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Recently I interviewed Dr. Aimee Duffy, as she discussed how to optimize the health of your adrenals. If you would prefer to listen the interview you can access it by Clicking Here.

Dr. Eric Osansky:

With me, I have Dr. Aimee Duffy. We are going to be chatting about the adrenals. I am going to give Dr. Duffy’s bio, and then we will chat about adrenal health, tying it into thyroid health. Dr. Duffy is the #1 bestselling author of Normal Doesn’t Have Side Effects. She is an award-winning speaker of Harvard Club in Boston, CNN, NASDAQ, New York City Bar Association, and the Philadelphia College of Physicians. Dr. Duffy has shared the stage with Martha Stewart, Suzanne Somers, Ice-T, and Dr. Oz. She is a frequent podcast guest and expert guest on ABC, NBC, CBS, and FOX Network TV shows. Thank you so much for joining us, Dr. Duffy.

Dr. Aimee Duffy:

Absolutely. I’m so excited to be here. Thanks.

Dr. Eric:                        

So excited to have you. Why don’t we go ahead and start off by discussing your background? How did you get into functional medicine?

Dr. Aimee:

Sure. I love to tell stories. That’s the best way people like to hear information as well. When I was younger, I absolutely loved babies. They were my favorite thing in the whole world. I had all the Cabbage Patch Kids with all their clothes and accessories. I became a babysitter at the early age of 11. I wasn’t allowed to stay alone with the babies, but I would go over to neighbors’ houses and play with the babies while moms were doing their thing.

Over the course of the next several years, I developed a great relationship with one of the families that I babysat for. They invited me when I was 17, a senior in high school, to be in the delivery room when their next baby was due to be born. That was really my first experience. I had never dealt with anything like that before. I was there. I got to see the whole thing. When that baby came out and was put on Mama’s chest, I thought this is the coolest thing ever. I want to be a doctor and do this. I am going to deliver babies. That was in high school.

I went through college and med school. I became the doctor that delivered babies. Over the course of my years, I have delivered over 1,000 babies. It’s been an amazing experience. What I found though was that when you’re not delivering babies, in that line of care, you’re doing a lot of women’s health and GYN-type stuff.

Early in my career in medical school residency, there was a lot of talk about hormones. The Women’s Health Initiative came out. There was lots of scary information about the concerns associated with hormone replacement. I found myself in these conversations with women. “What should I do about these hormones? Do I need to get off what I’m taking? I feel horrible. You have to fix me.” “Well, we have these hormones, but we’re hearing they have a lot of negative things. My job is to do you no harm, so I don’t know that’s the best option for you.” We didn’t have a good solution for that. Get stuck between a rock and a hard place of having horrible symptoms or risk the negative side effects. I didn’t think that was a good place for anybody to be, myself in trying to help these patients, or them having to make that decision on their own.

I started doing a lot more research and reading about hormone therapies. I came across this idea of bioidentical hormone therapy that I had never heard of in medical school or residency. That was like Alice in Wonderland, where she goes into the tiny door, and it opens up, and it’s this amazing world of beauty and knowledge. Where did this come from? Why aren’t we talking about this more?

When people first think about bioidentical hormones, they are thinking about estrogen, progesterone, and testosterone. Really, this is where we’re rolling into adrenals. Cortisol is a hormone. Thyroid is a hormone. Are there ways we can test, understand what’s going on with a patient, and then evaluate it in a better way to help them get back to normal again? Ultimately, that’s what our goal is.

I started with these patients who were really feeling miserable, whether they were having classic hormone symptoms, but they are also fatigued, they can’t lose weight, their hair is falling out, their libido is horrible, or they’re having painful intercourse. Their gut is a mess. They didn’t even think that was something they needed to talk to the doctor about because they are so used to having gut issues. That is where I started to really find the results: when we could test those patients, see what their issues were, and respond more naturally. That is where my book Normal Doesn’t Have Side Effects comes from.

When we are getting things back to normal in terms of hormone levels, be it the sex hormones or thyroid, people really start to feel better. You don’t have to worry about all those side effects. We are doing it in a more natural way. That’s really what started my process: going through the steps to get to those types of patients. Now, that’s the type of patient that I see in my practice for the most part. That’s where we get started.

Dr. Eric:

Always want to try to address the root cause of the problem, which of course we both do. There is a time and place for hormone therapy as well. Now that we have some of your background, why are the adrenals important to our health?

Dr. Aimee:

If people hear about adrenals, they don’t really know what that means, but there is a lot of chatter in advertisements for supplements about cortisol and stress. I must have high cortisol levels because I’m so stressed out all the time. What I have found over the course of my 15+ years doing this in practice is the adrenals are your stress hormone, but they are also really important for other things, like your immune system. They’re anti-inflammatory.

When we talk about the pandemic that we have been living in, and everyone being so stressed out, their cortisol levels are not normal. That could be affecting their ability to fight off infection and immunity. Not having the appropriate stress response, it starts to mess with your brain. You have to think about what the adrenals are supposed to do in the first place, so you can understand why if they are not working right, what the consequences could be.

When you wake up in the morning, your cortisol levels are high. It’s time to wake up. The sun comes up. You’re ready to go. Over the course of the day, your cortisol levels go down. Let’s imagine that at 1pm, you get chased by a saber-toothed tiger. You would have a fight or flight response. Your cortisol and adrenaline go way up. You’re able to outrun the tiger. Run fast, jump high, lift heavy things. You won’t stop and go to the bathroom and eat a snack. If you sprain your ankle, your body is smart. It doesn’t want to let you feel that pain, so you can keep running. Otherwise, if you stop, you won’t make it. That adrenaline is really important for our survival.

In that scenario, maybe you find a cave. You outrun the tiger. You catch your breath for 20 minutes. You go back to your home, and everything’s fine. You rest a little bit that afternoon, and you go back to normal.

What happens where we are now, fast forwarding from caveman days to here, is we have so much stimulation, starting with setting an alarm clock and turning on lights before the sun comes up in the morning to getting in the car to dealing with your schedule. Especially now with our smart phones, we have constant notifications all the time interrupting us. It may not necessarily be stress although everybody knows what stress is. That stimulation constantly throughout the day. Driving in your car, it’s not relaxing. You have to be on alert all the time. Your cortisol levels are always a little bit higher. You get home and turn lights on. Even though the sun is going down, we are not calming down. We have screens in front of us. We are not sleeping well. We call that “tired and wired” when you’re exhausted throughout the day but are not getting adequate sleep.

What I tend to see more in my practice is low cortisol. We have really used up all the reserves. What the adrenals are supposed to be doing, we have asked them to work so hard over time. We are running a marathon uphill without ever taking any breaks. That starts to lead to what we call adrenal dysfunction. It used to be called adrenal fatigue, and a lot of people understand that. It’s an imbalance in that pattern of high in the morning, low at nighttime. The signals from your brain start getting confusing. The brain is telling you, “I am being chased by a tiger, but you are not responding.” That gets really confusing. When there is really something stressful going on, like you get sick, or you do have an injury, then the signals are all messed up, and you are not able to recover appropriately.

What happens more so indirectly from cortisol dysfunction and adrenal fatigue is that it doesn’t allow us to do the things that we know we need to be doing to maintain our health. When you’re tired all the time, you are less likely to exercise appropriately. You’re not getting adequate sleep when your cortisol levels are cattywampus.

One of the most common symptoms that I see is carbohydrate cravings. You tend to crave salt and sugar because your brain is saying we need energy from somewhere, especially later in the day. We tend to go back and forth between this salty snack, this sweet snack. Margaritas are a favorite because they are both salty and sweet. Then we are frustrated. “I want to eat healthier, but I tend to crave these things.” Then we start rationalizing, “I have a busy day. I’m tired. I am just going to order pizza tonight.” We are not able to get over that hump and do the adequate lifestyle management things that we need to do. These people become overweight.

It starts to affect other hormones. There is definitely a connection between the adrenals and thyroid. There is also a connection between adrenals and progesterone; that’s a big one. Other hormones, too. Everything starts to fast forward. I see women who are going through menopause or feeling menopausal earlier, late 30s, early 40s because their cortisol levels are tanking, and it’s messing up the whole hormone connection there. There is some direct correlation with adrenal dysfunction and health, but it’s more indirectly because it’s not allowing us to maintain healthy habits. We start to get overweight diabetes. We are going to have blood pressure issues. More high cholesterol. It just goes on and on from there.

Dr. Eric:

We mentioned low cortisol. When I dealt with Graves’, I did a salivary test, and that definitely showed my cortisol levels were in the tank. My DHEA was low. I don’t know if you commonly see that, too.

Dr. Aimee:

Absolutely.

Dr. Eric:

For those listening, DHEA is also an adrenal hormone. It sounds like it’s not just emotional stressors, but also you mentioned the importance of diet when it comes to adrenals.

Dr. Aimee:

Right. The other thing that I talk about with adrenals, and I mentioned the stressors from the outside in terms of either work stress, home stress, finances, time management, we have all these stressors. A lot of people are taking care of elderly family members who are sick, and that’s a big stressor on life, those sorts of things. Everybody understands what stress means from the outside.

What a lot of people don’t understand is the stressors that are happening on the inside. That is where we deal with diet and gut. If we are eating and ingesting or being exposed to things that your body looks at as foreign or a threat, so any kind of chemical, all of our standard American die that is full of chemicals right now; medications you might be taking. We can’t control 100% the air we breathe and the water we are drinking. Now our insides are being exposed to these threats. It really sends the exact same signal to your adrenals. The brain is not delineating between that tiger chasing me and I just ate something like gluten. That is a very popular one. I just ate the McDonald’s McMuffin or something like that (I don’t know what it’s called now). If you eat that, your body goes, “What is this thing? It looks like a threat.” It will send all those same signals as if we are being chased by that tiger.

Those internal stressors are affecting your adrenals just as much as the outside stressors. You may not recognize that. People go, “Man, I ate that, and now I don’t feel good.” Maybe they don’t notice it at all, but later, they feel really tired, or they are having some aches and pains in their joints because of the reaction they had to the food they ate earlier that day or in previous days.

When you think about diet, what do I need to do to support my adrenals? There really isn’t an adrenal diet if you want to think about it that way. You need to think about what are the foods I am going to put in my body that are going to help heal and fuel my body and restore it as opposed to the foods that will be a threat? When you are ready to sit down and eat something, you are holding it in your hand, is this going to be fuel and restorative for me, or is it going to cause more stress to my body?

Dr. Eric:

Most people know what foods they should eat and what they shouldn’t eat, to some extent. Some people classify whole wheat pasta as being healthy. Like you said, there is gluten in that. There are other foods people might think of as being healthy. We know refined foods and sugars are not good for us. Unhealthy oils, like canola oil and seed oils like sunflower seed oil and peanut oil. Definitely agree most functional practitioners (hopefully all…) agree that people should be eating whole healthy foods, plenty of vegetables, and avoiding those refined sugars, unhealthy oils. There is no specific adrenal diet. There are books on adrenals that talk about diet. Everybody is different.

You mentioned adrenals can have an effect on thyroid health as well as the sex hormones, especially progesterone. Can you get deeper into how that has an impact?

Dr. Aimee:

In both scenarios, there are different things that happen. Sometimes it’s hard as practitioners even to figure out which one is driving the bus. People come to see me all the time,” I was diagnosed with hyperthyroid. I am on Synthroid. Maybe I felt better for the first month, or never really felt better although they told me my labs were better, but I still have all these symptoms.” Ok, what’s going on there?

For me, that’s a great place to look at other things, like hormones and adrenal function. Even though their labs say their thyroid levels are okay, they still have all the same symptoms. There is definitely a communication between the adrenals and the thyroid. It’s not really easily defined in my opinion as a direct, if you have low cortisol, you will have hypothyroid. It doesn’t always work that way.

I’m sure you’ve talked about this in your podcast before, but to take the inactive thyroid hormone and convert it to the active thyroid hormone. There is an ability to take the inactive thyroid hormone, which we call T4, and convert it to active thyroid hormone, which is T3, that hits your receptors and does the work. It takes an appropriate amount of cortisol to do that. There is a lot of other factors that go into that. It’s not a direct thing. If you don’t have enough cortisol, if your body is under stress, it won’t be able to make that conversion. In your blood work, your thyroid may look okay, but if your thyroid hormone is not getting to your tissues, then you won’t feel the response to those symptoms. There is definitely a connection there between adrenal and thyroid.

In the hormone section, if you look at the steroid hormone pathway, they all start with cholesterol. There are different signals that move it down. This is biochemistry 101 that I was awful in in medical school. Now I use it every day, which is crazy. You have progesterone. Right below that, you have cortisol.

