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.

Recently I interviewed Dr. Kasia Kines, as she discussed the Epstein-Barr virus, including how it can be a factor in 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. Kasia Kines. We are going to be discussing Epstein-Barr Virus (EBV). How are you?

Dr. Kasia Kines:

Hello! I’m doing great. No sun here so far, but a good day.

Dr. Eric:

Good. Let me go ahead and give your bio. Then we will have you give a brief intro. Dr. Kasia is the CEO and founder of Global Epstein-Barr Virus Institute. She is a leader in recovery therapy for chronic Epstein-Barr Virus, an author, a wellness expert, a highly respected Doctor of Clinical Nutrition, and a graduate of the prestigious Bastyr University. Since 2005, Dr. Kines has built an international reputation as a functional nutritionist, from being sought after by Johns Hopkins University to her groundbreaking Amazon bestseller book Epstein-Barr Virus Solution, which I have read. I read her book a few years ago. When was it released?

Dr. Kasia:

2018. Time is flying.

Dr. Eric:

Wow. Definitely check out her book. I will talk more about it later. Dr. Kasia has developed an international, proprietary, evidence-based methodology to EBV recovery and a successful EBV recovery program for those suffering from EBV. Also, she trains other practitioners in her methodology and clinician EBV training and certification program and an EBV practitioner workshop. We could talk more about this later, especially your recovery program. Dr. Kines is on a mission to bring the truth about EBV and solution to one million people globally, so no one needs to suffer needlessly from this misunderstood virus and its complications.

Currently, she lives with her husband and their companion animals in Kingston, Washington. We were chatting before starting the interview, and she said she is going to be moving soon to Wisconsin.

Dr. Kasia:

The Madison area, yeah.

Dr. Eric:

Thanks for joining us, Dr. Kasia.

Dr. Kasia:

My pleasure. So happy to be here with you.

Dr. Eric:

I interviewed you about a year and a half ago, and that interview is on YouTube. If you could give a brief introduction for those who don’t know you. How did you start focusing on Epstein-Barr?

Dr. Kasia:

As the medical literature says, if your patient is on a protocol, has chronic issues with health, and is not responding to the protocol as expected, you should check into testing chronic EBV. My journey, just to simplify it, is a couple of things. I lost a very good friend to complications of MS. I was always asking the universe and the higher powers why her? What happened? Why couldn’t I help her? It was devastating. She was fighting it for almost 20 years. The student is asking the teacher. There were a lot of circumstances that came.

The last one was when a couple of my patients asked for my educated opinion on a book. If one asks you to read a book and you don’t have time, you can brush it off. But when a couple others do, you have to read it, whether you like it or not. I didn’t have time. It was Medical Medium. I read it on a plane to a conference. I almost fell off the chair just because I saw-When you do functional medicine or nutrition work, if you do your job, you keep attracting more and more complicated cases. Sometimes you will help so many people, but there are a few you just can’t, you hit the wall. You probably know that, too. You get so frustrated because instead of focusing on everyone you can help, you can’t sleep over those who have been struggling. Nobody knows why. You’re doing everything right. That was my pain. The longer I was in clinical practice, the harder the cases were. I lost hope. We did everything right, and it wasn’t happening.

When I was reading that book on the plane, it struck me that this was my population. These are the people who did not respond. I don’t know if you are familiar with that book, but it’s a man saying the spirit of compassion tells him all this information. The claims in the book were that the majority of chronic conditions were immunity problems like Hashimoto’s, chronic fibromyalgia, MS, are driven by this one virus. Here I am, so many years in practice, best training I could get in the country, and I had never heard of it. If half of this is true, I have to look into this.

From that point, I jumped into medical literature, and I never stopped. The rest is history. What I discovered blew me away. There is so much evidence and medical literature. It’s right there. I was able to pinpoint protocols and create them. Then I watched in my practice people coming back to life sustainably, long-term. Magic was happening.

That’s why everybody was telling me I had to write the book. What book? I had never written the book. I don’t have time. I don’t have a life. Including my husband. So I sat down and wrote the book. I think I’m just the messenger. When the time comes you’re called to do a job, if you don’t say yes, somebody else will be asked.

I think I needed to bridge the gap between the medical medium claims and where the medical community is. There is this vast ocean between them. That’s why I was methodical with medical literature. I wanted to make sure that was the foundation. Then we can add spirituality and stress and emotions and all kinds of things. I started from there. That is the story.

Dr. Eric:

Before you mentioned Medical Medium, I was going to ask you about if someone was choosing between your book and Anthony Williams’ book, what would you say is the difference? Even though it’s great he brought awareness to EBV, they are two completely different books. Yours is more scientific-based.

Dr. Kasia:

I would say that. Another thing is I have most of his books, and I love the recipes, the wisdom. He doesn’t have a nutritional background, so some of the recommendations he makes for detox, people take too extreme without being educated on balancing things. Sometimes they lose too much weight. Sometimes they spiral in all directions. As a clinical nutritionist, I have to coach them in that process, reverse-engineering, and educate them on actually balancing meals or adrenals. What does that mean in the context of the day? That is very important. Of course, he doesn’t provide that because that’s not his background. That’s the missing part.

Every supplement that I recommend is a multi-performer. Very far in research. There are some that are good in research but don’t perform that well. We drop them. We don’t use them. They are fine theoretically, in studies, but they don’t perform in the community. We don’t need them. It’s very fine things, being strategic, also having that clinical nutrition background. Whether they have a virus or not, it’s balanced.

That would be the difference. It’s a good combo. He opened the door and made people realize that what they eat really matters. There is spirituality to food. That is all beautiful.

I think when you write a book for masses, you make blank statements that are black and white. “Everybody has EBV.” “Everybody will be helped with celery juice.” With celery juice, some people love it. Some people hate it. Some people said it’s like a miracle. Some people said it doesn’t work. It’s a mix. Everyone is different. That’s how we are. I think his job on this planet was to get our attention. Honestly, without that book, how would I know? I emailed him and thanked him because that’s how I started. I think we complement each other.

Dr. Eric:

He talks a lot about celery juice. I know he has a book dedicated to celery juice.

Dr. Kasia:

All the celery juice. I know.

Dr. Eric:

He talks about other things diet-wise obviously. We know the importance of food and eating healthy. I’m guessing most people who are drinking celery juice are also making other changes to their diet. It’s hard to pinpoint it to the celery juice since most people aren’t probably drinking celery juice yet going to McDonald’s and other fast-food restaurants. Hopefully they are cleaning up their diet. There may be exceptions, but hopefully they are making other changes. He doesn’t just recommend celery juice.

Dr. Kasia:

It’s all good. I know that certain things he claims may not be researched fully on that yet. I have seen a little bit of research on celery juice. We may catch up with him later, and that’s fine, too. I agree withyou. Some people in our community are doing a program, and they are still juicing celery just because they feel it supports them. They are happy about it and committed. That’s perfectly great.

Dr. Eric:

You mentioned supplements. There are certain supplements you have tested out that don’t work. Do you remember which ones? People aren’t taking those supplements. Maybe I’m recommending those, so I should stop.

