Last week I released a blog post entitled “Choosing Your Thyroid Healing Healthcare Team”, and one of the healthcare practitioners I spoke about was an endocrinologist. Many people with thyroid and autoimmune thyroid conditions end up being referred to an endocrinologist. And while I can’t say that I had a horrible experience with my endocrinologist when I was diagnosed with Graves’ disease, over the years I’ve had many patients inform me that they didn’t have a good experience with the one they consulted with.

This is especially true for those people with hyperthyroidism, as many endocrinologists will pressure their hyperthyroid patients to receive radioactive iodine or thyroid surgery. And not surprisingly, most endocrinologists aren’t open to natural treatment methods. Sure, every now and then there will be someone who tells me that their endocrinologist is receptive to them taking a natural treatment approach. But this is rare, as most feel that diet and other lifestyle factors don’t play any role in improving the health of people with these conditions.

I’d love to hear what your experience has been with your endocrinologist. If you had a negative experience please let me know! If you worked with an endocrinologist who was open to you taking a natural treatment approach please let me know! Thank you for sharing your experience with everyone!

It’s not easy dealing with a thyroid or autoimmune thyroid condition, which is why it’s a good idea to work with one or more healthcare practitioners.  Most people with these conditions will at the very least see a medical doctor, but if you’re looking to optimize your health then you also might want to consider working with someone who has an open mind.  Of course you also want to consult with someone who has a good amount of experience dealing with your specific condition.

So let’s go ahead and take a look at some of the different healthcare professionals you might choose to work with:

Primary care physician. Many people will initially get diagnosed with hypothyroidism or hyperthyroidism by their primary care doctor.  In the case of hypothyroidism/Hashimoto’s thyroiditis they might prescribe thyroid hormone replacement, although in some cases they will refer out to an endocrinologist.  In the case of hyperthyroidism the primary care physician will almost always refer the person out to an endocrinologist, although they might write a prescription for antithyroid medication or a beta blocker to manage the symptoms in the meantime.  This is what happened to me when I was diagnosed with hyperthyroidism in 2008, as I saw a primary care doctor, was given a prescription for a beta blocker, and was referred to an endocrinologist.

Endocrinologist. Many people with hypothyroidism and hyperthyroidism will be referred to an endocrinologist.  As mentioned above, this is especially true with most people who have hyperthyroidism, but many with hypothyroidism will also be referred to an endocrinologist.  Frequently it’s an endocrinologist who will diagnose someone with hypothyroidism as having Hashimoto’s, and will diagnose someone with hyperthyroidism with Graves’ disease, toxic multinodular goiter, etc.

For those with hypothyroidism/Hashimoto’s, the person will probably be given a prescription for Levothyroxine.  In the case of those with hyperthyroidism, the three common options are 1) antithyroid medication, 2) radioactive iodine, and thyroid surgery.  Although it’s a shame that endocrinologists don’t do anything to address the cause of the problem, this of course comes down to their training in medical school.  For those with Graves’ disease and Hashimoto’s (or the antibodies for both), keep in mind that endocrinologists aren’t immune system specialists, which is yet another reason why they treat the thyroid gland, while doing absolutely nothing to improve the health of the person’s immune system.

Sometimes I’ll get asked how someone can find an endocrinologist who has an open mind towards natural treatment methods.  The truth is that while over the years I’ve had a few patients who had an open-minded endocrinologist, most of these specialists don’t want anything to do with natural treatments.  If anyone reading this has worked with an endocrinologist who is open to a natural approach I’d love to hear from you in the comments section below.

Functional medicine practitioner.  If you are serious about getting to the underlying cause of the problem then I would strongly suggest working one-on-one with some type of natural healthcare practitioner/functional medicine doctor.  Obviously I’m a tad biased because I fit into this category, but it is very difficult to restore your health on your own.  Don’t get me wrong, as it’s not easy to restore one’s health even when working with an expert, but it is far less challenging when you have the proper guidance and accountability.  I realize that not everyone can afford working with someone, and ideally you want to work with a practitioner who has experience with thyroid and autoimmune thyroid conditions.

Finding someone who has experiencing working with hypothyroidism/Hashimoto’s shouldn’t be too difficult, as there are many natural healthcare practitioners who have a lot of experience with these patients.  It’s a different story with hyperthyroidism, which explains why approximately 80% of my practice consists of people with hyperthyroidism/Graves’ disease.  Even though I have written a book on Hashimoto’s, I’m perceived as being more of a “hyperthyroid specialist” since I personally dealt with Graves’ disease and restored my health.  Plus I also have written a book on hyperthyroidism, not to mention many articles on the topic, and recently I’ve even conducted a couple of hyperthyroid-related challenges!

So how do you find a functional medicine practitioner who has experience dealing with your specific condition?  Well, a lot of people find me through the search engines (i.e. Google, Bing) when conducting a search for certain keywords related to “natural hyperthyroid treatments”.  You can also visit the website for the Institute for Functional Medicine and conduct a search.  There are a lot of practitioners on the site who work with Hashimoto’s patients, although it might be more difficult finding someone who works with a lot of hyperthyroid patients.  In fact, I find that even some endocrinologists don’t have much experience with hyperthyroidism, and one reason is because it’s not as common as hypothyroidism.

Nutritionist /Nutritional health coach.  A few years ago I hired my first nutritional health coach (she actually was already working with me and I sent her to the Institute for Integrative Nutrition), and then in early 2020 I hired another nutritional health coach.  Prior to that I was the sole person talking with patients about diet and nutrition, and I felt comfortable since I received a masters in nutrition degree, along with a few nutrition certifications.  And so you certainly can work with a single practitioner who does it all, as my patients received great results when I took this approach.

That being said, I think patients appreciate having a dedicated person they can speak with who focuses on diet and nutrition.  And quite frankly, both of my nutritional health coaches do a better job than me when it comes to giving recipes, food substitutions, etc.  In fact, for some people it might be best to start consulting with a nutritionist or a nutritional health coach.  While diet alone might not be enough to restore your health, you won’t receive optimal results if you eat an inflammatory diet consisting of refined foods and sugars, fast, food, etc.  And it really is a good idea to cut out common allergens such as gluten and dairy.  I won’t get into detail about this here, as I’ve discussed diet in other posts, as well as in my books.

Acupuncturist.  I’ve had some patients see an acupuncturist while under my care, and while I can’t say that doing this is absolutely necessary, there are benefits of seeing an experienced acupuncturist.  I actually discussed this in a past blog post “Can Acupuncture Benefit People With Thyroid Conditions?”.  And so if you’re considering seeing an acupuncturist you might want to read this.

Other healthcare practitioners.  In addition to the ones listed above, there are other healthcare practitioners to consider working with.  Many wouldn’t think of a biological dentist when it comes to thyroid healing, but problems with oral health can sometimes play a role in thyroid health.  One blog post I wrote that you might want to check out that relates to this topic is entitled “Are Silver Fillings Harmful To Thyroid Health?“.

Although I’m a licensed doctor of chiropractic, I can’t say that everyone with a thyroid/autoimmune thyroid condition needs to see a chiropractor in order to restore their health.  But if you want to read more about this then check out my blog post entitled “Chiropractic and Thyroid Health“.

I understand that while many people will see a primary care doctor and/or endocrinologist to diagnose and manage their condition, many won’t see a natural-oriented healthcare practitioner because they simply can’t afford it.  If this describes you I would check out a blog post I wrote entitled “Following A Natural Treatment Protocol On A Budget“.

Who Is Part of YOUR Thyroid Healing Team?

I’d love to hear what type of healthcare practitioners you’re working with!  Perhaps you’re working with multiple practitioners. You might even be working with a different healthcare practitioner that I didn’t list above, and if this is the case I definitely want to hear from you!

If you’re feeling stuck with your thyroid or autoimmune thyroid condition, then you might be interested in joining our Free 5-Day Accelerated Thyroid Healing Challenge starting on Monday May 17^th!

During this 5-day challenge you will…

• Learn how to overcome both common and overlooked “roadblocks” that are preventing your thyroid/immune system from healing
• ​Discover how to reduce your “toxic thyroid”
• ​Find out why removing the trigger doesn’t always break the chronic inflammatory cycle associated with Graves’ disease and Hashimoto’s, and what you can do to stop this cycle
• ​Create your thyroid/immune healing action plan

The Free 5-day challenge will include the following…

Component #1: Daily Accelerated Thyroid Healing Video Lesson

During this daily 10-20 minute recorded lesson I will focus on a different topic that is essential to speed up the healing of your thyroid gland/immune system. There will be one pre-recorded lesson every day for 5 consecutive days, which means that you can access it at your convenience.

Component #2: Daily Accelerated Thyroid Healing Assignment

I want people to take action, which is the whole point of any challenge.  And so each day there will be a daily assignment designed to help speed up your thyroid/immune system healing.

Component #3: Daily Live Calls

Monday through Thursday I will be going live on Zoom (and will livestream to Facebook), and each day I will be discussing a different topic related to thyroid healing.

Component #4: Two 90 minute live Q & A sessions

There will be two separate live Q & A sessions.  These will be 90 minutes each, and I’m having two in order to accommodate those in different time zones.

Component #5: Access to a private members-only group

We want you to build relationships with one another and enjoy this challenge together. Although you can still watch the daily video lessons and attend the live calls and two Q & A sessions without joining the Facebook group, if you want to connect with others and be eligible for the prizes (discussed below) then you’ll want to join the Facebook group. I plan on having my nutritional health coaches moderate the groups, although I’ll also pop in every now and then.

Component #6: Prizes for Participation!!!

There will be a daily prize for those who answer the daily question, and then at the end of the 5 days there will be a grand prize!!!

You Get All of This For FREE!!!

For more information on the Free 5-day Accelerated Thyroid Healing challenge check out the link below:

www.RapidThyroidHealing.com

On Friday April 30th I interviewed Dr. Rudrani Banik on thyroid eye disease, and below is the written transcript. If you would prefer to watch the interview you can access it by clicking here:

Here is the transcript:

Dr. Eric:

With me I have Dr. Rani Banik, who is a board certified ophthalmologist and fellowship-trained neuro-ophthalmologist with additional training in functional medicine. Dr. Rani focuses on the root cause of eye diseases and uses integrative strategies for conditions such as thyroid eye disease, macular degeneration, cataracts, dry eyes, glaucoma, as well as other diseases of the visual system, and her treatments are based on nutrition, botanicals, lifestyle modification, essential oils, and supplements. Dr. Rani runs a private practice based in New York City.  In Manhattan. Is that correct?

Dr. Rani:

That is correct, yes.

Dr. Eric:

She is also an Associate Professor on Mount Sinai in New York City where she serves an educator and researcher. Dr. Rani also is frequently featured as an expert in the media, and has been interviewed on a lot of different places, Good Morning America, CBS, NBC ABC, New York Times, Washington Post, Fox, and a number of others. Dr. Rani has been voted as Castle Connolly Top Doctor and New York Magazine’s Best Doctor in Ophthalmology every years since 2017.

Well, thanks for joining me, Dr. Rani.

Dr. Rani:

Thank you Dr. Eric for that kind, kind introduction. That was wonderful. Thank you.

Dr. Eric:

You are very welcome, Dr. Rani. Well, I’d like to start out by asking you to explain to those who are unfamiliar the difference between an optometrist and an ophthalmologist, and then also a neuro-ophthalmologist. So, if you could explain the difference between the three.

Dr. Rani:

Sure. So, many people don’t realize that there are very different Os in eye care. So, there’s ophthalmologist, optometrist. There’s also optician. So, what’s the difference? Well, an ophthalmologist is a doctor who has gone through medical school, and then done an internship and residency in ophthalmology, and some of us have done fellowships as well. An ophthalmologist treats eyes diseases both medically and surgically. We also do prescribe glasses and do additional testing as well.

An optometrist has gone to optometry school. So, optometry school is for four years, and then after that, not all optometrists, but some optometrists do a residency as well, a one to two-year residency. Depending on the state, the scope of, I guess, care for optometrists varies. Optometrists typically prescribe contacts, glasses. They do primary eye care, again, depending on the state. Depending on the state, some of them can actually prescribe medications as well, for example, eye drops. They can manage basic diseases like early glaucoma, et cetera.

Then an optician is someone who actually has a license in opticianry, and an optician has an associates degree. I think it’s about two years, and they actually make the glasses, and they help to fit the glasses.

Then a neuro-ophthalmologist, which is what I am, is basically an ophthalmologist who’s done additional training. So, I did a fellowship in neuro-ophthalmology. It was an extra year of training. Neuro-ophthalmology, basically, encompasses all the connections between the brain and the eye. So, all the cranial nerves that have to do with vision, how our brain processes vision. So, I deal with a lot of different neurologic conditions like brain strokes, brain tumors, concussion, autoimmune diseases that affect the eye and the brain, for example, multiple sclerosis, and also thyroid eye disease. So, that’s also within my skillset in a nutshell. I also deal with migraines. So, that’s a big part of what I do as well.

Dr. Eric:

All right. That’s a big problem as well. A lot of people have migraines, and might not relate it to the eyes. So, that’s good that you’ve mentioned that as well. So we’re going to be chatting about thyroid eye disease, we’re going to be talking about an integrative approach to thyroid eye disease. So, why don’t you go ahead and explain what thyroid eye disease is?

Dr. Rani:

Sure. So, many people don’t realize that there is a thyroid-eye connection. The connection is an indirect connection. So, basically, when the thyroid gets involved with autoimmune disease, for example, either Graves’ disease or Hashimoto’s disease, if there are autoimmune antibodies in the body, they can cross-react. Those antibodies that attack the thyroid can cross-react with tissues in the eye socket.

So, in the eye socket, we have the eye muscles. We also have fat in the eye socket and some other soft tissues. So, the receptors on those tissues in the eye socket look very similar to receptors on the thyroid gland. So, these auto-antibodies can attack these tissues in the eye socket and cause inflammation. When there’s inflammation either in the eye socket or even on the lids or the surface of the eye, that’s called thyroid eye disease.

Dr. Eric:

All right. So, you mentioned it could occur in either Graves’ or Hashimoto’s. Even though it seems to be a lot more common on Graves’ disease, a small percentage of Hashimoto’s patients also has thyroid eye disease, correct?

Dr. Rani:

Absolutely. I think a lot of people, like you said, they automatically associate with Graves’ disease hyperthyroidism, but it can be seen with either. Then there’s also a subset of patients who are actually what we call euthyroid, meaning they have normal thyroid function test, they have normal TSH, free T4, T3, but they have antibodies. Even patients who have normal thyroid function can also have thyroid eye disease if they have the antibodies floating around.

