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.

 

Recently I interviewed Dr. Ritamarie Loscalzo, as she discussed how to address insulin resistance and thyroid hormone resistance. If you would prefer to listen the interview you can access it by Clicking Here.

Dr. Eric:

Although I am always excited to do these interviews, I am especially excited today because I have the honor of interviewing Dr. Ritamarie Loscalzo, as we will be chatting about thyroid and insulin resistance.

Let me give Dr. Ritamarie’s bio: She is the founder of the Institute of Nutritional Endocrinology. She is passionately committed to transforming our current, broken, disease-focused system into a true healthcare system, where every practitioner is skilled at finding the root cause of health challenges, and uses the wisdom of nature combined with modern scientific research to restore balance. Dr. Ritamarie is also a licensed Doctor of Chiropractic with certifications in acupuncture, nutrition, herbal medicine, and HeartMath. She specializes in digestion, thyroid, adrenal, and insulin resistance. I know you didn’t include it in your bio here, but she also has a great deal of knowledge when it comes to genetics.

She is also a master at using palate-pleasing whole fresh food medicine and is a best-selling author, speaker, and internationally recognized nutrition and functional health authority with over 30 years of clinical experience. She also has a podcast called Reinvent Healthcare. This provides health and wellness practitioners around the globe to be part of the movement to provide root cause care to people in need. Thank you so much for joining us, Dr. Ritamarie.

Dr. Ritamarie:                                     

I’m so excited to be here. I love talking about this topic, and I’m honored to be on your podcast.

Dr. Eric:

It’s an honor having you as well. I normally ask my guests to begin by discussing their background. If you could please discuss how you got to where you are today, that’d be great.

Dr. Ritamarie:

Like a lot of people in functional health and wellness, I came through my own journey of illness. In my 20s, my health broke down, and nobody knew what was wrong with me. I went to all kinds of specialists, neurologists, gastroenterologists, ear/nose/throat docs because of the symptoms I was having. I wasn’t getting well.

I asked the fated question one day—I don’t know where it even came from—in the gastroenterologist’s office after they said, “Good news. You don’t have an ulcer.” I asked, “Great. What’s wrong with me? What do I do?” They said, “We don’t know. Just keep taking the ulcer medication.” A little bit of intelligence came up and said, “Huh? What do you mean? I’m 25. I’m supposed to keep taking ulcer medication? I don’t have an ulcer. What am I supposed to do? For the rest of my life?” They said, “Oh, maybe, until you don’t need it anymore.” The question popped up. “Could it be my diet?” They looked at me like I was crazy. They said, “No, of course not. Diet has nothing to do with your health.”

I set out to prove them wrong. This was back in 1984 when we didn’t have summits and podcasts and any of what we have now. People were in the dark about what we just freely talk about, and people get the information now. It wasn’t available then.

Long story short, went and did a lot of research. Discovered toxicity, food allergies, insulin resistance, hypoglycemia, and all kinds of things. Did some things to get myself better, but it took a long time. That’s when I decided to jump ship and leave my computer job, which prepared me eloquently for what I do now because I was a diagnostician. I was helping to fix breakdowns in software on the computer. Now I said, “I just changed the hardware and software,” and now I’m working on the body. That’s where it started. I have been passionate ever since to help people not to have to work so hard to figure it out.

Dr. Eric:

Wonderful. Thanks for sharing that. We’re going to dive into insulin resistance, tie it into thyroid resistance. I don’t know where you want to start. It’s probably best to start with insulin resistance. We can talk about what insulin is. If you want to mention metabolic flexibility as well.

Dr. Ritamarie:

Insulin is a hormone. A lot of people don’t even realize that. The hormones that people think about when we say “hormones” are progesterone, estrogen, testosterone, and a more educated person will say thyroid. Insulin is actually a hormone. Its job is to take the sugar from the food you eat, glucose, and put it into the cells, so the mitochondria in the cells can make energy.

What happens is because of the diet, lifestyle that we live, not me and you, but other people out there, our living is loaded with starches and sugars and processed foods and hydrogenated fats and things that are damaging to the body.

What happens is every cell has receptors, little places that hormones latch onto and get entrance into the cells. The receptors for insulin get damaged and tired and resistant, and they start to want to protect the inside of the cells from that hormone. There is so much of it because we have so much glucose and starch that is converted into glucose coming in. We develop something called insulin resistance. When we develop insulin resistance, all of that sugar stays in the blood. Doesn’t get into the cells. We have hyperglycemia, which eventually can lead to diabetes.

Long, long, long, long, and I emphasize, long, before it becomes diabetes, it’s a problem in the body. It’s a problem because of the damaging effects of insulin. We are going to talk a little bit more about the damaging effects of insulin on thyroid function in a bit.

Getting back to metabolic flexibility and what that is. We’re intended to burn carbohydrates, or we can burn fat as fuel. Most people are eating enough glucose all day long that they just look for glucose. When they are doing that all the time, the body is going, “I can burn glucose. Whoops. There’s no more glucose. I need glucose.” You have food cravings, low energy in between meals, etc.

When somebody is metabolically flexible, it means that they can switch between fat burning and glucose burning. But you can’t be metabolically flexible if you’re eating corn flakes, sugar toast with butter and jelly, that kind of stuff. You just can’t.

Recent research around 2018 was that 88% of the population is metabolically unwell, meaning that whole glucose/insulin/metabolism and the way it’s supposed to work doesn’t work properly. 88%! Think about that. That means 12% of the population is metabolically well and healthy. 12%! That’s tiny. This was pre-pandemic. My guess is it’s a much higher percentage of metabolically unwell people over the last few years.

Metabolic unwellness leads to all sorts of problems: cardiac problems, kidney problems, blood pressure problems, and imbalances in other hormones. Thyroid is a train wreck when insulin is out of balance. We can’t get the thyroid in balance if we continue with the process of too much insulin and insulin resistance. That’s in a nutshell insulin and the whole concept of metabolic health.

Dr. Eric:

It’s more of a cellular problem. Insulin resistance is too much insulin, but it’s not getting into the cell.

Dr. Ritamarie:

This is true of all hormone resistance. People know about insulin resistance.  We have kind of started to hear about leptin resistance. But you can develop resistance to all hormones. The way it manifests is the body shows signs of too little of that hormone, even though in the blood, there is either enough or too much of that hormone. The cells are smart. They know that too much thyroid in a cell causes somebody to be hyperthyroid and all kinds of complications that you talk about a lot.