Dr. Kasia:

Proteolytic enzymes are one of them. They looked great in some studies. You would have to pop 25-30 capsules a day. We have other tools. That didn’t deliver. Literally there is one or two companies that provide this product.

In my opinion, lauric acid or monolaurin are not worth it. There is a lot of problems with them. They are just not worth it. They create a lot of havoc in the body. They do not provide that multi-tasking support that other things in our protocol do, like selenium. They don’t provide antioxidant support or nutrients that are missing in the diet. They just kill. Our protocol doesn’t tend to kill. It immobilizes the virus and turns it off, which is much safer. When you kill any pathogen, you are creating havoc. People have to detoxify it.

Sometimes the dead DNA is as detrimental as when the pathogen is alive. That is really not worth it. That is why people have die-off effect with headaches and malaise. That is not a healing process. It is a crisis that you don’t need to do. For some people, it doesn’t work. For some people, they just have a die-off effect. I don’t think it’s worth the money.

We only recommend it if you have co-infections because it is effective for H-pylori and fungal infections. If you have combinations, I might consider it, but it wouldn’t be my first choice.

Cat’s claw. Cat’s claw is pretty hard on the liver. It’s a pretty heavy-duty herb. Again, it doesn’t provide antioxidant or nutrient value in the way of things like selenium, NAC, or lysine provide. It will build your collagen. Botanicals don’t do that well. They have some qualities, but I stay away from botanicals. We use them as teas because we have to drink. That’s a win-win. It’s inexpensive and available, and you can pick the tea according to the bonus effects. Maybe you need iron or vitamin C. There are particular teas that can provide additional benefits.

The only herb I use in the primary protocol is licorice. That’s worth it.

Dr. Eric:

Licorice root. That is supposed to have antiviral properties.

Dr. Kasia:

Yes, that’s the big hitter. That’s worth it. You want to be strategic because people are so sick and brain fogged. Every time they open their mouth, we want to cut corners and go fast and strategize on supplements. You can take a lot of supplements and not be successful with EBV for years.

Dr. Eric:

I think it’s important to mention with licorice root, if someone has high blood pressure, they probably don’t want to take it because it can potentially increase blood pressure. Whenever taking in my opinion any type of herb, it might be a good idea to be working with a functional medicine practitioner. Most people don’t. Certain supplements, like nutrients, as long as you are not taking too high of a dose, you’re probably fine.

I know selenium, speaking of, safe dosage, you usually recommend a higher amount compared to most people. Most practitioners recommend 200mcg. You typically recommend 600-800mcg.

Dr. Kasia:

Yes. In the book, I walk people through counterindications. If you are a bigger built person, 800mcg. If you’re tiny, maybe 600mcg. Make sure there is no selenium in other supplements you are taking because you can overdo it. If you start losing hair, for example, having some symptoms, you may be overdoing it. Sometimes people overdo some of these supplements, and they need to pay attention to the doses. Or sometimes they think it’s 500mg per capsule, but it’s 900mg per capsule. Then they start spiraling with some new symptoms. Always pay attention to your dosages. Cross-reference. If I wasn’t working with a functional doctor, I would check with a pharmacist. Pharmacists have quite a lot of knowledge. They can provide counterindications if a person is not sure. Not a medical doctor. They are not trained in nutraceuticals.

Dr. Eric:

All the minerals and vitamins, fatty acids are important. Selenium, you focus on. That is one of the primary nutrients. Everything is important. You don’t want to be deficient in anything. But are there ones you focus on more than others besides selenium?

Dr. Kasia:

Specific to EBV?

Dr. Eric:

Yeah, EBV. There is research on Vitamin D.

Dr. Kasia:

Vitamin D is a given. It’s not even part of your initial protocol because I assume it’s in there. If it’s not, then yeah, Vitamin D3/K2. Licorice, as I mentioned. NAC is very important. Lysine is very important. Zinc is very important. Vitamin C and Vitamin E. That would be the initial protocol is just those seven. That can start shifting and moving the needle if you have potencies that are high enough.

You can’t patch holes in your life with just a bunch of supplements. It’s a bigger picture. You have to address where the bucket is leaking. Eventually you will replace the bucket with a new bucket. Your WiFi is blasting on you, which is not good when you have EBV. There’s your mold blasting at you, which is not good when you have EBV. You have poor diet, and you go to fast food restaurants because you’re in a bind. You have those holes in the bucket.

These supplements are amazing, but if you want to get out of that continual EBV reactivation, you have to build a new house with brick, so to speak, so you are invincible. Once you get to that point, EBV is not a problem. If it starts reactivating, you can know exactly why. You will start to anticipate it because of your circumstances. You will know exactly what to do. Within 24-48 hours, you will turn it off.

That’s exactly what I did in the fall. I reactivated here in this house when we moved. I was able to pinpoint and tested it. I developed vertigo out of the blue. I turned it off within 24-48 hours because I knew why. It was a new house. We had a smart meter. I am waiting for it to be removed. We were unpacking and positioning our desk in the wrong place with all the technology. Then I started going down the stairs and going, “Woooo.” I jumped on the protocol and moved the desk. You become literate in what happens with that virus. We had mold, so that’s another reason. Mold is unkind and will reactivate EBV. That is more of a priority before you tackle EBV: to get rid of the mold.

Dr. Eric:

That’s a good point. You have to address any source dragging down the immune system. I look at it more as an immune system problem than a virus problem. When you can’t get rid of the virus itself, you can improve other areas. Try to stop the replication of the virus. The mold, that’s a big reason you’re moving to Madison, Wisconsin.

Dr. Kasia:

Yes. We had four consecutive homes with mold. Much of it was missed by mold inspectors or started after the mold inspector checked. People don’t take care of buildings. They are cutting corners. It’s all sad. We have a lot of rain here in the Pacific Northwest.

Another thing about the virus—it’s such a teacher—is if you are a good caretaker of your body, spirit, and soul. You are in alignment with who you are. You love what you do. You are of service. You help others. It’s like a symphony with beautiful colors around you. You are living your life the way we came here to live. Most people are not in sync with that. 80% of people in the States hate their job.

Dr. Eric:

I don’t know the stats, but it wouldn’t surprise me if it’s that high.

Dr. Kasia:

I had a job I was not supposed to do for five months, and I was ready for therapy. I had to walk away. It was killing my spirit. I was physically so uncomfortable. I was an assistant at a local government office. It wasn’t for me. But people live this way. There is the physical level. But there is also the emotional/spiritual level. There is emotional pain from losses or betrayals or not being heard.

All this hits women harder. I find that the majority of people with chronic EBV who are really taxed and sick are women. I have seen more men now, too. We have a joke in our community: Welcome to the international, overeager, overachiever, type A personality, anonymous club. These are givers, healers, people with their heart on their sleeve. You are so vulnerable to a lot, and you overgive. You lose your boundaries, and you don’t listen to your voice. Maybe people take advantage of you. It’s taking effect. It’s easy for a virus to reactivate in circumstances like that because you oversleep, you are overworked, you may not be able to say no to your boss about Friday night work. Even building that personal muscle helps.