Dr. Eric:

When you say antibodies, there are different types of antibodies like thyroid-stimulating immunoglobulins…

Dr. Rani:

Any of them. So, TSI, thyroid-stimulating immunoglobulin, thyroid peroxidase antibody, thyroglobulin antibody, any of them can potentially cross-react with the tissues in the eye socket.

Dr. Eric:

Okay. That’s really interesting. So, what are some of the symptoms that you see with patients that come to your office with thyroid eye disease?

Dr. Rani:

Yes. So, interestingly, a lot of patients don’t even know that they have symptoms of thyroid eye disease when they come in. Many of them have perhaps been misdiagnosed as something else because symptoms can overlap with other eye conditions. So, I would say the most common symptom is probably dry eye. Many people with thyroid eye disease start off with a feeling of scratchiness, irritation of the eyes, like there’s sand in the eye or a grittiness.

Then what can happens is that there can be swelling of the eyelids. So, puffiness, particularly of the outer corners of the upper lid, sometimes even the lower lids can get very puffy, very swollen. Then as the disease progresses, there can be redness of the eyelids, redness of the surface of the eye, and also changes in the eyelid.

So, oftentimes, people develop what we call lid retraction, where the lids basically open up wider and it gives a look of a stare. We call it the thyroid stare because the eye is just wide open. It’s because the tissues in the eye socket have become inflamed and they become very tight. So, when the muscles get very tight, then the lids open up very wide. Then as the disease progresses, more serious types of symptoms can occur.

The next category would be bulging of the eye. So, people can get where one or both eyes may look more prominent, really just very inflamed. Their eye socket is very congested. Then if the muscles in the back of the eyes get affected, that can lead to a feeling of tightness, pressure. It can even lead to double vision because the eyes can get misaligned. So, if the muscles get very thick and swollen and congested, inflamed, the eyes may, for example, one eye may be higher, one eye may be lower or one eye may start to turn in a little bit, and give people double vision.

Then I would say the worst, I shouldn’t say the worst, but the most advanced form of thyroid eye disease is when there’s actually potential loss of vision, and that happens because the nerve, the optic nerve, which is in the eye socket, which is the nerve that connects the eye to the brain, that nerve can get, basically, compressed by all the congestion in the eye socket, so by the muscles, by the tissues that are all inflamed, and then people can actually lose vision. So, that’s at the other end of the spectrum, but there’s just a whole range of symptoms people can have if they have thyroid eye disease.

Dr. Eric:

Okay. As far as blindness, that’s pretty rare?

Dr. Rani:

It’s extremely rare. So, I just want to reassure everybody. Yes, it can happen, but it’s in less than 5% of people with thyroid eye disease that that actually happens. So, fortunately, the majority of people don’t progress that far. Most people with thyroid eye disease do have some lid changes, puffiness, dryness, surface issues, but not necessarily the other issues that I mentioned, but I did want to give people an overview of all the different types of manifestations thyroid eye disease can have.

Unfortunately, because many people come in with puffiness, and especially seasonal puffiness, for example, with allergies like we’re right in the middle of springtime right now, people may have puffiness of their lids, redness, irritation. So, many people with thyroid eye disease get misdiagnosed as eye allergies, which is dry eye. So, they get treated for that for months and months and months, and things just aren’t getting better with drops, et cetera. Ultimately, they end up being diagnosed with thyroid eye disease.

Dr. Eric:

So, you’re saying a lot of people think they just have dryness of the eyes, but they really have maybe a more mild case of thyroid eye disease?

Dr. Rani:

Yeah. So, patients themselves may think that it’s something else like dry eye or allergies and even doctors, even optometrists, ophthalmologists. There are physicians who just don’t necessarily think of it because there’s so much overlap between thyroid eye disease and other surface issues of the eye. There are some really characteristic findings that we look for, some very subtle findings that as a neuro-ophthalmologist I really look for, and that is really the lid retraction.

So, for example, normally, our lids should cover the white part of the eye. So, if you’re looking at someone, you shouldn’t be able to see on the top and bottom of the cornea. You shouldn’t be able to see any white, really. If you can see white, that means that there’s lid retraction, that those muscles are very tight and congested. That’s really one of the earliest hallmarks of thyroid eye disease is that lid retraction.

Dr. Eric:

Okay. That’s good to know because I also don’t want people to panic and think they have it because a lot of people do have dry eyes and we don’t want them to think that if they have dry eyes or they have allergies, and if they have Graves’ disease, it doesn’t…

Dr. Rani:

Yeah. Again, there’s overlap. Just because you have some of the symptoms doesn’t meant it’s from the thyroid because there are plenty of people who had Graves’ disease or Hashimoto’s who never developed thyroid eye disease. So, if you’re concerned about it, definitely just get it checked out by your eye doctor.

Dr. Eric:

Right. Why do some people, I don’t know if you know the answer to this, but why do some people with Graves’ disease develop thyroid eye disease while others don’t?

Dr. Rani:

I wish I knew the answer to that. That is the big mystery. I always try to ask my patients who come in with thyroid eye disease, “Were there any triggers? Did something change in your life, in your dietary habits, in your stress levels, in your exposure or was there anything new that you were exposed to like a new toxin or something in your environment?” The majority of people, there really isn’t a clear-cut trigger, but I will tell you that the cases I’ve seen, which are really very prominent, just cases that come on very quickly, many of those patients do report that they’re under a lot of stress.

So, I definitely think that there is some association between stress and cortisol levels and the onset of thyroid eye disease. I can’t tell you how many patients. For example, I had a patient who came in, a young woman who already had other autoimmune diseases. She had a couple of other autoimmune diseases diagnosed prior, but she just got married, so she’d been through planning a wedding, and then actually having the wedding, and a week later, she just came in and she had fulminant thyroid eye disease, and it was probably related to that stress that she had gone through, just with her life change and her celebration.

Dr. Eric:

One thing, also, just to let people know, again, if you think your Graves’ disease condition was caused by stress, again, that doesn’t guarantee that you’re going to develop thyroid eye disease. I learned this from self-experience because I had Graves’ disease in the past, been in remission for quite a while. Stress, definitely, was a factor in my case. Fortunately, I didn’t have thyroid eye disease, but who knows? Maybe I had a very mild case of thyroid eye disease, but it was never diagnosed.  But stress, I think, is a big factor with many chronic health conditions.

Dr. Rani:

Yeah. I also just want to mention that this is really interesting. The timing of thyroid eye disease doesn’t necessarily correlate with thyroid function at all. So, for example, there are some people who have been diagnosed with hyperthyroidism, Graves’ disease years ago and who were under control, well-managed, really asymptomatic from a thyroid standpoint, who maybe 20 or 30 years later may start to develop eye symptoms.

So, it’s very interesting, and I wish I knew the answer to what really triggers the eye issues, but it can be very discordant in that way. They don’t necessarily run in parallel. Then there are some people who actually develop the thyroid eye symptoms first, and then their thyroid, their TFT, they thyroid function test, their TSH, free T4, T3 seem to be normal, and then years later, but they do have antibodies, years later, then they actually develop thyroid dysfunction. So, doesn’t correlate, and in the majority of cases, there’s really no rhyme or reason to it. It’s really a mystery, unfortunately.

Dr. Eric:

Yeah. One thing I have noticed, again, it’s not across the board with patients, but the higher their antibodies, especially in the case of Graves’ with the thyroid stimulating immunoglobulins, it seems like the more likely they are to have thyroid eye disease. Again, I’m not sure if that’s something you notice, but if someone has a TSI of 300-400, they’re more likely, it seems, to develop thyroid eye disease than a TSI that’s in the lower 200s, for example, or in the upper 100s.

Dr. Rani:

Yeah. I don’t know if the actual numbers have ever been looked at, but I’ve definitely seen it. Just clinically, I’ve seen it where many patients who have very active thyroid eye disease, their numbers are really sky high, and not just TSI, but also thyroglobulin antibodies and anti-TPO as well. Sometimes we can use those numbers to track them, to see how they respond to treatment. So, they are useful to follow longitudinally.

Dr. Eric:

Yeah. One problem is, at least with endocrinologists, is that a lot of endocrinologists won’t test the antibodies. They just will look at the thyroid function test, TSH, free T3, free T4, and it depends on the doctor. Some doctors will do it every single time. Some will just do it initially to diagnose the person with thyroid autoimmunity, but, yeah, I agree. I guess it depends. In some cases, especially it seems like more so with the TSI, I do see when someone’s improving, it seems like it gradually decreases.

Again, there’s always exceptions, but sometimes with TPO antibodies, and the thyroglobulin antibodies, again, in my experience, it seems a little bit more of a fluctuation, where sometimes it will more of a roller coaster pattern, but, again, that does depend on the person. Do you think everybody with Graves’ should get their eye checked or you just think if they start experiencing symptoms and there’s…

Dr. Rani:

Not necessarily, no, because as you mentioned, the vast majority of people who have autoimmune thyroid disease, whether Graves’ or Hashimoto’s do not have eye symptoms related to their thyroid, but what I would say is … So, for most adults, they should have an annual eye checkup. So, just go see a regular eye doctor annually, and if there’s anything on the exam, then your doctor may go look further, but there’s no need to go rushing to get your baseline eye exam immediately after having the diagnosis.

Dr. Eric:

All right. Good deal. So, let’s go ahead and talk about some of the natural treatments, integrative treatments. So, what are some of the things that you recommend from an integrative standpoint for those with thyroid eye disease?

Dr. Rani:

So, I would say, first and foremost, is their diet. Most doctors, endocrinologists and ophthalmologists alike probably are not asking their patients about their diet, what they’re eating, but what I found in many of my thyroid eye disease patients is that they’re extremely sensitive to certain types of foods, and they know that when they eat those foods, their eye symptoms tend to flare up or perhaps they’re in remission and then they have a flareup, which is unfortunate.

The food groups that most people are sensitive to happen to be food groups that many people with autoimmune diseases are sensitive to. So, it’s not just specific to thyroid eye disease, but that includes, for example, gluten. Dairy is huge. I mean, I know some of my patients with thyroid eye disease, even if they have a little bit of hidden dairy in their food by accident, let’s say they go to a restaurant, there’s a little bit of cheese in what they’re eating, automatically the next day they feel it. They know that they’ve had something that caused them to flare up. Those are the two that I usually recommend that my patients avoid. Also, soy products and nightshades. Those are the main food groups that I recommend that my patients avoid.

Then for many of my patients, also, particularly the ones who have a lot of lid puffiness, it’s important to also be careful around histamine foods…like foods that are rich in histamine. It’s actually interesting. One of my colleagues and I did a study, this was a while back, maybe 15 plus years ago, using antihistamines for thyroid eye disease, and we found that people who actually took oral antihistamines tended to do better with their puffiness and their swelling, et cetera, just over-the-counter antihistamines like even Singulair or Claritin, Zyrtec can make a difference.

So, just from a dietary standpoint, it’s important to try to keep a food diary because what you may be sensitive to may be very individual to you, and it may not reflect what everyone else may be sensitive to. So, just try to see if there are certain things that are in your regular diet that you may be sensitive to, and then try to experiment and take them out for a few weeks, at least three weeks, but sometimes I tell people, “If you really want to investigate whether you’re sensitive to a certain food or not, eliminate it for a good three months, and then try to reintroduce it very slowly and see if you have a reaction to it.”

I don’t know what your experience is with foods and Graves’ disease and autoimmune thyroid conditions, but that’s been my approach, typically.

Dr. Eric:

I agree. I mean, I don’t think there’s a perfect diet that fits everyone, but I do have my patient with Graves’ and Hashimoto’s or at least most of them start out with an autoimmune paleo diet, and I always mention it’s a starting point, it doesn’t mean that, again, there are some people that don’t do well with it, and that could be the case with any diet, but autoimmune paleo diet, of course, involves avoiding gluten and dairy and soy and the nightshades, but it goes a step further, like corn and pretty much all grains, you’re avoiding and legumes, and even eggs. So, there’s a lot of people who find it challenging. Again, it doesn’t mean that everybody has a problem with eggs, but some people do. So, it’s just a starting point, and then eventually, we reintroduce foods.

You mentioned that most endocrinologists don’t bring up diet, and not only that, but I’ve had patients bring up diets to their endocrinologists and most of them will dismiss it. They won’t be open at all to diet playing a role in Graves’ disease, thyroid eye disease, and same thing with other autoimmune conditions. Usually, they dismiss diet, but, yeah, definitely, I see a huge difference.

That being said, I will say that diet isn’t everything, but what I tell patients is you could follow a strict autoimmune paleo diet or whatever, even a regular paleo diet, and there is a good chance you’ll notice some great improvements, but sometimes you do need to dig deeper. There could be potentially other triggers. Stress, you mentioned before, blocking out time for stress managements, and sometimes infections, and we live in a toxic world, so chemicals could also play a role.

Actually, one other thing. It ties into the supplement. I was going to ask you about supplements you recommend, but regarding the antihistamine. I don’t know if you’ve experimented with natural antihistamines like quercetin, for example, rather than taking something like Claritin.

Dr. Rani:

Yeah. So, I usually recommend that people get it through their food. If they want, they can take a supplement as well, but I usually recommend quercetin-rich foods like red onions, and apples, etc, as an anti-inflammatory, and also turmeric. So, curcumin is a potent anti-inflammatory. So, I do recommend people add that to their diet. If they do take a supplement, make sure you take one that has black pepper, so it helps with the absorption of the curcumin.

I just wanted to mention you were talking a little bit earlier about toxins. So, we know that one of the biggest triggers for thyroid eye disease is smoke and smoking. So, smoke contains, at least cigarette smoke, probably has over 400 different chemicals in it that get released. So, we don’t know exactly which of those chemicals may be triggering the thyroid eye disease, but we know, for sure, that people who smoke have a much higher, much more aggressive form of the disease, and many of them end up with optic nerve issues and potential vision loss. So, going a little bit beyond just stopping, smoking cessation and avoiding smoke.

I also do recommend that people try to avoid fumes of any kind, even cooking fumes, barbecue fumes. These can be really irritating to the eye. So, if you’re cooking, I usually recommend that, especially for people who actually have active thyroid eye disease, that they wear goggles or some covering for their eyes to protect their eyes from that direct exposure to smoke, et cetera.

So, I don’t know if you’ve ever heard that before, but it’s something that is really important, and I think most ophthalmologists do recommend that to their patients, but, again, I go a little bit further beyond just the smoking part of it.

Dr. Eric:

I’ve not heard about that. I actually did write an article years ago about cigarette smoking in Graves’ because in the literature, there’s also not just in thyroid eye disease, but Graves’ in general, a greater incidence of Graves’ disease in those who smoke, but, yeah, as far as avoiding other fumes I did not know. So, that, again, is good to know. How about other supplements like vitamin D is important for a healthy immune system?

