Recently I interviewed Beth O-Hara, as she discussed how to 0vercome mast cell activation syndrome and histamine intolerance. If you would prefer to listen the interview you can access it by Clicking Here.

Dr. Eric Osansky:

With me, I have Beth O’Hara, who is a functional naturopath and functional genetic analyst. She has a doctorate in naturopathy specializing in functional naturopathic approaches and a Masters in marriage and family therapy. She has over 10 years of experience working with hundreds of clients with mast cell activation syndrome (MCAS), mold toxicity, and related conditions. She has been through this journey herself, going from bedridden in excruciating pain and unable to function to living a full and joyful life by addressing the underlying root causes. Her mission today is to empower those struggling with sensitivities and significant chronic illnesses to reclaim their own full potential through individualized, precision approaches. Thank you for joining us, Beth.

Beth O’Hara:                          

It’s great to be here. I’m so excited. I think a lot of people in the community you have will find some light bulbs going off in this conversation. There is a big link to what we’re talking about and thyroid issues.

Dr. Eric:

I agree. I’m excited as well. As I said in your bio, you had a significant health journey yourself. That’s what got you into this field. Can you share some of that journey with us?

Beth:

Sure. I find that it’s a journey that a lot of people in the chronically ill population can relate to. I’d like to start there because it gives people hope. I started developing health issues when I was a child. I was about eight or nine when I started having some strange symptoms. We had moved to the country into an old farmhouse. I’m in my 40s now, so this was a few decades ago. Nobody knew anything about mold or Lyme back then. It’s not even talked about enough now, but back then, it really wasn’t on the radar.

Looking back, the farmhouse had quite a bit of mold, so I developed mold toxicity at a young age. We were in the country. We played outside. We were bitten by ticks. I thought we were having a Laura Ingalls Wilder kind of adventure. I didn’t have the stamina that my friends had. I couldn’t keep up in sports. I didn’t have coordination. Then I was kicked in the head by a horse when I was nine and had a traumatic brain injury. I had severe anxiety. I was then in a car accident when I was 16 and had severe fatigue. I just couldn’t seem to come back from that. I would whip myself every morning just to get out of bed to get to school on time. I did keep moving forward.

I was very driven to go to medical school, and that was the only thing I wanted to do. I had no backup plan. To illustrate how important this was for me, for my birthday, all I wanted was copies of Grey’s Anatomy. That was all I cared about. I was the weird little kid going through the woods finding bleached piles of bones and trying to put the skeleton back together. This was my super interest and my passion.

I went to college. I developed fatigue and brain fog, and the anxiety was severe. My junior year of college, I moved into a duplex that was 150 years old. It smelled musty in the basement. I didn’t know about mold again. My health really crashed. I worked my rear off and had multiple scholarship offers to medical school, and I had to turn them all down.

Instead of getting to go pursue my dreams, I became this chronically ill person. By the time I graduated, I barely finished my Bachelors. I went from this high-performing person, working three jobs, teaching at a vocational school, doing independent study research, taking graduate school classes, to taking the minimal number of credits to graduate. Nobody could figure out what was wrong with me. I had joint pain. I had brain fog. I had severe fatigue. I had blood sugar crashes to where I had to eat every two hours. Just to go out of the house, I had to bring a snack. This continued to accelerate so by the time I was in my later 20s, I had to walk with a cane. I wasn’t really even walking; I was barely hobbling. The joint pain was like walking with ground glass stuck inside my knees and my toes and my fingers.

I was misdiagnosed with rheumatoid arthritis. Treatments didn’t help because it wasn’t the right diagnosis. If nothing else, I was persistent in trying to find help. I exhausted traditional medicine, holistic. I did homeopathy, shamanic work. I did anything I could do. I did therapy to clear any kind of emotional pieces. I was the most complex case that all the practitioners I’d seen had ever worked with. They would tell me, “I have never met anybody as complex as you.”

I became extremely sensitive. I couldn’t tolerate any medications or supplements. I was having paradoxical reactions to everything I tried. Practitioners started telling me I was crazy, that it was in my head. I wanted to be sick, and I was getting something out of being sick, which was the farthest from the truth. I share that part because that’s also a common story. I hear it every week in my clinic. I’m sure you hear that all the time.

Fast forward. I had seen about 75 practitioners. I just kept spiraling downward until I hit a whole year of being bedridden. I could barely function. It was a good day if I could get the dishwasher unloaded, and then I couldn’t get it loaded. It was too much.

But I did land on first histamine intolerance. I had itching head to toe. I had all kinds of GI issues. Sleep disturbances. I didn’t sleep for four years. Practitioners would tell me, “You can’t go more than two weeks without sleep.” Not true.

Then I learned about this thing called mast cell activation syndrome. This was when it was still in the theoretical phases. This is fairly new on the scene of traditional medicine. There have been studies and theories about this for a few decades. Case studies coming around 2000, theorized around late 1980s/early 1990s. When I saw the descriptions, I said, “Oh my gosh,” everything makes sense. My GI symptoms, my skin symptoms, brain fog, fatigue, anxiety. This horrific insomnia. All of this is connected. The bladder pain, everything I was dealing with. I had symptoms in every system. I was pretty severe.

Learning about that started shifting my mindset of what we were looking at. I realized we weren’t chasing all of these separate things. This is all connected. The next question was why? Why are these mast cells dysregulated? We knew I had Lyme and bartonella and babesia, but I couldn’t treat it. Then we realized I had mold toxicity. That brought this huge lightbulb to what was going on, why I had the nervous system dysregulation, why I was so sensitive. That allowed me to start to unravel what was happening. I unfortunately had this premed back then. Every moment in my brain would work, I was studying, I was pulling things out, I was chasing down anything that could help. I started putting pieces together.

Eventually, I did get my brain back. I got my life back. I can wear heels, which doesn’t sound like a big deal to most people but is super exciting to me. I was somebody who at 28 had to walk in orthopedic shoes. I don’t wear stilettos, but I can wear cute shoes. I can go hiking. I don’t have stamina like an athlete does, but I can exercise for an hour. That’s a huge thing for me.

I went back to graduate school. I got two graduate degrees. I started this busy practice. I work a little too much and am working on that. But I can do it. I feel vibrant. I don’t feel like the person from 15 years ago. Even telling the story, I feel like I’m talking about this other life. It’s not the life that I relate to today. I do have a lot of health maintenance. I’m not out there eating Pizza Hut and McDonald’s. I eat very clean. I take my supplements. I exercise. I do my castor oil packs. I do my sauna. I do all the things to take good care of me.

But you can recover. I was one of those cases that practitioners didn’t think I would come back from. I was told I would be in a wheelchair by the time I was in my 30s. I could expect to have really poor quality of life. That road I was going down, that’s what was to be expected. Fortunately, we know all kinds of things we didn’t know 15-20 years ago. I see very similar cases: People recover within 3-4 years. They don’t take the 15-20 years that it took me or the hundreds of thousands of dollars it took me. That is the light at the end of the tunnel that I want to share.

Dr. Eric:

Thank you so much for sharing that story. You have been through a lot, but it’s great you’re doing so much better. Like you said, you need to maintain your health. You can’t go out and eat anything, and I’m sure stress management is important. Diet and lifestyle is huge with any chronic health condition.

One thing I want to ask: Most listening to this have a thyroid or autoimmune thyroid condition. There are certain symptoms associated with hyperthyroidism and hypothyroidism, some of them more classic, some of them not as common. With MCAS, are there classic symptoms associated with it, or does it really vary depending on the person?

Beth:

Great question. Maybe we should start because this may be brand new for some people: What are mast cells? I like to think of these as our front-line defending and sensing cells of the immune system. They’re in almost every tissue in the body. The only tissue I have ever seen documented that is up to date is the retina doesn’t have mast cells. I used to think the brain didn’t have mast cells, but that has been disproven in the last few years. We even have mast cells inside the brain. They’re sensing every molecule of air, food, water, supplement, medication, anything you put in your mouth, anything that we smell, that we touch. They’re sensing stressors. It’s that role of chronic stress.

They’re also sensing what’s happening inside our bodies. They line the blood vessels. They’re sensing the blood going through the vessels. They have hormone receptors for things like estrogen, progesterone, and thyroid hormones. The thyroid tissue has mast cells. They have over 200 different types of receptors. Some of the most complex cells in the body. They’re also sensing for pathogens, viruses, bacteria, parasites, molds, yeasts. There are all kinds of censors for different types of medications, even Vitamin D, which is actually a hormone.

And neurotransmitters. They have receptors for many different types of neurotransmitters and neuropeptides. They have over 1,000 different mediators housed inside of them that they can release. Most people are familiar with histamine. They are one of the major cells that release histamine. A couple others in the body. Prostaglandins, cytokines, now a household name. We could go down the list. Cell signalers.

What they do is mobilize an immune response if it’s needed. For example, if you cut your finger, you don’t get the bacteria cleaned out, and it starts to get red and puffy. That is the mast cells creating local inflammation as a protective mechanism. If we get a surgery, we get some local inflammation around the surgical site. Part of that is mast cells protecting us. If we get sick, and we get sinus congestion and the sore throat, that is not the virus itself, that is our immune system launching a protective attack.

They should be doing this normal protective response and then restabilizing. They are releasing these inflammatory mediators to protect us and then restabilizing themselves. In MCAS, the mast cells have become dysregulated for a variety of reasons, but really, it boils down to an overload of pathogens, toxins, stressors. Stressors could be emotional trauma, injuries, surgeries, and so on. Any combo of those.

Instead of being security guards, or guards of the castle gate, they are on an eight-hour shift, they do their work, they protect you, but they get to take a break and recharge. Just like as human beings, if we work security duty, we would need to take a break and recharge. But we live in a world now that is an onslaught of chemicals, EMFs, mold. All this stuff coming at us. So much that we didn’t have 150 years ago, 1,500 years ago, 15,000 years ago. Our mast cells haven’t caught up to this rapid change in the world that we live in. Even the level of stress that we have, just getting the kids to all the extracurriculars and getting through traffic and trying to pay the bills and coming out of this pandemic. All the stuff we deal with day in and day out. The war in Ukraine. The amount of stress that we’re all under day to day is astronomical compared to what we used to have.

Now the mast cells, instead of getting to do their protective job and relax, are all on guard 24/7. Just like if we were on guard 24/7, we would lose our ability to think clearly and start to lose our fine tuning. Instead of just firing at pathogens and toxins, now they are firing at what I think of as butterflies. We can start to have increased inflammation for all kinds of reasons, things we may not even think of as being triggering. Some people get food triggers. Not all but some. Some people get triggered by perfume somebody is wearing in the grocery store. They get triggered by the fragrance in laundry detergent, by molds, and so on.

These mast cells can become hypersensitive and overresponsive. The important information about this is MCAS is now affecting 9-17% of the general population.

Dr. Eric:

Wow.

Beth:

It’s huge. That’s at least one in nine. We’re talking closer to one in seven people dealing with this. People have no idea. It’s one of the most under-recognized, under-addressed conditions.

How do you know if you have this? There is going to be inflammatory symptoms in two or more systems: skin, GI tract, thyroid, bladder, reproductive organs, muscles, bones, nervous system, brain. Anything like this. That’s what makes figuring out who has this tricky. You need to have other things ruled out. Make sure there is not a cancer, IBS, those types of things. But those are all linked to mast cells. If there is inflammation, there is some mast cell involvement.

Symptoms can vary greatly. To circle back to that first question, symptoms can really vary because it depends on which mast cells are activated, in what tissues, which of these thousand mediators are being over-released, and which receptors are overly sensitive. If we think about the number of possible combinations there, it’s almost impossible to calculate.

Some classic examples are people who have skin symptoms, like hives, rashes, flushing, allergy symptoms. We’re not talking seasonal allergies. That is there for a short term, with pollen, and then it’s gone. This is going to be year-round. It may wax and wane, but it’s not like you have it in the spring and fall, and then you’re fine. And it has to be multiple systems. Some people get anaphylaxis reactions or anaphylactoid reactions. Those are the really frightening, “My throat is closing. My chest is tightening. I feel like I’m going to pass out. I do pass out. Blood pressure drops.” You don’t have to have those to have MCAS. Not everybody gets skin symptoms, so that’s some misinformation out there. If you don’t have hives, you don’t have MCAS. That’s not true.

Some other presentations can be GI issues: acid reflux, constipation, diarrhea, abdominal pain, the visceral hypersensitivity kind of pain. It can be lung issues with congestion, asthma, chest tightening. We can have sinus-related symptoms: post-nasal drip; red, inflamed, itchy eyes. We can have issues with urinary burning and pain. For women, we can have menstrual difficulties. Muscle pain, joint pain, fibromyalgia-type pain. Hypermobility is really linked. Orthostatic, tachycardia syndrome. Blood pressure changes are rapid with sitting and standing.

Because there are so many symptoms, we could spend the whole time doing just symptoms. I did put together a symptom survey people can find for free on our website, MastCell360.com. Under MCAS, there is the Symptom Survey. That’s based on the symptoms clearly correlated in the research. The more symptoms you have, the more likely you have MCAS. You can just count them.

Every form of autoimmunity that has been studied in relationship to MCAS has been linked to the mast cells. That will include Hashimoto’s, Graves’, rheumatoid, autoimmune GI symptoms, eczema, psoriasis, all these things. The reason is mast cells sit at this interface of the immune system. They have a role in fighting off pathogens. When our pathogen-killing side gets overwhelmed, this chronic inflammation side comes up, and those work like a seesaw. We have this elevated TH-2 for a long time. Certain positions can open us up toward autoimmunity, branching off that TH-17 response.  You may not develop autoimmunity. As far as I know, I have not had autoimmunity fortunately. But there is a huge number of people with MCAS that do have autoimmunity. If you have autoimmunity, that is a dead ringer. Go check for MCAS.

I know that was a long answer. Hopefully that hit at what you were asking.

Dr. Eric:

You gave a lot of great information and answered some of the questions I had for you. With the prevalence, you said 9-17%?

Beth:

That’s what the population studies have shown.

Dr. Eric:

I assume it’s increasing just because of the factors you mentioned earlier, like the increased toxic burden, the mold.

Beth:

We do think it’s on the rise. Just looking at case presentations from decades ago, beyond the increased understanding. When I talk to people who have been in practice for 40-50 years, Dr. Neil Nathan is a mentor and friend of mine who has been in practice for 40 years. He talks about noticing that the cases have gotten more complex, more challenging. Have you noticed that in your practice?

Dr. Eric:

I have. I have been doing this now for about 12 years. I would say that I think with any practitioner, the more experience they get, the more complex patients they see as well because of that experience. I think it’s a combination, but I agree. I would definitely say over the years I’m seeing more complex patients compared to 10-12 years ago.

Beth:

What I am finding is what worked 10 years ago isn’t working today. We know that something is shifting. Someone came in with candida issues, and I could work with them on herbals 10 years ago. They would be cleared up in 3-6 months. Boom, they were happy. That was easy. It’s not knocking it out now. Even these organisms are changing with what’s happening in our environment.

Fortunately, we have the knowledge to address it. We need more practitioners working in this space. We have some trouble that we’re in around what’s happened environmentally.

Dr. Eric:

When it comes to multiple chemical sensitivities, is MCAS linked to that as well? Or is it a potential cause?

Beth:

There was a great study that came out- Tania Dempsey was a co-author on that study. They called it TILT; I’m forgetting the acronym. That study definitively showed a role of mast cells in chemical intolerances, which makes a lot of sense because these mast cells are sensing everything that’s happening chemical-wise, whether we’re getting it through skin products that have parabens or a Glade plug-in, and releasing inflammation. They line every nerve ending and the nerve sheaths.

Mast cells are interwoven with the nervous system. That is why I said it was really important that mast cells have receptors for neurotransmitters. They can also release certain neurotransmitters. The nerve endings have receptors for some of these mast cell mediators. There is this constant cross-talk. That’s why when we start to get into MCAS, if we have a flare, they are getting triggered and activated, we can get all these nervous system symptoms, like heart palpitations or throat closings being triggered from the nervous system signaling. That’s why we can get reactions within fractions of seconds.

When people say, “As soon as my husband starts grilling,” someone for whom that’s a trigger may literally start to have reactions before they register the smell because the limbic system has already registered it. There are mast cells in the limbic system. It’s sending a danger signal through the body. This is often when people are told they are crazy because they used to think that immune cells could react that rapidly, but it’s through that nervous system signaling that it’s happening.

Dr. Eric:

You mentioned an overlap between MCAS and different autoimmune conditions. Not everyone with MCAS develops autoimmunity, like you said. As far as you know, you don’t have an autoimmune condition. Just so I can better understand, some of the same triggers of MCAS could also affect autoimmunity, such as food, stress, chemicals, infections, the shift in the immune system, the TH-2 dominant condition.

Beth:

It is. We looked at all these chronic conditions, like autoimmunity, MCAS, cancers, bowel disorders, neurodegenerative diseases. We keep trickling them down to the same root causes: pathogens; toxins, including mold; chemical toxins; metals; and stressors. We underestimate the role of chronic stress, but it’s huge.

The model I found that describes it the most is the cell danger response (CDR) model developed by Robert Naviaux, who looks at when we have an overload of these events, then the body is going to go into protective survival mode. The expression of that is going to look different person to person depending on their unique biology. For some people, it’s MCAS with autoimmunity. For some people, it will be neurodegeneration or cancer. We can pull it all back to the similar to problem. How is it going to be expressed?

In terms of these triggers, for example, food, certain smells, they are variable from person to person. Some people have histamine intolerance. Lectins are big in autoimmunity. Oxalates are a big deal in the thyroid. They enlarge the thyroid and can disrupt the thyroid functioning. A lot of times, it’s where the biochemistry is getting disrupted by something underneath. We peel back to why. If we can address that why, many times, the expression and sensitivities will improve.

I used to be so incredibly sensitive. If someone is on an elevator, I couldn’t go in because I couldn’t take the risk that they were wearing any type of fragrance. I don’t want to risk passing out in the elevator with a stranger. I couldn’t take an Uber or a taxi because they would have those fragrance things. When I couldn’t walk, that was oxalates, I realized over time. I can tolerate a much wider variety of oxalates now. I don’t eat beets, sweet potatoes, almonds, chard, or spinach now, but I can eat all kinds of foods that I couldn’t eat before with a dressing. The mold toxicity, the Lyme layers, the load is off of my body. We see that a lot in autoimmunity as well. People may have to be careful with lectins long-term because those are different in terms of activating. There are leptin receptors on mast cells, so it’s part of that link.

Dr. Eric:

I also read a journal article that said mast cells can potentially decrease regulatory T cells, which keep autoimmunity in check. That is another potential mechanism to make someone susceptible to an autoimmune condition.