The virus in that sense is a big teacher. Once you are congruent with who you are, and are aligned, you turn it off. It’s just there in the background. That’s it. We all have it.

Dr. Eric:

A small percentage don’t, but it’s like 90-95%. I wanted to switch gears and talk about blood testing. Most people who see you probably have already done the blood test for EBV either on their own or through another practitioner.

Dr. Kasia:

The notorious test, yes.

Dr. Eric:

I don’t know how much you rely on the blood test. Could you talk about your experience, whether you want to see all the tests? There are four different markers. Either way, I’d like for you to talk about the different markers and which ones you feel are more significant. We did discuss this during the last interview, so I know already.

Dr. Kasia:

It’s never enough. I have talked about it millions of times, but it never gets old. Pretty much everybody asks me about the labs. People email me, DM me on social media, or text me. We have an entire page on our website about it so people can interpret those labs. We even have a link to a 50-minute Facebook Live where we had a white board and colored markers, and I discussed this. It’s the beginning of a journey for people. You can be trapped in a wrong interpretation for years and continue to deteriorate. It’s because of one lab being misinterpreted.

There are four markers available by labs. If you ask a medical doctor, they will order a lab. If you don’t tell them anything, the lab will only include two or three typically, not four. You have to make sure that you ask the doctor to add all four. The most important one is not part of the panel typically. We will talk about that. That is the first step.

People spend 1-2 years going from doctor to doctor asking to be tested. Medical doctors are resistant because they know there is no cure, in their opinion. If you had mono, that’s it, you’re done, you won’t have EBV anymore. In their belief system, they won’t test you because it’s irrelevant. Even if you had it, there is nothing you can do. Plus they misinterpret it. Most of the time, the misinterpretation is negative for EBV, and that’s probably inaccurate.

You asked me if I recommend testing all the time. Not that much. The most important thing is the context. Have people tried different therapies and failed? That’s typical for EBV. Whether they have a history where they had all kinds of different presentations over their lifetime, idiopathic, juvenile arthritis, maybe mono at the university, maybe strength depressions by stress, and then they would spiral. Maybe they have Hashimoto’s or lupus. You look through the story, and you find out there is something causing all of this. The body is not just creating havoc because it has nothing else to do. There is always a reason. I ask people to pay attention to the context.

You can do testing again and again if you know when to test. Test first when you feel the best. Test during the first week where you feel like you have been hit by a truck. That is a typical expression. It’s the worst of the worst. You don’t want to wait. It’s hard to test when you feel so miserable, but that’s when you want to test to see if the markers are showing. If you wait a couple weeks, you will miss the markers. That is a pitfall. Depending on when you test, you can miss the logic of where EBV is in the context. That is a problem. Does that make sense?

Dr. Eric:

Yes. Most panels don’t have that early antigen. If you test when you’re not feeling badly, that might come back negative, but if you are feeling badly, it is more likely to come back positive.

Dr. Kasia:

Yes. There are certain irregularities in people. If you look at statistics, there is a case where a person can have everything negative. Is the lifestyle, history, medical history, complications, and symptoms consistent with EBV? Are they even producing antibodies at this time? In that case, I feel like a medical doctor has a responsibility to test total IGG, total IGM, total IGC to see if those immunoglobulins are even produced. Sometimes that is the reason why things are normal. Then you can recalculate if they are producing, what would it be.

Early antigen. There are three IGGs in the test and one IGM. Medical doctors, because they don’t know, they assume IGM is current infection, and three IGG is past infection, and that’s it. That’s where the first error is. That’s not how it works. IGM is VCA. It looks like it should be current infection. Statistically, empirically, from hundreds of people and tests and presentations, I can tell you it only reactivates and it’s positive from the first infection. Often times, when you reactivate, the VCA-IgM will not show. It will be normal. In a chronically infected person, we expect it to be normal, and that’s where the confusion is. Sometimes it’s elevated constantly with every time you test. This is very weird, but it happens.

Dr. Eric:

I have one patient who no matter what I have done, and she has seen another practitioner, gotten ozone treatment, the IgM keeps on coming back positive, which 99% of the time, it’s negative. The VCA IgG and the nuclear antigen are commonly positive.

Dr. Kasia:

It could be molecular mimicry. It could be co-infections. It could be other things like a tripwire. It’s rare, yeah. What I would say is keep testing. Do stool tests. See what other infections you have. Don’t live by your lab. Live by your symptoms and quality of life. Are you improving? That’s the one VCA IgM.

Then there is VCA IgG and EBNA IgG, those two you mentioned, are the big mamas. They will be elevated for the life of the host. Typically, what we don’t expect is to bring them to normal. If it’s triple digits, then we have a problem. When we say normal range, it’s from 0-19, let’s say. If you have 235, those are in triple digits. It’s multiple times of what it should be. You know it’s affecting your health; this virus has implications in your life.

It’s even worse when your levels say more than the current range. More than 600. More than 750. It could be 2,000. The lab doesn’t give you the number; it’s just above. As you’re getting better, the numbers may be dropping for both of them, but they are still above that range. Maybe it’s 2,000, and now it’s 800. If you have those still beyond the range, but you are feeling you are recovering, I don’t want any of your listeners to get depressed and say it doesn’t work. You may be dropping and dropping. At one point, you may drop into that range. Maybe it will be 480. You want to anticipate and not get depressed. People get depressed about that.

These two will be elevated. If you repeatedly test, you will notice that when you reactivate your early antigen, those two will go higher. When you feel better and don’t have early antigen elevated and feel your symptoms are better, they will start sliding a little bit. They come and go. Some were there.

The last one is early antigen EA IgG. That is the one that pops in during two or three weeks when you reactivate. You want to catch it when you feel the worst. It doesn’t live long. The virus goes in and out. Like I said, mine reactivated because of the combination of WiFi in the corner, mold, and stress. We had to move because of the mold. We moved into a place with mold. And we had mold inspections.

Dr. Eric:

That happens a lot unfortunately.

Dr. Kasia:

Yes. That is the trajectory. You want to have a context. You live in your body, so you know how you feel, and you know where you have been. Paying attention to that gives you empowerment, knowledge, independence. You can do those labs for $150-$200. You get that lab once in a while independently. You get a report. Go to our website or read the book. There is a whole chapter on lab interpretations. You can understand where you are. That’s all you need. You don’t have to beg the doctor and be frustrated that you waited two months to see the doctor, paid all this money, and they missed the marker, so they tell you there is nothing they can do. I don’t want people to waste their energy that they don’t even have because they are sick.

Dr. Eric:

I’ll say it again: Check out her book, not only for the testing, but it does give a lot of information about treatment, supplements, and foods. We won’t get into great detail here because it’s all in the book.

Dr. Kasia:

All 600 pages.

Dr. Eric:

It’s bigger than one of my books. One of mine is over 500 pages.

Dr. Kasia:

I beat you to it.