Dr. Rani:

Yeah. Absolutely. So, vitamin D, sure, many people have heard this said, it’s not just a vitamin. It functions more like a hormone in the body. It has many, many different roles in the body. One of them is immune regulation. So, it is important to have a healthy immune system, having enough vitamin D, and most of us are vitamin D deficient, especially during the colder months of the year. So, you want to supplement with vitamin D.

I typically recommend my patients try to keep their vitamin D levels around 60 to 70. Now, of course, just check with your doctor to make sure that that’s okay for you. Some people like to go higher, but if you do go higher, you just have to be concerned about calcium deposition in your coronary arteries and you don’t want to develop heart issues because of high vitamin D levels, but you definitely want to, if you’re low or even on the low side, you want to just boost your vitamin D levels.

The other thing, the other mineral is selenium, which I’m sure many people are familiar with when it comes to the thyroid. So, selenium supplementation has been actually studied in thyroid eye disease by a European group, and it’s been shown to help reduce some of the congestion in the eye socket, and the inflammatory response. So, for selenium, the dose is anywhere from 100 mcg twice a day to 200 mcg twice a day is the typical recommended dose.

Dr. Eric:

All right. Well, what do you say about someone who would prefer to get their selenium through foods like Brazil nuts, for example?

Dr. Rani:

Yes. That’s a great resource as well. So, a handful of Brazil nuts, maybe two or three Brazil nuts are wonderful source.

Dr. Eric:

Yeah. The one thing I will say about that, I brought it up because a lot of people, whenever I bring up selenium, they’ll ask about that, and I agree that Brazil nuts are a good source of selenium, but you never know how much you’re getting in a specific Brazil nut. So, it could be anywhere from 10-20 mcg to 70-80 mcg. So, yeah. I am of the mindset you want to do as much through food as possible, but, honestly, if someone is dealing with active thyroid eye disease, usually I will recommend supplementation.

Dr. Rani:

Yeah. In terms of the nutrient content of foods, I just also wanted to bring up that the foods that we get now they’re not grown in the same type of soil that foods were grown decades ago. So, our soil is actually depleted of so many minerals now just because of changes in agricultural practices. So, even though you may think you’re having a wonderful diet and super healthy, probably the nutritional value of that produce, both fruits and vegetables, is lower than it really should be, especially as you mentioned. If you have active conditions, it’s probably best to take a supplement. Now, if you’re doing well, you probably don’t have to take a supplement, but if you actually have symptoms, it’s probably a good time to start.

Dr. Eric:

I agree. Even if you eat organic, it’s important to mention, because a lot of people will be like, “Well, if I’m eating organic,” but it’s still not the same as 10, 15, 20 years ago. So, active versus inactive thyroid eye disease, how long on average, I know it varies, but what do you see as far as active thyroid eye disease lasting?

Dr. Rani:

So, the active stage of the disease is when people actually have a lot of congestion. So, their eyelids, their eye sockets, that’s when people develop the bulging or it’s what we call proptosis is the medical term for bulging of the eyes. It usually lasts anywhere from two to three years, probably closer to two years in most people. It’s very difficult for patients during this time because they’re uncomfortable. Their vision is affected. They see blurry because of the surface issues, the dryness, etc. They have pressure. They may see double.

What people need to realize is that you have to wait the active phase out. Of course, there are things you can do to try to modulate that, but it does run a course of about two years, and you really have to be patient. Then the disease usually, some people call it like it burns itself out. It doesn’t really burn itself out, but it basically becomes stable, and then a lot of the edema, the swelling starts to go away. So, then the puffiness resolves a little bit. Sometimes the bulging improves as well, and then people may have what we call, again, the stable … Some people call it the fibrosing stage of thyroid eye disease. Fibrosing basically means that it’s scarring, but it doesn’t necessarily have to be scar tissue. It’s just not as active inflamed and edematous as the active phase, otherwise.

I think education is really important and just setting people’s expectations that, “Okay. It’s active right now. Let’s see how things are going to go,” and it may take a few years before things really start to quiet down.

Dr. Eric:

How about conventional treatments? So, you spoke a little bit about diet and supplementation. When is conventional treatment necessary for thyroid eye disease?

Dr. Rani:

Yeah. So when there’s a risk of vision loss is when, as ophthalmologists and neuro-ophthalmologists, we become very concerned. There are a couple of different mechanisms where people can develop vision loss. So, one is optic nerve compression that I was saying. If there’s a lot of congestion in the eye socket, the optic nerve can get compressed. People can have peripheral vision loss, central vision loss, color loss. So, that’s definitely an indication for medical treatment.

Also, if the eyes are very prominent, if they’re really bulging, and the eyelids just can’t close properly, then the cornea can get very dry. It can get so dried out that you can actually develop corneal ulcer because the cornea is just not lubricated properly. People can develop infection, which is an ulcer, and even scarring. So, those are the two real main indications for when medical treatment is really indicated, and usually in an emergency type situation.

I like to tell my patients, “Well, I approach this in an integrative way. So, yes, of course, we’re going to try the nutrients, the nutrition first and the supplements, and the conservative measures like using drops and using cool compresses, and using humidification, and essential oils. We’re going to try all of that, but if it ever gets to the stage where your vision is at risk, we’re not taking any chances.” In that situation, then, yes, it really is so important to be started on an agent that will help to decrease the swelling and protect your vision.

The typical treatment is steroids, and I hate to say that, but that really is. Unfortunately, we don’t have anything. Well, I’ll take that back. So, we do have something, which we can talk about, but prednisone in the acute setting is really what’s necessary to help preserve the optic nerve, and in cases where people have actually lost vision or significant vision, we actually sometimes admit them to the hospital and put them on three days of IV steroids. If it’s not so bad, we may just try oral steroids first just to get the swelling to go down, and then people can be tapered off the steroids over time, but up until now, that really has been the mainstay of treatment.

Then recently, actually last January, the FDA approved a medication. This is really the first FDA medication for thyroid eye disease, specifically for thyroid eye disease. It’s called teprotumumab, which is Tepezza, and it’s a biologic agent. Biologic basically means that it helps to modulate the immune system. What it does is it actually … So, what happens in thyroid eye disease is that a particular receptor gets activated called insulin-like growth factor receptor IGFR. So, Tepezza blocks that receptor. So, it blocks that activation. So, a lot of the changes that happen in the eye socket don’t happen.

So, Tepezza is given as an infusion. It’s usually given over the course of 24 weeks, basically, eight treatment every three weeks. So, 24 weeks of treatment. For patients with really active disease, where they have significant vision issues, maybe double vision, a lot of bulging of the eyes, swelling of the eyelids, it really has been extremely useful, and in many patients, really transformational for their care. Again, I remind patients that, yes, we try to approach things naturally whenever possible, but in some cases, we do have to really rely on our medical treatments and a little bit more aggressive treatment.

So, it is part of the toolbox, and it is just something to consider. Maybe have a discussion with your ophthalmologist or your neuro-ophthalmologist about if you may be a candidate and if you are not responding to natural treatments.

Dr. Eric:

As far as I know, it’s only available in the United States?

Dr. Rani:

I think it’s available in other countries as well. I do want to say it’s available in Europe.

Dr. Eric:

At least Canada, I mean, there might be other biological agents in Canada…

Dr. Rani:

Yeah. So, I’m not sure about that, about other countries, but one interesting thing that happened in the US was the drug got approved in January of 2020, and then the COVID pandemic hit, and then once the vaccines were being manufactured, the factory where they actually made Tepezza had to switch over. So, it was mandated by the government to switch over to making the COVID vaccine. So, that became a shortage of Tepezza in the country for quite some time, actually, and it wasn’t until I think about two weeks ago that it became available again. So, there were quite a few patients who were mid-treatment, who actually had to interrupt treatment.

Dr. Eric:

I have one of those patients. I’ve had a few patients. One of them was able to complete the course, fortunately, but then another one, yeah, had to get it interrupted, which was unfortunate.

Dr. Rani:

Yeah, and we don’t know now. If you’ve had been in that situation where you’ve not been able to get the medication or that you basically have to start again from scratch, I’m not really sure how that would work. The other medicine, it’s also biologic that has been used for thyroid eye disease. It’s something called rituximab or Rituxan. That’s actually a much more widely available drug. It’s also given as an infusion, but it’s given every six months. So, in countries where Tepezza may not yet be available, Rituxan is the next best option.

Dr. Eric:

All right. Now, that’s good to know. Then with Tepezza, again, I haven’t had a lot of patients get it, just a couple so far, but one person who was able to complete the course said that it greatly helped with the bulging, the lid retraction, but really didn’t help with the double vision. I don’t know if you’ve seen that or if, again, just varies depending on the person.

Dr. Rani:

Yeah. So, the clinical trial, actually, looked…the primary endpoint was bulging. So, Tepezza helped improve bulging by I think it was about 3 mm or so, but they found that there were some improvement in the double vision, but not enough to be fully restorative in terms of resolving the double completely. Ultimately, let’s say if you’re a candidate for Tepezza and you do Tepezza for 24 weeks, your doctor will assess how effective it was, and then some people actually need a second course of the drug. So, it’s now actually available as a second course.

Also, initially, with the study, they looked at patients who were only in the acute phase, only within nine months of having had symptoms, but now, I think there is a recent study that was published that showed that it’s also effective for people who have chronic thyroid eye disease. So, in that stable progressive phase, you may still be a candidate for Tepezza with the hopes that with some improved swelling, congestion in the eye socket that maybe the double vision may improve as well, but the double vision can be quite challenging to manage.

Clinically, we always start with the most conservative therapy there, which is prism therapy. I’m not sure if your audience is familiar with prisms, but prisms are basically, they’re optical devices that you can put on to glasses, and they basically realign the image onto your eye. So, it’s not realigning the eye itself, but it’s realigning the image so people don’t see double.

So, that’s very effective for many people to use a prism, but, ultimately, if the prism doesn’t help and also as things stabilize, if people still have double vision, then a surgery may be what’s really necessary to get rid of the double vision, but that’s the last resort. Surgery is really not something that we think of unless people are very refractory, they’re not improving to other standard treatments.

Dr. Eric:

Okay, and surgery, typically, is not done in the active phase, correct.

Dr. Rani:

Absolutely not. No. For double vision, so my typical rule of thumb is, first of all, I work with the patient’s endocrinologist to make sure that their thyroid is stable. So, once their thyroid is stable and if they’re on medication, once that’s stable for at least six months, then the clock starts ticking. Then I wait another six months to make sure that their double vision is stable also. The reason is because if someone has double vision and we operate too soon, and things are still changing, they’re dynamically changing in the eye socket, then that surgery may become ineffective because the double vision may come back or it may go the other way. So, it really is important to make sure that everything is 100% stable before having any kind of surgery for double vision. So, patients, it’s really challenging and it’s really difficult for some people to have to know that they have to wait that long, but, really, it’s in their best interest that they should be waiting.

Dr. Eric:

Okay. That makes sense. So, I think this might be my last question, radioactive iodine. So, radioactive iodine, it seems like in the research there is a little bit of controversy, as  it seems like it can potentially cause or exacerbate thyroid eye disease. So, a lot of endocrinologist won’t recommend radioactive iodine in thyroid eye disease patients. So, where do you stand on whether someone should receive radioactive iodine if they have thyroid eye disease?

Dr. Rani:

Yeah. So, what happens with radioactive iodine is, basically, the thyroid tissue is destroyed. A lot of thyroid hormone is released, and also the antibodies are released. That can actually create a thyroid storm in some patients. Even if they don’t have a thyroid storm, if you have a sudden release of a lot of hormone and antibody, the antibodies can, again, cross-react in the eye socket and trigger active thyroid eye disease. Whether they have it before or not, the patient may suddenly develop eye symptoms.

So, what I do is basically let the patient know that they should really work with their endocrinologist to first decide what treatment is best for them. Should they be on a medical agent like methimazole or PTU or do they really need radioactive ablation? If they do, then what I usually recommend is a short course of steroids starting one week before and two weeks after to prevent any exacerbation or activation of thyroid eye disease.

I dose it based on the patient’s weight. So, basically, what I do is I take the patient’s weight in kilograms. So, let’s say somebody is 70 kilos, you take half of that, so it would be 35, and I give them 35 mg of prednisone starting one week before the radioactive ablation and continuing two weeks after, and then that’s it. Then they don’t need anymore. So, that carries them through or covers them for that time.

I have to say, knock on wood, that with that regimen in all my patients, and I’ve seen thyroid eye disease patients for well over 20 years, none of them, knock on wood, have had activation of their thyroid eye disease after having had RAI. So, it’s just something to consider, and make sure you talk to your doctor about it whether they’re on agreement and they can maybe prescribe it for you if you really need to have that radioactive iodine.

Dr. Eric:

Okay. That’s interesting. Again, I try to encourage people if they can, obviously, I can’t tell them what to do and what not to do, but in my opinion, in most cases, radioactive iodine should be a last resort…radioactive iodine and thyroid surgery. So, my goal is to try to address the cause of the problem, but I think it’s important to talk about both sides because sometimes conventional treatment is necessary. So, I just wanted to get your opinion on that.

Dr. Rani:

Yeah. I agree completely. If you can manage it naturally, that’s the best way to do it, but at some point, if it’s really causing a detriment to your health, and it’s not being well-controlled with other treatments, then yes, an intervention is necessary…either thyroidectomy or partial thyroidectomy or RAI. The same holds true for surgeries. So, I do the same for my surgical patients. I put them on steroids for three weeks before and after. I do the same thing.

Dr. Eric:

Okay. So the same routine whether it’s surgery or radioactive iodine. All right. One more quick question that’s related to this. Can someone have mild thyroid eye disease but not know it? Do you just recommend it if they have overt thyroid eye disease or as far as…

Dr. Rani:

If a patient has been seeing me and I know that they have mild thyroid eye disease, I would absolutely recommend the prednisone, yeah. I guess what you’re asking about is what if they haven’t been formally diagnosed, it’s probably best that if you’re considering getting it done or if your endocrinologist is recommending it, go see your eye doctor. Again, see your ophthalmologist and preferably a neuro-ophthalmologist if you can get in to see one, and just get their idea, their opinion on whether it’s active or not. If there’s any indication it’s active, it’s probably best to be pretreated.

Dr. Eric:

All right. Great advice. Thank you for that. This was awesome. Thank you for all the information. So, before we dive into questions, I want you to briefly mention your masterclass that you’ll be having, and I’ll put up here, just if I could display it here, there we go.

Dr. Rani:

Yeah. Wonderful. So, thank you. I really enjoyed our conversation. There’s just so much to talk about. We could probably keep talking for an hour or so about thyroid eye disease. So, what I’m going to be offering is a masterclass, the thyroid eye disease masterclass an integrative approach, where I talk about specifically what are the signs and symptoms of thyroid eye disease, what are the natural ways you can try to combat thyroid eye disease.

