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.

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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.

 

With me, I have Risa Groux, who is a functional nutritionist and certified autoimmune coach in private practice in Newport Beach, California. She has always been passionate about nutrition and good health. Today, she is passionate about cooking and healthy, nutritious food. She works with a wide array of clients from professional athletes, adults, and kids, to The Biggest Loser season 4 winner. Risa works with issues like diabetes, autoimmune disease, cancer, digestion, thyroid conditions, and hormone imbalances, to name a few. She firmly believes the body can heal itself with whole foods we obtain from the earth and sees living proof of that in her office each day. Risa looks at root causes using functional nutrition guidelines as well as blood and stool tests. Thanks so much for joining us, Risa.

Risa Groux:

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

Dr. Eric:

Look forward to talking about your wonderful book, FoodFrame… Diet is a 4-Letter Word.

Risa:

Yes!

Dr. Eric:

I was going to ask if you could talk about your background. I know you mentioned in your book you had Hashimoto’s. If you could talk about that and what led you to write your book.

Risa:

I do have Hashimoto’s although I am just about 10 points from reversing it at this point. I want to join the crew in my office that have reversed it already, so I’m getting there. I was diagnosed with Hashimoto’s after I had my second child. I was diagnosed with hypothyroid when I was trying to conceive my second child. No problems with the first. We just started having all these issues getting pregnant for the second child. It took a long time.

I did everything. I looked at everything. Why do I have hypothyroid? The doctor handed me a script and said, “Take this med every day.” I asked, “For how long?” He said, “No, every day.” I asked, “For how long do I take it every day?” He said, “For the rest of your life.” Isn’t that odd? Why would I be taking something synthetic that my body was actually born to produce? That started me on my journey.

I started to put together a little list of why you would become hypothyroid. When I was diagnosed with Hashimoto’s, I realized this is a pretty comprehensive list. I could not find a list anywhere, so I put my own list of root causes together. Why is my body in a state of attack? It’s just landing on my thyroid for me, but autoimmune lands in different tissues and organs and body parts. Let’s see if we can reverse this attack. I have compiled a very comprehensive list of root causes, which is in the book.

I have done extensive research and realized a lot of it is what we eat. I have seen thousands of patients through decades of work that I have been doing. I first started out with putting everybody on this one diet type, usually the diet type of the book I had recently read. It had all these great success stories and science to back up the success. I realized that not every diet type is right for every person. When that new diet book comes out, it says, “This is the great proven science.” Yes, all of those things are probably true. It’s probably going to work for a really good group of people. It’s not going to work for everyone.

I started customizing diet types according to your health status. FoodFrame is the methodology I created that basically says you should be eating according to your current health status. If you have blood sugar dysregulation, you should be either on Paleo or keto, depending on which one you qualify for. If you have IBS or IBD (irritable bowel syndrome or disease) or SIBO (small intestinal bacterial overgrowth), which is very common with thyroid, you should probably be eating on a low FODMAP plan, at least an elimination diet, for a period of time.

I realized that all these different health statuses should be eating according to different diet types. They are all matched up. In my book, I have highlighted six major diet types or eating lifestyles that I usually refer to. It usually hits pretty much everybody on the spectrum regardless of what your health status is. That is the book.

I wrote the subtitle “Diet is a 4-Letter Word.” I struggled with that one for a long time, but I couldn’t find the right words to say that we have this horrible relationship with the word “diet.” The actual real definition of a diet is what we eat throughout the day. It’s not starving and deprivation and restriction. I don’t like that idea, that people feel they should be restricted or starving or depriving themselves. Animals don’t do that. “Oh, I shouldn’t eat those berries on that tree.” They eat when they’re hungry; they don’t when they’re not. That is the premise of which I base my FoodFrame on.

Dr. Eric:

I do love the title and the subtitle. It makes sense that not everybody should follow the same exact diet. I work with a lot of patients who have Graves’ and Hashimoto’s, which are autoimmune thyroid conditions. I commonly recommend an autoimmune protocol as a starting point. I know that’s one of the recommended diets in the book. If someone has SIBO, then they probably shouldn’t follow an autoimmune Paleo diet, unless they have autoimmunity as well. Sometimes it gets complex if there is overlap.

What I’d like you to do is talk about the different FoodFrame diets. I know you also mentioned the book The Four FoodFrame Steps. I don’t know which one you want to talk about first.

Risa:

The four FoodFrame steps are basically find out what your FoodFrame is. Either take the quiz on my website, RisaGrouxNutrition,com, or get your bloodwork and stool test done. That is typically what I do during the first phase.

Find out do we have insulin resistance? Most allopathic conventional medicine doctors don’t typically test for more than just a fasting glucose. Occasionally, they will test you for hemoglobin A1C, especially if you are overweight or have diabetes in the family. But they don’t really ever test for C-peptide and insulin, which is what I test every single person for. I want to see if you’re insulin resistant.

What I do is functional nutrition. Functional nutrition is based on four pillars. We look at root causes. Why is this happening? Why am I having headaches? Why is my cholesterol high? Why, why, why? It’s not because we have a deficiency in statins that brings our cholesterol high. We know that’s not the case.

We also look at prevention. How do you prevent things, unless you have the information? We’re not really good at playing darts in the dark when I cannot see the target. I need all the lights on, and I need to be perfectly in vision with where I’m aiming.

Then we believe the body is one interconnected unit. Everything has to do with each other.

The fourth thing that I base my practice on is data. I have to see what I’m looking at. I order extensive labs. Insulin resistance is a precursor to prediabetes and diabetes, so I order that.

If you have a blood sugar dysregulation issue, fatty liver, congested gallbladder, or autoimmunity or SIBO, you have to find out what your particular health status is, so we can match your FoodFrame to it.

After you do that, then we do the RGN detox, which is super helpful because it cleans out the liver and blood. It optimizes your body, so you are operating much more optimally rather than sluggishly. We take out the trash of the body. Yes, you lose weight. Everybody does. But it’s not a weight loss program. Everybody loves to come in and do the detox to lose weight, which is fine. It’s a side effect of wellness, but we focus on wellness. The detox clears things out. Oftentimes—I see this all the time. Yesterday, I probably saw it three or four times—people’s main complaints already go away within those two weeks. You’re eating real food. You’re having collagen shakes. It’s not about starvation. Eat when you’re hungry; don’t when you’re not.

Then we do the recommended supplements for that health status. If you have blood sugar dysregulation, we do balanced berberine. Vitamin D deficiency, things like that.

Eating healthy food. I have a boatload of recipes on my website. Any food in your FoodFrame category is good to eat. That’s how we stay healthy.

The FoodFrame book highlights the six different diet types. As you mentioned, low FODMAP is for people with SIBO and IBS and IBD. That is meant to be an elimination diet. I would recommend that for 30-90 days. If you’re experiencing any chronic bloating, and you realize that it’s probably not a deficiency in digestive enzymes, then I would definitely recommend low FODMAP, whether you have been diagnosed with any of those things or not. It’s going to help you. It’s not calorie-restrictive, but it’s portion-restrictive for certain types of carbohydrates.

FODMAP is an acronym for fermented oligosaccharides, disaccharides, monosaccharides, and polyols. In plain English, those are certain carbohydrates that absorb water when you eat them. They tend to be a lot of prebiotic foods like onions, garlic, artichokes, and cruciferous vegetables like broccoli, cauliflower, cabbage, Brussels sprouts, and kale. Those things will make some people bloat and with major discomfort. What we’re trying to do is starve the bacteria that has inadvertently parked itself in the small intestines rather than the large intestines. We can do that through food. We see tremendous results from that.

