Recently I interviewed Dr. Rajka Milanovic Galbraith, as she discussed the genetics of detoxification and how it relates to thyroid health. If you would prefer to listen the interview you can access it by Clicking Here.

With me, I have Dr. Rajka Milanovic Galbraith, and we are going to be chatting about the genetics of detoxification. I am going to dive into Dr. Rajka’s bio. She is a functional medicine MD certified by the Institute for Functional Medicine. She is an international speaker and mentor to practitioners as well as a high-performance coach. She helps high-performing leaders, celebrities, entrepreneurs, and CEOs regain their energy, so they can increase their performance, productivity, and impact. She has expertise in anti-aging medicine, nutrigenetics, bioidentical hormone replacement therapy, and peptides. She sees patients at the clinic she founded, Simply Health Institute, outside Chicago, Illinois, as well as leads group online programs. Thank you so much for joining us, Dr. Rajka.

Dr. Rajka Milanovic Galbraith: Thank you, Dr. Eric. So nice to join you here today.

Dr. Eric: Look forward to chatting with you about genetics, specifically genetics related to detoxification. Before we start with that, would you mind diving a little bit into your background and how you started becoming interested in genetics?

Dr. Rajka: It had to do with my journey partly, and partly others’ journeys. Like many of us in the field, I have had my own journey and health issues. What I wish I would have known was how deep those issues went. Mine did start with thyroid disorder, Hashimoto’s. I know that’s a large portion of your population. I just really wish I had known, and someone would have said, “It’s not your thyroid.” It really was the dysfunctional thyroid, but it was everything leading up to it that wasn’t identified by myself because it took me the better part of half a decade to train in all these things.

It was finding that 80% of the patients I could get better with a usual functional medicine approach, but you had this 20% residual. How do you get those people better that were maybe a little bit sicker and not responding to usual means?

I kept doing the deep dive, and it led me to the road of nutrigenetics. I studied under a variety of people. With the first approach, I got a bigger layer of people better. I ended up with an autism reversal. I say this cautiously; people say, “That’s incredulous. Are you telling the truth?” I’m not the first person, and people need to know that you can get reversal. Of course, it didn’t happen overnight.

It led me into looking more and more. The irony of it is that I looked at everyone else’s genetics but mine. Isn’t that the irony of it? I did a really good job with what we call the epigenetics. That’s having your diet and lifestyle influence whether a mutated gene actually is expressing. We do have the power to turn off defective genes. I didn’t really understand all the ramifications then. I wish I would have.

It would have saved me two decades of intermittently feeling very unwell and ultimately culminating into an issue where my liver enzymes were soaring, and they were entertaining a second autoimmune disease. It really had to do with my underlying detox genetics that I wish I would have known from the get-go that went from Hashimoto’s to infertility to vision-losing migraines to PMS to that weight gain that comes seemingly when you hit perimenopause, to you name it, to ultimately, this near second autoimmune disease. I thought I had autoimmune hepatitis. The statistics on that are if you are not on steroids lifelong, the death rate is 30-50%. It’s very high. I’m happy to say that by taking the approach I did, I never got that formal diagnosis. All the symptoms and numbers, the markers reversed. Never ended up on steroids. That was now over nine years ago.

Dr. Eric: Wow. You said 30-50%, if they don’t take steroids?

Dr. Rajka: Correct.

Dr. Eric: That’s extremely high. Of course, happy to hear that you were able to avoid the formal diagnosis and restore your health. You also said that you were diagnosed with Hashimoto’s?

Dr. Rajka: Yep, that was the first diagnosis. It took about 10 years for me to get that diagnosis. That’s how long I was unwell.

Here is a fear, and I’m sure some of your audience has seen this: You go to your doctor, and you feel unwell. They do the labs. I know because I was one of those doctors. They say, “Your labs are normal. Nothing’s wrong. Perhaps you’re depressed.” The worst outcome is they suggest you’re depressed and offer you an antidepressant. That was my fear. Being a doctor, my labs were suddenly abnormal. I used to check them all the time. They’re not totally normal, but I didn’t know what I know now.

By the time I got the diagnosis, the endocrinologist was a little more savvy. Even though it was more traditionally allopathic, he was switched on to following patterns. He said, “You’ve had this for 10 years. Look at these antibody levels.” It was really shocking, the contrast of how little sleep I needed. I was going from 10-12 hours back to a normal sleep schedule. My energy really soared.

Dr. Eric: A lot of the audience consists of Hashimoto’s as well as Graves’. Can you tie in detoxification with thyroid health? I’m sure some who are listening might not understand how this all relates. I could add my feedback, but I’d like to hear what you have to say here.

Dr. Rajka: I’d love to have the banter. That’s what makes these interviews so much fun. I’d be curious to hear your input.

As you know, thyroid disorders are on the rise. You have to ask why. There is a strong correlation to exposure to environmental toxins. We’ll highlight some of the big ones. Perchlorate is found in contaminated groundwater. That is one of the ones I can measure. Even for people who filter their water, they may feel like they have a good filtration system. I’m talking about more than the filter out of your fridge. That won’t cut it. More than a Brita pitcher, that won’t cut it either. I found high levels in people who are doing everything right. You have to back it down to if these are all water contaminants, we have to figure out a better water filtration system for you.

We classically think that the xenoestrogens, like BPA and phthalates, will affect your hormones. Turns out they can also affect your thyroid. What you put on your skin and clean your house with really does matter. All of these can take out the thyroid with a variety of different means and mechanisms.

I was that nerdy, geeky kid in high school and college. I learned all these pathways in biochemistry, but I didn’t know how any of them applied. I even have all of my notes from the late ‘80s. I am dating myself here. Now that I understand it, it’s so crystal clear to me what needs to happen to support first proper detoxification and things we need to be on the lookout for as clinicians if someone is unwell. You can reverse engineer it, meaning you can assume things based on symptoms and certain findings and labs. Sometimes, I like to look at the genetics.

Dr. Eric: I agree. Obviously, the toxins can directly affect the thyroid. You mentioned perchlorate. Xenoestrogens. As you also mentioned, it’s not just about the thyroid. Especially Hashimoto’s and Graves’, they are more immune system conditions. There is also plenty of evidence in the research that heavy metals, xenoestrogens, and other environmental toxins can also be at least a contributing factor, if not a direct trigger, when it comes to the autoimmune response.

Dr. Rajka: I always say you have to remove all the triggers. I look at about eight of them, and toxins is one of the eight. When I speak about detox, I’d love to segue into the general about detox, what people should know. One of the areas I have found an interest in is oxidative stress. Would that be okay?

Dr. Eric: Yes.

Dr. Rajka: We call general detox two phases, but it looks like there are three phases. Here is my theory on the whole energy thing. The majority of adults, and even children unfortunately- Children are probably worse because their diets are awful these days. If you’re eating a standard American diet, they are protein-malnourished and are not getting the phytonutrients they need. When you measure it, most adults are deficient in 3-5 vitamins and minerals. Top of the list are magnesium and B vitamins.

Phase one takes that chemical, whether it’s an environmental toxin, a medication, etc., and breaks it down into a metabolite. I always learned it was more active, but that requires B vitamins and amino acids. These are the things people are deficient in. B vitamins get depleted when someone is stressed. You start with someone behind the 8 ball, they get stressed, and the last two years put many of us to the test. Everyone had different levels of stress for a variety of reasons. You get further depleted.

The interesting thing is toxins play a role in taking up energy. Our mitochondria are super sensitive to toxins because the DNA in our mitochondria are not protected in histones. You get the environmental toxins taken out, and you produce energy less well. It’s a combination of things. You don’t have the vitamins and minerals to properly detox. Your mitochondria, which make energy, are taken out by these toxins.

The second thing that is high up on the list for phase one is amino acids. That is a breakdown product of protein. Almost everyone who comes to my clinic is protein-malnourished or has an inadequate protein intake for their weight, activity level, age, and disease status. That is pretty profound.

To go from phase two to phase three, this is my hero’s journey. It takes that metabolite and makes it water-loving, so we can pee, poo, or sweat it out. One of the pathways, and there are several, is glutathione. That is where I am lacking two full genes for glutathione recycling. The third remaining major recycling gene is defective. I’m really behind the 8 ball in producing it.

The way not to make glutathione is add stress to the mix or live an unhealthy diet and lifestyle. There are ways to boost it. That’s why I’m careful and look at that. For me personally, I supplement, but I know my genetics, and it’s not the right thing for everyone to do. It depends on the whole story. I caution people when I say that. This is what I determined for me.

One of the things in detox that will take out our body tissues is something called oxidative stress. The way I like to explain this is oxidative stress is very similar to when you cut open an apple, and it starts to brown as a result of exposure to the air. It’s the browning of our tissues, whether it’s our thyroid, and causing thyroid dysfunction; our brain causing some memory loss; our joints causing osteoarthritis. That’s the area I have started to get passionate about: looking at what causes oxidative stress. We usually think of that as free radicals. How do we clear those? What is needed in those pathways and processes?

Dr. Eric: Like you said, the increase in environmental toxicants obviously is a big factor in the increase of oxidative stress. The autoimmune process as well. It’s safe to say that anybody dealing with an autoimmune condition has some degree of oxidative stress. You said you’re missing two of the genes related to glutathione?

Dr. Rajka: Yes, two of them.

Dr. Eric: When supplementing, if someone is missing the genes, I assume they can still take something like NAC that converts into glutathione? Or would they have to take a liposomal glutathione or an acetylated glutathione?

Dr. Rajka: It depends. I saw later some data on how n-acetyl cysteine (NAC) can increase levels of cysteine and further lead to oxidative stress. Anyone who wants to boost production, definitely NAC is the way to go. I am on a very small dose at all times. That is what maintains me. If I ever go through a period where I know I am ill, I will up that dose. I am pretty well versed in turning mine on and off. I’ve used NAC before. I’ll add that when there is an acute illness, too. I do not see benefit, but my patients have. It depends on where they fall on the spectrum.

Am I moderately unwell? I probably just need to boost it with epigenetics, and NAC would be just enough. If you know the genetics and they are depleted, for all of my chronically sick patients, I have started to look at their genetics. I say, “This is what we would need as we are getting you better. This is what you need to maintain and support you to mitigate that relapse.” Of course, with the whole mind/body, diet/lifestyle, comprehensive approach. It’s not just supplementation.

Dr. Eric: Agreed. Diet also plays a big role. You can eat cruciferous vegetables and other sulfur-based foods. If someone is really deficient, diet is still important, but that is where supplementation might be important.

How about IV glutathione? Are there indications where you would ever refer people to get IV glutathione?

Dr. Rajka: It’s interesting. Some of my really sick patients don’t tolerate any glutathione. You have to be really careful to give them an IV. For some people, IV is not the correct route. There are innuendos.

As I was learning the genetics, I was in between jobs. We were moving from Boston to Chicago, where we are now. One of the benefits of the clinic I work at is we have IV therapy. That is one of the perks of the job. I did IV Vitamin C, which I’ve found huge benefit for when I am acutely sick. That has helped me recover quickly. I also did it with glutathione. I didn’t get that boost. What happened? I had my genetics reviewed with another person that was in the field. They said, “This is why. They cancel each other out.” I’m blanking on what that actual process was, but I was intrigued that IV may not be necessary for some people. I underwent six weeks of therapy and didn’t see a benefit. I was trying to supercharge myself but didn’t see a difference.

Dr. Eric: I’m glad you mentioned the IV glutathione, especially some people not doing well because it would be a bummer for someone to get it. It sounds like maybe they should try the liposomal glutathione first. Not to say that everybody should try that and then do IV glutathione, but if someone is considering IV glutathione, maybe try regular glutathione. If they can’t tolerate that then that is an indication they might not be a good fit for the IV glutathione.

Dr. Rajka: Yeah, same thing. If you are sensitive to a lot of inputs coming your way, there is a high chance you will be sensitive to glutathione. Always proceed with caution. I always say sometimes, in those who are chronically ill, to go slow is to go fast. It’s really a hard concept for anyone who has ever been high-performing to accept or follow. There is nothing worse when we’re on the road to recovery, and someone goes through the steps at a rapid pace. They are made to feel worse and worse, but they don’t stop. They push through. Then it throws them under the bus, and that recovery, for me, in a client takes almost twice as long as the original recovery. I really caution people to pay attention to how their body is responding to things, and to have that direct communication with me on how they are feeling. They are given strict provisions on how to increase.

Dr. Eric: You spoke a little bit about nutrients. You also mentioned mitochondria. That is probably a big way this ties into fatigue as well. With the environmental toxins affecting the mitochondria, potentially causing mitochondrial damage. If you have the environmental toxin exposure and/or nutrient depletion, either one of those can have a negative effect on the energy powerhouses of the cell, which can lead to fatigue, correct?

Dr. Rajka: Yes. Just add in the everyday life stressors, which further deplete your nutrients. It’s like this vicious cycle that can be hard to get out of.

Dr. Eric: How about as far as the gut? All of this is important, but if you don’t have a healthy gut, that also could lead to nutrient deficiencies. Even the amino acids, you mentioned protein. People do need to eat sufficient protein. Also, if someone has low stomach acid or other gut issues, they need to address that, or else that could be a big problem when it comes to supporting the detoxification pathways as well, yes?

Dr. Rajka: Yes. You already mentioned the first way. We absorb our vitamins and nutrients less well when you have dysbiosis or low production of stomach acid. That puts people even further less well able to tolerate being exposed to toxic substances.

Ironically, I was re-reviewing things with phase three detox. The dysbiosis will not allow you to do that phase three. Excreting it, transporting those toxins out of the body. I do have a “right order,” my 3D protocol. I do things in the right process. If you go in and detox someone from the get-go as a starting point, you can make someone very sick. It’s never the first thing. I always tell people a diet will detox you.

I’ve had one woman in all these years who ate so terribly that when we put her on a healthy diet, she complained vehemently. She was gently detoxing but really felt the effects of it because she had never provided herself with the right nutrients. She was probably getting a backlog of those metabolites and was not able to clear them as well. We had to back step. That was a rare scenario. It’s the right order, too. I have seen people be made worse if they detox first and not with all the support systems in place.

Dr. Eric: You need to make sure phase three is working, which makes sense. If you’re constipated, you probably don’t want to get aggressive when it comes to detoxification.

Dr. Rajka: Yeah. Having the appropriate nutrients, having amino acids, making sure there is NAC glutathione, making sure someone is sweating and hydrating and having daily bowel movements. Not being constipated. I always laugh when I say the only field we talk about poop as being kind of sexy is our field.

Dr. Eric: Yep, no problems talking about poop here. You said when you were giving your background, you had your gallbladder removed, which unfortunately happens to a lot of people. A couple of questions with that.

One question is if you take any support since you don’t have a gallbladder, whether it’s bile acids or anything similar. Also, if someone is having gallstones, and their doctor is saying they need to remove the gallbladder, not to say there is never a time and place for that, but if it’s maybe in the earlier stages or middle stages, and there is still hope, do you have any tips?

Dr. Rajka: I do. Back story there. We were abroad, and the only American surgeon that was there had left, and we were returning to the same spot. He had said to me when I was pregnant, “I wouldn’t operate on you here non-pregnant let alone pregnant.” He was pretty much, in his mind, the only qualified surgeon. I started to have symptoms right before we moved back. Ironically, I had an appointment with a naturopath and the surgeons. I panicked because I thought, “Oh my god, what if I get into a situation where it’s an acute gallbladder attack that is a do or die? He is telling me he doesn’t trust the system or the process there.” When you have a surgeon saying, “You have a gallbladder full of stones. Get it out,” and I wasn’t trained like I am now, you probably will follow through. Mine is more of a worry about what if? If I had time, I probably would have done what I do now.

Knowing genetics, you first want to make sure there is proper bile formation. You have to make sure you have adequate choline. A good source is the yolks of your eggs. Some people have difficulty absorbing choline. I am in this mix. That is why I developed gallstone symptoms when I was pregnant. I wasn’t absorbing the choline. Pregnancy increases the need for choline. I have a whole pre-pregnancy protocol where we support choline a little more to meet the needs of the pregnancy. That would have been my first port of call: supplement with choline, either liquid or capsule form. I still do that. Your common bile duct, which is what remains, does produce a little bit of bile. I augment and do bile acids or bile salts. Ox bile with every meal, so I absorb properly.

Here is the kicker. Even that took a little while going into functional medicine to understand that I should be on this supplementation. From a genetic standpoint, the gene that governs the choline absorption is PEMT. I do have the mutation. Typically, you will see that those with the mutation experience symptoms when they are pregnant and in menopause. Those are the two time periods. I had a young lady brought to me by her mom and said, “Every woman in our family has had her gallbladder out. I want you to spare my daughter.” The daughter was a teenager. We took a look at her genes, and now she is on gentle supplementation. We have talked about what you can do. I’m on those two.

That was also going on at the time of when I had that whole liver flare. I avoided the foods that would trigger it: caffeine, alcohol, onions, garlic. I backed off on those foods. Things like beets, beet juice, beets themselves were very healing for me at the time. Sadly with the surgery, I had my common bile duct injured, and it closed off. That will make you more sick than anything because it really escalates a backlog of everything. The bile, the liver enzymes shoot up even higher. I’ve had that duct opened twice now before I was in functional medicine.

Now that I am, I rarely get a flare. I know what my triggers are. I had one probably like six months ago. You better bet your bottom dollar stress doesn’t help that at all. I thankfully had a lot of gut healing supplies with me. I travel with a little stash of stuff in case my family gets sick. By taking the ox bile, the PC, I even had some Colostrum, which is your immunoglobulins, and a good solid enzyme, it passed very quickly. Now I’m just super careful. I just try to maintain that, striving for a healthy diet and lifestyle.

For me, if I strive 100% of the time, because I want to hit 80 or 90, I am on board and doing well. I shoot for 80, which means I will hit 60 or 70. I have more resilience to things coming my way. Even asa high performer, overscheduling themselves and being clear on what my mission and goals are personally and professionally and sticking to them. Saying no more than I say yes.

That’s off topic and not genetic. We are genetically wired when you are a high performer and busy to go, go, go, and do, do, do. It’s probably not the best thing for you. I know when I was growing up, it became fashionable to go without sleep. It was like this badge of honor or something. Now I think it’s just not a good health choice to make. It’s fallen out of vogue thankfully. In our circles, sleep is prioritized. So is preserving your most precious asset, which is time. You can never get it back.

Dr. Eric: I’m glad you shared that. I haven’t really looked into the research when it comes to sleep and oxidative stress. I know lack of sleep will cause inflammation in general, like higher CRP levels, I believe. I imagine also oxidative stress plays a role in that, too. I think it all does tie together.

