of brain fog. Usually, the thing we are going to do initially is repair the fence. There are definitely some supplements that can repair the fence. Reducing inflammation is a great way to help repair the fence. I try those things. Usually, people say, “My migraines went away. My brain fog went away. I am able to focus. My mood is better.” We have probably been fixing that blood-brain barrier. I will test more if I get stumped, or something is not fixed the way I think it should be.

Another thing I have done before is straight GABA, which I know you’ve heard about before. It’s too big to go through the slats in the fence. If a basketball shouldn’t get through the fence, but you are finding them in your backyard, there are probably holes in the fence. GABA is too big to get through. If people experience symptoms from GABA that could be good or bad, that could be indicating there are some gaps in your barrier system.

In my career, I do more assuming than testing at this point because if I am going to use dollars for testing, I want to use them toward something else that might be more beneficial.

Dr. Eric:

Agreed. Can someone have brain fog without having that disruption of blood-brain barrier? Can there be other causes of brain fog?

Dr. Shane:

There can be. There are different immune mechanisms that take place in the brain. Any time you create inflammation, you can create that brain fog feeling. We see that with food most commonly. You also hear that with people who talk about spilled gasoline, and they have brain fog. “Somebody’s perfume gave me brain fog.” “When I get stressed or don’t eat, I get brain fog.” There are some other mechanisms that can take place, but they usually involve your immune system in some form.

Dr. Eric:

Let’s talk about thyroid-gut connection now.

Dr. Shane:

The thyroid self-produces a hormone called T4. It produces some T3, but T4 is the primary hormone that it produces, which is inactive. It doesn’t do much for us. We have to convert that into T3. T4, the reason why the number 4 is there is because it has four iodines attached to it. Your body takes off one of those iodines, so it is now T3. This conversion takes place within the gut and the liver. About 20% of this conversion takes place in the gut. It uses some enzymes that are produced via your flora or normal gut bacteria, meaning that you have to have good digestive function and a good number of bugs. They all have to be in balance in order to help convert your thyroid from T4 to T3. There is a big role that the digestive system has in this. If you’re not converting that properly, then your active T3 is now on the low side. You can start having thyroid symptoms not because the thyroid gland is not doing its job, but because the digestive system is imbalanced. That starts to look at some of the thyroid-gut function.

What is unfortunate sometimes is that one of the causes of gut dysfunction is hypothyroidism. Now we get into this chicken or egg concept. Do you have gut issues because you have hypothyroid? Do you have hypothyroid because you have gut issues? Who’s what, and what’s what? A lot of times, with patients, this is where you have to develop a treatment plan that catches all aspects of those vicious webs. If we can get the thyroid function better and the gut function better, then we are getting both ends of the story.

I see too many practitioners that focus on one and not the other. The patient is getting frustrated because they are not seeing the results they want. With listeners, it’s always good to say, “When you are talking to a doctor, do you know the whole concept of thyroid function because focusing on one might not get me to where I would love to be?”

Dr. Eric:

In a situation where someone is hypothyroid, and they have a lot of gut dysbiosis, you might recommend for them to take thyroid hormone replacement. That wouldn’t be the only recommendation. You would also do things to help restore the gut as well?

Dr. Shane:

Yes. We have a nurse practitioner in the office. There is a time and a place for medication. Maybe medication is great while I am working on their gut. You might find they don’t need the medication now because you are converting hormones properly. Having a nurse practitioner that we can put them on and take them off as needed if it’s possible. There are other times where we can utilize supplementation to support the thyroid gland while we are working on the gut and then retest and see how we are doing. These are very plausible treatment plans that we see quite often. It’s that functional neurology piece of trying to understand what is their function or dysfunction? How do we improve it? That becomes the goal of working with patients.

Dr. Eric:

Do you recommend any type of gut testing, like a comprehensive stool panel or a SIBO breath test in some cases?

Dr. Shane:

In some cases, we will do that. I don’t run stool panels on every single patient. I think they can be very beneficial depending on patients talking about constant constipation or diarrhea or bloating. You want to find out what is causing that? That is always a question I try to explain to the practitioners I have worked with: We are always trying to ask why. We can’t simply stop at saying, “Someone has gut dysfunction.” It should be, “Why does somebody have gut dysfunction?”