Dr. Eric:

Final question I want to ask you is the relationship between EBV and thyroid health, whether it’s not autoimmune, but especially autoimmune. There is some evidence in the literature showing the connection with both Graves’ and Hashimoto’s. Have you seen that, too, where it seems like EBV is a trigger or at least a contributing factor?

Dr. Kasia:

Yes, both, all of the above. Most women lean toward hypothyroidism, Hashimoto’s, autoimmune. Not so many with Graves’. But the virus can go either way. We also have specific thyroid tumors. I have seen the tumors removed, and I have seen radiation of the thyroid. Women are still miserable, and this is not addressed. The thyroid is such an issue.

EBV is one of the driving forces triggering Hashimoto’s thyroiditis. Graves’, too, but Hashimoto’s more so. Sometimes if we just focus on the EBV protocol, we can normalize the antibodies for the thyroid and normalize the symptoms. That sustains. Women know what to do if it reactivates. If it starts going down, they jump on the protocol aggressively. Like I said, in my case, I turned it off quickly. You don’t have to be sick or miserable. It is a possibility.

There are other factors like gluten, H-pylori, uricemia. There are other infecting agents. Environmental toxins. Those would be the triggers, I would say. Wouldn’t you agree?

Dr. Eric:

One of the books I wrote is Hashimoto’s triggers. It’s pretty comprehensive. I do talk about viruses, including EBV. I am not anti-iodine, but iodine can be a trigger. Gut infections. H-pylori. There is a case study on blastocystis hominis, which is a parasite. Foods like gluten and dairy. There is more than that.

To focus on Hashimoto’s triggers, you can check out my book. To focus on EBV, get Kasia’s book.Where can people learn more about you, Dr. Kasia?

Dr. Kasia:

We have a whole website. It’s my name, KasiaKines.com. It’s a huge website with all kinds of resources. EBV specific, we created a website called EBVHelp.com. We have symptoms, lab interpretations, consumer direct labs. We have programs. We have a masterclass series now. As we speak, we are going to talk about mold and EBV next week. We have EBV transformational workshops. An EBV challenge. We are trying to create space for everyone on the journey and be of service. We have a complete EBV recovery program for consumers. If people are sick and ready, we got it.

Dr. Eric:

Can you talk a little bit about that? They can get a lot of information from the book. Some people get the book and receive amazing results from the book alone. Why would someone want to join the program? Some people do need the 1:1 support.

Dr. Kasia:

The way we design it, and we have run it many times, and it still seems to be working. The one thing that people struggle with and really appreciate is in the transformational workshop, there is a community of people just like them. They are so isolated and lonely, and they don’t talk to anybody who shares their experience. When you have breakout rooms on Zoom, many times during that particular workshop, to get people connected. It’s an aha moment. Our students in the recovery program have a big Facebook community.

We also have monthly Q&A calls. Sometimes it’s two hours or two and a half hours. We talk and talk and talk, and I answer questions. We used to do it every week, so we have a vast library of those. If people are very sick, they can listen to the audio and get a sense of the virus. That gives people so much empowerment. It’s just a virus. We can zap it. We can turn it around. It’s not this big monster that people are so afraid of.

It’s a self-based online program with tons of support and materials. There are videos and reading and action steps to do. We are going through different areas of life, including spirituality and joy; supplements; and kitchen. A lot of practicality. This has to be practical. We have an initial protocol for supplements right from the start, so people within the first three weeks can start feeling better. They have their focus and less fatigue so they can continue implementing other things.

We added a health coach specializing in my methodology. We are building a team, so they are supported. We created small groups focusing in particular areas in the program with a coach.

They have an opportunity to schedule a 1:1 with me. For our students, I have a robust discount that they can schedule with me and do it as often as they need. Some people have SIBO. Some people have co-infections. My 1:1 practice is closed, but I am a consultant, so I can guide them and review labs.

We have protocols and so much support for SIBO. We have a full protocol for H-pylori that was successful in my clinical practice. There is a module on mold. We talk a lot about that. There is a module on WiFi. There are co-infections, hydrochloric acid, other labs they should test, traveling with EBV. Antibiotics, Vagus nerve, lymphatic systems, what to do with it, what exercises are okay to do or not.

You have access to it as many years as you need. We don’t restrict it. You have access to me as long as you need every month. We have a great community with beautiful people.

Dr. Eric:

You also offer a free discovery call. It sounds like there are a lot of options, not just that program, but some other ones, too.

Dr. Kasia:

Yes. On both websites, you can schedule a clarity session with Rachel, our operational manager, who came to me from that community, or with me. We had to put a price tag on it because we had no-shows when it was free. We do have to hold the place with a fee. It’s up to 30 minutes, and there is homework. The person has an opportunity to write the diagnosis, what they have done, what they haven’t done yet, what they need, where they are, their dreams, their pain, everything. I review it and reframe it and put it in my notes. I spend some time on it. When we talk, I understand where this person is, and I can guide them toward the next right step for them. They can ask questions. I really enjoy that because I get to know people and direct them and possibly invite them to our program. It’s the solution. We have it there.

Dr. Eric:

I forgot to mention earlier that for anyone who joins the program, I have a special code, where you can get 10% off. If you visit the website and are ready to do that, they can do that. They can also read the book first or do the discovery call.

Thanks, Dr. Kines. Appreciate you doing this interview again. It was a pleasure. Looking forward to part three of this in the future as well.

Dr. Kasia:

Part three, part 10, sign me up. Keep doing this wonderful work. It’s so needed.

Dr. Eric:

You, too. Go get her book! The Epstein-Barr Virus Solution.

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Recently I interviewed Dr. Tara Scott, as she discussed the relationship between sex hormones and thyroid health. If you would prefer to listen the interview you can access it by Clicking Here.

Dr. Eric Osansky:

With me, I have Dr. Tara Scott. She is known as the Hormone Guru. Dr. Scott helps people find the cause of their symptoms and get back to optimal health. With over 25 years of experience and three board certifications in OB-GYN, functional medicine, and integrative medicine, Dr. Scott has helped thousands of patients struggling with hormone issues. This includes endometriosis, breast cancer, weight gain, and other conditions. Dr. Scott has been speaking, including a TEDx talk, and educating for over 10 years and has taught doctors her approach in over five continents. For her expertise, she has been featured on The List TV, Women’s Health, Shape, Newsweek, Authority Magazine, and on numerous podcasts. Thanks so much for joining us, Dr. Tara.

Dr. Tara Scott:

Thanks for having me.

Dr. Eric:

When did you do that TEDx talk?

Dr. Tara:

It was last October, 2021. It’s still in final editing. It’s not up on their page yet.

Dr. Eric:

Before we start diving into the questions about hormones, I’d like you to briefly discuss your background. How did you become known for helping people with different typesof hormone imbalances?

Dr. Tara:

I am a traditionally trained MD and OB-GYN. After residency and training, I was in a very busy practice delivering a lot of babies. Then I had my own struggle with infertility and had my own hormone imbalances. I wasn’t ever able to get pregnant without fertility drugs. Thankfully, due to that, I did get pregnant. After that, when you have a hormone imbalance, you are either trying to get pregnant or prevent it. There is nothing in between to help balance it.