Beth:

It’s through this cytokine network. There are inflammatory and anti-inflammatory cytokines. That level is beyond what I understand right now. Serious immunologist level. They’re communicating to the B cells, T cells, and every kind of immune cell there is. I think of mast cells as being one of the big conductors and orchestrators of the immune system, keeping everyone in check. They are not the only cells doing that, but they have a big role to play. If your conductor gets out of sync, the whole orchestra will be out of sync and start to get dysregulated, too.

Dr. Eric:

Are there any other links you know of between thyroid health and MCAS?

Beth:

One of the biggest ones is mold toxins. This was a game changer in my practice in terms of really jettisoning the successes we got. We realized how common this is. Many people are underestimating the impact of mold on their chronic illness. Either they get a urine test, which shows low levels. They don’t realize those are fat soluble, so everyone has low levels on the first test. Or they only get one test, so it looks negative, so they don’t go any further.

Mold toxins have a huge effect on the thyroid. I do more frequently see hypothyroid. The thyroid needs iodine. In the mild toxicity population, I see iodine supplementation, until that mold layer is addressed, can tip people into hypothyroid. I did that to myself. I know I mentioned before I had hypothyroid. I was trying to get a little bit of iodine in. I am not old enough to have perimenopause; I think I’m not ready yet. I started having these heat flushes, and I was sweating. I didn’t used to sweat. All of a sudden, I am sweating in December. I run cold all the time, and I like it to be 78 degrees. I am hitting it down to 70, and my husband is cold. He is the Canadian, so he is usually hot.

We do have to be careful with that. I don’t know the exact mechanism of why, but I find people are more sensitive to iodine. It has a real disrupting effect on the thyroid function itself, on the thyroid hormones. We often will see that hypothyroid state. It usually gets better. I’m sure you find gluten being a big role with those proteins being so similar to thyroid. Getting the mold toxins out. If people can’t get those Hashimoto’s antibodies in check, they will get those mold toxins addressed, and they will usually drop down pretty well if other triggers are handled. Not if someone is eating gluten.

Dr. Eric:

A lot of people who have mold also have Lyme. If someone has mold and Lyme or coinfections like bartonella, would you prioritize the mold? The first problem is trying to get rid of the source of the mold.

Beth:

That is often a game changer for people who have had cases like mine and can’t tolerate Lyme treatment. Or people who have had Lyme for years and years and still have symptoms. There is often this missing mold layer. If someone has acute Lyme, they were just bitten by a tick last month, they have the fevers, and they are trying to fight off the infection, that’s a different story. People who have had chronic Lyme for years, like I did, if there is that mold layer, I find it’s much better to peel back the mold layer first for a few reasons.

Lyme and mold have very similar symptoms. When I say Lyme, I mean that to mean tick-borne infections. Particularly bartonella can look like Lyme. Not everyone gets this, but lightning bolt pains, or these shooting pains that move around. Tinnitus is really common. One of the most challenging symptoms. If you clear the mold layer, about 30-40% of cases, at least that I see, can spontaneously clear the Lyme. The body’s immune system kicks in.

That happened for me. As I worked on these other layers, my Lyme symptoms went away. They’re nonexistent. I never tolerated the antibiotics or stronger herbals. But about 60-70% have to address the Lyme or tick-borne infection layer. They tolerate the treatment so much better because you have gotten this massive toxin load out. As you are killing these pathogens off, the body is not trying to clear all these mold toxins with the biotoxins. The immune system is in better balance since mold toxins are huge immune deregulators.

We don’t give mold toxins the kind of credit they deserve in terms of how toxic they are. To put it in context for the listeners, they use these mold toxins for chemical warfare. Mycophenolic acid is used as a chemotherapy drug, and it’s one of the most toxic. They are highly carcinogenic. They disrupt every system of the body. It’s extremely estrogenic. It’s numerous times more powerful than human estrogen. Lots of reproductive cancers and other issues associated with that, like endometriosis and PCOS. We need to take this seriously. Neurodegenerative issues, Parkinson’s, Alzheimer’s, are linked to it. Big deal.

Dr. Eric:

You mentioned histamine is just one of many mediators released by mast cells. Can you talk more about the relationship between MCAS and histamine intolerance? How someone could know if they just have histamine intolerance versus MCAS.

Beth:

The symptoms can be similar. Histamine intolerance, we’re just talking about histamine. We’re not talking about tryptase or any other mediators. Histamine intolerance happens when the histamine in our bodies exceeds the capacity of the enzymes that break it down to remove it. The major enzymes we talk about are DAO, HNMT, which is dependent on methylation. Some of our more savvy listeners probably found that out. There are these other enzymes rarely talked about that are related to it: ALDH, which also breaks down alcohol. People with histamine intolerance often have trouble with alcohol as well. That pathway is affected. Acetylation, there is liver pathways. There is a glucuronidation pathway involved, and so on.

DAO is one of the big ones. It’s made primarily in the small intestine. You can have genetic issues that can impact that. If you have any kind of gut inflammation there, that will affect those small intestinal brush border cells in being able to make it as well. If you have nutrient depletions, too. If we can’t break it down-

I like to think of it as a sink. The histamine coming into our bodies through our foods or that is being triggered and released by the mast cells, that is the water coming out of the faucet. These enzymes are like the drain. If we have water pouring into the sink, and the drain is clear and open and large enough for the water flow, the sink will keep draining, and we are fine. If that water exceeds the capacity of the drain, or the drain gets clogged and gets smaller, the sink will overflow, and we will get those symptoms.

They can be similar because histamine is triggering the mast cells. The mast cells have four different types of histamine receptors. We can get GI symptoms, like acid reflux or diarrhea, constipation, flushing. People familiar with flushing after red wine. When I started getting into nutrition, I got into the Weston A Price work, which is wonderful work. I am a 150% person because I overdo everything. My kitchen looked like a laboratory. I had my kefirs and my cultured veggies and kombucha and raw milk. It’s all high histamine. I couldn’t figure out why I was itching head to toe 24/7, scratching my skin until it bled. I realized I was overdoing the histamine. Let’s dial this back.

Other foods like walnuts, spinach, cashews, peanuts, strawberries, pineapple, we have a thorough list on our website. I want to caution people to use a well-researched list. Dr. Janice Joneja’s work is really good. There is a SIGHI list. A lot of lists online are copied from other lists, and they make mistakes in the copying. About 95% of them have errors. Make sure you use a good list.

That’s histamine intolerance. If all that’s someone has, and they don’t have MCAS, the symptoms are usually much milder.

With MCAS, the symptoms will be more varied, complex, and intense. Someone could have MCAS and not have histamine intolerance. They may have issues with the other mediators with no problems with histamine. I have had some people come through who did a low histamine diet trial for six weeks. I usually ask people to do low histamine and low lectin for six weeks, see if you get a symptom improvement, and then introduce some high histamine foods to see if you get an increase in symptoms. That is the easy way to determine.

If you add in some DAO supplementation- Methylation supports are too tricky in this population, so I don’t do them early. That’s usually about two years into a program. If we get big improvements, histamine intolerance is on the table. I don’t get very many people who just have histamine intolerance. I’ve had a few, but I’m overkill for that, so I don’t see many of those people. They have usually figured it out on their own and are much better just doing those steps and are good to go. You still want to go, why? Why aren’t you making DAO?

I’ve had just a handful of people who only have MCAS without histamine intolerance. Most of my clients have both. They find they do get some symptom relief reducing the histamines and supporting that DAO and other histamine degrading pathways and what’s affecting them. It doesn’t clear it up. It’s not going to do enough.

That’s what I found myself. I followed the low histamine diet for about two years, thinking I found the Holy Grail before I knew MCAS. This will handle all my symptoms. It brought it down a good 20% for me, and it’s still very important. You can recover with that, too. I used to be very limited in the foods I can tolerate. As long as I don’t overdo it, I can have about 10 strawberries. I take my DAO, and I am pretty good to go. That is coming from about 10 foods I tolerated before.

Dr. Eric:

Do you do testing? I know you do genetic testing for DAO. It looks at other things. Do you test for histamine or any other testing related to this intolerance or MCAS?

Beth:

There is a test, Precision Point Diagnostics for DAO and histamine. It’s a good test. It’s not one consumers can get on their own, so I often don’t talk about it because of that. They can get it through you. That’s a fairly good test. It’s not 100%. If someone is on antihistamines, the histamine may look lower than it would otherwise.

In terms of mast cell mediator tests, I don’t ask people to get it because I am a consulting practice. I don’t diagnose. I don’t need it. But also, the problem with those tests is the histamine, the prostaglandins, and so on, to be accurate, they have to be kept chilled from the time of collection all the way through the processing, including the centrifuge has to be chilled. If not, it’s likely to show negative. These mediators are up and down the bloodstream very rapidly. I have known practitioners who had to get that positive mast cell mediator result for insurance coverage for a patient. They had them trigger a flare, which is always hard on people; then have them come in and sit in the office for eight hours; and draw their blood every hour on the hour hoping to catch that spike. There is still a lot of challenges in that testing. There are people who have access to the cold centrifuge labs and can get those samples handled properly. It’s hard to do.

Dr. Eric:

Could you give some action steps where people could heal from MCAS and histamine intolerance?

Beth:

I’d love to. The absolute first thing I tell people to do is I have different phases we work through. The first phase is stabilizing. It means that we are going to identify and lower triggers. If that means we haven’t done a clean out the cleaning product, we will do that. Make sure we are not using bleach or bigger trigger items. Clean out personal care products. Make sure the diet is clean. Most of the people who come in to work with me have already done a lot of work on this. I am not usually starting with gluten, sugar, or dairy. Working on those things and processed foods.

Mold exposure is huge. Most people think they have no mold in their home. It’s rare for me to work with someone who doesn’t have mold in their home once we look for it. Many times, people brought inspectors in to check. They tell them there is no mold issue, but they only run an air sample test, which is the least sensitive. They are comparing your spores of mold outside to inside, which makes no sense because- As an analogy, there are a million cockroaches outside. There are 2,000 cockroaches in your house. You are still not going to be happy with 2,000 cockroaches in your house. Same with the mold. We can’t be mold-free, but we need to be out of the toxic molds, the ones triggering to mast cells. The non-toxic molds aren’t as concerning unless you’re allergic. It is hard to find a good remediator and inspector who understands this level of sensitivity to mold.

That is the trigger management side. You talked about stress management before. Toxic relationships. People don’t realize if you are in a toxic relationship with an abusive person, that will keep your body in a fight or flight state as well.

We work on nervous system support. That is very specific limbic system and vagal system work. Both of those systems have to be worked on simultaneously. We can’t just do one or the other. These are much more refined than a YouTube meditation. Keep doing those; those are great. But we are talking about real specific practices here.

Mast cell stabilizing supplements. Some of my favorite starting points- Is your audience really sensitive?

Dr. Eric:

A small percentage. I would say the majority aren’t.

Beth:

I put my clients into three groups. I will start with the easy category. I don’t get many of those. People who are in the easy category can take some of the combo products out there that are mast cell-supporting. They usually take quercetin. They might be able to handle bromelain or stinging nettle. Those can work. I love the quercetin, perilla seed extract, Chinese skullcap extract. Vitamin D is huge for mast cell stabilizing. Being well hydrated is antihistamine. It’s important.

We mostly work with our sensitive compliance population and our super sensitive people who are struggling with any supplements and medications. Sometimes we will start people with microdosing, and we will take a few granules in water, stir it, and take a couple sips, and that’s it for the day. That entry can be helpful for really sensitive people.

Sometimes when people are super sensitive, I will start them with little sprinkles of baking soda. Baking soda is mast cell stabilizing. Many people have found that it calms down a flare for them if they do a quarter to half a teaspoon of baking soda. If there is high blood pressure, that might not be the right thing for you. Or if someone has extremely low stomach acid, that can make their stomach feel bad. But even sensitive people can do a little baking soda, too. That is our starting point.

All through that, we are looking at what are major underlying issues? What are the root causes? Like we talked about before, if mold is there, I almost always find it if I dig enough, and we look at the right panels for people. Some people are looking at panels that are missing it for them. Then we will address that mold layer.

We have to bring our symptoms down. We have to stabilize first. Once we start detoxing, we will have these swings in symptoms up and down. If someone is way at the top of what they can handle, I don’t want to flare them anymore and have them feeling worse. We will start with some precision targeted binders, going to some liver lymph support. Elimination is key. We have to address the constipation before we do any binders. Then that anti-fungal layer. That lays it out big picture framework.

Dr. Eric:

Thank you so much for sharing. That’s why you said most of your patients, it takes a few years to get them to the point where you are now, correct?

Beth:

On the really short end for adults, we are looking at a year and a half if they are not too complex and have some short mold exposures. Most people are looking at between 2-4 years. If they are really severe like I was, and I had about 30 years of mold exposures from place to place, that can take about 5-6 years. Generally, people are getting improvements as they go along. There is a very small percentage of people who may not feel better until they get all of the mold out of their system and the Lyme treated. That is the hardest case for the client to stay persistent with. It takes a lot of patience, trust, and faith that this will lead them somewhere. That persistence is key. This is hard work. I know your audience knows that. It’s not just taking two supplements, and you will be done soon.

Dr. Eric:

The big thing is that there is hope. It sounds like you are high on the spectrum of complex conditions. It’s great that you’re giving hope to the listeners with complex conditions.

Beth, where can people learn more about you? Your website is MastCell360.com. Can you repeat some of the resources you mentioned?

Beth:

We have the symptom survey on the website. We have our foods list if people are looking at histamine and want a lectins histamine list or an oxalate histamine list. We have a Facebook group, a nice community there. People can do both groups. They complement each other nicely. We have courses that get people started. Wellness stabilization steps, the nervous system, and mast cell supporting supplements. We have what I call my MC360 Precision Mold Masterclass. That helps people get started on their mold journey. They may need a practitioner somewhere along the way because you know how complex that is. It needs to be individualized. It helps people make choices and get going.

Dr. Eric:

Thank you so much for doing this, getting together. I’m sure the listeners learned a lot about MCAS and histamine intolerance. Please do visit Beth’s website, MastCell360.com. Sounds like there are some wonderful resources there.

Beth:

Thank you. I appreciate you having me on and all the work you do as well. We can help people get better faster.

 

Recently I interviewed Julie Olson, as she discussed how to stop hormonal hair loss. If you would prefer to listen the interview you can access it by Clicking Here.

Dr. Eric Osansky:                                                                                                              

With me, I have Julie Olson. We are going to be talking about hair loss with a focus on hormonal hair loss. Julie Olson is a triple certified evidence-based nutrition expert. She specializes in female hair loss as well as gut health and gluten issues. Julie is known to skillfully investigate, discover, and communicate root cause resolutions to naturally regrow hair and regain health. With more than 10 years’ experience collaboration with functional and integrative practitioners as well as her training in functional medicine, Julie has transformed over 700 women’s health and hair. She creates personalized health and hair rebuilding programs for clients that are realistic and sustainable for long-lasting results. This process empowers clients to take control of their own health. Julie’s program restores women’s luscious locks naturally by getting to the root causes of their health and hair loss so that they look and feel their very best. Thank you so much for joining us, Julie.

Julie Olson:                    

Thank you, Dr. Eric. I really appreciate being here.

Dr. Eric:

It’s great to chat with you about hair loss. A lot of people experience it, including a lot of my client base as well as yours since that’s what you focus on. Let’s start off with your background. How did you start helping others with hair loss?

Julie:

Good question. I have been doing this for 10 years. It wasn’t until the last couple of years where I had so many women come to me a hot mess, like I was before I got into nutrition. One of their chief complaints was hair loss. After I got them into balance, their hair started growing back. I experienced severe hair loss before I got into nutrition when I was transitioning over into the field. I didn’t know what to do, so I actually was walking in to get Rogaine. Thank goodness I didn’t because that’s a life sentence. If you get off of it, normally your hair all falls out anyway. It’s a pharmaceutical that has side effects. I really want to let women know that there are natural alternatives out there a lot because all you hear about is Rogaine or other pharmaceuticals or laser or hair plugs. It’s not fair. Like we’ll talk about, it all starts in the gut anyway.

Dr. Eric:

That’s true. Pretty much all health conditions seem to start in the gut. You’re right, the Rogaine still to this day is relied on by a lot of people. Once people are on it, they have to stay on it, or else they lose all their hair when they get off of it, correct?

Julie:

Yes. Normally, that’s what happens. Even on the bottle, it won’t say that. It happens to the majority of people that get off of it. Since it doesn’t happen to 100% of people, they don’t really have strong warnings about it. It’s misleading.

Dr. Eric:

I’m not too familiar with Rogaine as far as side effects, but I’m guessing just like other medication, there are other side effects as well.

Julie:

There is another medication called Finasteride, which is mostly for blocking DHT. A lot of men take that. The side effects are horrible. They lose all their sex drive. There has been a lot of studies actually where men got off of it, and they still didn’t have that sex drive at all. It’s pretty scary.

Dr. Eric:

Yeah, it is. Another reason I’m glad we’re having this conversation. People who might be thinking about taking the medication could realize that you can address the cause of the hair loss. Why is it important to figure out what type of hair loss someone has?

Julie:

That’s really important because you need to address it as soon as possible. You have to isolate the root causes. There are different root causes, and there are different types of hair loss. You have to address them differently. There is no one size fits all. Also, it’s easier to stop the process from getting worse and thicken your existing hair than regrow your hair that’s already gone.

To get more technical, hair follicles become very tiny; they call it miniaturization. Scarring can take place, especially with female hair loss. These conditions usually progress through hair shedding. The more shedding, the faster the miniaturization can take place. This can cause scar tissue, compacting all hair follicles, making regrowth nearly impossible.

Then hair growth exhibits enormous cellular turnover. Some people call it a mini organ because it has such an active metabolism requiring really good nutrients and absorption of those nutrients, which requires an enormous amount of energy. If you’re not absorbing your nutrients, or you’re not eating enough, or if your body is unbalanced, then it’s really hard to achieve hair growth. You probably get a lot of clients as I do who come to you. They might be eating well, but once you start doing functional labs, oh gosh, they’re not even absorbing their protein or healthy fats. It’s peeling back the layers and getting on it right away.

Dr. Eric:

People I work with mostly have thyroid or autoimmune thyroid conditions. The thyroid hormone imbalance can be a big factor. Like you said, if they’re not absorbing nutrients, that also could play a huge role when it comes to hair loss. I’ll let you talk about some of the different types of hair loss. Again, we’re going to focus on hormonal hair loss, but feel free to talk about other types as well.

Julie:

The hormonal hair loss is called chronic telogen effluvium. The main causes are hypo and hyperthyroidism; SIBO; dysbiosis of the gut; nutrient deficiencies or surpluses; and heavy metal toxicities. Those are the main causes. Functional lab tests that I know you do as well can help address it right away, like the full thyroid panel, SIBO breath test, stool analysis, food sensitivity panel, and heavy metals. Even looking at the parathyroid. That’s a hormonal one.