Anybody can do that, but I wouldn’t recommend it for everybody because it’s a little restrictive. It’s those people who are really experiencing chronic bloating. Usually, it’s coupled with either chronic constipation or chronic diarrhea.

Then we have AIP, as you mentioned, the autoimmune protocol. That is what I recommend for anybody with autoimmune. Doesn’t matter if you have been recently diagnosed or at some point down the line. If you have family members who are autoimmune, and you feel like you are going down that road, it would be great for you to do it. It’s an anti-inflammatory eating lifestyle, so it wouldn’t hurt anybody to do it, but I really recommend it for those who have been diagnosed with autoimmune. You can jump on that anytime.

Again, it’s an elimination diet, so 30-90 days. It’s basically Paleo, but a little stricter. Remove nightshades, nuts, seeds, and eggs. A little restrictive, but you will really quell the inflammation that is ongoing that cytokine storm. That is helpful for anybody, but mostly autoimmune people.

Then we have keto. Keto is very popular, and it seems to stay popular for the last few years. Keto was when you switch your body’s fuel source from carbohydrates, which turn into sugar, to fat. You’re needing to eat about 75-85% of your calories every day in fat. Eating less than 20 net carbs. This will get you into ketosis. Ketosis is great because you’re burning that fat for fuel.

This is the diet type for all the bacon and egg lovers. You can eat all the cheese you want and lots of fat. Avocados, nuts. Lots of meat. Hard to get a lot of fiber in this one because carbohydrates are found in vegetables, so it’s very hard to get enough vegetables that you’re getting enough fiber without getting out of ketosis.

This is not a diet type that I would recommend for anybody without a gallbladder or who have a hard time absorbing fat. On a stool test, I test for steatocrit. If GGT on your blood test is high, this is not for you. It’s also very difficult more so for women. Some women thrive with it, but more women have a struggle with it. Men do great with it. Pretty much all men that fit that description. People who are really stressed with a lot of cortisol production, mostly women, not a great fit.

I personally tried to get into ketosis, and it was very difficult for me to get into ketosis no matter what I do. I have to use exogenous ketones to get in there. I recommend people use a urine stick to find out if they are in a state of ketosis because it’s very frustrating. Very easy to get out of ketosis. Hard to get into it. It can be very effective. There is a lot of science that proves it’s very good for heart, cholesterol, all that. But it is really aimed at people who have blood sugar dysregulation. If you have very high diabetes or pre-diabetic, going into ketosis will be effective for you.

Again, I don’t recommend it longer than three months. Some people can go a long time, but I personally see it being more advantageous for people to stop after three months, take a break, and then you can get back on.

Then we have Paleo. Paleo is the one I would say has the broadest appeal. Paleo is eating like our caveman, our carnivores did back in the day. We are eating quality animal protein and quality vegetables. Unlimited vegetables, any way you want them, except deep fried. Sweet potatoes, yams, good fats, nuts, seeds, eggs, olives, avocadoes, good oils, good quality. We are trying to decrease that systemic inflammation and increase that good gut health. That will do it for Paleo. It will help with blood sugar regulation. That is a really good bonus for Paleo.

I find Paleo to be easiest to travel with and maintain. It is a lifestyle. I pretty much follow Paleo myself. I never really go off the grid there. It’s very easy to maintain.

Then we have low lectin. Lectins are under the umbrella of antinutrients. We all have our ability to protect ourselves and cope with any kind of danger. Humans can flee, bite, scream, kick, yell, call 911. Plants don’t have that ability, so they have what I call a hard candy shell around that germ or seed. They protect themselves, so they say, “If you are going to try to destroy me, I will stay as whole as possible, so I can survive and procreate,” our two main goals as living organisms. It can be very difficult to break them down. When they get into the system, they cause some inflammation.

We find lectins in nightshades: tomatoes of all kinds, peppers of all kinds except black pepper, eggplants, and potatoes, except for sweet potatoes and yams. Goji berries as well. These are foods that are high in lectins.

I recommend the low lectin plan for anybody who is just getting off AIP. Go low lectin or go Paleo after that. It’s aimed at being anti-inflammatory and good for gut health and decreasing systemic inflammation. Those two main foundational issues I believe are the definition of health: good gut health and no inflammation.

There is vegetarian or vegan. There are different types of vegetarians and vegans. I break this down in the book in detail. I believe that pretty much 60-80% of our plate should be plants, living things that were pulled from the ground or a tree. With vegetarian, there is different types.

I find too many times, people come into my office as a vegetarian or vegan and are on the carbohydrate diet, or carbivores. They are sustaining on bread, pasta, Oreos, French fries, Diet Coke. These are all vegan, but they are not real food. I recommend eating plants and plant proteins, like beans, legumes, nuts, seeds, grains, and vegetables. Watch blood sugars because a lot of people can increase their blood sugars because they are eating so many grains and legumes and carbs.

Dr. Eric:

Thank you for sharing that. I agree with your thoughts about Paleo being more of a wellness diet and lifestyle. That’s also what I follow most of the time.

A few questions. You mentioned that if someone has elevated GGT on the blood test, they probably shouldn’t do a ketogenic diet. Is it the same with if someone has elevated AST, ALT on a comprehensive metabolic panel? Or would that be okay for them to follow?

Risa:

AST and ALT is liver congestion basically. It depends how high it is. If you are confirmed fatty liver, it might be a good idea to do ketogenic. I would follow your labs and make sure that they’re okay. You should start to decrease that fatty liver. Depends what the source is. If it’s alcoholic fatty liver or non-alcoholic. Oftentimes I see it from sugar consumption. In that respect, for sure, keto would be really good for you.

GGT is a measurement of how sticky and gooey your bile is that your gallbladder holds. If your GGT is high, functionally, we like it less than 20. If you’re very elevated there, I wouldn’t recommend doing keto until you get that down. Have some bile salts and some enzymes that will help you break down that bile. You will get sick and not do well on a high fat diet.

Dr. Eric:

What’s the difference between AIP and a low lectin diet? Autoimmune protocol as well as even regular Paleo minimizes the lectin. Is there any difference between them? I imagine there is, or else you wouldn’t have put it in the book.

Risa:

Yes. In low lectin, you can eat eggs. In AIP, you cannot. In low lectin, you can eat specific nuts. In AIP, you cannot. Certain seeds in low lectin. No seeds at all in AIP. In low lectin, it is not recommended that you eat cucumbers, or at least the skin and seeds. In AIP, you are perfectly fine with doing that with cucumbers and squashes. There is a little bit of alcohol and coffee allowed on low lectin, but not on AIP. I sold a bunch of people there, didn’t I? There are certain sugars, like sugar alcohols, that are allowed on low lectin but not on AIP. AIP is really a very strict flushing of any kind of processed foods. The point is to live on plants, animal proteins, good organ meats is encouraged, and a little bit of fruit. In low lectin, it’s really only berries and only in season. Very little fruit. AIP has a little bit of fruit on it.

Dr. Eric:

How long again do you typically have someone follow AIP for?

Risa:

AIP is 30-90 days. If you’re having flare-ups or noticeable symptoms, I would go as long as you can go. If you can get to 90 days, I did that when I first discovered AIP. I had been diagnosed with Hashimoto’s long before that, but I did it. You can see numbers. I work with people all the time who do it, and they see remarkable changes in their flare-ups. I work with somebody who had Tourette’s, and their Tourette’s was dramatically down. The whole point is to decrease that systemic inflammation, just like low lectin. I would do that for 90 days. Then I would either hop on low lectin because it’s going to continue to take out those inflammatory foods, or Paleo.