What I typically see in my practice is women who are pre-menopausal, so they are under 50. Let’s just make it easy that way. If they start to have hormone-related symptoms, like night sweats, more irritability, irregular periods, weight issues, “Something is up with my hormones. Can I be in menopause already? It’s too early.” They’re 41. Usually, what happens is it’s the adrenal dysfunction, the low cortisol that starts to pull progesterone down because our body’s #1 job is to keep us alive. We are all about survival first. If you can’t run from that tiger, then you won’t make it. It doesn’t matter if you have the progesterone there to procreate because progesterone is important for helping you ovulate and prepare the uterine lining for baby and pregnancy. That’s where libido comes from, too. If your cortisol levels are low, it starts to pull your progesterone down, and you start to have hormone-related symptoms. That is really coming from the adrenal dysfunction.

In other women, we see them when they are 53/55, and they are like, “Man, I was feeling great until I hit menopause. Boom, all these symptoms showed up.” That is probably more the hormone changes that turned around and affected their cortisol levels. You can see it in two different places, but there is definitely a connection between those hormones.

One of my favorite things to talk about, and I’m going off on a tangent a little bit, is the connection between thyroid issues and estrogen. In post-menopausal women, why do women get thyroid disease more than men? It’s more rare in men. Oftentimes, we are seeing it in this older group. I have heard patients tell me all the time, “My doctor told me it’s normal for women to have low thyroid. They put me on my medicine. They didn’t talk about why or where that’s coming from.”

Estrogen is really important to help regulate the little protein called thyroid hormone binding globulin that carries the thyroid hormone around in your blood and delivers it to where it’s supposed to go. If you have low estrogen, it’s counterintuitive, but it increases that thyroid hormone binding globulin. It increases the carrier. All your thyroid hormone gets stuck to that, and it’s stuck to this protein and not being delivered to the tissues.

When women start to go through menopause, and their estrogen levels go down, they have less available thyroid hormone. Even if maybe their thyroid is actually producing what it’s supposed to produce, it’s not getting to where it needs to go. When people are frustrated, “I still have thyroid symptoms even though I’m taking this medication every day. Do I need a higher dose?” you need to look at that bigger picture and think, “Are we out of balance from a hormone perspective, whether it’s progesterone or estrogen affecting the thyroid and adrenals?” They all communicate together beautifully.

That’s why I love doing saliva testing. You get a really nice picture of what your cortisol levels are, estrogen, progesterone, DHEA, testosterone. It’s like putting music notes on a page. You can see how they all dance and work together and start to create a better balance there. Of course, thyroid normally is tested in blood. We don’t do saliva testing for thyroid. But you have that side by side. You can start to see the connection there in how all the hormones work together. In my opinion, you really can’t put blinders on and say we are going to deal with your thyroid and not look at the other parts of that hormone cascade picture.

Dr. Eric:

Just to repeat what you said: If you have low estrogen, that will increase the thyroid binding globulin. You will have less free thyroid hormones in the bloodstream. You need healthy adrenals to have healthy estrogen. If you have low adrenals, it’s common to see low estrogen and low progesterone. Like you said, there is an interrelationship, but that is where the adrenals tie in as well. There are other things that relate to having healthy estrogen levels as well. I’m glad you brought up that thyroid/estrogen relationship. Thank you for doing that.

A couple of questions I have. How about high cortisol? You see mostly low cortisol, but I’m sure you see some high cortisol. I know I do when I do saliva testing for example. Obviously, with an acute stress situation, we’ll see cortisol rise. But then there is that middle stage. I’m sure you’re familiar with the three stages of adrenals.

Dr. Aimee:

Definitely. I can see some high cortisol. Because I see so many people with cortisol levels that are low, I’m not saying that you can’t have high cortisol, but I’m usually questioning my interpreting of that. There is some triage there. What was going on that day? Did you have any surgery lately? Have you been on any kind of steroids? Do you do a Flonase for allergies every day? It’s so rare to see high cortisol that I want to make sure that’s actually real. Sometimes I will repeat the test again because if it doesn’t fit their clinical picture, that may not make sense.

The reason it’s so important to connect those two and determine if it’s real is our treatment approach is very different. They may have similar symptoms. For people with high cortisol, they are going 120 miles an hour, so they will be tired from that. They may still have fatigue and difficulty sleeping and things like that. You want to be able to make sure that is really what is going on because our treatment for high cortisol is going to be more telling the brain, “I’m not being chased by that tiger.” We use more calming herbs. L-theanine is a great one for that. Things that will help your brain turn off. My goal there is definitely supporting a symptom, but it’s more trying as much as we can to prevent them from getting worse and going into that low cortisol/adrenal fatigue stage.

Just like I made the connection from low cortisol, you need cortisol. Too much cortisol is also not good. It overwhelms the system. You will still probably see some dysfunction from a thyroid perspective as well. Again, it’s not a direct, if somebody has high cortisol, they will have high thyroid. If they have low cortisol, they have low thyroid. But they do talk to each other and connect.

Dr. Eric:

I agree with you in that if cortisol is very high, it’s a good idea to ask the patient on that day of collection if anything crazy was going on. I remember once, I had a specific patient, where their morning cortisol looked good, but in the afternoon, there was a spike. The last two cortisol levels on the saliva test looked okay. I asked her if anything was going on that day. She said she was studying for a test around lunchtime, which coincided with the saliva sample she took around that time. That makes sense.

Dr. Aimee:

I had a story like that real early on. When you’re first learning about this stuff, you have to learn from somebody else. I would do all these saliva tests and call the lab to ask about this particular person. It took some time to learn it. This person, I remember it was the same thing. It was a 2pm spike or something like that. Everything else looked normal or what I expected. After several questions and conversations, I found out that she was putting some sort of steroid spray or cream on her dog every day. It was that time of day. “I always put it on at lunchtime.” She didn’t connect that when she is putting this steroid cream on her dog, that would affect her saliva test. Once we figured that out, we did it the right way without exposure to that, and it came out okay.

The other thing that’s really important, and we should do this with all of our tests, is if the clinical picture doesn’t fit with what you expect the pattern to be, then that’s another reason for questioning. Again, I’m expecting somebody, when they fill out their intake form, or we’re having conversations, that their adrenals are going to be tanked. Then it’s not. Whether it’s high or even when cortisol is normal or appears normal, the way they are describing their symptoms, I would have expected them to be flatlined. Even then, I might say, “Tell me about that day. Was it a super stressful day?” In some patients, their norm may be really low, but the stress of that day increases their cortisol enough to make it go into the normal range.

That becomes the art of this medicine: Even though this test looks normal, this doesn’t fit the clinical picture. That happens in thyroid, too. This person has every single symptom of thyroid dysfunction, yet their thyroid levels look totally normal. That’s a little bit different. It’s not a direct relationship to what was going on that day, but it makes you start thinking, what else is creating those symptoms or the inability of the thyroid hormone to get where it needs to go? That should prompt you to look more directly into adrenals and gut health, too. If your gut is not happy, then you’re not absorbing that thyroid hormone that you’re popping into your mouth every day, and it’s not doing its job.

Dr. Eric:

Good point. You want to look at the whole picture and take into consideration the test. That’s also why we do a health history to get other information. Sometimes we need to dig deeper. Maybe do a comprehensive stool panel or other tests. Thanks for pointing that out.

Getting back to the adrenal testing. You do saliva testing. I’ve done saliva testing for years. Why do you do saliva testing over blood tests? I know the answer to that, but for those listening who figure, “Why can’t I just go to a LabCorp or Quest or somewhere else and get a morning cortisol?”

Dr. Aimee:

Specific to adrenals, there are two parts to that question. The first part is we talk about an adrenal pattern. I mentioned it earlier, but your cortisol goes high in the morning when the sun comes up. Over the course of the day, they go down. The sun goes down, and it’s helpful. I see a lot of patients where their morning cortisol may be pretty normal, but by the time they get to noon, they’re tanked. It’s bedtime for them. That’s why they’re complaining of all this afternoon fatigue. “I can’t stay awake at my desk. My kids drive me crazy when they get home at 5pm. I’m trying to make dinner, and they’re screaming. I feel crazy. I think I need some antidepressant or antianxiety medication” when their cortisol levels are low.

If all you do is go into a lab and get a one-time cortisol test, that’s not giving you an adequate picture of what the whole day looks like. Especially if someone is having trouble sleeping, it’s very common to see a little rise in cortisol at nighttime as you are getting ready for bed. If they are not sleeping well, rather than, again, us going down the traditional path of needing Ambien or some other prescriptive medication for sleep, if we see that their cortisol level is going up, there are certain supplements we can do to help stop that. You can get better sleep.

It’s really important in my opinion to get that full four cortisol test throughout the day to adequately see what that pattern looks like. That is step #1.

Step #2, sort of what I mentioned earlier about the stress. Let me go backwards for a second. Ideally, we want to collect the cortisol sample 30 minutes after you wake up. That’s when it should be at its peak. There are plenty of studies that show us that your peak cortisol level is going to be 30 minutes after you wake up and are ready to get out of bed. Imagine trying to wake up, get dressed, get in the car, find LabCorp, get a needle stuck in your arm, and have that test all done in 30 minutes. That’s unrealistic, but that will also be stressful. You will end up with a high or even a normal morning cortisol level that then doesn’t tell us the actual clinical picture of what’s happening throughout your day.

That’s my interpretation of why I do saliva testing for cortisol specifically. Yes, you can measure cortisol through blood. It’s accurate from the perspective of what your cortisol level is in your blood at that moment. But it’s not accurate of your personal clinical picture of what’s going on with you.

Dr. Eric:

The only way to look at the Circadian rhythm of cortisol is the saliva test or the dried urine test. I don’t know if you use Dutch testing in your practice.

Dr. Aimee:

I have a little bit. I like the saliva test better, but I do find the Dutch test helpful. That’s one of those things when you are starting to troubleshoot, and that clinical picture doesn’t fit. I have had times, and this can be a little bit confusing. This gets advanced. When somebody’s cortisol level is really low, so I’m treating them as such. I’m giving them lots of cortisol herbs or even hydrocortisone. That’s another conversation we can have. They are responding as if their cortisol level was high. They are saying, “This is really stimulating me. I can’t take this.” It’s not doing what we expect it to do.

There is a phenomenon where people make cortisol and get through it really fast. It doesn’t show up as readily in the saliva test because it’s already gone. The Dutch test, doing a urine analysis, gives us the cortisol metabolites that have been through. There are some cases where you can have low cortisol on a saliva test, but it will appear high in the Dutch test. That is somebody who actually has high cortisol; they are just super fast metabolizers and getting rid of it quickly. That’s rare. I have heard of that at conferences and things. I have had probably less than a handful of patients who fit that picture. That’s where I have found Dutch testing to be helpful.

Dr. Eric:

As far as the metabolism itself, those metabolites, it’s very common with hyperthyroidism, which a lot of people listening to this have. You prefer saliva testing, and you also use saliva testing for the hormones, too. You don’t test hormones in the blood, like progesterone or estradiol?

Dr. Aimee:

What I have learned and trained in my saliva testing courses, which I now teach to other providers, there are a few parts to that. One of the parts is hormone levels change throughout the day. That has been tested in bloodwork. I have seen the studies several times, where they took two women and tested their estrogen levels every 10 minutes. It looks like an EKG machine. It’s all over the place. Collecting four samples throughout the day, taking a pooled sample and getting one number that is more accurate of what your overall day hormone levels look like, especially if you are on hormone replacement.

Whatever your hormone replacement regimen is, you want to catch a nice balance. What does the average look like rather than a one-time blood test in the morning, and you took your hormone replacement that morning before you showed up? That level will be high. Or vice versa. If you took it yesterday, and now is a sample where it might be low, so that’s confusing. Having that test throughout the day can give us a nice average level. I do like doing saliva testing for that. It’s not impossible, but it is quite difficult to be able to go to a lab four times a day and get those tests done and then average those numbers. That’s not realistic. That helps.

The second part is we talked about thyroid hormone binding globulin, which is a protein that the thyroid hormone sticks to. You have the same kind of protein for your other hormones as well. Hormones don’t usually just hang out in the bloodstream. They have to be attached to those proteins, which carry them to the receptor sites on the tissues, whether that’s your hair, skin, breast, ovaries, etc. Blood testing misses those hormones that are stuck to that protein, so you don’t get accurate levels of what hormone is actually being presented and what the tissues are being exposed to. Oftentimes, in the bloodstream, you are getting the leftovers. It wouldn’t be unusual for it to be low. That could be inaccurate. By the time it’s high in bloodwork, then it’s really high in the rest of your body. That is going to cause side effects and things we don’t want to deal with. I find saliva testing to be more accurate in terms of actual physiologic. Where are these hormones going? What is your body being exposed to?

Dr. Eric:

If someone is cycling, do you have them do one of those cycling saliva panels?