When we are going to the core, we have to ask why. Sometimes it’s really easy. Someone loves to eat pizza and Cheetos every day. But there are other patients who are eating perfectly, so why do they still have issues? That is where testing comes in. That’s what’s cool about lab testing and technology these days. We have different styles of testing to figure out those whys. The further we can dive in to figuring out the why, usually the faster we can get someone feeling better.

Dr. Eric:

Let’s talk more about constipation. I wasn’t planning on going in this direction, but a lot of people experience it. You mentioned earlier the connection between the brain and Parkinson’s, where an early sign is constipation. In a situation where someone is constipated, and they are doing everything from a diet perspective, it seems like they have good gut health and everything is in line, from what you said, it could be the brain. Not to say it’s related to Parkinson’s, but it could be a potential brain-based disorder causing it?

Dr. Shane:

It definitely could be. This is where sometimes in the functional medicine space, they are using everything, every supplement, and they are not getting anywhere. That is where you can look at brain function to find out what’s going on. That is where the neurology testing or degree comes into play, which is helpful because I know not everybody has that capability. If you start looking at frontal lobe function, they are losing their gait mechanisms or their ability to walk smooth; they are losing some of their eye coordinations, not blinking; there is something funky going on that we need to investigate more. Or someone could have a concussion, and maybe their brain stem was impacted, so that Vagus nerve is simply not working the way that it should be. These are all different things from a neurological standpoint that can cause constipation.

That is why it’s so important to look at so many different mechanisms. It’s not always just take magnesium, and everything will be fine. Why do they have constipation? You brought up SIBO earlier. You can have it from too many bugs that produce too many methane gases. It could be a parasite or a virus or an autoimmune condition or IBS-C (constipation). There are so many causes. One that does get overlooked is the brain.

Dr. Eric:

How about blood sugar? Can you talk about the impact of blood sugar imbalances on brain health and even maybe immune health?

Dr. Shane:

Blood sugar might be one of those top things that we are trying to stabilize. A lot of people have either too much or too little, or they are rollercoastering all day long. They are experiencing these highs and lows.

Blood sugar is simple. In some regards, it’s one of those things we can control. We can control what we eat, how we eat, and when we eat. Stress can play a role in blood sugar, which can mess it up. There is a lot of things we could do, so we usually try to focus on it. We know that blood sugar affects the brain because if you have ever met anybody who gets hangry, that’s a neurological change. Did your blood sugar drop, and now you’re anxious, irritable?

I was just working on a kid earlier, and his blood sugar was low, and he started crying during the exam. Mom is like, “Your blood sugar is low. You haven’t eaten in a while.” We know that blood sugar affects brain function by looking at mood.

What people also forget is that that’s one of the main fuel sources for your brain. In neurology, we always talk about your brain needs three things to function: glucose, our blood sugar; oxygen; and stimulation. If one of those three things is off, then how is your brain going to function? Are you able to take a road trip without fatiguing, read, go to work, exercise? Your brain is involved in all those things. Once your brain fizzles out, it’s hard to function and do life.

Dr. Eric:

You mentioned oxygen. That also then ties into anemia. You want to correct not just iron deficiency anemia, but other types of anemia.

Dr. Shane:

Yes. When you’re anemic, it’s hard to deliver oxygen everywhere. You have to have iron to make hemoglobin, which is what attracts oxygen to carry throughout the body. Those are important things. Anemia, sleep apnea, shallow breathing can all impact how the brain functions.

It’s important when you look at brain function to make sure you are getting enough fuel, so glucose, oxygen, and activation, which means going for a walk, getting good sleep, having a good community, figuring things out, learning. All those different things that keep your brain engaged. That stimulation is important for long-term growth.

Dr. Eric:

One of the questions I wanted to ask was how do you diagnose brain-based disorders? I guess you kind of answered that. I don’t know if you want to expand on that. It’s putting people through that neurological exam, correct?

Dr. Shane:

It is. When you put someone through a neuro exam, you are able to look at systems. For instance, if we look at the frontal lobe, we will look at things like certain eye movements are associated with the frontal lobe; fine motor movements; certain aspects of coordination; memory. Then we get into the history side, which is multitasking, motivation, mood, libido, being able to finish a task that you started. Those are all ideas of the frontal lobe. We can see what the frontal lobe is doing by our testing.