The gut, depending on whether it’s healthy or not, really can produce or block hormones that cause hair loss disorders. They have linked it in a lot of studies. What happens is we have not only our gut microbiome, but we have our skin microbiome. Now they are saying we have our scalp and hair follicle microbiome. It becomes systemic. If we have dysbiosis, it’s not like what happens in Vegas stays in Vegas. It’s not that. It’s systemic throughout our entire body when we have that dysbiosis of our gut. It has a huge impact on our endocrine system, which regulates the secretion of our metabolism and different hormones, including our sex hormones. That being said, if there is any dysbiosis in the gut, studies really show that shifting that bacterial balance to the positive can have a huge favor in hair growth and hair health.

Dr. Eric:

Just another reason to focus on restoring the health of the gut. You are going to talk about the 5R protocol, which I definitely recommend to my patients as well. Before doing that, a couple of things.

One thing with the lab tests. You mentioned SIBO (small intestinal bacterial overgrowth), which could affect the absorption of nutrients. You also mentioned sometimes doing a comprehensive stool panel. Do you recommend those tests on all of your patients? Or does it depend on the history?

Julie:

It absolutely depends on the history. I didn’t even mention the DUTCH test, the hormone test that is important, too. I know you do these. I take each client case by case. I have them fill out- Do you use the living matrix questionnaire?

Dr. Eric:

I don’t. I am familiar with it. It’s from IFM, right?

Julie:

It shows the timeline of the client. You start to put together patterns, and it helps with detective work of deciding what labs to run on them or not. Like you, I like to test, not guess. You can waste a lot of money and time going down the wrong path.

Dr. Eric:

I agree. It’s a catch-22. I don’t want to over-recommend testing. I don’t want to go crazy with the testing. As you mentioned, you could also waste a lot of time if someone doesn’t do any testing, or they just do one test at a time. I would say I’m a little bit more on the conservative side, but that being said, I do run a number of comprehensive stool panels. SIBO testing is more based on their symptoms- The comprehensive stool testing is also based on the health history, but I’d say the SIBO test, at least in my experience, the symptoms are usually more overt. Even that is not always the case.

You can’t always go by symptoms. That’s the challenge when dealing with any kind of condition, including gut. Someone might experience constipation, diarrhea, gas, bloating, but there are also people who just feel fine from a gut /digestive perspective. Then you might do a comprehensive stool panel and still pick up H-pylori or something else. Same thing with SIBO sometimes. There is no perfect method, going by symptoms or doing testing. You have to pick and choose. Like you said, I do prefer to try to find answers rather than say, “Let’s treat someone blindly for SIBO or assume they have H-pylori and treat them for that.” I think we’re on the same page with that.

Julie:

That goes right into the 5R protocol. I spend a lot of time in the first R, remove. There is usually a plethora of things to remove and get in balance. I usually take people off all supplements. People come to me on supplements that they don’t know why they are taking. They’re not even on good quality ones. It’s education as well. Then go through replace, reinoculate, repair, and rebalance. It’s a little different for each person, especially if they have SIBO. As you know, you have to be careful about some probiotics and prebiotics. It can be a fine line. I think it’s really fascinating though. I love the detective work part of it.

Dr. Eric:

I agree.It’s challenging. Sometimes it can be frustrating because certain conditions, like I deal with a lot of Graves’ and Hashimoto’s patients. Autoimmunity is complex. You are right with that first R. A lot of people will be taking probiotics or digestive enzymes or drinking bone broth. Those are all part of the 5R, just the other Rs of the protocol. A lot of people will neglect that first R, remove. If you don’t remove the factor that is causing the increase in intestinal permeability, that leaky gut causing the dysbiosis, you won’t heal the gut.

Julie:

Exactly.

Dr. Eric:

We’re also going to talk a little bit after about fecal microbiotic transplants. I’m excited to chat with you about that. Let’s talk a little bit about some of the causes of the disruptive gut microbiome, the leaky gut. I know you mentioned food sensitivity testing, so there is food as well as other things.

Julie:

I want to mention that the pandemic has been really devastating for hair loss, especially for women, just because of our hormonal makeup. Hair loss between 1-4 months after getting it. They’re really struggling. There are Facebook support groups with 11,000 women. Men can join, too, but it’s really affecting women, hair loss after the pandemic. I really believe maybe they got it so badly just because their gut is out of balance.

If you look at this tree that I put together of root causes, our hormones are created in the gut anyway. If you get that imbalance, then that’s part of the chronic inflammation. Then you will have nutrient deficiencies, malabsorption, high DHT. Even women can experience that. Crash diets, poor digestion, even chronic insomnia, undereating, overexercising, underexercising, high fever, infections, pathogens, parasites, autoimmunity, toxic overload (we talked about heavy metals), even trauma/PTSD. The last couple of years have been pretty traumatic for a lot of people. The list goes on and on. Candida. People don’t associate hair loss with candida fungal overgrowth.

A big one is the thyroid. I want to mention that gluten, especially with your Hashimoto’s patients, you know there is a huge link between gluten and thyroid. Even with hair loss. It’s a cross-reactivity with the gliadin antibody, which attacks the hair follicle. They did one particular study with alopecia, the autoimmune hair loss. The subject was doing pretty well and then started eating a gluten-filled diet again, and the hair loss got worse. That is one of the big causes in making it worse, a mediator of everything.

Dr. Eric:

I wouldn’t make the connection directly. You said there is a cross-reactivity-

Julie:

Part of the gluten protein attacks the hair follicle.

Dr. Eric:

Wow, okay. In a perfect world, we would all avoid gluten. Very important especially for those with autoimmune issues. A study in 2015 showed that gluten can cause a leaky gut in everyone. Even if someone doesn’t feel bad eating gluten, you want to cut it out of your diet. Another reason to avoid gluten now.

Dietary fatty acid imbalance. I probably should test everybody for that, but it is an optional test when I send my follow-up to the patients. It seems like they are almost always deficient. I pretty much put everyone on omega-3 fatty acids. It’s not like I’m neglecting it if they don’t do the testing. I just tell them to take a fish oil supplement. That can cause problems like dry hair if not hair loss. It’s amazing all the different potential causes of hair loss.

Julie:

Even Vitamin D plays a role in stimulating new and old hair follicles. When there is not enough Vitamin D in there, hair growth is stunted. It’s just amazing how even though conventional practitioners now are testing for Vitamin D, I get alot of clients that come to me and have been tested for it, but no one managed to tell them, “You’re too low at 20.”

Dr. Eric:

You have to look at the optimal ranges. Many conventional medical doctors just look at the lab range, which is 30ng/ml or less. If it’s 30 ng/ml or greater, they will say everything is ok. Optimally though, you want at least 50. Maybe even 60-80. 20 and lower is not good.

Julie:

Some are even going up to 100ng/ml.

Dr. Eric:

Yeah, some labs will go up to 80 or 100 as far as the range. Are you talking about the range or the lab itself?

Julie:

Some of the new functional levels are anywhere from 60-100 instead of 60-80 now.

Also, iron is a big important nutrient in hair loss, but the caveat is you can also get too much iron, and you can lose hair. That was one of the reasons why I lost hair years ago. I didn’t know I had gluten sensitivity (not Celiac), and I was anemic because of that. I wasn’t absorbing my nutrients. It’s important to do a whole iron panel, just like a thyroid panel. You want to look at the ferritin. It needs to be at 70 at a minimum. If you get over 300, you will lose hair. That’s way too high. Some say over 200. It’s a narrow range, just like the thyroid.

Dr. Eric:

That’s true. Another reason you want to do a full iron panel is ferritin could also increase due to inflammation.

Julie:

Same with iron.

Dr. Eric:

If you do an iron panel, and everything, serum iron, iron saturation, ferritin is high, it could be inflammation, but also you need to be aware of a potential iron overload. If iron is looking good, iron saturation is looking good, TIBC is looking good, yet ferritin is 300-400, then that’s probably a good indication of inflammation over iron overload. That’s good to know as far as you need ferritin to be at a certain level when dealing with hair loss, but you don’t want it to be too high. If iron is too high it can cause oxidative stress, which overall isn’t good for the body. What are your thoughts on biotin in hair loss? A lot of people will run to get the biotin.

Julie:

Let me add one more thing about iron first. Iron is important because if it’s too low or too high, it affects the hair growth cycle.

Biotin is way overrated. It’s like the last hair nutrient you need. If you don’t have enough biotin, it can cause dry, brittle hair. It doesn’t help with the hair growth process. They put so much biotin in these supplements it’s ridiculous. It’s like they haven’t done their research. It’s way overrated.

Dr. Eric:

Good to know. If it’s part of a B complex or multivitamin, maybe not a big deal. What you’re saying is people shouldn’t run out to buy a separate biotin supplement when it comes to hair loss.

Julie:

There are other supplements that are more important. Biotin just helps to keep your hair from getting dry, brittle, and thin. Our hair is mostly protein, but it’s the branch chain amino acids you only get in animal protein. That’s why a lot of vegans struggle with hair loss because they aren’t getting those amino acids.

Dr. Eric:

You recommend to make sure you get some animal protein in the diet. Even if you are eating animal protein, but are low in hydrochloric acid or digestive enzymes, and having issues with digestion/malabsorption, you might not be digesting those amino acids, which could play a role in the hair loss.

Julie:

Yes. There was another study done on a subject who had H-pylori and was losing hair like crazy. Once they corrected that H-pylori, their hair started growing back. Their absorption was all messed up, so how can you grow hair?

Dr. Eric:

H-pylori is a bacterium in the stomach that could affect stomach acid secretion, which is important for breaking down nutrients and amino acids. If you have H-pylori, in my opinion, you want to get rid of it. There is some debate about It in the functional medicine world.

Do you want to dive into the fecal microbiota transplants? I know you have anew published abstract.

Julie:

I do. There are four subjects. One was a 20-year-old man who had CDIF. I call it the gut reset.

Dr. Eric:

As the name implies with the fecal microbiota transplants, it’s pretty much putting the stool of one person into another person. Of course, they do testing, which is not done as much as it probably should be. In the United States, it’s only officially for those with cdiff. I know functional medicine practitioners will recommend it for other conditions, but as far as the conventional medical world, it’s just still known for cdiff in the U.S.

Julie:

They did these studies, and one had cdiff. He had alopecia universalis. That’s losing hair all over his entire body. After the procedure, he grew hair everywhere that he was supposed to, where he hadn’t seen hair for years.

A 38-year-old man also had alopecia universalis. Same. He saw dramatic hair growth afterwards.

A 34-year-old woman had ulcerative colitis and hair loss. She had a huge improvement with hair growth even after a six-month follow-up.

My favorite one is an 86-year-old man. This man was told he would never grow hair, just like the other people in the study. He had a history of colon cancer, depression, and diarrhea. He grew his hair within four weeks after the procedure. He also had alopecia. It improved all his other health issues, too.

They are mostly doing this for other reasons in Europe and Canada. We are always far behind.

The reason I like to mention this is because it proves the fact that if you clean up your gut and get it in control and in balance, you can grow hair. Obviously, you can help other conditions, too. It proves the point. It’s pretty radical, and it’s not easy to get.

Dr. Eric:

A connection to how important the gut is. If you take the stool from a healthier person, seeing that dramatic impact on someone’s health. We’re not just talking about gut issues but hair. Alopecia areata- Are all of them autoimmune?

Julie:

They’re all autoimmune, yes. Areata is the most common. That’s the one that Jada Smith is experiencing.

Dr. Eric:

This is timely because of that. Unfortunately, the medical world doesn’t do anything to help with the gut to focus on the autoimmune component. Same thing with other conditions. There is hope. It’s amazing the connection with the hair loss. A lot of people might be surprised at how in depth we’re going with the gut. If you have an unhealthy gut, that can affect hair loss and other aspects of your health. If you have done everything, such as taking supplements, especially biotin, if you have an iron deficiency, if you’re not eating enough protein, there are so many different factors that could lead to hair loss. Arguably, most of these factors are related to the gut.

It’s great to go into so much depth about the gut microbiome and the fecal microbiota transplants. It’s important to show research when it’s available. Hopefully within the years to come, there will be more and more studies coming that show the relationship between FMTs and hair loss as well as other health conditions. Thank you so much for sharing this.

Julie:

Another study just published in the Journal of Nutritional Medicine and Diet Care found really strong evidence linking the gut to the diet with development of alopecia. Still, people are not convinced that the diet is going to have a huge role on our hair health.

Dr. Eric:

It’s not just about gluten. We spoke about gluten. We spoke about some of the things you should avoid, but there are things we should be eating to help support the microbiota, like vegetables. Eating a good variety of them. A mostly whole food diet, I’m sure you agree.

Julie:

A supplement people don’t think about with hair loss is niacin. It gets the circulation to the scalp. That’s another problem. People aren’t getting any circulation to their scalp. Niacin helps break down the buildup of DHT and calcium that can cause hair loss. A simple hack of standing on your hands or head, getting that circulation to your scalp. It feels good, too. Sleeping on a silk pillowcase retains the moisture in your hair and is good for your skin. There are simple hacks to keep things better aligned.

Dr. Eric:

Do you recommend hanging upside down?

Julie:

An inversion table. Or standing on your head or hands at the gym. Getting circulation to your scalp is important.

Dr. Eric:

You mentioned niacin as a supplement. Do you have thoughts on silica?

Julie:

Silica, collagen is great. Selenium, zinc, manganese are other top ones that also help with thyroid health. Selenium is another tricky one. People think they need selenium, but they end up taking too much.

Dr. Eric:

Or they combine that with Brazil nuts and get too much. Or iron overload. With selenium, that’s the case. Other nutrients, something like magnesium, probably not as big of a risk. You can overdose with anything. But the consequences or side effects are worse when taking too much iron or selenium compared to too much magnesium. Is there anything else we should discuss?

Julie:

Going through the 5R approach again. You could jump in there and not get to the foundation of what’s going on. You can waste so much time and energy. I know it’s all based in functional medicine and nutrition. Other practitioners are out there trying to help, but they can be more of a detriment than helping because they are not starting at the beginning.

Dr. Eric:

Let’s say if someone is experiencing hair loss, and there could be many causes as we discussed, where would you start? It sounds like you would start with that 5R protocol.

Julie:

I would start with my questionnaire and the functional labs. Then the first R, removing. I build from that. A lot of my clients come from dieticians or dermatologists, who would throw supplements on them and say eat better. It’s not all about that. You might be even eating well, but you’re under chronic stress, so you’re not absorbing your nutrients. There is something going on in your gut. Then I have to start over with them. They get frustrated because they already spent money with these other practitioners. I’m sure you get those people, too.

Dr. Eric:

I agree. Diet is a piece of the puzzle without question. Pretty much every functional medicine practitioner recommends to their clients, or hopefully, to eat a healthy whole food diet. Food could be part of that first R. Dairy and corn could also be factors, just like gluten. It could also be gut infections. It could be H-pylori or parasites. SIBO-

Julie:

Epstein-Barr. That’s what I had.

Dr. Eric:

Stress by itself can have such an impact on our gut and overall health. Of course, being that most people listening have a thyroid or autoimmune thyroid condition, even though you definitely want to focus on the gut, sometimes you do need to initially take, in the case of hyperthyroidism, antithyroid medication or herbs like bugleweed. In the case of Hashimoto’s, maybe take thyroid hormone replacement. Focusing on the gut is important, but you might need to do something to help balance the thyroid while you’re addressing the cause of the problem.

In the case of hyperthyroidism, the goal isn’t to be on antithyroid medication permanently. With Hashimoto’s, it might be different. They might need to be on thyroid hormone replacement long-term. I agree that the 5R protocol and having a healthy gut is important, but in many cases, people do need to take either the medication or herbs to help with the balancing of the thyroid hormone.

Julie:

Absolutely. Determining their food sensitivities, I used to do this when I worked in a functional medicine practice with an MD is put them on an elimination diet the first appointment. They really struggle with it. What I do in my practice and find more effective is do a blood test for food sensitivities. Then they see it. The elimination diet, they might be eliminating something they don’t need to because everyone is so different. At least in my experience, when they can see it, it’s more helpful.

Dr. Eric:

Good point. In our practice, we do a lot of the elimination diet. You could go back and forth as far as the perfect method. What I have been thinking about doing is both actually. Give them the option of doing a food sensitivity test. There is also mediator release testing, MRT. There is IgG testing, too. Starting with that, and also incorporating an elimination diet. There are pros and cons of each. You might eliminate something you don’t have to. You might be eating something that you’re sensitive to. An elimination diet, you aren’t usually eliminating broccoli or avocadoes, but you could be reacting to those. Food sensitivity testing is not perfect either. I have been thinking about combining the two or giving the option to the patients to focus on one or the other. Another example of how different practitioners practice differently.I can’t say I have been a big fan of food sensitivity testing over the years.

Julie:

We should talk because I agree. There are a lot of really bad food sensitivity tests out there. I only trust a couple. One of them is newer in the market. They take insurance a lot. What I like about it is they test not only the IgG, but the IgA, the IgE, the IgE4, and the complements. You’re seeing their allergies, sensitivities, and complements. It’s like 188 foods. A good amount. Then you can layer it. It takes most major insurance companies.

Dr. Eric:

That is good. I have used Cyrex Labs in the place. I do like them, but they are a little bit pricey, and I don’t think insurance will cover them. The ones you can order on your own, those are not too accurate. With any test, that has been the case, even with comprehensive stool testing. There  are ones I stopped doing because I didn’t find them to be accurate. I like the GI Map. GI Effects from Genova is also good. But that’s a great point. In this day and age, you can order tests on your own. Just like the supplement you mentioned, quality is important. We think about it with tests, but the average person thinks a test is a test. A stool panel is a stool panel. The point is, choosing the correct lab is extremely important as well.

Julie:

They can waste a lot of money on a lot of tests.

Dr. Eric:

This was a good conversation. We went beyond hair loss, but it does relate because we spoke about food sensitivity testing, which ties into what was discussed earlier.

Julie:

It’s like picking a scab. If you keep eating those foods you’re sensitive to, it will affect your hair.

Dr. Eric:

Thank you so much for sharing everything. Where can people find out more about you?

Julie:

JulieOlson.net is my website. I have a phone number on there, my office number. They can find me on social as well.

Dr. Eric:

Thank you so much, Julie. Appreciate you joining us. You shared a lot of valuable information.

Julie:

Thank you so much, Dr. Eric. It was really a pleasure.

 

Recently I interviewed Dr. Achina Stein, as she discussed depression, including how it relates to inflammation and thyroid autoimmunity.. If you would prefer to listen the interview you can access it by Clicking Here.

Dr. Eric Osansky:

With me, I have Dr. Achina Stein, who is an osteopathic physician, a board-certified psychiatrist, and has been in practice since 1994. She is a certified practitioner of the Institute for Functional Medicine, a distinguished fellow of the American Psychiatric Association, an Azarias energy healer. She was awarded the Exemplary Psychiatrist Award by NAMI Rhode Island in 2008. Located in Rhode Island, she is the co-owner of private practice Functional Mind LLC. She is the #1 Amazon best-selling author of What If It’s Not Depression? Your Guide to Finding Answers and Solutions. She has a YouTube channel and podcast by the same name. Thank you so much for joining us, Dr. Achina.