Dr. Rajka: Absolutely. The other thing to know is there is a level of oxidative stress that is going to be okay. We produce free radicals every time we make ATP. A small amount of that is super important because that is how we fight off the pathogens, the bugs we encounter: bacteria, viruses, etc. It needs to be in balance. When it escalates, and you need to appropriately eliminate those free radicals that do damage, that is governed by genetics. I look at the pathways and just love it.

I tell people I had a woman who came in with autoimmune conditions. We did all of these steps without knowing her genetics, and then we reverse engineered it. It was really telling why I chose the steps that I chose, based on her history, symptoms, and labs. That worked. That is how I am able to reverse engineer. You don’t necessarily need it. In fact, I wish we had a better way to affordably measure which gene is expressing. I always tell people you want to combine symptoms with labs along with the suspected action of what the gene might be doing rather than just looking at the genetics, which are worthless alone.

Dr. Eric: Do you look at any tests when it comes to oxidative stress or glutathione? Some organic acids tests look at pyroglutamate. There is some oxidative stress markers as well on the Dutch test. They have the organic acids section that has an oxidative stress marker.

Dr. Rajka: Pyroglutamate looks at your need for glutathione, and it’s presuming that your levels of oxidative stress are high. On the Dutch test, one of the ones that you should pay real close attention to is it looks at damage to our DNA. That marker is called 8 hydroxy deoxyguanosine, 8-OHdG. If you have DNA damage that is present, you better say what is driving that? Is it stress, toxins, lack of sleep, lack of nutrients, inappropriate diet, dysbiosis? You run the list and maximize as much as you can.

The other marker I’ll look at on a NutrEval is a lipid peroxidation, so damage to the lipids on the body. I look at oxidized LDL, which is the bad cholesterol. You not only have to have an elevation of bad cholesterol, but a portion of it has to be on the small particle stick, and a portion of that is the damage. That’s a perfect storm. If you have elevation, a lot of damaged small particles, that is the storm for forming plaque and having that plaque rupture. Think about a heart attack or a stroke. I have had people come back with high levels. I am still looking at what is causing it.

There are ways that I mock that up, so to speak. There are various things I give. If I don’t know their genetics, I will use molecular hydrogen, which will usually lower it nicely. We have to figure out where this is coming from, or we will never be able to stop. “I will protect your tissues by giving you this.” If I know their genetics, I will say, “Hey, is it a breakdown of the super oxide free radical? Do we need to give you an enzyme called SOD, which breaks it down to hydrogen peroxide? Is it broken down into hydrogen peroxide, but you can’t clear it through your glutathione system, through another enzyme called catalase?” I look at the big picture. If I don’t know, molecular hydrogen has worked wonders. I can lower it in about three months. It gives me time to find the source. That is the most important question to ask: What is the source? Why is it happening to begin with?

Dr. Eric: That’s a good point. If you see any of these markers out of range, you want to know why, and not just give the person a supplement. On a short-term, temporary basis, it might be important. You don’t want the person just to take, whether it’s glutathione or molecular oxygen on a permanent basis. Ideally, you want to try to find the cause of the problem.

Again, that ties into the genetics because sometimes, we just have the genetic variations, those polymorphisms, where someone might need to take some support. You mentioned a short while ago that you do take a little bit of glutathione every single day, a small amount, just because of the two genes that you’re missing. Because of this, do you recommend genetic testing to all of your patients?

Dr. Rajka: I recommend it to the chronically sick and those that really want to mitigate any long-term risk. The two varieties now. People aren’t interested, and they have youth on their side, so those in their 20s or 30s may not need it or want to know it. Then we really hit the epigenetics: diet, lifestyle. Just by their markers sometimes, I can tell.

Let me give you a really simple example of genes. When we are trying to get someone’s Vitamin D levels up, so they have proper immune function, the range can be a couple thousand IUs a day to 10,000+. Those people who are needing 10,000+ typically have genetic mutations in either the way they are converting, or they are converting with their Vitamin D transported. There is a whole host of genes that govern that. You don’t need to know the genes; you just titrate their D that they are taking according to what their body is showing you that they need. In the winter, you will need a couple more thousand or more than you would in the summer.

So far to date, I have had one person, and she was another practitioner, have optimal levels without supplementation. She lived in Austin, Texas. She is getting sun.

It was so odd. We were living in the Middle East. We were out in the sun all the time. That was the only activity you could really do when it was so hot was swim in the chilled pools. My kids and I were all deficient despite the sun exposure. We all have those genetic mutations ironically.

I have seen a pattern where some of my patients who have the chronic environmental illnesses are missing the same two genes I am. I am starting to do some research on is that why they are so sick from it? Is that why they succumb quicker?

I talk about how we all have different detox buttons. Some of it is genetic, and some of it is diet and lifestyle. if you are small, you will present being ill earlier in life. If it’s medium, maybe a little bit later. If it’s large, you might be that one lucky person. I’ve had one in a career of over 25 years of medicine where he is the Uncle Harry who smokes three packs a day and dies quietly in their sleep with no adverse outcome. That is the rarity, and I wouldn’t bank on that.

Dr. Eric: I agree. Unfortunately, my mother smoked for 40 years, and she is still with us. She is 80 years old. No bad damage. Don’t know what the next 5-10 years will bring. She stopped smoking 10 years ago, but she did smoke for 40 years. Her genetics were kind to her compared to others, but you never know. Obviously, she didn’t know. She was just lucky with that.

I agree. You don’t want to take the chance. The good news is there is genetic testing for those who want to find out the information. Like you, I can’t say I recommend it to most of my patients. At this point, I won’t say I’m new at it because six or seven years ago, I did 23andMe, which they have since changed. I have recommended some genetic testing. I’m not at the point where I am recommending it to most patients.

If someone is dealing with a lot of chronic health issues, that might be something to dive into and see, especially if they can’t tolerate- You mentioned that you have people who can’t tolerate glutathione, but there are also people who seem like they can’t tolerate anything. in that case, maybe it would be helpful to take a deeper dive into the genetics.

Dr. Rajka: Like I said, the two varieties, the person who wants to mitigate any long-term risk. I am a firm believer that your thoughts form your words, and your words can change your life. I shudder to think what would have happened had I not discovered this. The genes were ominous. We’ll have to do that another time, maybe over a nice dinner or something when we’re out socializing. I like it for a variety of reasons. You’re right. It’s not necessary in every single person.

To speak to your mom, if I may for a minute. She must have excellent genes. We started running an epigenetic test for aging. It gives you your age based not on your biological age, if someone is 50, but it measures what your diet and lifestyle have done to you. How old are you based on the markers in your body? Smoking is one of the ways that will age you quicker than anything else since it is creating oxidative stress. That speaks mountains. Maybe you have some really good genes if they were inherited. That is one of the eight things we would do to mitigate.We just ran that test on me and my husband to see where we are at.

The other thing that plays into it is sleep and stress. As you know, the past two and a half years have been a very interesting time for a lot of us. I know I’ve pulled out all the stops. I laugh when I tell people, “When I’m stressed, I double down on the meditation.” It goes from 15-30 minutes to an hour when I can. It really does help me stay out of trouble, is how I feel and how I recover.

Dr. Eric: I am a big believer in mind/body medicine. What I tell people, if someone is not in the routine, just start with five minutes per day. Just get in that routine. I don’t want people to think they have to do 30 minutes or an hour every single time. If you can do five minutes a day, get in that routine, and once you are in the routine, you can gradually increase. Maybe some days during the week, you will do it for 30 minutes or an hour, and the other days, you do it for 5-10 minutes. It’s getting into the routine, like just with anything.

Dr. Rajka: I like your five minutes a day.

Dr. Eric: Everybody can do it. Everybody can find five minutes. I know some people find the excuse that they can’t do five minutes a day, but those are the people who need it the most. They need to do 30 minutes a day probably, but at least start with five.

Dr. Rajka: I have started saying: What is my bare minimum of the things that fuel me? I have a bare minimum for breath work and exercise. It’s interesting that when you set that lower limit, and you’re successful, then you’re able to increase it over time. I have found that sweet spot.

Another thing I will challenge people on is when you wake up and get out of bed, hopefully you’re refreshed. Say you don’t have the time even to do five minutes. Do 10 breaths before you even get out of bed. I have trained so long on heart math, which is one of my favorite things we teach every single person because the data is sound. I have seen people say they have meditated for 20 years. You look at their stress response, and it’s either in the gutter or through the roof. It’s not getting you out of fight or flight.

This is a tangible way to test. After a while, you learn what breath pattern gets you out of fight or flight. I can do those 10 breaths and know those 10 breaths are working. Think about when you are answering emails. Do a breath hold. That’s good not only for supplying oxygen and fueling your brain, but getting you out of fight or flight.

Dr. Eric: If you can’t find five minutes in the morning or at any time during the day, but I agree that in the morning it’s nice to start out with meditation or any type of mind/body medicine. 10 deep breaths is an option.

I chatted with another practitioner recently about heartmath. She is a certified heart math teacher. I’ve used Inner Balance for many years, too. Definitely supportive of heart math.

You have shared so much great information. Is there anything else I should have asked you that I didn’t ask you, or anything else you want to share?

Dr. Rajka: I am going to share three things that keep coming up when I talk to people who are thinking about investing in their health. A lot of people say, “I will DIY it.” Set a time frame. Maybe that will work in a portion.

Find that guide. It doesn’t have to be me or you. Find a guide you trust. It will take you from Point A to Z much quicker. My original guide led me on the diet/lifestyle path, but he didn’t really know all the rest of it. If someone had told me, “I am going to give you exactly what you want and get you better from this acute illness. I will also give you everything you need,” I would have said, “I’m all in. What is it that I need that I’m not aware of?” Sometimes, what you don’t know can hurt you. Find that guide, especially if you have tried to DIY this.

If you’re having such significant symptoms, and I view that as any level of fatigue because most people are fatigued and have acclimated to a lower level of energy, and they don’t realize it. I’ll say that again: Most people have acclimated to a lower level of energy and are already fatigued. By the time you actually feel it, you are behind the 8 ball. There is some kind of dysfunction going on with the detox that is affecting you, whether it’s your thyroid, brain, or joints.

If you walk in a room and don’t remember things, those are serious signs. Pain of any sort that seems not to respond to usual measures. That says there is mitochondrial dysfunction. That means there is a lot of oxidative stress going on. You need to figure that out before it gets into a serious state.

It’s mind-blowing to me because I know I can afford help and reversal for people. When they say, “No, that’s okay. I’ll deal with it in two years,” if you’re at that point, you don’t have two years to wait. I only say that kindly and lovingly because I see people on the other end of the spectrum, where they are so far gone, and it’s a real challenge to recover what little you can and maintain them there. Even that six months prior or one year prior. Just to take some of those symptoms that people tend to write off as more serious because they are.

Dr. Eric: Where can people find out more about you?

Dr. Rajka: The main source right now is DrRajka.com. That gives a wide variety of info. We have an energy quiz on there that people can take and other resources. I do have a professional Facebook page and Instagram that is @DrRajka. We are getting more up there with Reels and Lives. When we are busy clinicians, that goes in waves. I like speaking on podcasts like yours because it’s empowering to be able to convey the information so that I can open people’s minds to the possibility of how well they can feel.

Dr. Eric: Thank you for doing this interview, Dr. Rajka. I appreciate you sharing your expertise, not only on the genetics of detoxification, but so much more, like oxidative stress, which I know ties into that, and sharing your story about your gallbladder removal and how you support it. A wealth of knowledge.

Dr. Rajka: You’re welcome. Thank you for having me.

 

With me, I have Dr. Alexandra Swenson-Ridley, who is a thought leader in outside the box and natural approaches to women’s health and hormones, focusing on what she has termed “selfless syndrome.” After suffering her own health challenges that resulted from focusing on everyone and everything but herself, her work turned toward helping other driven women navigate the world of fatigue, thyroid issues, anxiety, depression, difficulty losing weight, gut health, and more without the use of medications. Thank you so much for joining us today, Dr. Alex.

Dr. Alexandra Swenson-Ridley:

Thanks for having me. I’m excited to be here.

Dr. Eric:

Excited to have this conversation. I usually start off by asking people to share their background. How did you get started in doing what you’re doing? I know you have a wonderful podcast. Let’s share your background.

Dr. Alexandra:

I got started, a lot of us do, by my own health struggles and challenges in my earlier to mid-30s. I’m originally a chiropractor. I built a big practice and hit this point where it was not the dream, and my health was really suffering.

In terms of thyroid, I developed some anxiety. I was having panic attacks. My hair was falling out. I was going hoarse at the end of every day. I was exhausted. It was all I could do to feed my kid before I fell on the couch. I learned more, educated more, did continuing ed stuff that was related to women’s hormones. I understood stress and how that all interacted.

I ultimately took myself on a journey, where I knew I did not want to take medication. A) I don’t think I would have been diagnosed as having a thyroid issue because of lab ranges and how they look at that. They wouldn’t have looked at enough things. B) I wouldn’t have taken medication anyway. I was left with how to figure this out on my own.

I am happy to say that today, I have gotten there. Now I help other women do the same, whether it’s thyroid or something else. I really get to the root of why our bodies aren’t functioning the way they should and how we can get them back.

Dr. Eric:

I really want to address the cause of the problem. We will talk about your decision not to take medication as far as how that translates to others you work with. Before we talk about that, can you dive into selfless syndrome and maybe tie that into thyroid health?

Dr. Alexandra:

Selfless syndrome, most people have an idea of what it is by the label, but it applies to both men and women. I don’t know if your show is predominantly women.

Dr. Eric:

Mostly women, yeah.

Dr. Alexandra:

It’s that innate desire we have to take care of everyone and everything except ourselves. We are constantly putting ourselves last. We are the last thing on our schedule, the first thing to go. Before this, I was teaching a workshop around brain health related to this as well. Over time, the more we don’t make time for ourselves, the less capable we are of showing up for the people and the things that we really love and care about. That’s in a nutshell what selfless syndrome is.

I really talk about, especially in our modern world and society, where as women, we have taken on more roles. Some of it is self-perpetuated, and some of it is societal and generational. We have added to the plate but not had anything taken off. We have this very high level of stress that we’re always running through. We can get into the nuances of how that affects the thyroid, but it’s going to impact your thyroid function, your gut health, which has a lot to do with thyroid, and a bunch of other things.

Dr. Eric:

Essentially, doing too much. It’s something I ask when I have patients fill out their case history. Most of my patients are women just because, as you know, it’s mostly women who have thyroid conditions even though I was one of the lucky men who was diagnosed with Graves’. It’s obviously very common. Let’s talk about how selfless syndrome relates to the adrenals. Stress has a great impact on adrenals. We can perhaps tie this into thyroid health as well.

Dr. Alexandra:

We all have stress. We all know there is bad stress. The truth is we need some level of stress. Our body does need to produce some level of cortisol, and it’s supposed to rise and fall in a certain way throughout the day. When we’re living under constant stress or toxic stress-

For example, I had one woman who came in early on when I started doing this work. She said, “I’m not stressed.” As we kept talking, we got into how she actually has a daughter who is severely autistic and lots of appointments and PT and fighting for her at school. All of that is stress. Because it’s just her life, she doesn’t relate to it that way.

The first thing I would say is just be aware that just because you don’t feel it doesn’t mean that you’re not actually experiencing stress. Most of us are functioning in a way where we don’t know anything else. That’s just normal. If your body starts to break down, that’s a good sign we have some stress happening.

As that’s happening, your adrenals get more taxed. We have what’s known as the HPA and HPT axes in the body. They run parallel to each other. The hypothalamus tells the pituitary to do something with our hormones. It either talks to adrenals to produce cortisol, or it’s telling the body to produce sex hormones. It also talks to the thyroid. The pituitary then tells the thyroid, “Hey, make some thyroid stimulating hormone.” It’s released. All of that chain starts.

When you have stress, it’s taking away from that happening. That’s where we start to see a lot of breakdown, especially with hypothyroidism or even developing into Hashimoto’s or Graves’. Hypo seems to be more common from what I’ve seen.

Then you start having the symptoms. You can’t lose weight. You’re tired and cold all the time. Your hair is falling out. All of the fun that can come along with thyroid stuff. Going hoarse. That was my big one. I kept losing my voice by the end of the day. I couldn’t talk. We start to see those. But it starts somewhere. It’s not like you just wake up one day and have these issues, unless you have some genetic thing that has led to that after developing over time.

Dr. Eric:

You had a thyroid condition. Was it Hashimoto’s that you dealt with, or not autoimmune?

Dr. Alexandra:

On the scale of looking at it from a more functional standpoint, I did have antibodies toward Hashimoto’s. It wasn’t at the level where Western medicine is going to diagnose it as such. I look at it as if your body is producing any antibodies that is affecting an organ, that’s generally not a good sign.

My diagnosis on myself was subclinical hypothyroidism, meaning my levels looked more or less normal, going beyond looking at TSH, but TSH and free T3, free T4, reverse T3, and antibodies. My reverse T3 was high, which is another indicator of hypothyroidism. I had symptoms.

My rule of thumb, in all the research and reading and learning I have done and working with other clients, is if you have symptoms, it doesn’t really matter what your labs say. If your thyroid isn’t working, it needs to be for your body to feel good. That’s how I look at that.

Subclinical is everything is normal, but you still have symptoms. I don’t know how much you’ve talked on the show about the ranges they use for defining what normal thyroid is. They have bene arguing about it for about 50 years. It’s way too broad, and nobody ever changes it. By the time you hit a point where in Western medicine, they will say, “Your thyroid is off,” you are really not doing well. This is what I’ve seen.

Dr. Eric:

I’m glad you bring it up because a lot of doctors blow off subclinical hypothyroidism. The TSH, in your case, maybe it was well within the reference range or on the higher side, but either way, it was outside of the optimal range. With the conventional medicine, it’s a waiting game. They will say, “Let’s just keep an eye on it.” Maybe sometimes, if the person is experiencing symptoms, they might put them on thyroid hormone. Most of the time, they usually won’t do anything unless the TSH is overtly outside of that reference range.

Dr. Alexandra:

Mine as well. They very rarely look at anything beyond TSH. That’s the other thing. TSH is only one part of the picture. That’s what’s happening with your brain and the pituitary. You also have to look at the thyroid itself, which mostly releases T4. That goes to your gut, which is converted into T3, which is what your body can actually use.

My subclinical hypothyroidism, my T3 levels are what was hypo. Even though my brain looked normal, my body itself was experiencing being hypo because there wasn’t enough usable thyroid hormone available. That’s what’s going to help our metabolism and help regulate a bunch of stuff in our body.

Dr. Eric:

You said you also had an elevated reverse T3. Correct?

Dr. Alexandra:

Yes. That’s the one thing I haven’t totally impacted yet. I ran labs on myself recently. The other thing I experienced was I put on 50 pounds overnight and couldn’t get it off. That was a combination of I had some stuff that happened with my estrogen. I was estrogen dominant. The thyroid was also being impacted and causing part of that, too.