I became interested in women’s hormones. I first became a certified menopause practitioner with the North American Menopause Society. Then I did a lot of studying of bioidentical hormones, perimenopause, and menopause. The more you learn, you find out the less you know. I went ahead and did a functional medicine fellowship and was able to sit for my integrative medicine boards from the American Board of Integrative Medicine as well. I really have focused on women’s health for the most part and have expanded it to integrative medicine. We are talking about all things that affect women and their health, including the gut, thyroid, adrenals, metabolic issues. They are all connected.

Dr. Eric:

When it comes to hormones, a lot of people have low sex hormones (estrogen, progesterone, testosterone). Why do so many people have low sex hormones?

Dr. Tara:

One of the biggest reasons today that people have low sex hormones is the effect of stress. Men, your testosterone can decrease as the effect of chronic stress. DHEA is made in the adrenal gland, and that is a source for men and women of hormones. If you were stressed before the pandemic, you capped it out. Our lives are changed now. We also have environmental stressors. All the endocrine disruptors in our environment are affecting us. Which came first, the chicken or the egg? The environment changed, which gave everybody issues. The obesity epidemic, which certainly is connected to your hormone issues. It suppresses ovulation and theway your body gets rid of estrogen. It’s like a vicious circle.

Dr. Eric:

Would you say that low progesterone is the most common hormone imbalance in terms of lower sex hormones?

Dr. Tara:

For women, that’s very common. You are born with so many eggs. So many eggs are obviously released first. We all know that when you’re trying to get pregnant, over 35 is called advanced maternal age because you have an increased risk of chromosomal problems because the eggs aren’t as good quality. Even though we’re not trying to get pregnant potentially, it still would transfer. If those eggs are not as good quality for pregnancy, they are not as good quality for hormone production. It’s very normal over the age of 35 and certainly 40 for your progesterone to decrease. But there exists the phenomenon that stress can affect ovulation and deplete your hormones and hormone precursors. It can prevent ovulation, which would prevent you from producing progesterone and estrogen. That all can be tied in.

Dr. Eric:

Like you said, stress is huge with all the hormones. Not just progesterone, but estrogen, testosterone, adrenal hormones, like DHEA, cortisol, etc. How about elevated sex hormones? Estrogen dominance, elevated testosterone levels. What are some of the causes of those?

Dr. Tara:

For a female, estrogen dominance happens when either 1) you don’t have a lot of progesterone as you age, or 2) you just make a lot of estrogen, and that is common in perimenopause because these old eggs can’t hear. The brain is sending out a signal called FSH to stimulate the egg to grow. When the egg is old and it can’t hear, it requires more of that pituitary hormone, the FSH, and LH. What you have then is an increase in estrogen as you get older, and also an increase in testosterone at that particular time. But you don’t have an increase in progesterone that follows because those eggs ovulate, and you still have poor quality follicles, so you have low progesterone.

You can also see high testosterone in younger women who are not ovulating for the same reason. FSH and LH are increased, and it’s that LH that stimulates the production of testosterone. You get high testosterone as in PCOS or someone who is not ovulating. Then it’s a vicious cycle because high testosterone prevents ovulation.

Dr. Eric:

Also, with high testosterone, one of the potential causes or at least factors is insulin resistance, like PCOS. Is that correct?

Dr. Tara:

It is definitely related. There is no agreement as to what the inciting hormone imbalance is with PCOS. Some say it starts in the pituitary. You have abnormal pulsations of the gonadotropins.

The second theory is it starts with androgens. The theory to support that is you will have high androgens in two different cell lines. You have high DHEAS and high testosterone, which comes mainly from the ovaries, not the adrenals. A lot of girls who are young will have higher DHEAS.

The third theory is it comes because insulin is high. You have high insulin, so you get insulin resistance, which suppresses ovulation and causes the vicious cycle.

Dr. Eric:

You mentioned DHEAS. I’m glad you said that. I’ve seen some of my adult patients with elevated levels of DHEAS. Two questions: 1) Can you explain for those who are not familiar what the difference between total DHEA and DHEAS is? 2) What are some of the potential other causes when you see DHEAS elevated on a test?

Dr. Tara:

DHEAS is the sulfated form of DHEA. It’s the most populous hormone in our human body, men and women. There is the most quantity of it. DHEA is made in the adrenal gland and gets sulfated in the liver. DHEA is the unconjugated form that is made, and it’s a much lower quantity. We always monitor DHEAS.

I always explain to my patients: Think of your ovaries as your monthly paycheck. You’re getting a little bit of estrogen every month and some progesterone. Your savings account is your DHEA; that’s your adrenal gland. When you retire, when you stop getting paid by your ovaries, you will live off of that bank. Your DHEA is highest in your teens and 20s, and then it decreases as you age.

It would increase when everything is upregulated in times of stress. The brain doesn’t know if you’re running from a bear or if you have a deadline at work or if you have just lost your job because of the pandemic or COVID. The physiological response to stress is the same. Cortisol up, blood sugar high, to feel your muscles so you can runfrom the bear. The result and increase of cortisol is like fire. DHEA will compensate to try to be a teeter-totter of catabolic/anabolic in your adrenal gland and your homeostasis. DHEA will go up as a response.

Here is the difference between cortisol and DHEA. There is a feedback loop with cortisol back to the brain, but there is not with DHEA. What eventually happens is DHEA goes up at first from stress. If stress is prolonged over time, it will decrease. There Is no signal that goes back to the brain, saying, “DHEA is low. Let’s make some more.” There is for cortisol and testosterone and estrogen, but not for DHEA. A lot of people will have DHEA that is decreasing, and nobody really checks it in the traditional world. In the functional world, we check it.

Dr. Eric:

I should mention that most of the time, when testing for DHEA or DHEAS, it’s usually on the lower side. There have been situations where I see it elevated. I work with a lot of hyperthyroid patients. I have a history of Graves’ Disease as I mentioned when we were chatting earlier. With hyperthyroidism, a lot of people lose weight, though some people do gain weight. I also work with Hashimoto’s patients, who also have more of a tendency to gain weight. Of course, it could be many different factors when it comes to weight gain. Can you talk about the relationship between some of these hormones and weight gain?

Dr. Tara:

That’s a main thing that I think is overlooked. A lot of women go to their providers, and they say, “I have put on weight. I’m exercising and eating less.” The providers sometimes dismiss them because they think all that has to do with weight is calories in/calories out. I can tell you that for a woman, if you’re not hormonally sound, that will not work.

We do know from some studies out of the University of Colorado that around menopause, your basal metabolic rate will drop. Exercise does not counteract that. A lot of women around the time of menopause will start to see weight gain in that visceral area and their abdominal area. In those studies, they try to increase exercise, and it did not counteract this drop in basal metabolic rate and weight gain in the abdomen. They then did another arm where they gave estradiol(bioidentical estrogen), and that did counteract weight.

