Recently, I interviewed Dr. Meg and we discuss the basics of histamine and its metabolism, symptoms of histamine intolerance, the connection between histamine and thyroid health, the impact of gut health, hormonal balance, and the microbiome on histamine levels, practical tips for managing histamine intolerance, and more. If you would prefer to listen to the interview you can access it by Clicking Here.

Dr. Eric Osansky: 

I am super excited to chat with Dr. Meg Mill, as we will be talking about histamine and tying it into thyroid health. A lot to talk about when it comes to histamines.

Let me dive into Dr. Meg’s impressive bio here. Then we will start our conversation. Dr. Meg Mill is a Pharm.D. and certified functional medicine practitioner with over two decades of clinical experience. She is also a bestselling author, podcast host, summit host, and sought-after corporate wellness speaker. 

Her virtual functional medicine practice has transformed the lives of hundreds of clients worldwide by connecting the dots between the diverse, unexplained, and often overlooked health struggles such as migraines, gut issues, chronic fatigue, skin reactions, anxiety, or allergies. She uses her EAT Method to uncover and resolve the underlying connections, whether it’s histamine intolerance, hormone imbalances, gut dysfunction, or MCAS (mast cell activation syndrome). Welcome, Dr. Meg. 

Dr. Meg Mill: 

Hi! Thank you so much for having me. 

Dr. Eric: 

It is a pleasure to have this conversation, talking about histamine. So many people have histamine imbalances. Many of these people don’t know they have histamine imbalances. Let’s first dive a little bit more into your background. How did you start helping people with histamine intolerance as well as MCAS? 

Dr. Meg: 

I actually have it myself. I didn’t realize it for so many years. I was the kid who had tons of allergies. I remember my parents actually redid a dresser for my room, had it painted, and I couldn’t keep my clothes in the dresser after it was painted because it would make me so sick. “My clothes make me sick.” My mom was like, “Why? What’s wrong with your clothes?” There are all these clues for people over time.

What I started to find was that histamine issues, MCAS, they are growing more. They are connecting a lot of different symptoms. I am saying I was someone who had allergies. I was highly reactive. Then I started having GI issues, where I couldn’t even eat anything. I was having so much stomach pain. I jumped around from gastroenterologist to gastroenterologist and was told I was fine, that I was the picture of health. Then I got anxiety, which led to insomnia. All of these things that started happening and building on each other seemed to me unrelated, but they all have this common link, which is histamine. 

Sometimes, when you’re looking at it through the histamine lens, you start to connect all of these dots and think, “My anxiety and my allergies and my gut issues, they don’t all seem related.” But when we are looking at it from that point, if we can get the histamine to be lower, to get it under control, a lot of things will clear up.

I was having a lot of my own personal health issues. Then I also was not getting any answers and being told I was fine. Here I am in the health space, and I can’t get answers for myself, which led me to functional medicine.

I actually made a career change. I got certified in functional medicine and opened a functional medicine practice. Now I help people all over the world get to the root of their mystery health conditions. Looking at the connections of all of these different symptoms and how your body builds on the connections. We can just unwind it to get you feeling a lot better. 

Dr. Eric: 

Histamine issues can definitely be complex. It’s safe to say some people watching this are familiar with histamine. There are some people who aren’t familiar with histamine. That is my next question. For those who are asking what histamine is, can you explain what it is? We will go deeper. We are not going to get too much into MCAS. Or we could. It depends on you actually. I want them to know the basics of histamine and histamine metabolism. 

Dr. Meg:

Histamine is the new cortisol. When you think of cortisol, you think of bad. When you think of histamine, you think of bad. But they do have purpose in your body. 

Histamine is what we call a biogenic amine. When your immune system detects an allergen or invader, histamine is released primarily from your mast cells or basophils as part of your immune response. 

In your immune system, we have two different systems. We have your innate immune system and your adaptive immune system. The mast cells are part of this innate immune system, so they are ready to go. They are ready to fight. They are not selective. Let’s get this. 

One of the things they release is histamine in order to do things like increase permeability of the blood vessels, which allow immune cells to reach the area more quickly. Histamine helps with immune defense.

It helps with regulating your gastric acid secretion to break down food and aid in digestion. 

It affects your neurotransmitters. It can affect serotonin, norepinephrine, acetylcholine. It can be involved in your wakefulness, your alertness, your cognitive function, your mood. 

It’s a part of the allergic response. That’s what most of us think of when we think of histamine. It can also cause broncho restriction. It constricts your airways to prevent harmful airborne substances to enter too deep into the lungs. 

And it actually also creates an inflammatory process. It actually creates inflammation. It recruits immune cells to the site of infection or injury through this increased vascular permeability and blood flow to create this inflammatory response.

However, when it’s excessive or not regulated, it can lead to chronic inflammation. That is when we start to get a lot of these symptoms and problems.

Dr. Eric: 

I’m glad you mentioned an excess. Histamine by itself isn’t a bad thing. It’s important. We need histamine, just like inflammation by itself is not bad. It’s when it becomes excessive and chronic. 

Let’s talk about histamine, especially the metabolism. There are different enzymes: diamine oxidase (DAO). I’ll let you take over because you are the histamine expert. 

Dr. Meg:

Let’s use a bucket analogy. Think of your body like a bucket with holes in the bottom of the bucket. You’re filling it up, and it’s draining. You’re filling it up, and it’s draining. We keep doing that. Everything is fine. You feel good. You’re moving through life.

When we start to have these symptoms of histamine intolerance, we start to have one of two or both things happen. We are either pouring too much water into that bucket, and it’s overflowing. Or we plug the holes in the bottom of the bucket. Or both.

When we plug the holes, it fills up too much. When we fill it up too much, we fill it up too much. If we get this overflow, that is when we start to have all of these symptoms.

 We will talk about what plugs the holes. You break down histamine by two different pathways in the body. One is diamine oxidase, which you mentioned. The other one is histamine n-methyl transferase (HNMT). 