Same thing with insulin. Too much insulin in the cell can cause lack of elasticity. It actually damages endothelial linings and cells. The body tries to protect itself from it, and it becomes resistant. You can get resistance to hormones by taking too much hormone. We think, Oh, hormones are not like drugs. It’s not like the chemical things that are foreign to the body; it’s natural to the body, so we should be able to take hormones safely. In reality, we have to take just the right amount to fill in what the body isn’t doing. Otherwise, you develop lots of complications of hyper hormone, but you also develop the resistance to that hormone.

Dr. Eric:

What are some of the common causes of insulin resistance? Why do so many people have insulin resistance these days?

Dr. Ritamarie:

Have you looked at what people are eating? That’s one reason. The garbage processed food.

Second is stress. Under stress, we release a lot of another hormone called cortisol. Cortisol is meant to help us run away from hungry animals. A tiger is chasing me, so I need cortisol to run away. One of the mechanisms by which cortisol works is to mobilize stored energy. That could be in the form of fat, protein, or glycogen carbohydrate, and create more sugar in the blood so we can run away from tigers. In that situation, it’s a good mechanism, and we don’t get in trouble unless we slow down and get eaten by the tiger. For the most part, it doesn’t get us in trouble to have that elevated sugar. It actually helps us.

In the day to day, modern life, I don’t know about you, but I haven’t had a tiger chase me recently. I’ve had deadlines chase me. I’ve had lots of anxieties perhaps. I don’t really get anxious, but people have lots of fear and anxiety around our current world: the economics, the crime, all that stuff. That causes that same stress response as if we have a hungry tiger chasing us, except we don’t get to run away from the tiger and burn that energy. It sits in the blood and causes that elevation of the sugar.

What the pancreas does when it sees the sugar so high, and it’s not getting into the cells, is it goes, “We just need more insulin.” It keeps producing more and more insulin. Then the cells become even more insulin resistant.

A lot of it is a modern lifestyle disease. We can change it, and I have seen people completely reverse even type two diabetes within two to three weeks of changing their diet, getting on a good stress regime, sleeping, moving, all the basic foundations of good health. That’s how we can reverse this and prevent it.

There are genetic factors that play in. I have a lot of the genes that predispose me to diabetes, so I have to be a little bit more careful than maybe somebody else who doesn’t have those genes. For the most part, the genes are a little bit of it, and the lifestyle is much more.

Dr. Eric:

Similar with autoimmunity. If someone has the genetics for Graves’ or Hashimoto’s or another autoimmune condition, that doesn’t mean they will necessarily develop the condition. Same thing. If someone has certain genetics, doesn’t mean they will certainly develop insulin resistance.

Dr. Ritamarie:

Just because they don’t have the genetics doesn’t mean they won’t develop it. You can outsmart your genetics with good diet and lifestyle, but you can also defy your good genetics and get diseases if you mistreat the body. It’s like a car. We don’t put jellybeans in the gas tank. “It must be tired because of that high octane fuel. I’m going to try something else.” Doesn’t work that way. Gums up the mechanism. Same here.

Dr. Eric:

I’m glad you expanded beyond diet because diet plays a role, but you mentioned stress and sleep. If someone is only getting four or five hours of sleep consistently, that could also be a factor.

Dr. Ritamarie:

Huge factor.

Dr. Eric:

What testing do you recommend? As you know, most conventional medical doctors just look at a fasting glucose, and that’s what they go off of when it comes to insulin resistance and diabetes.

Dr. Ritamarie:

The fasting glucose is actually the last thing to change. You can have this problem going on for decades. That’s why I said a long, long, long time. You can have it go on for decades because the fasting glucose goes too high. Plus their ranges for fasting glucose are a little too wide and not narrow enough.

The other tests I recommend is insulin. Test your insulin. We can see kids in their teens with hyperinsulinemia. You can tell by some of their behaviors. The point is you can test the insulin. You can test the fasting insulin.

You can test something called hemoglobin A1C. It’s not quite as accurate as it could be sometimes in somebody who is extremely anemic or an intense athlete, but you get a general range. Hemoglobin A1C is how much of your red blood cells are sugar-coated. We all have some percentage of them that are sugar-coated because they’re bathing in this glucose in the serum.

Around 5 is a good amount. A little bit less, a little bit more. The conventional medicine looks at 5.6. By the time somebody gets to a 5.6 in hemoglobin A1C, their average glucose is around 119. As it starts to go up, we are getting all of the complications of diabetes in somebody who has never been diagnosed. I have worked with patients who have had complications that are typically diabetic: diabetic nephropathy, diabetic neuropathy, diabetic retinopathy, but they are not diabetic. Doctors say, “Your glucose is 95. You’re just fine.” They missed the boat. This poor person, because of the swings up and down over the years, make a difference.

I remember one person having that situation. He went and got his A1C checked, and it was 10. More than double what it should have been. No wonder he was having these things. Because of his big, wide variations in swings, by the time he made it to morning, he was okay. It was “normal.” Probably because he was producing so much insulin, and his insulin was high as well, that it got his sugars down when he had the eight-hour sleeping window.

Most of them are not recommending what I recommend: postprandial glucose. You get yourself a little glucose meter, poke your fingers, and see what your meals are doing, what your stress level is doing. What happens when you don’t have a good night’s sleep? What happens when you exercise versus when you don’t? You can see all of this.

I have been talking about these forever. I have been having people test their glucose that was prandial for the last 20 years. But more recently, there is these things called continuous glucose meters. You can actually wear it. I have one underneath. A bright blue patch. It’s got a little filament, not even as thick as an acupuncture needle, that is under the skin. It’s detecting the glucose. You know at any moment what the glucose is. “Oh, I just ate a donut. My glucose is 192. I just had a nice salad with avocado and tomato and lettuce. My glucose is 98. Wow, what a difference.” There are all kinds of ways that people can be empowered to take charge of their own health. I know that’s what you and I are all about.

Dr. Eric:

Definitely. When it comes to the levels, you mentioned with hemoglobin A1C, around 5, so a little bit higher, a little bit lower. If someone is a 5.4/5.5, you’re suggesting-

Dr. Ritamarie:

I’m suggesting let’s get you really taught and educated about how you get it lower, how you get it down to 5/5.1/4.9. It’s an early warning sign.

Dr. Eric:

Are there concerns if it gets too low?

Dr. Ritamarie:

Sure. If it gets too low, probably someone is in a hypoglycemic state most of the time. You talk about hyperglycemia and hypoglycemia. Hypoglycemia is “The blood sugar is low. We have to eat something to bring it up.” Most of the symptoms that people are having when they feel like they are hypoglycemic is actually hyperglycemia. The blood sugar is too high, but it’s not getting into the cells, so the cellular sugar is too low.

If the A1C goes down to 4.5, maybe your average glucose is in the 70s, but that means there may be times where it’s lower. You just have to watch. Is the person symptomatic? What’s happening overnight? What’s happening with their meals? They may just have very tight control. Their body keeps it in a very tight range. We investigate further if it goes too low. You need sugar in your system to get cellular function.