Dr. Aimee:

We can get into a topic of irregular cycles. If they can test somewhere between 18-21 days, which is basically a week before their period is supposed to start, that is when the progesterone level is going to be at its peak. After you ovulate, progesterone levels start to go up. If you get pregnant, it will keep going up. If you’re not pregnant, it starts to go back down again.

18-20 is when it should be at its peak. If somebody is low then, then it’s very likely they will be low the rest of the time, too. That is where we are focused for progesterone in particular. Estrogen does change. It peaks a little bit earlier, but we can have a nice level of what we expect it to be during that time as well.

When somebody is cycling, estrogen is probably not the issue because they are cycling, which means they still have adequate levels of estrogen. It’s looking at progesterone and the balance in their cortisol levels. I haven’t found it to be helpful. I did it in the beginning when I was first learning. There are some labs that have you do eight days throughout your cycle or 11 days. That’s just a pain in the butt for the patient to do, and it’s not very exciting for me to interpret all of those numbers and results. I try to simplify things with getting the best information. That’s what I have found to work really well. Do that test about a week before their period is supposed to start.

Dr. Eric:

Let’s talk about treatment. I know you mentioned high cortisol, you don’t see a lot of those cases, but you mentioned L-theanine. When it comes to low cortisol, you mentioned hydrocortisone. Some practitioners will give licorice root or adrenal glandulars. What approach do you take? Does it vary depending on the person?

Dr. Aimee:

Absolutely, it varies, depending on what their levels are. I have various adrenal supplements. There are so many out there that can be overwhelming and hard for me to choose sometimes. Either I have another practitioner who says, “This is working really well for me,” or a little bit of trial and error.

As a physician and a mom of four, my cortisol levels were not very good for a long time. I have tried every single adrenal supplement out there. Even treated myself for a couple years with hydrocortisone. I have personal experience on that level as well.

I have adrenal supplements that I call mild, medium, and hot. Kind of like salsas. If you have that cortisol pattern that is a rollercoaster, you may be high, then low, then high, then low. It’s hard. Do I give them a more stimulating adrenal supplement or a shut down the adrenal supplement?

There are some supplements out there that are more adaptogenic. More mild, let’s just try to balance things out a little bit. That’s where coming to the brain, having some L-theanine or something calming that way can be helpful.

The medium one is that cortisol is okay in the morning but tanks later in the day. I call that the Gatorade of the adrenals. Those herbs we commonly see, like ashwagandha rhodiola. We see some other herbs there. Lots of B vitamins. The P5P.

The hot one is in addition to some of those herbs, we add some adrenal glandulars to that. There is a lot of supplements that have mixtures of adrenal glandulars as well as other herbs. Siberian ginseng is found in a lot of those supplements to get the brain working a little bit.

I play around with those. Which one depending on which the patient’s symptoms are in terms of what sort of support we can give to the adrenals. Hydrocortisone, I have used a lot in my practice. I think it’s a great tool, especially for that flatlined person.

Let me go backwards for a second. Remember when I said earlier that when you are sprinting this marathon uphill all the time, that is wearing out your adrenals. We can give you Gatorade throughout that process so you can keep sprinting. Ultimately, one of our goals in long-term treatment of adrenal dysfunction is to lower the slope. We have to start working on that stress. We have to make that hill less steep. That comes from working on outside stressors. I can’t manage your stress for you. I can’t go to your job and help you figure that out. What are some things we can do with meditation and breathing and getting you back into parasympathetic mode? There is a lot of conversation we have about that.

Also, those internal stressors. That will go back to the dietary stuff. Let’s start eating to minimize that stress on the side.

Treatment of adrenals is not just pop that new supplement, and you will feel like a million bucks. Ultimately, that is what I started doing. I had great results with that. Patients would come back six months or a year later and wonder how long they have to be on these adrenal things. It felt good at the beginning, but some of those symptoms are coming back. This should be a magic pill. If you don’t support the adrenals to heal, then those supplements are just the Gatorade that is keeping you going on that hill.

Now, hydrocortisone fits very nicely in that when somebody is literally, “I cannot get out of bed. You’re telling me that I need to eat healthy. I can’t even process that. I can’t even think about going to the grocery store. I don’t care about eating. I don’t even eat anything, and I’m still overweight. Everyone thinks I should be a skinny mini because I hardly eat. I can’t sleep. I can’t do anything. My brain is a mess.” You see a flatline cortisol. We may need to use hydrocortisone for a while. That could be anywhere from three months to two years in some patients until they can really start to recover. If they aren’t in a place where they are going to be able to do the things they need to do to start healing, we have to get them feeling better.

Hydrocortisone is bioidentical cortisol. We use it in physiologic dosing, which means that your own body normally, in a perfect world, makes about 30mg of cortisol a day. I might start with 5-10mg in the morning and another 5mg in the afternoon trying to create that normal high and low curve. It just supports the process. Then they are starting to feel better. It takes them about a week or so to notice it. It’s not like you’re popping an Adderall and running around cleaning out closets. It’s not stimulating. But they start to notice they’re less tired, and they need less of a nap or didn’t need a nap at all today. They are going through the motions of regular life.

Now we can start introducing the supplements to support the adrenals to do their job. If the brain is not sending the signal, those supplements won’t do anything. You have to get the brain back.

I tell them hydrocortisone will do three things. Help you feel better and control some of those symptoms. Let your adrenals rest a little bit. Here they are on this hamster wheel trying to run this marathon of life, and they never get a break. We have to let them rest. We are not suppressing them. That’s what prednisone does. Hydrocortisone is let’s stay on this hike, but I will carry your backpack for you for a while, so you don’t have to work so hard.

The third thing it does is it resets the brain to say, “This is what’s normal.” High cortisol in the morning. Low at night. We will do that over and over every day for 30 days, 60 days. When you take it away, the brain is like, “I need cortisol.” Send the signal. Your adrenals have rested. You have some Gatorade in there. Now everything starts to work the way it’s supposed to.

Dr. Eric:

If you were to give a summary or action steps people can take if they feel like they are experiencing problems with adrenals. You can’t always go by symptoms. Can you give them some action steps? I’m sure there are things they can do on their own with stress management and diet.

Dr. Aimee:

What I have experienced is the more knowledge people have, the more they will have power to support their own health. They will be empowered as opposed to depending on others. Of course, you might need to depend on a doctor like me or you to help you get started in that path.

Yes, there are steps you can take on your own. If you think you have adrenal fatigue, look at a list of symptoms. It’s very easy to Google this. If you look up the symptoms that you have, and it feels like adrenal fatigue, you can look at some of those supplements and say, “Maybe I need some Gatorade.” They won’t hurt you. They are pretty safe supplements to take for the most part. If our goal is to get you to feel normal again, and you don’t feel normal, then you stop taking it. If you’re feeling overstimulated, or it’s upsetting your stomach, you can stop taking it. It’s not super dangerous to take an adrenal supplement necessarily.

But if you have so many symptoms, it’s hard to be subjective. “I feel this way. I took a pill for a week, two weeks. Didn’t work. How do I feel now?” Having objective measures of what is your cortisol now? How intense is it? We talked about the different phases of adrenal fatigue. If you are so low on that spectrum, those supplements won’t do anything for you. That doesn’t mean you don’t have adrenal fatigue, and the supplement didn’t work. Your brain is not sending the signal, so it doesn’t matter what you have there.

There is some trial and error with supplements out there. You can experiment. If it makes you feel better, that gets you one step ahead of the game. Again, we have talked throughout our conversation about the importance of everything working together. You might have adrenal fatigue symptoms. Is it because your hormones are out of balance? Your thyroid’s not working?

Finding a practitioner that is like me or you that can do some more objective testing and help you understand what is going on, where is that balance. If that is overwhelming for you, you can start with the basics. Let’s get us back into parasympathetic mode. I tell my patients all the time to Google how to be parasympathetic. There is a lot of good information out there about the things I can do to get out of that fight or flight mode, out of that stress mode. It’s easier said than done.

I have been doing a lot of talking on cold water plunging. There are a lot of studies on that. If you don’t have a tank where you can throw a bunch of ice water and get into a cold water plunge, you can turn your shower cold at the end of your shower. I think that’s fascinating. Even if you don’t have adrenal fatigue, it will be helpful for you.

At the end of your shower, turn it to as cold as you can possibly manage. The colder, the better. Count to 30. Your first response will be to hold your breath. “If I have to be here for 30 seconds, I can’t hold my breath that long,” so it forces you to start breathing and exhale. You have to do that calm, big, deep breath to help your body relax while you are in that water. The more you do that, that’s a great way to force yourself into that parasympathetic mode, that calm mode. If you can mimic that throughout your day, you don’t always have to be in the shower, but you can start help managing your stress a little bit better.

Back to the diet. Whatever you want to term it, whole food diet, I tell patients all the time: The closest you can get to nature in the least steps possible, that is the diet you want to be on. Pick an apple. Hopefully it’s organic. Pick an apple, and eat it. There are no steps to prepare that apple. Protein in meat is different. You want the minimum amount of steps. Nothing added to it. Get that raw meat. Cook it however you want to cook it, and eat it. Your veggies, as much as you can, raw veggies. One step. Steam them, sauté them, roast them, whatever. Minimal steps.

When you start thinking about something like whole wheat pasta, like you were talking about, or what we think is healthy grains and carbs, we didn’t go out and pick a stalk of wheat and chew on it. Even then, when you take the wheat and grind it up into flour after drying it out, we don’t sit there and eat spoonfuls of flour. That all has to be mixed with something else. These preservatives get in there to prevent it from getting moldy and hard. There are 52 steps to get from where it came from to your mouth. That’s an easy tool to let patients start looking at foods. How many steps? Three or less, that’s your diet you need to be on. You can start there. That will make some big changes before you find a practitioner like myself or another integrative functional practitioner that does more in-depth testing.

Dr. Eric:

I do take my cold showers. Not fully cold. I alternate. I do hot, cold, hot, and then finish up with cold. I recommend those. I can’t say I do it every single time, but most of the time, I do it.

Where can people learn more about you, Dr. Aimee?

Dr. Aimee:

My own personal website is AimeeDuffyMD.com. You can find links there to my book, Normal Doesn’t Have Side Effects. Also, if you click Learn More, you can flip over to my website for Carolina Integrative Medicine, which is my practice. You can also go to CarolinaIntegrativeMedicine.com. We have lots of info about what we talked about today, maybe not in quite so much detail. Adrenals, hormones, gut health.

There is a place where you can click Work with Me, which will get you to schedule a free discovery call with my team. We will chat with you for about 15-20 minutes. What is going on with you? What are your health issues or goals? If we’re a good fit to work together, that will get you set up on our schedule to go through the labs and the consult. That’s how people find me.

Dr. Eric:

Wonderful. Thank you so much for sharing this wonderful information with the audience. I’m sure they learned a lot about adrenals and sex hormones. Appreciate you taking the time for this interview.

Dr. Aimee:

You’re welcome. I enjoyed it.

Recently I interviewed Julie Michelson, as she discussed AIP diet tips and troubleshooting. If you would prefer to listen the interview you can access it by Clicking Here.

Dr. Eric Osansky:

With me, I have Julie Michelson, who is a national board-certified functional medicine health coach, bestselling author, international speaker, and the host of the Inspired Living with Autoimmunity podcast. Through her journey of overcoming more than a decade of decline with rheumatoid arthritis, Julie became passionate about functional medicine and using lifestyle to create healing. Julie is an expert in supporting others achieve the changes necessary to experience true healing. Thank you so much for joining us, Julie.

Julie Michelson:

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

Dr. Eric:

You are welcome. I am excited to have you as well. We are going to be discussing diet with a focus on autoimmune paleo (AIP) diet, giving some tips and troubleshooting. Before we dive into this, I would like to have you talk a little bit about your background, how you became an AIP-certified health coach and how you got into what you do now, helping people with autoimmune conditions. Of course, we said a little bit in the intro because you had rheumatoid arthritis, which I’m sure ties into that.

Julie:

It does. It is just one of the diagnoses I had. When I was in my early 30s, newly single mom with three little kiddos, I was diagnosed first with rheumatoid arthritis. I was told when I was diagnosed to expect to decline. There was nothing I could do except take the medications they gave me. On their end, what they would try to do was slow my decline as much as they could and keep me as comfortable as possible. Unfortunately for me at the time, I believed that. I had great doctors. Everyone seemed to agree. When you are diagnosed with something like that, that’s your fate.

I of course did decline for over a decade because that’s what I was expected to do. I kept piling on the prescriptions. I was on 10 prescriptions at the end of 11 years at once. I was taking 10 at a time. It wasn’t working. I was unable to work. I was resting while the kids were at school, so I could handle that afterschool to bedtime window. I had severe brain fog. I was in severe pain. They were trying to get me to put a handicapped placard on my car to save energy and steps. That was the current conversation at the time that I luckily had my aha moment, my dark moment, my light moment, whatever you want to call it.