That’s something I see with a lot of my clients: It’s more common for women, especially in their 40s and 50s, to be in that place where,“ All the things I used to do to get weight off aren’t helping anymore.” There is a breakdown at the hormone level. Until you deal with it-

Dr. Eric:

Speak about weight gain and weight loss. Obviously, you need to get the thyroid hormone levels in balance. That free T3 is very important. Is there any specific diet that you recommend? Does it depend on the person?

Dr. Alexandra:

It depends to an extent. I’ll be honest: Food is something I love. Designing nutrition stuff isn’t my wheelhouse. I’ll leave that to the nutritionists. From my own experience, last year, I lost about 30 pounds all through eating. I didn’t exercise at all. I was exercising, but that’s not how I lost the weight.

Just recently, I found a book by Haylie Pomroy, The Fast Metabolism Diet. I will reach out to her to see if I can get her on my show. If you’re looking for something and are tired of doing Weight Watchers and all that stuff, I love her book. Her definition of “diet” is Did I Eat Today? This is a common thing I see, especially because with thyroid, if our thyroid is off, our metabolism will be off as well. If you are hyper, which is much less common, you’re eating a ton, but you’re losing weight. If you’re hypo, you probably don’t have much appetite, and you keep packing on the pounds. Those things go hand in hand.

Her approach resets all of that and is one of the first things I found that resets the thyroid as well. I guinea pig myself on everything. I think in a week, I lost about five pounds just following her plan, which has more variety than most of your diets out there. You’re eating, which is very important. It’s counterintuitive to think you need to eat in order to lose weight because we have been so trained to eat less and work out more. We have taken that way too extreme. That stuff impacts the thyroid as well. If you’re dealing with hypo, you have to train your body to eat again so that your metabolism turns back on, and it starts producing like it’s supposed to.

Dr. Eric:

I need to check out that book as well. Getting back to selfless syndrome, what do you do to help people with that? Do you tell them to slow down, block out time for stress management, incorporate mind/body medicine techniques? How do you handle that?

Dr. Alexandra:

I have come up with a proprietary combination of a whole bunch of stuff that I have done recently, grounded in a lot of neuroscience, and the concept of neuroplasticity, which is our ability to rewire our brain, what we think about all the time. Our habits are wired into our subconscious.

To really impact what I have defined as selfless syndrome, we have to go deeper than just trying to convince ourselves to do something differently. There is actually something that needs to shift in recognizing our own value. For a lot of women, there is a self-worth conversation that runs underneath all of that: we don’t value ourselves enough to take care of ourselves.

I do a lot of work there actually. I’m less in the nutritional and hormonal world. In terms of doctor hat wearing these days, I’m more in the how do we really rewire our foundation, so that it’s not such a challenge to show up for ourselves, and not in a selfish way, but to do it in a way where we are just the best version of ourselves because we are making time for ourselves?

I got there by looking at every woman who had a huge amount of success working with me. Came off medication, lost weight, balanced the hormones. It didn’t stop there. Their relationships were better. They made shifts in their career. They did a lot of the hard, challenging work. We do have to slow down some to take those steps. There is a level of having to foster some courage and confidence and clarity in yourself and where you’re going and what your values are to make those moves and make those choices.

That is a lot of what I did to heal as well. I made the choice to retire from chiropractic. I got divorced and remarried. I’m not saying you have to do those things to heal, but we have to be willing to look at what has been going on in our lives to get us to this point? Where can we start to make shifts and changes so that we have the life we love and the body to enjoy it with? That’s really what I’m about.

Dr. Eric:

It sounds like you go beyond the diet and stress management. I’m guessing you probably get people from other health care practitioners, not to minimize and say that’s all they did. Some people, that’s all they do. Maybe even on their own, they just read some books or listen to some podcasts like this one, but they just try to do things on their own from a diet perspective or stress management. It sounds like you go way beyond that.

Dr. Alexandra:

Yeah. Honestly, I’ve learned we really have to. If you’re constantly just in information accumulation, you’re missing- I’m a classic high performer who lives in my head, so this has been part of my journey recently that I’m doing with the women I work with, who are driven and in leadership roles but are struggling with their health: getting out of your head, tuning into your body, and asking it what does it actually need? As we start to do that, a lot of how you’re eating and sleeping might shift, as will exercise, in the way that they need to. We have to get out of analysis paralysis and take some action. Our bodies know a lot. If we just tune in and listen, it will tell us things that we need.

Dr. Eric:

Very true. Let’s talk about the medication. It was your personal decision not to take medication. When I dealt with Graves’, I chose not to take medication either. With hyperthyroidism, many people take antithyroid medication, but I chose to take an herbal approach while addressing the cause of the problem. Fortunately, that worked, and it’s worked for a lot of people that I have worked with over the years.

I do think there is a time and place for antithyroid medication, just like with thyroid hormone replacement. I’d like to know your thoughts on not necessarily your personal experience, but how you approach other people with thyroid conditions, more specifically hypothyroidism since it sounds like that’s who you mainly work with when it comes to those with thyroid conditions.

Dr. Alexandra:

Yeah, hypothyroidism and Hashimoto’s is more of what I see. My stance on this, with the caveat that I cannot give you any advice around medication legally under the umbrella of my licensing.

However, what I do like people to know is first recognizing you do have a choice. There is more than one way to handle it. As a society, once you’re on thyroid meds, you’re on them for the rest of your life. All of that is a myth. None of that is true. Realizing it is a choice.

Like you, there is a time and place for medication. It’s not like all medication is bad. If you are really struggling and can’t even start doing the things that are going to help start turning you around, that is a time where I might say, “Hey, let’s talk to your Western medical doctor and get some help for your body, so you start feeling better” with the understanding that it doesn’t mean you’re on it for the rest of your life.

Finding someone who will work with not just looking at- They normally give more T4 combined with T3 if we need to. The gut is left out a lot of managing thyroid. Most of your usable thyroid hormone is made in your gut. While you heal that, because that’s not a quick process by any means, could you benefit from some support if you’re really struggling?

It’s a choice. It’s absolutely one that I think every woman should feel empowered to make or not. Man, too. Recognizing who you are. Are you someone who can make lifestyle changes? With selfless syndrome, you have to show up and make time for yourself to journal, meditate, and ask yourself the hard questions. Have someone go on that journey with you. I provide a road map for that experience. Just getting clear on yourself. Are you willing to slow down? Are you someone who just needs the medication to keep going? In choosing that, you’re recognizing that you’re not heading in a good direction, we’ll just say that.

Those are my thoughts. It’s there. It’s a tool. You don’t have to be chained to it forever. There are other options out there.

Dr. Eric:

Can you dive into the core pillars? You might have already touched upon them a bit, but if you could dive deeper.

Dr. Alexandra:

I keep changing what they are, but they’re all similar. The ones I’m operating with right now, there are seven of them. Most of us tend to think of how I eat, how I move, how I sleep. That’s true to being healthy. I look at them as perspectives. What is your general outlook in life?

Nourishment doesn’t just have to do with what you’re feeding yourself, feeding yourself well, but also how nourished you are by your job, your environment, your relationships, your spiritual practice. It’s that kind of stuff.

Connection is a big one these days. Especially with thyroid, I see both in nourishment and connection, if you feel you are not expressing yourself fully, there is a lot of energy that is stored in your throat. I don’t want to get woo woo on people. I talk about energy centers, not chakras. There is a connection between not being self-expressive and hypothyroidism in particular. Connection is one of the places where we get that. Especially as women, we need to sit down and talk. We haven’t had a lot of that recently.

Rest is not just sleep, but also rejuvenating activities, like not killing yourself in the gym, but when you come down from deescalating.

Attention is how you are able to focus. This is another thing I see a lot of, brain fog. We focus on somebody else or something else or allow someone to focus on you. That can be a bit confronting for people.

Your purpose and contribution. How connected are you to your passion and purpose in life? Are you doing things that light you up, and you feel you are put here to do? Or are you going through the motions?

I look at that whole picture in how we define health and how healthy we really are. A lot of those are access points to having your hormones balanced, your thyroid working right, your gut happy.

Dr. Eric:

Wonderful. What are some of the steps people with thyroid and autoimmune thyroid conditions can take to get their life back? If someone is listening to this, they’re like, “Yeah, this is me. I have been dealing with selfless syndrome. Everything you said sounds great.” Maybe it’s not an order, but could you give some guidance about what some of the next steps could be?

Dr. Alexandra:

With every woman, the journey is a little different. Sometimes, when we help a lot with the physical side, there is an emotional side to healing. That’s the other piece I work a lot in: trauma stuff and other things that most of us have underlying. Either we feel better physically, and they are ready to let go of all of this stuff. Or they are ready to let all of this go, and the physical heals as a result of releasing that. It’s finding an avenue to work on that within.

If that’s super overwhelming, my first two things for anybody is to learn how to breathe again and drink water. Those are the two steps; we can keep it really simple. Twice a day, you take five deep breaths, breathing in five count, holding it five count, breathing out five count, doing this five times. I think we overcomplicate it often.

Water, our bodies are mostly water, so if you’re not drinking half your body weight in ounces of water, and I do mean water, not coffee or soda, etc. If you can start there, you will start to feel better.

From there, there is work we have to do, both emotionally and physically, like working through healing the gut and other things we are storing in the body. Thoughts are the power of the brain. Emotions are the language of the body. All of our experiences and emotions are stored there. Until we let them out, things don’t usually work right.

A little broad. Breathing and water are the easy places for everybody.

Dr. Eric:

I think that’s great. Everybody can start with that. Everybody can start with doing a little bit of breathing each day. Obviously, we breathe all day, but doing some focused breathing exercises, even five deep breaths to start out with.

Dr. Alexandra:

You don’t even have to count. You need to slow down your breathing and breathe a little more slowly and deeply than normal.

I was just certified in heart math. Bringing focus to the heart is another way to push reset on your nervous system and state. That will allow a lot of function to start to come back in your body.

Dr. Eric:

Can you quickly talk about heart math? I don’t think I’ve mentioned that yet. I’m familiar with it. Can you talk about heart rate variability and how you incorporate that into your practice?

Dr. Alexandra:

This is newer stuff I have been doing, but I really love it. Heart math brings a lot to the idea of coherence in our body. We are both chiropractors, so we have lots of background in the nervous system. When we are in a hyperaroused state or stressed, generally, there is a lot of chatter going on. We’re not connected between our head and our body. Heart math is a tool that allows you to start to build coherence. They have biofeedback devices that help you measure how often you’re in coherence.

I have an Oura ring that I use. I don’t get anything if anyone buys one. I happen to like the product. It measures my heart rate variability and gives me a score for the day. It will measure things like how much restorative time you got. With thyroid and a lot of the more hormonal imbalances, if we try to push too much, it’s going to make it worse. I have been someone who has needed that information to be like, “Hey, so your heart rate variability kind of sucks, and you haven’t had more than five minutes of restorative time a day the whole week. Why don’t you chill?” The Oura ring will tell me that, and it’s helpful for those who need that kind of input.

The bigger point behind it is you give your brain a chance to slow down with heart math and find that coherence. The more you can learn how to shift out of a hyperaroused state into a coherent state, coherence is where our intuition lives, energy lives, creativity lies. There is a lot of health benefits, like heart rate variability will increase. We want it to be higher. Heart rate variability is not just measuring your resting heart rate but measuring how much it changes in time. A good healthy heart is able to flux a lot. If you are on the lower end of that, which I tend to be at times still, I am experimenting with how I make this better. And you learn. Maybe I shouldn’t have worked out like that on that day. Maybe this kind of exercise helps.

Heart math has techniques to bring that in. One is heart-focused breathing, where you focus on your heart. I like to touch my heart. Some people don’t like to touch. I bring awareness by touching my heart, the area over my heart on the left side of the chest. Either focusing on something or closing my eyes for a little bit, and just breathing, a little more slowly and a little more deeply. That’s something that will start to train that coherence.

We can talk about heart math, too. Whatever you want to bring up. I think it’s really cool and a great tool for people.

Dr. Eric:

I agree. I have been using the Inner Balance for a number of years. I know others who have an Oura ring. You use the Oura ring as part of measuring the heart rate variability, keeping track of that.

Dr. Alexandra:

Mostly because I haven’t gotten an Inner Balance yet. I really like the Oura ring for that. They keep adding stuff. Now it measures blood oxygen when you sleep. It’s pretty good at measuring sleep. I find it cool when I do a great job of meditating, it will register a nap, which is awesome.

Dr. Eric:

Yeah, that is cool.

Dr. Alexandra:

We have lots of tools available to us to start to tune into how my body is actually doing. How many of us pay attention to them is another story. Those are two that I like. I don’t like the Apple Watch because it just yells at me to move every day even if my body is not ready for that.

Dr. Eric:

I haven’t thought about getting an Apple Watch. I have thought about getting an Oura ring, but I haven’t done it yet. I use the Inner Balance. Everybody is different when it comes to stress management, and I find myself not doing meditation. I’m not a big yoga person. Honestly, I haven’t tried getting into the routine of yoga. I have been in the routine of the Inner Balance and using it to measure heart rate variability for years. It works for me. I’m sure there are some listeners who have been doing yoga or meditation for years. You can continue doing what works.

As you said, there are so many tools. If there are those listening who said, “I tried getting into yoga and meditation, and it wasn’t for me,” it’s just another tool, whether it’s the Inner Balance, or the Oura ring is another option. I know there are others, too. There is a newer device that came out that someone was talking about on another podcast recently. I’m sure there will be many others in the future.

Dr. Alexandra:

There is lots out there. You also don’t really need a device if you’re capable of just checking in with yourself. One of the most challenging things I had a business coach ask me recently was I was ramped up about something. She was like, “Where do you feel this in your body?” It really stumped me, both because I am a high achiever, and I like to have answers, and I didn’t know. And thinking about it, where am I feeling it in my body? What is that telling me? It allows you to tap into that intuition. There are a lot of ways to do it. It’s just figuring out what works for you.

Dr. Eric:

Anything else that I should have asked you that you wanted me to ask you that I didn’t? Anything else you’d like to share?

Dr. Alexandra:

No, I think we hit a lot for people to think about. Bringing it full circle, it’s looking beyond your symptoms. The answers to whatever you’re dealing with, thyroid or anything else, is you have to go beyond the symptoms and be willing to get to know yourself in a new way. On the other side of that is a lot of freedom: freedom from medication, symptoms, and feeling crummy. It is possible. It takes time, and it takes a willingness to do the work.

Dr. Eric:

Definitely agree. Dr. Alex, where can people find out more about you?

Dr. Alexandra:

I’m on all the social places. I hang out more on Facebook and LinkedIn. I’m @EmergentWomanCoaching on Facebook and Dr. Alex Ridley on LinkedIn. I’m also on Instagram.

I also have a podcast, which I’m currently rebranding to The Selfless Syndrome Show. We are getting into some of the nuances of how you really overcome that. Not that there is something wrong with you, but to transform it to live and exist in the fast-paced world we have and be healthy. You can check that out on all the podcast platforms.

In this episode, I interviewed Berris Burgoyne about herbal quality. This was a great interview, as Berris discussed the herbs she uses in both her Graves’ and Hashimoto’s patients. Just to be upfront, the goal during this episode was not to promote any brands of herbs, but one of the main reasons I decided to do this episode was because for years, I had been recommending the MediHerb brand of bugleweed to my patients with hyperthyroidism. Due to the supply chain issues, it’s been on backorder for quite a while. I have noticed that other brands of bugleweed haven’t been as effective. I reached out to Berris because she is an expert in this area and has a lot of experience with MediHerb products.

***

With me, I have Berris Burgoyne, who is a renowned naturopathic clinician with 33 years of experience. She owns and runs a naturopathic practice in Brisbane, Australia. She is a well-known international speaker. She has lectured in Australia, New Zealand, the United States, Canada, the United Kingdom, and South Africa. What sets Berris apart as a speaker and educator is her ability to take complex technical data and transform it into practical, clinical information that is easy to understand and apply. This, coupled with her extensive clinical experience, makes her an authoritative and dynamic presenter. Thank you so much for agreeing to do this interview, Berris.

Berris Burgoyne:

Thank you very much. It’s a pleasure to be here with you.

Dr. Eric:

I’ve looked forward to this. Berris and I are going to discuss the importance of herbal quality and get into talking about bugleweed and other herbs that could benefit thyroid health. Can you start out by discussing the importance of the quality of the herbs?

Berris:

Certainly. I have been a naturopath, and my main modality in doing that for the last 33 years is herbal medicine. That’s where my real passion lies. I have always been very careful about the quality of the herbs I use. There is a brand in Australia that I use called MediHerb, which is also available in the United States. I have always used that brand of herbal medicine because I’m really confident in the testing procedures they use to make sure that they are giving the practitioners the very best quality herbs.

When we’re talking about herbal quality, it’s very complex. We have to start thinking about how the herb is grown. The reason we use herbal medicine is if they are full of phytochemicals, these magical ingredients, that have the activity in the body we are using them for. We have to think about how they grow and how they are harvested, how they are dried and how they are processed after that.

There is a lot of testing that has to go in when a company gets an herbal medicine in to make sure first of all, that it’s the correct species, that it’s the correct herb. They do a lot of different testing for that to make sure it’s not adulterated with anything because that’s not that uncommon.

Also, to make sure it’s the correct herb part that is used. Plants have lots of different parts. People don’t always differentiate between the different parts that are actually used. They will talk about the herb per se. Sometimes, you don’t know what part is used when doing research on an herb. A good example of the importance of this is something like nettle root or nettle. Most people would know of nettle, stinging nettle. We use the leaf in herbal medicine as a really good depurative herb, which is very good for the skin and internal cleansing. Then we use the root for prostate problems. We have to know what part of the plant we’re using. If we’re using the wrong part of the plant, then we’re not going to get the benefits we’re after. In many cases, we won’t get any benefits at all. That’s very important.

You have to test the herb when you get it in and make sure it’s the correct herb. You have to test during the procedure of making that liquid herbal extract or tablet. You have to test the finished product to make sure it still has the level of active phytochemical we need. It’s very complex. I feel very confident that the brand that I use really goes through all those steps to make sure we have good quality medicines. That’s what I want to give my patients. Ultimately, if I’m not giving them good quality medicine, we won’t see good clinical outcomes. That’s what I want for my patients, as we all do.

Dr. Eric:

That’s true. That’s definitely important. We want people to get better. Is it true, at least I’ve heard, that Australia has much higher standards when it comes to herbs compared to some other countries?

Berris:

Yes, we do have very high standards. We have the TGA, the Therapeutic Goods Association, that oversees the manufacturing of all medicines. Unlike the United States, in Australia, herbal medicines are classed as medicines. They are not food supplements or dietary supplements; they are medicines. Anybody manufacturing herbal products for sale to practitioners, etc., have to do it under what’s called GMP, Good Pharmaceutical Practice. That covers all medicines whether you are producing pharmaceutical drugs or nutritional supplements or herbal medicines. Any company that has that GMP/TGA license, they are set up in exactly the same way as a pharmaceutical company with the same stringent guidelines in place. They get audited. Auditors from the TGA can turn up and do an audit.