All of your hormones are kind of like Goldilocks. Too little is not good, and too much is not good. It’s on a bell curve, but the symptoms on either end can be similar. We also know that estrogen is a growth hormone, so it makes everything grow, including tissues like breast and hips for women. Having too much estrogen without that balancing progesterone can be another factor in weight.

You mentioned low androgens, low testosterone. Think about a man and his body fat. Where does a manbdistribute his fat when he has low testosterone? He usually gets man boobs and a big pregnant belly. He either has low testosterone, and his balance between testosterone and estrone, which has just one enzyme dividing them called aromatase, that is usually how they distribute fat.

Men with a normal amount of testosterone are going to naturally have lower body fat, whereas women don’t. We have to grow a baby and store fat for that. Estrogen’s job is to get you ready for a pregnancy. Without that balancing progesterone, you can gain weight. With low DHEA and androgens, you gain weight. With high cortisol, your body is constantly trying to get the blood sugar up. Cortisol goes up, blood sugar goes up, and insulin goes up. They start fighting each other. Your insulin stops working, and you become insulin resistant. That is another hormone that can be off.

You can certainly have functional hypothyroidism. You know that as a thyroid expert, TSH is made in the pituitary gland. T4 is made in the thyroid. T3 is the active form. It’s like clocking your hours. That’s your TSH. Your paycheck would be your T4. Then you have the cash. You can’t walk into Walgreen’s with a paycheck. You need cash. T3 is what you need. These hormones are tightly bound to binding proteins, which estrogen will manipulate. If you have too much estrogen, it will increase the binding protein. You will have less free hormones available at the receptor.

In addition, there is that enzyme that has to be cashing your check, that 5-deiodinase. If you don’t have enough iron or Vitamin D, if you have too high or too low cortisol, which most of our population does now, you won’t convert that T4 to T3. Instead, you will convert it to reverse T3. That’s like taking your paycheck and putting it all in your 401(k). You have the money, but you can’t get to it. It’s reverse T3. That is what is missed a lot with women patients and potentially men, too. The effect of estrogen on cortisol, on insulin, on thyroid is really predominant.

Dr. Eric:

It’s all really interconnected. As far as knowing whether or not it’s a hormone problem, I imagine the only way is through testing.

Dr. Tara:

Yes. You can take a history. If someone comes in with weight gain in a specific area, and they have really heavy periods, more than likely it’s estrogen if they’re 42. But you’re right. It’s always hard to guess and know what the hormones are. It’s always better to test.

I don’t know why there is such resistance in the traditional community, my traditional colleagues, who are saying, “You can’t test hormones. They fluctuate every day. There is no validity.” Yet we test male hormones all the time with pre-testosterone placement, post-testosterone placement. We have no problems testing hormones when you’re going through fertility treatments. I went every day for estrogen levels when I was having my IVF. We tested progesterone levels. It was valid then. Why is it not valid when you’re not trying to get pregnant? It’s really confusing. We can test hormones, even if you’ve been told we can’t.

Dr. Eric:

As you mentioned, things like T3, the active form of thyroid hormone, many times they don’t test that. When they do test, it’s usually in the blood, which for thyroid, that’s the way I test. Not to say blood doesn’t have value when testing for sex hormones, but dried urine testing, the Dutch test, is one way. Even saliva testing, which I don’t use- I used to use in the past for adrenals sometimes. I actually used that for sex hormones in the past, too.

The point is many times, when you go to a regular medical doctor, they don’t look at the complete picture. If they are willing to do any type of testing, they might just do a TSH test for thyroid alone. Sometimes they will do a TSH and free T4. It depends. There are some medical doctors who do the entire thyroid panel. Same thing with sex hormones. Many times, they are resistant to do any testing at all. When they do, they will try to get away with the bare basics.

Dr. Tara:

In places like Canada or the UK, where they have the NHS, they are limited. They are not allowed to order the reverse T3 or T3 generally. We don’t have those limitations that I know of in the United States. I have been an employed physician with a hospital system, and they never told me not to order certain things. They may not be covered by insurance.

Thyroid isn’t as controversial as far as how to test; it’s just what to test. We all agree that blood is the best place. Thyroid hormones are large peptide hormones. They are not lipophilic, steroidogenic hormones. They are peptides. It’s a little bit different in the blood. They are bound of course, but we do have the assays to do free assays. We don’t for sex hormones. We have free testosterone. Sometimes I have seen a free estradiol, but it’s not that common. With progesterone, you don’t know if you’re getting a free assay.

Dr. Eric:

I have actually seen Labcorp, I think, where they do offer the free estradiol or even free progesterone. I have never seen doctors order the free tests other than testosterone or thyroid hormones.

Dr. Tara:

We do have now an ultrasensitive estradiol that seems to be a lot more accurate. If you order the LC-MS, it’s supposed to be more accurate also. I know if you order progesterone LC-MS and estradiol ultrasensitive at either Quest or Labcorp, those are getting a little bit better. There is some data coming out of the North American Menopause Society about those lab assays as well.

Dr. Eric:

I don’t know if you can answer this, but when it comes to blood testing and sex hormones, I have noticed in some patients, and I don’t know where I started testing for total estrogens. Sometimes estradiol will look fine, and total estrogens are elevated. There are multiple estrogens, including estradiol, estrone, estriol. Would that be your explanation: If total estrogens are elevated, but estradiol is looking fine, it could be more related to estrone, for example?

Dr. Tara:

First of all, estriol is very hard to measure in the blood because it’s a metabolic byproduct of estradiol and estrones. It’s not made and circulated in the blood; it’s only made during estrogen metabolism. Then we’re talking about estrone and estradiol. 95% of your estradiol comes from the developing follicle and the ovary. Estrone is made in a lot of places but mostly with aromatization from DHEA or testosterone. There is a bidirectional enzyme, 17beta HSD, that you can make estradiol into estrone, and vice versa.

When we are talking about blood, you have to think about what you’re measuring. Where is it coming from? If you’re measuring blood levels on somebody who is having a menstrual cycle, their ovary is producing those hormones and putting them out into the blood. If you’re measuring someone who is postmenopausal, it’s not coming from the ovary. It’s happening in the periphery, in the muscle and fat. DHEA in the periphery is converting to either estrone or estradiol.

You wouldn’t expect to see high estradiol in somebody either postmenopausal, not on hormone therapy, or someone with no ovaries. That would be like if my 20-year-old daughter said, “Mom, I’m going to the library tonight to study.” She left the house in sweats. I thought, “I’m so lucky. She’s such a great kid.” She gets to her friend’s house, pulls off her sweats, and reveals a tank top and miniskirt. She pulls out her fake ID and goes clubbing. I am never going to see that conversion because it happens outside of my house.

The estradiol to estrone, testosterone to estrone, DHEA to estrone, that all happens outside of the blood. I don’t know how accurate that estrone is in the blood. Yes, I will see it high if it’s so high that it’s recirculating. That bidirectional enzyme.