The diamine oxidase is the main enzyme responsible for breaking down histamine from foods in our intestinal tract. We will get into some of these histamine-producing foods that are often healthy foods. That can be really confusing sometimes because things you think are eating for certain purposes to help your body can also be high in histamine and create some of these problems. 

We want to look at some of the other reasons that diamine oxidase can become compromised. First of all, people can have genetic variations. I am one of those people. I told you, I had some of these symptoms forever. Generally, they build because even if you have the genetic variations, we’ll get into how gut health can play a huge role. If everything is functioning properly, we can usually overcome some of the genetic variants. You can have genetic predisposition not to process histamine as well.

The main thing we see are imbalances in your microbiome. We need to have certain gut bacteria that can help us break down the histamine. Then we have bacteria that actually inhibits the DAO. We can have histamine-producing bacteria. We can have mast cell-activating bacteria. We can also have things start to happen that compromise this enzyme function. 

Once we have compromised enzyme function, then we can’t break down histamine very well. Everyone pretty much knows about lactose. There are certain people with lactose intolerance. When you have lactose intolerance, you can’t eat dairy because you have problems breaking it down. It’s a very similar enzymatic reaction. 

When we are eating histamine, we need diamine oxidase to break down those foods, so they are not affecting us. We can also see that once we start to get intestinal permeability or leaky gut, we can also get chronic inflammation. This inflammatory response can also downregulate the regulation of diamine oxidase, so the body can shift more toward resources for managing inflammation. Then it can further exacerbate histamine-related issues. We are seeing some of those things happen.

We can also see certain nutrient deficiencies. We know that certain nutrients are required to make diamine oxidase. Things like Vitamin B6, copper, and Vitamin C can also be a problem. I know I keep coming back to the gut, but sometimes, even if we are eating all those nutrients, but we can’t digest or absorb them, we may not really be getting the full effects of those.

We are looking at all of these things together to look at how well are you really breaking down histamine? 

Another one that might be surprising to you is fluctuation in hormones. Estrogen can cause the mast cells to release histamine. Estrogen can also influence diamine oxidase activity. Higher levels of estrogen can lead to a reduced diamine oxidase activity. 

Progesterone actually helps increase diamine oxidase. 

When we start to become estrogen-dominant, having high estrogen to progesterone, we can also see hormones creating an imbalance that can affect it. That can play a role in one pathway.

We have another pathway, which is HNMT. You have probably heard of methylation at this point. Everyone is talking about that now, which is good. We are starting to see that we need methylated B vitamins. We need to be able to methylate in order to break down histamine. 

Histamine is methylated into HNMT. It goes through this methylation process and is excreted in the kidneys.

One thing I just want to clarify is a lot of people are talking about MTHFR. A lot of people are talking about methylated B vitamins, which is great. That is not the only thing that is affected in this pathway. Sometimes, we actually need to look further down the pathway. 

We can also see an MAO variant, monoamine oxidase, affect this pathway. You may need a riboflavin, B1, or B2. You can push some methylated B vitamins. If you feel worse, it might be because you have blocks further down that pathway. That’s something to keep in mind.

We also need certain vitamins and nutrients for that. We mentioned folate, B12, B6. Different nutrient deficiencies can play a role. Sometimes, we see poor liver function affecting the methylation pathway. Some drugs. We want to make sure that we really have those pathways open. 

Dr. Eric: 

I’m glad you shared that. I will summarize. There are two main enzymes that break down histamine. DAO, diamine oxidase, is the main one. HNMT, which is the other enzyme that can help with that. There are different factors that can influence these enzymes. You mentioned the importance of the gut microbiome and of course genetics. When you talk about genetics, it’s not just MTHFR. With HNMT, you mentioned methylation. You mentioned MAO.

One thing related to that is COMT. You also mentioned that COMT is involved in methylation. But you mentioned, and I am going down a rabbit hole here, estrogen can inhibit DAO. The COMT also plays a role in estrogen metabolism as well. If someone has a genetic variation in the COMT enzyme, can that also affect the breakdown of histamine at all?  

Dr. Meg: 

It can. A lot of these pathways we are seeing are interconnected. That is one of the main points of functional medicine, right? When you’re talking about something, you’re looking at this one thing, but I’m always telling people, this relates to that, and this is connected here. They’re all connected to each other in various ways. When we look at this, we are looking at it from a whole person perspective. We are looking at how each one of these pieces, your lifestyle, your genetic factors, all of your levels are playing a role into what’s going on in a unique way for you. A lot of different things can play in when looking at some of these pathways and breaking down.

Dr. Eric: 

What are some of the more common symptoms people will experience when having a histamine intolerance? 

Dr. Meg: 

I think this is a tricky one for people to understand. We think of nasal congestion, sneezing, asthma, difficulty breathing. Then you’re thinking about highly reactive, maybe hives, rashes. Those all can be. But we can also see headaches and migraines. The people I work with with migraines, a high majority of people have histamine intolerance. We see fatigue, heart palpitations, dizziness, anxiety, depression, difficulty concentrating, PMS, irregular periods, flushing, joint pain, insomnia, high or low blood pressure. As you can see, there is a lot of different symptoms. 

A lot of digestive difficulty. There is more and more research with IBS and histamine intolerance and the effect of mast cells. A lot of IBS symptoms are also coming from histamine issues, too, that are playing a part. 

I think that’s one of the messages I’d love to hit home in this episode. Like we’re saying, it’s more than just allergies. When you’re talking about your thyroid, let’s say you could overlap some of these symptoms with thyroid. You can overlap some of these symptoms with a lot of different things. It’s really looking at what lens are you looking at it through? Could histamine be a part of this picture? 

Dr. Eric: 

Speaking of thyroid, would some of the relationships between histamine and thyroid that you’re aware of? 

Dr. Meg: 

Thyroid hormone, particularly T4 and T3, can influence the metabolism of histamine. We do want to make sure that we have proper thyroid function to help maintain balanced histamine levels. They can play a factor in the activity of the diamine oxidase and HNMT. Looking at making sure your thyroid levels are balanced. 