Dr. Eric:

What advice would you give for someone who has been following a vegetarian diet or is a vegan, and they’re autoimmune? Ideally, they should follow AIP. Would you modify the vegetarian/vegan diet?

Risa:

Great question. This is a tricky situation. I’m working with somebody right now who is vegetarian. I spoke to her yesterday, and she tried eating meat and said, “I just can’t do it.” I got her labs back. Her sugars are just starting to come up. She is now insulin resistant. She has been living on grains and beans and bread. I always urge people to get their bloodwork done, so they can see.

I was vegan myself. Same thing happened. I was just 1/10 of a point shy of being prediabetic. I stopped immediately and brought back in animal protein a little bit. I just think that it’s better for most people to eat that way. I understand that people want to be vegetarian, and I completely support that.

I would say watch the grains. Make sure you’re having millet, which is low lectin, and higher in protein. Quinoa, which is a seed, not a grain, but it’s higher in protein, lower in carbohydrates. A little bit of brown rice, which is higher in protein and fiber. A little bit of legumes. When I was a vegan, there wasn’t a salad or meal that I wasn’t having hummus beans, garbanzo beans, black beans, or lentils. I loved it. It’s a great source of protein. We also get protein from vegetables as well.

It’s important to know where your blood levels are, where your blood sugar is, where your protein levels are. We have to make sure you’re getting the right proteins. Nuts are a great way. Seeds, too. Start to calculate how much protein you’re getting, so you understand.

Dr. Eric:

Makes sense. I briefly brought up a scenario earlier where someone has autoimmunity, like Graves’ or Hashimoto’s, and they have SIBO. In that situation, would you have them follow both diets, AIP and low FODMAP? Would you prioritize one over the other?

Risa:

Another great question. SIBO is something I address immediately. I would do a stool test to make sure there is no H-pylori, which is very common. I would address the SIBO. If you kick that can, it will just get worse. It’s hard for you to heal when you’re in this inflamed state. If you have SIBO, I would do a stool test to determine it. There are SIBO tests we do as well. I treat that.

There are three ways to treat SIBO. One is with an antibiotic, which I don’t know that everybody needs. Severe cases may need that. No matter which way you go, it’s not 100% effective for anything. They are all about 70-80% effective. SIBO is very recurring. You may have to do it again.

I do a supplement protocol with a low FODMAP diet. I keep somebody on that for a good 30-60, maybe even 90 days, depending on how bad they are. The stricter you are at the beginning, the better off you’ll be. You are trying to starve that bacteria. Once you starve it and can kill it with supplements, then you are good to go.

I of course had that because it’s on the list of triggers for autoimmunity. I am always looking for root causes. When I had it, I was pretty one and done. I did it, and it’s never come back. I have tons of patients who will experience recurring SIBO. It depends on how you eat afterwards. It depends on how you live. It’s important to get your stool checked all the time, so you know where you are and where you stand. If you’re bloating, you should absolutely look into that.

Dr. Eric:

I agree. If I am working with someone who has Graves’ and Hashimoto’s, and they have SIBO, I usually tell them to hold off on the AIP and focus on getting rid of the SIBO. I usually try to do the herbs first. There are times when someone will choose the antibiotics. There is that elemental diet, which most people won’t choose to follow, unless they have a severe case. If nothing else works, or if they are just an extreme situation. Even then, they will usually go with the herbs. We take a similar approach.

Risa:

Exactly. No food for 14-21 days is pretty brutal for most.

Dr. Eric:

Agreed. In your book, you mention that you use and recommend reverse osmosis water. You told a story of why you use reverse osmosis water. Can you share that here?

Risa:

People should learn from my mistakes. I moved into this home. We were remodeling it pretty much floor to ceiling. I have this plumber I worked with for a long time, and he was great. I said, “I want the best water filtration system you can find.” I had instant hot because I do tea. When I cook, I always want to drink out of that filter. Then I had my tap water. We did this research, and I was so busy doing all these other things with the house that he said, “I got this great filter.” He put the whole system in and charged me a fortune. I said, “This tastes so good.” I was drinking it. I’m pretty good about tasting chemicals, and it tasted really clean to me. I used this for quite some time.

One day, I thought, Hmm, I wonder if I can just check it and see how many things are in my water. I found a meter on Amazon for like $10 or something. I came home and was so excited. First, I tested the tap water, and it was 498. I said, “Oh, great, good start.” Let’s go to the filtered water. It was 494 or 495. Just shy of that. I went, “What?” I redid it again. Sure enough, it was just a hair below. I was devastated. I couldn’t believe it.

I immediately got on the horn and looked into reverse osmosis. I bought this tank that was not even that expensive. At the time, I probably paid about $200. I had it installed under my sink. It took so much space under that sink, but I said, “Forget it. If it’s good, it’s fine.” It was installed. I tested it, and it was 11 versus 490-something. I was absolutely thrilled. Reverse osmosis is, I think, the best water to drink. That’s what I do. That’s what I recommend.

Filtered water tells us really nothing. It really is just tap water. It just contains a ton of fluoride. 70% of the water that we get in the United States is fluoridated. Fluoride is a halogen that blocks iodine absorption. Not good for a thyroid person. We need our iodine. I wouldn’t recommend chlorine in the water as well, fluoride, bromide. It’s what we get from bread. That was an interesting lesson.

Dr. Eric:

I also use reverse osmosis in my home. Sometimes I actually commonly drink Mountain Valley Springs water. I have a glass bottle as well. Most of the time, it will be the reverse osmosis.

One other thing you mentioned in your book: Sugar is the devil. I’m sure people realize they should avoid sugar. For those who aren’t aware of that, can you talk a little bit about that?

Risa:

First, sugar doesn’t really glean any nutrition. There is no value to it. I have these foods I call food for sport and food for survival. That would be in the food for sport category that we could occasionally have. There is not a bonus. There is no value to it.

Sugar, table sugar or most sugars, even natural sugars, spike our blood sugar levels. We go high, then we go low. This causes a lot of imbalance in the blood sugar. It causes the pancreas to pump out a lot of insulin. It causes the cells to require an influx of a surge of sugar. We want to make sure that those receptors that are on those cells are alive and functioning. We don’t want them impaired, which is what happens when we get insulin resistance.

The other reason I don’t like sugar is it eats up our white blood cells, which are our army, our protector, our immune system. Even a tablespoon of sugar can deplete your white blood cells for about 50% up to five hours. If you’re feeling that tickle in your throat, I wouldn’t recommend sugar at all. You have no way of fighting if you kill your army.

Sugar causes a fatty liver. I was talking about that earlier. Lots of sugar and carbs will cause a fatty liver without a doubt.

Sugar feeds cancer cells. It proliferates cancer cells. It is astonishing to me that in hospitals, when they are giving you chemo, they are giving you Coke, brownies, cookies, chips, bread. They are giving you sugar. There is tons of sugar in hospitals. It should be banned. It makes us unwell.

Sugar makes us fat. Sugar causes that pancreas to pump out insulin and puts it in the cell. If we have excess energy for the cell, then it just parks it in fat cells and fat tissues. This is how we get fat. To lose weight, we want to give the cell less than it needs, so it has no choice but to pull from the storage unit.

Sugar makes us tired. After that spike, we come down, and we are tired. We want a coffee or another cookie or another pick-me-up.

Sugar comes in many forms, not just in a cookie or cake, but it comes in your wine glass, lemonade, big glass of orange juice. Especially if you take the fiber and protein out, you will spike big-time.