Then we can look at the parietal lobe, which is mainly sensory. How well can you feel the right side of your body, the left side of your body with sharp, dull, light touch?

The temporal lobe is more smell, short-term memory, math.

The cerebellum, which is in the back part of your head at the base, looks at balance, gross motor, some aspects of memory, some of your eye movements.

All that to say, certain tasks go to certain parts of the brain. By looking at different parts of the brain, we have the patient go through certain tasks. If they can’t do something, we get an idea of where the dysfunction is taking place. If someone has a hard time with fine motor movements and gait, their long-term memory is getting thrown off, they have lost their motivation, they are more depressed, libido is decreased, they are great at starting tasks but have all these unfinished tasks around the house, you start to go, “I don’t think your frontal lobe is working as well as it should.” That is how we are able to diagnose these dysfunctions.

There are things you’re taught on looking at more pathological conditions as well. Mostly, what we see coming into the office is functional disconnect or functional deficit disorders.

Dr. Eric:

I know you see a lot of tough cases. If you happen to have someone who had Hashimoto’s, and their symptoms weren’t too severe, maybe they were referred to you by one of your tough cases, but this particular situation didn’t seem too challenging, would you still recommend for them to go through a neurological exam? Do you put everyone through that exam?

Dr. Shane:

Yeah, we do. Sometimes, patients will come in thinking that it is a very simple issue. When you start doing the exam, you start finding out these little things that shouldn’t be there. Sometimes, patients go, “You know, I’ve been dealing with that for a while.” You see this twitch in their face or their head, and you go, “Do you have restless leg syndrome?” “Oh my gosh, for the past 20 years. I don’t talk about it anymore because I thought it was normal.” There are a lot of things patients think are normal that are not normal. As you go through a test, you figure it out.

I remember one time, I was working on a 14-year-old girl. Her parents brought her in for simple Hashimoto’s. When we started doing the finger to nose test, where you are looking at your cerebellum, it was terrible. She couldn’t even touch her nose. Her hand was jerking all the way. She ended up touching her cheek. Her parents were like, “What’s wrong with her?” Through the course of it, we did some testing. She had a mix of Hashimoto’s and Graves’, but she also had an autoimmune condition that was affecting her cerebellum. There are some interesting ties between cerebellum and thyroid function, too. The whole case took a left-hand turn. Okay, we have a lot more things going on than just Hashimoto’s.

That is kind of common to see those things. People might be so focused on Hashimoto’s that they miss everything else, or they didn’t think to tell the doctor because they didn’t think it was important. “No, you’re the Hashimoto’s person. I didn’t think to bring up my vertigo to you.” For me, it’s important to do a thorough evaluation on everybody.

Dr. Eric:

You have been practicing for a long time, so you probably have people who have been in past traumas, but until you go through that health history, they don’t even think about it. Maybe they had a car accident 10 years ago. It could be severe, but to others, it might just be a rear end, and they felt fine after, or maybe they had a fall. I assume you see some of those cases, where it might be impossible to pinpoint it was due to that trauma, but they are not coming to see you because of that trauma. When you go through the health history, you can relate some of the symptoms to a past trauma. I’m sure sometimes, you can’t. Again, what are your thoughts on that? If someone had a trauma 20-30 years ago, after that, maybe they felt fine. No pain, no discomfort. Could that, decades later, lead to some of these issues that we’re discussing?

Dr. Shane:

We see that all the time. When you start doing the history and timelines, “When did this start?” “It started in 2008.” “What happened in 2008?” “In 2007, I was in a car accident.” Or, “I slipped and fell and hit my head on the concrete.” “We went through a really traumatic experience.” “I went through a bad divorce.” “Huh. What else has happened since then?” Sometimes it seems like everything ties back to that one moment in time. Then we can start working our way forward.

If there is a trauma, like a car accident, maybe there is a neurological imbalance. If they had a loved one pass away, I’ve had counselors in my office. Counseling might be a great thing for you because maybe counseling is now part of your treatment plan.