We are talking about histamine intolerance as gut health. When we are looking at Hashimoto’s and thyroid, the leaky gut, gut health is really critical. We want to make sure that we are optimizing our microbiome, that we are looking at what good bacteria we have, what overgrowth we have, and really getting a balanced microbiome in order to optimize this function. 

Also, we are going to talk more about- I can bring this up a little bit here, too. The mast cells. We sometimes can see mast cells present in the thyroid gland. Their activation can affect thyroid function. 

We brought up mast cells. Histamine is released from mast cells. Some people can get what’s called MCAS. When we’re talking about filling the bucket, one of the things that starts to fill that bucket is MCAS. 

When we start to have this, our body starts to go into what we call a cell danger response. We start to feel like our cells are under attack. Once we go into the cell danger response, we start to react to everything. If someone has MCAS, they are more likely to be someone who is reacting to a lot of different foods. Sometimes, we can react to heat, smells, sounds, EMFs. We start to be more hyperreactive. Our mast cells almost are getting angry, and they are firing for no reason.

An example I like to use here is if you’re smelling a rose, and you’re touching a stove at the same time, every time you smell the rose, you touch the stove. This beautiful smell is associated with this pain. Then the person tells you, “Smell the rose, but take your finger off the stove.” You can smell the rose and still feel that pain because your body is still associating that it’s in danger. It’s associating that the smell of that rose is going to cause you pain even though that’s not there anymore. 

That’s what starts to happen in MCAS. Our body is starting to release these mast cells even when it’s not necessary, when we’re not in danger. In that case, we need to look at what is the root cause? What is happening to your body that is causing this excess release of mast cells? 

We sometimes also need to work on nervous system rewiring, working on bringing our body back into that parasympathetic nervous system to feel calm, to feel safe, to be able to do some different exercises to rewire our body and feel safe in where we are. 

Dr. Eric: 

Not everyone who has a histamine intolerance has MCAS, correct? That’s more advanced, you would say? As you explained, if you have an abnormal amount of mast cells, and things go a little bit haywire. 

Dr. Meg: 

Yes, exactly. Not everyone who has histamine intolerance has MCAS. A lot of people that have MCAS will have histamine intolerance because one of the chemicals released from mast cells is histamine. One of the major symptoms of that are histamine issues. 

You can just have simply an inability to break down histamine and maybe are putting too much histamine in your body with the inability to break it down well. All we really need to do is help you break it down, help you rebalance your gut microbiome through the lens of histamine intolerance. Look at some of these specific things and make sure some of these pathways are open. We can create balance very easily. 

Dr. Eric:

Is there a way to differentiate the two? I don’t know if you officially diagnose histamine intolerance by looking at histamine and looking at DAO. I know there are ways to do that, or if it’s more looking at the whole picture and the symptoms. Similar with MCAS. Are there markers that you look at on a blood test or elsewhere? 

Dr. Meg: 

Yes. There are diagnostic criteria for MCAS. You have to do certain testing a few days in a row. There is often urine testing. There are more diagnostic criteria. It’s hard to do. A lot of people aren’t actually always getting the diagnosis. They just can feel the symptoms. 

With histamine intolerance, we can test histamine levels in the blood, so that is a place to start. I personally don’t find that the end-all be-all marker because I see a lot of people with histamine issues who aren’t necessarily showing high blood histamine or DAO levels on a blood test. 

I personally like more of the diagnostic criteria. We do stool tests. We look at the microbiome. We look at some of the different factors to see what the person needs.

I think that’s another frustrating feature of people who have this issue. Sometimes, even the testing isn’t showing up as something that is conclusive. You feel like, “I’m having these symptoms. I don’t feel well.” Everyone is saying, “You’re fine.” It’s not so clear. Listen to your body. If you’re saying, “Okay, I do have some of those symptoms. I do have a cluster of more than one thing. I want to see what’s going on. I do feel like I’m more reactive.” Listen to yourself, and start thinking of this. 

It’s going up and up. We are seeing more and more cases. It’s becoming more mainstream because more people are really experiencing it than ever before. 

Dr. Eric: 

It’s a good point. Even if you are able to diagnose histamine intolerance or MCAS, you still need to address the cause of the problem. You mentioned that you do stool testing. You also mentioned earlier that you do things to balance the parasympathetic nervous system and some rewiring. People still want to have an answer. If they have type 2 diabetes, insulin resistance, it’s nice to see that on a blood test. When it comes to histamine intolerance, they may or may not get the answer. Either way, you want to do things to address the cause. 

You mentioned earlier IBS. I don’t know if this still holds true, but I know at least a few years ago, there is an overlap between SIBO and IBS. Not all cases of SIBO are IBS. Maybe it’s a percentage. I guess there is that overlap with histamine intolerance and SIBO. The question I’m trying to ask is: When you see people with SIBO, a lot of those people then do have histamine intolerance? Or is that something that you see in a lot of SIBO patients? 

Dr. Meg: 

Yes, there is three different ways. Great question. First of all, when you start to have SIBO or IBS, you have a disruption in the mucosal layer of your gastrointestinal system. That is where diamine oxidase is produced. When we start to get this imbalance, we start to potentially have a compromised function of diamine oxidase. That’s one bucket.

We also know there are certain bacteria that are histamine producing. We have things like certain forms of Lactobacillus, Morganella, Pseudomonas, Citrobacter, Klebsiella. We have certain bacteria that can actually be histamine-producing and be behind some of these triggers on their own. 

I am going to tell a side story because I think it’s very interesting. I worked with a man who had Urticaria, itching so bad for 20 years. He had to take hydroxyzine every day, which is a prescription antihistamine. It makes you very drowsy. As soon as it would start to wear off, he would just full body itch. He would have to take another one. He was getting shots. He had been to so many different doctors. 

He had no GI symptoms. I said, “I want to do a stool test.” He said there was nothing wrong with his gut. I said, “Bear with me.” He had really high levels of Morganella. That is a histamine-producing bacteria. We treated the Morganella. Within 3-4 weeks, his itching was gone. 