Dr. Eric:

When it comes to insulin, some functional practitioners like to see that fasting insulin below 5. Would you agree with that?

Dr. Ritamarie:

Absolutely. Between 2-5 would be the “ideal” range. Between 2-3 is even more ideal. That’s the range I like to see it. If someone has a fasting insulin between 2-3, it could be perfect, or it could be a sign that they actually have been very high, but they are heading into a pancreatic failure or have antibodies that are attacking their pancreas. I always investigate that. I look at their symptoms. What are the other factors playing in?

If they have a fasting insulin of 1.5, hemoglobin A1C of 5.1, a fasting glucose of 79, they feel good, they have good energy, then it’s perfect.

But if they are complaining of some other things, then I would want to do what’s called a postprandial insulin. I have them eat their highest carbohydrate meal that they typically would eat and then check it to see if the pancreas responds, to see if that insulin level goes up. It shouldn’t go up a lot, but it should respond. If not, it might mean they have some pancreatic failure going on.

Dr. Eric:

How soon after eating would you recommend that?

Dr. Ritamarie:

Usually 45 minutes to an hour. When you look at studies, it shows the insulin and glucose peak right around 45 minutes.

Dr. Eric:

With regular fasting insulin, or even postprandial, I haven’t done postprandial insulin testing, but I do regular insulin testing all the time. Do you get concerned if it’s a 6 or 7, or do you not really get concerned until it’s in double digits?

Dr. Ritamarie:

I get concerned as soon as it’s above 5. When I say “concerned,” that means I’m educating somebody. There is an indication you are producing too much insulin. Here are the downsides of too much insulin. Oh, you have a history of cardiovascular disease? Too much insulin stiffens your blood vessel lining, so you are more prone to have a heart attack if you go to run for the bus because your blood vessels can’t expand. High blood pressure, thyroid resistance, and other cellular hormonal resistance. At that point, I’m investigating, and I’m helping them to bring it down within the 2-5 range.

Dr. Eric:

Thyroid resistance. Let’s talk about how that relates to insulin resistance and also how that presents on a thyroid panel.

Dr. Ritamarie:

It doesn’t present on a thyroid panel. Here’s the deal. It can present as a perfectly normal thyroid panel. Normal TSH, normal T3, T4, free T3, free T4. But the person has clear symptoms of thyroid problems. We go, “Wait a minute.” The typical Western approach is you have constipation, here’s a laxative. If you have depression, here’s an antidepressant. If you have dry skin, put some moisturizer on it. They are not addressing it as a combination. Those are low thyroid symptoms. I always say if it looks like a thyroid problem, and it sounds like a thyroid problem, it’s a thyroid problem. But it’s not with the thyroid itself.

Those numbers look good, yet the person presents with thyroid symptoms. It’s usually because the receptors have become resistant. There are some really common imbalances that affect the thyroid receptors that cause them to underwork.

We have homocysteine. How many people do you test homocysteine? I listened to your podcast episode on your favorite tests. You test homocysteine on people. Elevated homocysteine can damage the thyroid receptors. We’re looking at that. What is elevated homocysteine caused by? Usually a deficiency of Vitamin B6, B12, folate. There are a number of other things that are less important, but those are your majors. We look at that.

Deficiency of Vitamin A can affect the thyroid receptors. If somebody is not getting enough Vitamin A, or they are getting enough Vitamin A in their diet but have a problem with fat digestion and fat-soluble vitamins, those are two very important things.

But the most important one that I think most people suffer from is either excess cortisol or not enough cortisol. In order for those thyroid receptors to work properly, we need the right amount of cortisol. Stress can respond. Cytokines, we all have heard of cytokines over the last few years in terms of cytokine storm. Cytokines are inflammatory mediators in the body. Excess inflammation, excess cytokines damage the thyroid receptors.

Last but not least, our good old friend, insulin. Insulin not only causes receptor resistance for insulin, but it causes receptor resistance for thyroid and other hormones as well.

Dr. Eric:

On a thyroid panel, it might very well be normal, so you can’t always pay attention. In some situations of thyroid hormone resistance, you will actually see thyroid hormone levels look on the higher side. In the case of hyperthyroidism, that would result in depressed TSH, but in the case of thyroid hormone resistance, sometimes you will see it elevated on a thyroid panel. TSH will actually be elevated as well, which shouldn’t be the case when you have too high.

Dr. Ritamarie:

Yes. In fact, that’s why it said it can look normal. There is no classic way it presents. I always tell people when they’re looking to solve their thyroid problems, and I give people a document that shows different kinds of imbalances, if the T4 is low and the T3 is good, or vice versa, what to do, so we can address those imbalances. If you don’t address that there might be thyroid resistance, you can address all those other things that are out of balance, get them in perfect balance, have the panel look perfect, yet there is still a problem. They are still symptomatic. I always say to address that.

Right from the start, assume thyroid resistance. If you’re wrong, great. Check the homocysteine, Vitamin A status. Address the stress levels. Address the insulin. That’s super important.

Yeah, excess of any hormone can cause resistance to that. It’s a clue: When that hormone is high, it’s turning off those receptors.

Dr. Eric:

Thanks for clarifying. As far as fixing the problem, diet, stress management, getting proper sleep, all these diet and lifestyle factors. The homocysteine, which could oftentimes relate to nutrient deficiencies, specifically some of the B vitamins and other nutrient deficiencies like Vitamin A. Trying to address all these imbalances.

Dr. Ritamarie:

Absolutely. What I find, and you may find this in your patients as well, is people want quick fixes because that’s what they have grown accustomed to throughout their lives. If you have a headache, pop Motrin. If you have heartburn, pop some antacids. That’s not the way the body really works. There is no quick fix. We have to address the underlying causes.

We have to look at what’s the gut function like? A lot of thyroid issues, especially the autoimmune, we have some sort of leaky gut usually. Hyperpermeability of the gut lining. We have some inflammation, some dysbiosis. We have to address that.

We have to address all the different stressors on the body, not just the mental and emotional stressors, but heavy metal stress, mold, all kinds of things like that. Chronic low-grade infections that aren’t resolved. There are all sorts of things we need to look at in the big picture.

Dr. Eric:

You’re right. A lot of people will focus on the diet, the stress, and the exercise, but they still might see elevated hemoglobin A1C and/or fasting insulin, but they might have disruption in the gut microbiome. They might have a higher toxin load. They might have stealth infections. Sounds like there are a lot of things that could at least be a contributing factor when it comes to insulin resistance and thyroid resistance issues.