Dr. Eric:

You also mentioned different parts of the herb are important. This goes for all the herbs, like echinacea or ashwagandha. That is something that most consumers aren’t aware of. Do you see where, not to knock other companies, but some companies might use the wrong part of the herb? Maybe it’s because they don’t know any better, or it’s less expensive to use different parts of the herb.

Berris:

Mostly herbal medicine people will be using the right part because they know. Tribulus is a good example of this. In Western herbal medicine, we tend to use the aerial part of the tribulus plant, the leaves. Most people have heard of tribulus. It’s been used in other traditions of medicine. The fruits have been used. That’s a very valid medicine in that system of medicine for what they use it for. But when we’re talking about using tribulus to improve male and female reproductive health, for example, we need the aerial parts, the leaves, because that’s where all the research on that topic has been done. You do see in health food shops and over the counter sales tribulus, which is sometimes the fruit. That’s very valid, but you can’t think it’s going to help with these other things where the research has been done on the leaf.

I personally think if you’re going to a naturopathic physician or someone who is specializing in using herbs and nutrients, whether they are chiropractors, naturopaths, acupuncturists. Doctors sometimes go to a professional to get what you need because I’ve seen patients who have wasted a lot of money just going into health food shops and buying products that they have read about on the internet, or their neighbors told them about it or something. It’s not often actually what they need. You can easily waste a lot of money.

Dr. Eric:

That’s true. A lot of people read about something or watch a video and get it on their own. They might ask the person working at a health food store, who might just have very basic knowledge. It is a good idea to work with a qualified health care practitioner who has knowledge when it comes to the quality of the herbs.

Berris:

When you go into a health food store, those people have very limited time. They are giving you advice the best they can under the circumstances. But when you go to a practitioner, practitioners will be gathering all the information they need to prescribe very appropriately for you. That is extremely important.

Dr. Eric:

I also wanted to ask you the difference between using alcohol, specifically ethanol, versus glycerin. There are some people who are cautious about using herbs that have ethanol. Can you talk about some of the advantages and disadvantages of each?

Berris:

This is a really interesting topic. I can totally understand people thinking, “There is alcohol in this herbal medicine. I don’t know that I want to be using that. I’ll get the glycerin-based ones or glycetracts, as they’re called.” We’d probably all do that if it was viable to do that, but it’s not. The reason that alcohol/ethanol is used to make herbal extracts is that the ethanol is a fantastic solvent. It draws out the chemicals from that herb. Glycerin doesn’t do that. It doesn’t draw out phytochemicals of very many herbs at all.

The other thing is that ethanol is a very good preservative, whereas glycerin is not. You can get herbal extracts that have a shelf life of a few years depending on the level of ethanol in them. Even though glycerol is a nice idea, it doesn’t work for most herbs. One herb that it works very well for is marshmallow root. I use that in a glycetract in my clinic because it works well with marshmallow root. But for most herbs, it doesn’t work well.

You can buy liquid herb medicine that is a glycetract, but it’s not going to have the level of phytochemicals that you need to do the job that you’re using it for. Sometimes, companies will make ethanol water extract of the herb, and then they will take the ethanol off and add glycerin to it. That sounds like a good idea, too, except the problem with that is those constituents that are soluble in ethanol or alcohol are not soluble in the glycerin, so they drop to the bottom and don’t mix through properly.

I think most companies would be making glycetracts if it was viable, and you could make very good quality herbal medicines doing that, but you can’t. When you think about the amount of ethanol, if you were to get an herbal formula from your health care practitioner, maybe in that whole formula, there would be an average of maybe 40-45% ethanol. That sounds like an awful lot. You’re only taking a 5ml or 7.5ml dose in most cases. If you think about the level of ethanol in that, it’s not very much. It’s maybe a third or quarter of what you would get in 100ml glass of wine. I’m not sure what that is in ounces; I should have looked that up. I know you have wine in six and nine ounces, is that correct?

Dr. Eric:

I’m not much of a wine drinker, so I can’t tell you from experience.

Berris:

It’s much less than what you would get in a standard drink. Your standard drinks in the USA are much smaller than ours. I think they’re 150ml. If anyone wants to look that up in ounces, it gives you an idea. Very little alcohol in there. Our body is actually designed to metabolize small amounts of alcohol because we produce alcohol in our normal day to day metabolism. The liver is designed to metabolize small amounts at any one time.

When I think about this and get asked things like this, I have been in clinical practice for 33 years. I use a lot of liquid herbs in my practice along with herbal tablets. I have never seen an issue; I only have seen good results. Probably for the first 10 years of my clinical practice, I used only liquid herbs because we didn’t have any good quality herbal tablets in Australia. I used only liquid herbs. Every single one of my patients got maybe one or two different formulations to take.

Dr. Eric:

A small amount of alcohol, which I realize, but then also, it’s a better preservative, so it lasts longer on the shelf. Perhaps most importantly, it has a higher amount of phytochemicals, so it will have a greater therapeutic effect with the ethanol compared to the glycerin.

Berris:

Absolutely. Some herbs will work well with making them in alcoholic water extract and taking the alcohol off. Most herbs don’t. You’re not going to get good therapeutic activity if you’re not using good quality medicines. That’s the bottom line. Basically, you’re absolutely wasting your money.

Dr. Eric:

Before we started this interview, I briefly told you about my experience with Graves’ and how I took bugleweed, specifically the MediHerb bugleweed. Can you talk about bugleweed, some of the indications for those who are unfamiliar with it?

Berris:

Bugleweed is an herb that we use for hyperthyroidism, high thyroid function. The species of the one we use is lycopus virginicus. In Europe, they use a different species called lycopus europaeus. But they are exactly the same; they are interchangeable basically. The research is often done on the European one because that is where a lot of the research has been done.

There is definitely research to show that bugleweed, or lycopus species, is very good for reducing thyroid hormone in patients with hyperthyroidism, whatever the cause. Most times, when people have Graves’, for example, that is an autoimmune disease, and it is the most common cause of hyperthyroidism. There are other causes as well. Whatever the cause, lycopus is the key herb that you’ll use. For us, it would be bugleweed. In Europe, it’s called gypsywort.

That is the only use for it. You don’t use bugleweed for anything else because it will reduce thyroid. We want to do that if we have overactive thyroid, but not if we have poor or underactive thyroid. It’s an excellent herb. That is my key herb that I use in my practice to support patients with hyperthyroidism. It works extremely well.

Dr. Eric:

Same here. That is the main herb I recommend for those with hyperthyroidism because I had a lot of success with it. I don’t know if you have an answer, but I’d like to pick your brain on this. I find that bugleweed works for a lot of people, but there are some people where it doesn’t seem to work, and maybe they need to take antithyroid medication while trying to address the cause of the problem. I’m sure it’s not just bugleweed; I’m sure it’s other herbs as well. Can you talk about why bugleweed or other herbs might work wonderfully in some people but not in others?

Berris:

That’s a really good point. I treated a lot of thyroid conditions in my clinic. It’s one of the areas where I specialized as well. Partly because you said you had Graves’. I have a history of Hashimoto’s, which is an autoimmune thyroid disease causing hypothyroidism. When we have a condition, we know a lot about it. Mostly in my clinical practice, I have seen patients with hypothyroidism, and I have also seen a lot with hyperthyroidism, too.

My experience with hyperthyroidism is exactly the same as yours. Most patients will respond well to the herbal medications, but some, you just cannot get on top of it. They have to go on the antithyroid pharmaceuticals. That is something I think as practitioners, we have to face: Sometimes, what we do works, and sometimes, it doesn’t. Quite often, when we see these patients, they’re also under the care of a physician or endocrinologist. Often, we’re working in conjunction with them. You wouldn’t give bugleweed to someone who is already taking those antithyroid medications though. Don’t do that.

For me, my experience is that the hyperthyroidism is a little bit harder to treat than hypothyroidism. It depends how far advanced it is when you see the person. It depends on their underlying health of the patient, their lifestyle, a range of things. Sometimes, it comes down to genetics and how susceptible they are.

Dr. Eric:

Good point. I mentioned that I took the MediHerb bugleweed. One question I had is what differentiates the Mediherb bugleweed from other brands? I think you mentioned it. You said it uses the lycopus virginicus. For some reason, I thought it had a couple of different types of bugleweed.

Berris:

Mostly it would be lycopus. It might just say “lycopus species.” Lycopus species generally reduces thyroid function. Certainly the MediHerb is the one I use in my clinic as well. You can guarantee a good quality. It is what it’s supposed to be. There is no “Somebody has made a mistake when they harvested it or something;” that doesn’t happen here. It’s not adulterated with anything else. As I said, I’ve only ever used MediHerb in my clinic, so I don’t have experience with others. I do sometimes have patients come in and say, “Look, I have been using this, and it doesn’t work.” I say, “Try what I use, and I think it will probably work.”

Dr. Eric:

That’s why I wanted to bring it up. As of this recording, hopefully this won’t be the case too much longer, but the MediHerb bugleweed has been on backorder, so I haven’t been able to recommend it. Since then, I’ve had a number of people say that other herbs that they have been taking haven’t been as effective as the bugleweed. They were taking bugleweed, and once it was on back order, they had no choice but to switch to something else. Not to say the other herbs didn’t work at all, but I’m realizing how good of an herb bugleweed is because I do get people who mention that this brand is just not working as well. When we do a follow-up thyroid panel, it’s not having the same effect. That’s why I wanted to bring it up.

It’s a unique situation with it being on back order for so long. Seeing the effects of other herbs. To be fair, bugleweed is not like ashwagandha or milk thistle or other herbs where you can find those herbs in every single health food store or many places online. There is only a handful of companies that have bugleweed.

Berris:

Yes, that’s correct. For many herbs that we use in clinical practice, there might be “That’s out of stock,” or “I’m out of stock in my dispensary at the moment, so I can use this other herb instead.” When we are treating nervous system problems, for example, there is a whole range of herbs we can use. But when we are talking about bugleweed, there is no substitute. It’s bugleweed. It’s the herb for hyperthyroidism, to directly deal with the thyroid and reduce the production of the hormones. There is no substitute for that.

With things being out of stock, as a practitioner, since 2020 with the beginning of the COVID pandemic, supply chain issues. Everything that we deal with, including the medicines that we use. Manufacturers can’t get the raw materials because of supply chain issues. 100 ships are sitting off the coast of different countries waiting to dock and unload. Then of course, it’s getting things from the manufacturer to my clinic sometimes. It’s very difficult. As a practitioner, it’s been very frustrating, but it’s one of those things that we can’t do anything about. It’s happening around the world; it’s a thing of daily life really.

Dr. Eric:

Can we discuss some of the other herbs that can benefit thyroid conditions?

Berris:

For hyperthyroidism, if it’s an autoimmune disease, then as a practitioner, I would also treat the immune system to deal with that autoimmunity. If you can have an impact there, then of course, you can deal with the hyperthyroidism through that route as well.

What’s happening in Graves’ Disease, for example, is you have antibodies that sit on the receptors, thyroid stimulating hormone receptors (TSH). When those antibodies are reproduced, they sit on those receptors and keep telling the thyroid gland to keep producing more thyroxine, even when we don’t need it. That’s why our thyroxine goes high. If we can modulate the immune system so that we can maybe reduce the production of those antibodies, then we are also solving the problem, particularly when we do that along with the bugleweed.

For me, echinacea. Everyone has heard of echinacea. It is a great herb for immune modulation. There is some research showing that it can be beneficial in autoimmunity. That’s one herb I use a lot in my autoimmune patients, whatever the autoimmune disease is.

There are also other herbs, like an herb that comes from the Indian tradition of medicine called hemidesmus that I use a lot in my clinic. That is a very mild immunosuppressant herb. In my clinical experience, it tends to bring down the production of those auto antibodies. I might bind them with anti-inflammatory herbs, for example. I often give that in a tablet formulation, but sometimes in liquid. Echinacea, I use in tablet form. I use echinacea root. I use a combination of echinacea angustifolia roots because that is what I found works much better.

Dr. Eric:

It’s interesting that you mentioned echinacea because a lot of people are familiar with it when someone has a cold but not so much with autoimmunity. Some people are concerned about taking echinacea with autoimmunity. The concern is it might possibly exacerbate the autoimmune response, but in your experience, that hasn’t been the case.

Berris:

No, just the opposite in fact. Very early on, when we started using echinacea as a common herbal medicine, of course, the First Nations people in the United States have been using it as long as they have been there. That’s where we have gotten our traditional information about echinacea from.

In the early days of research with echinacea, it stimulates your immune system; therefore, it probably can make the immune system overactive, so it will worsen autoimmune disease. It was a lack of really good understanding about how echinacea works. There is evidence to show that echinacea primarily works on the innate immune system, and then we have the adaptive immune system, which has the antibodies. There is research to show that many people with autoimmune diseases have a deficient innate immune system. They think the origination of the autoimmune disease is a problem in the innate immune system. If we can use anything that can support the health of the innate immune system, then we are going to benefit from that. Not only in coping with the autoimmune disease, but also keeping the general immunity up to fight infection efficiently.

Echinacea can be taken long-term. We also read sometimes that it should only be taken short-term because it can wear the immune system out, and that is not great either. It does work better if it’s taken long-term. You don’t need a high dose to do that.

Dr. Eric:

When you say long-term, do you mean many months or even years?

Berris:

Years. I take it every day and have done so for many years. My college mentor has taken it every day of his life as well.

Dr. Eric:

I have heard that, too. I just want you to share your experience. It’s great you are letting people know not to be afraid of echinacea when it comes to autoimmunity.

Berris:

All of my patients who come to me with, say, Graves’ or hyperthyroidism, I would give bugleweed. I also give echinacea, and I also give that combination of hemidesmus and angustifolia. That is dealing with the autoimmunity and the hyperthyroidism very well. I will often also give them another herb called motherwort.

Dr. Eric:

I took motherwort as well when I dealt with Graves’.

Berris:

Motherwort, as far as I know, doesn’t have any direct effect on the thyroid, but it’s very good for some of the symptoms of hyperthyroidism, like the fast heart rate and that sort of thing. It’s a very nice for the nervous system to help keep people calm. That’s my approach for Graves’.

If we’re looking at Hashimoto’s, which is the most common cause of hypothyroidism, another autoimmune disease, then I use herbs like ashwagandha. It’s been shown mostly in animal research. A lot of the herbs that we have, due to funding issues primarily, we don’t always have clinical trials. For many of them, we do.

For ashwagandha, animal studies have shown that you can improve thyroid function and thyroid hormone output. It’s another one that I have used a lot. I use it in combination with bacopa. It’s an herb that we use for cognition, memory, etc. It’s another nice nervous system herb. That’s been shown in animal studies to improve thyroid hormone output as well.

I also use bladderwrack, which contains iodine. That is the main reason I use it. Iodine is a key constituent for thyroid hormone production. If you don’t have enough iodine, you can’t produce thyroid hormone in the body. That’s a really nice combination that I use to support improving thyroid function.

Dr. Eric:

For Hashimoto’s, you recommend ashwagandha, bacopa, bladderwrack. For Graves’, bugleweed, motherwort, hemidesmus, and echinacea. Correct?

Berris:

The hemidesmus and echinacea for Hashimoto’s as well.

Dr. Eric:

Hemidesmus and echinacea for both.

Berris:

For any autoimmune disease in fact. I sometimes use coleus for Hashimoto’s or low thyroid function. It does also improve thyroid output. It can also reduce body fat, which is sometimes an issue when you have low thyroid function. There have been a few clinical trials showing that coleus can do that.

Dr. Eric:

Interesting. I didn’t know that. Coleus can reduce body fat in some cases?

Berris:

Yes. You need a good dose of coleus to do that. I use coleus in my clinic as a tablet for that purpose and for low thyroid. The active constituent in coleus is called forskolin. In the clinical studies, they’ve used doses of forskolin per day that I can get, 50mg of forskolin per day in coleus in clinical studies. I can get that in using three of the coleus tablets in my clinic every day. That is what I use in my thyroid patients because it helps thyroid, but it also helps them to lose body fat as well.

Dr. Eric:

A couple of quick questions I know people are going to have. One is going to be the iodine in the bladderwrack. No question, iodine is necessary for thyroid hormone production. But there is some concern with iodine exacerbating some thyroid conditions, like hypothyroidism or hyperthyroidism, but also the autoimmune component. Same with Hashimoto’s. Some say to stay away from iodine completely, even from a food perspective. What are your thoughts on that? Obviously, you’ve had a good experience with the bladderwrack over the years with your Hashimoto’s patients. You yourself have it as well.

Berris:

Iodine can increase the level of the auto antibodies we find in Hashimoto’s. You probably need higher levels in order to do that. You can’t avoid iodine. You just can’t avoid it. Low thyroid function and goiter, which we don’t see so much now because we have an understanding of what causes it, and it’s iodine deficiency. There are certain areas in the world where the stores are very iodine deficient, including places in Australia. Before we realized what was happening, we would see a lot of people in those areas with goiter. You can’t avoid iodine. It’s not good for your thyroid, but it’s also not good for a lot of other tissues in the body. It’s not just thyroid that requires iodine.

The amount of iodine in the tablet I use with bladderwrack in my clinic is not very high. I have never seen an issue. However, sometimes, to be quite honest, most of this I have seen from out of the United States, where some people will advocate hugely high doses of iodine. Iodine is usually prescribed in the mcg dose, but you see them prescribing huge doses of iodine. I have never been a fan of that; I have never done that in my clinic. I have actually never prescribed iodine as a separate supplement in my clinic. When I give it to patients, it’s always in the bladderwrack. You have a complete herb there. It’s not just straight iodine. That is very important when we are talking about herbal medicine in particular.

If you have too much iodine, you can see Hashimoto’s occur as well. I have seen this in some areas of Japan, particularly on the west coast, where they eat huge amounts of seafood and seaweed, and they get huge amounts of iodine. They see a lot of goiter and Hashimoto’s there because of too much iodine. If you are taking some bladderwrack prescribed by your health care practitioner at the correct dose for you, you aren’t going to see those issues at all. It’s very important.

If we’re thinking, Well, should I be giving this patient something with iodine in it? We can prescribe iodine level testing for patients. I do a 24-hour sample collection, where I get patients to have that tested. That gives us an indication. Is the iodine already high? Obviously, I wouldn’t use it. But often, it’s low. It’s very rare that most people are supplementing with high doses of iodine or eating huge amounts of seafood, which we don’t see in most of our patients. Otherwise, they won’t have high iodine. It’s more likely to be low. When in doubt, as practitioners, we test.