My youngest daughter begged me, “Please don’t die and leave us.” Obviously, I couldn’t promise her that. What I said that changed my life, and hopefully a lot of people’s lives because this is why I do what I do. I promised her, “I would try everything.” In that moment, I realized I hadn’t tried everything. I tried every medication they had me try, thinking that was everything.

Luckily, I had the history of a little bit of improvement with diet change that I had done on my own. That was where I started with diet. At the point I made that decision, I was already gluten-free. My son had been diagnosed with Celiac a few years before that. To support him, I went gluten-free with him. We would do it together. I noticed my joint pain had gotten a little bit better by going gluten-free. Come to find out, I had Celiac.

I remember even back then, asking my doctor, “Wow, if this helped a little bit, what do you think about dairy? I’ve read that nightshades can be a problem.” “No, nightshades is one in a million. It’s not really a thing.” Back then, I believed her. It was enough. It was stuck in my head, and that’s where I decided to start on my own.

It took me years. AIP wasn’t around yet. I was uneducated. I thought I was eating Paleo at that point. I was still eating corn. I didn’t know corn was a grain. I was eating loads of sugar. I was still avoiding fats, even healthy fats, because I still had that mindset of fat is bad. It took a long time. It was a process.

I am really fortunate that without even managing my other underlying causes, just over the years, by continuing to tweak diet and learn, I was able to get well enough to reduce the brain fog, so I could learn more and continue down the journey. It has become my life’s calling not only to help people but also to shout from the rooftops, as you do all the time, that we can heal. People need to know that autoimmunity is not a death sentence; it can be turned around.

Dr. Eric:

Well said. I definitely agree. Your rheumatoid arthritis is under control?

Julie:

I have no symptoms. I have been symptom-free for about six years, maybe longer now. Time keeps marching on quickly.

Dr. Eric:

True. You mentioned AIP wasn’t around. Same thing when I was diagnosed with Graves’ in 2008. There was no AIP then. I started out with more of a modified Paleo diet, you could say. I was still eating nuts, which I had to eliminate later on because I was having some issues. I wasn’t 100% certain it was due to nuts, but when I cut them out, I progressed further.

Why don’t we talk about AIP? Could you give a brief overview of what the diet entails?

Julie:

Absolutely. I want to start right away by saying when people hear AIP, they think diet. We are going to focus on food today, but AIP is a lifestyle. It’s important for people to understand that they may dial in their diet perfectly, but if they are not actively managing their stress, not sleeping well, not in community and connected with others, not handling toxins, not moving properly at the level for their body. If one thing is perfect without the rest, I can guarantee you it won’t get you the results you’re looking for. To me, diet is a low-hanging fruit and such a big driver. It’s not just a diet.

What AIP is, as far as the food plan, it contains a comprehensive elimination diet, where we are eliminating all of the most common drivers to autoimmunity. I say “most common” because usually by the time most of us are diagnosed with an autoimmune condition, we know we have leaky gut. When we have leaky gut, we have food sensitivities. A lot of them can be to really healthy, nutrient-dense foods that aren’t on an autoimmune list, things like spinach. I try to stop saying kale because people are tired of hearing about kale. There is no one written plan that is going to be optimal for everybody. But AIP is so comprehensive that we now have great scientific studies behind it.

As you mentioned, it’s a Paleo diet. It’s just beyond that. The key, and the part I think gets the most misunderstood, is yes, the elimination phase is very restrictive. It’s supposed to be a phase. It’s not supposed to be a lifelong thing unless someone really needs to be avoiding all of those foods long-term. You mentioned Paleo. It’s completely grain-free. Yes, even oatmeal. These are the things people like to negotiate all the time. I know we will get into that later. It’s sugar-free. It’s sweetener-free. No legumes, nuts, seeds, eggs, nightshades, alcohol. What else am I missing?

Dr. Eric:

Paleo allows eggs, nuts, and seeds. You mentioned those are not allowed.

Julie:

No dairy.

Dr. Eric:

No nightshades, grains, legumes, alcohol. Of course, it goes without saying: no unhealthy oils.

Julie:

No processed foods. All of those additives and chemicals, we’re talking about a whole real food eating plan.

Dr. Eric:

Even certain spices are not allowed, correct?

Julie:

The ones that aren’t allowed are either nightshades or seeds.

Dr. Eric:

Speaking of coffee, would you say that falls under the legume category?

Julie:

It is a bean. Coffee may technically actually be a seed. I can’t remember which category it’s in. Full confession: I have coffee right here. It’s earlier here than it is where you are. I have done my reintroductions, and I am okay with coffee although I am not okay with other legumes. I don’t eat legumes.

Dr. Eric:

In your situation-

Julie:

Where we start is not where we end up ideally. That restrictive phase is a phase.

Dr. Eric:

I agree. I look at AIP as more of a starting point. It’s a phase. When I have someone start on an AIP diet, and I can’t say I have every single one of my autoimmune patients start there, but for those who do start there, I usually will try to encourage them to go at least three months. Even 30 days is better than nothing. But a minimum of three months. What do you have to say as far as duration of that phase?

Julie:

It’s individualized. It’s going to depend on response. I’ve had the rare occasion where we’re working toward a full AIP elimination, and someone feels phenomenal. If someone is feeling amazing, then I will say, “Okay. I don’t need to get more restrictive.”

I agree. It depends on where they are. What are their symptoms like? How long have they been struggling? It usually takes at least a good 60 days. Here’s the thing I find. I will start with an at least. I don’t say 90 days to anybody because I don’t want to scare them off. I do say, “This will depend on you.” Nobody believes me when I tell them this, but I always tell them, “I promise, I will be encouraging you to do reintroductions. You are not going to want to.” At the beginning, it sounds really hard and overwhelming. When it is the right thing, and you feel amazing, nobody wants to put those things back in because they don’t want to feel crummy again.

For me, the whole purpose of AIP is information and power. It’s not about the elimination. It’s about the reintroductions and really learning what each of those foods is doing. People don’t understand. I have people ask me all the time, “Are we creating a food sensitivity? I have been eating tomatoes my whole life, and now they bother me.” I liken it to because I am over 50, that fuzzy TV screen, those of us in my age group remember when the antenna wasn’t just right. You have so many little sources driving your inflammation that you can’t feel what just one is doing. That is the beauty of this protocol.

I know we may touch on some other eating plans. The thing I love, I am working on my Bredesen certification, and I have worked with a Bredesen-certified physician. That’s an Alzheimer’s plan. Anyone familiar with the Wahls protocol. All of these things come down to the same thing. They are all grain-free, dairy-free, nutrient-dense, loads of veggies, lots of good healthy fats, and no sugars. All of the higher-level diets have some level of ketosis involved. There is a crossover. I study all of them and see these are the things that must be important no matter what your diagnosis or symptoms are.

Dr. Eric:

I agree. I want to talk about grains. Toward the beginning, you picked a little bit on oatmeal. Before the interview, we were chatting a bit. That is one of the things patients like to introduce. Oatmeal, rice is common. As you mentioned, a lot of these diets avoid grains. Why are grains not part of AIP or a Paleo diet or a ketogenic diet? Keto might be different. You are trying to get into ketosis, so there are different reasons.

Julie:

I think that’s still part of it. There is more than one answer, and there is overlap. We will start with the easy part. Grains are going to increase your carbs. At some point, for everyone, carbs become inflammatory. Just that alone, without the other reasons, is why someone who is dealing with chronic inflammation needs to be careful of their carbs.

I have gentled as I have aged and coached more and more. I did pick on oatmeal. The reason I picked on oatmeal is most people think oatmeal is really good for them. It’s marketed really well. I had a client recently who was a type one diabetic who was eating oatmeal every morning for breakfast. She had no idea that was bumping her blood sugar. Easy reason #1 that carbs can be a problem for people.

Also, certain gluten-free grains, because gluten is another thing- Everyone who works in the autoimmune world will agree that gluten is a problem, especially for those with autoimmunity. One problem with other grains is molecular mimicry is a thing. They can send similar signals and trip similar immune responses. Some of those proteins are similar. That’s another piece of the problem.

I go by what I see. When I first started coaching elimination diets, we would introduce gluten-free grains all lumped together. We would do oats, rice, and corn. I don’t do that anymore. We need to know exactly what each particular driver is doing. I do have clients that are okay with rice when all is said and done. Even those clients can’t eat rice every day, or they will bump their inflammation back up. My kids would tease me, “Not all grains are evil.” I did used to be so, “No, grains are bad!” The ones I think sometimes people can eventually handle in moderation are rice (cook it, cool it completely, then it becomes a resistance starch, and you can eat it) and oats here and there. I don’t eat oats. I will occasionally have sushi if I pour MCT oil on it. It really does depend.

Through coaching hundreds of people through this process, corn is a big problem for people. They typically have no idea. That is another reason why I think the gluten-free movement is not that great. I thought it was great with my son before I knew better, but that food is just loaded with junk and high-sugar stuff and corn.

Dr. Eric:

Some people might say it’s organic, so it’s GMO-free. It’s not just the GMOs. It’s the corn itself. Even if you have organic corn, it’s something you still want to avoid, arguably not just when trying to restore your health, but generally. It’s difficult because so many products, especially if it’s packaged and gluten-free, will usually have corn.

Julie:

Humans were not designed to be able to process grains, from the way we chew. There are a lot of reasons when we look back. If we think of paleo, that’s this approach. How did we eat in Paleolithic times? What are we designed for? We weren’t sitting around eating carbs all day. We weren’t sitting around all day either. When you think of what that mindset means, that’s what it means.

Dr. Eric:

They didn’t sit around eating popcorn, speaking of corn.

Julie:

My daughter was just teasing me about that. When I said I was doing Paleo all wrong. I thought I was eating Paleo, and I was having popcorn almost every night, when I had that treat mentality still. No, they weren’t watching movies and eating popcorn.

Dr. Eric:

Some people might be able to get away with some gluten-free grains, possibly rice and maybe oats. The thing is you never know how someone is going to respond. When someone is trying to negotiate, it’s up to the person. We can’t force people to follow any type of diet. We just give recommendations. What I always say is if you deviate, it’s ultimately up to you. You might progress fine. But we just don’t know. If that’s a risk you want to take, if you go 30 days or a few months, then you hit a road block. If you hit a road block, we don’t know for sure that you’re eating bad food. If you’re eating rice, we don’t know for sure that’s why you’re not progressing. If you’re eating strict AIP, we can’t blame it on certain foods. If you’re eating that food, then we don’t know.

Julie:

It’s the scientific approach. That is why I believe wholeheartedly the proper reintroductions are the most important part. Then you’re not guessing what does rice do to me? I don’t always coach AIP straight as it’s written. We use it as a framework. If you ask Sarah Ballantyne, that’s what it was designed for. In order to be a resource for people, you have to give them the framework.

I just had a potential client come to me until she told me she was vegan. I said, and I know you have a question about that, that I was not the right coach to help her heal unless she was willing to incorporate some animal protein into her diet. Luckily for both of us, she said, “I will do whatever you tell me to do. Let’s get started.” As a vegan, some of her really high sensitivities were things like soy and a bunch of the wonderfully nutrient-dense vegetables she was eating.

Here is where I love the food sensitivity panel not only as a backup but how to get a vegan not to eat soy. You show them data that their body is having a problem. For me, it made that part of my job so much easier. She just reintroduced kale last week. She did a full elimination diet and has been very slow to reintroduce. “Please, can we do kale now?” “Sure.” She can’t eat kale; it’s not her friend. And she loves kale. It doesn’t even have to be an evil food, like my kids think I think, on that list of things. Now, her body has told her that. If she had been eating that the whole time, she wouldn’t have gotten the results she got on her elimination phase because she would have had inflammation the whole time.

Like you said, it’s so important to take it out, and then to really feel. I’m one of those. I get it. I was eating gluten my whole life. I didn’t have gut issues. I thought it was fine. When they wanted to test me for Celiac, they told me, “You have to eat two pieces of wheat bread a day for a week or 10 days” in order to get an accurate read before the biopsy. That’s where I learned that. It didn’t happen. I couldn’t. I was that sick. That’s that sense of your body can tell you. Had a health coach told me however many years ago that was, 15 years ago, I shouldn’t eat gluten, I probably would have still dabbled in gluten. Feeling what it does to my body, it’s a never ever food for me.

Dr. Eric:

Definitely listen to your body. One thing I want to say about soy. You do a food sensitivity panel, and soy comes back positive. The one flaw with that, in my opinion, is if it comes back negative, you’re not just avoiding soy because you’re sensitive to it.

Julie:

Which is why it’s on AIP.

Dr. Eric:

Exactly.