I have seen those assays of the total estrogens. I don’t prefer them. I would prefer to do the estrone LC-MS and the estradiol ultrasensitive. Again, if you’re somebody who is menopausal, I have seen estrone go up almost to compensate because your estradiol is low because your ovaries are not working. Sometimes, if we give them an estradiol patch, that may drive the estradiol up. You will see the estrone come down because those hormones act differently at the receptors. The concentration is important.

Dr. Eric:

Dried urine testing, such as a Dutch test. It’s one example. There are a few other labs that perform that. One of the big advantages of the Dutch test is looking at the estrogen metabolites. Would that be the main advantage? If you were just wanting to look at estradiol, estrone, estriol, progesterone, would you say there is an advantage looking at the levels in the urine compared to the blood?

Dr. Tara:

I think that the Dutch test is a great test. We do a lot of it. I kind of analogize it to like if you came to me and said, “I’m bankrupt. I can’t pay my bills,” I would wonder if you’re not making enough money or spending all of your money. What is the problem? Maybe you make a lot of money, but you spend it. When people have a lot of estrogen, it’s good to know if they are making a lot or just not getting rid of it. It’s like charging a credit card and not paying off that balance. Cut up that credit card and never use it, and you would still be paying a finance fee if it went on long enough. I see that in women.

The Dutch test for the dried urine is all your hormones that are being excreted. It’s like me looking at your receipts and seeing how you spend your money. My accountant doesn’t care what my bank balance is. He wants to know what I spent on rent, payroll, supplements, salary, etc. He wants to see how I break it down. That’s what we see in the urine. It’s also a great way to look at your cortisol because you get your cortisol and cortisone metabolites. What is going on with that lone betaHSD? Are you favoriting conversion to cortisone? You can see how you metabolize your androgens. Do you have a 5-alpha or 5-beta preference? That’s really helpful.

I think one of the reasons we really missed the boat on hormone therapy with a lot of people is this estrogen metabolism problem. They can have genetic SNPs that affect estrogen detox. Or their environment or lifestyle choices affect those enzymes as well. Giving one person a dose of estrogen with good estrogen detox, they pay their bill every month, they might be fine. The other person might get the exact same dose but accumulate estrogen.

Dr. Eric:

Sticking with the topic of estrogen metabolism. If someone on a Dutch test is showing higher levels of the 4-hydroxy metabolite, which is the—I hate calling it the bad estrogen because they are all important, but you don’t want this one to be too high. Let’s say that’s above the range. It’s showing low methylation. You mentioned the genetic variations, the SNPs. Would you dig deeper and recommend genetic testing for COMT, MTHFR, for example?

Dr. Tara:

We do in many of our patients, especially my patients with breast cancer. There is data that says that a high 4-hydroxy estrone has been isolated in breast cancer patients. If it’s not detoxified, it can intercalate and agonize DNA and cause rapid division. There haven’t been a lot of studies that looked at it because it’s just not a focus. I found quite a few that do reinforce that.

Dr. Eric:

You mentioned breast cancer. If someone has elevated 4-hydroxy metabolites, could that also be a factor with other conditions such as endometriosis or uterine fibroids?

Dr. Tara:

Endometriosis is a tricky disease. There is an abnormal hormone response, but also we’re finding out so much more, that it also involves inflammation, an altered immune response. Yes, it is driven a lot by estrogen.

Fibroids are different. It’s a different tissue. Endometriosis is a tissue of the uterine lining or endometrium that responds to estrogen and quiets down with progesterone. Fibroids are a different cell line. They are part of the muscle.

There is data that shows both estrogen and progesterone play a role. I haven’t been able to pin down the authors and say, “Is it progesterone or progestin?” That also stimulates the growth. I just did a talk at the World Congress on Fibroids, so I looked into this data. I was surprised to hear that progesterone may play a role in fibroids. Because it’s a different cell line, it acts a little bit different than endometriosis. Endometriosis is also an altered immune response and inflammatory. Fibroids also, but not quite as much as endometriosis.

Dr. Eric:

You’re saying that as far as the estrogen imbalances, endometriosis would be a great factor when compared to fibroids. I know you said for endometriosis, there were other factors, too, like the immune system.

Dr. Tara:

I do see that at least with myself, I have estrogen metabolism issues. I had endometriosis for many years. That seemed to be the case for me. Once I fixed my methylation, you gotta fix the gut. I don’t have issues with it now.

For fibroids, it’s not as common a thing, so I can’t say I have done quite so many Dutch tests on people with fibroids. I had one patient that had rather large fibroids. She did seem to have lower progesterone, but it wasn’t terrible. Her estrogen detox was flawed. What the studies are showing is it’s almost like estrogen primes the growth, and progesterone also contributes to the growth. I am not sure that’s clearly understood as far as the mechanism and the connection to hormone issues with fibroids right now.

Dr. Eric:

I have seen research studies when it comes to thyroid nodules showing potential problems with estrogen metabolism as well as other factors like insulin resistance. I don’t know if you have seen any of the research or in your patients because I know you also work with thyroid patients. Have you seen any connection there?

Dr. Tara:

I haven’t seen any data on thyroid nodules. You’re talking about hot nodules or cold nodules?

Dr. Eric:

It just said “thyroid nodules” as well as uterine fibroids. It actually mentioned estrogen in those. None of the studies I saw mentioned specifically what type of nodule.

Dr. Tara:

There is definitely that relationship we discussed with estrogen and thyroid, so I would not be surprised if there was a connection there.

Dr. Eric:

And you mentioned breast cancer. Whenever one of my patients has a history of breast cancer in the family, or if they personally had breast cancer, then I would recommend doing a Dutch test. I’m guessing you also recommend it probably in all of these conditions.

Dr. Tara:

These are all conditions that I think the Dutch test is extremely beneficial for.

Dr. Eric:

How about cycling women? That’s another advantage of the dried urine testing. They can look at the hormones throughout their cycle and not just a single snapshot, which is what you’re getting through blood testing. Would you recommend certain cases? The question is would you recommend for all cycling women to get the cycle map?

Dr. Tara:

That’s available in both salivary and urine. There is a company that does it in salivary; I think it’s Genova.

Dr. Eric:

Diagnos-Techs also does it.

Dr. Tara:

I don’t love their assays. Genova does a cycle map. ZRT and Dutch for the urine. Gosh, if everything was free and the same price, I would have everyone do it. It’s not. The cost is really prohibitive. I’m in middle America. It’s over $400 to do that test. I guess that makes sense. There is a lot of collections. Mark Newman from the Dutch was telling me how hard it is to process those tests because there are a lot of things. If somebody wanted to do it, I would love that information. In the patients who have had the resources to be able to do it, it’s been extremely valuable information for us.

Dr. Eric:

How about a fertility case? Would that be a good reason to do that? If they are doing IVF, they are spending who knows how much money on that. When you compare the cost- But I agree, the average person, I don’t recommend the cycle map testing either. Just in certain situations.

There is a lot more we could talk about testing. As far as balancing out the hormones, different treatment options. Earlier you mentioned bioidentical hormones. When is it time for bioidentical hormones? When is it time for using herbs and other more natural methods?