I think it’s such a profound story. It’s showing that 20 years of this really severe problem that had nothing to do with his gut health in his mind was really a histamine issue from some of these microbes. They are very powerful. We sometimes don’t realize that. I wanted to give you some context around some of the things that can be going on that you’re not even realizing from the microbes.

The third bucket is when we have SIBO, when we have a parasite, when we have H-pylori, when we have some of these invaders, that can be a root cause. “I have to create an immune response. I have to fight this invader all the time.” That’s stimulating your immune system. If you’re sensitive in your immune system, you can be releasing more mast cells to degranulate and create more histamine, more mast cell issues. 

There is three different ways. All of them can be playing into this dynamic. 

Dr. Eric: 

All right. You gave the example of Morganella, but if you have other imbalances, like H-pylori or parasites or candida overgrowth. How about SIFO? 

Dr. Meg: 

Yes. 

Dr. Eric: 

When people are aware they have histamine intolerance, or they suspect it, some people just eliminate foods higher in histamine. That could in some cases make a big difference in the symptoms. It’s not addressing the cause of the problem, but do you still have people do that while they are addressing the cause of the problem, to avoid those foods, to do the low-histamine diet? 

Dr. Meg:

I think it’s a very good tool to use. I love how you said that. I think people can get really caught up in the low histamine diet and the nuances and start to feel like this is how they need to live. I want to stress that’s not the end-all be-all. It’s not just stop eating all histamine foods forever. It can be a really good resource for you to start.

We want to start looking at different kinds of foods. We know there are certain foods that are high in histamine, such as cheeses, fermented foods, cured meats, alcohol. 

We are talking a lot about gut health here. If you are looking at a generalized protocol for gut health, fermented foods and bone broth are generally on those protocols. We know they support the microbes and are good in general, but not for people with histamine intolerance. You just have to be careful that when you’re looking at this, you’re doing it through this lens. That can be very confusing. You might be stimulating some reactivity in yourself. 

We also can see histamine liberating foods, like strawberries, tomatoes. We can have foods that limit diamine oxidase. Tea is a good example of that. Caffeine can block diamine oxidase. 

The other interesting component here is that when it comes to this freshness count, you can actually have issues with histamine from cooked meats. If you’re a meal prepper, you might want to flash freeze. We have a lot of people have issues with leftovers because histamine can grow in cooked meat. Always make sure you are eating more fresh foods than leftovers or canned products. 

Dr. Eric: 

That makes sense. Be careful about some of the foods. Bone broth and fermented foods, you’re right. They’re healthy foods, but if someone has histamine intolerance, it could cause other problems from a symptomatic perspective. Also, you mentioned increased inflammatory pathways as well? 

Dr. Meg: 

Yes. 

Dr. Eric: 

Okay. Supplements. Just like how eliminating foods can help but not fix the cause of the problem, same things with supplements. There are certain ones like quercetin or DAO. What are your thoughts on those? 

Dr. Meg: 

I think they’re great tools. We want to calm down the mast cells. We want to reduce the histamine load. While we’re working on the root cause, I do think finding relief is really important. 

You can get the DAO enzymes. I like some combinations of the quercetin with some other bromaline and nettles. There are different things we can put together that really are effective to bring some of these symptoms down. They can be very helpful for a lot of people. 

Dr. Eric: 

Gut microbiome, stress, adrenals. You mentioned nutrient deficiencies. Having healthy hormones because estrogen dominance can inhibit DAO. You mentioned the thyroid and the importance of having a healthy thyroid. A lot of different factors out there. 

What would be the first steps people should take for someone who is thinking they might have a histamine intolerance? Should it be working with a practitioner like yourself? Are there things they can do on their own to get started? 

Dr. Meg: 

I would say start with the low histamine diet. I have a handout that lays that out nicely. A lot of low histamine diets out there maybe are inaccurate or confusing. I will give that to you as a resource. If anyone wants to go to that, it’s a lot of information on histamine and foods. You can follow that. It’s nice to have a road map in what to do. Start with this low histamine diet.

If you’ve done that and are still having issues, or if you don’t want to stay on this low histamine diet forever, people just do that alone for too long, and they start to react to foods when they start to put them back in. Then work with a practitioner to get to the root and put some of these pieces together. If you do, you can see a dramatic difference in the way you feel. 

Dr. Eric: 

You have a summit coming up. Before you talk about the summit, where can people find out more about you, like your website? Anything else you want to share? 

Dr. Meg: 

My website is MegMill.com. I do free discovery calls. If you want to learn more information, I’d love to get on the phone with you and talk through what you’re going through. You can book that on the website.

I am on Instagram @DrMegMill. I also have a podcast called A Little Bit Healthier, where we talk about all different health topics. I’d love to see you over there. 

I’m really excited about this summit. It’s going to have so much great information. I’ve spent the last eight months working on this. There are over 50 experts in this field. We are going to talk about histamine intolerance, mast cells, and all of the different ways it can affect you. 

It’s a free event, June 18-24. It’s with DrTalks. Go to DrTalks.com. Just sign up, and you can watch about 50 hours of education for free. That’s a great place to start. We will put a lot of these connections together and give you some great tangible tips. 

Dr. Eric: 

That’s going to be awesome. Check that out. Check out her website and podcast. Thank you so much. You shared some great information about histamine intolerance and MCAS. Looking forward to the summit as well. 

Dr. Meg: 

Thank you so much. Thank you for having me.

 

Recently, I interviewed Nagina and we discuss how adding metabolism-boosting foods and spices helped her lose 40 pounds, the importance of incorporating adequate protein and vegetables into the diet, the benefits of spices like cinnamon, turmeric, and cayenne pepper, intermittent fasting, the need for personalized dietary choices, and more. If you would prefer to listen to the interview you can access it by Clicking Here.

Dr. Eric Osansky:

I am very excited to chat with Nagina Abdullah. We are going to be talking about metabolism and spices. It will be an exciting conversation. Let me go ahead and dive into Nagina’s bio. Then we will get more of a background.