Julie:

I run into that all the time. I try to explain I’m doing that panel for extra data. I’m looking for things like kale on that panel.

Dr. Eric:

You’re looking for foods that are allowed on AIP.

Julie:

That are nutrient-dense that I would normally encourage you to keep eating. To clarify, I take soy away from everybody all the time. That’s not usually one they argue with me a lot about. It’s usually dairy. “I only eat cheese.” I will offer to everyone contemplating, whether it’s AIP or any eating plan, to take a week and become truly educated about what you are eating. I have had so many people say, “I avoid dairy,” and there is dairy in the products they are using even if they are not eating straight dairy. I’m not picking on dairy. My family was in the dairy business, so I love cows. It’s not about that.

Dr. Eric:

Even dark chocolate. That is also not allowed on AIP. Some people might think they are eating dark chocolate, but it will have milk chocolate in there without saying. If you look at the label, it will say so.

Julie:

But they will have casein added, which is a dairy protein. I had that recently with someone, “I am eating these dark chocolate keto things.” “What’s in them?” “Oh, there’s milk in here.” If you have one takeaway from this conversation today, the starting point for everybody is really being truly aware of what you are eating because often we think we’re avoiding stuff, and we’re not.

Dr. Eric:

Quick question about food sensitivity testing. I personally don’t do a lot of it. Do you do IgG testing?

Julie:

I do IgA and IgG testing. I do the combo.

Dr. Eric:

You have them do the blood draw first without doing any type of elimination diet.

Julie:

The panel I use, they will send a kit right to the house. It’s a finger prick test. There is plenty to eliminate just on AIP. Most of the time, unless somebody is, “No, I want to go all in right away,” we’re stepping toward that, whether it’s slowly or rapidly, anyway. We get started right away while we are waiting for those results to come back.

Dr. Eric:

Let’s talk about constipation. That’s a common problem, where people are used to eating whatever they eat, whether it’s fast food, or maybe not eating a lot of unhealthy foods, but are eating grains and legumes, etc. Not necessarily a vegan/vegetarian, but a person in general who gives up all these foods. All of a sudden, they are experiencing constipation. What tips do you have for them?

Julie:

I’m going to go way back. I just had this conversation with a physician I work with. Sometimes we forget to start at the beginning. Are you drinking enough water? We jump to, “What can I take to help me with constipation?” There is often an adjustment period. It is interesting. I don’t experience that very often with the clients I walk through AIP. It could just be the way we handle that transition into the full elimination. It’s very rare actually for me. I know it is a big problem in the AIP community in general. #1 is how much water are you drinking? We have to be flushing things out. Look at that first. It sounds so basic, but it is so important. This could be why I don’t see a lot of it in my practice. AIP, we focus on the elimination phase and what you’re avoiding.

The other important piece is what you’re including. We’re including a lot of nutrient-dense vegetables. Here’s that crossover with AIP and Wahls and the Bredesen recode. Lots of vegetables and a variety: leafy greens, colors, cruciferous veggies. Those all have fiber. That could be a good reason why we don’t see a lot of it. I am not going to say my clients within a week are eating nine cups of veggies. That’s not true. But it is important, and it does help. “I need my oatmeal so I can poop.” We’ll find another way.

I’m not a physician. I work with a physician. Typically, if there is an adjustment period, we encourage people to make sure they are getting magnesium. They may have to increase that intake for a little bit to keep themselves regular. Typically, then they can back off. Most of us are deficient in magnesium, and there isn’t a part of your body that doesn’t love it. Tell me what you do for constipation.

Dr. Eric:

Similar to what you said. Make sure they’re hydrated. Make sure they’re eating plenty of vegetables. Like you said, it can sometimes be challenging because they are not used to eating a lot of vegetables at first. They are not making the transition to eight or nine cups a day initially. They might only be eating two or three servings a day. That can be helpful to increase the vegetable intake. Magnesium, I agree. If you’re constipated, citrate-

Julie:

Or a blend if you don’t want to go overboard. I’m guessing you would do the same, but for those listening who don’t know how much magnesium to take, it’s a brief, maybe unpleasant experience. You want to keep increasing your dose until you have too much motility, and then you back off. If you’re taking capsules, you drop it down one. That’s usually how we do it. You can do it gently. Then the beauty is once you get the veggie intake up, and the body is adjusted, you can drop down. It’s a really important supplement. We all need magnesium. I personally love blended forms. Different parts of the body like different forms of magnesium.

Dr. Eric:

I don’t recommend citrate for most of my patients. It’s just for-

Julie:

Motility, yeah. Absolutely.

Dr. Eric:

I like glycinate and other forms of magnesium, like malate. Just focusing on constipation, I would say citrate. You could also take a blend. Nothing wrong with that.

I will also say movement. I had this conversation recently with someone who experienced constipation after following AIP. She wasn’t moving around enough. I told her my experience. I was really sluggish when I was in my early 20s. I would have a bowel movement almost once or twice a week. My diet was horrible growing up. These days, I have regular bowel movements. Sometimes it’s on the sluggish side. But if I am sitting too much, which I try not to do—I have a treadmill desk, so I can walk and work at the same time—if I start moving, it’s usually not a problem. But if I do everything else, and I’m not moving, that can be a problem when it comes to constipation.

Julie:

I’m so glad I asked you. It’s like the water. These are things our body needs to be doing. When we were talking about Paleo, they were moving all the time. Whatever that level looks like for you, it doesn’t mean you have to go out and do a HIIT workout. Get up.

Dr. Eric:

Exactly. I don’t know how many patients you see with Hashimoto’s or Graves’. Hashimoto’s is more common.

Julie:

Yes, more common. It’s such a common crossover, I find, whether it’s a secondary or primary diagnosis in autoimmunity. Definitely ¾ of someone sharing a different diagnosis also has Hashimoto’s. Not as much with Graves’.

Dr. Eric:

I’m bringing that up because there is controversy in the world of thyroid health with iodine. I wanted to get your thoughts about sea vegetables, which are really high in iodine. Do you recommend sea vegetables to your patients with Hashimoto’s?

Julie:

I do. I know everybody takes a different path. They are nutrient-dense. We do need iodine. Most of us aren’t getting iodine in our diets elsewhere. They are not hopefully eating iodized salt anymore by the time we are getting going. We are looking for other good sources to support them.

We also use labs a lot. I work with a functional medicine physician. Whether it’s in my program or with the patients at the clinic, we are always doing labs as well. Working with the women I work with, one of the things that we see a lot, women who have cystic breasts need iodine. Sometimes supporting iodine in them will clear something. We look for signs and test as well.

Sea vegetables, people aren’t usually coming in and saying, “I eat a ton of these. Is that okay?” That won’t be the bulk of somebody’s diet. I think it’s really good to incorporate.

Dr. Eric:

Just to confirm, you are not really seeing problems with your Hashimoto’s patients as far as sea vegetables go?

Julie:

We don’t. A lot of it comes down to how many are they eating? I’ll qualify that. He doesn’t have Hashimoto’s, but I have a client right now who is an avid podcast listener and reader and learner and loves wellness. For the people who think they should be eating a ton of sea vegetables and are intentionally trying to do something good, that can be a problem. Everything in balance is what I will say. I don’t have people that really need to be avoiding sea vegetables.

Dr. Eric:

In the last few minutes, I want to do something I haven’t done before.

Julie:

Oh boy.

Dr. Eric:

I want to do a rapid-fire round, where I bring up a topic and have you give your opinion for 30 seconds.

Julie:

Let’s do it!

Dr. Eric:

Ashwagandha and AIP?

Julie:

I say no.

Dr. Eric:

Because it’s a nightshade?

Julie:

Yep.

Dr. Eric:

Pea protein powder and AIP?

Julie:

No, it’s a legume.

Dr. Eric:

Bone broth powder and AIP?

Julie:

Bone broth and AIP, yes.

Dr. Eric:

I knew you’d say yes to bone broth. I am purposefully bringing up the powders because there are so many. I’m sure you get, “I don’t have time to make bone broth, but I will add this bone broth powder to my smoothie.”

Julie:

I will ask what is in your bone broth powder? It’s the trick answer to the trick question. It’s about becoming a label reading master. There are AIP-prepared bone broths. I understand not everybody wants to make their own bone broth. Going back to my formerly vegan client—who still identifies as vegan. I said, “You can’t say you’re vegan when you eat salmon four days a week and drink bone broth and eat eggs. You’re no longer a vegan.” If you can’t handle chicken feet, there are reasons. I would never ask her to make her own bone broth. She hasn’t jumped to the beef world yet. You have to read your ingredients and know what’s in there.

Dr. Eric:

What’s your favorite cooking oil?

Julie:

Depends on what I’m cooking and how. I love avocado oil. To me, it’s a middle of the road oil in the sense that it doesn’t taste like coconut. It doesn’t have an intense flavor. It’s very mild, and it can handle a higher heat than olive oil. I don’t like cooking with olive oil; I like dressing with olive oil. Coconut oil as well, we use.

Dr. Eric:

Chlorella and spirulina in AIP?

Julie:

Again, it’s going to be a non-answer. It’s an individual thing. I’m a fan of chlorella. I mentioned I occasionally take sushi. I will take chlorella when I eat sushi to try to bind some of those nasty things. It’s going to depend on your autoimmune pathways as to whether you can handle certain things or not. Those are not typically a problem for people. It’s almost like the sea vegetable thing. There is such good stuff in both of those things. For the most part, people can handle it, but I would be aware. I would take them as an introduction. I would take them when you’re feeling well and eating clean, and you see how your body feels about it.

Dr. Eric:

I bring it up because I’m pretty sure Sarah Ballantyne says not to eat it. It’s a No on that list.

How about AIP and ghee? Which I asked you about when you interviewed me on your podcast.

Julie:

You must get this question a lot. The answer is yes, we allow ghee. If you know you have a dairy allergy, don’t do ghee. The proteins are gone, so it’s one of the ways to make AIP more successful for people is to allow them to have ghee. I almost added it in my list of cooking oils. I don’t know if it’s an oil oil.

Dr. Eric:

Last rapid-fire question. Reintroducing gluten and dairy if remission has been achieved.

Julie:

Yes. I believe everybody should reintroduce everything. Gluten and dairy are absolutely the last two on the list. When I have people reintroduce dairy, I have them do different dairies at different times. I will have them do goat separate from cow. Goat might be an occasional food for someone, and cow may be a never. I want people to feel what it does so that six months later, they don’t end up at a birthday party where they accidentally had the birthday cake. It was loaded with gluten and sugar and dairy, and now they are in a flare with no idea what it was. I do believe everybody should reintroduce everything. I will reiterate because I have to: I believe they should avoid gluten for the rest of their lives.

Dr. Eric:

I didn’t expect that response. How about if they reintroduce gluten, and they feel perfectly fine?

Julie:

I cry. It has happened to me literally twice out of hundreds of people. It’s very rare, and I cry. Then I explain. We review leaky gut and autoimmunity and how this all happened to begin with. I still remember you talking about the occasional pizza. For them, I say have a little gluten in Italy. It seems to be less of a problem there. Don’t make it a part of your regular diet.

Dr. Eric:

Thanks for that. I know we are just about out of time. Anything I didn’t ask that I should have asked? Any last words you want to give to someone who is thinking about following AIP and isn’t sure they will be able to stick with it?

Julie:

I can say it can sound overwhelming, and it will be way easier than you think once we get into it. I think we may have talked about this on my podcast, but as you make changes, you will start to feel better. You will have more energy to make more changes, which is why ripping off the Band-Aid and just jumping in from a standard American diet to a full AIP elimination is probably not going to work.

Look for support, whether it’s someone doing it with you. Find a coach. This is why there are coaches. You want to really be supported through that process.

I would say if you’re thinking of it, but it seems overwhelming, and you’re still eating gluten, then go gluten-free. Take one step. Look at the elimination plan. I always tell people to start with the easiest thing. What is the easiest thing they think they can eliminate successfully, so they can start to build some momentum?

Dr. Eric:

Thanks for that. How can people learn more about you and your services, Julie?

Julie:

The easiest place to find me is JM.Coach. That can then take you to my free mini course, my website, my social handles, my podcast. It’s my gateway to anything you might want to know. JulieMichelson.com is my website.

Dr. Eric:

The name of your podcast is Inspired Living with Autoimmunity.

Julie:

Come check it out. If you need more Dr. Eric, we did a great episode there.

Dr. Eric:

That was fun. This was fun, too. Thanks so much for taking the time to share your thoughts on AIP and other diet aspects.

Julie:

Thank you so much for having me. I always enjoy chatting with you.

 

There are many natural agents that can modulate the immune system.  And when it comes to autoimmunity, some of them are controversial, such as the herb Echinacea.  I decided to do a deep dive into some of the more common medicinal mushrooms to see if they can benefit those with Graves’ disease and Hashimoto’s, and I must say that I was impressed.