Dr. Ritamarie:

A few years ago, I did an all-day workshop on hormone resistance. Nobody is teaching this. People need to know how to address it.

Dr. Eric:

I know you kind of answered this, but if they have cortisol resistance, they’re thinking cortisol/adrenal stress. But they can’t just block out time for mind/body medicine. They should do that, but if that’s all they do, it’s probably not going to address the cortisol resistance.

Dr. Ritamarie:

We have to do it all. We can’t just pick and choose. The yogis want to do the stress piece. The foodies want to do the food piece. The marathoners want to do the exercise piece. There is such a thing as overexercise, which we can talk about another time. We can’t just address the pieces that we like, that resonate. We have to address all of it. The sleep is huge. I don’t know about you, but people come in and tell me, “I can’t fall asleep. I can’t stay asleep. I can’t sleep more than six hours.” That’s putting a huge stress on the body and the hormone balance.

Dr. Eric:

I definitely agree. Sleep is a priority. You can’t negotiate the sleep.

Dr. Ritamarie:

I tried. That’s when I developed insulin resistance.

Dr. Eric:

Most of us notice a difference, even if it’s not reflecting right away in the blood sugar. Like you said, it can take years for that to develop. But it can affect the body in many other ways.

How about exercise? You mentioned exercise. Everyone is different. Some people listening to this might not be able to engage in certain types of exercise. On average, do you recommend more resistance training, cardio, high intensity interval training (HIIT)?

Dr. Ritamarie:

All of the above. It depends on the person. Ideally, do all of that stuff. But not everybody can. People have injuries in certain parts of their body, and they can’t move that particular area.

For blood sugar balance, the HIIT works really well, burst training, 30 seconds to a minute of all out, rest for 2-3 minutes, and do it again. Or do it throughout the day. You go for a walk, and then you run or climb a hill for 30 seconds to a minute, get your heart rate going, and then continue to walk. Other people do separate times throughout the day, 30-60 seconds of exercise. People find that easy to incorporate.

There is such a thing as overexercising, especially if there has been a lot of stress, and the adrenals have been going. Too much exercise for your constitution right now creates a cortisol release. That cortisol release puts you into stress mode. We have to watch it. If you are someone who says, “I want to exercise,” and you go out and do all out, weights, interval training, and then come back and can’t exercise again for 3-4 days because you’re exhausted. That’s a sign that you overdid it.

The hardest thing is when athletes burn out. They just want to keep doing it, and they can’t. The couch isn’t a bad idea right now. Just walk around the block a couple of times. Keep it light. Keep your heart rate going. Keep the oxygen flowing.

But I find that it’s harder to get people who are avid exercisers, who are burned out, to slow down. That’s even harder than some people who have been couch potatoes and don’t want to start it. But it’s super important to get the right balance of exercise for you.

Dr. Eric:

Agreed. I mentioned in past episodes where I was guilty of overtraining, and I’m pretty sure that was a contributing factor to the development of my Graves’ condition years ago. You don’t want to be a couch potato. You want movement to be a regular part of your daily routine, but you don’t want to overdo it in the gym or at home.

Dr. Ritamarie:

Even at home, there are so many little things you can do. If you have a staircase, running up and down the stairs 2-3 times can get your heart rate up. If you have a knee problem, you won’t do that. Work with your body and the limitations to find things.

There are these little exercise things you can put on the table. They’re like a bicycle. You can put it for your feet, but you can use it for your shoulders. If you have knee problems or hip problems, put it on the table, and you can work your heart rate up by using them as an arm exercise. There are a lot of options.

Dr. Eric:

The last thing I want to briefly chat with you about is intermittent fasting. We chatted a little bit before the recording started, but to remind you that some of the listeners have hyperthyroidism and might be losing a lot of weight. It’s not a perfect fit for everyone. On average, would you say if someone is dealing with insulin resistance, and let’s say they are gaining a lot of weight, is that something you usually address?

Dr. Ritamarie:

Intermittent fasting, I have been talking about it since before it became popular. I have been teaching it since like 2008 in my programs. We didn’t call it intermittent fasting; I don’t remember what we called it.

Meal spacing, let’s space your meals out. No more than three meals a day. 12 hours between the last meal and the first meal, minimally. If you can go longer, great. Finding your fasting window. Some people do great by skipping breakfast and starting to eat later in the afternoon. Some people do horribly with that, but they are really good at eating first thing in the morning, having another meal, and a light dinner. 2-3 meals a day.

Some people are doing one meal a day, but some of the research I have seen on that is it actually backfires. You gorge yourself, and you are putting all of these calories in at one time. I have a continuous blood sugar meter, so I find if I overeat at a meal, even if it’s all low glycemic stuff that I normally would eat, my blood sugar will go up. It’s just too much of a load all at once.

I’m a real big fan of intermittent fasting. I have seen amazing results with it to help people get past the plateaus of weight loss. I’ve seen it work really well for folks who have mitochondrial disruption, so their energy is low. People think, “Oh my god, I can’t not eat to get energy.” Yeah, you can. It can work really well. There is a lot of research to that effect.

It works well for brain stuff. That’s where a lot of the ketogenic diets came from. When you have intermittent fasting, you’re going longer periods of time. You have more of an opportunity to get into a ketogenic state, especially if you do a 16-hour, overnight, or from bedtime to whatever. That will help you to get into a state called autophagy, which helps your body do cleaning out. There are so many benefits to intermittent fasting.

But it’s not for everybody. You do need to be careful if you’re a menstruating woman. Don’t do it the week before your period because it can disrupt your hormones. If you find you start doing it, and your periods stop, it’s probably not the right thing for you. Like everything, it’s not for everyone.

It’s certainly not for someone with hyperthyroidism or who is underweight and has a high metabolic rate even if they’re not hyperthyroid. While everybody else is told to eat two meals a day, space your meals 4-6 hours, I say, “Eat every 2-3 hours,” because otherwise they will just burn away to nothing.

Dr. Eric:

Is there anything I didn’t ask you about insulin resistance or thyroid resistance that I should have asked you? I know there is a lot we could talk about.

Dr. Ritamarie:

There is so much. Here is the thing. If you are working on a thyroid problem, and you are ignoring your blood sugar, you won’t get very far with healing your thyroid. You must address both.

Dr. Eric:

Just a final summary as far as action steps, if someone is looking at their blood test report now and are seeing high A1C and/or fasting insulin, would you say to start with diet, cleaning up, whole healthy food, minimizing refined foods and sugars as a good place to start?

Dr. Ritamarie:

That’s a great place to start. Watch your sleep. Some people don’t sleep, not because they can’t sleep, but because they don’t get to bed. That was my situation. “I have plenty of energy. I can push it. I can stay up.” You do that and get a second wind. Just go to bed.