Nagina Abdullah is a weight loss coach for women in midlife and founder of the website MasalaBody.com. She teaches women to boost their metabolism by adding and combining metabolism-boosting foods to reduce body fat and overall weight gain in midlife.

Nagina has a degree in molecular and cell biology from UC Berkeley. She has helped over 1,500 midlife women successfully lose weight and create a lifestyle change. Thank you so much for joining us, Nagina.  

Nagina Abdullah: 

I’m so excited to be here, Dr. Eric. Thank you for having me. 

Dr. Eric: 

It’s great to have this conversation. I think a lot of people will find it to be fascinating, especially when you talk about some of the different spices. I’m really excited about that. Of course, you have a lot of other things to share, too. If you could give more of your background, how did you start helping midlife women to increase their metabolism? 

Nagina: 

Absolutely. This is really a product of a personal transformation, where I had struggled my entire life with getting healthy, being at the weight I wanted to be at, at a healthy weight, having control over my sugar cravings, and actually creating a lifestyle versus going off and on diets, which I did for my entire life. 

I had tried every single diet out there from Weight Watchers to eating less and exercising a lot to Atkins to South Beach. For all of those diets, I would lose some weight, but then I would put it back on pretty quickly after because I would just start doing all those things I had restricted myself from for the weeks it took me to lose my weight.

After I had children, I actually was at my highest weight ever because I had pregnancy weight from two children. I also never had really gotten to a place where I was very satisfied with my overall balance of how I was managing my weight. That is where I reached into my background. I have a degree in molecular and cell biology from UC Berkeley. Let me do my own research instead of reading magazines and website posts. I no longer have the time to go on diets with two children, with a full-time career. I needed to lose the weight, feel good about myself, and be healthy. It was more about having more energy for myself and my children for all the years to come.

I started researching that information. I started finding foods we can add to our diet instead of take away. When you add foods, they boost your metabolism. There are other things you can add like certain spices that actually help you boost your metabolism and make your food taste good. 

I started doing those things. I lost 40 pounds in nine months. This was not easy. Right now, when I’m saying it, I just said it in one moment, but it was a lifetime of transformation that happened in nine months. It was because I learned how to eat differently.

That is when I started coaching women. A lot of people asked me how I did this. How did I look more in shape after children? Everything was working really well. 

Then I hit midlife, and things started changing. I realized there is definitely something different happening. There was more belly fat. More plateaus. No matter how much I exercised or what I ate, it wouldn’t come off. 

That’s where I started looking more at blood sugar management, balancing what you’re eating, and hormones. My weight was able to come down. Increasing muscle mass, too. It’s not even about weight; it’s about changing your body. That’s how I specialized in helping women in midlife. I have helped over 1,500 women lose weight, gain strength, and create a healthy lifestyle, which is the most important of all. 

Dr. Eric: 

I like that you said 40 pounds over nine months because some people might say, “That’s it? It took you nine months to lose 40 pounds?” Some people say 20 pounds in one month. I think what you did is reasonable. You want people to have reasonable expectations, and you want them to do it in a healthy fashion. Not to say some people might lose more weight in that period or a shorter period of time. 

To me, that sounds very realistic. If you said, “I lost 40 pounds in two months,” not to say that can’t happen, you might have clients where that did happen. Again, you’re being up front and not coming up with a crazy number in a short duration. Appreciate your honesty. 

Nagina: 

Absolutely. The thing is, a lot of times, when someone has 40, 50, or more pounds to lose, even 30 pounds, it can seem pretty daunting. Especially when you start doing things, and it feels like the scale is moving so slowly, it feels like it’s a long journey. Setting yourself up for that by doing increments of either two pounds or five pounds is really helpful. I lost the first five pounds. I couldn’t believe it. Then I lost ten pounds. That is where I realized this was a real journey I was on. It felt so easy, so I kept going. Then it just adds up. 10 pounds can turn into 20 pounds, 30 pounds, and more. 

It’s just about getting started, but getting started in the right way, where you can feel like you can keep doing this. Once you get to the weight you want, you don’t want to start reversing all of the things that you had done to get there. You want to enjoy that journey, love what you’re doing, so you can keep it up even when you’re there. 

Dr. Eric: 

One thing you also mentioned is to improve metabolism by adding certain foods, not necessarily removing certain foods. I am guessing if someone is eating a lot of inflammatory foods, you probably would recommend cutting those out. If they are eating a lot of refined foods and sugars, fast food, maybe they could still lose weight, even if they followed your recommendations. From an overall health perspective, would you still recommend for people to eat relatively clean? 

Nagina: 

The way I educate and teach people to make this lifestyle change is by focusing on what you can add. As a result, you don’t have a craving for those processed foods or inflammatory foods. You actually feel the difference in your body. You don’t want to feel like that anymore. 

By adding the metabolism-boosting foods, which we will talk about, the cravings for other things go away. An example of how this works is a lot of the inflammatory foods or unhealthy foods break down to sugars. Lots of carbs break down into sugars. That is the definition of what they are. They are carbs but positioned in a different way. They may not even be sweet.

When you are eating foods that break down to sugar, sugar makes you want to have more sugar. If you’re eating those foods that are not clean, that are breaking down to sugars, even if you’re not eating sweet foods, your body is going to feel overwhelmed in craving more sugary foods. It’s really hard to get off the cycle.

When you start introducing and leading with foods that don’t break down to sugar as quickly or at all, what happens is your body doesn’t want that anymore. Sugar is a drug. You give yourself a little bit, and it wants more of it. When you replace it with other really good foods for your gut, your brain, your metabolism, then it starts to become a very easy cycle, where you don’t even have those sugar cravings anymore. 

Dr. Eric: 

Do you recommend a lower carbohydrate, or a medium carbohydrate? 

Nagina: 

Overall, the most important part of carbs is you are eating the right kinds of carbs, so the sources of carbs should be important. The amount of it is going to vary with where you are in your journey. 