Many people are aware of the nutritional value of mushrooms, but they are also recognized for their medicinal properties. Medicinal mushrooms have actually been used since ancient times.  Research has shown them to have antimicrobial, anti-inflammatory, immunomodulatory, antidiabetic, cytotoxic, antioxidant, hepatoprotective, anticancer, antioxidant, antiallergic, antihyperlipidemic, and prebiotic properties (1) (2) (3).  These activities are attributable to many bioactive metabolites (1).

The Significance of Polysaccharides                                             

In this blog post I’ll mention a few times the importance of polysaccharides, as these are structural components of the fungal cell wall. It’s the diversity in monosaccharide composition and structure that causes them to have different biological activities (R1), including antitumor, immunomodulatory, antioxidant, anti-inflammatory, antimicrobial, and antidiabetic activity. The best known and most abundant are α- and β-glucans (4).  Heteroglycans, peptidoglycans, and polysaccharide–protein complexes also contribute to biological activity (5) (6) (7). They are mainly responsible for immunomodulatory effects due to their ability to bind to specific cell wall receptors and stimulate specific immune responses.

Here are some of the most popular medicinal mushrooms:

• Chaga (Inonotus obliquus)
• Cordyceps (Cordyceps sinensis)
• Lion’s Mane (Hericium erinaceus)
• Maitake (Grifola frondosa)
• Reishi (Ganoderma lucidum)
• Shiitake (Lentinus edodes)
• Turkey Tail (Trametes versicolor)

Before diving into some of these medicinal mushrooms, I’d like to first discuss some of the health benefits they offer:

• Anti-cancer effects.  Although the focus of this post is how medicinal mushrooms can help with autoimmunity, they are actually more well known for their anti-cancer effects.  One study showed that a water-soluble extract from a cultured medium of Ganoderma lucidum mycelia suppresses the development of colorectal adenomas (8).  Another study showed that Ganoderma lucidum might prevent some cases of skin cancer (9).  Yet another study involving Cordyceps sinensis shows that it inhibited breast cells in mice (10).
• Cardiovascular/metabolic health. A number of studies show that medicinal mushrooms can benefit those with insulin resistance and type 2 diabetes.  One study looked to see if the medicinal components in edible mushrooms can benefit those with diabetes mellitus (11). Out of 23 edible mushrooms studies, 13 varieties were found to have anti-diabetic properties, including Ganoderma lucidium, Hericium erinaceus, and Agricus bisporus. Another study showed that Agaricus brasiliensis and Ganoderma lucidum can potentially treat and prevent diabetes mellitus (12).  Yet another study showed that Ganoderma lucidum can provide beneficial effects in treating type 2 diabetes by lowering the serum glucose levels (13).

• Hepatoprotective benefits.  We all know how important the liver is, as it plays an important role in drug elimination and detoxification.  There are a lot of things that can cause liver damage, including infections, and many medications, including antithyroid medication (i.e. methimazole and PTU), which is commonly prescribed to those with hyperthyroidism.  A few different studies show that Ganoderma lucidium has hepatoprotective effects (14) (15).  Another study showed that the mushroom Agaricus blazei normalized liver function in patients with chronic hepatitis B (16).

• Neurological benefits.  Evidence shows that culinary-medicinal mushrooms may play an important role in the prevention of many age-associated neurological diseases, including Alzheimer’s and Parkinson’s diseases (17) (18).  The action mechanisms include reducing oxidative stress, neuroinflammation, and modulation of acetylcholinesterase activity, protecting neurons or stimulation, and regulating neurotrophins synthesis (18).  Ganoderma lucidum, Grifola frondosa and Sarcodon scabrosus have been reported to have neurite outgrowth and neuronal health benefits (19).

• Respiratory benefits.  One study looked to see if medicinal mushrooms can have a prophylactic or therapeutic effect against the pneumonic superinfection and severe lung inflammation that often complicates COVID-19 infection (20).  This involved the mushrooms Basidiomycota Agaricus blazei Murill, Hericium erinaceus, and Grifola frondosa.  Another study showed that β-glucan polysaccharides isolated from different species of mushrooms (including Lentinus edodes and Hypsizygus tessellatus) can help with inflammatory lung conditions (21)

5 Medicinal Mushrooms That Can Benefit Thyroid Autoimmunity

Now that you know some of the health benefits that medicinal mushrooms have to offer, let’s go ahead and take a look at some of the individual medicinal mushrooms.

Reishi (Ganoderma lucidum).  You might have noticed that Reishi was mentioned a lot above, as it is probably the most widely studied medicinal mushroom.  It has been widely used for the prevention and treatment of various health conditions, including gastric cancer (22), hypertension (23), arthritis (24), hepatoxicity (25), diabetes (26), asthma (27), nephrosis (28), and immunological disorders (29).

So how can Reishi benefit people with Graves’ disease and Hashimoto’s?  Well, autoimmunity is characterized by an imbalance of regulatory T cells (Tregs) and Th17 cells. In order to suppress autoimmunity you want to have an abundance of Tregs and a lower amount of Th17 cells.  And numerous studies show that Reishi can help with this Th17/Treg balance (30) (31).

Cordyceps Sinensis.  Although there are multiple species of Cordyceps, C. sinensis is the most documented one.  Research has shown that its properties include antiaging, reparative, anti-cancer, anti-inflammatory, and as an antioxidant (32).  One study showed that C. sinensis has a protective effect on rats with gastric damage (33), while another study showed that it can also benefit the kidneys by reducing proteinuria, improving renal function, and inhibiting glomerular sclerosis (34).

As for it’s effects on the immune system, one study showed that C. sinensis reduced IL-17 (35).  Earlier I mentioned how Th17 cells play a role in autoimmunity, and they secrete IL-17 cells.  So essentially C. sinensis reduces IL-17 by decreasing Th17 cells.  Another study showed that it can increase the antioxidant Superoxide dismutase (SOD) (35).

I came across a very interesting journal article that looked at the effects of C. sinensis on autoimmune thyroid disease (36).  This included 44 patients with Graves’ disease and 56 patients with Hashimoto’s Thyroiditis.  The study showed that at the end of treatment TPO antibodies and TSH receptor antibodies decreased by 40.06% and 46.94% of baseline in the Graves’ disease patients.  TPO antibodies and anti-thyroglobulin antibodies decreased by 51.30% and 39.49% of baseline in the Hashimoto’s patients.

Lion’s Mane (Hericium erinaceus).  Hericium erinaceus is a medicinal-culinary mushroom widely found in East Asian countries, and it is well known for supporting nerve and brain health (37) (38).  Not only can it improve cognitive function and possibly prevent dementia (39), but it also might be an option for the treatment of depression (40).  In addition, it can treat certain neurological conditions, as it contains neurotrophic compounds that can pass through the blood-brain barrier (41) (42).  It has also been used as a treatment for Alzheimer’s disease (43) and ischemic stroke (44).

This wouldn’t be my first choice of mushroom to help with autoimmunity, as I definitely would prioritize Reishi and Cordyceps.  That being said, it does have some immunomodulatory properties.  One study showed that Hericium erinaceus improves immune function by enhancing cell-mediated and humoral immunity, macrophage phagocytosis, and natural killer cell activity (45).  In addition, this mushroom was found to upgregulate the secretion of secretory IgA.  Another study showed that extracts from Hericium erinaceus can relieve inflammatory bowel disease by regulating the immune system and the gut microbiota (46).  One way it accomplished this was by increasing regulatory T cells (Tregs), which as mentioned earlier, can help to keep autoimmunity in check.

Maitake (Grifola frondosa).  This is an edible mushroom with both nutritional and medicinal properties, and is also known as “hen-of-the-woods”.  While it is increasingly found in many nutritional supplements, it’s also considered to be a healthy food, as it is a good source of protein, fiber, and minerals (47).  The different polysaccharides from G. frondosa possess various bioactive effects including immunomodulation (48), antitumor (49), antivirus (50), antidiabetic (51) and anti-inflammation (52).

From an immune system standpoint, I just mentioned that some of the polysaccharides from this mushroom have shown significant antitumor, immunomodulatory, and anti-inflammatory activities.  But when it comes to autoimmune conditions such as Graves’ disease and Hashimoto’s, having a healthy gut is important.  And the reason for this is because most of the immune cells are located in the gut.  And G. frondosa (along with some other medicinal mushrooms) has been shown to regulate the gut microbiota (53).

Chaga (Inonotus obliquus).  This mushroom is widely used by people in China, Russia, and Korea, and like the other mushrooms discussed so far, it has numerous health benefits.  Perhaps the main bioactive compound is Inonotus obliquus polysaccharide (IOPS), which possesses antitumor, antioxidant, anti-virus, hypoglycemic, and hypolipidemic activities (54). Of these, it seems like many of the studies focus on how chaga can help with the treatment of cancer and type 2 diabetes.

I didn’t come across any studies which showed that Chaga can specifically help with Graves’ disease or Hashimoto’s.  However, it does have immunomodulatory effects, and a couple of studies show that it can regulate the Treg/Th17 balance (55) (56).  One of these studies also showed that oral administration of IOP in mise can help with the tight junction proteins occludin and zonulin, which are associated with a leaky gut (56).

Are Mushrooms Safe For Autoimmunity?

There has been controversy over whether mushrooms are safe to consume in those with autoimmune conditions such as Graves’ disease and Hashimoto’s.  This is especially true with mushroom extracts found in supplements.  The concern is that some label them as being “immunostimulatory”, and thus might exacerbate the autoimmune response.

However, the research I presented in this post suggests that they don’t necessarily “stimulate” the immune system, but instead “modulate” the immune system and in many cases help with the Treg/Th17 balance, which explains why they can be beneficial in helping people with autoimmunity.  So based on my research I not only think it’s fine for people with autoimmune conditions to eat mushrooms and consume certain mushroom extracts, but in many cases it can actually be beneficial in modulating the immune system.  That being said, if you eat a certain food or take a specific supplement and don’t feel right, then listen to your body and stop consuming it.

Can Mushrooms Directly Impact Thyroid Health?

I wasn’t able to find any research showing that any of these medicinal mushrooms have any direct effects on thyroid health.  This doesn’t mean that you can’t benefit from these if you have a non-autoimmune thyroid condition, as they can improve one’s immune system health in different ways.  Plus I mentioned how they have other health effects that can benefit those without a thyroid or autoimmune thyroid condition.

Are There Any Risks With Taking Medicinal Mushrooms?

With any supplement there is a concern over safety, especially with long term use.  But overall medicinal mushrooms seem safe to consume…especially the ones discussed in this post.  One study showed that Reishi is well tolerated and could be safely used continuously for long periods of time (57). And anecdotal use of Cordyceps in the treatment of cancer patients has produced promising results at 3–5 g of Cordyceps daily with zero reports of Cordyceps related toxicity (58).

Another study looked to evaluate the safety of erinacine A-enriched Hericium erinaceus in rodents over a 13-week period using different dosages, and revealed no mortalities nor noticeable toxicological effects in all the rats (59).  Another study looked at the cytotoxicity of IOPS, and the results also showed that 20–160 μg/mL of IOPS administration was safe and would not produce drug toxicity (60).

In summary, medicinal mushrooms in both food and extract form can potentially be a good option for immune support for those with Graves’ disease and Hashimoto’s.  This is especially true with Cordyceps Sinensis, as I mentioned the study which showed how this can potentially benefit people with Graves’ disease and Hashimoto’s.  But I also discussed how other mushrooms can help with the Treg/Th17 balance, which is a key factor in addressing any autoimmune condition.

Have you taken medicinal mushrooms? If so I’d love to hear about your experience in the comments section below.

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Recently I interviewed Dr. Carol Lourie, as she discussed an integrative approach to breast cancer. If you would prefer to listen the interview you can access it by Clicking Here.

Dr. Eric Osansky: With me, I have Dr. Carol Lourie, who is a dedicated practitioner with over three decades of clinical experience as a naturopath, acupuncturist, and homeopath. She has helped thousands of women recover their health and restore their life through her holistic protocols involving focused nutrition, targeted supplementation, lifestyle changes, and a centered mindset. According to Dr Carol, the key to wellness is to understand that treating the symptoms of a disease is not going to help you recover your health. You need to get to the bottom of the cause to begin your health journey. I definitely agree with that, and I’d like to thank you for joining us.

Dr. Carol Lourie: I’m really honored and excited to be here. Thank you for having me.

Dr. Eric: Why don’t we start out with your background, Dr. Carol? How did you start helping people with breast cancer?