Make it a point to move your bedtime back so that it’s before midnight at least. Some experts would say by 11. I haven’t done that one yet, so I can’t recommend it yet. I have moved mine back to before midnight.

I’m really focused on getting 7-8, even nine hours of sleep. Some studies show that the closer you get to nine hours, the more rapidly the results and the shifts happen with healing insulin resistance.

Dr. Eric:

I can’t say I’m there yet. I usually strive for 7-8 hours, not that I wouldn’t love to get nine hours. Most nights, it’s 7-8.

Dr. Ritamarie:

Exactly.

Dr. Eric:

How can people find out more about you?

Dr. Ritamarie:

You can find me on Facebook. We post a lot there. It’s @DrRitamarie, I think. Same thing on Instagram. We are reviving our YouTube channel. Same thing. We are starting to do weekly lives and putting more content on there. If you’re a practitioner, we have a new website opening up soon. The URL is INEMethod.com. We have a lot of great resources for practitioners. I can’t wait to share those. My podcast is Reinvent Healthcare. Those are all great ways to reach me.

Dr. Eric:

Definitely check out the podcast. I mentioned I have listened to some of the episodes. Excellent information. Thank you so much. Thanks again for sharing your knowledge with us.

Dr. Ritamarie:

Thank you for having me. It’s my pleasure to do so.

Recently I interviewed Sarah Clark, as she discussed how to overcome infertility. If you would prefer to listen the interview you can access it by Clicking Here.

Dr. Eric Osansky: With me, I have Sarah Clark, and we are going to chat about fertility. When Sarah was 28 years old, she received a diagnosis of premature ovarian failure. She had both of her children through IVF (in vitro fertilization). Years later, she realized the root cause of her infertility was a food sensitivity and later a gut infection.

Sarah is a certified life coach with accreditation from the International Coaches Federation and a health coach with training from the Institute of Integrative Nutrition. She is the author of Fabulously Fertile: Supercharge Your Fertility Naturally. Her fertility coaching program, which includes functional lab testing, supports couples to make diet and lifestyle changes that dramatically improve the chances of a healthy pregnancy and baby. On her Get Pregnant Naturally podcast, she shares with functional medicine and natural fertility solutions, we can eventually reverse infertility. For more information, you can visit her website, FabFertile.com. Thank you so much for joining us, Sarah.

Sarah Clark: Thanks for having me, Eric.

Dr. Eric: You’re welcome. Let’s dive into your background. Let’s talk about how you started helping coaches with infertility.

Sarah: In my early 20s, I had irregular cycles. During my teen years, I had great skin, and all of a sudden, I got acne in my early 20s. I had a weird fungal rash. With irregular cycles and acne, I went to see my conventional medical doctor. They put me on hormonal birth control. That obviously regulated the cycle, but falsely, and helped the acne a little bit, but not a lot.

I’m a big planner, so I had a life plan of getting married at 25 and having kids at 28. I got married at 25. Shortly before I was 28, I knew I needed to get off the pill and figure out what’s going on here. I went off the pill. That is when I had the diagnosis of premature ovarian insufficiency or failure as it was known, which is a loss of function of ovaries before the age of 40. I was told the only way I would ever have children was through donor eggs. I remember the OB-GYN reaching up on her shelf, grabbing the brochure for IVF, and saying, “Here you go.” I was completely shocked, devastated. That wasn’t my plan of how to have my children.

But I didn’t take any time to grieve. I went straight into action. I got on a list for a donor egg. Back then, the donor egg profile came in the mailbox. I waited for the maternal and the paternal info. I got the profile. We were lucky enough on our first transfer to have our daughter. She is about to turn 21.

When I said “donor egg” back then, people didn’t know what that was. Now, we have more couples going through IVF. We have embryo adoption and embryo donation. I had a guest recently who did embryo adoption. She adopted an embryo that was frozen for 13 years. The natural siblings are 13 years to her little children, who are now two and four. Science can do some cool stuff.

We had a couple embryos left over. We wanted the kids close together. I was super stressed about having them close together. I went back in after a year. That first transfer did not work. I went on another list for a separate donor egg. We were lucky enough after three years to have our son. He is about to turn 18. I don’t know where the time has gone.

After I had my daughter, I had nine colds. Every cold turned into a sinus infection. I thought it was a good idea to take tons of antibiotics for all those sinus infections. I had chronic bladder infections, sinus infections, yeast infections, toenail infections, dandruff. My immune system was low. I caught every cold and flu that went by. I still wouldn’t have said I was unhealthy.

I was working in a corporate environment. I was in HR for years. I decided I wanted to bring a life coaching course into HR.When I did that, I had my own personal wakeup call. It’s always health and wellness I have loved. I took a health coaching course. That is when I discovered all these food sensitivities: dairy, gluten, and later, corn. I had gut infections, bacteria, and parasites.

The thing I discovered that took me forever was chronic stress. I actually thought I wasn’t stressed. When I got that diagnosis, I wouldn’t have said I was stressed. I am the kind of person who likes a lot of energy. Let’s go. That was stress all along. I was disconnected from my body. I didn’t discover this until years later.

Now I help people who have been told donor eggs are their only option. Most people have gone through multiple failed IVF cycles. We are helping them get pregnant naturally, or if they go to IVF, they get pregnant with their own eggs.

Dr. Eric: You said that with your daughter, it was successful the first time. With your son, you had to do two rounds?

Sarah: We had embryos left over from my daughter’s donor. That didn’t work. We went on another list for a separate donor. I had to wait for that. Then I had my son. Both times, it was on the first transfer of the fresh embryos, when they used to do fresh transfers. They do fresh and frozen now.

Dr. Eric: Is it common for everything to go okay with the fresh transfer?

Sarah: Usually with IVF, it takes three rounds at a cost of $60,000. The fact that it worked for me on the first fresh transfer, I had my daughter at 31 and my son at 34. The donor eggs were in their late 20s. That may have helped. Many people we see, that’s not the case. It’s been failed cycle after failed cycle.

Dr. Eric: Like you said, even if it does work on the first try, it’s very expensive. Ideally, you want to try to get to the root cause of the problem, so you can hopefully avoid IVF.

Sarah: Exactly.

Dr. Eric: Speaking of causes, can you talk about some of the common reasons why more and more women are dealing with infertility?

Sarah: We are coaching couples, even though we are primarily dealing with low AMH (anti-malaria hormone) or high FSH (follicle stimulating hormone). Typically, people are being told that donor eggs are their only option. 50% of fertility can still be a male factor. Even though males are being told their sperm is fine, they haven’t looked at it through functional reference ranges.