When you are losing weight, you want to have more of these what I call slimming carbs. Slimming carbs are carbs that don’t break down as quickly. Instead, they break down slowly, so they’re not elevating your blood sugar. When your blood sugar is elevated, that is when you’re storing fat. When your blood sugar is going up and down, insulin is being released. It’s taking that excess sugar out of your bloodstream and being stored as fat.

Ideally, you want to keep your blood sugar levels even. You can do that by adding carbs. Just eat slimming carbs. Slimming carbs are things like lentils. Lentils are amazing. They are carbs, but they are full of fiber. They also have some protein. That causes them to break down more slowly, so your blood sugar stays even. You can have carbohydrates in your diet, but you’re not feeling like you want more because you’re not feeling that up and down in energy. It’s also better for our stress levels. 

Lentils, beans, high fiber bread, like Ezekiel bread or even rye bread or sourdough bread are good options. Also, starchy veggies. Things like zucchini, squash, along those lines, sweet potatoes. Finally, what I call slimming grains, which are alternatives to rice. There are things like buckwheat or farro, other things that look and feel like rice, but they are not breaking down quickly. 

When you are in this weight loss mode, you don’t want to lead with carbs. I recommend having carbs to once to twice a day. Have them at lunch and either at dinner or breakfast. Have about a half cup to a cup. Your body is going to break it down slowly because these are slimming carbs. You also won’t be craving more carbs because you will be adding a lot of other foods as well that are anti-inflammatory. 

Dr. Eric: 

Here’s a question. If someone is following a paleo diet, is it okay for them to eat starchy vegetables but not eat some of these other slimming carbs, like Ezekiel bread? I know it’s healthier than other types of bread, but if they are following a paleo diet, they will be avoiding grains and Ezekiel bread. Can they focus on the starchy vegetables and some other foods you will mention? 

Nagina: 

Oh yeah, they can do that. Carbs is something that is like a lever. If you want to have more, you can. You don’t have to have more. A lot of people respond better to less carbs. Some people need more.

In general, you’re not leading with carbs anyway. Carbs are coming from these healthier sources. Yes, you can absolutely get them from vegetables. Over the course of the day, we get a lot of our carbs from vegetables. If you’re eating fruit, they’re going to be in your fruit because they will have more sugar. You will get them in different ways, but if you are wanting to have that extra serving of carbs, those are those alternatives that I talked about in terms of slimming carbs. You can use any source you like. 

Dr. Eric: 

Speaking of fruits, do you recommend minimal fruit or no fruit? 

Nagina: 

Fruit is something you can have, but I recommend low sugar fruit. Then you are not getting that sweetness, that breakdown of sugar. You are not feeling the need for more sugar. 

Fruits like berries, especially strawberries, taste so good. Raspberries, blackberries. Blueberries have more sugar than other berries, but if you do it in a mix, it’s okay. Tangerines are lower sugar. Having an apple or a pear, if it’s small, or having half of it, is really key. 

If you’re having apple or pear, which are higher sugar fruits, combining that with a healthy fat or a protein like peanut butter or nuts, because that slows down your blood sugar absorption, and you are not getting that elevation of blood sugar. Having fruits is good.

I really advocate having veggies with every single meal. With breakfast, have your fruit, but keep it on the low sugar side. Pair it with a protein or fat as part of a healthy breakfast. 

Dr. Eric: 

Sounds good. How about protein? How much protein do you recommend people consuming on a daily basis? 

Nagina: 

Protein is the #1 food to add to boost your metabolism. Protein is going to solve so many problems. Most women are undereating protein. We do need a significant amount of protein. You actually have to try to get that protein. You have to be diligent to have the right servings of protein and to have enough over the course of your day. 

First of all, I’ll talk about how much. But the #1 thing is if you add protein to every meal, and then have one snack that has protein, you are going to feel such a decline in your sugar cravings and your cravings for all the unhealthy foods we were talking about earlier, whether it’s processed foods, packaged foods, sweets, unhealthy, fast-burning carbs. You will no longer have those cravings. 

That may seem unbelievable, but watch. This is the quickest way to switch over having an unhealthy diet to a healthy diet: add protein. Really start by adding it. All the other things are naturally going to fall away. You will not feel like it. 

This is the #1 thing that my clients say has helped them lose their first 15 pounds, is to start adding more protein at breakfast. That is the #1 way. That is an area that so many people skip, especially women for many reasons, maybe because they’re busy, because they feel like if they eat less, they will lose weight, or they are following an intermittent fasting diet. They are not getting protein in the morning, and that adds up over the course of the day. You will likely not have enough protein for your body.

What I recommend is to have .8-1g of protein per body weight. What that means is if you’re somebody who is around 150 pounds, that is having somewhere around 120-150g of protein. You do have to try for that, but once you start doing it, your appetite is going to be reduced all across the day. 

It’s easy to start to get that protein if you start thinking about having 30g of protein at each meal. Having 30g at breakfast, which is something like two eggs and a cup of egg whites. You cook it together and have a side of berries or any of the other fruits we talked about, or have a breakfast salad, which could be arugula with strawberries, or something like that. Having your two eggs with a cup of egg whites gets you to 30g of protein. 

You can also do Greek yogurt, which has 20g of protein. Oikos 20 just came out. 

Or cottage cheese. I love good cottage cheese because they have almost 20g of protein there. You are getting a good boost of it. 

Try to get to 30g by layering on different things. Maybe you have two eggs and Greek yogurt. That can be a really great way. That’s a good start to your day.

Protein is so important. If you focus on anything, adding protein to your breakfast is going to get your metabolism going, and you will see your cravings shift. You won’t have to fight with yourself throughout the day. 

Dr. Eric: 

I agree with making sure to get enough protein. Usually, I recommend at least 75%. 80-100% is what you’re aiming for, so we’re close. If someone is 120 pounds, I would recommend 90-120g of protein. We are pretty close with that. 

Also, I’ll add people could have leftovers for breakfast. If someone is a vegan/vegetarian, maybe a different story. If someone eats meat, and they are having beef or chicken for dinner, they could have leftovers for breakfast to make sure they get enough protein. If they are not eating eggs for whatever reason. 