Dr. Eric:

Good points. Ashwagandha. Some people are concerned about ashwagandha being a member of the nightshade family. Some people don’t do well with nightshades. I wanted you to mention that.

Also, with ashwagandha, since it can help in some cases with lower thyroid hormone levels to increase it, should those with hyperthyroidism avoid ashwagandha?

Berris:

People with hyperthyroidism should avoid ashwagandha. It’s a fabulous herb. It’s one of my favorite herbs, one of my most prescribed in my clinic. But it’s not the adaptogenic nervous system herb for hyperthyroid patients.

In fact, I have read some research, case reports, where a patient developed hyperthyroidism or was diagnosed with hyperthyroidism after taking reasonable doses of ashwagandha. It may well be that that patient already had borderline or undiagnosed hyperthyroidism, and the ashwagandha just made it worse so that the symptoms were much more obvious.

If you have normal thyroid function, and your thyroid is healthy, ashwagandha is not going to suddenly make it hyperactive. I don’t think I have a single patient in my clinic who hasn’t had ashwagandha at some time. Not for hyperthyroid patients.

As for being a nightshade plant, it is indeed. I have used it in patients who have a nightshade sensitivity without problems. One patient I had once, she said, “I absolutely cannot have anything in the nightshade family. Do not give me anything.” I never gave her ashwagandha. Sometimes, you don’t even know. Patients may not even think to mention they have a nightshade sensitivity when you see them at first consultation. It might be something they mention down the line later. They have been taking ashwagandha with no issue. It’s one thing in practice: we never get all the information in the first consultation.

Dr. Eric:

It sounds like most of the time, you don’t see a problem with your Hashimoto’s patients when it comes to ashwagandha. It is something you give pretty much to everybody, it sounds like. Just like with any herb, besides the nightshade, anybody could have a negative reaction to any herb. If it’s not agreeing with them, you will tell them to stop that herb.

Berris:

Absolutely. That happens in clinical practice. It’s what we call idiosyncratic reactions. Their reaction is very uncommon and totally unpredictable. It’s the same as how people can suddenly develop an allergy to nuts in mid-life that they never had before.

In my practice, if somebody comes back and says, “This herb doesn’t suit me. This is what’s happening,” then I will take them off of it. Most herbs, we can bring other herbs that will have similar effects.

Ashwagandha is excellent for the thyroid not only because of its seemingly direct action on improving thyroid hormone, but also, it helps to improve energy, and it keeps people calm. You would think with low thyroid, because it’s low metabolism, energy is low, but you can sometimes have thyroid patients who are very low energy but also feel quite anxious. They are not sleeping well, etc. Ashwagandha is very good for that.

Bacopa is also good for concentration and memory, which is lacking when you have low thyroid. It also gives you that nice nervous system support.

The beauty of herbal medicine is that all herbs have multiple activities, actions, not just one. If you give an herb to someone, we are not just doing one thing, we are doing multiple things.

Dr. Eric:

Ashwagandha is also great for the adrenals, which can also cause low energy. From what I understand, it can be taken whether someone has high cortisol or low cortisol, correct?

Berris:

Yes, it can. It supports the adrenals. The adrenal gland produces cortisol. If it’s producing too much cortisol, we need to support the adrenal gland, so it doesn’t wear out from doing that, which happens. Then we get very low cortisol. But if there is low cortisol, we need to support the adrenal gland to balance in producing the correct amount of cortisol.

What we are talking about here is not just the adrenal gland; we are talking about the HPA axis, the hypothalamus pituitary adrenal axis, which controls our response to stress. Herbs like ashwagandha support that whole HPA axis, not just the adrenals.

It’s called an adaptogen because they help us to adapt the effects of stress. When we are talking about the adaptogen’s effects on the adrenals, they don’t have a direct effect per se on the adrenals, but what they do is they spare the adrenals from the effects of the stress we’re experiencing. They are improving the activity of the whole HPA axis.

I think these adaptogenic herbs that we have, nature has been amazingly generous. I think these are the real key herbs for our modern lifestyles because they help us adapt to the stress that we experience. Most of them help to improve immunity in one way or another. Most of them will help to improve energy and sense of wellbeing. They are all things that are fundamentally essential in our modern lives.

Dr. Eric:

You’re right. One other herb I wanted to ask you about, if you have any experience with it, is lemon balm. That is also commonly given to those who have hyperthyroidism.

Berris:

Thank you for reminding me. Lemon balm can improve hyperthyroidism as well. It’s also a really nice calming herb. It does help digestion in some people if stress affects their digestion. That’s another one I often use in my hyperthyroid patients.

Dr. Eric:

Wonderful. I personally did not take lemon balm when I dealt with Graves’, but I do have some hyperthyroid patients take it. Bugleweed is my main go-to, as it is with you. Motherwort is #2 probably as far as the herbs that I give for those with hyperthyroidism. Lemon balm is on the list, too, for some people.

I want to respect your time, but is there anything else that you’d like to share? You shared so much, so if not, that’s fine. I appreciate the time you spent so far going over all these herbs.

Berris:

No. Thank you for the opportunity. As a practitioner, things that I think are really important, if you are going to feel better in taking herbal medicine or any medicines, is to see a health care practitioner in order to have the correct medicines prescribed at the correct doses and to be sure that you are getting good quality medicines. I personally would never go online and purchase an herbal medicine where I didn’t know it was made, how it was made, how it was overseen in the manufacturer.

When I went into naturopathy in college, I am still very altruistic, but I was under the assumption that the whole herbal medicine industry would be altruistic. It’s actually not. There is a lot of deliberate adulterations and substitutions, and there are a lot of accidental ones. You have to make sure you are using a product where all that testing has been done, so you are guaranteed you’re going to get good quality, safe herbal medicines.

Dr. Eric:

Well said. Thank you so much, Berris. Appreciate you sharing your knowledge. I learned a lot, and I’m sure the listeners did as well.

Berris:

Thank you very much.

 

Recently I interviewed Kevin Ellis, known as “the Bone Coach”, as he discusses how to increase bone density, how osteoporosis and osteopenia are diagnosed, risk factors for bone loss, risks vs. benefits of osteoporosis medications, natural sources and supplements to consider adding to your diet, the most beneficial types of exercise for your bone health, and more.. If you would prefer to listen the interview you can access it by Clicking Here.

Dr. Eric Osansky:

With me, I have Kevin Ellis, who is also known as The Bone Coach. Kevin is a certified integrative nutrition health coach, podcaster, YouTuber, bone health advocate, and the founder of BoneCoach.com.

After an osteoporosis diagnosis in his early 30s, Kevin realized just how challenging it can be for the average person to make sense of what needs to be done to improve and how to move forward confidently with a stronger bones plan. Today, not only has he transformed his own health and made continued progress on his own journey, but he has now dedicated his life to helping women with osteopenia and osteoporosis gain clarity and confidence that improving is possible. Through a unique three-step process and world-class coaching programs, Kevin and his team of credentialed experts have helped people in over 1,500 cities around the world get confident in their stronger bones plan. His mission is not just to help one million people around the globe build stronger bones, but it’s also to help our children and grandchildren have the education, resources, and nourishment needed to prevent osteoporosis and other diseases in the future so they can lead a long, active life. That’s what we’re all here for.

Kevin, It’s a pleasure having you here.

Kevin Ellis:

Thanks so much for having me here. It’s great to be here.

Dr. Eric:

It’s great to chat with you. Why don’t we dive in with your background? If you could please let us know how you got started on this journey helping women with osteopenia and osteoporosis.

Kevin:

Absolutely. A lot of times, when you hear about osteopenia or osteoporosis, you’re not talking about a 30-year-old male. You’re talking about women, 50s-70s, or maybe the grandma who had fractures, hunched over, or was walking with a cane. You’re not thinking about the 30-year-old male.

For me, I was shocked when I was told I had osteoporosis. The great majority of my younger years, I was really active. I went into the Marine Corps and spent five years there. I got out of there and had these health issues that came to fruition and the surface. I had high stress, poor sleep, really poor energy. I could barely get out of bed some days. I had all these other health issues that started taking place.

Then I found out I had Celiac Disease, which is an autoimmune condition where the villi, these nutrient absorption centers in your small intestine, become damaged when you consume gluten. For me, my villi were becoming damaged and blunted to the point where they couldn’t do their job. They couldn’t absorb those nutrients that I needed that were so important. My body still needed those minerals and nutrients to execute its daily functions. It went to the bones, which are our greatest source of mineral reserves, and pulled from the bones. Then it only makes sense that I was subsequently diagnosed with osteoporosis right around 30 years old.

It was actually a physician’s assistant. It wasn’t even a doctor I was working with at the time. None of my doctors said, “Let’s do a bone density exam. You have Celiac.” It was actually a physician’s assistant who asked me, “Have you done this?” I said, “No.” They told me to do this. We both thought it was going to come back as normal.

When I got the results back, they sent me a letter in the mail. They didn’t call me or anything else. The letter said, “You have osteoporosis. Go on a gluten-free diet.” That was it. I remember reading that letter, and the blood drained from my face. I had tingles. What does this mean for my future, especially after I started Googling what osteoporosis was? All I saw was fractures and medication dependency for the rest of my life. It was scary.

At that point in time, I didn’t mention this before, but my father passed away at a really young age, when he was 35 years old. At the time he passed away, I was two months old. My entire life, I had this fear that I was going to follow in his footsteps to an early grave and not be there to be a father for my own kids. That was my biggest fear in life. I had a young daughter and a son on the way. I thought I was headed down that path. It was a living nightmare.

I realized at that point, I had to do something. I started doing a lot of reading and research and consulting with people. I spent a lot of money on food and supplements. I have an osteoporosis atlas. It was the most expensive book I ever bought on the topic. I have just about every book on the topic. I don’t recommend this to anybody. This is the level of research I was going to do to figure this out.

I started getting the right plan in place. I improved my health and my bones. I realized it’s not the average 30-year-old male who needs help. It’s the women in their 50s, 60s, 70s who is told they have osteoporosis and are presented with calcium, Vitamin D, go for a walk, take a bone medication, we’ll see you in one year for your next bone density exam. I’ll tell you that’s not enough.

That’s the reason why I became the Bone Coach, a certified health coach, built out a team of credentialed experts, now have launched a program called The Stronger Bones Solution that has helped people in 1,500 cities around the world, and launched BoneCoach.com. That is my journey of getting into and becoming the Bone Coach.

Dr. Eric:

That is some story. Obviously, cutting out gluten was important for someone with Celiac, so it was a piece of the puzzle. You did a lot more when it comes to, not just in the past, but currently, to maintain healthy bones now.

Kevin:

It is so much more than just going gluten-free. If you are Celiac, gluten-free is a must. It’s not a negotiable thing. It’s not like eating a little bit of gluten from time to time, and you’ll be okay. No, you have to remove it from your diet completely.

Dr. Eric:

When it comes to osteopenia versus osteoporosis, I’m sure some listening know the difference, but some people have heard of osteoporosis and may not be familiar with osteopenia. Can you differentiate between the two?

Kevin:

Let’s talk about what osteoporosis is. Osteoporosis means literally “porous bone.” It’s a condition characterized either by not enough bone formation, excessive bone loss, or a combination of those two things. In osteoporosis, both your bone density and your bone quality are reduced, which is going to increase the risk of fracture.

The way you find out you have osteoporosis is through a bone density scan, also called the DEXA scan. This is dual energy X-ray absorptiometry. It’s a painless test. Kind of like an X-ray, but low levels of radiation. You lay down on the machine, the machine does the scan, and it tells you your bone mineral density, the actual mineral content of your bone. Then it generates a score, which is called the T score.

The T score is telling you how much your bone mass differs from the bone mass of an average, healthy, approximately 30-year-old adult. If you have a score of +1 or -1, that is considered normal and healthy. If you have -1 to -2.5, that is considered osteopenia, also called low bone mass. That is a precursor to osteoporosis. If you have -2.5 or lower, that is considered osteoporosis. The greater that negative number becomes, the more severe the osteoporosis.

Most people are getting a DEXA scan, most women especially, in their 50s, 60s, 70s as a check in the box. Their doctor will order it, or they may not order them. You may be listening to this and thinking you haven’t had one yet. That is not uncommon either. If you have not had one, get one. You want to get this objective information, and you want to get a baseline from which you can monitor future changes.

If you had a parent or someone you know who had osteoporosis or a lot of fractures, and you are avoiding getting that information because you don’t want to know, that is not a good strategy. We don’t want to avoid doing something because we don’t want to know what the answer could be.

Dr. Eric:

What age do you recommend starting as far as getting a DEXA scan? 30s or earlier than that even?

Kevin:

Especially the women I am talking to in their 50s, 60s, and 70s who have daughters, I’m telling their daughters to go get a bone density scan. You’re reaching peak bone mass right around 30 years old. If you get a bone density scan in your 30s, that is a great baseline to have. You can monitor future changes in your 40s, 50s, and so on and so forth.

Especially when you get to a point where you hit menopause, you will have a reduction in hormones, which will impact your bones. You can lose up to 20% of your bone mass in a five-year period after you go through menopause. Really important to know that. A lot of people don’t understand that.

Dr. Eric:

Obviously, more common in women, which is why you focus on women. You’re a guy. You got diagnosed with osteoporosis. I will quickly ask: Should men also consider getting a bone density scan? I’m going on 52 this year, and I have never gotten a bone density scan. This chat makes me think, maybe I should get one.

Kevin:

Men should absolutely get their bone density scan, too. It’s not just women who are affected. We know primary osteoporosis is related to a decrease in estrogen in post-menopausal women. Estrogen has a reductive effect on bones. When estrogen levels decrease, as they do during menopause, that causes an increase in the activity level of cells that break down bone.

There is another cause of osteoporosis called secondary osteoporosis. This is where osteoporosis occurs as a result of behaviors, disorders, diseases, medications, and other factors. Men will fall into those other factors. Especially if you have overt digestive issues, Celiac, Crohn’s, ulcerative colitis, even thyroid conditions, or maybe you were taking specific medications for a long period of time. I can talk specifically about what some of these things are. Your bones could have been impacted.

For me, 30-year-old male, former Marine with a background in weightlifting, you would never think that I would be told I had osteoporosis, but I was. It was a total shock. It’s always good to get that information, know where you stand, and then the younger you are, the more things you have in your favor. It’s not saying the older you get, it becomes impossible. That’s absolutely not the case. You can build bone strength at any age. It just becomes more challenging the older you get and the more bone you lose. There are fewer cells involved in that process. That process becomes less efficient. We want people to be on the side of prevention, not reaction, and to get that objective information as early as possible.

The other thing I’ll mention about men, and this is just an observation that I have made, is that men are more likely to see this as a suck it up condition. I’m tough. I can handle it. Trust me, this is coming from a guy who thought he was pretty darn tough for quite some time. This is not a condition that is one of those you can just suck up. It’s really important to make sure you objectively figure those things out.

Dr. Eric:

Let’s go over some of the causes in greater detail, like the medications. As women, going into menopause. Can you dive deeper?

Kevin:

Absolutely. I know you talk a lot about thyroid. You and I did a podcast on thyroid, too, that we can refer people to also. Let’s talk about thyotoxicosis. That can be a contributor. That refers to having excess circulating thyroid hormones. That can be hyperthyroidism, overactive thyroid. That occurs when your thyroid gland produces too much thyroxine. You could have thyroiditis, inflammation of the thyroid gland. Iodine-induced and drug-induced thyroid dysfunction. Excessive intake of thyroid hormone in patients with hypothyroidism can also be a contributor, too. These can be some of the things that are contributing from a thyroid perspective to bone loss.

Let’s talk about some of the other more common ones as well. There are medications specifically that some people aren’t even aware of that can contribute to bone loss that they have been taking for quite some time. One is glucocorticoids. This would be prednisone, cortisone. Glucocorticoids are steroid medications designed to suppress inflammation. They mimic natural steroid hormones produced by your body and are used to treat conditions like asthma and autoimmune diseases like rheumatoid arthritis.

The reason they contribute to bone loss is they are reducing the gastrointestinal absorption of calcium, which is increasing the urinary excretion of calcium. That is also going to lead to a calcium deficit. You are not absorbing; you are excreting more; you have a calcium deficit, which is the primary mineral of your bones.

The biggest impact is that glucocorticoids act directly on the cells that break down bone, osteoclasts, to increase their life span. It ends up reducing bone density. That is a really big one to be aware of. If you are taking that medication or considering taking it, it will contribute to bone loss.

Another one is SSRIs, selective serotonin reuptake inhibitors. These are a class of drugs typically used as antidepressants. There was a review of 19 studies on the effect of SSRIs on bone that show they have a negative impact on bone density and increase the risk of fracture.

Also, antacids. These are drugs that reduce the production of or increase the suppression of stomach acid. A lot of times, when people are considering taking these medications or are taking them, they have heartburn or reflux. When you have those things, a lot of times, you have too little stomach acid. People take these medications to suppress what little stomach acid they do have. This would be your Omeprazole, Nexium, Prevacid, and H2 receptor antagonist drugs like Pepcid and Zantac.

The reason suppressing stomach acid is a problem is you need stomach acid to break down and extract nutrients from your food, like amino acids, the building blocks of protein. Your bones are 50% protein by volume. You need a constant supply of amino acids, calcium, magnesium, iron, B12. If you have low stomach acid, your body will be starved of these nutrients. You won’t be getting the nutrients you need.

Long-term, there are plenty of studies that show just using these medications will not be good for supporting your bone health and can have a negative impact. That is important to understand.

I already talked about GI conditions. Celiac is a big one. Ulcerative colitis, Crohn’s. Those are also big ones.

In terms of autoimmune conditions, when we are talking about these, Ankylosing spondylitis is one that primarily affects the spine and the vertebrae.

Rheumatoid arthritis is one where the body’s mistakenly attacking the joints. That is creating inflammation inside the tissues and joints that also can lead to bone loss.

Lupus is another big one that can contribute to bone loss as well. Anything that is contributing to inflammation in the body is going to be fueling those osteoclasts and extend their life span and continuing to break down bone, which will contribute to bone loss.

Dr. Eric:

When you interviewed me, I spoke about that, too. The research I did when I was looking at the impact of Graves’ and Hashimoto’s, thyroid autoimmunity, on the bone showed that the inflammatory process from those conditions has a great effect. It’s not just the thyroid hormone imbalance. That translates to other inflammatory conditions, so I’m glad you mentioned that as well.

Medications. Let’s talk about medication that they typically use as treatment for osteoporosis. You spoke before about some of the meds that could increase the risk of osteoporosis. You said if you go to a conventional medical doctor, they will recommend calcium, Vitamin D, walking, and some meds. Can you talk about the risks versus benefits of meds for osteoporosis?