I am not a fan of sugar at all. It tastes good. We now have so many other things we can eat that taste sweet and don’t spike our blood sugar levels, cause gastric upset. I am a big fan of allulose. I use that in all my sweeteners and products, like my collagen bars. It really protects your blood sugar levels.

Dr. Eric:

When you speak of blood sugar, some of the testing you mentioned, like insulin, which I also recommend fasting insulin. You also mentioned C-peptide. With insulin, which range do you look for? What would be your optimal range?

Risa:

For fasting insulin?

Dr. Eric:

Yes.

Risa:

Less than 5. 4.9, 4.7. You can even go down to 3.9. Something less than 5.

Dr. Eric:

That’s what I ideally look for as well. What other tests do you recommend in your practice?

Risa:

I do a full comprehensive bio screen for everybody that I work with. I’m looking at all four markers of your blood sugar. I’m looking at all nine markers of your thyroid. I’m looking to see if you have reverse T3, T3 uptake, free totals, antibodies. I’m looking at fatty liver. I’m looking at your GFR, your kidney filtration. I’m looking at GGT, the breakdown of your white blood cells, your eosinophils, your monocytes, your neutrophils, your lymphocytes. I’m looking at your Vitamin D levels of course.

I’m looking at the size of your red blood cell that is your MCB. That will tell me if you are likely to have MTHFR, if you have methylation issues. MTHFR is a gene mutation that I commonly test people for. You should know if you have MTHFR. I have it. Both of my kids have it. 90% of the population has it. It is 100% genetic. It tells us if you are having trouble methylating your B12 and/or your folate. You should know which one you have. Make sure you are taking a methylated B vitamin.

I also look at inflammation markers. How do we know how you are if we don’t look at inflammation markers? I always order a C reactive protein, CRP, cardiovascular inflammation, and general inflammation. I look at homocysteine, which is a methylated marker. If it gets driven high, and it stays high for a long time, we look at dementia, cardiovascular disease, and other things. I am all about looking at systemic inflammation.

Gut health is what I was talking about earlier. I send everybody home with a stool test. I am looking at 84 pathogens. I want to see if there is H-pylori. Are there any pathogens, parasites? Blastocystis hominis is a root cause of Hashimoto’s. If you have these parasites, pathogens in the gut, if you have these autoimmune triggers, let’s kill them. See if we can reverse this autoimmune situation.

Whether it’s fibromyalgia or colitis or anything else, I am looking at gut health. I order a zonulin to see if you have leaky gut. Leaky gut, leaky brain. I am seeing an influx of a lot of Parkinson’s lately. I am seeing a lot of brain deterioration. Leaky gut, I am focusing on big-time.

I look at if you have fat malabsorption, if you are producing your own digestive enzymes, which is your secretory IGA. Your immune system is doing it in your gut. I am looking at all those numbers. How inflamed you are in the intestinal linings. Do you have IBS? Was that just a name your doctor gave because they don’t know what else to say?

I look very comprehensively. When I look at the breakdown of your white blood cells on your blood test, I can see if there is a viral pattern or bacterial pattern. If there is a viral pattern, I will do further testing and see if there is Epstein-Barr virus or Cytomegalovirus. Those are also root causes to immunity. I am always looking at those root causes.

Dr. Eric:

Sounds good. I order a lot of the same tests. I also have the MTHFR polymorphism, the C677T. The way I found out was the elevated homocysteine, which led me to further testing.

Finally, can you discuss some of the supplements you recommend? Maybe expand on the RGN detox. Why you recommend it and how it differs from other detoxes.

Risa:

I love my detox. I have made several. I have tried every one on the market practically. I love this one the best. The reason is because it’s fully doable. You can work, travel, eat. You’re having two shakes a day. They are collagen-based. Collagen is the grout for leaky gut. I am always about protein, fat, and fiber. Then you are eating food. You are eating animal protein, unlimited vegetables, sweet potatoes, yams, good fats. We stay away from a couple of foods. We are not drinking alcohol for 14 days or coffee, hopefully, if you can. If you can’t, bring it down to one cup, and don’t put any cancer-causing chemicals in it. Put full, non-dairy fats. We are taking out dairy. We are removing grains and legumes. You should have plenty to eat, and it’s very good.

People feel amazing. I had two people yesterday on the detox say their body aches went away, just from the detox. It really quells that inflammation. It’s there to support gut health, get the ball rolling, and decrease systemic inflammation. There are a million benefits to it. It’s all good.

That is 14 days. Sometimes I recommend people do it for 28 days if they have fatty liver or just feel good and are thriving on it.

I have a line of supplements that I am picky about. I am picky about what goes into my body, my kids’ bodies, so I make my own. My Vitamin D has Vitamin K in it for absorption. I don’t have any gluten, dairy, soy, sugar, or anything artificial in my supplements at all.

I make these amazing collagen chocolate bars that are sweetened with allulose, so they don’t spike blood sugar levels. They are low carb but packed with protein, fat, and fiber. They are delicious. We all need a little something to eat.

I have a myriad of products to help with gut, blood sugar, inflammation.

I have a Fab 5 that I have everyone who has autoimmune on. That is Vitamin D, my Omega Max, resveratrol quercetin, turmeric max, and glutathione. Glutathione is our master antioxidant. It helps protect us against any oxidative stress. That is anything that wants to come in the body and cause disease. That is the Fab 5 that everybody who is autoimmune should be on.

If there is thyroid, I have some opti-thyroid. I have AI balance for people with general autoimmune. All the products I have are to decrease systemic inflammation, support the body, and increase good gut health.

Dr. Eric:

Wonderful. Thank you so much, Risa. Where can people find out more about you? Of course, your book. I found it on Amazon. What is your website or any other resources?

Risa:

My book FoodFrame is available on Amazon, Barnes & Noble, and Target online. It’s also available on my website, RisaGrouxNutrition.com. You can find me there. You can reach out and set up an appointment. I work with people all over the world. On Instagram, TikTok, Facebook, RisaGrouxNutrition. I have lots of healthy meals and tips. I do lots of videos. Lots about thyroid. You can see all the yummy food I cook and eat and enjoy.

Dr. Eric:

Thank you so much for being here. I appreciate you sharing your wealth of knowledge with us.

Risa:

Thank you so much for having me. It was great to be here.

 

Recently I interviewed Laura Frontiero, as she discussed how to restore mitochondrial health. If you would prefer to listen the interview you can access it by Clicking Here.

Dr. Eric Osansky: With me, I have Laura Frontiero, and we will be chatting about mitochondria. Laura has served thousands of patients as a nurse practitioner over the last 22 years. Her work in the health industry marries both traditional and functional medicine. Laura’s virtual wellness programs help her high-performing clients boost energy, renew mental focus, feel great in their bodies, and be productive again. Her belief is that to create optimal wellness, first, we need to identify and clear the root causes of our health problems, usually toxins, chronic infections, and stress; eliminate inflammation; and restore gut and mitochondrial health. Her signature system helps to reclaim what she calls the energy edge. For each person, it’s a unique journey back to their peak mental, physical, and biological performance. When your body is bio-optimized, and you are operating at your energy edge, you are unstoppable, productive, happy, and fulfilled. Thank you so much for joining us, Laura.

Laura Frontiero: Doesn’t that sound good? Don’t we all want to be happy, fulfilled, and producing at our highest level?

Dr. Eric: It does. I definitely want my body to be bio-optimized.

Laura: Yeah, for sure. Thanks for having me on the show, Eric. It’s fantastic to participate and collaborate with you again.

Dr. Eric: You’re welcome. Again, I look forward to this conversation. Let’s go ahead and start off by sharing your story. Why did you transition from working as a nurse practitioner in the largest HMO in America to specializing in functional medicine?