I know a number of people in the community don’t consume dairy, but I agree dairy could be a good source of protein. Either way. Sufficient protein is definitely important, not only for curbing appetite but also for maintaining healthy muscle mass. 

You mentioned intermittent fasting. I am not against intermittent fasting. One of the concerns is if someone has a very small eating window, they might not be able to get enough protein. Besides the curbing of the appetite, I am concerned about them not maintaining a healthy muscle mass if they only have a four-hour or six-hour eating window.  

Nagina: 

Oh my gosh, absolutely. Let’s touch on protein increasing muscle mass. This is so key. This is why this is more important than ever for women in midlife. In midlife, around age 40 or before, our muscle mass starts rapidly declining. It’s by multiple percentages a year, anywhere from 1-3% a year. 

If you feel like you’re at a place where you’re stuck, and what was working before wasn’t working, a lot of this, there’s a big hormone aspect to it. The other aspect is because your muscle mass is declining, that means your metabolism is declining. Muscle is burning more calories than fat. When your muscle is transitioning to fat, you might be at the same weight, but you’re not able to lose it as much because you don’t have the same metabolism. You can create that by building your muscle back up. 

What is surprising is you can actually rebuild muscle just by taking in protein, not even working out. Of course, working out is great. It’s going to accelerate it. It’s what you will need to add on at some point. I have seen so much research of my clients who are simply adding the amount of protein that we talked about, and their muscle mass is increasing week after week. This is so important to keep your protein intake high.

The other thing is that protein actually digests more slowly than other food. That is part of the reason that you are not feeling as many cravings for sugar if you’re eating protein. You’re feeling more satisfied and full for longer with less calories. That protein is digesting more slowly, so you’re not hungry again. It didn’t go through your system so quickly.

Touching on intermittent fasting. I have to say I would be an advocate only for the right person. That person is a very small percentage of our population. If you are looking to feel more energy and lose weight in a healthy way. This is because I have seen intermittent fasting work well only if you are somebody who is significantly overeating, and you really need to cut your calories over the course of the day. Or you’re binge eating at night, and you need to control that. 

What is happening more often with women in midlife is that women are not eating enough to begin with. That is because of the stories that we have been told for so many years, that you have to eat less to lose weight. We have this running story in our head that we have to eat less. Skipping breakfast is an easy way to do that. 

What is actually happening is you’re staying stuck because you’re not getting nearly the amount of calories that you actually need. Our body needs calories. We have to take care of ourselves with food and eating the right amount. When you eat the right kinds of food, that is going to help you lose weight versus trying to eat less of the calories that you actually need. You’re just going to stay stuck because your metabolism has slowed. You’re not giving your body enough to burn. You’re just giving yourself enough barely to survive. That may be why you’re not feeling that much energy; you’re undereating. 

Dr. Eric: 

I agree. Most people who are struggling with losing weight, it’s not a calorie problem. There are other issues. Many people who are listening to this have Hashimoto’s or hyperthyroidism. Hyperthyroidism could go either way. 

When I dealt with hyperthyroidism, I lost a lot of weight unintentionally, even though some people with hyperthyroidism gain weight. Arguably, that is more the case with Hashimoto’s, having low thyroid hormone. Even in those situations, balancing the thyroid hormone many times won’t cause the person to lose weight. Same thing with caloric restrictions. Same thing with exercising. 

You don’t want to overeat carbs and eat unhealthy foods. You don’t want to be a couch potato. For those who have low thyroid hormone, you want to make sure you have healthy thyroid hormone levels. There are a lot of other factors when it comes to losing weight. With talking about some of the factors, too: not enough protein, making sure you are eating the right foods. You mentioned combining foods.

Spices. I haven’t had anybody talk about spices, at least not in great detail like you have on some other interviews. I don’t know if there are any other foods you want to talk about. If so, feel free to do so. I want you to start talking about spices as well. 

Nagina: 

Yes! Spices are so exciting and fun. If you could imagine losing weight could be fun, it actually can be. When I lost 40 pounds, it was the most exciting moment of my life. I was loving what I was eating, and I was seeing my waist shrink. I was seeing my pants fit me again. I had more energy. I was loving what I was eating every day. It was because of the spices.

Spices come from my background. I am Indian. I grew up in a traditional Indian household where spices were like water to us. We had them with breakfast, lunch, and dinner. 

When I started learning about how to get healthier when I was an adult, nothing that I saw out there had spices. It was all about plain chicken and broccoli with maybe a little bit of something on it. For somebody who loves flavor and food, which is a lot of us, it was impossible for me to eat healthy because I thought healthy equaled boring. I really needed that excitement, flavor, and pleasure in the food I was eating.

When I had gone back and done the research, which preceded my 40-weight loss, one of the other things I had done was made It my own. I started adding spices I knew about from growing up with them. This really accelerated my weight loss journey. I ate more than I was eating growing up. 

My husband, who is not Indian, got healthier with me, and he just really stood by the fact that cayenne pepper helped him lose 20 pounds in the first month. He was sweating. He felt that his weight was coming off whenever he added cayenne pepper.

Spices have a lot of metabolism-boosting effects, and they help your food taste really good. One of the first spices I recommend for people to try is one that we mostly all have in our kitchen cabinet. So are all the ones I mentioned. They are very common. They are not hard to find. They are not exotic. 

This one is to use a spice that is sweet. That is because a lot of times, when you’re on this journey, we have a taste for sweet. Using a sweet spice, which is otherwise known as cinnamon, is a really great way to get started.

One of the ways I first kickstarted my weight loss journey was I added cinnamon to my coffee. It took the place of my sugar or Splenda. I was using an artificial sweetener, which there is a lot of studies and reasons that artificial sweeteners are keeping us addicted to sweet foods. You really want to replace that with something that is natural. 

Having cinnamon in my coffee helped me prevent the need for artificial sweetener. It also helped me no longer need my creamers like a French vanilla creamer. Those things you end up using more than you think, and it’s not that those are causing you to keep your weight on, but it’s causing you to have sugar cravings throughout the day. That’s really adding up over the course of the day. 