Dr. Carol: I didn’t start out by focusing on breast cancer. I started out by wanting to go to medical school many years ago. Then I was living in a spiritual community in New York, and my roommate had cancer. I went with her to Memorial Sloan-Kettering where the doctors told her, “There’s nothing more we can do. You’ve had a ton of radiation. You can go home and probably die in a few years.” She was in her 20s, and she looked at me and said, “No, I don’t think so.”

She investigated and discovered this doctor in Long Island who was doing detoxifying diets using iridology. You need to understand this was in the mid-70s when the word “detox” was not a household name. I started working in his home office. I saw people come to him, all different types of people with all different types of medical conditions. I was extremely naïve in the power and beauty of natural healing.

A young woman came in with acne, and I thought to myself, “She has acne. What’s the big deal? Why is she here? You go on antibiotics.” Then she came back a month later. Her skin was clearer, she had lost weight, and her whole energy was different. I saw that with a lot of the people who came to see him. That was my introduction to another way in working with illness and disease.

One day, I was going through this very large pile of paperwork. Out popped the catalog to the National College of Naturopathic Medicine. I thought, “Hmm, maybe I should go here instead of regular medical school.” That was the beginning of my journey of becoming a naturopath, acupuncturist, and homeopath. I have been on that path ever since, and that was a long time ago.

The beauty of natural medicine is it is science-based, and it takes the best of both worlds. It’s not one or the other. You don’t want to pit natural medicine against regular medicine. It’s a bad idea to make it “us versus them.” You want to use the best of both worlds no matter what your illness or disease is.

Dr. Eric: When discussing an integrative approach to cancer, what is your definition of that?

Dr. Carol: That’s a good question. Ideally, it’s everyone’s definition. You want to take the best of both worlds. Integrative or complementary is using what regular medical oncology has to offer and adding in the other side of treatment, which is to reduce the side effects, prepare for chemotherapy, protect your healthy cells. When you are done with active treatment, to recover from radiation/chemotherapy, restore your health in your gut, reduce the oxidative stress caused by radiation. The third phase is to reduce the risk of recurrence.

Dr. Eric: Do you know what the rate of recurrence is?

Dr. Carol: It can still happen even 20 years after you have been initially diagnosed. The risk is greatest in the first 2-5 years. There can be up to 15% recurrence rate. You don’t want to be in that statistic. There is a lot you can do to make sure that is not you.

Dr. Eric: There are people who are listening to this, and it’s easy to put yourself in this situation when you’re not in this situation, meaning some people might be thinking, “If I had breast cancer, I wouldn’t want to get chemo or radiation.” An integrative approach is you are thinking about people might go through those procedures, but you want to address underlying imbalances and prevent a recurrence. Do you have any thoughts on those who want to completely go natural and don’t want to receive any chemo or radiation?

Dr. Carol: A lot of that decision needs to be based on the parameters of the tumor and what comes back from the pathology report. Sitting down with both your oncologist and an experienced integrative doctor, making that decision from the standpoint of what is going to ensure my longevity for the long term? I want to note that men also get breast cancer, but that is not the community I work with, so I am going to use the word “women” because that is who I work with. There are women who adamantly refuse to do medical oncology work. That is their choice, of course. There are clinics I know of in Europe which use non-medical methods to address the tumor and cancer. I can refer someone there. My area of expertise is the woman is under the care of an oncologist, and I am offering supportive supplements and clinical advice regarding reducing side effects through nutrition and homeopathy. I am not the primary doctor treating this illness.

Dr. Eric: Can you talk about the diet? Is there a specific diet you recommend for breast cancer?

Dr. Carol: There is a lot of varying options out there. I have women come into my practice who are keto; vegan; doing the Budwig protocol, which is cottage cheese and a certain type of oil, which I think is absurd; vegetarian; the standard American diet. They are overwhelmed and don’t know what to do.

There is a lot of research on the ketogenic diet. If there is a case of brain cancer or epilepsy, keto has been beneficial for brain disease. There are people who feel that even with breast cancer, you should be on the ketogenic diet. I have more of a modified Mediterranean approach. It’s gluten-free, very low carbohydrate, and almost all sugar-free. It verges between ketogenic and modified Mediterranean. We need to reduce the amount of sugar available to the cancer cells.

In 1918, there was this German scientist named Otto Warburg who won the Nobel Medical Peace Prize. His discovery was that cancer, given a choice between glucose and oxygen for what I call the cancer gas tank, chooses glucose, even though it has to work much harder and go through a much more difficult pathway to get there.

The ketogenic diet is very low sugar, and that’s what happens when you don’t eat carbs. People have to live, and they have families. It can be very difficult to live in a family unit if you are eating only keto. You don’t want to have to cook one way for yourself and another way for your family. The modified Mediterranean takes the best of both worlds. The research which has gone into the modified Mediterranean diet over 25 years with thousands of women has shown that eating this way has resulted in a reduced risk of breast cancer.

Dr. Eric: From what I understand, if someone absolutely wanted to follow a strict ketogenic diet, there is no problem with that. It is just restrictive. It might be difficult if you live with other family members since you might have to prepare multiple meals. The modified Mediterranean diet is not easy to follow, but it’s not as difficult as keto. It sounds like it’s effective, or else you wouldn’t be recommending it.

Dr. Carol: I think it is easy to follow. First of all, this brings in an important concept for the way I work and how I want to encourage women to view what they are doing with their life. It is easy because you are choosing to do it.

The way the standard American diet proposes that you eat does not support health. There is a lot of research which shows that the standard American diet quadruples the cancer rate. That is a really clear indication how you were potentially eating and how you should, want to, or choose to eat, now that you have a cancer diagnosis, there needs to be a change.

Modified Mediterranean is filled with luscious food. There is a lot of healthy fats in it. It is easy to prepare. It is wonderful for not just you but the entire family. You can go out to eat and order appropriate food. You can go to someone’s house and hopefully enjoy what they are having. It encourages health all around. I think it is easy. But it is definitely not cereal from a box with milk for breakfast, which nobody should be eating no matter what.

Dr. Eric: Definitely. That is how I ate growing up.

Dr. Carol: We all ate that way growing up.

Dr. Eric: How about stress and emotional trauma? Can you discuss the connection between those and breast cancer?

Dr. Carol: It’s almost impossible to be an older person and not have had something upsetting or traumatic happen in your life outside of being diagnosed with cancer. Many times, when I first start working with a woman, I ask them, “Have you had any trauma or upsetting experiences in your life?” She will say, “There was this incident that happened 25-30 years ago, but it couldn’t be that.” The reality of it is it absolutely can be.

We have a protective mechanism in our body. When something upsetting or traumatic happens, we take a breath in, and the energy of that event goes into our cells. It hangs out there. We process it at the level we are able to handle emotionally at the time. The rest of it is stored in our psyche and our cells. Over periods of years, with added stress and busyness and elevated cortisol and the chaos of life, all of a sudden, the overload of all of that emotional work and restraining can pop up. You can have a lot of unexplained depression and anxiety and the creation of illness. It doesn’t just have to be breast cancer. It can be an autoimmune problem, insomnia, gut problems, or some other form of cancer. Incorporating and acknowledging the trauma of the past into the healing you choose and want to do in the present is very important and helpful.

Dr. Eric: Do you recommend any techniques—mind/body medicine techniques, working with a counselor, etc.—or does it depend on the person?

Dr. Carol: I am a big proponent of therapy. I think therapy is really wonderful. There are different forms of therapy. I think it’s important to interview the therapist. I think women should be working with women therapists. You need to interview the person you are choosing to see to make sure you feel comfortable and safe with them, and the type of therapy they do is a match for what you’re looking for.

You go into therapy not just one time. Ideally, you go in and do a bit of work, settle, and then go back because other stuff comes up. Being in therapy off and on throughout your life is a healthy way of looking at your mental health.

Dr. Eric: How about the impact of environmental toxins, such as xenoestrogens? How have those impacted cancer rates?

Dr. Carol: I will give an example of a 35-year-old woman who came to see me. She walked into the office, and I have a scent-free office. She had on enough perfume that you thought you were on the ground floor of Macy’s. For those of you who can’t relate to that statement, it’s the makeup area, and it smells unbelievable. She walked in, and I said to her, “Tell me about scents.” She said, “I love scents. I have those plugins in the wall. I have those sticks in the oil.” This was the cincher for me. “I spray my sofa with Febreze.”

There are, as you mentioned, xenoestrogens. They are estrogen blockers. These are certain chemicals which look like estrogen. Estrogen in your body needs to be metabolized to be excreted in the healthy form. In order to do that, it needs to go int the parking garage and park, and the nit’s bound to a receptor and excreted. Xenoestrogen or estrogen-looking chemicals take up the parking spot in the garage. When the healthy estrogen goes to park and be excreted, there is no space for it, and it turns into an unhealthy version of itself. That is what is known as estrogen dominance. That can create infertility, PCOS, lots of menstrual irregularities, endometriosis, and breast/vaginal/ovarian cancers. Detoxifying your home is a very important aspect of recovering your health.

I said to this young woman who came to see me with a diagnosis of unexplained fertility, “Could you go home and put every single item that you use to clean your house on the counter and take a picture?” There were 29 items on that countertop. I said to her, “You don’t have unexplained fertility. We have an explanation. There are too many chemicals.” We had to throw out her sofa because she couldn’t detoxify it. She spent a week cleaning everything, getting eco laundry detergent, and throwing out all of her shampoos and soaps. Within three months, she was pregnant.

I should explain that when you wash your clothes and maybe use a dryer sheet, when you get in the shower or sleep, your pores are open. You wrap your body in a towel, and the chemicals from the detergent and the dryer sheets are absorbed into your skin. Your skin is a porous organ. All those chemicals you use in your laundry, shampoo, body wash all have chemicals that block healthy estrogen from being excreted. Detoxifying your home is the first step of reclaiming your health.

Dr. Eric: I assume you recommend things to support detoxification rather than just minimizing exposure.

Dr. Carol: Yes. Now we are getting into supplements. I am a big proponent of supplements. I think they are really important. Women say to me, “Can’t I get everything from the food I’m eating?” Even if you are eating 100% organic, if you have breast cancer, you need to support the pathways that block the cancer and increase the pathways that promote health at a level that eating a regular diet, even organic and lots of phytonutrients from vegetables, you need more than what you can get from your food.

Dr. Eric: In addition to supplements, do you recommend other methods of detoxification, such as infrared sauna? Gerson recommends coffee enemas.

Dr. Carol: I’m not a big coffee enema person. I’d rather do Epsom salt enemas. What happens when you use Epsom salts is you take two tablespoons, boil the water, add the Epsom salts, dissolve them in a glass jar, and add them to your enema bag. It’s a little bit of water with Epsom salts with the rest of the bag. What the salts do, and this is from the doctor I studied with originally, is it pulls toxins from your gut and your lymph.

It’s not about being constipated. You don’t want to use an enema to help you eliminate your daily evacuation. You want to use your enema very targeted, not all the time. You need to prepare when you do that. You want to change your diet the day before. Eat very lightly. Do the enema. The day after, eat very lightly before you go back to your regular diet.

Dr. Eric: You are not recommending daily enemas then.

Dr. Carol: Absolutely not. If you have constipation to the point where you are not eliminating daily, we need to do some work as to why you are not able to evacuate on a daily basis. There are a lot of Americans in the U.S. who are constipated. People come in and say, “I go to the bathroom maybe every other day. I’m not sure. Maybe every couple days.” As we get your health better, we need to have one evacuation in the morning and then another smaller one 1-2x a day. That is a healthy elimination of toxins.

Dr. Eric: Getting back to supplements. There are a number that could help with detoxification. There is milk thistle, n-acetyl cysteine, alpha lipoic acid.

Dr. Carol: You mentioned all the ones I was thinking of, yes.

Dr. Eric: Do you also use supplements like DIM to help with estrogen metabolism and calcium D-glucarate?

Dr. Carol: I use calcium D-glucarate, but I don’t use DIM. Well, it depends. If a woman is on tamoxifen or an aromatase inhibitor, I think DIM is contraindicated, or you don’t need it. We have to stack the supplements because they are on a lot. We have to be specific about what we take.

Sometimes people say to me, “Can’t I just take DIM instead of an aromatase inhibitor or tamoxifen?” You can’t really take enough DIM to block the estrogen. If you have estrogen-positive, hormonal-positive breast cancer, you want to block the uptake of that hormone. The problem with tamoxifen is it isn’t without its side effects, just like aromatase inhibitors. Tamoxifen is anti-estrogenic in how it blocks the hormone from your breast. It’s pro-estrogenic with what happens with your uterus. There is a 15% risk of getting uterine cancer.

Before a woman, ideally, is prescribed tamoxifen, I encourage her to speak with her oncologist to get what is known as a CYP2D6 enzyme test. That enzyme is the enzyme that breaks down the tamoxifen. If you have a deficiency in that enzyme, you will get an increase in the tamoxifen byproduct, which can contribute to lots of oxidative stress and an increased risk in uterine cancer. You need to be prepared to speak to your oncologist about this. There are certain supplements and methods we use to reduce the toxicity and side effects of tamoxifen and aromatase inhibitors.