Actually, in my practice, I use something called the thyroid eye disease diet or TEDD. So, I would be sharing that in the masterclass. Also, the specific types of supplements and botanicals that I found to be most effective for people with thyroid eye disease, as well as some of the essential oils that I use for my patients. In terms of dry eye, what are the best natural therapies for dry eye beyond just using drops, lubrication. What else can you do in your home environment to help with thyroid eye disease?

Also, just talking about some of the more medical treatments that we touched upon a little bit today. What are the indications? Also, lifestyle things you can do to decrease your risk of activation or worsening of thyroid eye disease.

So, I’m going to be offering this along with Dr. Eric. We’re going to, hopefully, do this together as a single masterclass. There’s only one module. It’s going to be tentatively on June 23rd, which is a Wednesday at 8:00 PM Eastern. Hopefully, if you’re interested, you can register. If you’re watching and you do decide to register, we are offering a 50% off discount. So, the normal price of the masterclass is $99, so then it would be $49.50. So, if you can go ahead and register, I think we’re going to have that available for the next week or so. Is that right, Dr. Eric?

Dr. Eric:

Yeah. I think we decided on a week from Friday, May 7th or, actually, today is Friday. That’s right. So, a week from today.

Dr. Rani:

A week from today, yeah. If you’re interested, please register early. There is limited capacity. There’s only 100 participants that we can have in the masterclass. So, please consider registering.

Dr. Eric:

All right. Wonderful. Well, you’re ready to answer some questions? Looks like we have a lot of questions.

Dr. Rani:

Absolutely. Okay. Wonderful.

Dr. Eric:

All right. Oh, and one other thing about the class also, if for any reason if someone is unable to make it, it’s hard to pick a time that works for everyone, but this will be recorded. So, if for any reason they can’t make it, they could always watch the recording?

Dr. Rani:

Absolutely. Also, I’ll make available downloadable PDF resources, so not just the thyroid eye disease diet, but my resources on how to manage dry eye, eye allergies with thyroid eye disease, digital eye strain, which is I know a big concern of many people is we spend hours looking at a screen. So, how can we help to manage that with thyroid eye disease. So, there’d still be a lot of resources available.

Dr. Eric:

All right. Good deal. Looking forward to that. So, let’s go and we’ll try to get to as many questions as we can. So, Tammy, it looks like myasthenia gravis. Do you have any experience in your practice?

Dr. Rani:

Absolutely. I’m so glad, Tammy, that you brought this up because … So, for people who are not familiar with myasthenia gravis, it is also an autoimmune disease. Myasthenia gravis and thyroid go hand-in-hand or at least thyroid eye disease and myasthenia gravis go hand-in-hand. What myasthenia does is it can cause double vision, and it can cause droopiness of the lids, so opposite of what thyroid eye disease does. So, thyroid eye disease causes wide open lids. Myasthenia gravis causes drooping.

So, a certain percentage of patients with thyroid eye disease will have coexisting myasthenia gravis, and a larger percentage of patients with myasthenia gravis will also have thyroid eye disease. So, definitely, if you have any of those symptoms that are a little bit unusual for just thyroid eye disease, ask your doctor about whether it could be myasthenia gravis or not, and get tested.

So, myasthenia gravis, there’s a couple of different tests for it. There’s a blood test looking for the antibodies. That’s the easiest way to test for it, but there are many people who have myasthenia where it affects the eyes, where their blood test is negative, and we have to go a little bit further. We have to dig a little bit deeper to figure out if someone has it or not.

The last thing I’m just going to mention about myasthenia gravis is that it causes weakness of the eye muscles, and that’s called ocular myasthenia or OMG, but there’s also a chance that other muscles in the body can get affected by myasthenia gravis as well, so your arms, your legs, breathing, swallowing, voice. So, definitely, if you have any symptoms of weakness, and you have a history of thyroid eye disease, definitely talk to your doctor and consider getting tested for myasthenia gravis.

Dr. Eric:

All right. Great. Thank you for that. Then May here has a question, “Do you have any advice for tearful eyes?”

Dr. Rani:

Yeah. So, there are many reasons why your eyes may be tearing. Actually, the most common reason is because the eyes are dry. It may seem very contradictory, “Why are my eyes tearing if they’re dry? That just doesn’t make sense,” but I’ll explain to you why that is. So, first of all, what happens is the surface of the eye dries out, and then we have a large tear gland up here called the lacrimal gland. In response to that dryness, it overproduces tears. So, people end up tearing when they have dry eye.

So, the way to deal with the tearing is to first treat the dry eye, and if you do that appropriately, then usually the tearing also improves as well. Then, again, with thyroid eye disease, there are many other reasons why people may have tearing. For example, eye allergies can also case tearing. Then just swelling of the surface of the eye can also cause tearing and even mucous discharge. So, a lot of other things can happen with thyroid eye disease that people should be aware of.

Dr. Eric:

All right. Jenny, you might have to clarify. I’m not sure if you mean thyroid hormone levels or sex hormone levels. Anyway, if you can maybe further elaborate, if Jenny could elaborate, but then Kelly here asks, “Can you have thyroid eye disease and not be sure?” which we answered that early on. Someone can have a mild case and it not being diagnosed, correct?

Dr. Rani:

Yes, and the best way to make the diagnosis is to get those thyroid auto antibodies done. Really, I advocate to get them done. So, your endocrinologist may say, “Oh, we don’t need them. We just need these TSH, free T4, T3,” but I would really strongly push to get the rest of the antibodies done because that will confirm the diagnosis.

Dr. Eric:

All right. Great. So, this is a bit of a long one, “Recently been diagnosed with demodex in my eyelids. Do you think this could be a sign of TED? Also, do you know how long it could take for demodex to go away? Can it spread to my scalp, nose, other parts of my body?” So, maybe, I don’t know if you could…

Dr. Rani:

Sure. Yeah. So, demodex is basically an infestation of the eyelids of, really, lice. So, we can get lice around the follicle, the hair follicle of the eyelash. So, it’s independent of thyroid eye disease, but it can certainly case irritation, inflammation. The best way to actually treat it is to really just smother the infestation. So, basically, you just goop up your eyelids at nighttime with an ointment, whether it’s just a regular ointment, eye ointment or an antibiotic ointment, and it basically just gets rid of those organisms.

Dr. Eric:

Okay. All right. Just a comment here, “After miscarriage of my twins, I developed Graves’.” I’m so sorry about that. Then Jenny, “I took an allergy test and histamine showed positive.” You mentioned earlier how sometimes the antihistamines can help with thyroid eye disease.

Dr. Rani:

Yeah. One of the things, as an integrative practitioner, that I also try to do for my patients is I do order food sensitivity testing because sometimes it’s really hard just to do a food diary to try to figure out what you may be sensitive to. So, sometimes it’s actually good to get a whole panel done so that you really know which foods you should try to stay away from. So, this is not IgE testing. This is IgG testing. So, I would again advocate for that. Talk to your practitioner about it. Ask if you can get it done, and it really will give you a lot of insights into the foods that your body may be sensitive to. I don’t know if you do that, Dr. Eric, in your practice, but I found it pretty effective.

Dr. Eric:

Yeah. I mean, I have done it. Sometimes I’ll do it. Every practitioner is different. So, I usually start people off with elimination type diet, and do an elimination and reintroduction. It’s not perfect. I find IgG testing … I don’t think there’s any perfect test or perfect method, but I usually reserve it if someone is not improving and we suspect … because we usually, with the part of an elimination diet, we’re having them eliminate pretty much just all the common allergens and things that could be causing inflammation. Of course, there’s always exceptions. Someone could be still reacting to something that they haven’t eliminated.

Speaking of food, so this person asked, “Why nightshades?” I don’t know if you want to talk about it or if you want me to talk about it.

Dr. Rani:

So, I’m not an expert in why nightshades. I mean, I have my theories, but I would love to get your opinion on it if you have some insights.

Dr. Eric:

If you visit my article, I’m sorry, my website, naturalendocrinesolutions.com. You search for nightshades. Essentially, there’s lectins and other compounds in the nightshades that potentially could be inflammatory. They’re not inflammatory necessarily in everybody. They can also potentially interfere with gut healing when someone is dealing really with any chronic health condition, but especially with autoimmunity. You really want to focus on healing the gut, but, yeah, that’s the main reason why you want to avoid nightshades.

Let’s see. Do you see anything as I scroll down? It looks like a lot of these are just comments and not questions. So, Stacy, “What’s good for the pain? I have terrible back pain from fibromyalgia.”

Yeah. It’s a little bit not necessarily related to the topic, but inflammation is huge. I mean, with fibromyalgia, also nutrients, mitochondria, mitochondrial dysfunction, which are nutrient-driven. So, again, as we discussed before, even though you want to try to eat whole healthy foods, in my experience, when someone has nutrient deficiencies, usually, supplementation is required.

Then Dr. Rani mentioned other things that could help with inflammation like turmeric, curcumin, CBD oil, a lot of people are using these, but with that being said, you also want to address the cause of the problem. So, is it a nutrient deficiency? Do you have a chronic infection? Are you eating an inflammatory food such as gluten or dairy? So, there are things that you could take like the curcumin, like the CBD oil, and there are other things you could take for pain. Also, you want to try to address what’s causing the pain.

All right. “How much vitamin D daily?” This does depend. In my practice, and most practitioners will test vitamin D levels, 25-hydroxy vitamin D, and then based on the results. As Dr. Rani says, I like to see a minimum above 50, but some like to see between 60 and 80. My levels is usually upper 50s, lower 60s. As Dr. Rani said, you don’t want it to be too high. So, probably a good idea to work with a practitioner just to make sure you’re not taking too much vitamin D. Then, of course, try to get as much sun as you can as well.

All right. This person, the salt question. So, I mean, I usually recommend, I think, Celtic sea salt is fine, natural sea salt. I think Himalayan salts, for years, I’ve mentioned that it was fine, but recently, there’s been a book that says that Himalayan salt is higher in iodine, which I … I’m not sure. I’ve had people take Himalayan salts without a problem, but Celtic sea salt seems to be pretty safe to take.

Dr. Rani:

Yeah. I’ll just add a comment about salt intake. I do notice that when my patients do report that they’re on high salt diet that their eyelid swelling is worse. So, I usually do salt restrict my patients if they have active Graves’, just as an aside since we’re talking about salt.

Dr. Eric:

Hmm, interesting. So, even like sea salt?

Dr. Rani:

Yeah, especially, I mean, people will notice it especially after they have been sleeping. They tend to have a lot of because they’re lying flat. So, all that congestion, the fluid accumulates in their lid. So, really, it’s just more puffy, but then when they reduce their salt intake or eliminate it completely as much as possible, then they have less swelling in the morning. So, it’s just something you can experiment with to see how your salt intake may impact your thyroid eye disease.

Dr. Eric:

Besides the sea salt, there’s salts in everything. Anything that’s packaged or processed, I mean, if you’re buying fresh fruits and vegetables, you don’t have to worry, but anything that pretty much comes packaged will have sodium. So, that’s also worth mentioning as well.

By the way, Dr. Rani, how are you on time? Do you have a few minutes?

Dr. Rani:

Oh, yes, I can. Yeah, I’m good.

Dr. Eric:

Okay. All right. So, Emem here says, “I’ve read that selenium supplementation can make iodine deficiency worse. With that in mind, although high dose iodine can aggravate Graves’ disease, do you recommend that Graves’ disease patients who want to try selenium for thyroid eye disease also supplement with a small amount of iodine?

I’d love to get your feedback, but I will say that, there’s definitely a lot of controversy with iodine and thyroid health. So, I was one of those that was on the bandwagon years ago. I took high dose iodine. I did fine. I did really good with iodine. So, I was one of those people that was able to tolerate it well. Early on my practice, I would have everybody do urinary testing for iodine, and for those who were deficient would put people on iodine. A lot of people did okay, but not everybody. Sometimes it does seem to make people worse.

Again, I’ve written about this in articles as well. So, I’m not anti-iodine, but I’m definitely cautious when it comes to iodine. So, even if someone is deficient in iodine, even if they’re deficient, I’d be a little bit cautious about having them supplement with iodine, but, especially, just randomly, take iodine. I can’t say it’s something I recommend to my patients, but, again, I’d like to hear what you have to say.

Dr. Rani:

Yeah. I also typically don’t recommend it. If it’s naturally present in foods, then that’s fine, but I wouldn’t take an extra supplement. Now, in terms of the other question, I think maybe she was getting at whether the iodine could be a competitive inhibitor of selenium. I think maybe that was the other question was. I don’t know. I don’t think that they have the same function in the body. Selenium has many different functions. So, I don’t think that they would be a competitive inhibitor of each other.

Dr. Eric:

I would agree. Yeah. I skipped over that, but I haven’t heard where taking selenium will worsen an iodine deficiency. All right. Someone is using eye pressure drops it looks like.

Dr. Rani:

Yeah. So, I’ll just talk a little bit about eye pressure if we have a few minutes.

Dr. Eric:

Sure.

Dr. Rani:

So, one of the other manifestations of thyroid eye disease is because there’s so much pressure, congestion in the eye socket, the eye pressure can go up. Eye pressure is different than blood pressure. It’s actually the pressure within the eyeball itself. So, many people, it’s something that we worry about because if their eye pressure goes up, then they can have damage to their optic nerve or a type of glaucoma.

So, certainly, if you do have orbital symptoms or eye socket symptoms, get your pressure checked by your eye doctor. If it is elevated or if it’s quite elevated, usually in the 30s or so, we do start patients on drops. Hopefully, once their swelling improves, their congestion improves, patients can come off the drops, but it’s more of a protection that patients need the eye drop for.

Dr. Eric:

Okay. Cool. Thank you for that. How about this question? “Would you recommend Tepezza if the proptosis is only 2 mm difference?”

Dr. Rani:

So, it’s FDA-approved for greater than 3 mm. So, 2 mm is actually, glad you brought this up, it’s actually within the range of normal. Many normal people have a difference in their eyes of 2 mm, but three or more is typically what we attribute to thyroid eye disease. So, right now, there are very strict guidelines on whether insurance carriers will cover Tepezza, and one of those guidelines is the amount of proptosis or the asymmetry in proptosis.

Dr. Eric:

All right. Thank you for that. “Could you talk about the pros and cons of Tepezza versus the second infusion option that was just mentioned?”

Dr. Rani:

Sure. So, the second infusion option is Rituxan. It’s R-I-T-U-X-A-N or rituximab. So, rituximab has been used. It’s a slightly different biologic. It works on B cells. It’s a CD20 inhibitor. Rituxan has been used for many, many years. It’s been out there for many years, for many different inflammatory conditions ranging from a lot of eye conditions that we use it for.