Laura: That is a story, I’ll tell you. I spent 20 years working in conventional medicine in the clinic setting. A great portion of that time, I actually worked in what we call preventative medicine. It dawned on me many, many years into the process that preventative medicine on the conventional medicine side is not really prevention at all. When you think about what we’re doing in a preventative medicine clinic, we’re doing colon cancer screenings, breast cancer screenings, prostate cancer screenings, and thyroid cancer screenings. We’re screening, but it’s really looking for early disease. One day, it just hit me that this isn’t really prevention. This is early detection. That’s a really huge problem in the Western medicine world. We’re not actually showing people how to prevent early disease.

As I dug in and started learning about functional medicine, I also realized that some of the things we tell people to do in the Western medicine world to prevent disease are actually harming people. For example, we tell people in the Western world to be sure to eat lots of whole grains. We tell people to use artificial sweetener instead of sugar if they’re diabetic. You and I both know, Eric, that lots of whole grains and artificial sweetener are probably not really helping people.

We also tell people to monitor your 10,000 steps. Use a wearable monitor. I have some concerns about that because the level of personal body EMF exposure, there are wearables that you can use that don’t cause problems, but the majority of the people in the Western world don’t know that their wearable could actually be causing problems for their health.

I realized I can better serve people if I just focus on true prevention, true root cause, and truly reducing risk for disease. That is where it came from.

Dr. Eric: How long have you been a nurse practitioner for?

Laura: 22 years.

Dr. Eric: Wow.

Laura: I know. For those watching, you can see I don’t look like I have been a nurse practitioner for 22 years. But there is something to say. I’m going to be 50 this year. Clearly, I know something about preventing aging and taking the best care of your body possible. It’s obvious when you can see my face because I don’t look like I’m old enough to have worked that long in medicine.

Dr. Eric: I never would have guessed you’re about to turn 50. You’re looking great. You are taking awesome care of your mitochondria apparently, which is what we’re about to dive into. Why don’t we talk about mitochondria and explain in simple terms what mitochondria are as well as what they can do to support our health?

Laura: I love this topic. I’d really like to make it easy to understand. Mitochondria are your life force. They are called the powerhouse of your cells because they are responsible for 90% of energy production. We hear that over and over when people talk about mitochondria. I like to break it down even further.

What is this energy production? I like to think of it as we have two types of energy: physical energy and invisible energy. Physical energy is that energy that you experience throughout your day where you hit the mid-afternoon, and you have still got energy to keep going and be productive. Or maybe you don’t have energy, and you feel like you want to take a nap or have a cup of coffee. That is that physical energy, that energy to keep going with. How we notice our brain functioning and how we notice our body feeling.

Then there is something called invisible energy. Your mitochondria are responsible for that, too. That is a higher level of cellular energy. It’s required for everything from gut healing to restoring your immune system. It’s responsible for you being able to digest your food and your liver to be able to detoxify and for your urinary system and kidneys to work. That is the invisible energy that we don’t even know is happening, but we need it. Our mitochondria are supplying that ATP energy.

That is an overview of invisible energy versus the physical energy. This is not scientific; this is my experience of energy and how I help my clients make sense of it. I’m not quoting a research study here or anything. This is a Laura-ism.

The next thing I want to talk about is where mitochondria are at in our body and how they function. The best way I can explain this to you is to really compare mitochondria to houseplants. Let’s have a discussion about houseplants, okay?

Dr. Eric: Sounds good. I wasn’t expecting this, but I like houseplants.

Laura: Let’s talk about a couple of things. Let’s talk about mitochondria and houseplants in terms of location of where they like to live and their living conditions and their function. Those three aspects are really important to mitochondria health. It’s easy to understand it if you think of houseplants.

Before I say that, I should say mitochondria are these tiny, microscopic organelles that live inside of all the cells in our body, excluding red blood cells. They’re even smaller than a cell. In fact, in some cells, you have 10,000 mitochondria. They’re itty bitty and inside the cells. That is a huge concept to understand.

Let’s break it down to houseplants. Location is everything. Houseplants live in a specific spot in your home. Think of them living on a windowsill or sitting on a shelf. They have a spot where they live. That special spot is inside a room. For example, a bathroom or kitchen or bedroom or patio. That room is inside the larger structure of your home. We’ve gone from the most small part where they live to the large structure of the home. Each of those plants that you have in your home, they’re suited for certain rooms. Some plants do better in a moist bathroom. Some plants do better in a bright kitchen. Some do better in a dark bedroom.

Now, let’s explain mitochondria, now that you have that concept in your brain. Similarly, mitochondria live inside the individual cells. Think of that like the windowsill or the shelf in your home. The cells are located in organs, kind of like how the shelf or the windowsill is located in a room in your home. The organs are like the rooms. Think about brain, liver, kidney, heart, all the organs. Those rooms or organs are in the larger structure of your body, which is similar to the home, the house, for the houseplants. Does this make sense, Eric?

Dr. Eric: It makes sense.

Laura: Just like the houseplants that have a certain living condition that they want to be in, like the moist bathroom or the dark bedroom, your mitochondria are the same. They are suited for certain areas of your body. Some mitochondria are specific to brain. Some mitochondria are specific to heart. Others for muscle, others for your digestive tract, and so on. It’s the best analogy I can give you to make sense of these mitochondria.

I said there are three things I was focusing on: location, living conditions, and function. The next thing is living conditions. Given the right living conditions, houseplants will thrive, grow, and even sometimes reproduce. I have these little air plants right now in my kitchen window that are reproducing. They are making baby air plants.

Mitochondria are similar. Given the right conditions, they will thrive, grow, and reproduce. Mitochondria are fragile. If you withhold what they need, they will die, malfunction. That’s no different with houseplants. Some people have a green thumb, and some people kill everything they put in their house because they also need certain things. If you withhold what they need, they will die or look limp and terrible.

The funny thing is that mitochondria and houseplants are so much alike that they both need clean water, they both need sunlight, and they both need nutrition. They are quite similar. We even know through studies that if you speak negatively or talk negatively to your houseplants, it’s more likely to stunt their growth. The same thing goes for mitochondria. If you live in a stressful environment, and you’re stressed all the time, high levels of stress, trauma, that will yield lower mitochondrial function.

That leads us to function, the third point. Houseplants create life-giving oxygen. That’s why we want them in our house in the first place. They help remove toxins from the air. They clean the air. They create oxygen. Mitochondria also create something; it’s called ATP, a unit of energy that is needed for every cellular function in your body. Plus they even assist in the detox pathways. Like houseplants detoxify the air, mitochondria assist in the detox pathways to keep your body flushed of toxins. Then they remove toxins from the body. Very similar. That’s the best, easiest analogy that I can give. I think it’s fun.

Dr. Eric: Mitochondria are not only important for energy, but they are the powerhouses of the cell and important for ATP production. Also, they play a role in reducing one’s toxic load. If you don’t have healthy mitochondria, you could have an increased buildup of toxins. Is that correct?

Laura: It is. People constantly think of mitochondria as being energy producers. There is actually a long list of functions that mitochondria are responsible for in your body. Yes, detoxification and energy production. They’re also really important for calcium homeostasis to promote cell growth and multiplication. They are responsible for cell death, which is really important. Apoptosis is a word you may be familiar with. This is programmed cell death, and this needs to occur to make space for new cells. They are responsible for cleaning out cellular debris. They generate oxidative radicals, or free radicals, and reactive oxygen species. That’s a whole talk, but those reactive oxygen species can be helpful when you have an invader, like a virus or bacteria. Mitochondria support your nervous system function. They help with heat production. They are organs of metabolism. They help the whole body communicate with your immune system as well. Lots of things that your mitochondria do.