Kevin:

This is a great topic because it will come up. If someone is diagnosed with osteopenia or osteoporosis, they are going to have a bone medication recommended to them most likely at some point. 90-95% of people I talk to, that is the situation they are in. They get diagnosed. In a 15-minute window, they get their bone density results back, are told they have osteoporosis, and are handed medication. There is very little education around the big picture of medication. Let me give you that education right now at a high level.

The first thing I want to point out is these bone medications are not like taking an aspirin. They have a dramatic effect on bone physiology. That is the first thing we have to understand.

There are two different categories of drugs: antiresorptive drugs, which are designed to slow down the resorption or breakdown part of the remodeling process. They are reducing the rate of bone breakdown and reducing bone formation. Then, we have another class called anabolics. I will talk about those in a minute.

Antiresorptives are like bisphosphonates. Fosamax is a common one. Or RANKL inhibitors. Prolia is one you have probably heard of. With bisphosphonates, there are a lot of side effects: bone/joint/muscle pain. One of the biggest ones I hear from people is digestive issues. If you have digestive issues, you are probably going to have issues absorbing your nutrients, too. Some of the side effects that can happen but happen less, like osteoporosis in the jaw. That occurs when the jawbone begins to starve from lack of blood. You have cells in the jawbone that can start to die. That’s rare, but it’s something to be aware of, too.

The biggest concern with these bisphosphonate drugs is the safety and efficacy of the drugs are for patients who took them for less than five years. I have people who come to me who are on these drugs for eight or ten years. That’s a long, long time.

The reason that’s a problem is because, as all of us, we are going about our daily lives, doing our activities. We are starting to get these tiny, little, micro cracks in our bones; it’s normal. Then what happens is we have these cells in the bone that send out a signal; they say, “Hey, we have damage to the bone.” We have these bone-resorbing osteoclasts that come in and scoop out that damage. Right behind them, we have these osteoblasts, building cells, that form new, stronger, healthier bone.

When you are taking antiresorptive medication, if you slow down the activity level of that cell that is scooping out the damaged bone, over time, you start to accumulate that old, worn, damaged, weakened bone. That is one of the most important things that can ultimately lead to loss of structural integrity and strength in that bone. A lot of people don’t know that.

The other point is if you start something like Prolia, which is a RANKL inhibitor, you can’t just come off of it really quickly. It can actually increase your risk of vertebral fractures. You need to understand that if you are starting out on a medication, there are implications later on for you stopping that medication. It could require another medication after that.

Let’s talk about the other class of medication, anabolics. These are drugs that are designed to build bone and build it faster. They are stimulating the formation part of this bone remodeling process. What happens is more bone ends up being formed than is taken away.

Usually, the people who are recommended these drugs are those who have had low or no trauma fragility fractures. They have poor quality bone. They need a medication to help them build good quality bone. These drugs can help build that bone. They can help build better quality bone.

But what you have to understand about these medications is that you can only take them for a certain period of time, about 13 months-2 years. After you finish it, you have to follow it with an antiresorptive. Otherwise, you will lose all that bone that you just spent years of time taking medication for.

I have seen situations where people who had no business being prescribed an anabolic medication were being prescribed an anabolic medication. It’s really important for people to understand that you may be getting to a point where you are going on this endless cycle of medication, not even knowing it, just by starting out with that first doctor’s visit.

Dr. Eric:

It sounds like there might be a time and place for the anabolic medication. If they are on it, typically, they are on it for 13 months-2 years. Then they have to take the other medication to maintain what they built up. Is that correct?

Kevin:

Yes. I would say most of the people coming to us are trying to do everything they possibly can naturally before considering the medication option. There are situations where some people have had 5-10 or more fractures, which is an indicator of really poor quality bone. A lot of times, in those situations, there may have to be a quick intervention, which could be necessary and lifesaving.

I am not pro-medication; I am not saying you should take a medication. I’m saying you need to make an educated and informed decision. Most people don’t need a medication at all when they are prescribed one. That is my personal opinion that I have seen. It’s not necessary. But there are some situations where that may be necessary and lifesaving.

Dr. Eric:

Makes sense. Obviously, you want to try to do things to address the cause of the problem. These people aren’t deficient in any of these medications. There might be some situations where it’s really extreme. Maybe it’s a good idea for them to take it.

Let’s say if someone is listening to this, and they are already on one of those anabolic drugs, I assume they could switch gears if they want to and just take more of a natural approach. You won’t tell them to stop taking the medication, but if they make that decision on their own, they could stop taking it on their own or under the guidance of a prescribing doctor.

Kevin:

For sure. This is not me giving medical advice for any individuals because we are talking about the medications. If you are on an anabolic medication, if you have already started it and been on it for any length of time, you will need to follow it with an antiresorptive medication. Otherwise, the entire reason you’re taking it is going to be washed away. You’re going to lose everything you gained.

What happens is when you take an anabolic, yes, it speeds up the cells that build bone and build it faster. But it also speeds up the cells that break down bone. In order to build new quality bone, you have to speed up the osteoclasts, too. If you don’t slow down that train, that’s what’s going to happen after you come off of that. We have plenty of people who have been on an antiresorptive medication who are like, “You know what? I don’t think this is the right fit.” They decide to stop using it and are just fine. That’s not me telling anyone here specifically in your situation, but I would say most of the people that we encounter, they can do a lot of things naturally to build stronger bones and set themselves up for an active future.

Dr. Eric:

Speaking of doing things naturally, let’s talk about food. Is there any diet or specific foods that can help to improve bone density?

Kevin:

Whenever I talk about food, I always like to start out by saying there is no one single dietary approach for every single person, or one specific set of foods that are only good for every single person. Now, there are some uniform things that I would suggest to most people.

You have probably beat this down, and I am going to put one more nail down in this coffin: sugar. Reduce your sugar intake. It’s key for bone health. Sugar will damage your bone by triggering an inflammatory response. It will lower your Vitamin D levels; deplete bone healthy minerals like magnesium, calcium, copper, and chromium; inhibit intestinal absorption of calcium; and block the absorption of Vitamin C. Vitamin C is key for maintaining a healthy skeleton. I will talk about that in a bit.

Your breads, cakes, cookies, crackers, pizzas, and pastas break down into sugar. That won’t be the best thing for your bones. Make better swaps. Get those things out of your life if you haven’t already. Find better alternatives for some of those things that are your favorites.

The other thing I would say is chemicals. If you can get food that’s organic or from your local farmers, go to your farmers’ market and ask them at the table, “Do you spray?” They will tell you if they do or not. Ask those questions.

You can always go to the Environmental Working Group. They have the Dirty Dozen and the Clean 15. If you are on a budget, they will tell you where you can get the most bang for your buck for organic. Don’t ever eat non-organic berries, especially strawberries. Those will be laced with lots of different chemicals. We want to make sure we look at that list. That’s a good starting point.

In terms of general dietary principles, if you are looking to handle an autoimmune condition, or you have Hashimoto’s or Graves’ or something like that, your dietary approach is probably going to work to put that autoimmune condition into remission. Your dietary approach may be different than somebody who is not working to put an autoimmune condition into remission. Those are just some important things I like to preface when I start talking about food.

Now, there are some foods that I’ve found that are pretty universal for most people that work really well for a lot of people. The first one is fish. Not just any fish. I would talk about fish with the bones in them. This would be canned fish. Non-BPA lining. We don’t want the BPA.

Dr. Eric:

Sardines.

Kevin:

Sardines, mackerel, wild salmon. You can find wild salmon with the bones in. The reason you want the bones in is because these bones are a natural source of not just calcium but all the other minerals that your bones need with the right co-factors and the other nutrients in nature’s perfect form. It is a great source of calcium and other minerals.

The other reason I like these is because they have protein. Protein breaks down to amino acids. Your bones are 50% protein by volume. You need these amino acids. Also, to support muscle building. Muscle and bone have a really important relationship together. You need to be able to support stronger muscles, and that’s why you need additional protein.

The other part of fish I like, especially canned fish, is they are easy to take to go if you are hiking or doing activities or on vacation. Throw them in a pack. Don’t open them up on an airplane. They smell horrible; people will hate you for it. Don’t get fish juice on yourself. I’m not making the case here for mackerel and sardines here, I know that.

But they have Omega-3s. These are fatty acids that can help dampen inflammation. Like Dr. Eric and I were talking about, anything that contributes to inflammation contributes to bone breakdown. That’s a big star for me. I really like that one.

Another one of my favorites is arugula. I have been talking about arugula for years. It’s a leafy green. Same cruciferous family of vegetables as broccoli and kale. It’s rich in potassium, folate, Vitamin C, Vitamin K, and calcium. All of those are important for bone health. You can get a great bioavailable source of calcium from arugula.

This is super interesting. There was a recent study that found a bioactive compound in arugula called erucin that helps turn off osteoclasts, those bone breakdown cells, which is awesome. It’s amazing. I didn’t even know this when I first started consuming arugula. Now, it’s just confirmed: Arugula is a great food for bone healthy diet.

There are two other reasons I really like arugula. One is it’s a bitter food. Our diets nowadays don’t have a lot of bitter foods in them for the most part. The reason we want bitter foods in our diet is they stimulate bile production and bile flow. Bile is produced by the liver and stored in the gallbladder. When you are consuming foods, it will help break down your foods, so it’s important to have.

The last reason is arugula, unlike spinach, a common green a lot of people use, is low in oxalates. I don’t ever like to vilify foods, other than candy, usually. Spinach has some great nutrients in it, but it’s high in oxalates. Oxalates are an antinutrient that bind up bone healthy minerals like calcium. They will prevent you from absorbing them. If you’ve got digestive issues or kidney stones, arthritis, or joint pain, those can be some indicators that you have a hard time breaking down and degrading that oxalate. You might not have the intestinal bacteria, oxalobacter formigenes, to break them down. You can swap spinach for arugula. If you need any other reasons to why arugula should be added in your diet, give it a shot.

One of my other favorite foods is Vitamin C-rich foods. You heard me talk earlier about why we shouldn’t consume sugar because it will block the absorption of Vitamin C. Vitamin C is super important for general health. We all know that. If you remember, our bones are made up of this collagen protein matrix upon which minerals are laid. Vitamin C stimulates pro-collagen, enhances collagen synthesis, and stimulates something called alkaline phosphatase activity, which is a marker for osteoblast, bone building cell, formation. That’s pretty cool.

Some of the best fruits, berries, citrus like lemons and limes, plums, cherries are all great ones. In terms of Vitamin C-rich vegetables, for those with autoimmune conditions who are putting those in remission, you don’t want to eat red and yellow bell peppers, but those are great sources of Vitamin C. They are also a nightshade, so if you are on an autoimmune protocol, you won’t be consuming those. You can get dino kale or lacinato kale, lightly steamed broccoli, Brussels sprouts. You can incorporate those. Those are some other good options to start incorporating into your plan.

Dr. Eric:

A number of years ago, I used to stuff my smoothie with spinach. Then I did a test from Great Plains Lab, their organic acids test, that looks at oxalates. Mine were definitely high. There were other high oxalate foods I was eating, but that definitely was the top oxalate food. That was the main change I made. I cut out the spinach and did add arugula. I can’t say I have eaten that as regularly as I should have because I didn’t realize how much calcium it has. I try to diversify when it comes to the greens and other vegetables. I did a retest of the Great Plains Lab. Sure enough, the oxalates decreased just with that change alone.

I was eating more nuts than I should have been eating, which are higher in oxalates. I can’t say I completely avoided the nuts. Berries, raspberries, higher. Anyway, you can’t completely avoid the oxalates, but the spinach is a big culprit. You’re right. It doesn’t mean that people can’t have spinach every now and then, but there are people who are doing what I was doing years ago, either stuffing their smoothies with spinach or having a lot of spinach in other ways. It has a lot of calcium, but not the bioavailable type of calcium that is found in other foods. I do need to incorporate more arugula into my diet.

Kevin:

I want to touch on one other thing here. You highlighted something that’s really important. I was also trying to talk about how I don’t like to vilify specific foods that could have healthy nutrients or could be in a dish you’re going to consume infrequently. What I don’t want people to do is develop a fear around some healthy paleo spinach casserole that somebody made for Thanksgiving, and they are completely avoiding something that they would possibly enjoy because it has this one food in it.

Same thing with beets. Beets are high oxalate. Cacao and dark chocolate, high oxalate. You can still enjoy those things from time to time. If you have issues with oxalate, you won’t be eating those every single day.

Dr. Eric:

Some are higher than others. I attended some of the Great Plains Lab workshops. They said spinach is by far the highest oxalate food. Even if you cook it, it might decrease the oxalates a little bit, but it won’t lower it from being a high oxalate food to a lower one. It’s still going to be a high oxalate food. I agree. Even with spinach, every now and then, or beets and sweet potatoes, you could drive yourself crazy trying to completely eliminate oxalates. A) You won’t be able to do it. B) You don’t need to do it.

You mentioned the importance of muscle when it comes to bone density. Can you talk about exercise and what types of exercise? I’m guessing resistance training based on what you just said.

Kevin:

Exercise is super important for your bone health. If you have younger kids, this is also important for them. By the time you turn 18, you have put on 90% of your bone mass. As you’re younger, you’re in these years that you’ve got a great chance to build a solid foundation for the rest of your life with your bone health. Get your kids in gymnastics. Get them playing sports. Soccer players do a lot of running in multi-directional ways. They have stronger bones in their legs.

The reason for this is that your bones need two different types of stimuli. They need muscle pulling on bone, and you need impact. The most effective interventions are using one or both of these in combination. You need muscle pulling on bone to become stronger, so you have this mechanical signal sending a chemical signal to tell those bones to become stronger.

Usually, what you’re going to be told to do, if you’re in the doctor’s office, and you have osteoporosis, they will tell you to do weight-bearing exercises and walking. You know what? Walking is great for your health. If you’re doing it now, keep doing it. But do not count on that as your only form of exercise. You need to do more than that. It could help you maintain your bone density in certain areas of your body, but it’s not going to help you build bone density. You need to incorporate other weight-bearing exercise.

When I say weight-bearing exercise, that’s where your muscles and your bones are working against gravity to keep you upright. They are exercises you’re doing on your feet. Doing that on your feet, where you are working against gravity, you are placing stress on your bones. That’s a good kind of stress that we want. This would be your running, hiking, jogging, gardening, playing tennis, aerobics, jumping rope, climbing stairs, playing soccer with the kids or grandkids. All of those things are included in weight-bearing exercise. It also includes things like tai chi, yoga, Pilates, dancing. Those kinds of things can also be weight-bearing. If you’re doing those, keep doing them. That’s great.

Now, there are also some things called non-weight-bearing exercise. This is where your body is not working against gravity to keep you upright; you’re not placing that stress on your bones. This is the same situation that astronauts go up to space. Working against us to place that stress on our bones. They end up losing bone density over certain periods of time. We have to actively work against that. The exercise that we could be doing, non-weight-bearing, would be cycling, kayaking, seated stretching, seated exercises, or the biggest one is swimming. Swimming is a big one.

What I’m not saying is that if you’re doing these things now, if you’re riding your bike, you’re swimming, and you’re putting in some laps in the pool, or doing some kayaking, that’s great. If it makes you happy, if it reduces your stress, do it. But don’t overdo it. Don’t count it as your only form of exercise. It’s not going to be enough to stimulate what your muscles and bones need.

What is the other type of exercise we have to incorporate to give our bones what they need? Resistance training. This is where you’re using dumbbells, resistance bands. Could be even your own body weight if it gives you that level of intensity. You may be thinking, “Oh my gosh. Muscle strengthening. I have to be a body builder.” No, you don’t. You don’t have to be in that position. You just have to be able to do these exercises at an intensity that stimulates your muscle and your bone.

What intensity level is that at? The studies show the greatest effect on bone is in the 5-10 repetition range. There has been a lot of work done by Dr. Belinda Beck and some other research. They looked at things like overhead presses, deadlifts, squats, chin-ups with drop landings. Those were all effective.

If you are listening to this and are like, “I have never done a squat or a deadlift before. That’s so intimidating.” Don’t just YouTube it and knock out some sets. Understand it’s okay to expand what you may not be familiar with. Just do it safely. Find somebody who can help guide you through that. Get your proper body mechanics down. Make sure you’re doing the right things. Let’s slowly progress you to the point where you’re actually building muscle and bone strength.

This is not a quick fix. Bone health is not a quick fix. It’s not like you can get two good workouts in every other week, and your bones will be noticeably stronger. This is a long game. Play the long game with your bone health.

Dr. Eric:

You spoke about certain foods and just covered exercise. Do you have time to go over supplements a little bit? I’m sure people are wondering about calcium. I know you don’t recommend high dose calcium supplements. If you could talk about that, Vitamin D, and some other ones you might recommend.

Kevin:

Vitamin D is super important, not just for your overall health, but for your bone health. It’s not just a vitamin; it’s a hormone. It induces the transcription of more than 50 genes. It increases the intestinal absorption of calcium. It promotes higher bone mineral density. It will help lower fracture risks. It’s super important for our bone health.

Your best source of Vitamin D is going to be the sunlight. Midday sunlight, UV ray radiation. Bare skin, no sunscreen. 5-30 minutes a day in those warm months. Just enough not to burn. If you can go longer, that’s great. That’s the bare minimum for your best source of Vitamin D.

But most people aren’t even getting that in the warm months. We’re covered up. We cover up in our hats, our sleeves, our chemical-laden sunscreens. For sunscreens, when you get to the point where you have already gotten your sun, just enough to the point where you won’t burn, use a mineral-based sunscreen.

In terms of dietary sources, you can also get Vitamin D from salmon, herring, sardines, anchovies, oysters, and egg yolks.

With supplementation, you never want to supplement blindly with Vitamin D. You always want to test your levels. Test your 25 hydroxy Vitamin D levels. If you’re going into fall or winter wherever you are, there is a likelihood you will increase the level of supplementation you’d be using to maintain a healthy level of Vitamin D. It’s an important one to incorporate into your plan.

Vitamin K2. This is one that not everyone is too familiar with, but let’s talk about it because it’s super important for your bone health. You probably know about Vitamin K, and maybe K1. K2 is important because it aids in bone mineralization formation by activating something called osteocalcin. This is going to ensure that calcium is deposited in our bone and not our soft tissues like the arteries and kidneys.

There are different forms of K2. There is an MK4 form and an MK7 form. The MK4 form will be found in beef liver, grass-fed ghee and butter, dark meat chicken, pastured egg yolks, emu oil. MK7 is going to be found in things like hard cheeses, fermented foods, sauerkraut, kimchi, natto (which is the greatest source, but most people won’t be eating a lot of natto). This is a really interesting one. Bacterial fermentation in our guts can actually help produce Vitamin K2 as well. If you’re not getting enough K2, which most people aren’t, consider supplementation there as well.

Vitamin C. I talked about how important that was. Obviously, we want to try to get as much Vitamin C from our diet and nutrition. Sometimes that’s not possible. Incorporating that into your plan could be helpful.