Dr. Achina Stein:

Thank you for having me, Dr. Eric. My pleasure.

Dr. Eric:

I’d like you to start off by giving your background. How did you start out in psychiatry and eventually getting into the functional medicine world?

Dr. Achina:

We’re going back almost 30 years.

Dr. Eric:

I guess we could focus more on how you made that transition to functional medicine and not just giving anti-depressant medication.

Dr. Achina:

That’s an easier question to answer. I was a traditional psychiatrist, working in a community health center. I have worked in the prison system. I have worked on consultation liaison in hospitals. I liked moving around because I loved having different perspectives. I worked on the child unit, on the geripsychiatric unit. I have basically treated all ages primarily with medications and psychotherapy. I am trained in psychotherapy.

I was finding that I was hitting a wall in treating certain people where they just weren’t getting better. I am one of those people who gets a thorough history, spending a lot of time with my patients, more than the average psychiatrist. I really want to try to figure out what’s going on. Why aren’t they getting better? I spent a lot of time already talking about diet, exercise, sleep, and habits. There was this feeling that in my gut and my heart that I was missing something.

Around that same time, coincidentally, I don’t believe in coincidences. At the same time, my son had a significant mental health crisis. This was back in 2010. He was 14 years old. He basically had a tiff with his brother that ended in a meltdown, resulting in him standing on a fifth floor ledge of a building ready to jump. That is the kind of thing that kids tend to do. They feel like it’s the end of the world in that age group, anywhere from 10-16. Something happens, and it’s the end of the world. He just lost it. It wasn’t something that we anticipated. It was just out of the blue.

He became severely depressed and very anxious, and he had insomnia. I thought, Oh well, this is it. This is my son who is now having an exacerbation of symptoms based on our family history. Both sides have pretty significant depression and suicidal ideation with attempts. Actually completed suicide attempts. This was very concerning for us. I was blindsided by this. Here I am, a psychiatrist, and my son is having a serious situation. I did not see it coming. It makes you think about your parenting skills and why you didn’t see it coming.

The thing that made me think that something else was going on was the fact that he was not able to read at all. This was a kid who was an avid reader and had really good memory skills. He would read it once and know it. He would hear songs once and know all thewords. That kind of memory. And he was not able to read and retain. I felt at that point, because of my skills, there is something neurological going on. I really honed in on this is a brain-based, neurological problem and not psychiatric, so to speak. I took him to many doctors, and they weren’t able to explain it.

I had to do a deep dive in research myself and find other practitioners to help me. Serendipitously, I came across a functional medicine practitioner and had him see my son. I asked him if I could shadow him because I was so intrigued by what he was doing. I shadowed him for a period of time, and that’s why I decided to have him see my son.

Long story short, he got him well. He made changes to his diet. He found that he was nutritionally deficient. He had Celiac Disease. He had a considerable amount of inflammation in his body as a result of having long-term, long-standing constipation since he was a baby; long-standing eczema since he was a baby. You take symptoms that are pretty serious and think that’s normal, but it’s not.

A lot of those symptoms, including the constipation and the eczema, completely resolved. It took a little while for the depression and anxiety to resolve. Mind you, he was on four medications at the beginning for psychiatric purposes. He was on an anti-depressant, anti-anxiety, sleep, and stimulant for concentration. He was not my kid. He was able to come off all those medications by the end of two years.

What we found was the reason he couldn’t read was because he had double vision. He had diplopia. His eye muscles became very inflamed, so much so he had double vision. That actually was the symptom that took the longest to resolve.

Once you learn those things, you can’t unsee them. You can’t practice. I became certified in functional medicine. I left my job as a medical director at a community mental health center to practice functional medicine with the gentleman, Dr. Levitan at Visions Health Care at the time, and started working for his organization. There was no other organization that did this kind of work locally, so I worked from them and learned functional medicine. Once that practice closed, I opened my own practice with my partner Sally Davidson. Here we are, almost five years later.

That’s all I do now. I have a handful of patients I see for psychotherapy. That’s my mission: to tell people about this. After we got my son well, I did the functional medicine approach to my own health issues. I have Hashimoto’s, which has been stable for a number of years. I had depression as a result of that and was on medication. I have since been able to taper myself off that medication as well and am doing great.

Dr. Eric:

A few things you mentioned. You mentioned inflammation, and you mentioned symptoms related to the gut, including constipation. It’s only been recent, and I can’t even say all psychiatrists, you would know better than myself, but many psychiatrists still think about depression as related to the brain. Same thing with anxiety. No relation to inflammation or the gut. It probably comes down to the training you also had in medical school. Would that be correct?

Dr. Achina:

As a DO, we are required to do a year internship in all other disciplines. I delivered babies. I saw kids in pediatric rotation. I did surgery. We are required to do an internship, which is followed by three years of psychiatric residency. I am very comfortable talking about medicines and medical issues, much more than the MD counterparts.

Like I said, I have always talked about medical issues with my patients, particularly in the community health mental center. Many patients do not like to go to doctors. They have to go to their psychiatrist to get their medications. They are either paranoid, or they don’t trust them. I would really talk about their medical issues and connect the dots for them. This is before I did functional medicine. I had that mindset talking about diabetes or weight or hypertension. There was a point where I would be monitoring some of these things for them. Now I really need you to see your primary care person. I can’t manage these things. It was such a logical transition for me to become a functional medicine doctor because that was a piece that was missing for me in caring for my patients. It made so much sense.

I remember seeing a patient at the community mental health center who said, “Is it normal to see pills in your stool?” Undissolved. I had to ask myself, Is it normal? I don’t know. No, it’s not normal! It’s not normal to see pills in your stool. Whole pills. That means you’re not digesting at all. It’s not normal to see large particles of food in your stool. You’re not digesting. That’s a major root cause of mental health issues. You’re not digesting and assimilating all your nutrients, fats, and proteins, which are so necessary for the brain and the rest of your body. With the brain being so sensitive, you absolutely need to be able to digest, absorb, and assimilate your food.

As I became a functional medicine doctor, there were patients in my mind. Oh, that’s why that person didn’t get better. All these people would pop into my mind about what I could have done differently. I am always thinking about them. Still to this day, there are puzzles that I have not solved. That’s how I approach people. I like to solve problems and issues and try to figure out what’s going on and keep digging and digging and digging and finding out what’s going on with that patient.

Dr. Eric:

Since a healthy gut microbiome is important for overall health, including mental health, everything is connected, that sounds like that’s a big part of what you do. We could talk about leaky gut, I guess, but do you want to try to find out the cause of the leaky gut, or the dysbiosis, the imbalance in the gut flora, and try to address that? When you see that, I’m guessing you see dramatic changes in your patients’ depressive-like symptoms.

Dr. Achina:

Absolutely. Depression is just a symptom of inflammation when it comes- That’s not 100% true. It’s the root of the root of the root really. It’s figuring out where the inflammation is coming from. We look at biological causes, psychological causes, social causes, and physiological or functional causes. It’s really connecting the dots.

The depression is just one manifestation of that complex of symptoms. If someone has an underlying autoimmune process going on, then the root cause for the depression really is that autoimmune process, or at least one layer. You want to find all the layers. It could be because your job is stressful. It could be that you have a toxic boss. It could be that you have three kids, and one of them has special needs. It could be that you had trauma from your early childhood. All of those things cause your cortisol levels to go up, which can cause a leaky gut.

It always comes down to in my mind five things: foods, infections, chronic infections, toxins, and stress. All of those really affect your hormones, particularly cortisol, your stress hormone. If you are looking with that foundation of issues at those five things, you will definitely find all the root cause. It’s looking in all of those realms. What most psychiatrists do is look at the biological and possibly the psychological and possibly the social. They don’t really connect the dots in terms of nutritional deficiencies.

I have a patient today who had a Vitamin D level of 18. Her primary care provider put her on Vitamin D, but only 1,000 or 2,000. She sees a psychiatrist. She has seasonal affective disorder. They don’t think about these nutritional deficiencies. Never asked what bloodwork had been done. At least hers never did, she says. Some psychiatrists have more training around this, looking at B12 and folic acid, which are highly connected not only to depression but other issues. It is looking at all this nutrition.

Nutritional psychiatry, believe it or not, is a brand-new field. Integrative psychiatry has been around for a decade, but it’s not really as accepted. But it’s coming around. People are learning more and more about these connections that are in the field. Especially the newer graduates are learning about inflammation, brain inflammation, BDNF alpha, and all of these things that are now in the literature. You might learn these things, but it doesn’t really come into practice honestly for 10 years. It takes 10-15 years to see it in everyday practice, where it’s common knowledge. But at least, it is moving in that direction.

I can say I was asked to be the plenary speaker for an American Psychiatric Association conference out of Oklahoma. I was asked to talk about my methods as a pioneer in the field doing this. They considered me a pioneer doing this. I have been doing it for 10 years now. It is good that they asked me. They could have ignored me, “Oh, she does that thing.” People want to learn. I am seeing shifts in a positive direction around this. It will take its time, but it will happen.

Dr. Eric:

I’m sure it’s moving in the right direction. More and more younger psychiatrists coming out of school are getting different types of training than you did when you were in school. It will be more than just dispensing medication in the future. Unfortunately, that sill happens probably too frequently.

You mentioned you had Hashimoto’s before the depression. I work with a lot of Graves’ patients and also had Graves’. Just like Hashimoto’s, it’s autoimmune. With Graves’, anxiety seems to be more closely associated, but Graves’ patients can also experience depression as well. That is tied into the inflammatory process as well as the leaky gut that is associated with autoimmunity. Essentially, anyone with any autoimmune condition, would you say they are at an increased risk of developing depression because of the increased inflammation and gut issues?

Dr. Achina:

Sure. Some more than others. Lupus, multiple sclerosis, MCI have higher incidence of depression as well as Hashimoto’s and Graves’. Much more than the other types of autoimmune diseases. Definitely Celiac. You will see certainly low levels of depression and anxiety across the board, but the more severe types of depression, you will see in lupus in particular. It can actually show up first as an initial symptom of lupus.

About 50% of patients with hypothyroidism have been given a diagnosis of major depressive disorder. Hypothyroidism is a major root cause. It happens to be the one illness that is searched for as a possible explanation for a major depressive disorder. If bloodwork is not done to look for that, then the average doctor is not practicing the standard of care. That’s been done for at least as I’ve known and even before my day that getting a TSH—there are certainly limitations with getting the TSH—but there was an effort to determine whether or not a person had the depression from hypothyroidism. There is certainly not enough data nowadays to know if you have a sub-clinical hypothyroidism that is playing a part, or just not looking at the entire thyroid panel. It’s so important to do a full thyroid panel. There are still many doctors today who don’t believe in getting a full thyroid panel.

Dr. Eric:

True.

Dr. Achina:

I have to convince doctors to do a full thyroid panel. It’s just a matter of not being educated about these things. Eventually, things like that will catch up.

Dr. Eric:

You mentioned sub-clinical hypothyroidism. For those who don’t understand, that would be an elevated TSH, and thyroid hormone levels are within the lab reference range. It might be lower than optimal. If someone has overt hypothyroidism, where the thyroid hormone levels are below the lab reference range, that could definitely increase the risk of having symptoms of depression. It sounds like if I heard correctly, if someone has sub-clinical hypothyroidism, that could also be a factor when it comes to depression even if the thyroid hormone levels are within the lab range.

Dr. Achina:

I think so, yeah. It depends on what the numbers are and what else is going on. I have seen when people have had high levels of adrenal-

Dr. Eric:

Cortisol?

Dr. Achina:

Cortisol levels. Their adrenaline is up all the time. They’re energizer bunnies and under a great deal of stress. The thyroid will downregulate to balance as a normal response to the adrenals. It’s looking at the whole picture. Why is that happening? Why is the thyroid putting on the brake? Sometimes the thyroid goes into hibernation and shuts down the metabolism on some level, so it goes into safe mode. Like our computers go into safe mode, our bodies go into safe mode. How? By downregulating the thyroid.

Not everyone needs to be treated. I wouldn’t necessarily say they have a disease or disorder, but it’s a dysfunction. In a way, it could be an appropriate function or a response to something else happening in the body.

Dr. Eric:

Some of the things we mentioned, they have Hashimoto’s, that inflammatory process, the gut microbiome, there are other things as well. You mentioned testing for the thyroid, but are there any other types of testing? You mentioned nutrient deficiencies. Do you do neurotransmitter testing? What type of testing do you do? It might vary depending on the person. If someone comes in, and you’re suspecting depression, what are some basics that most people get? If there are other tests that you might give some people, too.

Dr. Achina:

I get a stool test through GI Map. If I suspect SIBO, I will get a breath test through Aerodiagnostics. I get the organic acid test from Great Plains Lab. I will also get a whole battery of bloodwork: CBC, CMP (comprehensive metabolic panel), homocysteine, lipid panel. A cholesterol below 160 is very concerning with depression. Vitamin D, Vitamin A, copper, zinc, magnesium, selenium. Those are critical minerals that are needed under a stressful environment. Imbalances in those areas can cause depression and anxiety. HSRCP, DHEA, which is a marker for stress hormones like cortisol. This is bloodwork. An Omega 3/6 panel to see what the balance is of Omega-3s and 6s. I’m sure I’m missing something else.

Dr. Eric:

You don’t have to give everything. I was just trying to get an idea. But that is pretty comprehensive, even if you have left a few out.

Dr. Achina:

I don’t necessarily just treat the depression and narrow my focus as depression resolution. I treat the whole body. I have always treated the whole body. It’s the other symptoms that will help me to understand where the depression is coming from. If somebody has metabolic syndrome and insulin resistance, then depression can be caused by that. If they have a low cholesterol, and they have anorexia, then the depression can be coming from that. It’s really looking at patterns in the symptoms and patterns in the bloodwork that will help to find the root causes of the depression. I go after the root causes, and the depression resolves because I see the depression is a part of that pattern. It’s part of the manifestation of what is happening in the whole body.

The times where I really hone in in terms of specific symptoms is after doing a full gut restoration: removing what’s causing inflammation, repairing what’s missing, reinoculating the gut microbiome, repairing the gut lining. What happens is the fog clears. Then there are pieces of that depression we can then really focus on. It might be childhood trauma. It might be that their life is so stressful that they are not taking time to rest. Of course, we have already addressed sleep, exercise, movement, and diet by that point. It’s honing in and fine tuning the approach to specific things that are happening that keep triggering the inflammation, like the toxic boss or the marital problems or not knowing how to manage the kids at home or giving time to yourself or having chronic feelings of guilt, fear, shame, or anger.

You asked about neurotransmitter testing. I used to do it quite often earlier when I started doing functional medicine, but I don’t find them to be useful. It is a dynamic process. You can really figure out where there needs to be support by just getting a really good clinical history.

Dr. Eric:

I agree with the neurotransmitter testing. I don’t do it. I don’t use the organic acids testing on everybody, but I do it on some of my patients. That looks at some of the metabolites related to dopamine, serotonin, epinephrine, and norepinephrine. Of course, that gives so much more information like yeast and candida and mold markers and indicators of detoxification.

Dr. Achina:

The beauty of that test is that first page, the microbial organic acid, especially the clostridia. You can’t really pick that up without testing.

The thing about depression is that many of the symptoms of a major depression are things you would see in a classic sick syndrome: low energy, sleep problems, thinking problems, appetite problems, concentration problems. If somebody had the flu and was really sick, you would feel that way. It just happens to be that people with major depression feel that way every single day all day.

What I hadn’t been trained in is to look at that as this is a whole body illness that just happens to be affecting the brain. It’s the brain hardware and software. Why don’t we look at this as a whole body problem? If you had a problem with your computer hardware, it will glitch. Our brains are just glitching on some level.

I find that when people don’t feel well, their perceptions of what’s happening around them changes, including their perceptions of any trauma that they may have had in the past. When you’re not feeling well, you’re not processing things well. Things come up that in the past probably wouldn’t have come up if you felt well. Just the not feeling well shouldn’t necessarily be considered that you have major depressive disorder and completely isolate it from the body. Your head is connected to the body. It’s all connected. To treat it as a separate entity is a huge disservice to people.

Dr. Eric:

I definitely agree with that. With any type of condition from a functional medicine standpoint, you want to take a whole body approach. Pretty much all conventional medical doctors take the opposite approach. More and more practitioners are learning about functional medicine and keeping an open mind.

When it comes to diet, is that one of the starting points, too? Pretty much with all functional medicine practitioners, it’s changing diet. Where do you start when it comes to diet? Is it just eat whole healthy foods? Do you require your patients to go gluten-free or dairy-free?

Dr. Achina:

Ideally, I would want them to be gluten-, dairy-, and sugar-free in the beginning. I always start where the patient’s at. If they have never been gluten- and dairy-free and don’t have the resources or support around doing that, they have to start in baby steps.

If they are terrified of this deficit of things they have been eating, I’ll start with adding some fruits and vegetables. Generally, people who are on the standard American diet will be devoid of fruits and vegetables. Starting by adding things, it’s easier to add things first. That might not be the case for some people who have a really hard time with vegetables. It’s a negotiation.

With the patient, where are you willing to start? This is where you need to be. This is my experience in being gluten- and dairy-free. It’s worth doing an elimination diet. I have found that the whole 30 is something that people can wrap their heads around as a modern elimination diet. That might be a good place to start for some people.

Essentially, my goal is to get them to a Mediterranean diet. Then maybe a paleo. Then potentially, if they still need some more push or oomph in the clearing of brain fog, let’s say, I might push to keto. If they are still having energy issues or brain fog, the ketogenic diet. I don’t believe that people should stay on a diet long-term. Diets should evolve seasonally. They should evolve based on what other issues are happening. I use the diet as a way to shift the metabolism, shift the microbiome in order to heal.

Then you can start adding things back. I have had people be able to add things back in that otherwise they thought they would never be able to. A lot of times, you can reintroduce these foods, but there is a proper way to do these things.

Dr. Eric:

You mentioned low cholesterol. I’m glad you brought that up because it’s very common for people with hyperthyroidism to have low cholesterol. That could be a factor in depression. You mentioned you don’t like to see the levels below 160, correct?

Dr. Achina:

Correct. Below 160 can definitely be causing depression. Cholesterol is a building block of insulation around your brain cells. Your brain is 80% fat. Cholesterol is fat. You need enough cholesterol in order to make hormones, too. There are studies that show cholesterol levels below 100 or even 80 can cause chronic suicidal ideation daily. There are multiple studies that show that.

Unfortunately, when we have people in the hospital, it’s not even a test that’s drawn. In kids, teens, and young adults, it should be drawn. A lipid panel is rarely drawn in the younger age group. I think it should be part of every battery of tests when it comes to depression and suicidality.