“I was sick in 2007. I don’t know what it was, but I was really sick during that time.” Maybe they had a viral infection. We know that Hashimoto’s, the #1 virus that impacts it is Epstein-Barr or mono. Sometimes you go back and realize, “What did you have?” “I don’t know, but I was so exhausted for like three months. I had to take time off from work.” All right, starting to see how this picture is unfolding. A lot of times, things in the past are dictating the future events, but it’s been a slow brew of dysfunction over the next 5-10 years.

Dr. Eric:

When it comes to treatment, obviously everybody is different, so I’m sure you don’t treat everybody the same. Across the board, are there some things you recommend for everybody? With diet, you may not recommend the same exact diet for everyone, but I would imagine an anti-inflammatory diet consisting of whole, healthy foods. Can you talk in general about treatments?

Dr. Shane:

Usually, our treatments are multi-factored. If we are doing a neuro exam, let’s say there are findings that seem to be relevant to the case. Here is our neurological treatment plan. We have a more metabolic treatment plan. Metabolic might be working on adrenals, thyroid, gut dysfunction. We have an immune side of it. A lot of times, we have had that three-pronged approach of neurological, metabolic, and immunology. We combine those worlds together. You can’t, in my mind, do one separately all the time for everybody. That is our protocol, so to speak.

A lot of the metabolic, we have to work on foundational stuff. We have to make sure you are eating an anti-inflammatory diet. If you can’t get someone to sleep, you won’t get far with them. We have to work on sleep, but, blood sugar stability, adrenals. If they are anemic, we have to fix that. That’s that metabolic arm.

With neurologic, if it’s a frontal lobe issue, we work on the frontal lobe. If it’s a vagus nerve issue, we work on the exercising and stimulating of the Vagus nerve. If there is Hashimoto’s, what do we do to support the immune system? that’s our treatment plan.

That’s probably the easiest way I can say that is our protocol for all patients. The only way they don’t get those three arms is if I do a neuro exam, and I go, “Dang, this is one of the best brains I’ve seen in a while,” then they don’t get anything in that treatment plan because it doesn’t make sense. Someone might stimulate the Vagus nerve because that could be a great way to get the gut moving. Maybe they have a healthy Vagus nerve, but I will use that mechanism to get the gut moving and functioning better.

Dr. Eric:

You shared a lot of amazing information. I learned a lot. I’m sure the listeners did, too. Is there anything I didn’t ask that I should have? Anything you’d like to discuss? We could easily go on and on and on. Anything that I missed that you have a burning desire to cover?

Dr. Shane:

No, we talked about a lot. This might be one of those podcasts that they need to listen to several times to get some more nuggets. That’s always my goal. I like coming on podcasts and sharing a bunch of nuggets because not one size fits all. Everybody is a little different. Maybe that is a great way to end.

Sometimes, people get stuck on they did a food allergy test, and it fixed them. Everybody has to do a food allergy test, and that is the end-all be-all. That is not always the case. Everyone is so different with their own history and circumstances and genetics. It’s important to find practitioners who are talented at looking at the whole person. That is the fastest way to get better. In the holistic field, I like holistic medicine and practitioners. If you have a hammer, and everything looks like a nail, I don’t care if I do parasites or adrenals only or food allergy testing or everybody has to gargle. If you have a hammer, and everything looks like a nail, finding somebody else might be a better option. Life is too complex, as are our bodies, to think that one thing can fix everybody.

Dr. Eric:

Well said. Where can people learn more about you?

Dr. Shane:

There are two websites that we use and update. One is IntegrativeHealthDenver.com. I live in Denver, Colorado. The other one is IntegrativeBrainCenters.com. We have two arms. We get people who come in with concussions, so they use the brain website to find us. We are trying to be active on social media. @IntegrativeHealth and @IntegrativeBrainCenters on Instagram and Facebook. It’s good to sign up because we are throwing stuff out there. We do webinars. I am doing one tonight on migraines. We are trying to disseminate information and articles and nuggets and pearls, whatever you want to call it. We want the world to be a better place. Follow us and like us and share. We will keep putting it out there.

Dr. Eric:

Sounds good. It really was a pleasure chatting with you. I learned a lot about the brain-gut-thyroid connection.

Dr. Shane:

Thanks for having me. It was a lot of fun.