So, it has more data behind it. In terms of its actual benefits for thyroid eye disease, it’s never been formally studied head-to-head with Tepezza, so we don’t know if one is better than the other. They’ve been independently looked at in clinical trials. So, again, we can’t really answer that question whether one is better than the other.

In terms of side effect profile, I think Tepezza has a very low side effect profile. Probably, Rituxan has a couple more side effects, but it is less frequent. So, Tepezza is every three weeks versus Rituxan is every six months. So, there’s a big difference in terms of the frequency of the treatment.

Dr. Eric:

So, a single infusion every six months?

Dr. Rani:

Single infusion every six months. So, there’s a first dose and then two weeks later, there’s a second loading dose, but then after the second dose, it’s every six months.

Dr. Eric:

Okay. Does everybody need that? After six months, a lot can change.

Dr. Rani:

A lot can change, yeah. So, usually, people need maybe one or two cycles of it before they start to respond, but then there are other conditions where people need it really indefinitely every six months. There are other autoimmune conditions that I manage that affect the eyes, where people do need it a lot longer.

Dr. Eric:

All right. Thank you for that. This is just someone thanking you for this.

Dr. Rani:

You’re very welcome. Thank you for tuning in.

Dr. Eric:

Yeah. We appreciate everyone tuning in and asking questions. Then Julie here asks, “I had very mild thyroid eye disease when I had two doses of radioactive iodine five years ago. It has become very active and much more severe. What can I do to help it?”

Dr. Rani:

Yeah. So, it really depends, again, on what your specific symptoms are, whether it’s puffiness, whether it’s bulging, double vision, dryness. So, certainly, talk to your doctor about the stage that you’re at, whether it’s still in the active phase or maybe now hopefully after a couple of years, if this all started five years ago, hopefully it’s becoming a lot more transitioning into that more quiescent chronic stage. Talk to your doctor about the options whether it’s drops, supplements or something perhaps a little bit more involved like either medications or even surgery may be an option for you.

I would also suggest perhaps considering taking the masterclass that we talked about because I will talk about, okay, for this stage, these are the best options, and then if it progresses to this stage, these are the best options, and then so on. So, I will break that down in the masterclass.

Dr. Eric:

Great. I’ll bring that up quickly again. Are you good for maybe another three questions?

Dr. Rani:

Sure. Sure.

Dr. Eric:

Okay. Great. So, Jenny is just saying thank you and thank you, Jenny.

Dr. Rani:

Thank you. You’re very, very welcome.

Dr. Eric:

All right. Let’s see. Another, Debra, “Had radioactive iodine two years after thyroid eye disease, Graves’ diagnosis. PTU, methimazole sadly didn’t work for remission. Liver could be damaged at two years on these meds. Took prednisone before radioactive iodine, and after largest radioactive iodine dose allowed without hospitalization. Helped reduce more bulging, then waited to have six reconstructive surgeries in two years.” Wow. “Still get kenalog injections into orbit when they swell or hurt years later like steroid direct into affected area than oral steroid pill and bounce-”

Dr. Rani:

Oh, I’m so sorry to hear that, Debra. Yeah, you’ve been through so much. Again, I haven’t examined you. I haven’t seen you, but from what you’re telling me, it seems like it’s still active despite having the surgeries and the steroids, etc.

You may be a candidate for Tepezza even though it’s been some time. So, definitely talk to your doctor about that option just to get everything to calm down because there’s still some activity there it sounds like. It’s not great getting kenalog injections into the eye socket because that type of a steroid injected into the eye socket, it can cause problems. It can actually lead to high eye pressure, glaucoma even, thinning of some of the muscles in the eye. So, definitely talk to your doctor about the options.

Dr. Eric:

Yeah. I was just going to ask you about the kenalog injections, but you’ve answered the question, so very cool. All right. We’ll go through two more questions. So, “My anti-thyroid peroxidase, anti-TPO levels are 154, not the best, but I manage to lower them. Before they were 195. Still, my right eye is bulging. I know when my levels are not normal because my right eye lets me know right away.”

Yeah. So, again, I will say, and Dr. Rani could also give her feedback, but of course, I don’t know what you did as far as lowering them, but try to do as much as you can through diet and lifestyle. Again, maybe attend the masterclass as well. Tepezza might be an option as well. Again, I think even with that, I will say with the Tepezza, again, I would say probably more for moderate, severe cases of thyroid eye disease, and then also from what I understand, it’s also very expensive for those who don’t have insurance, too.

Dr. Rani:

It is.

Dr. Eric:

Yeah. So, it’s not an option for everyone, unfortunately.

Dr. Rani:

Yeah. So, just to provide a comment there. It’s wonderful that you’re so in tune with your symptoms. Many people, they may dismiss certain symptoms, but it’s wonderful that you’re in tune and you know that, you feel, you can tell from your eye status what your antibody levels are. So I applaud you for that because it’s important to just be aware that you can convey to your doctor what’s going on better and hopefully get treatment that you need if necessary.

I also just want to say about the Tepezza. So, it is expensive. It’s estimated that one course of treatment costs $200,000. So, that’s eight infusions. So, I don’t know whether the price will be going down at any time in the future, but right now, it is at that level. So, it is sometimes challenging for patients to get the authorization that they need to get the medications, but I do think that the company offers some patient assistance programs, so certainly if you qualify based on the criteria.

I didn’t mention this earlier, but I just wanted to show you all. I don’t know if you can see this here. The CAS score is Clinical Activity Scale. Basically, it’s a guide here. I don’t know if you can see here. I’m not quite centered here, but there is a rating scale that we use to really determine how active a person’s thyroid eye disease is. Really for Tepezza to be approved, people have to meet some of these criteria based on their CAS score or worsening of their CAS score.

So, this is something that, again, you can talk to your eye doctor about assessing that score to see if you may qualify for Tepezza and also whether your insurance will cover it or not.

Dr. Eric:

I could also include that sheet as well when I send out the email with the link to the recording.

Dr. Rani:

Absolutely. Yeah. So, I’ll scan this in and create a PDF of it and then we can include that with the link.

Dr. Eric:

Yeah. Let’s get to one more question. So, Lily here and, again, if we didn’t get to your question, I am so sorry, but we might do another one of these in the future. Again, definitely consider joining the masterclass. So, Lily asks, “Hello, Dr. Banik. Thank you for taking my question. I was diagnosed with Graves’ disease in 2018, and my very first symptom was thyroid eye disease. Before, I had bulging eye in the left. I developed heavy eye bags below my eyes first. My blood test has been normal for T3, T4, and TSH for a year now. So, my bulging eyes has gotten better, but the heavy eye bags are still there. Are the cause for the bulging eyes are the same cause for the eye bags? Will the eye bags improve later or will they not?”

Dr. Rani:

Yeah. Great question. So, many people actually experience this where it’s not just the lids that get puffy and swollen, but they actually develop bags. What the bags are are actually fat pads. We have fat pads in the eye socket to help cushion the eye, the eyeball, etc. So, those fat pads get inflamed with thyroid eye disease. It’s all due to that insulin-like growth factor receptor being activated. So, there’s a lot of tissue that gets laid down in those fat pads and makes them very prominent.

Now, what I’ll tell you is that after the active phase of the disease improves, many times the fat pads do increase in size, but they may not go back 100% to how they used to be, how you used to look. I’ve actually only had a handful of patients where they actually went back to their normal pre-thyroid eye disease state. Sorry. Sometimes the fat pads do persist, and in that case, again, some of the natural treatments that we’ve talked about can be effective.

Ultimately, sometimes there’s a surgery that can be done to actually remove the fat pads or to decrease their volume to help people just have better cosmetic appearance. We didn’t talk about this aspect as much about thyroid eye disease, but the cosmetic changes can really be so, for some people, really, really to difficult to manage and very debilitating and their self-image is just so affected by the cosmetic changes, but there are wonderful treatments out there for the cosmetic treatments.

Now, of course, many of them are surgical options, whether it’s lid surgery or something called blepharoplasty, where sometimes the skin and the fat is removed or strabismus surgery, which is where the eyes are realigned. There are many cosmetic options out there. Even orbital decompression, which we didn’t mention at all, but it’s basically a surgery to remove some of the bone to help the eyes go back into a more natural position.

So, those are all extremely effective treatments. Now, of course, they’re surgeries, so they’re not taken lightly and they have to be timed right, but they are wonderful options to help to restore cosmesis and improve people’s appearance, make them look more similar to how they used to look before they had thyroid eye disease.

Dr. Eric:                All right. Thank you for mentioning that. Again, thank you so much for this interview, for getting together for this Facebook live. Hopefully, everyone found it valuable. Again, consider attending the masterclass if you’re dealing with thyroid eye disease. Again, you could just visit thyroideyediseaseclass.com. Until next Friday, a week from today, Friday, May 7th, you could get a 50% discount by entering the code TED. I assume during that class we’ll also be doing some Q&A.

Dr. Rani:

Absolutely. Yes. So, we’ll do a didactic session, and then we’ll stay on for Q&A as long as people have questions. So, happy to answer all your questions. Thank you for having me. I enjoyed our conversation, and I think we covered a tremendous amount, which is amazing. I loved all the questions people typed in. It’s really wonderful to make this an interactive session. So, thank you for having me.

Dr. Eric:

Yeah, you’re welcome. It was great. Excited for the masterclass. Again, maybe in the future we’ll get together for another Facebook live because we definitely had a lot of interest, a lot of questions. Again, I apologize for the questions that didn’t get answered, but definitely, if you can, show up to the masterclass. As Dr. Rani says, we will have a Q&A session there as well.

Well, anyway, everyone, hope you have a wonderful Friday, a wonderful weekend ahead. Again, thank you so much, Dr. Rani, for getting together.

Dr. Rani:

Thank you, Dr. Eric. It’s my pleasure.

Dr. Eric:

All right. Take care, everyone.

Dr. Rani:

Bye-bye.

On Friday April 9th I interviewed Dr. Beverly Yates on insulin resistance and type 2 diabetes, and below is the written transcript. If you would prefer to watch the interview you can access it by clicking here:

Here is the transcript:

Dr. Eric:                                                                                       

I have a very special guest, Dr. Beverly Yates. Dr. Beverly is a diabetes expert and author who has over 27 years of experience working with those who struggle with blood sugar issues related to Type 2 diabetes and prediabetes. And she is the creator of the Yates Protocol, which is a simple and effective lifestyle-based program for people who have Type 2 diabetes or prediabetes. It helps them to achieve blood sugar control, healthy A1C, and fasting blood sugar levels.

Dr. Eric:

Dr. Yates, she’s on a mission to help 3 million people heal from Type 2 diabetes and prediabetes. She is an internationally recognized speaker and expert in the field of diabetes and heart disease. She is author of Heart Health for Black Women, A Natural Approach to Healing and Preventing Heart Disease, and co-author with Jack Canfield of the Soul of Success, volume two. Dr. Beverly, I really look forward to talking with you about insulin resistance and Type 2 diabetes. Thank you so much for allowing me to interview you.

Dr. Beverly:

Hey, it’s my honor. Thank you so much, Dr. Eric, for reaching out. I’m delighted to have this conversation with you today. I hope we are able to help folks get motivated and to feel inspired and to have maybe some more clarity about how these things can happen, how they interact, and most importantly, what they can actually do that would be helpful for themselves.

Dr. Eric:

Yes, I agree. Why don’t we start out with some basics. For those who might not be familiar with insulin, if you could just describe what insulin is, why insulin is important.

Dr. Beverly:

Sure. Insulin is a hormone that is made in your pancreas, and it’s made in a particular part of the pancreas called the islets of Langerhans. And specifically as that’s secreted, insulin does some amazing things for you. It is what grabs up your blood sugar, also known as glucose, and makes that energy ideally available inside of your cells. Insulin does a lot of things for you. You don’t have to think about it consciously. This all happens in the background if your body still makes insulin. If you don’t make the insulin naturally, if you have no insulin production at all, then that person is a person who is diagnosed as a Type 1 diabetic. That is a distinction and that’s different than people who have Type 2 diabetes or prediabetes where their pancreas does indeed still make insulin and perhaps their body’s just not as sensitive to it anymore or is insulin resistant.

Dr. Eric:

Okay. So is prediabetes then the same as insulin resistance?

Dr. Beverly:

Some would say yes, some would say no. That could be a point of controversy and you could say it’s just wordplay, maybe it’s semantics. I think it like this. Prediabetes is watching this train wreck in slow motion. That’s how I explain it to my patients. And so a lot of people will comment and will say, oh, well, I’ve been watching this with my doctor for years and we haven’t really done anything about it. I’ll come back in six months. Then we test certain blood markers, whether it’s fasting blood sugar, or it is A1C, things like that. And then they’ll say, “Well, come back in six months. We’ll see how you’re doing. We’ll just keep an eye on your sugars.”

That’s a common conversation anywhere in the country, perhaps maybe even around the world, but certainly in the US this is often standard conventional medical treatment. And the person’s blood sugar unfortunately will often start to creep up, creep up, creep up, creep up over time. And then when they finally hit a certain number, then they have Type 2 diabetes. And to me, that’s watching the train wreck in slow motion. If you had an actual physical train on the tracks, Dr. Eric, would you be okay with watching that train wreck in slow motion?

Dr. Eric:

Nope.

Dr. Beverly:

Yeah. We’re on the same page. I know we are.

Dr. Eric:

So obviously diet and lifestyle play a big role with both insulin resistance and Type 2 diabetes. And I guess, because you also mentioned Type 1 diabetes, so how does Type 2 diabetes differ from Type 1? And there’s also…I don’t know if you want to get into Type 3 diabetes, but at least Type 1 and Type 2 and maybe differentiate between those two.

Dr. Beverly:

Yeah. People are more familiar with that. With Type 1, it’s one where there’s usually been an autoimmune attack on the pancreas and it has made it unable to produce insulin naturally. That’s typically what is the way Type 1 can unfold. Historically, it used to be something that happened at childhood, a sort of an illness, childhood onset. I definitely know adults who’ve had onset of Type 1. I think a lot of things are changing in our world, whether it is the chemical soup we’re all in, the amount of stress that we are under that is just relentless, etc. Any number of things I think can provoke that autoimmune attack. And so Type 1 diabetes is not strictly anymore just childhood onset.

Similarly, it used to be that Type 2 diabetes in any medical setting was always taught as being adult onset and usually older adults, people in their 60s, 70s, 80s. Now you can have unfortunately people with Type 2 diabetes in their 20s and even as young as 10 years old, which I think there’s a lot that’s wrong in that situation. And nutrition can play a huge part here, regular consistent exercise, but there’s also two pillars that people usually don’t talk about that are every bit as important. That is consistent, great sleep and being able to alleviate stress so that the person isn’t chronically and severely stressed, huge difference because sleep and stress can just run off with blood sugar.