Dr. Eric:

When it comes to low cholesterol, if someone has hyperthyroidism, they have to address the elevated thyroid hormone levels. It could take time for that to increase. When it’s not related to hyperthyroidism, do you have any strategies for low cholesterol? Sometimes it can be genetic. Do you mostly try to increase it through diet?

Dr. Achina:

Other than food, like eating eggs, cholesterol is made by the liver. Sometimes, the liver gets congested, and it doesn’t have the machinery running in terms of making cholesterol. There is a supplement that is made by a company called Sonic. You can get it from New Beginnings. There is only one company I know of that makes cholesterol pills. You can take some supplements to boost your cholesterol level. I have had a couple of patients with autism that have taken that. I see low cholesterol in quite a few kids with autism as well.

Dr. Eric:

When someone comes in with depressive-like symptoms, just to summarize, we know that you want to address the cause of the problem and treat the whole body. What were some of the first steps you would take? If someone is convinced they need to see you or a different psychiatrist that practices functional medicine, what should they expect?

Dr. Achina:

Doing a screening to make sure you’re not in an acute crisis. I would make sure that you’re safe and that you were able to function on some level because functional medicine does take work, and it is time. You have to be well enough unfortunately to do the work of changing your diet, doing exercise, and all of these habits that need to be in place.

If you are having an acute depressive episode, and you’re in crisis, you shouldn’t go to a functional medicine doctor to help you. You really should see someone who can stabilize you possibly with medications or even hospitalization if that is necessary. Sometimes people have called me, and they need to go to the hospital because they are safe and are not functioning. If you are hearing voices, if you are having chronic suicidal ideations, if you are paranoid, you should seek help right away and get stabilized first. Once you’re stable, then come see me.

I’m not going to be able to help you until you are able to do the work that is required. Your brain needs to think on some level. That doesn’t mean to say it might not be hard, but you have to be able to do a certain amount of work over time. You won’t get results immediately, but you could get results within 30-60 days. I see people feel so much better just by changing their diet in 30-60 days. Sometimes that’s faster than people who start an SSRI and didn’t change their diet at all.

I would say that making sure you’re safe, making sure you’re not in a crisis, and you do have to be willing to do the work and invest the time. Creating that space for yourself, putting yourself first, putting your oxygen mask on first, saying you deserve it, and you are worth it is a really important mindset change.

Having a destination. Where do you want to be? You need a destination. It’s not just, “I want to feel better.” It’s not about suppressing symptoms. It’s about being well. You have to have an idea of where you’re going in the process. I have people do this exercise to have in their mind’s eye, “This is where I want to be, and these are the things I want to be doing when I’m well.”

Dr. Eric:

Where can people find out more about you? There is your book I recommend getting, What if It’s Not Depression?

Dr. Achina:

You can find my book on Amazon. You can get it at my website, FXNMind.com. I have another website, AchinaSteinDO.com. I am also on Instagram and Facebook. On Instagram, @Dr.AchinaStein. On Facebook, it’s “What If It’s Not Depression? with Dr. Achina Stein.” I have a YouTube channel, too. You were one of my guests, so we can watch your video. Other experts in root causes of depression as well as tools to resolve symptoms of depression and anxiety. Thank you.

Dr. Eric:

Thank you so much, Dr. Achina. It was great chatting with you. We might have to have you on again in the future because there is so much totalk about, and I have so many other questions.

Dr. Achina:

Great. I would love that. Thank you so much for having me. It was my pleasure.

***

Dr. Eric:

It’s just amazing how important the gut microbiome is when it comes to depression and anxiety. For years, practitioners would just focus on the brain. There are plenty of psychiatrists who still do this. I’m not saying there isn’t a time and place for medication. But it really is important to focus on the health of the gut.

If you or someone you know is suffering from depression, please have them check out this episode. Perhaps also send them to Dr. Achina’s YouTube channel so they can learn even more about how to overcome depression and anxiety without relying on medication.

That being said, here is a clip of Dr. Achina and I chatting about SSRIs:

***

One thing I wanted to quickly ask you, as far as SSRIs, a lot of people are on medication, including a lot of children. What are potential long-term consequences of being on medications? One is just not addressing the cause of the problem and masking them with medications. Are there any side effects?

Dr. Achina:

First of all, medications do poop out. At some point, they really don’t work any longer. What it can do is cause some neurological problems in terms of this imbalance of serotonin and dopamine. You end up becoming low in dopamine, resulting in these neurological issues almost like Parkinson’s symptoms. It’s not called Parkinson’s, but there are people who have these neurological symptoms related to low dopamine. That is a long-term risk of being on SSRIs.

As a result of taking them for a long time, it really changes the balance in your brain on an almost permanent level. When you try to come off of these medications, many people do have a discontinuation or withdrawal syndrome that is really hard for many people. It’s very painful in many ways. People get zapping, ear ringing, tinnitus, dizziness, lightheadedness, nausea, upset stomach, headache, even neurological symptoms in terms of finger sensations. There is a whole list of symptoms that people can have. Dyskinesias, which is abnormal movements. Akathisia, which is a restlessness, ants in the pants feeling. These are not comfortable feelings. Unfortunately, people end up having to go back to the dose that they were taking. Although it’s not necessarily doing anything for their depression anymore, they have to take it because they can’t get off of it.

There are many doctors who don’t know how, and we’re certainly not trained, to be able to taper a patient off of these medications safely. When we were trained, and this was when I was working as a psychiatrist, our understanding is once you’re on a medication, you have to stay on it. Now you have this illness that will never go away. That is far from the truth.

If you address the root causes, you can absolutely bring the body back into balance. I have been quite successful in getting many people back into balance and getting them off of medications as well. It takes a while. It’s not for everybody.

If some people have been on four or five medications- That’s the problem. One medication poops out, so you get put on another medication, and another, and another. It’s this whole polypharmacy that at some point, the side effect combinations of these can cause side effects. The #1 cause of death in this country is being on all these medications and no one managing the drug-to-drug interactions that are occurring. The solution is to keep increasing the dose until a person is so frustrated that they just stop the medications without even discussing it with a doctor because the doctor won’t support that. That seems to be the trend.

Of course, you will find the occasional doctor that will work with you and try to reduce and discontinue these medications. For the most part, there is no training around what to do. It’s very important to find someone who knows how to do that.

Also, know there is definitely risks in taking these medications as well as benefits. I’m not suggesting that you shouldn’t take the medication. You have to look at the risks versus benefits at the time. These medications can be lifesaving, but you want to have the conversation and have good, informed consent around the decision. You also want to have aplan to come off of it when it’s time.

I liken it to rehab. If you ever had a car accident, and you had multiple broken bones, and you need the jaws of life to get you out of the car, you are going to want to be helicoptered to the hospital and be in surgery and fix whatever needs to be fixed, etc. But you know that you will come out of those casts. The plan is coming out of those casts once you heal.

There is no plan like that in psychiatry. There really isn’t. There will be crises. Things will happen. My son had an acute mental health crisis, and he was put on meds. Thank God there were meds. But there was no plan for him to come off of them. Fortunately, for him, I became a functional medicine doctor and was able to do that with him.

There is hope that can happen. I’m not anti-medication. I am pro-informed consent. There is certainly a place for them.

Dr. Eric:

Thank you so much for sharing that. It’s probably a good idea for someone who is taking a medication, and if their doctor isn’t willing to help them wean off, they probably should see someone like you. Would you say they need to have a functional medicine background, or is it just the fact that many conventional doctors refuse to help people wean off? Like you said, once they’re on it, it seems like all they do is over time increase the dose. Someone like you would definitely help them, but other conventional medical doctors that do help people.

Dr. Achina:

There are definitely organizations that do help people come off of SSRIs. There is one major one out of England that is a huge proponent of trying to get people off of SSRI medications. There are other possibilities. If you needed a supplement, there are things you can use like L-theanine and GABA. There is taurine, tyrosine, 5HTP, SAME, all of these natural formulations. There are combinations as well. A combination of vitamins and things that work really well and can help to stabilize you while you are searching for the root causes. It doesn’t have to be these heavy-duty medications.

In a severe crisis, you should try the medications. But if it is mild to moderate, sometimes there are risks in medications. Medications in certain populations like kids and adolescents can cause suicidal ideations or a manic episode. There are risks in taking them. You want to make sure the benefits far outweigh the risks when you are choosing to take a medication.

There are supplements you can take instead of taking medications. I don’t recommend taking them while you are on medications because there are drug to drug interactions. You want to avoid combining the two. That’s not safe at all. There are things like serotonin syndrome that can put you in a crisis. If you are listening to this, you need to work with someone who knows what they’re doing in this arena.

 

Recently I interviewed Dr. Wendie Trubow, as she discussed many of the different environmental toxins that can not only affect the thyroid, but one’s overall health as well. This is one episode that everyone can benefit from listening too, regardless of whether you have Graves’ disease, Hashimoto’s, or a non-autoimmune thyroid condition. If you would prefer to listen the interview you can access it by Clicking Here.

Dr. Eric Osansky:

Today, I have Dr. Wendie Trubow. We will be chatting about environmental toxins. I am going to dive into Dr. Wendie’s bio here. Dr. Wendie is a functional medicine gynecologist with a thriving practice at Five Journeys. She is passionate about helping women optimize their health and lives. Through her struggles with mold and metal toxicity, Celiac, and other health issues, Dr. Trubow has developed a deep sense of compassion and expertise for what her patients are facing. She is co-author of Dirty Girl: Ditch the Toxins, Look Great, and Feel Freaking Amazing. It’s a great book with a great title. Thank you so much for joining us.

Dr. Wendie Trubow:

My pleasure. Thanks, Eric. Great to be here.

Dr. Eric:

Great to have you. If you could talk about why you decided to write the book, get a little bit into your backstory.

Dr. Wendie:

When I was 48, I went off the cliff. I blamed it on perimenopause. In reality, it was because I had gotten a level of toxic exposure that I was now showing symptoms from. I had a lead exposure just before turning 48 in September. The next year, in April, I was 48, and we went to Notre Dame right after it had burned down. We slogged through the dust, came home, and I gained nine pounds, had a rash on my face, eyes, nose, under my lip. I wanted to rip off my face. My hair was falling out in droves. What was going on?

It took me a few months to figure it out. I do functional medicine. I applied all the testing to myself. My thyroid was fine, perfect, never better, amazingly because I had always been a little off. My adrenals were good. My gut looked good. My minerals/nutrients looked good. What’s going on?

Finally at the end of the summer, I heard a report on NPR that said when Notre Dame burned, 500 tons of lead were released into the air. The closer you were to Notre Dame, the more exposure you got; the farther away you were, the less exposure you got. We were legit there right after it burned. I turned to my husband and said, “Oh my god. I must have gotten lead exposure. It’s not perimenopause.” #notperimenopause. It’s lead.

I did the testing, and I was higher. I did the testing for mycotoxins, and I had four strains of mycotoxins, which are the toxins that mold puts out when it’s in your body. For a penny and a pound, I did all the testing. I tested environmental toxins, things like gasoline fumes, nail polish, makeup, plastics, flame retardants. I was positive for a bunch of those. I am such a dirty girl! We need to write that book if I have all these toxins.

Eric, I’m the poster child. I don’t eat gluten because I have Celiac. I don’t eat cow’s dairy. I don’t eat sugar or processed carbs. I don’t drink alcohol. We eat organic food. What’s there to give up? Yet I have all these toxins. If I’m doing all this work, and this is what I have, what does everyone else have? That’s why we wrote the book.

Dr. Eric:

Most people know we live in a toxic world. You are eating clean and doing other things to reduce your toxic load, yet you had a higher toxic load. It makes you wonder if someone like you is taking such good care of your body. On average, I’m sure our listeners are doing things to improve their health and eat healthily. Those people also could have higher toxic loads just like you did.

It’s great that you wrote the book. I have read the book. As I was telling Wendie before this interview, I have all my questions. I wrote notes. I do research on all my guests. Here, I wrote down notes. Part of it was selfish because I wanted to learn from reading the book. I wanted to benefit from the information.

Dr. Wendie:

I am every person. I’m not special. Every person has this. Nobody gets through the toxins testing negative. They come out and are like, “I’m so cool. I have nothing.” Nope. If you live on this earth, you’ve got these, too.

Dr. Eric:

Exactly.

Dr. Wendie:

It’s horrifying. Bad news. You need a hashtag, #badnewspodcast. It’s depressing. But it’s fixable. That’s really the take-home message. It’s fixable.

Dr. Eric:

That’s the good news. No matter what we do, we can’t completely eliminate the environmental toxins. Like you said, the good news is we can do things to minimize our exposure, reduce our toxic load. That’s what your book is about. Then you will share some of the things here that you could do as well. I’m going to dive into these questions here. There are so many different things.

Dr. Wendie:

I know.

Dr. Eric:

I don’t know where to start because I know we’re not going to get to everything. I want to make sure to get to the more important things. You could always interject. But how about xenoestrogens, the endocrine disruptors? Most of my audience have autoimmune thyroid conditions. If you could talk a little bit about those.

Dr. Wendie:

I totally can, but I think we should go up a level before we dive into that if it’s okay and talk about where do you get this stuff from? What do you need to look out for? How do you think about it? If you think about it, anything can be a toxin: too much sugar, too much alcohol, too much smoking, too much sleep, too much sex, too much stress, whatever. We’re looking at the things that we’re exposed to on a regular basis that are causing problems.

The way to think about it is what are you putting in your body directly? What are you eating, drinking? Are you using plastic water bottles? Are you drinking alcohol? Are you eating sugar? Is your food organic? Are you eating grass-fed meat or not? What’s going in there?

What’s going on there? Makeup products, shampoo, body washes, lotions, all of that on your body.

What’s around you? That’s your environment. Do you live near a highway? Do you live near a golf course or a farm where they are spraying? Do you have poor air quality, water quality? That goes back to in you. Do you pump your own gas? Do you have an electric car? There’s lots of layers here.

When you are looking at toxins, what you want to do is be systematic. I think it’s easiest to start with what are you putting in your body. That’s where the xenoestrogens often come in. Plastic water bottles are everywhere. You cannot get away from them. They are so harmful. The plastic water bottles leech these xenoestrogens into the water. Think of kombucha. Nobody ever thinks of it as a plastic bottle. That’s how it comes at Whole Foods. Plastic bottle. Or those juices that come in a plastic bottle. It’s not just water. It’s anything in plastic that you’re putting in your body.

That also includes things like if you’re storing warm food in plastic, it’s leeching into your food. They go into your body. It mimics what your body thinks of as hormones, and it confuses the body and disrupts your normal hormones and throws it off. They are called xenoestrogens.

They’re just as hard to get rid of for a lot of people as other toxins. Because they’re everywhere, they start to build up. They particularly impact the endocrine system, especially the thyroid. The poor little thyroid is like, “What are you doing to me?” It’s like waves crashing on the shore. It never ends. Xenoestrogens can be particularly harmful for the thyroid, high and low and autoimmune. It’s all three.

Dr. Eric:

A few things to point out, which I know you mention in your book. It’s not just about BPA. Some people will say, “I have a BPA-free water bottle.” There are other analogs like BPS, BPF, and more. From what the research shows, some of those are even worse, or at least just as bad as BPA.

Dr. Wendie:

Here’s the problem, Eric. We have been effective at putting out hundreds of thousands of synthetic chemicals, materials, substitutes. Only about 500 of them have been tested for whether they are harmful. The biggest issue is that often in our quest to continue iterating and make it better and make it less harmful, it’s not being tested. It can often be more harmful than the original.

How do you quantify harm? If you have cancer, it’s bad whether it’s cancer or cancer. When you say the word “cancer,” it’s still bad. I’m not necessarily looking for do you want to level up on your plastic? No. I’m not looking for going to a better plastic. I’m looking to get rid of the plastic wherever possible. Making choices that mitigate it and trying not to bring in another source as you’re mitigating. It can be hard.

Dr. Eric:

You’re right. One thing that you mentioned in your book is a study showed that we’re eating about 2,000 tiny pieces of plastic per week. It’s equivalent to eating a plastic credit card each week.

Dr. Wendie:

In a year, yeah. It’s crazy. Not a week, a year. But there is microparticles everywhere. It’s funny. I was talking to someone who is really into fish. The problem with fish is all fish are contaminated now because the microparticles wind up in the fish, and they eat it, and it doesn’t get digested and broken down. If it does, it goes into their body. We eat the fish; we eat the plastic. It’s endemic.

Dr. Eric:

Real scary. When we talk about fish, a lot of people are concerned about the heavy metals like mercury. There are many other toxins that they get exposed to. That’s a great point. That’s a good question. Everything is risk versus benefit. Where do you stand where it comes to fish, recommending wild salmon or other types of fish? Do you just tell your patients to refrain from fish?

Dr. Wendie:

Isn’t that funny? I was talking about if you are getting plastic when you are eating wild-caught fish, but fish that is farm-raised, you’re not getting the wild-caught, but you’re also not getting their freedom to run around. The diet they are fed is not as matched to what they need. There is a trade-off.

I never, ever, ever, ever eat high mercury fish. Period. It’s not negotiable. We don’t eat it. It’s so funny. Even moderate mercury fish, one of my family members made black cod. I think that’s a high mercury fish, and it was high enough that it was considered moderate. I didn’t eat it. I spent years trying to get rid of my toxins. I’m not going to retox.

I say to people: You have to live on this earth. It has to work for you. I have four kids. My mother-in-law and mom eat with us a lot. We have a live-in nanny. We often have nine people eating. We don’t live on a farm. We don’t have access to as much as people who might live in the South and have year-round growing stuff. You want to make it work for your life.

Try to pick a better choice. If you can do wild-caught, that’s great for the cold-water fish. If you can’t, don’t go too crazy over it. Just don’t eat the high mercury fish that are wild-caught because they have eaten all the fish and aggregated all the mercury in them. I would draw a line there. Then I would say sometimes depending on where you live, you might not be able to get either wild or farmed depending on what’s local and fresh. It’s a navigation process.

Dr. Eric:

Can we talk about heavy metals? Start wherever you’d like to start. Mercury, cadmium, arsenic, lead. You mentioned lead earlier of course.

Dr. Wendie:

Pick your poison. They’re really common in a lot of people. My almost 18-year-old has mercury. I’m sure it’s from me. When you separate it into the generations, if you’re 75 and older, you were exposed because it wasn’t as regulated. You were exposed to mercury, which is the fillings and fish.

You were exposed to lead from chemical processes, lead pipes. 10 million homes still have lead pipes in the United States. They create an inflammatory state, and in some people, this will manifest as high or low thyroid, autoimmune disease. The inflammation itself leads to disease. However your body goes down the path of disease, you can show up with that. The metal is the lead pipes. Anyone who lives in a home built before 1978 most likely has lead in the paint. When you hear about people talking, “I did a weekend warrior. I knocked down the wall,” I’m like, “Oh, you got exposed to lead.” Living in that house as it settles, it dusts, you breathe it, you eat it, you touch it, you absorb it. That’s the lead and mercury.