Energy production is the one we talk about the most. It’s the one you learn in biology class in high school, the Krebs cycle, when we talk about ATP and the cycle of energy production. That was about the time I tuned out in high school; I found that very boring.

Dr. Eric: Same here. Overall, I like biochemistry, I guess, but the Krebs cycle, I can’t say that it’s something that I’ve kept up with over the years. We had this conversation because I’m in Laura’s upcoming summit, which we’ll chat about later. I was telling her not to ask me about the Krebs cycle because it’s been years since I’ve learned about it. I’m sure some of it will come back to me if I review it, but I try to distance myself from it.

Laura: Totally there with you. I am not a biochemist; I am a nurse practitioner. My superpower is educating people, breaking down complex concepts into easy-to-understand concepts so that you can take action. If I just sit and talk to you about biochemistry, I promise you you’ll tune out.

Dr. Eric: Same with me. I also try to stay away from the biochemistry. Let’s talk about certain health conditions. Mitochondria, as you mentioned, are in pretty much every cell except for red blood cells. Let’s talk about mitochondria and chronic health problems. I know mitochondrial dysfunction can lead to health issues, but I want to hear you discuss this relationship.

Laura: When we have strong mitochondria health, we can avoid chronic health problems. It’s as simple as that. There is a cascade of things that need to occur for mitochondrial damage. There are a few levels. Let’s start at the beginning.

Let’s talk about how we damage mitochondria in the first place. We have to talk about that before we can talk about how we get to chronic disease. Chronic disease is cancer, heart disease, autoimmune conditions. The list is long. There is a lot that goes on between healthy mitochondria to that end point.

The first thing is how we damage our mitochondria. Most of the ways we damage our mitochondria, we have control over. There are a few things we don’t have control over. We don’t have control over the genetics we’re born with. However, we do have control over our epigenetics and whether we turn on or off those genetic switches. We are born with a set of genetics.

We also can’t control aging. Aging is going to occur to us no matter what. Every year, we are a year older. We can influence whether we age in a healthy way or whether we age in a way that is accelerated. Those two things, we really don’t have control over.

Everything else I’m about to list to you, we do have control over. These all affect mitochondrial health. This sets you up for mitochondrial decline: sedentary lifestyle, not eating healthy, poor diet, eating sugar and processed foods, and non-organic food that contains pesticides. Having nutrient deficiencies because you don’t eat a wide range of foods. Having hyperglycemia or high blood sugar levels and blood sugar dysregulation due to the way we eat and types of food we eat.

Chronic stress. Not sleeping. This is a big one. Burning the candle on both ends. Sleep problems and stress kind of go hand in hand.

Then there is this whole category of infections. Everything from viral infections like Epstein-Barr virus, hepatitis, and herpes to bacterial infections, like infections that occur in the gut microbiome or urinary tract—many people have chronic UTIs. Fungus or candida infections. Parasites that are not just in the GI tract, but parasites can be anywhere in your body. They can be anything from visible to the naked eye to protozoa, which you can’t see with the naked eye. They are microscopic and can live anywhere in the body.

There is a category of environmental toxins and industrial toxins. Some of the stuff we get exposed to from industry and things being produced in factories and petroleum and exhaust from planes and cars. Then there is the environmental toxins that we put on ourselves from our body products, our beauty products, our cleaning products for our home. Burning toxic candles in the home and air fresheners.

Another category of problem that I touched on is EMFs, electromagnetic fields. I mentioned it with the wearable devices. Then there is the problem of radiation. Heavy metals. Industrial mold mycotoxins.

All of this leads to chronic inflammation, which is possibly the #1 killer of mitochondria. This chronic inflammatory process in the body. The first step of hurting your mitochondria and going down the chronic disease path is how we damage them.

Once you have damaged mitochondria, the next thing that happens is you start to get into metabolic instability. What that means is you have a lowered energy production. We talked about ATP energy, the Krebs cycle. That’s your energy that your body uses for every cellular function. That starts to decrease. The invisible energy and the physical energy I talked about, we don’t have enough of that for our body processes and to feel good as well.

When we have lower energy production, we also have increased metabolic waste, so the cells are releasing damaging free radicals and waste that needs to be carried away through your detox pathways. You have an increase in oxidative stress. These are concepts you may have talked about with your other guests, and your listeners are probably aware of because you have a high level of highly educated listeners here.

Once you get through that phase of metabolic instability, the downward spiral to chronic disease, you are getting closer to it. You go into what we call metabolic inflexibility. We went from instability to inflexibility. That is the inability to respond to metabolic demand and choose the best fuel source.

Your body uses two types of fuels to make energy: glucose and ketones. Glucose is like using leaded gas in your car. It burns dirty; it makes a lot of exhaust. Ketones are like using super premium unleaded gas in your car, where it burns clean. Like the engine in the car doesn’t suffer, your body doesn’t suffer either. You’re unable when you’re inflexible to choose between what type of fuel to burn, and you just end up burning glucose all the time. You get dysfunctional energy production, poor fatty acid metabolism. This results in chronic protein damage and more increase in oxidative stress. Now, you have created a chronic disease. Those chronic diseases manifest as cardiovascular disease, cancer, Alzheimer’s, Parkinson’s, metabolic syndrome, muscular dystrophy, epilepsy, autoimmune disorders, autism, fibromyalgia, chronic fatigue syndrome, migraines, and on and on. Thyroid disorders, Eric?

Dr. Eric: Most thyroid conditions are autoimmune. Graves’ and Hashimoto’s fall under that category. A lot of what you mention are triggers of Graves’ and Hashimoto’s and autoimmune conditions. You mentioned the impact of certain infections, not only gut infections but stealth infections and environmental toxins, including heavy metals, xenoestrogens. There is a lot of overlap.

Laura: Yes. You see that cascade. It’s really important how we live our life and the choices that we make in our day-to-day. That is going to spiral you and cascade you toward that chronic disease state.

Dr. Eric: Are there tests out there that you recommend to evaluate mitochondria? Or do you go more by symptoms, or just assume everyone has a mitochondrial issue?

Laura: I love not to assume. I love to test. You’ve heard that concept of “test, don’t guess.” Let’s see what’s really happening with your mitochondria. Are they mildly dysfunctional? Are you in full hypermetabolic state, where your mitochondria are lying flat on the ground and not producing energy at all? The way you approach supporting those mitochondria would be different.

The beautiful thing is we can test this through an organic acids test. It’s a simple urine test. It tells us what’s happening in that fancy Krebs cycle, the biochemistry of what’s happening in the body. Eric and I are really good at reading organic acid and Krebs cycle tests but aren’t so great at explaining the biochemistry. This is our superpower, being in this space that we’re in right now.

An organic acids test is incredible. It tells us whether you are efficient at making energy from glucose or fat. It tells us what your metabolism is like and whether those mitochondria are super suffering. An organic acids test is pretty awesome because it also gives us an idea of what nutrient deficiencies you might have and what nutrients you may need to help support mitochondrial function. Everything from B vitamins to magnesium to lipoic acid to CoQ10.

The other test that I really like to do is a toxin test. Look at your toxic burden, mold and mycotoxins, environmental and industrial toxins, everything from pesticides and herbicides to folates and parabens, endocrine-disrupting chemicals. You can also test for heavy metals.

Those are tests that are really supportive in knowing what to do to help you at a foundational level and help you have a starting point so that you’re not willy nilly trying to figure out what to do to help your mitochondria and figure out how severe the problem is. Where are you in that cascade of lifestyle to chronic conditions?