People often accidentally become diabetic. They certainly aren’t trying to have health problems. And unfortunately, the way the conversation often goes, at least here in the US, and I know this is on the internet so people can see it from all over the world. But at least here in the US, people often talk about Type 2 diabetes and prediabetes with a tone of blame or shame as if people are trying to struggle and to have a hard time. I always want to dispel that myth and call out that nonsense right up, because it’s not fair, it’s not true. And it’s not helpful. No one’s trying to correct their health, but now here they have this situation. We need to be able to embrace people, have empathy and help them to make their situation so much better.

Dr. Eric:

You mentioned stress and sleep can cause blood sugar issues.

Dr. Beverly:

Yes, most definitely.

Dr. Eric:

And I guess it’s a little bit of a catch 22 because if someone has blood sugar issues, they might also have problems sleeping, correct?

Dr. Beverly:

One can be like a chicken and egg, which one came first. Similarly with thyroid. People often present with thyroid problems and they often say they’re fatigued. Well, when they have blood sugar issues, they’re often really fatigued. Fatigue is a tricky thing. There’s at least 80 things that could cause fatigue at least. It’s a big list.

Dr. Eric:

Yeah. A good point. There could be numerous causes of fatigue, numerous causes of sleep problems, not just blood sugar obviously. So when it comes to your patients, it sounds like that you, just like I do, I talk about the importance of stress management, importance of sleep in addition to eating well. So diet wise, and again, I don’t know how deep you want to get into the diet, but what typically do you recommend from a diet perspective? Do you recommend more of a ketogenic diet or more of a Paleo diet or just like a whole foods, low sugar, low carbohydrate diet?

Dr. Beverly:

Yeah. In terms of levels I’m always mindful, right? When I talk to my patients, I’m listening carefully about what their history has been with food. Some people’s history is very simple and uncomplicated. For people who have issues where they have emotional eating, or if they know they’ll eat with a lot of stress, they’re stress eater is how they usually say it, or if they truly have disordered eating and they know it. If they have a history of anorexia, bulimia, things like that. I know I need to tread very carefully on any nutritional recommendations I make, else we trigger and set people up to have a problem and to fail. And that’s not what we’re here for. We want to see our patients succeed and thrive.

So I don’t necessarily recommend exclusively one approach over another. What I do emphasize is that they eat a more whole foods regimen relative to what’s going to be safe for them and that they can be successful with. Sometimes I have people do lab testing for food intolerances because food intolerances or food sensitivities can often set up all kinds of problems, including frankly, blood sugar battles. It can also cause cravings because of that oddball reaction where you get that 15 minutes of dopamine pleasure from eating whatever it is that isn’t a food intolerance and then the crash that comes after it and your blood sugar might do that same thing. Go up and bam, it crashes.

So with food, here’s the things that I tell people to do for whom the main conversation is around blood sugar health which is focused on having them become friends with two kinds of food groups, high fiber along with leafy green vegetables. Leafy green vegetables are so full of hydration and water and nutrients. They’ve got lots of vital nutrients. They’ve got vitamins, minerals, antioxidants, polyphenols. They’ve got it all. And that fiber helps to fill you up so you feel full. A lot of times people forget to drink water if they had to drink anything, and then when they finally do, they tend to go towards maybe sweetened beverages, even if it’s artificially sweetened. So they’ve got these fiber goodies in them, these leafy green vegetables and other sources of fiber, it often helps to mute the damage. It helps to get that blood sugar instead of it being this rollercoaster event, make a much more even blood sugar throughout the day. Something I tell people to do is controversial.

Dr. Eric:

What’s that?

Dr. Beverly:

I have people start their day with leafy green vegetables. We make it a featured element of breakfast. And then we add it into lunch and to dinner. And at first people are like, “Dr. Bev., you got to be kidding me. Who eats vegetables at breakfast?” I’m like, “I do. A lot of people, the people who work with me do.” And then after time people love it because they begin to realize it sets up a whole day for success. That one simple thing.

Dr. Eric:

So you recommend it as part of a salad?

Dr. Beverly:

It could be a salad, it could be its own dish. It could be like for instance some… Well, before the pandemic, some of my patients traveled a lot. And so I would tell them wherever you land, get a bag or a pre-washed box of leafy greens because now salad boxes, things like that, it’s like $3, $5. Anywhere in the country, it’s gotten so much more affordable and convenient and get a handful. If you’re going to eat a buffet at a hotel or something like that, bring it with you. That way you’re not at the mercy of somebody else’s idea of breakfast, which is probably some sort of variation of a white bread and some sort of greasy kind of meat. And that’s it for breakfast, right? Bring your veggies with you. It could be steamed spinach. It could be a salad if you like. It doesn’t need to be as fancy as a salad. Literally a handful of say leafy greens. You could have already cooked some if you’re at home. It could be kale, it could be chard, it could be collard greens, bok choy, broccoli. Anything leafy and green, eat it.

Dr. Eric:

All right. I have to ask you then, because I do eat leafy green vegetables for my first meal, but it’s usually in the form of a smoothie. I personally don’t have any blood sugar issues, but for someone who is pre-diabetic or has Type 2 diabetes, is there an issue with both juicing and smoothies? Smoothies is keeping in the fiber, but still some will say maybe that those with blood sugar imbalances shouldn’t have smoothies and maybe they should have a salad. So I’d love to hear what you have to say about that.

Dr. Beverly:

Sure. That’s a great question. I’m so glad you’re calling that one out specifically. I think smoothies are fine for everyone. However, now that I just said that, to me, a smoothie has probably a base fruit in it like say banana, something like that. Bananas have electrolytes, including potassium. Many people are low in potassium. Apricots, plums, dates, things like that, they’re all good for potassium. Typically when people are taking medications, and many people with diabetes often have blood pressure issues so they might well be on a med that’s causing them to leak potassium. So of course they eat the banana from a blood sugar point of view, it’s high on the glycemic index.

Now, not everybody gets a spike in their blood sugar from eating bananas, but some people do. That’s why I say test, don’t guess. When you eat, check your blood sugar, find out if you are having a big response to a food. And if it’s out of bounds, you either cut that food in half, or maybe you just need to eliminate it depending on how sensitive you are. But for smoothie, though, Dr. Eric, I will have people add protein powders along with the banana. We might add ground flax seeds in there for additional fiber boost. And then we can add in things like fresh spinach. We can add in celery, we can add in ginger, apples with the skin on.

I have people eat their fruit with the skin on unless it’s a banana, that’s a little much. But if it’s like peaches, apricots, apples, please don’t peel them because sometimes you will even get say peaches from a can or a jar with a syrup on it and they’re like, “No, ditch that syrup take that peach and rinse it.” You don’t need the extra syrup. And better if you can get the peach fresh, local and in season. You know what I’m saying? Set yourself up for success. So that base smoothie, you can add avocados. There’s just so many things you can add to a smoothie. So I don’t rule things out based on the name. I say, make sure we make it nutrient packed so that you can be healthy and whole and help that blood sugar to heal. That’s what we’re after.

Dr. Eric:

All right. That sounds good. I typically add berries to my smoothie, usually like half a cup of like blackberries or blueberries.

Dr. Beverly:

Berries are great. Those are usually gentle on blood sugar for most people.

Dr. Eric:

Sticking to the topic of fruit…when I first made smoothies years ago, it was more of a fruit smoothie and over time I made the transition to more and more veggies. Now I have five, six, sometimes seven cups of veggies and only a small amount of fruit. Is there any problem with the opposite, having like three or four cups, maybe not five, six, seven cups of fruit, but three or four cups of fruit, or does it depend on the person?

Dr. Beverly:

I’d say it depends on the person. But as a general guideline, if blood sugar is your primary issue, you really don’t want to run a muck with fruits. That doesn’t mean you have to avoid them entirely. Fruits, just like vegetables, are full of nutrients. They have the polyphenols, the antioxidants, the vitamins, minerals, all kinds of goodness, fiber and water. They have hydration actually just packed in there. The thing about fruit is sometimes if a person has a tendency to have a sweet tooth, that you crave sweets, it might be something that kind of pushes them that way. And some people just don’t know when it’s enough. They don’t really measure and they just pour, pour, pour.

And so instead of say having up to a cup of fruit in a smoothie, they might have three, four, five cups of fruit which their blood sugar tolerance, their situation is probably not going to be very kind about. Not a good idea. So I always tell people to start with a small amount, like say a half cup of something, like say a blackberry or a blueberry or a strawberry, raspberry, because those little Harry Berry fruits, they have plenty of fiber, other nutrients. And again, test. Test, don’t guess. Use your glucometer, check that blood sugar, see how you respond. And if your blood sugar is in a good place, it’s okay. But if you have three, four or five cups and you find your blood sugar has spiked, now you have your answer. It’s too much at one time.

Dr. Eric:

Okay. No, that’s great. Just to clarify, do you recommend a glucometer? I assume pretty much all your patients have either prediabetes or Type 2 diabetes. So would you say just people in general, even those who don’t have blood sugar issues, should use a glucometer or mainly those who are pre-diabetic or have Type 2 diabetes?

Dr. Beverly:

Great question. Those who have already been diagnosed with prediabetes or Type 2 diabetes, absolutely you should have a glucometer and should do testing. Now we have even the continuous glucose monitor options, CGMs. I don’t have one, I don’t have diabetes, but just letting you know. I’ll just pan this because that’s where they go now, which is really an amazing piece of technology which is so helpful, so people aren’t constantly having to stick their fingers to get that proper blood. I would recommend if someone has a family history of diabetes, and I do know people who are vigilant this way, that they too check their blood regularly, get that glucometer, get the glucose strips and test so that you too know.

Don’t wait for the train to wreck because sometimes this stuff comes up pretty silently. It can be rather sneaky and you may not have any idea your blood sugar is in that range for either prediabetes or Type 2 diabetes. And then they’re often shocked when they show up at their doctor’s office. You can do this for yourself at home quite safely. There’s just no mystery around how to do these things these days.

Dr. Eric:

All right. How about blood testing for blood sugar? There’s glucose, of course. Fasting glucose I assume is what you recommend, and then hemoglobin A1C, we have insulin. I assume you use at least some if not all of those markers.

Dr. Beverly:

Yes, yes. I look at people’s fasting blood sugar, their fasting morning glucose levels because that’s an important indication of blood sugar regulation. It really should be under 100 when they awaken and go to the lab because they’ve had an entire nighttime’s worth of sleep. Hopefully they had a good night’s sleep. We want to know if the body has reset. So many things happen in sleep. That’s a different interview. So many things happen in sleep, but that blood sugar should reset. It absolutely should be under 100. Ideally, it’s somewhere, in my opinion, between 80 to 90 for good blood sugar relation. It’s not too low so that they feel hypoglycemic and it’s not over 100 and all where their blood sugar didn’t dip low enough that their metabolism reset. We really need those resets throughout the day. I feel like your soul, your body, your spirit, your mind, everything has to reset with sleep.

Dr. Beverly:

And then for A1C, I always love to see it in the fours. Of course, if somebody has prediabetes or Type 2 diabetes, their A1C is not in the fours. From about 5.6 to 5.7, it’s still not yet technically considered pre-diabetic. When I start to see that upward creek, now I’m getting concerned for that person. Then when they hit 5.8, 5.9, 6.0 and up to 6.3, that’s the range, from about 5.8 to 6.3 for prediabetes. 6.4 and higher is considered Type 2 diabetes. If they’re on medications, their doctor might say, oh, well, as long as your blood sugar is under a 6.4, then you’re well-controlled, and they may not consider you. Technically they still have Type 2 diabetes, but if you go off the meds and your blood sugar is still there, you do have Type 2 diabetes.

The good news is that it can indeed be reversed. But if you go back to anything that was causing it beforehand, it will return. So this is the big, big work. The coaching, the support, the encouragement, the practical information and tips to guide people safely and sanely as something they can sustain to keep that blood sugar in good shape.

Dr. Eric:

All right. I’d like to talk a little bit about the treatment, getting into the diet and lifestyle. We spoke about diet, but maybe dig a little bit deeper. So with the testing, you ideally, like to have a hemoglobin A1C of less than five, but for someone without blood sugar issues, you like to see that hemoglobin A1C in the fours?

Dr. Beverly:

Ideally. If they don’t have blood sugar issues, absolutely. If it’s 5.2, I’m not going to freak out, or 5.4, that’s okay. But if I see that trend over time where, like I said, they start out in the fours maybe and then suddenly it jumps maybe as they approach ages 38 to 42, or as they head to either menopause or andropause where hormonal balance might be shifting as aging starts to be more of the conversation that their body’s having, and they see a jump and it jumps maybe four-tenths. So it goes from like say 5.4 to 5.8, now they’re on the low end of prediabetes. Maybe the next time you see them it’s 5.9, 6, stays at 6, then it goes to 6.2. That’s watching the train wreck in slow motion in my opinion.

So they hit 5.8, 5.9, now we need to put a program in place to get it to go back down. I’m not one who’s going to sit there and in good conscious watch someone climb on board the Type 2 diabetes train unnecessarily. I’ll do all I can to help them and encourage them and help them figure out how to make sure the rest of their life supports getting that blood sugar lower. At worst case, it goes no higher. Best case, it goes back to the healthy range in the fours.

Dr. Eric:

All right. No, it makes sense. Now, I’m sure you’re familiar with Dr. Mark Hyman. He’s written a few books on blood sugar and he talks also about insulin. I don’t know if you look at fasting insulin with your patients as well.

Dr. Beverly:

I have looked at fasting insulin. I’ve found sometimes it’s helpful to figure out with people how sensitive their fasting insulin level is. Again, that whole idea of reset. Given your work with thyroid, I’d love to hear what your interactions have been with your patients about this. Because I found fasting insulin sometimes can help explain when people have really tough problems with weight. When their obesity is just beyond sovereign. That patient comes in and they’re just doing everything. They’re busting their butt and they cannot get their weight to move. And I found that the lab testing for fasting insulin sometimes helps uncover what’s behind this. It doesn’t always correspond, in my opinion. That’s not been my clinical experience. How about you? What have you seen?

Dr. Eric:

Yeah, that’s another topic with the relationship between insulin resistance and weight gain and yeah, if someone has not only higher insulin levels but higher hemoglobin A1C levels. But a lot of times they do go hand in hand. I did recently have a patient where the hemoglobin A1C looked pretty good. It was just 5.0, yet their fasting insulin was around 10. I know the lab reference range is like up to 24, but he talks about ideally you want it below five. If I see someone like six or seven, I don’t really get too concerned, but reaching double digits. But it was just a little bit of an unusual situation because the hemoglobin A1C looked good.