When it comes to calcium, I am a big fan of get as much as you can through your diet first. Get it in those forms where it has all the other nutrients that you need. I do find a lot of times though that people are still falling short, or they’re having a hard time making sure they are getting calcium into their diets.

In those situations, usually the maximum I would want to see somebody incorporate is 500mg a day. Not all at one time. Maybe spread out in two different meals. Use an absorbable form of calcium. Any of the ones bound to an organic acid or amino acid can be helpful. Malates. Citrate is a highly absorbable form. MCHC calcium, which is like bone meal basically. That can be helpful, too.

If we are talking about a controversial topic, dairy. Let’s talk about that one. If we have an autoimmune condition, dairy is most likely not going to be a part of your plan, especially initially. If you or someone in your family has that as part of their plan, for bone health specifically, cultured dairy, fermented dairy would be the way to go. If you’re going to incorporate it, make sure you are getting some additional benefits from it.

The benefits of fermented and cultured dairy is you have probiotics, beneficial bacteria and yeast that come in large quantities, which can help your gut health. They could also lead to better nutrient absorption. Those are my thoughts on calcium.

Another big one I will touch on is magnesium. You have to have magnesium. It has 300 functions in the body. You need it to build proteins back inside your body. I talked about how important proteins were. In order to rebuild anything inside our bodies, you need magnesium to do that. If you want to rebuild stronger bones, magnesium has to be part of your plan. As you’re increasing your calcium and Vitamin D, your need for magnesium increases as well.

And Omega-3s. I touched on that before. If you’re not eating healthy, fatty fish, get some Omega-3s in your diet. Get them in their bioavailable form. Those are all good things to incorporate.

Dr. Eric:

You mentioned healthier forms of dairy like fermented dairy. If someone is going to eat dairy, it’s optional, you would say. If someone is eating plenty of arugula and other vegetables higher in calcium, and maybe the fish with the bones, there is no need for dairy. Would that be correct?

Kevin:

Especially if you’re adding in some supplementation, that can help you. If you’re eating a can of mackerel, for example, you may be getting 250mg of calcium from those bones, maybe a little bit more, like 300mg. How many cans of mackerel are you going to eat in a day? I can tell you: I eat quite a bit of mackerel and sardines. I’m at my limit at about two a day. That is 600mg.

Let’s say I add in three ounces or 85g of arugula. That is one of those big plastic clam shells full of arugula. That is 200mg of calcium. That is a pretty significant volume if you are eating a raw salad. If you sauté that down in some good quality olive oil, that can make it a little bit smaller to consume. You have 200mg of bioavailable calcium there. Now we’re at 800mg.

Now we’re starting to try to figure out some of the other sources for we can bring in calcium to our diet. Cruciferous vegetables. Those have a pretty good absorption rate for the calcium. There has to be some supplementation that takes place usually for most people because they have a hard time from a practicality standpoint and from a convenience standpoint, figuring out how they are going to get enough into their diets.

Dr. Eric:

You shared so much great information. I’m sure there are people who want to know more. Can you let us know where can people find out more about you, Kevin?

Kevin:

You can always find me at BoneCoach.com. That’s where we have Stronger Bone Solution coaching programs. We help a lot of people; the program was featured in Forbes and other places. Even medical doctors, physicians, registered nurses, nurse practitioners, and orthopedic surgeons come through our programs and refer their patients to us after. We have physiciansspending their own money to learn about bone health outside of the pharmaceutical treatments and then referring their patients to us. I am proud of that and happy to see that because I think we have a long way to go in our conventional system. If you want to learn how to build stronger bones naturally, and you want to do it the right way, head to BoneCoach.com.

For your audience, Eric, I have a free Stronger Bones master class. This is where I would encourage every single person who is listening to this right now, if you are worried about your bones, fractures, or if you have someone you know who has osteoporosis, forward this onto them. Help them out. Make them listen to this podcast. Get them to sign up for that free master class.

If you sign up for that master class, not only will you get the awesome information that comes with it, but I will send you the replay, so you can watch at your own convenience, and I will send you a bone healthy recipes guide, too. Those are the best ways to get a hold of me.

Dr. Eric:

I need that free bone recipes guide.

Kevin:

I’ll send it to you.

Dr. Eric:

It was great chatting with you, Kevin. Thank you so much for sharing your expertise related to bone health. Really do appreciate it.

Kevin:

Happy to help.

 

Recently I interviewed Cynthia Thurlow, as she discussed the benefits of intermittent fasting, and of course she discussed whether or not it can benefit those with thyroid and autoimmune thyroid conditions. If you would prefer to listen the interview you can access it by Clicking Here.

I am thrilled to chat with Cynthia Thurlow, who is a nurse practitioner and author of the best-selling book Intermittent Fasting Transformation: The IF45 Plan. She is a two-time TedX speaker, with her second talk having more than 10 million views. She is also the host of the Everyday Wellness podcast. With over 20 years of experience in health and wellness, Cynthia is a globally recognized expert in intermittent fasting and women’s health. She has been featured on ABC, FOX 5, KLTA, CW, Medium, Entrepreneur, and The Megan Kelly Show. Her mission is to educate women on the benefits of intermittent fasting and overall holistic health and wellness, so they feel empowered to live their most optimal lives. Thank you so much for joining us, Cynthia.

Cynthia Thurlow:

Thank you for having me. I have been looking forward to our conversation.

Dr. Eric:                            

Same here. If you could start off by sharing your background and why you are so passionate about intermittent fasting.

Cynthia:

I am a traditionally trained allopathic nurse practitioner. My background as a nurse was in ER medicine. I am a bit of an adrenaline junkie. I trained in inner city Baltimore, so I got to see a lot of amazing things. It was a natural extension to then go into cardiology as a nurse practitioner. I did 16 years of clinical cardiology, both in-patient and out-patient management. I love everything about the heart.

After becoming a parent, I had a child that developed life-threatening food allergies. He had really terrible eczema. Having never really dealt with eczema as an ER nurse, it was really baffling. I kept saying to the pediatrician, because at the time he was exclusively breast-fed, “Do you think it’s something I am eating?” “No, not at all.” His eczema got worse and persisted. We used all the conventional allopathic treatments, like topical steroids, etc. I kept asking, “Is it something that he is eating?”

I finally got a referral to the allergist. Boy, was I surprised to find out that my beautiful, otherwise very healthy two-year-old had life-threatening food allergies. That set me down a proverbial rabbit hole. All of a sudden, I went from thinking of food as being a safe thing to all of a sudden we had to be very careful where we ate. We didn’t eat out much at all to begin with. I got very careful about where we ate in restaurants, ensuring he wasn’t getting cross contamination or exposure of these allergens. It really shifted my focus.

I always say it’s a blessing I had that experience with my son. Thankfully, he is nearly 17 years old and is otherwise very healthy. Only 30% of kids will outgrow their food allergies. He is one of the many children that has not outgrown their food allergy.

I really started looking more deeply. I read a book called The Unhealthy Truth by Robin O’Brien. Then I actually considered doing a doctoral program. I took one class and decided that wasn’t it. I went down another rabbit hole and did a wellness coaching program, which was interesting, but did not light me up. Then I read another book, and I reached out to that author and asked where they got their training.

I think nutrition is what I am most interested in because I was seeing patterns with my patients. Despite the best evidence-based medicine you can imagine, we weren’t curing their cardiovascular disease or diabetes. We were stabilizing symptoms. It was very disheartening. I did this functional nutrition program, and that lit me up. That was the beginning of the end of my traditional path.

Within about a year, even though I was going to work and following those evidence-based guidelines, I became acutely disconnected/frustrated, feeling like we were missing opportunities with our patients. I left clinical cardiology without a business plan. I wouldn’t necessarily recommend anyone do that. Almost instantaneously, I had a large following of women who started coming to me because they felt like their needs weren’t being met. For me personally, during that time period, for a lot of women, as they enter perimenopause, which is the 10-15 years preceding menopause, all the things that used to work no longer work.

For me, the value of the N of 1 was this is someone who had always done everything right. Nutrition, exercise. I thought I was sleeping enough. I thought I was managing my stress. In perimenopause, the game changes. I started having some weight loss resistance. Intermittent fasting to me was something I came to out of an interest to see if I would lose weight. That is how most people are.

What I found was that I didn’t lose weight initially. What I did find is I had more energy. I started sleeping better. I started to feel like I had a very different relationship with food. I could recognize true intrinsic hunger as opposed to “It’s X time. It’s time to eat.” I started with intermittent fasting. Then I started talking to everyone who was willing to listen to me about the strategy, not realizing it would be something I would be known for several years later.

From my perspective, it was traditional allopathic medicine, cardiology, ER medicine. Then pivoting and taking this opportunity.

The other thing that is probably worth sharing is that in 2018, as an introvert, I decided I was going to challenge myself. I was going to do a TED Talk. My husband thought I was nuts. “No, I’m an introvert. This will be a scary challenge.” I didn’t realize I would get multiple offers. I did one talk on perimenopause, that super sexy topic. Around the same time I did my first talk, I was offered a second. That changed everything. Obviously, now I am known for intermittent fasting in women because that talk went viral and really changed a lot of things for me.

Bringing greater awareness to a strategy that is not new or novel, and certainly one that thyroid patients appropriately can integrate into their lifestyle is something that I take as a great honor. I am able to impact more people than I ever would have or could have being just in a hospital or in clinic.

Dr. Eric:

Speaking of thyroid, you have been diagnosed with Hashimoto’s, correct?

Cynthia:

Yes, I have. That is why I like women in particular to understand that you can successfully utilize intermittent fasting and have thyroid disease. As we were talking before we started recording, there is always exceptions. If we really understand that intermittent fasting is not just about weight loss, it actually improves the health of our mitochondria, which are the powerhouses of our cells. From substantive to less substantive, there are lots of benefits. Thyroid patients in particular can benefit from this mitophagy, autophagy, getting rid of these diseased, disordered cells that are no longer serving us.

Dr. Eric:

Can you talk a little bit about metabolic flexibility, what it is? How does it improve when practicing intermittent fasting?

Cynthia:

This is something I have gotten very outspoken about. As you can imagine, in cardiology, I saw a lot of metabolic inflexibility, metabolic syndrome. When we are talking about metabolic flexibility, it is specific to our body’s being able to use both fats and carbohydrates as fuel sources. We don’t want to just be using one over the other. Most individuals, we know based on recent data, it’s 92% of the population here in the United States, is not metabolically flexible or healthy. That is most of us.

How do we actually define what metabolic syndrome is? I look at a couple of variances. We look at waist circumference. This is very important. If people have a waist circumference greater than 35 inches or men greater than 45 inches, that is one.

Another is triglycerides greater than 150. I would advocate it should really be under 75. It’s really a reflection of the quality of carbohydrates someone is consuming.

Looking at HDL. HDL is considered to be “heart healthy cholesterol.” There is more to it than that. In men, we want to see that number greater than 45, and in women, greater than 55.

You also think about fasting glucose. To give you a sense of how long I’ve been practicing, when I graduated from my nurse practitioner program in the early 2000s, you wanted to see blood sugar under 140, which makes me cringe. Now we are saying we want it under 100. I would argue your fasting blood sugar should be under 90, or at least under 95.

When we are looking at these metrics, there are more, like fasting insulin or uric acid. These are all metabolic markers of health. It’s important for you to know these numbers. Some of these things, you can measure at home, like waist circumference. Every year, you should be getting fasting blood sugar, triglycerides, HDL. You should know those numbers, so you can trend and track them.

When we are looking at metabolic inflexibility, these are the people who struggle with weight loss resistance, energy. They will probably get sleepy after meals. They may in fact have poor quality sleep. They won’t have the energy to get up and play with their children or go for a run or engage in sustained exercise. These are individuals who will get hangry. They get this hungry grumpiness that you see in little children because they don’t have the ability to articulate that they are hungry, or they just get grumpy. They also generally tend to gravitate toward foods that are carbohydrate-dense as opposed to protein and healthy fats. These are obviously generalizations.

When we are looking at someone who is metabolically healthy, they won’t deal with weight loss resistance. They are going to be able to go for longer stretches without eating. They will put their meals together differently. They will use protein and carbs or protein and healthy fats.

This is really important for people to understand. I am not anti-carb, but if you are insulin resistant or diabetic, you should absolutely be on some degree of carbohydrate restriction. We can talk more about that.

When I am looking at someone who is metabolically flexible, they sleep well, have plenty of energy, have lots of cognition so they can power through tasks. They don’t think about when their next meal is.

The person who is less metabolically flexible is going to be focused on watching their watch. When is my next meal? I’m hungry. I am running out of gas. I need that candy bar, energy drink, soda in the middle of the afternoon because I get a slump. Those things shouldn’t be happening.

What I think people have forgotten about is that metabolic flexibility is our birthright. It is the way that our bodies are designed to thrive. We have just forgotten. The processed food industry has convinced us as a nation, as a society that we need to eat snacks and mini meals to stoke our metabolism and to have energy. I am here to tell people that eating less often with very few exceptions is the way our bodies are designed to thrive. It is definitely a way to support metabolic flexibility.

Unfortunately, the lay press and magazines like to focus in on this hot new diet system. I remind them that this is our birthright. Intermittent fasting has been incorporated in all major religions. We wouldn’t be here as a species if our bodies had not been able to go through periods of time with food scarcity or even periods of feasting and famine. Metabolic flexibility is something that every single person that is listening should be focused on because our health care system and our nation can no longer support this kind of sick care system that is potentiating and exacerbating metabolic inflexibility.

I will give you an example. Obviously in cardiology, we are dealing with people with disease. They have cardiovascular disease, whether it’s their heart, their brain with strokes, peripherals vascular disease. More often than not, almost all of them have diabetes. Unfortunately, we go about addressing inflammation, oxidative stress, insulin resistance. We wait until someone has disease. We don’t go proactively and say, “Your fasting insulin is abnormal. Your fasting blood sugar and hemoglobin A1C look great. Let’s wait until they look abnormal.” Being more proactive and being truly preventative.

I technically am trained in primary care medicine. I never worked in primary care because at the time, there wasn’t as much of a desire to educate nurse practitioners in acute care medicine. Of course, that makes me laugh because that’s all I did as an NP. The reason why I’m sharing this with your community is that we have to start taking accountability as individuals and as clinicians to be more proactive and not wait until someone is diagnosed with disease. Diabetes takes 10-15 years to be diagnosed.

There is lots of things that start to happen in our bodies, and especially for andropause and menopause and perimenopause. These times we are all going through reverse puberty, there are things we have to be more proactive about in terms of the hormonal changes that are happening in our bodies. It doesn’t mean that you will develop diabetes, but you could become insulin resistant. We want to do everything we can to shift that happening.

We want to be as proactive as possible. This is where the hard work comes in. There is no magic pill. I don’t know if this has been your experience, but I have patients who say, “Give me the pill. I’m not going to change. I’m not going to stop smoking or change my diet or exercise.” I always tell them that’s so disheartening. Yes, lifestyle changes are hard, but the long-term yield is pretty significant.

Dr. Eric:

You mentioned carbohydrates. If someone has insulin resistance, they definitely need to restrict their carbohydrates. If you could talk about if someone has insulin resistance, on average, how many grams of carbohydrates they should be eating? Also, if someone doesn’t have insulin resistance. Like you said, we want to prevent someone from developing insulin resistance. If someone doesn’t have it on a wellness basis, how many grams of carbohydrates should they be consuming?

Cynthia:

Unfortunately, I am sometimes labeled as anti-carb. That couldn’t be further from the truth. I eat lots of carbohydrates: lots of non-starchy vegetables, low glycemic berries. When we are approaching this topic, the first question is are you insulin-sensitive? If you are part of the 8% of the population that is, you probably get a bit more leeway than the rest of the population. What does that look like? On days I earn my carbohydrates, and by that, I mean lift heavy things, I lift at least three days a week.

Every person listening should be doing and incorporating strength training because you have to think of your muscles. Dr. Gabrielle Lyon says they are the organ of longevity. After I started leaning into her work, I started to fully understand and appreciate that she is absolutely correct. Muscles help with insulin sensitivity. We want to maintain lean muscle mass for as long as we can.

Why is this relevant to this discussion about carbohydrates? The more muscle mass you have, the more high quality carbs you can consume. That may look like sweet potatoes, rice (if you tolerate grains). That is the unprocessed stuff. I am not a fan of people eating lots of bread and pasta. I’m sorry to say that. Cookies, candy, that is not the quality carbohydrates I am referring to. But if you are working out hard, and you go to the gym and lift, and you are lean, and you’re insulin sensitive, you can utilize carbohydrates.

I typically recommend that people consume no more than 30-40g in a meal. You have to understand that a candy bar could be 60g of carbohydrates. Just to give you an idea. Really understanding that if you are insulin sensitive, you can very likely get away with 30-40g in a meal. For me, that might be half a sweet potato. We are not talking about a starchy carbohydrate.

When you are insulin-resistant or diabetic, you have to be very mindful. You already have a sugar handling problem. This is where I would say to get your carbohydrates from green, leafy vegetables, low glycemic berries. That doesn’t mean one cup of berries. That means a quarter cup of berries. That means you can have lots of broccoli and cauliflower. Those are good things for your body. That does not mean you sit down with a massive bowl of pasta and have a miniscule amount of protein.

When you have carbs, you never want to have them naked. You should have your carbohydrates with your protein. There is a very interesting book I’m about halfway through by a biochemist called Glucose Revolution. She has some very interesting ways to buffer the net impact of carbohydrate intake. You start with vegetables, then protein, then the carbohydrates. I am very much a fan of pairing your carbohydrates with protein. Never carbohydrates and fat. They generally don’t occur that way in nature, and they are very easy to overeat. Think about chips and guacamole. Let’s be honest. Guacamole is delicious, and salted chips are fantastic, but you won’t trigger the same satiety cues in the body.

To get back to your original question, if you’re insulin-sensitive, you can probably handle 30-40g of carbs in a meal. Always with protein, not by itself.

Another thing people can do irrespective of where they fall on the insulin sensitivity spectrum, and this is well-researched. This is not just me telling you to do this because it’s good exercise. Walking for 5-10 minutes after a meal helps with insulin sensitivity. The organs of longevity are muscles. Your muscles will help with the glucose disposal and insulin sensitivity.

I always encourage people, especially if you have eaten a larger meal than normal that had more carbs than normal, to get out there and take a walk as a way to disperse some of the carbohydrate load that you consumed. A lot of people are thinking, “I eat way more carbohydrates than that in a meal.” You need to examine if you are metabolically healthy, if you are insulin sensitive. Everyone should know what their fasting insulin levels are; they should be between 2-5. If they are higher than that, you have work to do. It may take a bit of time. We don’t become insulin-resistant overnight. I don’t expect that people will become insulin-sensitive overnight. I do think adjusting your carbohydrate intake, lifting weights, taking walks after meals.