Cadmium is from oysters. West Coast oysters have high levels of cadmium. Some batteries have cadmium. You can get exposed that way.

Arsenic, everyone knows about the rice. That’s the most common way we get exposed to it.

Thallium comes from organic vegetables from California. Acute exposure can make you very sick. High exposure can make your hair fall out. Typically, people don’t aggregate it as much as lead and mercury and sometimes cadmium. I don’t see a lot of cadmium exposure. I’m on the East Coast though. We’re not eating West Coast oysters. They’re not fresh.

Dr. Eric:

You said thallium is in organic vegetables from California.

Dr. Wendie:

The soil is contaminated. It’s grown organically, which is great. The green leafy vegetables have high levels of thallium in them.

Dr. Eric:

Is there anything people can do? There are those rinses, or they can make their own. Does that help at all?

Dr. Wendie:

No. Here’s what I’ll say. Alcohol is really stressful for the liver, our bodies, the adrenals, the gut. When you drink alcohol, the body is changing its focus from normal detox to alcohol detox. If you’re looking at what are the ways to support my liver and improve my detox, the first thing I would say is don’t drink alcohol. It’s so stressful, and it distracts your liver from doing what it normally does. Then it says, “It’s a toxin. I have to detox from the toxin.” Particularly if you’re female, we’re not set up to deal with alcohol the same way men are. Even two drinks a night is way too much for a lot of women.

Dr. Eric:

Another factor is it can increase permeability of the gut. Maybe if you drink just a little bit, it might not. A lot of people tuning in have autoimmune conditions such as Hashimoto’s or Graves’. Another reason to try to avoid alcohol. I did some research for one of my past books. Even red wine, because people ask all the time about red wine, white wine, there are some studies that show that red wine even increases the permeability. Not to mention the toxins, if you are not getting an organic wine as well.

Dr. Wendie:

I would agree with that. Put yourself in two buckets. If you’re perfectly healthy, cool. You can have a couple of drinks a week. If you are struggling with any issue, particularly autoimmune, endocrine, then I would say alcohol is not your friend, and it’s setting you back. I know that’s not popular. At this point, people are like, “Okay, I’m done.” Click. It really is very harmful for the liver, the adrenals, and the gut.

Dr. Eric:

How about aluminum? How frequently do you see that in your practice?

Dr. Wendie:

Not as frequently actually. Aluminum foil, you can get it. My family thinks I’m crazy. I’m like don’t put the food right on the aluminum. Put it on the parchment paper. I’m not making my own parchment paper. I’m not making my own aluminum. I have to trust that at some level, the chain is cleaner. I don’t see any toxicity from aluminum all that often. I don’t see high levels typically. You really have to use a lot of aluminum for it to add up. It’s just not one I see that often.

Dr. Eric:

When it comes to testing, are you using provoked urinary testing?

Dr. Wendie:

Yes. We do a baseline test to make sure there is no acute exposure we’ve missed. Maybe someone did a weekend warrior project, and they got a huge exposure. That should show up on the baseline test. Then we’re looking at a provoked test.

The reason you want to provoke it is your body knows these metals are very toxic, so you are not going to have it in your bloodstream unless you can’t cope with it, unless you’ve overloaded it. You’re going to store it in your bones, organs, fat, and brain. The provoked testing pulls it out from the storage depots so that you can actually get a sense of what’s going on here. Is it worrisome? Is it not worrisome?

Dr. Eric:

For those listening who aren’t familiar with the provocation testing, there are different chelating agents. I’m guessing you use different ones like EDTA, DMPS.

Dr. Wendie:

We use DMSA in our practice. We get it from the compounding pharmacy. They make it up for us. When we do IVs, we use EDTA, DMPS. We use EDTA orally at home, too. We use everything. For provoking, we use DMSA.

Dr. Eric:

Also, I think in your book, unless I wrote it down wrong, you said one of the major sources of mercury is corn syrup. It’s not just fish and silver fillings.

Dr. Wendie:

Right. For people who eat a lot of high fructose corn syrup, the process used to make that high fructose corn syrup has mercury. It’s a contaminant. It gets into the high fructose corn syrup. By the way, high fructose corn syrup also has really high levels of glyphosate and pesticides. You’re concentrating everything in that corn into this syrup. The pesticides and the persistent organic glutens don’t get removed. The mercury is present because of the processing. It’s used as a processing aid. It’s kind of crazy that that’s being put in our food.

Dr. Eric:

That is pretty crazy. I didn’t know it had a lot of glyphosate. I know a lot of things have a lot of glyphosate. We could chat a little bit about it. What can people do about glyphosate? Is it try to eat organic and make sure you have purified water?

Dr. Wendie:

Yeah. Glyphosate is the most commonly used herbicide in the world. In 2014, in the United States, we used about 400 million pounds of glyphosate on the crops. People use it on their lawn. Their landscapers use it. It’s called Roundup in the commercial use. It’s applied to everything. It’s also applied as a desiccant. After you’ve harvested, it’s applied to the fields to dry them out faster, so they don’t get moldy, as well as the product. It’s used in a lot of different manners.

It was originally developed as an antibiotic. It has microbiome disruptive capabilities as an antibiotic. It disrupts the microbiome, and it’s classified as a probable carcinogen by the World Health Organization. In medicine, you can’t say this causes this. You’re not allowed to say this. But you can say it’s implicated in four separate cancers. It’s not in your favor.

When you’re looking at trying to get rid of it, one of the low-hanging fruits is to say I am going to eat organic because they’re not putting glyphosate on their crops. But there is contamination that happens. If you’re eating chickpeas, all the chickpeas in the United States are contaminated. You do your best. Try for the organic, but know you’re going to get some. There’s drift. Organic farm on the right, non-organic on the left. Non-organic sprays, wind blows, and it gets onto the organic crops. There is a lot of contamination that will happen that way.

If you have glyphosate, it is pretty easily removed from the body as long as you’re not taking in so much that you’ve loaded the system. It’s pretty readily water soluble. If you improve your liver function, sweat, get enough rest, and avoid filling the pump up with glyphosate, it should be pretty easy to come out.

Dr. Eric:

That’s good to know. Just try your best to minimize exposure. Do things to improve your liver health. That will help as well not only with glyphosate but of course with all other toxins.

In your background, you mentioned urinary mycotoxin testing. I wanted to ask you a quick question about coffee. I’m not a coffee drinker, but a lot of my patients are. I don’t really tackle the mycotoxin issue, the mold issue with the coffee beans. I’m bringing it up now because I want to get your opinion.

Dr. Wendie:

This is like alcohol. Taking away coffee is like taking away alcohol. We can talk about it, but people are going to be mad at you.

Dr. Eric:

If someone insists on drinking coffee, I’ll recommend drinking an organic brand. Organic doesn’t necessarily mean mold-free.

Dr. Wendie:

No. There are two brands I know of that are specifically tested for mycotoxins in the coffee. One is Bulletproof, and one is Purity. I’m sure there is more out there. I haven’t tested them. I don’t drink coffee. If you can imagine me, this is how I am, so I would not do well all hopped up on anything. I don’t drink coffee either.

But coffee is very moldy, as are grains. If you’re eating a lot of grains, those are really high in ochratoxin. You are going to want to minimize the grains and the coffee. Those are big sources for people when they are getting exposed.

Dr. Eric:

Seems like most of the time, if I do urinary mycotoxin tests, I will use Great Plains Lab. There is Real Time Labs as well. Ochratoxinis very commonly high. I think it could also come from inborne air sources, but it’s good you mention that because a very common source is food.

Dr. Wendie:

Food and water damaged buildings, those are the ways you get it.

Dr. Eric:

How about fluoride?

Dr. Wendie:

I’m not a huge fan of fluoride. I’m going to get in trouble for saying too much about fluoride, but it is a toxin. Can we move on?

Dr. Eric:

Yeah, we can move on. There are plenty of other toxins to talk about. Let me get your opinion. What are your thoughts on microwaving? Even though it’s not really directly toxin-related, it is. When you talk about radiation, EMFs.

Dr. Wendie:

It’s not well studied. My friend was giving me grief because one of the examples I give in the book is our daughter did this science experiment where she fed a plant with microwaved water cooled and Bunsen burner water cooled. The plant with the microwave water died. He was like, “That’s an n of one. You can’t quote that!” I can quote it, but it’s not well studied. It does kill the food. You’re diminishing the quality of the food by throwing it in the microwave.

The next layer is if you are using a pre-packaged food, then it’s inevitably got chemicals, pesticides, plastics. It’s stored in plastic often or in a container that has BPA or some other chemical that will leech into your food. Then you heat it in that. You are releasing even more chemicals into your food. There are a lot of layers to this.

We divorced our microwave. I remember my youngest was two. We had a microwave and an oven underneath. The oven went. I was like, “Let’s get rid of the microwave, too.” We got a double oven. On leftover night, it’s harder. It really is. We have 10 things we’re reheating. What a mess. All these pots and pans. But it is healthier for you not to use your microwave.

Dr. Eric:

If someone does have a microwave and are unwilling to get rid of it, you would recommend not standing right next to the microwave when using it.

Dr. Wendie:

Don’t keep peering in. The other thing I would say is microwaves are somewhat lower on my hit list. What I want to understand is what are you eating? How are you living? It’s not usually the first thing I’m saying, to get rid of your microwave. Once you’ve fixed your food and lifestyle, and you’ve leveled up all this stuff, then get rid of it. It’s relatively low on the list. But if you’re going to use it, no plastic in the microwave, period. It has to be ceramic.

Dr. Eric:

I agree. How about flame retardants? Can you talk about those?

Dr. Wendie:

Yes. If you’re a smoker, you need flame retardants in your bed. Think about it. Our ancestors lived in tenements, thickly settled. If one person set their bed on fire, they set the whole block on fire. It was a huge hazard many years ago. If you’re a smoker, definitely get a bed with flame retardants.

However, if you’re not a smoker, the odds of you being in your bed when you have a fire are so small as not to justify the harm that the flame retardants are doing to you. They are tremendous endocrine thyroid disruptors. If you think about it, you spend eight hours, maybe more, every day in that bed. You are pulling in those flame retardants into your body. They then disrupt the thyroid and the rest of the endocrine system, too. It’s really important if you’re getting a bed to do your best not to get flame retardants in it. That goes for furniture, too. If you’re buying a new couch, a futon, whatever furniture you’re buying, it’s important to look for if it contains a flame retardant in it.

Dr. Eric:

The bed would be a priority because hopefully you’re spending at least six, seven, eight hours at night getting sleep. If you’re spending a third of your life in the bed, you want to have a bed that is not only not flame retardant but free of other chemicals, too. I actually have an avocado mattress.

Dr. Wendie:

I have a birch.

Dr. Eric:

Cool. Since we’re talking about the bedroom, I was going to ask you about air purification systems. That leads us into what to do to reduce one’s toxic load. Before we go there, are there any other toxins, chemicals I didn’t bring up?

Dr. Wendie:

Yes.

Dr. Eric:

I know there’s a lot of them. But are there any I missed you really wanted to focus on? Or did I hit the more important ones?

Dr. Wendie:

I would say the ones I would add in are if you pump your own gas, stop. You’re being exposed to the gasoline additives. Those are extremely harmful for you.

If you are wearing makeup or using nail polish, you want to make sure your makeup is natural because phthalates are a huge source of endocrine disruption. A lot of makeup contains phthalates as do plastics. Nail polish also disrupts the system.

Water quality is really important. Some people live in areas where their water is not safe. You want to know if that’s you. Test your water. Know whether it’s reasonable for you. Filter it if it’s not. Your skin is both a detox organ and an absorption organ. If you’re applying toxins every time you get in the bath and sit in it, it’s not safe for you. Know what you’re getting exposed to.

Dr. Eric:

I’m glad you brought water up. I’ll quickly ask you your opinion. Obviously, everyone has different opinions. What do you recommend as far as water purification? At least drinking water.

Dr. Wendie:

It depends what kind of water you have. If you have municipal water, that’s different from well water. You’re going to need to tailor your reaction based on what you have. We have used municipal water. The quality is pretty good. The perchlorate was a little bit high. We wanted to make sure there was no fluoride or other things, so we have a number of levels.

We have a whole house water filter. My favorite one, because of the flexibility of it, is Aquasana. What I mean by that is if you have well water, you’re going to get the thing that irradiates it, but we don’t have well water. We don’t need to worry about bugs. They have an irradiation option. They have the filtration for various stages of what you’re dealing with. I really like that because it’s components you add on together.

If you have high levels of perchlorate, the only thing that gets rid of it is reverse osmosis. There is no whole house reverse osmosis I’ve found. You have to put it on pointed use. This is where I start to say pick your battles. We have four kids, and we have done all these DIY projects and expanded the house. We have all these bathrooms. How many filters am I going to put in my house? You can put one on everyone. What we say to the kids is, “Don’t drink from your bathroom. Drink from my bathroom. Drink from the downstairs bathroom.” We have selected filters. Pick your battles. We put the whole house filter and then the point of use. Go from there. Water quality is important.

Dr. Eric:

It definitely is, which is why I asked you. I give people my opinion every now and then, but it’s nice to get another opinion from another practitioner, especially one who wrote a book focused on toxins. Thanks for letting us know.

What are some action steps people can take to reduce one’s toxic load?

Dr. Wendie:

Sure. I always recommend starting with food. No question. You do it three times a day, maybe more. Maybe you eat five times a day. Eat amazing food. Organic and local is the ideal. I live in Massachusetts. There is no local food right now. That goes out the window. But if you can, organic, local.

Minimally processed, meaning you can identify what it is based on what it looks like. It’s not, “Hmm, mystery.” Don’t eat mystery food.

Sugar falls into that category of alcohol. Minimal sugar. Sugar is very inflammatory. Disrupts every system in the body. Try to minimize your sugar content or avoid it completely.

Don’t drink alcohol, or drink very little. Make sure your coffee is mold-free. Don’t drink from plastic bottles. Just not plastic water, but it’s plastic bottles, period. That’s the food.

Then the next really impactful thing is, especially for women because we use so many products in the course of a day, is whatever you’re running out of, there is no magical, you have to do this first. Whatever you’re running out of is the thing you should focus on because you’re about to buy it. If you are about to buy something, go to EWG.org or ThinkDirty, and look up the product you’re using. Maybe you hit the jackpot. You got it right, and it’s healthy and clean. Cool, keep going. But if it’s not highly rated, then that’s the opportunity to look for a replacement. When you’re ready to order, order that.

As you do that, in the course of a year, I can’t tell you how many things we order in the course of a year. It’s impactful if you say, “Every time I order, I’m going to level up.” You’re going to make a huge difference over the course of a year. This is not a thing you do in a week or a month. This takes- I’m three years in.

By the way, you get greenwashed. If you don’t look at what EWG or Think Dirty say—these are both apps—you can totally get snookered. I’m all excited. I find this new product. I think it looks great. I forget to check EWG because there’s a sale, and I’m running late, and I’m running around, so I buy it. I’m all psyched. A month later, I go, “Well, that was silly. I never checked that. Let’s check that.” I got greenwashed. The package is all natural, no chemicals. You know what? Not as good as they said it was. Be careful with the things that are touting how amazing they say they are. Don’t take their word for it.

Iterate. As you are getting new things, clean it up. I had a patient who had really high flame retardant in her system and thyroid disruption. I said to her, “Did you just get a new bed?” She said, “I did.” I was like, “Okay then. If you just got a new bed, get a good air purifier.” It’s a lot of money to buy a bed. But if you’re in the market for a bed, get one without flame retardants in it. Same with a couch. Make choices when you have the ability, control the narrative, and change the outcome. You don’t have to get rid of all your furniture at once though. That’s not sustainable.

Dr. Eric:

Agreed. Definitely better to get an air purifier. Next time you’re on the market for a new couch or mattress, then try to get one without flame retardants.

To summarize, start with food. You spoke about water. Cleaning products, cosmetics, furniture, if you can, but if not, when you get furniture the next time, make sure. In the meantime, if you do have a mattress, especially if it’s newer- How about if someone has a mattress that is five years old? Would you still recommend getting an air purification system?

Dr. Wendie:

Probably not. I think they’re great in general. If you have an older mattress, it’s probably done the majority of its offgassing. Although maybe not. It is designed to be the life of the mattress. I’m not sure if you’re still getting exposed to that.

I would say you’re never going to regret getting an air purifier. Ugh, my air is clean! No. You’re never going to say that. It’s one really nice way to level up. You won’t regret it. I’ll put it that way.

Dr. Eric:

We have one for the office and a few for the home. I wanted to again get your input with that. Thank you for sharing. Where can people find out more about you? Obviously, there is the book. Definitely check out Dirty Girl: Ditch the Toxins, Look Great, and Feel Freaking Amazing. I know you can get it on Amazon. Maybe on your website, too.

Dr. Wendie:

Yep, it’s cheaper for people on Amazon. Then we have a free guide that’s meant to be a companion guide to the book. Now that you’re ready to clean up your life, you might be like, “Well, what’s the best pan to use? What’s the best cleaning product to use? What’s the best mattress to use?” We put that all in a guide for people. It’s FiveJourneys.com/Promo.

On all of the social media handles, Instagram, Twitter, Facebook, LinkedIn, I’m Wendie Trubow, M.D. This was a decision I made when I was 13 to spell my name this way, and I stuck with it. My website is FiveJourneys.com. Our podcast is Five Journeys: Live Like You Matter.

Dr. Eric:

Wonderful. Thank you again for this interview. I learned a lot. I’m sure the listeners learned a lot. They’ll definitely learn a lot more in the book. There is so much more we could have covered. Just limited time here. It would have taken all day to cover everything in the book. Check out Dr. Wendie’s book. Thank you so much, Dr. Wendie. I do appreciate it.

Dr. Wendie:

My pleasure, Eric. Great to be here.

Recently I interviewed Dr. Westin Childs, as he discussed how to overcome unwanted weight gain if you have hyperthyroidism or Hashimoto’s thyroiditis. If you would prefer to listen the interview you can access it by Clicking Here.

Dr. Eric Osansky:

With me, I have Dr. Westin Childs. We are going to be discussing unwanted weight gain in both hyperthyroidism and Hashimoto’s. I’m going to give Dr. Childs’ bio, and we will dive into the content. Dr. Westin Childs is a former osteopathic physician that focuses on helping people with thyroid problems, weight gain, hormone imbalances. He takes a functional medicine approach to these systems and believes that everyone regardless of their hormone status can get back to 100% through using a combination of natural and medical therapies. It’s great to chat with you again, Dr. Childs.

Dr. Westin Childs:

It’s good to be here, Dr. Osansky. Thanks for having me on again.