Typically, we are seeing all these missed healing opportunities. Obviously, thyroid issues. We see more hypothyroid issues, Hashimoto’s or subclinical thyroid issues. Especially with the high FSH, we see blood sugar irregularities and insulin resistance. We are seeing a lot of autoimmune disease in conjunction with low AMH and high FSH. Typically, Hashimoto’s and Celiac. They go do IVF and have an autoimmune disease, and no one does anything. No one has targeted changes.

We see food sensitivities, non-Celiac gluten sensitivity, gluten off the charts. People may have gotten gluten-light or 80% gluten-free. If you have a sensitivity, even a crumb will cause reaction in your body.

We see the chronic stress piece. Doesn’t matter how old you are. Whenever you decided you want to expand your family, there is a lot of stress in that when it’s not working. Especially if you have gone through failed IVF, thought that was your solution, spent a lot of time and money in there, and it hasn’t worked, fertility can impact all aspects of your life: your social life, seeing families at church, going out in public and seeing families and children and pregnant bellies. You may lock yourself off from some of your friends and family because it’s too painful. The chronic stress of this.

We see alot of trauma, either childhood trauma or trauma from the infertility diagnosis that needs to be addressed. We believe in a mind/body/spirit approach. We look at the biochemical stuff. It’s important to look at mindset and the spiritual side of it, really believing that the spirit of your baby is waiting for you. It’s ready to come down. Here she is. Many people feel that diagnosis from the reproductive endocrinologist can get embedded in their subconscious. “You will struggle. It’s not going to work. You can only use donor eggs.” People start to believe that. It’s really important to believe that you’re not broken. You’re fertile. You can conceive.

Dr. Eric: It sounds like you take a whole-body approach. You mentioned diet and the importance of gluten. Also stress and past traumas could have a big impact, of course. Sleep. You look at the whole picture.

Sarah: Yeah, sleep, for sure. We see a lot of people with dysregulated sleep. Tired and wired when they wake up. Unable to fall asleep. It could be gut bugs or gut infections. Nutrient deficiencies. We see a lot of sleep in both partners. People have struggled for years and can’t sleep at all. After making the changes, they are able to finally get their eight hours.

Dr. Eric: Let’s talk again about diet. You mentioned gluten, which a lot of people listening to this are familiar with the concerns with gluten and gluten sensitivities. You also mentioned Celiac. Even if you don’t have Celiac, you could have a gluten sensitivity. I’m sure there are some people who say, “How can eating gluten prevent myself from getting pregnant?” Either the impact on the female or male. Can you expand on food sensitivities and talk about the relationship between gut health and infertility?

Sarah: Yeah. A lot of people like me were put on hormonal birth control. That can predispose you to food insensitivities, gut infections, and nutrient imbalances. We see that a lot. With the food sensitivities, if you have a food that you’re eating, and it’s coming in every day, it’s causing inflammation in your body, then your body wants to survive, not procreate. It’s causing all this inflammation.

We have our couples start off with an elimination diet, taking out those top allergens, like dairy, gluten, soy, corn, peanuts, eggs, processed sugar, and alcohol for 10 days. Then we systematically reintroduce over the course of 30. You can really see how each food impacts your body. Most people who come to see us, it’s not a sick population, but they don’t know how unwell they are until they feel amazing. They could have niggling bloating, eczema, post-nasal drip, digestive issues. They don’t know how great they can feel when all those common but not normal complaints go away. The food piece is huge. We see people’s energy and all areas of their life improve by eating the right diet. Taking out those top inflammatory foods, reintroducing them.

We have them tweak it with food sensitivity testing. You may take out foods for 60-90 days. If it’s read on some of the testing, you take it out then. Most of the food, not gluten, you can bring back in, once you’re healing the gut.

We are doing gut testing, looking at the DNA of your stool. We see a lot of people with bacterial infections, fungal infections, multiple parasites. We see H-pylori. You won’t be able to absorb all your nutrients. Passing back and forth to partners. Once you heal the gut and work on gut repair, alot of those food sensitivities you may have, especially if you have leaky gut, your body is mounting that immune response to your favorite foods. People take the food sensitivity test, and lo and behold, you realize you are intolerant toall the foods you are eating on a regular basis. We see that a lot with our clients.

As you heal the gut and eradicate the infections and repair the gut and take out those inflammatory foods, then the body starts to come back alive. We just had someone here who has .02 AMH. She is very young, like 26/27. Within six weeks of working with us, her period is already back, and she hasn’t had it in years. We have had people get pregnant naturally when their AMH is .04. Conventional medicine turns their back on those people.

Dr. Eric: That’s awesome. Do you use the GI Map?

Sarah: Yes.

Dr. Eric: For food sensitivity, you said you start them off with an elimination diet and do food sensitivity testing.

Sarah: Yes, we start the elimination diet protocol that they follow. We use the Vibrant Gut Zoomer depending on where they are in the country.

Dr. Eric: Okay. Before doing these interviews, I always do my research and try to listen to an episode or two of the person guesting on other podcasts. I heard you did Dutch testing as well, yes?

Sarah: Yes. We may do an adrenal test to start with. A lot of times, it’s a type A, busy, ambitious person who in the past, they have done a whole bunch of stuff. Now they are throwing everything at this. Maybe their adrenals are completely fried, and their cortisol is flatlined. It’s important for them to see what is happening with their cortisol levels, so they can pull back and work on self-care.

We do the Dutch adrenal or a full Dutch complete, looking at your sex hormones, which pathways are going down, your melatonin. People in the fertility sphere will read It Starts with the Egg, a popular book by Rebecca Fett. There is some good information in there, but some of it is geared toward IVF. Taking melatonin can be helpful, but let’s figure out why it’s low in the first place. It may be necessary. People aren’t even taking magnesium. We use a Dutch test.

We do genetic testing. We do a female hormone panel. It will give us what’s happening with your blood sugar, your thyroid. It looks at the FSH number and more. Female hormone panel. Then it will tell us specific diet and lifestyle and supplement recommendations to support those genetic SNPs. It’s not just, “Here’s your genes. You’re doomed.” It’s, “We can support those with these targeted steps.”

We also do a blood chemistry view. We do a semen analysis, looking through functional reference ranges. We don’t do all these tests at once. They can be overwhelming. We could do a hair tissue analysis testing. Check to see if there are heavy metals or nutrient imbalances. Those can be helpful, too.

Dr. Eric: Quite comprehensive, it sounds like. As far as the semen analysis, a few questions. Do you require the couple to be present? Do you always also evaluate the male, or do you focus more on the female? How does it work in your practice?

Sarah: We will exclusively coach couples unless they are single by choice. By just coaching women, we are missing the whole other piece of the equation. Even if he doesn’t have any issues with his semen, there could be issues in the relationship. This infertility will impact all other aspects of your life. It will either pull you together or tear you apart.