But I know there’s no perfect test either. That’s why you got to also, you mentioned a glucometer as another method, fasting glucose. But yeah, you are correct where if someone does have higher insulin levels, not all the time, everybody is different, but I certainly agree that many times it might cause difficulty losing weight. So it, again, depends on the person. I work with a lot of people with hyperthyroidism and Graves’ disease and there are some people with hyperthyroidism that gain weight, but a lot of people lose weight. And I will say probably even I do see insulin resistance in some hyperthyroid patients, although it probably is more common in those with hypothyroidism Hashimoto’s.

Dr. Beverly:

I would agree with that.

Dr. Eric:

Yeah. Diet and lifestyle, again, that could play a big role, but would you say it’s true that for those with insulin resistance/Type 2 diabetes just cleaning up their diet alone isn’t always enough?  I mean, you did mention that earlier when you said sleep and stress management. But I guess also from my research and what I’ve seen, inflammation is a big driving force in these people too. And diet of course could play a big role as well as getting proper sleep and stress management. But sometimes I find that there could be other factors affecting blood sugar or affecting that inflammatory process, which could be at least a contributing factor for blood sugar issues.

I don’t know if you find that as well where it’s not always as simple as just, because you get people who are like, I’m eating low carb, low sugar, I’m getting proper sleep. They might say they’re managing stress. We don’t know for sure but they say that they’re blocking out time for stress management. Yet they still are gaining weight. And again, there could be other factors. It could be they could have low thyroid hormone levels, they could have problems with adrenals which also could relate to blood sugar. But do you find that there are also other factors too that might make it not easy to lose weight just with diet and lifestyle?

Dr. Beverly:

Okay, let’s have this piece of the conversation. There’s the data. There’s the A1C. There’s their fasting blood sugars. There’s their thyroid numbers. There’s insulin as a measurement, their fasting insulin. There’s all this data. Then there’s our patients and our friends and our neighbors, our colleagues, family members, there’s their lived experience. And sometimes the data and the lived experience don’t match. So you’ll find people back in the day, probably decades ago, you could say to someone, “Eat less and move more.” And that might work. Today’s world is far more complex. I know lots of people and I think at this point it’s got to be tens of millions of people, maybe 100 million people for whom the eating less and moving more is inadequate. That’s simply not a helpful treatment plan.

You run the risk of getting punched right across the desk because they’ve already done that and it’s not working and people are so frustrated, they’re really upset. And often they feel like their body is betraying them, as if they’re broken or something’s not working right, or just whatever. And so then when I think about some of these other factors, whether it is chemical and industrial pollution, environmental toxicity, many people have grown up or currently live around places that are very, very toxic. We know that mammals in general struggle with processing toxins because their bodies weren’t made to process a lot of toxins. They were meant to detoxify things that either we ate that were food poisons, break down hormones, stuff like that, as opposed to a constant bombardment of all these other outside exogenous chemicals.

Now you flash forward to 2021. We live in a very different world than what our ancestors had. So if you look at pictures, if you have them in your family, of your great-grandparents, your grandparents, parents. I certainly have in my family. I could see the difference where taller with these generation was also way a lot more. And in this last 20 years, it’s just been this acceleration. When you look at the explosion of Type 2 diabetes here in the US, it is stunning, and around the world. It’s just amazing to see how many more people are struggling with their blood sugar. We’re going from a number where it’s like more than one in three in the US people struggle with blood sugar and are diagnosed, and who knows how many aren’t diagnosed. But who are diagnosed with Type 2 diabetes and prediabetes, we’re approaching one in two.

So that means if you’re in a room full of nine, 10 people, three out of the 10 people to four out of the 10 people have this problem and we’re approaching, it’s going to be five out of the 10 people. It’s not sustainable. And so if it’s environmental causes, if it’s nutrition, strictly speaking, if it is stress, sleep or exercise, really we got to do something about this. And I’ve had success working with people for whom exercise is actually not an option because they’ve been severely injured, maybe they have a knee and/or a hip that hasn’t been replaced, et cetera, where their ability to really move those big muscles of the body and do that metabolic fire is gone.

So it forced me clinically to rely on that electrical engineering background from MIT, that science side, to really look at this from a systems point of view, along with naturopathic medicine with treating the causes and peeling back the layers of that onion to figure out what is it we’re missing. That’s where I got off the train of eat less and move more because I realized it was inadequate. I wasn’t meeting people where they were at. So from my training and clinical experience in the ’90s to now, I really shifted where my focus is and to help people address the things that they actually can control so they don’t feel so out of control, they don’t feel like their body has betrayed them and they are now active players in their own success. I find that is critical in helping people to get the results in the day one, whether it’s blood sugar, weight control, better cholesterol profile, getting rid of high blood pressure, you name it.

Dr. Eric:

All right. Thank you for that. That was great. How about supplements, because everybody loves supplements so a lot of people will try to shortcut the process. Not to say I never give supplements for blood sugar, but just wanted to get your perspective on things like berberine or gymnema or chromium, which is a mineral, and there’s alpha lipoic acid. Where do you stand when it comes to taking supplements to support blood sugar?

Dr. Beverly:

I think supplements for supportive blood sugar are wonderful and I use them with my patients all the time. I have from the very beginning, it’s really very helpful, I call it a healing partner. It’s really a great help. And sometimes with things like where we’re in, you can get multiple coverage. Some of my patients have both diabetes and heart disease. My focus areas are those two. And sometimes I get people with both, and we can get a lot done. So instead of them having 12 bottles of things, they might have three or four that are their key supplements to take. It’s in those evidence-based clinically research levels of therapeutic dosage and it’s just really, really helpful.

And in today’s world, I had read some studies, I can’t remember if it was on FDA’s website or USDA, one of those government websites had analyzed the soil from this was in 2008, I think 2009, and compared it to soil samples that they had from the ’40s, ’50s, ’60s, ’70s, 80s, so 1940s, 1950s, et cetera. They found that the average amount of nutrients in the soil in the US nutrient density had really declined precipitously, had gone down a lot. As a result, the food that we eat from the soil is not giving us the same nutrient density that our grandparents and great-grandparents enjoyed, which would explain why I could easily observe having been around my great-grandmother and then my grandparents and all that I could see like, oh, wow, no wonder they wanted a small portion of something and they were delighted with it. They felt satiated. They were satisfied.

I think that’s one of the struggles that isn’t talked about a lot. In my opinion, in the popular media, we don’t talk about people’s satisfaction. It’s almost like we are all bottomless buckets. We just cannot seem to feel full. And I don’t know if it’s strictly speaking some of the chemical additives to the food, is it the lack of nutrient density upfront, or all of the above? I’m not sure.

Dr. Eric:

Yeah, you make some good points there. Unfortunately, these days it’s very difficult to get everything from diet. A common supplement in the world of thyroid health is selenium. I have a lot of people ask about Brazil nuts, which are high in selenium. And I agree. They are high in selenium. You just don’t know how much selenium you’re getting. It’s variable. If you’re eating organic Brazil nuts, it will be probably higher in selenium than non-organic, but still you don’t know you might be getting anywhere from like 10-20 micrograms to 70-80 micrograms. I mean, it is preferred over supplementation for maintenance, but even then, it’s still variable.

Dr. Beverly:

I think in today’s world, for best results for patients and clients, supplements need to be a part of what is that they do for their own health and wellness. It’s just too variable. You can’t predict it. I would love if it were just food, but I don’t think that’s true. I think you need to do food along with supplements.

Dr. Eric:

Yeah, I agree. Is there a time and place for medication such as Metformin?

Dr. Beverly:

Yeah. Metformin can be really helpful and some people do super well on it. Some people are really aggravated with it and get the side effects, not necessarily the benefits, especially the GI side effects. So I always tell people, you know what, make your best choice, understand what you’re choosing, let’s see if there’s side effects. If you’re okay with them, then try it and see how you do. I think it’s a fine bridge strategy. For the people who are well motivated and who want to take on the lifestyle side of things, I think it’s fine if they’re already on medications, prescription meds. I’m not someone who says, “Oh, you can’t take that.” That’s silly, that’s ridiculous. You take what you need to take. And legally I cannot nor would I unprescribe something. I didn’t prescribe it, therefore I can’t unprescribe it. I think everyone listening needs to know that. Everybody has to stay in their lane.

But with that in mind, if you’re going to make the lifestyle changes and oh my gosh, I sure hope you would, then recognize that your blood sugar may well start to decrease. And if it gets to sort of healthy range, your need for prescription medications may decrease with it. You must, must, must test. Do not guess. Use your glucometer or your continuous glucose monitor, so you know what your blood sugar is doing and make sure you’re in conversation with whoever prescribed your diabetic medications for you and adjust as appropriate. Don’t go and decide you saw a blog somewhere and you’re going to do it yourself or take advice from your mechanic or the nice lady at the hair salon or whatever it might be. Go to the actual expert who prescribed it for you. This is not a time to go rogue for your own safety. I just feel like I have to put those disclaimers in.

Dr. Eric:

Yeah, I’m glad you did. I face the same thing with people on thyroid medication as well.

Dr. Beverly:

I know you do. I have a lot of patients that are on medication. I know you see people just go and do some strange things, don’t you?

Dr. Eric:

Yeah. For those with hyperthyroidism, Graves’ disease, those side effects could sometimes be pretty bad with the antithyroid medications. So I can understand people not wanting to take it. I actually dealt with hyperthyroidism and took more of an herbal approach, but it’s a little bit different with Hashimoto’s because if someone needs thyroid hormone, then there’s really not an herb or something else that they could take as a substitute for thyroid hormone. But sometimes in people with Hashimoto’s, you balance the immune system, and they might be able to get off of thyroid hormone or reduce the dosage. But again, it’s best to go to the prescribing doctor rather than try doing that on your own.

Dr. Beverly:

Yeah. We have those keys to inflammation. For Hashimoto’s thyroiditis, that inflammatory aspect, the “itis”, you always want to be able to dial in on that inflammation. I know with your work, that’s a powerful part of that healing conversation that really help people get that awareness of what is driving inflammation for the immune attack. There’s something behind it.

Dr. Eric:

Oh definitely. For both Graves’, Hashimoto’s and really all autoimmune conditions, that’s a big goal. Try to find the triggers and underlying imbalances. One thing I also wanted to say just because the topic, again, relating to insulin resistance, there’s evidence that insulin resistance can cause thyroid proliferation, maybe resulting in a goiter, swelling of the thyroid gland. And then also nodules too. There could be other causes of nodules like problems with estrogen metabolism, but blood sugar also potentially plays a direct role in thyroid health. But then there’s that inflammatory process as well associated with many cases of insulin resistance. We were just talking about inflammation in relation to Hashimoto’s and Graves’ disease as well. So blood sugar is definitely important, and having healthy blood sugar levels is important with anybody, but that also includes those with autoimmune conditions such as Graves’ and Hashimoto’s.

Dr. Beverly:

That’s right. In literature, all the different aspects of metabolism are in good harmony. And when you’re not in good harmony, different problems can show up. And so you can see multiple things in parallel. Insulin resistance, you could have thyroid nodules. A person might have fatigue. They might have muscles that seem to be atrophying or they don’t get the same kind of benefits like maybe they used to from exercise if they used to do weight training, things like that are a number of shifts that can be really good clues that the metabolic system is really starting to shift.

Dr. Eric:

Yeah, definitely. How about one other thing before we go into, I do want to make sure we answer some questions. We did talk a little bit about weight gain. I don’t know if you want to expand on that just because it is a big issue, more so probably with Hashimoto’s than with Graves’, even though with some people with Graves’ they also experience weight gain. Hashimoto’s, again, we got to factor in the low thyroid hormone. So perhaps to summarize, if someone is struggling with weight gain, what steps do you have them do? Is the first thing you have them do is to just modify their diet? Do you have them do testing to look at their blood sugar levels and maybe other markers such as thyroid?

Dr. Beverly:

Yeah. The first things we would do is to make sure that they have current lab work. So we have the baseline for the data just to make sure we haven’t overlooked anything because sometimes health problems are blamed on weight when they aren’t necessarily related. We have certainly seen where patients have come in and they’ve lost 80 pounds and they still have their original presenting symptoms. So clearly weight was not the cause, was it? You want to be sure that as a doctor you’re not hiding behind that where weight is a shield for thinking about any other problems.

And then from there, look at how they’re eating and what they’re eating and also what time of day they’re eating. Sometimes what I found is that if people eat from early in the morning to late at night, so they never really have a fasting period throughout their day, that that can be a problem. Particularly people who eat really late at night and then go to bed within a half hour, they almost always have a weight problem of some kind.

Then you look at the quality and quantity of the food. Make sure portions make sense, and that they’re eating in a healthy manner for whatever are the foods that are best in agreement with them. I prefer that if people have high fiber diets with healthy protein, healthy fats, and then slow burning complex carbs. I love things like lentils and chickpeas to try to get them in the mix because they are packed with, it has healthy carbs, slow burning, it has fiber and it has protein, all in one convenient little package. You get a lot done with lentils and chickpeas, and they’re delicious. There’s many different ways that you can prepare them.

From there, I don’t insist on exercise. I love it for mental and spiritual reasons, stress relief, for people to exercise. But I’ve had the opportunity to work with so many people for whom their knees or their hips, their back, they’re in so much pain. They just can’t do it. And so I learned to not make that the centerpiece of the treatment.

So then our next stop is either going to be after we’ve looked at food, which is the target, we’re going to look at either stress issues or we’re going to look at sleep. I talk to people about sleep. Typically if they’ve raised kids or if they remember their own childhood, if they had a good childhood, did you have a regular bedtime? Did you have a regular wake time? And if you didn’t have good childhood, what would you have liked for your younger self? Because what you don’t want is chaos in your sleep world. Have that one to two hours of clear transition to sleep.

Give your body every possible signal that it’s going to be time to go to sleep now, and then get out of bed at the same time. So your day and night make sense. Let your hormonal system settle, because if you get up at really different times and go to bed at really different times, guess which system is going to least be able to handle that is your hormonal systems. Your thyroid will be affected, your pancreas, your ovaries or testicles. All of the various organs are sensitive to that. Your digestive system, it really loves regularity. It wants you to go to bed at the same time and get up at the same time.

And just getting people’s sleep ordered from their stress. Some people have extraordinary levels of stress that they carry now in their adult lives, or maybe as a kid. Childhood was awful and they could have a lot of what are now called ACEs, adverse childhood experiences, where they really, really got pushed and their stress systems were always in high drive. It wasn’t the emergency, it was nonstop constant emergencies. And in that environment, it’s just really hard. So now here they are 20, 30, 40 years later and where their health should be in a pretty good place relative to how their life is lived now, they’re starting to fall apart. The problem started a long time ago, now we’re seeing the results.