Dr. Eric:

Yep, we have already had you on my podcast. It’s great to talk with you again. This time, we will be talking about weight gain and problems losing weight. I’m sure there are some people with hyperthyroidism viewing this and thinking, “Hey, I’m losing weight,” which is also common. When I dealt with hyperthyroidism, I lost 42 pounds. There are some people with hyperthyroidism where it’s the opposite problem. When some people become hyper, they’re hoping to lose weight because most people with hyperthyroidism are women, not that men don’t want to lose weight. Either way, whether you’re male or female, a lot of people want to lose weight when they realize they are hyper, yet they are gaining weight. “What’s the deal with this? I see weight loss is a classic symptom.” Of course, with Hashimoto’s, it’s also common for people to gain weight. Either way, we know that weight gain is a common symptom. Why is that? What are some of the reasons some people with hyperthyroidism gain weight instead of losing it?

Dr. Westin:

That’s a great question. In order to talk about this, we have to get clarity on what we mean by hyperthyroidism and hypothyroidism. I want to talk about the way that I was seeing patients, the way you are, too. It will make more sense as we dive into this. Traditionally, we think of hyperthyroidism as having too much thyroid hormone. Someone is producing too much thyroid hormone, and it’s overstimulating their body in various ways. It’s causing increased heart rate, their hair follicles and cycles to rapidly turn over so they are losing hair, revving up the metabolism so they are losing weight, having more gastrointestinal function so they are having looser stools or even diarrhea.

Hypothyroid means low thyroid, so it’s the exact opposite. Traditionally, we think about people with hyperthyroidism as those people losing weight, and those with hypothyroidism are gaining weight. That is theway we think about it.

The problem is it doesn’t quite add up all the way. We still have hyperthyroid patients gaining weight, as you mentioned. First and foremost, it depends on where you’re at in this treatment, if you’re going natural or doing the conventional medical route. Let’s just assume you’re somebody who is diagnosed with hyperthyroidism, doesn’t matter if it’s Graves’ or toxic multinodular goiter. If you have hyperthyroidism, and you go see your doctor, what is your doctor going to do? They are going to reduce your thyroid function. They are taking you from a high thyroid level to a lower thyroid level; they are trying to bring you to a normal thyroid level. All of the treatments you are going to receive are going to slow down your thyroid.

Imagine if you have a level of 100. 100 is a normal thyroid function. Let’s say that when you’re hyperthyroid, that level is 200. If you go to the doctor, your doctor’s goal is to take you from 200 to 100, using methimazole in this case (it could be PTU), some sort of thyroid-blocking medication. Your doctor tries to get you to 100 from 200, but they take you to 50. In this case, they took you from hyperthyroidism down past your normal thyroid function down to low thyroid function. They effectively turned you from hyperthyroidism to hypothyroidism with the use of antithyroid medication.

Most of these medications that doctors use, in fact, all therapies for hyperthyroidism, do result in hypothyroidism. We can go through these if you want. We have antithyroid medication, beta blockers (to reduce symptoms, but those can cause problems with thyroid function as well), thyroid surgery (either hemi-thyroidectomy or complete thyroidectomy), and radioactive iodine ablation. All of these therapies that hyperthyroid patients undergo result in low thyroid function. That’s #1. We will talk about the importance of thyroid function as it relates to metabolism and controlling various aspects of your body.

Hyperthyroidism is an abnormal physiologic state. There are problems that are underlying that issue which are then manifested in the thyroid. For instance, inflammation, gut dysfunction, insulin resistance, and leptin resistance may all have preceded your diagnosis of hyperthyroidism. When you get hyperthyroid, you have these underlying issues that still exist. They can cause weight gain by themselves.

Another one I would add in there would be medication such as beta blockers. We talked about methimazole and antithyroid medications. Other medications including SSRIs, antidepressants, narcotics can all impact thyroid function as well. If you are a hyperthyroid patient taking some of these medications, these can also slow down your thyroid beyond which would be normal for you and lead to weight gain or at least conditions that exacerbate weight gain.

I would say those are the three or four main ways that hyperthyroid patients can start gaining weight. Actually, I would say this is very common. Another thing that is worth mentioning, if I could take a couple seconds here, is explaining the difference between the people that would probably be going to see their conventional doctor versus the people seeing you.

Let’s say you were diagnosed with Graves’, the most common cause of hyperthyroidism. You have one of two options. You can go the natural route and try to avoid the antithyroid medications, using supplements, diet, and lifestyle, which would probably lead you to someone like Dr. Osansky. Or you can go to your doctor, which is what most people do. Then they go down that path of taking antithyroid medications.

Depending on which path you take, the outcome is going to be a little bit different. If you’re going down the path where you are trying to do things more naturally, you will be using supplements perhaps instead of medications. Maybe you’re using motherwort or bugleweed instead of antithyroid medication. They aren’t necessarily as powerful as the medications, which means the thyroid function won’t go from 200 down to 50. Instead, it might go down from 200 to 125. You’re still borderline hyper in that case, which means you are more likely going to lose weight on that route versus taking the more aggressive route of using medications.

The distinction between which path you’re taking, where you’re at in the life cycle of treatment (Did you get your thyroid removed? Ablated? What type of underlying issues do you have?). It’s a complicated scenario, and it depends on the individual and where they’re at. That’s a long-winded answer, but that’s how I think about it.

Dr. Eric:

I do see a lot of patients on the medications. Usually it’s the methimazole, becoming hypothyroid. Sometimes it is extreme. As you said with the beta blocker, propranolol could affect conversion of T4 or T3 and some others as well. Very interesting as far as you mentioned that they could have underlying conditions like insulin resistance or leptin resistance before they developed hyperthyroidism. They may not be aware of that condition because when they go to see the endocrinologist, they are focusing on the hyperthyroidism, doing the thyroid panel. They might do a comprehensive metabolic panel, looking for glucose, but that doesn’t always tell if someone has insulin resistance. They might do a CBC with differential.

Let’s talk a little bit about insulin resistance and leptin resistance with both hyperthyroidism and Hashimoto’s. How do those impact weight loss? How do those lead to problems losing weight?

Dr. Westin:

That’s a good question. The relationship is such that insulin resistance can cause weight gain. Also, thyroid dysfunction can lead to insulin resistance. It’s an underlying cause, which may precipitate weight gain. Once you have the thyroid problem, that is also going to make worse insulin resistance.

Those of you listening probably have some awareness of insulin and leptin. Insulin is a hormone secreted by the pancreas. Its job is to control blood sugar levels. What happens as a result of lifestyle, chronic stress, the overconsumption of sugars and carbohydrates, your body becomes resistant to the effects of insulin inside the body. It’s very common. Statistics put it as high as 50% of all people in the United States have some degree of insulin resistance. You can think of it existing on a spectrum. Some people have very severe insulin resistance, and some people have it less severely.

Just discussing my experience in looking at and treating people, most people who end up with thyroid problems already had some level of insulin resistance before their diagnosis of their thyroid problem. The problem with insulin resistance is it can stir up inflammation inside of the body. It can cause various conditions, including metabolic syndrome and cholesterol problems.It’s impacting how well your body is able to utilize sugars inside the body and where they go. When insulin resistance is present, it’s sending the signal to your body to push more of the foods that you eat inside of your fat cells. The way I think about it is when insulin resistance is present, losing weight will be very difficult for that reason.

In the case of hyperthyroidism, we have a double whammy thing going on here. Hyperthyroid states do result in insulin resistance. At the same time, hyperthyroid states, if left untreated, also usually result in weight loss. You have this ebb and flow wherein the hyperthyroidism, if causing weight loss, is sensitizing the body to insulin while simultaneously causing insulin resistance. There is probably some teeter-tottering that occurs there. Depending on where you are at in the treatment, with antithyroid medication, that may tip you more over into the insulin resistance side of things as opposed to the insulin sensitizing side of the equation. It’s a seesaw effect.

Leptin is another story. I would consider that to be a fat-storing hormone as well. Leptin is also a hormone secreted by fat cells instead of the pancreas in this case. It’s probably the most important and underappreciated hormone as it relates to your ability to lose weight, especially if you are a thyroid patient.

The way it works physiologically speaking is that as you gain more weight in your body, as your fat cells accumulate in size, they start to secrete more leptin. The goal of that is for your fat cells to communicate with your brain. They don’t have a direct messaging system built in, so they start secreting leptin out. It floats up to the brain, triggers the hypothalamus, and is supposed to be the communication between the fat cells and the brain, when fat cells are high, to tell the brain, “Hey, we need to change whatever we’re doing. We need to increase metabolism. We need to alter our appetite. We need to alter enzymes and protein production,” such that we start burning off fat so we can lower these leptin levels. That is the communication between leptin, your fat cells, and your brain.

The problem is the communication is between the fat cells and your brain in the hypothalamus. That is the same area that the thyroid is being regulated. We have the hypothalamic pituitary access that is then involved with the thyroid gland. Leptin and thyroid hormone are connected to each other such that when you have problems with thyroid hormone or leptin, you have problems with the other. It’s a bidirectional relationship there. When there is an issue with leptin, there is an issue with thyroid hormone. When there is an issue with thyroid hormone, there is an issue with leptin.

Leptin is one of those that we’re not looking for. We know the importance of insulin because people have diabetes or metabolic syndrome, etc. I was ordering it a lot. Are you ordering a fair amount? Where do you sit on the leptin thing?

Dr. Eric:

I can’t say I order leptin in a lot of patients. After our first interview, I started doing it more with some patients, mainly if they are gaining weight and having problems losing weight. I do commonly recommend insulin testing, doing a fasting insulin along with hemoglobin A1C. I don’t know where you stand on those markers. With leptin, a few months ago, I started, depending on the person. I can’t say everyone with hyperthyroidism or Hashimoto’s, maybe I should, I don’t know.

Dr. Westin:

It depends on their symptoms. If weight is in the equation, if it’s a problem for them, I would always recommend getting it. In order to test for leptin, you need to be in a fasted state. Typically, I will test for leptin and insulin because you want to be in a fasted state for insulin, too. You can check your cortisol and thyroid function at the same time. You can get a good idea of what’s happening in the body by checking all of these hormones at the exact same time.

Leptin is one of the most important fat/weight loss hormones, however you want to describe it. If it’s dysregulated, weight loss is going to be very difficult. I can talk a little bit about leptin resistance if you don’t mind.

Dr. Eric:

Sure.

Dr. Westin:

Leptin resistance, and its diagnosis, is something a lot of doctors are unfamiliar with. If you are going to a conventional doctor and saying, “Hey, can I check my leptin? I heard that it’s important for losing weight. I’m not losing weight. What’s the deal?” Leptin plays a big role in this obviously. The problem is a lot of doctors are not familiar with the physiology we just described. Let me explain what happens with leptin resistance.

Similar to insulin resistance, if you have leptin resistance, your body becomes desensitized to the leptin that’s there. Remember, under normal physiologic conditions, as fat cells increase, leptin levels will increase, too. That leptin is supposed to go to the brain and tell the brain to make some changes. We need to do something to lower fat cells.

When you become resistant to leptin, either because your fat cells are inflamed, or you have some underlying issue like a thyroid problem, which people here will likely have a combination of both, especially if you have an autoimmune-related issue, that system becomes dysregulated, and the brain is no longer sensing it. What ends up happening is that leptin levels increase, and your body, instead of getting the signal that there is too much there, it ends up getting the exact opposite signal. It thinks there isn’t enough leptin to go around because it’s resistant to it. What does that do? That triggers more appetite. That triggers a decrease in metabolism.

Now you have the exact opposite of what should be occurring actually happening inside of your body. This is where people who have thyroid conditions get ravenous appetites, where they are already overweight. Maybe they are reducing their calories already to 1,500 per day, but they are still gaining weight. Their metabolism is the highest it can possibly be. You have this mismatch between appetite and metabolism even though you are already overweight, and it should be changing. But a lot of that is driven by the mechanism of leptin resistance.

Dr. Eric:

Makes sense. Similar with insulin resistance, that’s what you’re looking for on a test. You’re looking for the leptin to be high, and the person is going to have an increased appetite and still going to want to eat. That won’t help. Is it safe to say that even in cases where they are restraining themselves from eating, it still might not be enough? If someone just changes their diet with leptin resistance- I find that with insulin resistance, it’s usually an inflammatory component. The person could be following a ketogenic diet, and they might lose weight. Depends on the person. Some people, still following keto, might struggle with making the dietary changes alone, or in combination with exercise. I don’t know if you found that when you were seeing patients.

Dr. Westin:

Definitely. If you werein a position like ours where you get to see a lot of different patients, you get to see how they react to different diets and protocols, it becomes easy to look at it from a different angle than most people do. If you are looking at it from the perspective of if you want to lose weight, all you need to do is reduce your calories and exercise more, and if you’re not losing weight, then you’re not doing that, there is something wrong with that model. It doesn’t apply to everyone, especially those with thyroid situations.

I can recount numerous examples of patients who are eating 1,000 calories per day. I have no reason to suspect they are lying. I believe they are telling the truth when they say that. Most people will say, “They are eating more than they say they are.” That may happen in some instances, but I believe most of the time, people are pretty accurate, plus or minus 10-15% of their caloric intake, if they are tracking it pretty rigorously. The problem is you have a lot of these thyroid patients who are consuming 1,000 calories per day but still gaining weight. What gives? I put them on the ketogenic diet, elimination diet, AIP, carnivore diet, all sorts of types of diets with these people, and they still don’t lose weight. This tells me that there’s something more to this idea that weight gain is primarily driven purely by calories.

In the case of thyroid patients, including those who have had their thyroid removed, a lot of it is driven by hormones. More important than calories, even though calories are important, is what is happening inside of the body at the level of the hormones? A lot of people know this. This is why the ketogenic diet exists. They will say, yes, calories are somewhat important—how important is debatable—but they believe insulin is the primary driver of weight gain. The whole goal of the dietary recommendations of the ketogenic diet and the carnivore diet to some degree is to reduce as much stimulation of insulin as we possibly can. Therefore, we will sensitize the body to insulin, and we will lose weight. They do that and still don’t lose weight. There is something else involved other than insulin.

I would say insulin is important, but there are other hormones just as important, including thyroid, cortisol, sex hormones, leptin. If you are a thyroid patient struggling with weight, my opinion—and I have had a lot of success in helping people lose weight—is to focus more on the hormones than the calories. Yes, you definitely can and should focus on the quality of the food you’re eating and even the quantity to some degree. We can talk about that if you want.

I’m sure you have shared a similar experience to me, where you see people doing exactly what you say, and I have no reason to believe they are lying about how much food they’re consuming, and they are still gaining weight, or at least not losing it. What do you do at that point? How do you explain this away? My explanation is these hormones are taking a front seat to calories. They’re most important. That’s where I sit on calories versus hormones when it comes to weight gain.

Dr. Eric:

Let’s talk about diet. You mentioned quality versus quantity. What do you typically recommend when it comes to diet?

Dr. Westin:

I think it depends on the type of person we’re talking about here. In this discussion, we’re talking a lot about hyperthyroid patients. I would say the way that you would treat a hyperthyroid patient who is undergoing natural therapies to treat Graves’ is going to be different than the dietary recommendations for someone who had hyperthyroidism who underwent a thyroidectomy or radioactive iodine ablation. You have to stratify what type of patients we’re talking about and what problems we have.

In the case of someone who has active inflammation going on in the body, we are suspicious they have elevated antibodies floating around in their bloodstream. We will use Graves’ as a prototypical example here. They are trying to treat Graves’, maybe with methimazole or not. The goal of their dietary changes should be to reduce inflammation and alter immune function. I would look into diets such as the elimination diet, a whole food-based diet, AIP diet. Anything that is reducing any stimulation from foods that might stir up inflammation inside of the body, leading to worsening thyroid function, weight gain, etc.

That is different from the person who has undergone thyroidectomy or radioactive iodine ablation. That is a person who could be different in their dietary approaches because presumably they don’t have the same immune/inflammation aspect. Yes, they may have some inflammation underlying their condition, but you can treat them differently.

I would recommend focusing more on intermittent fasting, prolonged fasting, water fasting. You still want to be cognizant of the quality and quantity of food you’re eating. Any whole food-based diet would be good in this situation. You could play around with the ketogenic diet, carnivore diet, or whole 30 diet. As long as the quality of the food is high, the actual weight loss will come as you start focusing on those other hormones I mentioned.

That is a different approach than I would take to the person who is hyperthyroid with an active immune dysfunction we mentioned previously. That is someone you don’t want to put on a fasting regimen. Fasting may make them worse or cause more weight gain.

Also, how are you going to make changes to their diet based off of their personal preferences? I am not the type of person who thinks you can apply a broad stroke to everybody with a thyroid condition. This universally is the best diet for hyperthyroidism. This is the best diet for Graves’, etc. I don’t think that works. I try to take a more individualized approach to dietary management of a particular patient. That works the best. I have had people who have lost weight consuming high carbohydrate diets or high potato diets with lots of fiber and everything in between. The one thing I’ve found is that no two thyroid patients are really alike. They can have similarities, but they are not the exact same in terms of what’s going to work for them.

Dr. Eric:

Agreed. There is no diet that fits everyone perfectly. I’m glad you brought up fasting. I agree that when it comes to my hyperthyroid patients, I typically don’t recommend intermittent fasting. Interesting when you mention someone who gets a thyroidectomy or radioactive iodine that you do recommend fasting. With Hashimoto’s, I’m guessing you also don’t recommend fasting since it’s more of an active inflammatory state like Graves’.

Dr. Westin:

Actually, I do recommend frequently fasting with Hashimoto’s. It depends on thyroid function. My hesitancy in recommending fasting in the case of active Graves’ in which you’re being treated naturally is that the fasting state might cause overstimulation of metabolism and lead to worsening weight loss beyond the point that you want.

In the case of Hashimoto’s, you do have some people who have a hyperthyroid state, and they can fluctuate in and out of hyperthyroidism. That is usually uncommon. Usually Hashimoto’s, low thyroid function generally, but it can fluctuate up and down. Hyperthyroidism with Hashimoto’s, that does occur. But in the case of Hashimoto’s, most people are hyperthyroid, and fasting does have benefits in terms of its impact on inflammation and other areas inside of the body.

It is beneficial in the case of autoimmunity. If someone had MS or any sort of lupus or other autoimmune diseases, I still think fasting is highly beneficial for those patients. I would say fasting as a therapy, outside of its impact on weight loss as it relates to thyroid function, is still beneficial. Fasting should be used if possible. In the case of Graves’, I think it can be used, but it should be used cautiously. Hopefully that clarifies my standing on that.

Dr. Eric:

It makes sense. I’m just concerned that it might exacerbate the hyperthyroid state, but to play it safe, you would say probably on average, a person with hyperthyroidism, even if they are gaining weight, maybe not due to intermittent fasting, at least not right now. With Hashimoto’s, you do recommend, as well as those who receive thyroidectomy or radioactive iodine.