Even when his semen analysis is fine previously, or they have gone through years of treatment- Typically, they have gone through IVF, so they have had a semen analysis. Sometimes, they have tried naturally for two years, and no one has checked the man’s semen analysis. We work with Legacy, a digital semen analysis at-home testing kit for men. They get their testing done. It will give you the count, DNA fragmentation, fertility, and more. We will look at that through the lens of functional reference ranges. We look at the male’s blood chemistry as well.

He has his own health goals. She will have her own health goals. Then they come together as a couple to discuss them all.

Dr. Eric: I’m guessing you have them both follow maybe not the exact same diet because it depends on the testing, it sounds like. It’s up to the person obviously. You would ask them to both follow a strict diet.

Sarah: Yes.

Dr. Eric: And make other lifestyle changes, too.

Sarah: Yes. If they are living together, cooking together, eating together, we wouldn’t want the woman over here making all her changes, and he is over there eating Big Macs and pizza. No. They are doing this elimination diet together. At the end of it, she will get more tweaking with food sensitivity testing. We will look at his semen analysis and blood to see if that’s necessary for him, if he presents with any kind of fertility issue. He has his own goals.

Sometimes, in the partnership, the woman ends up nagging the man to take his supplements, change his diet, get rid of alcohol and caffeine, but she needs to focus on herself. He will come over when he is ready. That’s why it’s important to have a coach here. We never recommend coaching your partner. It’s disastrous. Focus on yourself. We will coach the male partner. 99% of the guys are ready to make the changes. They are open-minded and ready to go. If they’re not, it’s not a good fit for the program.

Dr. Eric: I’m sure you screen them before, just to make sure they are both on the same page, and you can coach both of them.

Can you talk about environmental toxins in fertility? Obviously, that has been a huge issue overall, over the last few decades. It seems like it’s getting worse as far as our toxic world, the impact that that has.

Sarah: We always ask our couples to check all their products against the Environmental Working Group. You want to get lower than 3. You want to ditch the plastics. You want to slowly move up the personal care. You don’t want to throw it all in the garbage; as each one expires, you would get a new product that is non-toxic. All of these are endocrine disruptors. There are the Dirty Dozen in the EWG.

Make sure that you have filtered water, that you’re not drinking out of a plastic water bottle. All of these things can leach into the body and disrupt the endocrine system. If it’s freaking you out, and you want to go around the house with a garbage bag, we say to slowly do it as each one expires.

I interviewed Dr. Shanna Swan, who wrote the book Count Down. She had a study that just came out talking about how in the last 40 years, male fertility has dropped by 50%. A lot of it is due to some of the environmental toxins, like glyphosate spread on food crops. Make sure you go organic. Stuff that’s in our water, over 85,000 chemicals we’re exposed to. Looking at that stuff is really important as a first step. Go organic. Cheap food is not good. Good food is not cheap. You can do the clean 15 or the dirty dozen. Make sure the dirty dozen foods are organic. The environmental toxin piece is key. Slowly do it.

Dr. Eric: Organic food, filtered water, cleaning products, cosmetics. A lot will be in their own home because once you step outside, there is only so much you can do. Do you recommend air purification systems or supplementation to help the detoxification process?

Sarah: You can get an air filter and do that. Blue light impacts the body, too, from the tablets and screens. We recommend blue light blocking glasses.

From a supplement perspective, we are recommending a whole protocol based on the testing, your health history. We have binders and things to mock up if we see exposure. With detox symptoms, we look at doing rebounding and dry skin brushing. We always recommend a castor oil pack over the liver to help move the sludge out of there. We have some teas, like milk thistle tea

Drink lots of water. Many people come to us, “I am drinking 1-2 glasses of water a day.” Make sure you have a good filter, like a Berkey water filter. A Brita is okay; it’s not our favorite. Get a glass or stainless-steel water bottle to drink out of.

Dr. Eric: I’m not a big fan of Brita, but it’s better than just drinking tap water.

Sarah: People do the fridge or the tap.

Dr. Eric: Fridge is not much different. I would agree with that. Do you ever recommend infrared sauna?

Sarah: Yes, we can recommend that, too. It can be good.

Dr. Eric: Earlier, you said you see mostly hypothyroidism, which is a lot more common than hyperthyroidism, which is what I and a lot of my patients deal with. We also get listeners who have Hashimoto’s. Most people who have hypothyroidism have Hashimoto’s. When you see someone who has lower thyroid hormone levels, and part of the testing is to see if they have Hashimoto’s, if they haven’t been diagnosed, you test for the auto antibodies and maybe recommend for them to see a practitioner with prescribing rights to be on thyroid hormone. How do you handle your hypothyroid patients?

Sarah: 99% of the people we work with, there is something going on with the thyroid. They have been told their TSH is normal, and it’s 3 or 4. Typically in the reproductive endocrinology world, for fertility treatments, they like to have it under 2 or 1.5. They may be taking a T4 supplement, a Synthroid or levothyroxine. Maybe they are already taking that. No one has looked at the full panel or the antibodies.

We are not diagnosing, but we see things out of alignment. The physician on our team is licensed in about 27 states, so she can do a prescription with a consult with her. Practitioners in other states can then get a prescription. Sometimes people are like the idea is to be off the thyroid medication. For us, bioidenticals may be necessary. Thyroid medication may be necessary. It’s also important to do the targeted diet and lifestyle changes with them because medication alone is just a Band-Aid.

We have had people with antibodies at 900 and making these changes come down under 100. People who have Hashimoto’s and are trying to get pregnant before they come to see us with repeat miscarriage, failed IVF cycles, and it hasn’t worked. No one addressed the Hashimoto’s or the high antibodies.

There is lots to do from a thyroid perspective. I do a masterclass and ask the question, “How many people here have a normal TSH?” All these people are struggling with low AMH and high FSH. No one has looked at the full panel, the T3 or T4. There is no due diligence. The doctor can’t run it because of insurance issues and stuff like that. So dig deeper.

Dr. Eric: Sometimes, what we’ll see is they will say it’s normal, and it is normal according to the lab reference range, but it is outside of the optimal range. TSH is maybe 3.8, which is within the lab range, but definitely above optimal. Same thing with the T3 and/or T4. It’s on the lower side but still within the lab range but outside the optimal range.

Sarah: Yeah, that was me. My TSH was 3.5. My hair was falling out. My skin was dry. Everyone is like, “Your thyroid is normal. There’s no problem.” But there was a problem.

Dr. Eric: Before we started the interview, I mentioned that years ago I wrote a blog post on infertility. There are a few statistics. I wish I could say I remember it all, but I have it right here. One of the studies show that the prevalence of infertility was 47% in those with Hashimoto’s and 52.3% in Graves’. Either way, whether you have Graves’ or Hashimoto’s, much higher incidence, prevalence of infertility.