Dr. Eric: Does the testing depend on the person? Maybe not necessarily the organic acids test, but let’s say mycotoxin testing. Do you recommend that to everybody or just if you suspect there might be a mold issue or toxic mold problem?

Laura: Good question. It’s interesting. You would be surprised how many people have mycotoxins affecting their health who don’t think that they have ever been exposed to mycotoxins. If people are resourced and can really afford some investigation into their health, then I do recommend, not right out of the gates, but maybe after we have taken a little bit of binders and opened the internal detox pathways in the body, and your body can start releasing some of those toxins, and we can start seeing them. Then I will often recommend we do a total toxin evaluation that includes everything.

As an example, I didn’t think I had mycotoxins, and I was stunned at what I saw in my own test. If you have any brain fogginess and low energy, that’s a good sign that you should probably include it in your evaluation. Not necessarily right off the bat. It will probably get more bang for your buck if you do it four weeks into taking some binders and doing a little bit of opening those drainage pathways.

Dr. Eric: Makes sense. It’s not just airborne. Of course, that’s probably the major source of mycotoxins, but you can also get them in food, too. If someone is eating grains, corn-

Laura: Grains, corn, coffee. Those are big sources of mycotoxins. I was surprised to see I had those as well. The surprising thing is I also had the type of mold toxins that you get in a wet building. The thing with mycotoxins is once you’re exposed to them, they can be in your body for the next 30-40-50 years. You may not be able to clear them on your own. Probably you won’t. We can’t tell you exactly when you were exposed. Once you start digging into your past, oftentimes you can pinpoint when it happened. I was able to do that. I know exactly when I got exposed once I started thinking about it.

Dr. Eric: Are certain heavy metals more significant than others? Obviously, you want not to have any metals. Do you find that mercury or cadmium or arsenic or lead-

Laura: Heavy metals are a problem. It’s really hard to accurately test for heavy metals in the urine without actually challenging them to come out of the body. If you are going to do heavy metal testing, you want to work with a practitioner who can put you on some supplements to move the metals, or even a prescription medication. It’s a hard thing to do. The beauty is a lot of us who work with detoxing the body, our protocols that remove industrial toxins, mold toxins, the same binders will move metals as well. Even if you don’t see metals on your testing, doesn’t mean they’re not there. Oftentimes, a protocol will also help support removing them. That’s good.

Dr. Eric:Can you discuss how you go about restoring mitochondrial function?

Laura: Yeah. Obviously, you lived into mitochondrial dysfunction. You need to live out of mitochondrial dysfunction. This is not an overnight process; it takes time to restore your health. Definitely give yourself an honor space and time for this.

The first thing you can do is really support your nutrition by eating a nutrient-rich diet and eliminating refined sugar and processed grains and bad fats. By bad fats, we’re talking about vegetable and seed oils. Removing casein, which you find in dairy. Removing gluten. Removing artificial ingredients. Then eating all the things that your body craves and wants, like greens and vegetables and herbs and fruits and nuts, seeds, legumes, and some whole grains. You don’t have to remove all whole grains. If you have autoimmune disorders, you should probably remove all grains. If you are not dealing with autoimmune disorders, you can probably eat some, and you can work with your practitioner to find out what would work best for you.

Incorporating healthy fats like avocadoes, olives, coconut, grass-fed butter and ghee, pasture-raised eggs. Clean proteins, like grass-fed beef, wild-caught fish, wild game, pasture-raised poultry, free of hormones, free of antibiotics. All of that matters when you are choosing your animal proteins. Organ meats by the way are also really healthy for you: liver, kidneys, heart, brain, bones. If that grosses you out, you can always get encapsulated forms of organ meat, which are really nutritious and supportive to mitochondria.

While we are on the topic of food, the way you eat your food, or the timing of eating your food, is also important. If you can tolerate it, some intermittent or extended fasting, you may need to work yourself up to that depending on what your current glucose dysregulation could be. If you are really dysregulated, you may not be able to do intermittent fasting right away.

When you’re fasting, your damaged mitochondria are purged through something called autophagy. Your body removes and gets rid of damaged cells and damaged micro-organelles. This is amazing because damaged debris and accumulated reactive oxygen and nitrogen species are removed from your body. Intermittent fasting, you can start with a short 12-hour window.

The keto diet can be supportive. This is not something I recommend long-term forever, but getting you to become more of a fat burner than a glucose burner could be supported by keto. Work with a practitioner on that.

Moving your body in regular exercise. Studies show that you get a 50-80% increase in mitochondrial capacity when you exercise with interval training. I am not saying it has to be crazy athlete-level training because that would be too much for damaged mitochondria. Work with your practitioner to see what kind of low intensity exercise would work well for you to do in intervals. The high intensity exercise, leave that for the athletes right now. If you have mitochondrial dysfunction, there is no way that high intensity exercise will be helpful to you. It will be more harmful.

Reducing stress. I talked about the link between stress and poor sleep. There is also a huge link with increased inflammation and reducing your immune function. Reducing stress is absolutely critical to healing your body. You’ll hear integrative and functional practitioners talk about this all the time. That was something missing in the Western world when I was working in a Western clinic. We didn’t focus enough on helping people heal from trauma and reduce stressors in their lives.

Sleep is really important. Circadian rhythms. Sleep and sunlight, as I mix these two concepts together. Our sleep cycle is actually dependent on and related to our Circadian rhythm. Sunlight is part of that. It’s really important that we get at least seven hours of sleep a night to support mitochondrial health. Circadian rhythm is supported when you get out into the sun or look at the sun. Get your eyes on the sun first thing in the morning when you wake up. It’s also equally important to see the sun setting at night. Don’t spend your entire waking cycle inside your home. Get outside. It’s really critical to mitochondria function and Circadian rhythm.

Also, in sunlight, you’re making Vitamin D from your skin. You can’t wear sunscreen if you want to go out and make some Vitamin D. It’s important for mitochondrial function. It promotes mitochondrial biogenesis. It increases oxidative capacity. Vitamin D is critical. Sunlight is so healing.

There are a bunch of things we can do, like red light therapy, cold exposure. You have heard of people taking cryotherapy or cold showers or cold baths. That shivering recruits your mitochondria to generate heat. You can do heat exposure. If you go into a sauna, this is a mild stressor signal that triggers cell responses. It creates a beneficial response in the mitochondria.

Then there are nutrients you can use, like supplements. I mentioned a few of them. When we look at the organic acids test, we can tell if you are deficient in CoQ10, L-carnitine, magnesium, alpha lipoic acid. Other things that can help are resveratrol, d-ribose, curcumins, PQQ, a lot of supplements. Work with a practitioner to figure out what supplements would support. I’m sure you have some tricks up your sleeve as well.

Dr. Eric: Did you mention CoQ10? You might have.

Laura: Yes. Absolutely. On the organic acids test, we can see your oxidative stress levels, and that will tell us if you need more CoQ10. We can also see what’s happening in the Krebs cycle. CoQ10 is one of the cofactors there. We can tell if that would support you. It’s probably a simple thing that everyone could do, even without an organic acids test or working with a practitioner. CoQ10 is safe and supportive to your cardiovascular health, mitochondrial health. It’s a good idea.

Dr. Eric: It comes to mind not just because it’s very commonly taken. A lot of people associate CoQ10 with mitochondria, but especially with hyperthyroidism, it’s common for people to take beta blockers. A lot of beta blockers will have a negative effect on CoQ10. Statins as well for those on cholesterol lowering medication. Wanted to bring that up.