Dr. Westin:

Yeah, that’s a good way to think about it. It’s all based on the situation. I do think there are situations in which somebody who has Graves’ could do intermittent fasting or start out with mild fasting. You could do maybe 14-hour eating windows or 16-hour eating windows. When I talk about fasting, I’m generally recommending prolonged fast, water fast, or dry fast of 24 hours or more. That is where you get those therapeutic benefits I was mentioning previously. I’m a big fan of using fasting as a therapy for weight loss but also for treating autoimmunity or balancing immune function.

Just be cautious. The worst thing you can do is if you run out and start doing a two- or three-day fast and are already in a hyperthyroid state, and you start catabolizing some of your muscles, that is not what you want to do. Before you run out and do something like that, touch base with someone that understands this philosophy, so you don’t put yourself in a worsening situation. I don’t ever want to lead anyone down that path.

Dr. Eric:

You briefly mentioned cortisol. How does that play a role when it comes to weight gain? High cortisol will have a greater impact than depressed cortisol levels.

Dr. Westin:

Cortisol is another really important hormone. In fact, I would say in terms of its impact on weight, it’s not as important as insulin or leptin. I would put those up there as 1 and 2. They are the most important hormones as relates to your ability to lose weight. I would put thyroid hormone up there as three. Cortisol is important, but not as important as the other ones we have been discussing.

Just a brief physiology for those who aren’t familiar: Cortisol is the hormone secreted when you are under a lot of stress. Its whole goal is to help you adapt to stress. Normally this is not a problem, and it can be a good thing. Much like these syndromes we have been talking about previously, whenever something becomes overstimulated, that is when it becomes a problem.

We commonly refer to this as adrenal fatigue or adrenal-related issues or even cortisol resistance. When cortisol is becoming overstimulated inside of the body, the body is no longer utilizing it as well as it once was. A lot of people believe that as your body becomes more pressed with stress over a long period of time, cortisol levels tend to increase. Over time, your body loses ability to handle that production, and it peters out and goes down. That cycle of cortisol production has mostly been debunked. I don’t necessarily believe that is the case. I have seen people with weight gain with low cortisol as well as high cortisol and everywhere in between.

My way of looking at cortisol is more of what’s happening at the cellular level. As you mentioned, absolutely, high cortisol tends to be the thing that triggers weight gain. We also have to expand our thinking beyond what is the absolute cortisol level inside the blood? How are the cells able to utilize and manage cortisol? Is it efficient or inefficient? How does that impact weight?

I do think it’s worthwhile checking cortisol. That’s why I mentioned to grab your fasting leptin, fasting insulin, serum 8am cortisol, thyroid hormones, sex hormones. You can grab all these at the same time. But they need to be looked at in context. No single lab test can be looked at in isolation. You can’t just see that your cortisol is 16; therefore, it’s fine. It may be fine, but you also may have some degree of cortisol resistance, in which case cortisol is causing a problem.

Furthermore, this is compounded by the fact there is a close relationship between cortisol function and thyroid function such that usually, especially in the case of hypothyroidism, but also with hyperthyroidism, changes to your thyroid function will impact cortisol levels as well. This has been my experience, and you can chime in here, too. I have yet to meet a thyroid patient who didn’t also have some cortisol-related issue.

How you treat that is up in the air. If someone is hyperthyroid, maybe you want to lay off some of the adaptogens and use a more mild version. I’m a big fan of using adaptogens and glandulars in the hypothyroid patients. That includes people who have had radioactive iodine or thyroidectomy. In the case of active Graves’, you might want to use a different type. You can also do things like meditation, stress reduction, improving your sleep, and mindfulness. There is so many things you cando to improve your stress outside of taking an adaptogen. I am a big fan of using adaptogens in certain cases of thyroid patients.

Dr. Eric:

It sounds like cortisol is a factor, but you would say the top three are leptin, insulin, and thyroid hormone. Cortisol would potentially be a factor, but it would be #4.

Dr. Westin:

This is the helpful way to think about it. I don’t think this is exact. Let’s imagine somebody is 50 pounds overweight. The conventional thought might be, “That weight is because I have gained 50 pounds. I have been eating too many calories.” I would say to scratch that.

When I was treating patients, this worked effectively. Some fraction of that 50 pounds is due to leptin resistance. Some fraction is due to insulin resistance. Some fraction is due to cortisol. Some fraction may be due to sex hormone imbalances. The thyroid regulates all of these things. If you have a thyroid problem, you will have a problem in all of these areas.

What you will see is somebody who comes in, gets treated, starts doing a ketogenic diet. They lose 10 pounds. You have treated the insulin resistance fraction, but you did not address the leptin, sex hormones, or cortisol. It’s not until you address the complete hormone disruption inside of your body that you will lose that complete 50 pounds of weight. Everything is contributing either together or in concert. There is never really a case where someone just has 50 pounds of weight gain related to their insulin level. All they need to do is go on the ketogenic diet and lose weight because they fixed that problem. That does happen, but that’s very rare. Most common is someone does something and loses 2-5 pounds and they plateau.

What’s going on here is you didn’t address those other hormone imbalances we talked about previously. That is how I would wrap my head around it. That is the way I would explain it to patients I would treat in the past. That seemed to work the best. We addressed one problem and then looked at how much is left over. We would see leptin resistance is still here. We just checked your leptin levels again, and it’s still high. Leptin needs to be addressed still. Then they lose 25 pounds and have 25 pounds left to lose. We need to address leptin in order to get that down.

Whenever you are trying to lose weight, a plan should be multifactorial. It should have a lot of different therapies. It should never just be,“I am going to go on the ketogenic diet, and that’s that.” That’s a recipe for losing a couple pounds and maybe damaging your thyroid in the process, especially if you’re eating pro-inflammatory foods. It’s easy to do some of these diets in the wrong way. That is how I would think about that. I hope that’s more clear.

Dr. Eric:

Another hormone I want to throw at you is estrogen. If someone has estrogen dominance, whether it’s too much estrogen or not enough estrogen in relation to progesterone, I’m guessing not as big of a factor as the insulin, leptin, thyroid. Would you say that could also be a factor?

Dr. Westin:

Absolutely. 100%. I would say sex hormones are also heavily neglected by conventional doctors as it relates to their impact on weight. As you mentioned, it’s less important in men. Testosterone is important in both men and women in terms of its impact on immune function and weight loss. Estrogen is important in primarily women. It is important in men as it impacts libido and so on, but for women, it’s much more important.

What’s really important is not your absolute estrogen levels, so much as it is the balance between estrogen and progesterone. This is the way I explain it to people: Imagine we took 100 women, lined them up in a line, and looked at the physique of each of these women. There will be differences in terms of ratios, heights, busts, thighs, weight, everything. Those differences are primarily related to the impact of these sex hormones on their body during development. That is how you can think about what estrogen is doing.

If there is a relative imbalance of estrogen such that estrogen is much higher than progesterone, you will start to develop certain things. You will develop weight gain, usually in the breasts, hips, thighs, and butt. That is what estrogen does. Estrogen is stimulatory to adipose tissue. That is physiology 101. If you have too much stimulation of estrogen, the fat cells in those areas are going to enlarge. It’s as easy as that.

How you get to this state of estrogen dominance, there are a couple ways. You can have an absolute increase in estrogen levels, which means that estrogen can go up, progesterone stays, and the gap between the two widens.

You can have a reduction in progesterone, which is pretty common, especially as women are aging.

You can have a combination of estrogen staying the same, if not falling, but progesterone falling more rapidly than estrogen is falling, so the gap is still widening even though they are both going down.

Then you can also have exposure to endocrine disrupting chemicals or xenoestrogens. These are compounds you come in contact with. Milk and dairy products have a lot of these things. They stimulate the estrogen receptor cells inside the body. They act as if estrogen is there even though it’s not. You can have a relatively normal estrogen and progesterone, but due to overstimulation at the cellular level, it is appearing to the body as if estrogen levels are higher than they really are. That one is more difficult to diagnose because you can’t really test for it. There is no test for EDCs really. At least none that are available to most people.

The other ones are more common. You can check for estrogen and progesterone levels. You can look at the serum levels and see how they are changing. The problem is women have menstrual cycles. Those levels fluctuate over time. If you don’t know how to test estrogen and progesterone levels, and you are not consistent in how you’re testing them or what time of the month you’re testing them, then the levels are going to be whatever. Nobody really knows what to do with them necessarily unless you’re testing consistently at a similar interval.

To answer the question, I think estrogen is very important, especially for women. The way I would think about it in women who are gaining weight is you want to look at where that weight is being placed on your body. Where you are gaining your weight can tell you a lot about what type of hormone imbalances you have inside of the body. For instance, is the weight primarily in the hips and thighs area? Is it primarily in the breast? Is it in the abdomen? Abdomen tells you something different than in those other areas. Think about where the weight is being gained. Think about how it’s presenting on your body and how rapidly it’s occurring. That can tell you a lot about what hormones you should be looking at. Even if the hormone lab tests aren’t 100% indicative of what’s happening, you can look at the patterns on your body, and that can give you a lot of information.

Do you mind if I talk about testosterone as well?

Dr. Eric:

No, not at all.

Dr. Westin:

Testosterone is really important for both women and men, and especially those people who have autoimmune thyroid disease. There is some debate inside the medical community- Let me put it this way. We know women tend to get autoimmune diseases at a higher frequency than men do. No one knows why. Some people thought it might be due to the baseline level of testosterone in men versus women. Men have much higher testosterone levels than women do naturally. Women tend to get autoimmune disease, sometimes 8-10x more commonly than men. They thought it was because of that. In fact, we do have studies that show testosterone is playing a role in the immune system in some ways.

I do think low testosterone is very common in women who have Graves’ or Hashimoto’s because they are both autoimmune diseases. We also know the thyroid is impacting testosterone levels. We also know testosterone impacts your weight through its impact on lean muscle mass, energy levels, libido, and mood.

Testosterone is very important because it can be used as a therapy not only to treat the underlying autoimmune disease, but it can also help with weight loss. That is assuming your testosterone is low. Testosterone is like a secret therapy if you will for treating autoimmune disease because of its impact on weight and autoimmunity.

Treating estrogen is more difficult. You rarely ever want to give a woman an estrogen hormone, like a bioidentical hormone, unless they are in menopause. If you are a premenopausal woman, estrogen is off the table in terms of hormones you should be taking. Progesterone and testosterone can both be used, but not estrogen. That is why I say focusing on testosterone can be beneficial because increasing that can cause a good impact on immune function and weight loss.

There are roundabout ways of increasing testosterone such as using DHEA. I don’t know if you recommend DHEA at all. The problem with DHEA is it is a precursor hormone to the other hormones downstream. Giving someone DHEA and hoping they produce more testosterone doesn’t always work. Someone might take it and use it as a precursor to produce more estrogen instead of the testosterone you want them to produce. In this case, you’re worse off than you were.

There are different things you can do as a patient. You can get testosterone creams and gels. You can use DHEA. Pregnenolone can be a potential option. That can also be used for the treatment of cortisol issues.

The topic of hormone balance can get complex. It’s very nuanced. It depends on the person. It’s hard to give broad statements and recommendations for individuals in this setting.

Dr. Eric:

What I’m sure people are wondering is the action steps they should take, the solutions. If someone has hyperthyroidism or Hashimoto’s, and they are struggling to lose weight, as far as testing goes, the testing as you mentioned does probably depend on the person. Let’s say if someone goes to a functional medicine practitioner or does some testing on their own, these days you can go to a lab and test yourself for insulin, leptin. If someone finds out they have higher insulin and/or leptin and maybe some of these other imbalances, how do you get these hormones in balance? What would you recommend?

Dr. Westin:

There is a lot of things you can do. We could probably spend an hour or more talking about treatments. Let me try to distill it down to this. The first place you want to focus is your thyroid. That is the thing that will have the most impact in this setting. If you are not a thyroid patient, you want to focus on your leptin. In the case of these thyroid patients, they have thyroid problems. The first thing to do is address thyroid function.

Let’s assume you are someone with hyperthyroidism, and you are not taking antithyroid medication. What you want to do is address the autoimmune aspect of it. Try to get thyroid function back to normal as quickly as possible.

If you are taking antithyroid medication, try to get off it. The best thing you can do is get off of methimazole. It is the brakes on your metabolism. If you are taking methimazole and gaining weight, the single best thing you can do is whatever it takes to get off of it. That does not mean to yank yourself off of it. I am talking about doing the natural therapies that balance immune system and function. Take supplements you need. Fix your gut. All those underlying issues we have been talking about. That is where I would start, without getting too depth into those. That is the best thing you could do for that person. Try to get that under control as quickly as you can. That will give you the most bang for your buck in terms of efficiency.

The second thing you would want to do, which goes along with the first, is adjust diet and consider fasting. The reason I say these is because there are other therapies. We have medications, sauna therapy, detox therapy, cryotherapy, and more. Diet and fasting are two things that you are in control over. You may not be in control over what medication your doctor is giving you, but you do have control over what you put inside of your mouth. Focus on the diet as much as you can. On the flip side, with fasting, you can control what you don’t put in your mouth since you are going without food. If you have found you are in a situation where fasting is safe, use that. No matter what, focus on your thyroid and do your diet.

When it comes to people who have undergone thyroidectomy or radioactive iodine ablation, and I’m not sure how many of those people are listening here, that is a different story. The philosophy of addressing your thyroid is still the same. However, in this case, that means you will have to address thyroid medication. In the case of hyperthyroidism, you’re still producing some, in abundance in most cases.

In the case of thyroidectomy or RAI, they no longer produce thyroid hormone, which means they are 100% reliant on thyroid medication as their primary source of thyroid hormone. This means if you are trying to optimize your metabolism, you have to adjust this thyroid medication. That makes it more difficult because that means it’s outside of your hands and in the hands of the doctor.

Thyroid function, no matter where you’re at, is the first thing to focus on. If that means getting off of antithyroid medication, balancing your immune system so your body stops overproducing it, that will go a long way with inflammation. Or on the flip side, if you still need to take thyroid medication, that’s #1. #2 or 3 would be diet or fasting. Fasting for sure in the case of RAI and thyroidectomy. Possibly in the case of active Graves’, where you don’t take antithyroid medication. Is that a decent starting place? We could go into more detail if you want.

Dr. Eric:

That’s great. I assume also stress management for cortisol. How about supplementation?

Dr. Westin:

Sure. That is going to depend heavily on the type of hormone imbalances that you have. Preceding the treatment recommendations I mentioned, you want to get testing first because testing will help direct the type of therapies you will be focusing on.

Let’s say you get your insulin checked, and it shows that you have a significant amount of insulin resistance. That means you can now focus your supplementation on treating that problem. You could use dietary fibers, konjac, glucomannan, fish oil, turmeric. In the case of insulin resistance, you can target supplementations to that particular issue.

In the case of leptin, let’s say your leptin is high, there are some things you can do. Glycosaminoglycans, l-glutamine. Those are particularly beneficial. Fish oils is another one beneficial for both leptin resistance and insulin resistance. I will throw berberine on as well even though that is more of an insulin resistance issue.

In the case of thyroid, let’s say you’re trying to balance your immune system. in that case, your supplementation will be directed more toward your immune system: magnesium, Vitamin D, zinc. It depends on what the underlying issue is and how you want to address that.

Universally, some good supplements everyone could benefit from would be a solid multivitamin, Vitamin D, probiotics, magnesium.

Dr. Eric:

You said Omegas.

Dr. Westin:

Fish oils, Omegas. Let’s say somebody doesn’t know what their lab tests are. These would be the things you could start with right away. The goal of these wouldn’t be to help with weight loss, but to level the playing field. Replace lost nutrients to the body, so that it is functioning more optimally and can take care of itself.

I would also add protein powder regardless of whatever situation you’re in. It’s really good for managing appetite, helping build lean muscle mass, and some other benefits. It’s general supplementation for pretty much anybody with thyroid conditions. You’d be safe to use those.

Dr. Eric:

Any specific type of protein powder? Pea protein, whey protein, etc.

Dr. Westin:

In the case of autoimmune disease, generally you want to stay away from whey-based protein powders. Some people can get away with it. The benefit to whey protein is it has a pretty robust increase in glutathione naturally based off the amino acid profile, which is amazing for anybody who has thyroid inflammation, which is all autoimmune disease. If you can, you would want to use whey protein for the pure benefit of getting more glutathione. The problem is it also has an immunogenic component, wherein it can cause worsening inflammation inside the body.

If you can get by with whey, it can be beneficial in some situations. But you’re more safe starting with a pea-based protein or plant-based protein. Avoid the whey for now until you can tolerate things and get your gut function under control. Stick with the more vegan plant-based proteins to start for thyroid patients. Maybe you can dip your toes in whey.

Another one would be egg protein, which is pretty good if you can get it. You can also try bovine-based protein powders as well. Those are good for AIP diets. You can play around with the various types of powders available. If it’s getting into the weeds, focus on the pea-based protein powders. Those are the best places to start.

Do look for fillers, binders, hidden dairy in there. If you are going to the grocery stores and grabbing a vegan protein powder, you never know what’s in it. All sorts of artificial flavors, dyes, fillers, binders, that’s all stuff you want to avoid. Make sure you’re getting a good-quality protein powder that doesn’t have any added ingredients.

Dr. Eric:

I agree. I typically don’t recommend whey. I threw that out because a lot of people do consume whey protein powder. I agree that the pea protein, the hydrolyzed beef for AIP. Even pea protein, I find if someone is following AIP, they can tolerate a good organic pea protein in most cases.

Dr. Westin:

I think so, too. A lot of people will say, “I can’t use this because I’m on AIP.” I don’t see any issue usually. There are 5-10% of people who don’t fit the mold, and they always react. For the most part, I think it’s fine. It sounds like our experience is pretty similar there.

Dr. Eric:

As you mentioned, we could go on probably for another hour. Unfortunately, we gotta wrap things up. Where can people find out more about you?

Dr. Westin:

You can go to my website, RestartMed.com. You can search my name, too. I have a podcast, YouTube, Instagram, Facebook, Pinterest, you name it. I have a bunch of free downloads. My information tends to focus more on hypothyroidism. I do talk about all types of thyroid conditions. Generally, the people who are coming to seek information from me are people with hyperthyroidism who are now hypothyroid. These are people who have undergone radioactive iodine ablation or thyroidectomy. I have some information on hyperthyroidism, but not as much as you, since you primarily focus on it, right?

Dr. Eric:

I would say 80% of my patients are hyperthyroid. I do work with some Hashimoto’s patients though.

Dr. Westin:

It was a flip for me. I still have information on both. Still obviously enjoy helping patients with any type of thyroid problem. Doesn’t matter to me what they have. That’s my passion.

Dr. Eric:

Wonderful. Thanks, Dr. Childs. It was great chatting with you again. Look forward to having yet another conversation in the future, whether it’s about losing weight or some other topic related to thyroid health.

Dr. Westin:

Let’s do it. I think it’ll be good. Pleasure being on here.