Also, you mentioned the TPO antibodies. I did come across some studies that show that in female infertility, there is a higher prevalence of positive TPO antibodies when compared to controls. A few other studies have shown increased risk of miscarriage with thyroid autoimmunity. There was one more here that showed that during the first trimester, the pregnant woman with autoimmune thyroid conditions carries a significantly increased risk for miscarriage. Actually, even when they had normal thyroid hormone levels, so when they were euthyroid. Obviously, the low thyroid hormone levels are a concern. Or high if you have hyperthyroidism.

Most of the evidence I presented was related to the autoimmunity. Whether you have Graves’ or Hashimoto’s, definitely get the thyroid hormone levels balanced, but you also want to do things to improve the health of the immune system.

Sarah: Going to IVF when you haven’t addressed these things, you’re at a higher risk for miscarriage and the devastating effects of that.

Dr. Eric: If a couple has problems conceiving before looking into IVF, they should seek someone with experience like you. When would you say that IVF is necessary?

Sarah: It’s a very personal choice. IVF can be necessary if there are structural issues. We think most people are fertile, but there are other healing opportunities that haven’t been addressed. IVF is there to push it. If we address the chronic stress, food sensitivities, mindset, all of this is how we get you out of the fight or flight, down to the parasympathetic, reduce inflammation, and get you in that receiving stage. Then you can get pregnant naturally.

IVF can be there. It’s typically in the patience piece. We find more of an average of 12-18 months. We have a six-month program, but then it goes into our monthly piece. It’s 12-18 months before you can get pregnant. People want to push it. It’s a personal choice. Obviously, the older you get, you may feel your window is closing in, so you have to do it. To me, there is never any negative side effects of you working on your health. Either you get pregnant naturally, or IVF will actually work.

Your RE won’t tell you any of this stuff. I heard an RE say the other day, “You should go gluten-free and dairy-free.” That’s good. Some of this stuff is permeating into the conventional side of things. Typically, it’s pushing you over there.

It’s a personal decision. You have to do what feels right for you. They are selling packages of IVF. Buy a three-cycle package. A lot of insurance and egg freezing. There is a Wild West of fertility industry, which is billions. The stuff that’s going on in the world right now, infertility, 1/8 mistakes and 1/8 couples are trying. Most people know someone who is struggling. It’s only going to get worse because of all these environmental toxins and things that are coming at us.

To me, working on your health first, either pregnant naturally or doing IVF, when you’re ready, if necessary, then you can make that decision.

Dr. Eric: Are there a lot of side effects associated with IVF?

Sarah: I have done an episode on that. Some of them can be at higher risk of ovarian cancer and other things from these drugs. There is not a lot of research around some of these things. If you are pushing your body to do something that it’s trying to say, “Hey, I’m not ready right now,” because the reproductive system will be deprioritized, and it wants you to keep walking and moving. You’re pushing it. We don’t really know.

Even with IVF children, both my kids, I didn’t figure any of this out. Both of them have food sensitivities. Both of them have mood imbalances. I didn’t work on my stuff beforehand, so they got that? Maybe. I think so. Epigenetics, they are saying you can pass infertility on to your children. We want it done yesterday is the culture we’re in. Taking the time to prepare your body instead of rushing, it just makes more sense.

Dr. Eric: Yeah, I definitely agree. I also speak with many women who I’m working with on their thyroid conditions or autoimmune thyroid conditions. Many of them want to get pregnant, too. They are at the age. They are telling me, “Can I start trying within three months or six months?” They are putting a timetable on it. I definitely understand.

I agree that you want to try your best to avoid the IVF, but even if you end up doing the IVF, you want to try to do things prior to that to improve your health, not just jump into the IVF. It makes sense that you wouldn’t want to give it just three months or six months. Maybe in some cases, it depends on the person. If six months isn’t enough, 12 months might be the answer for you. It would be a shame for someone listening to give up after six months and get the IVF when they maybe just needed another three to six months.

Sarah: Just to dig a little bit deeper on some of these things. If you have a targeted plan with testing and someone looking at it to see how we can optimize it. Many times, people are finding generalized guidelines of fertility diets and superfoods. These things may work for someone else and not you. If you take a targeted, functional approach, and have a team to help you dig in and work on a lot of these limiting beliefs or dealing with stress, this can be helpful, too.

Dr. Eric: If couples have been struggling with infertility and really want to try to avoid IVF, what are some action steps they could take?

Sarah: If you are ready to go hardcore, do the elimination diet. I have an episode on my podcast about how and why to do the diet. If that’s too hardcore, at least go organic. Really work on the diet piece with your partner together.

Second would be focus on sleep. The most restorative sleep is between 10pm-12am. Go to bed before 10 if you can. Really prioritize sleep. Get the full amount.

Work on your intimacy. It’s not just about baby making; it’s lovemaking. Date nights. There is often a lot of strain on the relationship. Reconnecting with your partner. Don’t put joy on hold until the baby comes. Focus now on what makes you happy.

That whole self-care piece. It’s a buzz word, but it’s important to mother yourself and parent yourself now before your future child comes.

Work on diet, sleep, and dig into that self-care to get yourself out of the fight or flight. If you are feeling panicked, and you feel your eggs are too old, dig into that piece. You are fertile. You are a parent now, the moment you start trying. Dig into that intuition that you know your body better than someone else who may have labeled you with this diagnosis. It’s important to know that and be empowered by that.

Dr. Eric: Wonderful. Is there anything we missed? There is a lot of information on your podcast. Anything else, or did we cover at least the basics?

Sarah: The basics are covered. It is this mindset piece of if you have the diagnosis, you are not the label. To dig deep or get a second opinion. Don’t let the medical gaslighting of you, thinking “I should get my full panel,” and your doctor won’t run it. Know your numbers. Dig deeper. Take charge.

Dr. Eric: Definitely check out Sarah’s podcast, Get Pregnant Naturally, as well as her book Fabulously Fertile. Also, you have a fertility challenge opt-in. The website is FertilityDietFreebie.com.

Sarah: There are summer recipes available there. There is a meal plan and grocery shopping list. It helps you dig your toe into the fertility diet. It takes out those top allergens. There is some awesome food in there. It’s not about you starving.

As the seasons change, if you’re listening to this later on, there will be fall recipes, winter, and spring. Right now, we’re doing summer.

Dr. Eric: Thank you again, Sarah. Appreciate you sharing your experience and knowledge with everyone. Look forward to maybe having you back in the future.

Sarah: Thanks for having me, Eric.

www.ThyroidChallenge2022.com