Dr. Tara:

My protocol would be everybody really should start with diet, exercise, lifestyle, stress management. You can go pretty far from cleaning up your diet, getting off inflammatory foods, decreasing your alcohol and sugar, taking the plastics out of your environment.

For a patient who is younger, in her teens and 20s, I am more likely to try something like Vitex, which is an herbal supplement. Look at their estrogen detoxification and see if we can foster enzymes. Sometimes it’s a problem with phase one detoxification, so we will work with that.

When you are getting an older woman who has a lot of estrogen, my concern is the health of the breast and the uterus and the increased risk of breast cancer with all that estrogen. We know that estrogen upregulates its receptor, and progesterone will downregulate its receptor. I more feel compelled to use progesterone in somebody like that because I know that progesterone will cause apoptosis or cell death, which is what we want. We don’t want that unregulated cell growth.

When you are talking about the indications for menopausal hormone therapy, it’s individualized. The FDA suggests the indications are vasomotor symptoms, prevention of bone loss and osteoporosis, and vulva/vaginal, which they call genitourinal symptoms of menopause (GSM). Those are the FDA indications.

Although there have been studies that show a 19% reduction in diabetes, we can’t say that it will reduce your diabetes. We can’t say that it will prevent heart disease although there is a lot of data saying it has a favorable effect on your cholesterol and does reduce the risk of heart disease. We can’t say that because it didn’t get the indication for that.

More importantly, there are some studies out of the Women’s Alzheimer’s Translational Research that they looked at over 400,000 women taking hormone therapy. They saw a 60% reduction in neurocognitive disorders, including Parkinson’s and Alzheimer’s. That’s a pretty steep reduction. There is a lot with estrogen and brain health that we still are trying to find out. Estrogen in the older age.

There is all of the vanity symptoms. We talked about weight and the studies out of University of Colorado. Yes, bones. Yes, heart. Hair, skin, mood. There are a lot of studies about depression in midlife because of low estrogen. Anxiety, those kinds of things.

It is an individual choice. I don’t think every single person needs to take hormones. I think every single person needs to be told of the risks and benefits and alternatives and given that option.

Dr. Eric:

It sounds like obviously you’re going to recommend dietary changes, lifestyle changes. As you mentioned, when someone is younger, less likely that you recommend hormones. I’m sure there is a time and place sometimes even in younger people. With the bioidentical hormones, when you do recommend them, it’s mostly in women postmenopause. Like you said, not everyone postmenopausal will get bioidentical hormones.

Dr. Tara:

That’s not my practice pattern. I know some places are like, “Take your hormones, and your skin will be-“ The Suzanne Somers approach of “Still have periods at 80. It’s good to have your periods. It’s good to have all this estrogen.” I’m not really in that camp.

Dr. Eric:

I agree. I can’t prescribe bioidentical hormones, but if I could, I don’t think I would recommend it to everybody. I would try to do things to optimize their adrenal health and gut health. There is a time and place, just like there is a time and place for thyroid hormone replacement.

You mentioned Vitex. If a younger woman, a woman of cycling age, if she had low progesterone, would you automatically recommend that? Or in certain situations, would you work on adrenal health first?

Dr. Tara:

We are always working on adrenal health, diet, and stress. Some of them might start with something called seed cycling, which is a regimen where you do certain types of seed in the first half of the cycle to boost your estrogen and a certain type of seeds in the second half of the cycle to boost your progesterone. That’s an alternative.

The Vitex is not progesterone. Does not cause apoptosis. Doesn’t have the benefits of downregulating the estrogen receptor. Somehow, it works with the HPG access to try to foster your own body to have better quality ovulation. I don’t really know what the exact mechanism is. Somehow, through the HPG access. It’s not progesterone. If I am worried about at the cellular level upregulation or downregulation of estrogen receptors, or hyperplasia or apoptosis, then I am more likely to go with progesterone.

Dr. Eric:

Sounds good. What are your thoughts on maca root?

Dr. Tara:

I can’t say I am an expert in maca root. I have looked into the data on it. What I have seen is it’s mostly helpful for libido. It’s an adaptogen. I know some hormone preparations that have a lot of stuff in it might have that in there, plus Vitex and some other things. I don’t have a lot of experience with it myself.

Dr. Eric:

I was just curious. Figured I’d pick your brain on that. There is so much more we could talk about. Is there anything urgent that I didn’t bring up that you thought I should have asked you?

Dr. Tara:

I jump at the chance to educate people because I want to validate women out there. The people who are struggling, the people who have been dismissed, the people who have had these symptoms and don’t really know who to go to. They are thinking their PCP should know. They are not trained. They are thinking their OB-GYN should know. As a traditionally trained OB-GYN, we do not get this kind of training. They don’t know who to go to. They are told, “We can’t check hormones.” They should be checked. People should have the option. Doesn’t mean everybody needs to take something. We discussed many options from food to lifestyle to herbs to hormones.

I want to encourage anyone who is struggling, if they have their gut feeling telling them something is wrong with their hormones, they may have gone so far as gotten a doctor to order hormones, and they say they are normal because they don’t know how to interpret them. It’s frustrating. That’s my message and my megaphone. It’s why I spend time on social media and try toeducate. I want to advocate for people and educate them.

Dr. Eric:

Thank you so much. You’re right. If someone does a Dutch test on their own, and if they were to bring it to their medical doctor, most medical doctors wouldn’t know what to do with it. Some might be interested, but most of them probably would be like, “I don’t do that type of testing.” Maybe they will recommend something in the blood or to go to someone else. It’s probably a good idea, to go to a functional medicine practitioner, someone like yourself.

Dr. Tara:

Hopefully that would be what they do instead of slamming it and saying- I have had providers saying, “Anyone who talks about the Dutch test, unfollow them immediately.” Those providers get money from the Dutch test. Do you get any money from the Dutch test? I don’t. It’s just crazy.

Dr. Eric:

I deal a lot, especially with the hyperthyroid patients seeing endocrinologists who don’t want to hear anything about diet or lifestyle changes. It’s all about taking medication or getting radioactive iodine or thyroid surgery. Same with Hashimoto’s. Take your thyroid hormone replacement. Nothing else is going to help. Similar here.

Where can people find out more about you, Dr. Tara?

Dr. Tara:

They can follow me on TikTok. I’m @hormoneguru. On Instagram, it’s @revitalizemed. I have an online course at hormone-guru.com. We have a lot of free programs. We have some courses for sale as well that they can enroll in at their own pace. Usually, we are doing workshops and things like that as well. Those are the main things. My YouTube is Tara Scott, M.D. I am also trying to upload things there. It’s easier to search there than in the TikTok format. I am trying to get caught up on that as well.

Dr. Eric:

Thank you so much for doing this interview. I learned a lot. I’m sure the listeners did as well. Appreciate you taking your time to share your knowledge with others.

Dr. Tara:

Thanks for the time you’re putting into this. It’s your time as well to try to educate people.