Dr. Eric:

All right. Well, thank you for that. Again, I would like to get into some questions, but  is there anything else you’d like to add?

Dr. Beverly:

No, I think we’ve covered this really well. For our first conversation, I’m thrilled to be a part of this. I don’t want people to think it’s complicated because kind of in a way it’s not. But it’s not always obvious. As I tell people, the things I ask you to do, and you might have this conversation too with your patients, Dr. Eric, the things that I ask you to do are simple. I never said they’re easy.

Dr. Eric:

I agree. Well, where can people learn more about you, Dr. Beverly?

Dr. Beverly:

Sure. Welcome to visit my website. Https://dr, the abbreviation for doctor, and then my name Beverly, B-E-V-E-R-L-Y, Yates, Y-A-T-E-S.com. You can find me on Instagram. The handle is the same thing @DrBeverlyYates. On LinkedIn, you can type in my name and find me there. And soon I’ll have a YouTube channel that’s repurposed specifically for blood sugar issues. Those are the primary places. You can also find me on my Facebook business page. Feel free to check in there as well.

Dr. Eric:

All right. Wonderful. Thanks again for getting together. Are you okay with diving into some questions?

Dr. Beverly:

Yeah. Sure.

Dr. Eric:

All right, great. Let’s take a look.

Dr. Beverly:

Someone asked if Type 1 diabetes can be reversed. Let’s clear that up. No. Type 1 diabetes, based on today’s knowledge right now in 2021, April 9th, no. Type 1 diabetes where someone’s pancreas no longer makes insulin unfortunately cannot be reversed. People can benefit from very similar strategies around having a healthy blood sugar in all of the goodness that we were sharing earlier, but unfortunately we don’t have a way to reverse Type 1 diabetes at this point in time. I want to be crystal clear about that.

Dr. Eric:

Those with Type 1 diabetes, do they have to be on insulin?

Dr. Beverly:

Yes, it is mandatory they will need to add it. Otherwise any of the blood sugar that their body is making, their glucose, will not get into their cells successfully. You have to have insulin, it’s a requirement. There’s insulin pumps. There’s all kinds of things that are, again, kinder and gentler than what used to go on back in the day. Treatment has improved, but we’re not at a place yet to reverse Type 1.

Dr. Eric:

One question, Type 2 can be reversed, but is there a point of no return where certain people with Type 2 can’t really… I know you can’t guarantee that anybody can be reversed…

Dr. Beverly:

I tell people that there is always a potential with Type 2 diabetes for healing from the damage from diabetes. For some people that will include reversal of the diabetes diagnosis to where their blood sugar will lower to the point where it’s out of the diabetes diagnosis range. So for Type 2, once they get under 5.8, so let’s say if their blood sugar goes to 5.6, 5.5 and back into the fours, they’ve reversed for sure. Now, that doesn’t mean they are no longer susceptible to having the problem and if they were then to, if it was at all a lifestyle or habit based, if they were to go backwards in time and go back to the situation that got them started in the first place, it’s likely to return.

I mean, I want people to be sure that they understand that if they have figured out what are the most healthy levers to pull, so to speak, for themselves, and they’ve got that dialed in, they need to stay that way. If they then decide, “Oh, hey, I’m better,” and then they start to do things that just don’t make sense like they let their sleep just cycle all around and get out of control, lots and lots of stress, no exercise and eat poorly, it’s very likely that Type 2 will return and probably return quickly.

Now, is there a point at which it’s the point of no return? I always tell people I’m not a psychic and I don’t play one on TV. I’m also not God. I don’t feel like that kind of an answer is in my hands. I do think that there is a place at which there’s so much damage that they may not get the full benefit they would have gotten if they’d done something sooner. That’s like watching that train wreck in slow motion or in some cases wreck in fast motion, real time.

If someone has a severe compromise of their circulation, if they’ve lost one or more body parts, if they’ve lost vision and have gone blind in at least one eye, if they’ve lost or are rapidly losing kidney function, if they have severe pain from peripheral neuropathy or they’re flat out numb, these are all great indications about how much healing potential is left. Whatever they can do, even if it’s at end stage severe is not too late, but it might mean that they might not get all the way back to the status of reversal. Make sense?

Dr. Eric:

Yes, definitely. Thank you for that explanation. We have a question from Vicki. How do you stop the constant sugar craving?

Dr. Beverly:

Yeah, sugar cravings are so very annoying. Let me share with you guys a fun factoid. I discovered this in some of my research several years ago, and other people have since brought this forward to share with me. Did you know that the cells on your tongue turnover every 10 to 21 days? So every week and a half to three weeks, you get a brand new layer of cells on your tongue. That’s where your taste buds are. Now, this is important because if you’ve got a taste for sugar, if you have a sweet craving, if the sugar bug has bitten you, you’re going to need to give yourself some time. This is not something that’s going to go away in 24 hours. But you can make a change over the course of 10 to 21 days, for sure.

I find that the herbs can really help, like gymnema and especially fenugreek, with that craving for sugar. Also those leafy green vegetables, like I said, at the beginning of our interview time here. Those leafy green vegetables. In the Facebook group, we have this hashtag of GreensBabyGreens. Those leafy green vegetables can really help get that desire for certain foods to be shifted gradually, steadily and permanently towards the healthier desires. So if you’re constantly battling that desire, that brain-based urge for sugar, that’s a great way. Either the herbs, the veggies.

Dr. Beverly:

And then another tip is simply to try and eat some things that you don’t normally eat, especially if they tend to be bitter. Get your tongue and your palate used to eating things that are a variety and have different flavor profiles than sweet. So much of US food, especially fast food, is all about sugar and salt.

Dr. Eric:

Yeah, that is true. Someone just made a comment here about the protein. There’s so many different protein powders out there.

Dr. Beverly:

Yeah, there are.

Dr. Eric:

Let’s see. Jenny, I can’t lose weight despite thyroid and insulin in range with menopause and no other conditions.

Dr. Beverly:

That’s interesting. With menopause, as we all know, the reproductive hormones for women shift. And so you’re no longer losing that menstrual lining every month. Now, for some women, that leads to a certain kind of peace and calm that maybe they didn’t have before, particularly if they had difficult menstrual cycle. If you had a pretty easy time, then hopefully the dust will still settle. From menopause, you’ll be okay. If you’re finding you’re struggling with weight, including when you have thyroid problems or don’t have thyroid problems, I found a great way to go is to try intermittent fasting.

Intermittent fasting, which if you think about it, the spiritual traditions of the world, every single one of them has some kind of fasting baked right in there. I can’t think of one that doesn’t. I think humans have been wise for thousands of years and we’re just getting caught up now about this and documenting it and giving it the proper credit. I would really suggest to consider intermittent fasting and try and see what happens for you. It is a great way to reset issues with insulin resistance, that’s for sure. And if that’s at all the issue, hopefully you would get some benefit from that. I think trying that out might be a safe, good way to go.

Dr. Eric:

Yeah. I’ll also add what we were discussing earlier. Remember there’s the lab ranges and there’s the optimal ranges. Like the thyroid hormone levels might be within the lab range, but they might be on the low side. It depends on the lab, but for example a free T3 of 2.1, a lot of labs would consider that to be normal, but that is really on the lower side and the active form of thyroid hormone. Same thing we are talking about insulin. The person who had an insulin of 10, the lab didn’t red flag that as being out of range, but from a functional perspective, from an optimal perspective, it’s definitely higher than we’d like to see. And then there could be other factors as well. I mean, I agree with Dr. Beverly. I personally do intermittent fasting as well.

I do think some people need to be cautious, especially when dealing with hyperthyroidism. When I was dealing with hyperthyroidism, I lost over 40 pounds. So in that case, I probably wouldn’t have wanted to do intermittent fasting. And then maybe if someone has really stressed out adrenals too. But overall, , intermittent fasting can many times do wonders for weight loss. But if there’s something else going on, like an inflammatory process, or again, there could be numerous factors, those do need to be addressed. But yeah, I do agree about the intermittent fasting. And then here, it takes a lot of willpower to eat healthy, especially now in the COVID environment.

Dr. Beverly:

Yes, it does.

Dr. Eric:

Yeah. I think it’s always a challenge. Once you’re in the routine of eating healthy, it’s definitely easier. But I grew up eating everything that you shouldn’t be eating. Eating fast food and refined sugars. It wasn’t easy making that transition, but once you start feeling better and you’re maintaining a healthy weight and you have energy, it’s still not easy. I still get temptations. I’m sure Dr. Beverly gets temptations. I’m not saying I never want to indulge and I can’t say I never indulge, but yeah, you are correct. I mean, over the last year, arguably for many people, it has been more of a challenge.

Dr. Beverly:

Yeah, that’s real.

Dr. Eric:

So LDN, low-dose naltrexone. So I could answer this.

Dr. Beverly:

Yeah, go ahead. I’m curious to hear about LDN.

Dr. Eric:

Low-dose naltrexone, that’s a medication that modifies the immune system. It can potentially calm down the immune system in autoimmune conditions. I’ve written some articles on low-dose naltrexone. Definitely check those out on my website. I like LDN, but it’s more hit or miss and it doesn’t work for everyone. When it works, it could do wonders. And it also, it’s not addressing the cause of the problem. So I guess that’s another thing too. I do have patients that take LDN but just keep those things in mind. One, it’s doesn’t work in everybody. And this also for Graves’ too. You mentioned Hashimoto’s, but it can help with other autoimmune conditions. But again, I find it’s hit or miss. And then also you still want to do things to address the cause of the problem ideally and not just rely on the LDN.

All right. And then we’ve got, Dr. Yates is so very knowledgeable. Yes, definitely. I enjoyed this as well. Thank you for that comments. Okay. This is, yeah, I don’t eat after 7:00 on most days. Yeah, I also agree with that trying not to eat late.

Dr. Beverly:

Yeah. Give three to five hours before you go to bed. From your dinner time to sleeping, three to five hours. Just let your gut really go into CP time so now it can do its renewal because that’s the only time it can do its renewal is when you’re asleep.

Dr. Eric:

Yep. I agree with that. I guess we didn’t talk really about duration of sleep, but most will say like seven to eight hours. I guess I would agree with that, but then also take into account if you don’t fall asleep right away. So if you’re in bed for eight hours, but it takes you a while to fall asleep, then I wouldn’t count that time.

Dr. Beverly:

I’ve started to talk to people about this a little differently after reading, oh boy, he’s a researcher over here at UC Berkeley, Matthews. I can’t remember his full name. He has a book on sleep, wonderful book, to talk about sleep with people around give yourself the opportunity to have eight to nine hours of sleep a night. Therefore, if it takes you time to get to sleep, you’re still good. People just seem to relax a little bit with that idea. So otherwise then that’s part of why they don’t go to sleep. They’re stressing them because they can’t sleep easily.

Dr. Eric:

Yeah, that is true. Once you’re in a pattern of not falling asleep, some of it does become psychological and then, yeah, it is helpful if you try to go to sleep earlier. But again, sometimes I have to practice that too. I mean, I’m pretty good with sleep, but again, I can say every single night I get eight plus hours sleep. But I’m also not a night owl, fortunately. So I’m not one that stays up to midnight or one o’clock. All right. Let’s see. I know we got to wrap things up. And I will be on Facebook next week. So if there’s any questions that are unanswered, next week I’ll be doing a full Q&A, so definitely save your questions. But I’m trying to see if there’s anything related.

Janet, my best meal plan for a Hashimoto’s insulin resistance. I mean, since the topic was insulin resistance, I know Dr. Beverly said she doesn’t really recommend a specific diet. She did say the fiber and the green leafy vegetables is what she recommends across the board. And then of course the basics with not eating refined foods and sugars and just really trying to eat a whole foods diet, plenty of fiber, plenty of green leafy vegetables. Anything you want to add, Dr. Beverly?

Dr. Beverly:

Yeah. Those healthy lean proteins and the healthy fats, the avocados, nuts and seeds. And for your carbs, you want those complex slow burning carbs, especially like lentils and chickpeas, because you just get so much nutrient density from it without any problems. I found that to be really helpful. Some of my patients have Hashimoto’s or they have hypothyroidism without necessarily being Hashimoto’s and combination with insulin resistance. So far we’ve not had any problems with people than if they had a history of disordered eating or eating problems that it hasn’t triggered anything. Because I find sometimes if people have those issues, if you put them strictly on something like Keto, they can get kicked pretty hard. So if they start to introduce carbs later, they sometimes really just go hot wild with it has been what I’ve seen happen. It doesn’t happen to everyone. Most of the time people are fine, but for a few I’m like, Ooh, is there some tuning I could have done to avoid this?

Dr. Eric:

Yep.

Dr. Beverly:

Maybe there’s one here I’d like to address. A lot of my patients are Asian. Shout out to Asian folks, hello. I totally get what you’re saying here. The comment is, I used to not crave sweets, but since Graves’, this person has been craving every day, and vowed to stay away from it. Starting to eat brown rice. I totally get, in Asian culture, white rice is preferred. Brown rice has the fiber jacket on it. I get the deeper issues here. I used to practice it in Hawaii and I’m here in California in San Francisco, Bay Area. Lots of conversations have been had around this very topic. So I would simply encourage you to do this.

If you’re going to have white rice, go ahead and have it, enjoy it and consider maybe if it’s a problem for you, cut that portion in half. I have found that that by itself has really helped people, especially if you’re in family events or special celebrations where white rice is absolutely going to be served and you’re not going to be able to get wild rice, brown rice, etc. There’s no point in struggling and trying to fight that river. Instead, maybe look at your portion and make sure you have lots and lots of fiber with it. And I think that that combo will be practical and helpful. It certainly has helped others of my patients who are Asian and who’ve had a similar concern, whether it was food intolerance or it spiked their blood sugar or they craved it or whatever the case might be with rices, in particular white rice. I hope that’s helpful.

Dr. Eric:

All right. Well, thank you for that. Thank you so much for, again, getting together Dr. Beverly. And again, can you let people know one more time where to find… Someone also did mention about your Instagram. I did see over there.

Dr. Beverly:

Yeah. So Instagram is the same. It’s @ sign, and then my name, DrBeverlyYates.

Dr. Eric:

Okay. And your website one more time.

Dr. Beverly:

So the website, if you go to the Google or however you do your web searches, if you put in drbeverlyyates.com, you’ll go right to my website.

Dr. Eric:

All right. Wonderful. Well, again, thank you again for getting together. I think that this was great. Hopefully everyone found it very helpful. I know I learned a few things as well.

Dr. Beverly:

Thanks so much. Take care.

Dr. Eric:

Bye-bye. Thank you, Beverly. Take care. Have a great rest of the day.

Dr. Beverly:

You too. Bye-Bye.

Dr. Eric:

Bye.