Of course, you mentioned food and nutrients. What you mentioned earlier, reducing your toxic load, if you have mycotoxins, clearing those out. Reducing your exposure to EMFs. There are so many things that need to be done. Good news is a lot of things you can do on your own. In some cases, it is a good idea to work with a healthcare practitioner because it could get complex when it comes to things like toxic mold and stealth infections.

Laura: I think it’s really hard for people to go through a true detoxifying process on their own. When I went through my own detox, I actually hired a practitioner to walk me through it, even though I know what I know. You will be held more accountable. You will have somebody to talk to. Your body shifts and changes as you go through detox. If you live on planet Earth in today’s day and age, you have exposure to a level of toxins and chronic low-grade infections. Almost everyone on the planet could benefit from working with a practitioner on some level of detox.

Eric and I are not talking about doing a juice cleanse. That’s not detoxing. You cannot detox your body with food. You can’t. You need to have binders. You need to have support for your organs for phase one and two liver, kidneys, lymphatics, bowels. This is not something you can do with food. It’s a misconception. You can’t actually thoroughly detox. It’s just impossible.

Dr. Eric: Especially in this day and age. Food plays a role, but if you just are relying on food, it’s difficult with the toxic world we live in.

Laura: You know the concept, “Let food be thy medicine?” How many thousands of years ago was that stated? Hippocrates? Did he say it?

Dr. Eric: I believe so.

Laura: This was before the Industrial Revolution. This was before big food, big pharma. This was before the level of stress that we have now. I really like to think of that concept of after you have restored your body to its balanced and healthy level, and after you have learned how to live a clean, healthy life in the 21^st century, once you have accomplished all of that, you remove the chronic smoldering infections, you have reduced inflammation, you have removed the toxins in the body. Once you’re there, let food be thy medicine.

Dr. Eric: Well said. Gut health. The last thing I wanted you to chat about, even if it’s briefly, is why you like to start the process of restoring mitochondria health by first addressing gut health.

Laura: This is a really important concept. In all of my programs, when I work with my clients, we address gut health first and foremost. It is foundational to wellness. If you don’t address gut health, you’re never going to get rid of the smoldering inflammatory fire that is happening in your body. All programs begin in my mind with gut health and detoxification and build from there.

Let’s talk about why gut health is really important. In order for mitochondria to survive and do their job, they need nutrients. We talked about the cofactors and nutrients required to make ATP energy. Primarily, those nutrients come from the food that we eat. It’s simple for people to understand that all food goes to one place first: into your digestive tract, into your gut, where the food is broken down into smaller parts, so your body can utilize the nutrients required to make energy and all body functions.

Here’s the thing: Our body can’t do any of it without the help of your gut microbiome. It’s made up of three main things. You have this community of bacteria that live inside of you. Plus you have the immune and neurological axes that regulate everything and help it communicate with our body. Here is where it all syncs together. Your mitochondria are stimulators of the same immune and neurological systems that interact with your gut microbiome.

Let me give you an example of where things go wrong. If you get food poisoning, you start having communication back and forth between the mitochondria and microbiota, the community of microbes that live in your gut. That regulates the body’s immune system response. Mitochondria, microbiota, are communicating. The body’s immune system is doing its thing. What you have here are two different set of organisms, bacteria and mitochondria, communicating back and forth to keep everything going smooth and healthy.

What goes wrong is you get this infection from food. You get food poisoning. This dysregulates everything, driving inflammation. You have an overgrowth of disease-causing pathogenic bacteria. The cycle of inflammation increases. Inflammation damages the mitochondria, which are supposed to be communicating to the immune system to tell your immune system what to do. Everything goes haywire.

If you don’t start at that really basic level of assessing and supporting gut health, then it’s going to be an uphill battle. It’s kind of like that concept of trying to solve your problem with just food. You’re leaving something big out. You must start with gut health. I know even in your programs, Eric, you focus on gut health when it comes to thyroid. It’s so vital.

Dr. Eric: Agreed. Healthy gut is important for overall health, especially for those with immune system conditions. Graves’, Hashimoto’s, other autoimmune conditions, you need a healthy gut to have a healthy immune system. It’s safe to say that just about every functional medicine practitioner at least pays attention to some extent to the gut. You dive into great detail. You’re definitely a gut expert. I agree. I spend a lot of time as well helping people to optimize their gut microbiome.

Laura: When people come to me and say, “Hey, I’m a high performer. I have a big life to live. I have big goals, big vision, big dream. I want to be present with my family. I want to excel in my business or at work. I want you to fix my energy, Laura. I want energy, and I want brain stamina.” Great. Let’s check your gut. That’s where we start. Let’s look at your gut health. Then we will be successful at building from there.

Way back when I was a nurse practitioner working in the conventional world and working in pseudo prevention, we did not talk about gut health. It did not exist. We did not talk about mitochondria health. We did not talk about toxins in the environment. We did not talk about how to truly nourish your body and solve underlying infections and toxins so that you can restore your health to optimal function. It’s really what it’s all about.

Dr. Eric: Quick question: Do you recommend testing, like a comprehensive stool panel, to your patients as far as evaluating gut health?

Laura: I do. You and I both know that we can do a pretty strong health intake. Really comprehensive. Learn a lot about what people are suffering from based on their symptoms and health history. If you have a gut test, it will tell you a few things about the good bacteria, the bad bacteria, the opportunistic bacteria. It will tell us about inflammatory markers, digestion. The most valuable piece of having a gut test is once the client sees what’s happening in their body in black and white, written out, and they have an explanation of what’s happening, it helps you stay the course. It helps you stay motivated. It helps you with accountability. It’s really nice when six months down the road, a year down the road, if you retest and see that all that effort, all that work you put into it, actually changed something, it really feels good. We want proof that what we’re doing is working.

I could help you heal your gut without ever doing a gut test. There are all kinds of things we can do to support your gut health. It’s knowing what’s happening that can give us little tweaks in your protocol and get you faster results. The most valuable piece is you seeing what’s going on so that you’re motivated, and you keep going.

Dr. Eric: Awesome. I want you to discuss your upcoming summit, the Mitochondrial Matrix Summit.

Laura: Restore your mitochondrial matrix, boost your energy, and fix your health, so you can live the life you love. It all starts from this talk. If we ignore mitochondria, it’s going to be really hard to restore energy levels, fix chronic health problems, and live your most productive and amazing life. When people ask me, “Laura, why did you do a mitochondria summit of all things?” Because it’s so foundational. It’s so critical. We have to support mitochondria health in order for you to reach all those goals.

Dr. Eric: I am one of the speakers, but I am also looking forward to listening to the other speakers. You have a lot of different experts, but this is the first mitochondrial summit I have heard of. Speaking of the gut, you always hear of gut summits and things about environmental toxins, but I think this is going to be a unique summit truly. Check out my talk, but check out as many of the talks as you can. It is a free summit.

Can you discuss other ways people can find out more about you?

Laura: Thank you. I’m really looking forward to your talk. We got deep into thyroid. We talk about hypo and hyperthyroidism and how they relate to mitochondrial health. We talk about simple strategies all coming from the brain of Eric, which is amazing because he is the thyroid guy.

In terms of getting in touch with me, you can find me at LauraFrontiero.com. I’m also on Instagram @Laura.Frontiero. You can find me on Facebook. Occasionally, you can find me on Tik Tok. I gotta get better about being on there. Thanks so much!

Dr. Eric: Thanks, Laura. This was great. I’m sure people will find this to be extremely valuable. Definitely register for Laura’s upcoming summit. Check out her website and social media. Take care!

Laura: You, too.