Dr. Eric: I wasn’t going to get into the genetics, but since you brought it up, would you recommend other genetic testing? Like for the COMT enzyme or MTHFR.

Dr. Carol: Those are fine to know about. If you’re MTHFR-deficient, we want to make sure you are getting the right form of folate. If you’re COMT-deficient, we know that your pathways to metabolize are a little deficient, so we have to make sure you are taking enough calcium D-glucarate and berberine, and maybe doing a castor oil pack on your liver once or twice a week. Those are not the major driving factors of what has contributed to your breast cancer.

There is no one thing, I should say, that makes or creates breast cancer. It takes awhile for this tumor to develop. When you’re initially diagnosed, most of the time, it’s not a surgical emergency. You can take a week or two to get a second opinion.

If you have children at home that need to be taken care of, develop a care tree. The kids are being dropped off at school and being taken to their extracurriculars. You need to involve friends and family to take care of your children and bring food. Women multitask so often that when a woman of the household is not feeling well, a lot of things are too much for her spouse to take on. It does take a village ideally to get through breast cancer.

Dr. Eric: How about testing? Do you recommend testing the hormones through the blood or dried urine testing?

Dr. Carol: If a woman wants to check her hormones through a Dutch hormonal panel before she either starts treatment or after treatment is over for a while before she goes on tamoxifen or an aromatase inhibitor, I think that’s a valid thing, especially if it’s a young woman.

There are women getting breast cancer earlier, at the age of 32. I have several young women. If you get breast cancer at that age, and there isn’t a family history of either breast cancer or colon cancer, we want to understand what is happening with your estrogen and hormone metabolism. The Dutch hormonal panel tells us how your hormones are being broken down, and at what level there is a problem, so we can target that in addition to whatever medical treatment you are doing.

For older women who are on tamoxifen or an aromatase inhibitor, that test is not valid. It’s not going to give us any valid information. There are other tests we can do.

Dr. Eric: If someone is taking tamoxifen, they wouldn’t want to do the Dutch test for looking at estrogen metabolites.

Dr. Carol: No, it’s being disrupted by the drug. Aromatase inhibitors block aromatase enzyme. The aromatase enzyme is the enzyme that is responsible for taking the androgen, which is then broken down into estrogen and progesterone. That is blocking the conversion from the androgen. It is not a valid test if you are either on one of those types of drugs.

Dr. Eric: Is there anything people shouldn’t do with regards to supplements or foods they shouldn’t take or eat? There is some controversy with phytoestrogens like soy or flax. If you don’t mind, can you talk about the phytoestrogens?

Dr. Carol: In answer to the question of to soy or not to soy, because I wrote an article about that, where we need to start is looking at the Japanese culture before it became Westernized, i.e. fast food and American-style processed food. When it was pure Japanese culture, they had almost no breast cancer. That right there is research for the answer of soy or not to soy. Their soy was non-GMO. If you’re getting organic, non-GMO soy, and it hasn’t been fried in a toxic saturated fat oil and turned into a soy snack, soy and gluten-free tamari are fine.

Are we eating eight ounces of tofu seven days a week? That’s a problem. How can someone really do that? If you are eating four ounces of steamed tofu, like I made a kale and tofu dish last night for dinner, and I had two thirds of a block of organic tofu in it, and I will have some for lunch today, there is nothing the matter with that. That is not going to increase the estrogen in your body.

Neither is soy milk. I am not a big proponent of soy milk. Even though people do their best to make sure the soybeans are non-GMO, it is very difficult to control all of that. If you are drinking eight ounces every day, that’s a lot. At this point, there are so many nut milks you can drink that you don’t need to be drinking soy milk if you want a non-water product to drink.

I don’t think there is a problem with soy. The caveat is it needs to be organic and non-GMO, and you shouldn’t eat it every day of the week.

Dr. Eric: I assume flax is okay, too?

Dr. Carol: There are two different types of flax. There is a lighter seed and a darker seed. You want to buy the darker seed. You want to make sure it’s organic. You want to smell it before you bring it home if it’s in one of those bulk things. Flax as an oil is sensitive to heat. If it smells fine, you want to bring it home, put it in a glass jar, and keep it in the freezer or refrigerator.

What I recommend is you use a mortar and pestle before you put it in your smoothie to break up some of those seeds, or you get yourself a $10 coffee grinder you just use for the flax and pulse it two or three times. You don’t need to make apowder of it. You want to break up some of those seeds. If you don’t want to do any of that, fine. People put it into their smoothie whole and drink it every day. You get more of the lignans available.

What are we doing, eating a pound? We are eating a tablespoon or two in our smoothie. Sometimes this verbiage gets out there, and people go, “I can’t eat flax.” Flax is a healthy oil. It’s a powerful antioxidant. It has positive anti-inflammatory lignans in it. I think flax is a wonderful thing to eat every day.

Dr. Eric: What I do is buy organic whole flax seeds and do what you mentioned. I put a tablespoon in a coffee grinder and add them to my smoothie.

Dr. Carol: It’s an easy way to get a lot of positive lignans. I should say that Dr. Eric’s area of expertise is the thyroid. Often, the stress of going through cancer can bring out a latent thyroid problem. There is fatigue that is associated post-chemotherapy/radiation/surgery. With the addition of hormone-blocking drugs, there is a lot of fatigue that shows up. One thing we need to look at is have you developed a thyroid problem?

If you are having unexplained fatigue, when you go to the doctor, too often they will say, and this is an upsetting phrase for me, “Let’s just put you on some antidepressants for a while and see if that helps.” I am not opposed to antidepressants, but I don’t think it should be the first line of therapy.

If you’re having unexplained fatigue, first of all, it’s not unexplained. You have been through an arduous 18 months or longer of treatment. It can bring up a thyroid problem. There is a lot of emotional trauma that women tend to put on the backburner when they are getting through treatment. When you finish, it comes rushing up, and you are emotionally overwhelmed.

Before you go on antidepressants, which might be your choice, let’s see if it’s a thyroid problem. Let’s see if detoxifying works. Let’s see if working with an integrative person for a month or six weeks works, if you have that time frame. If you are severely depressed and can’t get out of bed, that’s more like an urgent care moment. But if it is low-level depression, let’s do a differential diagnosis and see if it’s your thyroid. Do you need to detox? Do you need to do some therapy to appreciate and understand all the trauma you have been through because it is very disruptive of your life? It does create a ripple effect not just for you, but for your spouse and household.

The other component of this is when you are done with active treatment, your workplace and your family think, “She’s done now. She is going to be back to her normal self.” That is not necessarily the case. You may not be feeling well. You may have fatigue. You may have emotional trauma. You may have developed anxiety. All of these are real and appropriate. You are not back to yourself.

You may have had body changes. If you had surgery, you had one or two breasts removed. That is a big deal, even with reconstruction. It is not such an easy moment. Fatigue and depression are very common and normal. That is part of the emotional recovery work we need to do and help you with when you have been through cancer of any kind, especially breast cancer.

Dr. Eric: It sounds like it’s common for women who go through this to have fatigue and depression, which is not a surprise. You will recommend for them to do a full thyroid panel?

Dr. Carol: Absolutely. I love testing. I’m a big testing person. Testing provides us information about what’s going on in your body metabolically. Cancer is a metabolic disease. The more information we have, the easier it is to address that with nutrition, supplements, and lifestyle.

Just doing TSH is inept. We need to know if you are having inflammatory antibodies show up in your thyroid. Are you developing hypothyroidism/Hashimoto’s? Very rarely does a doctor do a complete thyroid panel the first time. If a woman knows to say to a doctor, “I want more than TSH. I want this, this, and this,” then they can hopefully have a doctor who works with them to get those additional tests done.

Dr. Eric: Agreed. Unfortunately, a lot of medical doctors will still only look at the TSH. Endocrinologists might go a step further and do a T4. Maybe free T4 and free T3. The antibodies, it depends. I deal with a lot of hyperthyroid patients. Usually, they will test for antibodies. With Hashimoto’s, the treatment is pretty much the same. If they don’t have antibodies, they will be given thyroid hormone replacement. Either way, I agree. Regardless of the symptoms, more hyper or hypo, do a full thyroid panel with antibodies.

The reason I wanted to interview you is because I have had some patients with breast cancer. Interestingly, I have had more patients with Graves’ who have breast cancer than Hashimoto’s patients. It could also be because I see more patients with hyperthyroidism/Graves’ than Hashimoto’s because that’s what I dealt with. Maybe there is a higher prevalence in Hashimoto’s, I’m not sure. Either way, there is that risk. I don’t even know if there is an association. I think the research is unclear.

Dr. Carol: Between thyroid disease and breast cancer?

Dr. Eric: Yes.

Dr. Carol: I don’t know of any. I’m not saying there is or isn’t. I haven’t researched that component of that illness and breast cancer. In my clinical practice, it’s not uncommon for a woman to develop a thyroid disorder after the physiological and emotional stress of treatment. I don’t think of hypothyroidism contributing to breast cancer.

Dr. Eric: From what I have seen, I don’t think so either. It’s a little bit iffy with hyperthyroidism. There are some studies, but it seems to be unclear as far as there being a connection. We will see what future research shows.

If someone was recently diagnosed with breast cancer, what are some action steps that she could take for those looking to take an integrative approach?

Dr. Carol: Understand the oncologist at the medical center has a certain area of expertise. Integrative care is not their skillset. They follow a protocol that has been researched: With this type of cancer, you get a mammogram, then an MRI and an ultrasound, and then a biopsy. That generates a pathology report. From there, it’s decided if you need neoadjuvant chemotherapy, which means the tumor is a certain size, it’s hormonal-positive, and they feel if they give you chemotherapy beforehand, the tumor will shrink. Hopefully you will be able to have a lumpectomy and not a mastectomy. There is a lot of decisions to make in that initial chapter.

Bringing in an integrative practitioner right away to help you, first of all, make sure you are getting the right tests. For example, if you have DCIS, the next moment, the oncologist should order an oncotype breast cancer recurrent index test. What that does is it gives you a number, which will tell you your risk score if you do chemotherapy and/or radiation. Doing that will reduce your risk of recurrence by XYZ%. That is important information. You want to know that.

Unfortunately, sometimes women have DCIS. I will ask them if they have an oncotype, and they go, “No, the doctor didn’t order it.” If you know that, you can say to the doctor, “My understanding is this is a really valid test that should happen with my type of breast cancer. I am wondering if you can order it.” It should be ordered.

There is other more advanced diagnostic genomics SNPs testing. According to the methods the oncologist use, they may not be used at the first stage level. For example, there is the Caris Molecular Intelligence test. There is the NeoGenomics test. Those go further into the genomic SNPs that created your breast cancer. They will give you chemo sensitivity. What types of chemodoes your tumor respond to? It will also say these are the clinical trials you might be eligible for.

The way medical oncology works is that test is not usually run as part of first line treatment. If you have the funds, you can talk to the doctor about it, and you will have to pay out of pocket because first line treatment will not cover those tests. If you fail chemotherapy, then your insurance can be billed, and it should be covered because it is part of second line treatment. There is a lot of information you need to know about that that is not normally discussed with your medical oncologist.

Dr. Eric: Is there anything I didn’t ask that I should have asked? Anything else you’d like to discuss?

Dr. Carol:I want to discuss reducing risk of recurrence because so often, women finish active treatment, ring the bell, and all of a sudden, the oncologist disappears, you are told to take a pill, and that’s it. That really isn’t it. Cancer is a metabolic disease. That gives you a lot of empowerment to reduce the risk of recurrence because you have the ability to make your body less hospitable to cancer recurrence. It doesn’t have to be random.

That is how I developed my Empowered Against Recurrence program, which is an online, live, group coaching program with me. You also get the other part of my program, which is science-based, educational, and you have 24/7 access to it. I am bringing this information to the world beyond the ability of who I can see in my clinical practice.

Dr. Eric: Where can they find out more about this program? I assume your website.

Dr. Carol: I have a website for this called EmpoweredAgainstRecurrence.com. You can go to my practice website, which is my name, CarolLourie.com. Use the Contact Me page at the top. Send me an email. I will send you the information I think is appropriate. I answer all my emails personally.

Dr. Eric: Thank you so much, Dr. Carol. I appreciate you sharing with everybody your experience and thoughts on an integrative approach to breast cancer. Anything else as far as resources? Or is everything on your website?

Dr. Carol: I have a lot of free downloads on my website, CarolLourie.com.

Dr. Eric: Wonderful. Thanks, again. I learned a lot today.

Dr. Carol: My honor and pleasure. Thank you for having me.