Checking your blood sugar. I am a fan of continuous glucose monitors. If that is not in your budget, glucometers can be very beneficial. You can track what your blood sugar response to your meal is. If it’s more than 20-25 points, you probably had too much carbohydrates. Hopefully I’m not busting people’s minds about how we navigate carbohydrate loads. I think a lot of it is dependent on where you are in your life stage, how insulin-sensitive you are, and getting nuance.

I know for myself, I’m 51 years old. I just had a birthday. I am very conscientious about how I time my carbohydrates, when I time my carbohydrates. Always earlier in the day we are more insulin sensitive. I think very thoughtfully about carbohydrates. I probably didn’t when I was younger. Now I definitely am very strategic about when I eat them and how much of them I eat.

Dr. Eric:

I’m glad you mentioned that because a lot of people do the exact opposite. When they have dessert, not that they should be having any bad dessert, but even if they are having a cup of fruit, it sounds like maybe have it early in the day and not after dinner.

Cynthia:

Yes. The other thing to think about is right now, it’s summer. It stays light until 9pm at night where I live. I remind people that in summertime, you can actually get away with a little bit more carbohydrate intake. When I say a little bit, I mean a little bit. I’m not talking about having a brownie sundae at 9pm; that’s a disaster. Maybe you can get away with a little more discretionary- We just got through stone fruit season. I love apricots. It’s one of my favorite things to eat during the summer. They’re not very sweet.

Being mindful of when you eat and what you’re eating. I remind people you really want to be done with eating within 2-3 hours of bedtime. I actually like an earlier stop to my feeding window personally. That is one thing the pandemic showed me. I actually don’t do well eating dinner at 7:30 or 8pm. I do better finishing my meals earlier.

The other thing is this is aligned with current biology, meaning it’s better for us to eat earlier in the day than later. We have these melatonin clocks. We have a centralized clock in our brain called the super chiasmatic nucleus. We also have peripheral clocks in the gut, the pancreas, the liver, and elsewhere. When we eat late at night, it disrupts these clocks. It disrupts melatonin secretion, which impacts our sleep quality, our blood sugar, our cravings the next day.

Getting attuned to your body might be that you have that watermelon or fun summer food that has some fiber in it, the digestion of which will be slowed. Have them earlier in the day. Don’t eat the brownie sundae at 9pm and think you’re doing yourself any favors. My teenagers can get away with that, but my husband and I can’t. Just be mindful of where you are in time and space.

Dr. Eric:

Let’s switch gears and talk about protein. I’m sure just in general there are people who are not getting enough protein. I know some people who do intermittent fasting definitely aren’t getting enough protein. Can we talk more about how people can get enough protein when doing intermittent fasting?

Cynthia:

This is a very important concept. I say this because I inherited co-hosting another podcast. I have one of my own, and I have Intermittent Fasting that I co-host with Melanie Avalon. My predecessor was a big fan of OMAD. OMAD is one meal a day. My biggest criticism, and this is irrespective of gender, is you cannot get enough protein in in one meal a day. I don’t know of anyone that can.

What is enough protein? I say at a minimum 100g a day. For most women, that’s going to blow their minds because they probably are getting 40-50g a day. You heard me mention earlier that muscle is this very important organ. We start to lose muscle mass at a fairly exponential rate after the age of 40. The less muscle mass you have, the less insulin-sensitive you are, the less calories you will actually burn. One of the ways that we circumvent the development of sarcopenia, which is muscle loss with aging, is we have to lift heavy things, eat enough protein, and sleep, amongst a myriad of other things. But those are the three big ones.

I remind women and men that when you are plating your meals, you need at least two food bolus a day. You need to eat at least two good-sized meals a day. I can eat 50-60g of protein in a meal because I have been doing this for a while. In fact, when I was on vacation, I was the person asking for a second portion of protein because I knew I wasn’t going to hit my protein threshold. In Europe, they have small meals. Everything is small, most of which is good, but protein can be a little less than what I’d like.

Maybe you have never tracked your protein intake. Chronometer is a good app. It’s cheap. It’s free in fact. I think it’s very helpful to track your macros for a period of time. Not forever. Not so you feel like you’re being obsessive. But it builds awareness. I find most people are probably doing 25-30g of protein a day. You can’t hit that 100g of protein threshold. Gabrielle Lyon talks about 1g per pound of ideal body weight. I’m 115 pounds. I aim for 115 a day. Sometimes I hit 120. Some days, I hit 90. Over time, it will even itself out.

Protein is not just about maintaining muscle mass. It’s also for satiety. You eat a big enough piece of steak, and you will be full. You won’t be looking at the brownie sundae or more pasta or bread. You’re full. Triggering these satiety cues and switches in our bodies is another really important benefit of protein.

When we are looking at animal-based versus plant-based. I’ll be the first person to tell you that animal-based proteins, the amino acid profiles, are superior to any plant-based protein. For a lot of vegetarians and vegans, they can be very low in protein at the expense of too much carbohydrate. Legumes aren’t a bad thing. Beans aren’t a bad thing.

In order to get the same amount of protein in a plant-based diet, people end up either deficient in protein, or they have completely dysregulated their blood sugar because they are consuming a lot of quinoa, beans, legumes, etc.  It’s a careful dance to ensure that people who are predominantly plant-based are getting enough of protein macros.

Protein is very important. In fact, I will often say it is the most important thing you have on your plate. You can technically make carbohydrates from protein through a process called gluconeogenesis. We cannot make our own protein. We have to consume it. We want to consume high-quality, animal-based protein; that’s what I advocate for and speak openly about.

Dr. Eric:

What are your thoughts on protein powders? Obviously, a plant-based protein powder isn’t going to be as good as a hydrolyzed beef one, let’s say. If someone feels like they can’t eat enough protein, is it okay for them to have a smoothie with protein powder with hydrolyzed beef or collagen or maybe even an amino acid supplement?

Cynthia:

Great question. I am a total realist. I am not sitting here on this mountain saying, “I’ve never had protein powder.” I occasionally have a protein bar while I’m traveling. Plus I have teenage boys. The amount of protein they eat is astronomical. If you’re going to consume protein powders, you want to ensure you’re consuming a high-quality product. Something like Marigold, which is whey-based protein. New Zealand, grass-fed, grass-finished cows that you know aren’t being fed a bunch of chemicals. Less ingredients on the label are going to be better than not. I myself don’t tolerate dairy, so I have that one in my house for my kids. I have a bone broth protein.

I think collagen peptides are fine. It’s not a complete protein, but it’s good for hair, skin, and nails. What person isn’t looking to have better hair, skin, and nails, especially as we are getting older?

In terms of plant based, I have talked to some of the leading experts in the field about this. With regard to pea, because that appears to be a very in vogue plant-based protein, we don’t have any research to know what’s going to happen. Does it have estrogenic effects like soy does? We don’t know.

I would recommend if you are doing plant-based proteins that you source from a really high-quality company. Truvani is one that has been recommended. I have tried every protein powder out there to find one that is palatable. I generally don’t find them to be palatable; they are chalky. Truvani is the one I generally recommend if people are looking for a cleaner option, but we don’t know about long-term effects of pea protein.

There is a lot of rice protein that is out there. I always get a little concerned about making sure you have a high-quality product because rice can be heavily arsenic-laden by virtue of where and how it grows.

I am a complete realist. I am all about meeting people where they are. I do have a problem if people are choosing just to have protein bars and shakes and not eating real food. But if you are traveling, on the go, if it’s a busy morning, I get it. You definitely want to put your body through the mechanism of chewing food, swallowing it, having that food bolus hit your stomach because that is much more satiating than a shake or a bar is.

In fact, the hyperpalatability of some of those products, even cleaner-sourced ones, my concern is always if you finish that bar, and you’re thinking about another one, it’s because the processed food industry does a really good job of creating flavor profiles in a way that keeps us wanting more. That’s always the concern.

There are companies out there like Epic as an example that set a reasonable price point. They have a bar that is more like a meat bar. Or Paleo Valley is a company I definitely buy and enjoy their products. Jokingly, that is my protein bar. I take Paleo Valley beef jerky and some salted macadamia nuts, and that is a small meal if I’m on the go. It’s at least clean, and I can live with myself.

To answer your question, I think you want to find the highest-quality supplement with the least amount of ingredients if you go that direction. Things like Perfect Aminos, there is a company out there that has these amino acids. Three years ago, when I was hospitalized for 13 days, I took that product for a while because I could not get enough protein in my diet. My digestive system had gotten so rerouted that I only tolerated protein. Some days, when I was trying to push my protein intake without upsetting my stomach, I would take the aminos, and that worked really well. Again, no affiliation with that company either. Spending some time to think thoughtfully about how to get to that threshold where you are getting at least 100g of protein in a day.

Dr. Eric:

Let’s dive into some of the different intermittent fasting regimens if that’s okay, including of course your IF45 plan. If you could expand on that as well as comparing it to other popular regimens.

Cynthia:

My bulk intermittent fasting transformation, IF45, is a 45-day program focused on a 16/8. 16-hour fast with an eight-hour feeding window. I feel like that is a very approachable window for most people to work up toward. Obviously, there are lots of varieties.

I mentioned OMAD, one meal a day. There are people who do 24-hour fasts. There are people who do longer fasts. There are people who do alternate day fasting. There are individuals who do a combination like a 30/16, meaning they will fast for 30 hours, have a meal, then do a 16-hour fast. A lot of these variations are for different reasons.

I’m at a healthy goal weight. I’m not looking to lose weight, so I don’t do long fasts. After spending 13 days at a hospital and not being able to eat for almost two weeks, that cured me of any desire to go a long period without eating ever again.

I think if you’re metabolically unhealthy, you’re part of that 92%, doing alternate-day fasting, doing longer variations of fasting can be very helpful. If you are diabetic or someone who has high blood pressure or on chronic medications, you want to be having a conversation with your provider to see if you need to be monitoring your blood pressure or sugar more closely. Let me slide that caveat in there.

Typically, the plateau busting comes from variation. Once someone has mastered the basics, then you want to have some variety. Just like we don’t eat the same food every day, like we don’t do the same type of exercise every day, I think our bodies naturally desire to have some flexibility.

Today is a very good example. I broke my fast at 9am because I have a super busy day. I was up early this morning to get the workout in before my day started. I am going to have a wider feeding window today. I have been fasting for a long time. I was also very hungry when I woke up. That was the clue. I have been doing more lifting. I am more hungry.

I don’t believe nor do I recommend anybody white knuckle fast. Meaning if you have a day you’re hungry, if there is a specific time in your cycle, maybe you are lifting heavier, maybe your body needs more macros, more protein, etc., there is nothing wrong with having some variety to your fasting window. But there are a lot of varieties, both time-restricted eating or intermittent fasting and then those longer fasts. Anything over 24 hours is a longer fast.

Dr. Eric:

It’s funny. I was thinking about asking you if you were in a fasting state. I figured we started after 10am. In the back of my mind, I was thinking you were in a fasting state. I’m glad you mentioned that. It’s not like someone has to every single day start at the exact same time, say at 11am and then end at 7pm, depending on how long of a fast you go. You pretty much listen to your body.

Cynthia:

Yeah. Intuitive eating is great. If you’re metabolically flexible. If you’re not, that’s very hard. You go back to the basics. It may take someone who is insulin-resistant six months to get to a point where they are attuned to the cues in their bodies, and that’s okay. I always tell women, “Put your blinders on, and just pay attention to what you’re doing.”

I don’t care how old you are or young you are. We are all influenced by what we see on social media. It’s the extremes. I’m seeing a lot of women in their 50s who are still very lean. Their rhetoric is very different than what I see in a very young 20-ish woman. What happens is people who are in between those age ranges see that, and they are influenced by that behavior. That is why it’s very important that those of us who are in the public eye and have podcasts and are out in the space are very cognizant of the messages we are sending to people our own age and people younger in us about what’s reasonable and attainable versus some stuff- I question if they naturally got to where they are. There is no judgment. We are all influenced by what other people are doing, whether we are aware of it or not.

Dr. Eric:

You mentioned earlier about fasting is not a perfect fit for everyone. Just a few minutes ago, you mentioned you have high blood pressure. Diabetes, you might want to check with your healthcare practitioner.

Let’s get back to thyroid health. Before we started the interview, I mentioned that a lot of listeners have hyperthyroidism or Hashimoto’s. You mentioned your experience with Hashimoto’s. If someone has a thyroid condition, autoimmune thyroid condition, it doesn’t mean they can’t fast. When I dealt with Graves’, I was losing a lot of weight. I lost 42 pounds. I probably wasn’t a good candidate for intermittent fasting then. Now I do incorporate it into my diet. I have been in remission for many years.

If you could expand a little bit more about when you work with thyroid patients, how do you determine who is a good candidate for intermittent fasting? Who might not be a good candidate? Maybe even tie in adrenal health. If someone has compromised adrenals, should that be an indication that maybe they are not ready to fast either?

Cynthia:

Those are good questions. First and foremost, intermittent fasting is a form of hormesis. Hormesis is a beneficial stress in the right amount at the right time. What I see is a lot of men and women desperately want intermittent fasting to be the thing that is going to change it all for them.

If you are newly diagnosed with Graves’, which is hyperthyroidism, or you are newly diagnosed with hypothyroidism/Hashimoto’s, it is not the right time to add more stress to your body. If you were going through a divorce, you were just in the hospital, you are in the midst of a move, you have a lot of stress going on in your life. Don’t add intermittent fasting. It’s not going anywhere. Wait until there is less stress. Your body can’t adequately distinguish intermittent fasting from the divorce or the hospitalization or this stress of a new autoimmune condition.

My standard refrain is if you are stable on medication, which means you haven’t had to have an adjustment, if you wake up and have energy, if you have energy to get through your day, if you’re sleeping, then it is certainly okay to have a conversation with your health care practitioner about whether or not this is the right strategy for you. Now there is enough awareness about fasting that those practitioners are aware of it. They know how to carefully navigate around the strategy.

I do find that there is still a lot of fearmongering about individuals with thyroid disease. I remind people that intermittent fasting can help improve mitochondrial health. We know that if you have an underactive thyroid as an example, your mitochondria aren’t functioning as optimally as they could be, largely because-There is so many reasons why you can become hypothyroid. Is it a nutrient issue? Is it because you have an autoimmune condition? There are so many reasons why you can be hypothyroid.

I think the bulk, somewhere from 80-85% of us with hypothyroidism have Hashimoto’s, even if you have negative antibodies. I want to publicly share that for many years, I was told I did not have Hashimoto’s because I did not have positive antibodies. That probably has everything to do with the fact that I don’t eat gluten and haven’t for over 10 years. More often than not, you have Hashimoto’s until proven otherwise.

With that being said, I do find that intermittent fasting for those with both thyroid health issues and adrenal health issues—adrenal health issues is really your body’s perception of stress. The hypothalamus and pituitary adrenal axis. A lot of what these individuals need to work on is managing stress. That is not five minutes of meditation once a week. It’s getting out in nature. It’s doing things to tap into the parasympathetic, which is the rest and repose side of your brain. It’s sitting down to digest your food. It’s acknowledging that digestion starts in our brains. It goes on and on. The right types of exercise. Doesn’t mean Orange Theory or Cross Fit five days a week. There are many lifestyle things that have to be adjusted before we add in intermittent fasting.

I speak from personal experience that I absolutely have had significant bouts of HPA axis dysregulation. I obviously am thriving with thyroid health issues. I am very stable on medication. My labs are stable. It’s an n of one. Bioindividuality rules. Getting your health care provider involved in the decision-making process. Is this the right time? The answer may be no, but maybe six months from now, you will be ready.

There is no one listening that can’t go 12 hours without eating. No one. Not one person. It’s not going to hurt you. When I walk women through intermittent fasting around their menstrual cycles, I tell them 12 hours of digestive rest, which is exactly what it is, is not going to harm you. Even my teenagers, who eat voluminous amounts of food and are growing like weeds, they can go 12 hours without eating. So can you. Is that technically intermittent fasting? No, but that’s digestive rest, and we all need that anyway.

If you look at the data on meal frequency here in the United States, it’s horrifying. 12 hours of not eating is not going to hurt your adrenals or your thyroid. You want to make sure that you are hooked in with your health care provider, so you can both detemrine when the right time, if at all, is to intermittent fast.

Dr. Eric:

There are so many more things we can cover, but we are running out of time. We may need to do a part two in the future. Everybody needs to dive into your book, which I have also been reading and find fascinating.

For those who are not intermittent fasting and perhaps are thinking about it, or maybe those who are currently intermittent fasting and may look to incorporate your plan, can you give some action steps they should take?

Cynthia:

The first step is to stop snacking. I know that seems trite, but we have been conditioned to believe we need to have snacks and mini meals and eat all day long. The only way you can get from breakfast to lunch and lunch to dinner and dinner to breakfast is to stop snacking because it will force you to restructure your meals. What does that mean? That means you will prioritize protein. You are either having protein and carbs or protein and healthy fats.

The next step is to do that 12 hours of digestive rest and see how you feel. For some people, it may take weeks to get to a point where they have their meals adjusted enough to go from breakfast to lunch and lunch to dinner and dinner to breakfast. That is a very good first step. Once you have mastered 12 hours, you go to 13 hours. Then you go to 13.5. You go to 14.

If you are not fat-adapted, if you are not metabolically flexible, it could take you 6+ weeks or longer. I remind people that if you are metabolically flexible, intermittent fasting is not going to be as challenging. A lot of it can depend on where you are in your menstrual cycle and what life stage you’re in. Those are some very straightforward logical first steps.

If people follow those—stop snacking, restructuring your meals, and doing 12 hours of digestive rest—they generally end up being pretty successful.

Dr. Eric:

Wonderful. Where can people find out more about you? Your website is CynthiaThurlow.com. I’ll let you take over.

Cynthia:

The website is a great place to start. You can catch Everyday Wellness Podcast, which is my solo podcast. I also have Intermittent Fasting Podcast that I co-host with Melanie Avalon. I am active on Instagram. I am a little snarky on Twitter. Depends on the day. I have a free Facebook group called Intermittent Fasting Lifestyle/Cynthia Thurlow, which you are more than welcome to join.

The easiest way to get a sense for who I am and what I’m about is to listen to the podcast. I get to interview really amazing people in the health and wellness space. I have been humbly surprised at how much I love podcasting. It’s one of my favorite things to do. That is probably a great first step if you want to learn more about me.

Follow my crazy dogs. I have teenagers who don’t like to be on social media at all, so out of an abundance of respect for them, you won’t see them much on social media. But I do feature my dogs quite prominently.

Dr. Eric:

Thank you so much for sharing your knowledge. It truly was a pleasure chatting with you.

Cynthia:

Awesome. Thanks so much for having me.