Putting some cinnamon in your coffee, you can add some almond milk to it or some milk if you want to have some type of creaminess in there. Milk doesn’t have as much sugar as a creamer does, or you can use an almond milk creamer. That’s a really great start to your day. 

Cinnamon helps you lower your blood sugar. The spikes we were talking about, going up and down, if you add cinnamon, you prevent those spikes from happening. As a result, you store less fat. It starts in your belly; you store less belly fat.

When I started doing this, I was so excited because I realized how good my coffee was. I saw the benefits and effects on my body. I not only was storing less fat in the morning, but it was giving me the sweetness I needed. I wasn’t having sugar cravings either. 

Starting with cinnamon and getting proactive with adding that into your coffee, tea, or on top of your fruit is also going to help you counteract some of those blood sugar spikes. Cinnamon is a top one to get started with. 

You can use any cinnamon. There is a lot of research on which one you can use, which we can talk about. Overall, it doesn’t really matter unless you are using large quantities. Get started with the cinnamon you have. 

A really great spice to add is a spice I call neutral taste. This is turmeric. Turmeric is very popular right now. A lot of people are using it for anti-inflammation, and that’s exactly what it does. It’s anti-inflammatory. You want to combine it with black pepper because that increases the absorption of the compound called curcumin, which is in turmeric, by 2,000% in your body. 

Let me tell you a little bit about turmeric. It is a gorgeous bright yellow color. It actually has hardly any taste. It is very neutral in its taste. You can really add it to so many things. 

A natural blend is to add it to your eggs if you eat those. Add a half teaspoon to your eggs. Turmeric is yellow, so it goes with eggs. It doesn’t really add too much of a different flavor. It has a slightly earthy taste. It’s nowhere near spicy. It’s extremely neutral in its taste. That’s really good.

If you are somebody who has a protein shake, if you go to the gym and work out, adding it to your protein shake, doing a half teaspoon, will help your muscles relax even more because it’s anti-inflammatory. You will feel that relaxation. 

Or making a tea at night with turmeric tea is such an amazing replacement to something like wine if you have a wine habit at night. Have turmeric tea instead. It actually relaxes your entire body because it’s so anti-inflammatory. It’s great if you can make your own. I have a turmeric tea recipe on my website. You can also buy a turmeric teabag from anywhere you can find it. Trader Joe’s has some good ones.

Turmeric is the second one. I will share one more that is a complement to these other two. That is a spicy spice, or the spice that my husband credits for helping him lose 20 pounds in the first month of eating this way. That is cayenne pepper. Cayenne pepper has a compound called capsaicin in it. It’s in most of the spicy spices, things like cayenne pepper, red chili powder, jalapenos, serrano peppers. That is the compound in it.

If you want a milder version to get started with, you can try paprika, which has less capsaicin. It’s a little spicy and a little sweet, so it’s a good way to get your foot in the door. You actually do learn how to eat more spicy foods when you start eating some spicy food. Your tastebuds open up.

What cayenne pepper does is increase calorie burning. It increases your metabolism. You’re burning more calories when you add this on. You can also use it in the form of red chili flakes, which are what we see at pizza places. Those are a little milder as well. It increases calorie burning. It adds flavor. 

A really good way to use cayenne pepper is to add it on any protein you’re having, whether it’s chicken, fish, or on your veggies. Just add a sprinkle on, whatever your preference is. Doing 1/8 of a teaspoon or less is really great because you’re getting some of those benefits and the flavor. 

Starting with cinnamon, a sweet spice, to lower your blood sugar and store less fat. When you use turmeric, you will lower inflammation. When you use cayenne pepper, it’s going to help you increase your metabolism. These are all different elements of losing weight in a healthy way that is sustainable and using natural ingredients to do that. 

Dr. Eric: 

You said half a teaspoon of turmeric. With cayenne pepper, a sprinkle, maybe up to 1/8 of a teaspoon. With cinnamon, is it half a teaspoon of cinnamon, like turmeric? 

Nagina: 

That’s a good question. For cinnamon, you just want to have a sprinkle. That is because cinnamon can actually get spicy if you have too much. If you want to have something to measure it with, 1/8 of a teaspoon is the most you should have. It starts to get spicy after that. I really recommend that you just sprinkle some on and don’t go over what 1/8 of a teaspoon would be because the flavor shifts.

Also, if you’re putting it in your coffee, you don’t even have to mix it in. You can just sprinkle it on top and drink it. It doesn’t always mix in as well. Having a sprinkle of it is great. 

Dr. Eric: 

Okay. Cinnamon, turmeric, cayenne pepper. I heard you on another interview talk about using spices to make your veggies taste better. There are people who just don’t enjoy eating vegetables. I imagine you’re probably not using cinnamon on your vegetables although I could be wrong. What spices do you use on your vegetable to make them taste good? 

Nagina: 

This is so important. Vegetables are one of the secret ways to keep yourself full and give your body the nutrients it needs without adding a lot of extra sugar or extra calories that are above and beyond what your body needs. Because vegetables have so much fiber in them, when you pair them with protein and have 50% of your plate for protein and 40-50% for vegetables, you’re really going to have a lower appetite for other foods. You’re giving your body what it needs. You’re taking care of your body with the right foods.

One of the core terms that I talk about is “tasty veggies.” We all know we are supposed to eat veggies, but the biggest reason many people don’t is because they don’t like the taste of them. Imagine if you were able to get to a place where you’re craving vegetables, where your body is needing vegetables, where if there is a plate of breads and other carbs and protein and veggies, you go for the veggies first. That will happen when you start adding this amount of veggies to your diet.

The way to do it is to have them be tasty. The best way is to add these spices. 

The other way is to roast your vegetables. They are very tasty when you put them in the oven for 15-20 minutes on a sheet pan. Just spray the sheet pan with cooking spray. The sweetness comes out from the veggies. 

Some really good spice blends I recommend are to add either turmeric, because you are getting the anti-inflammatory benefits, with black pepper. You can add cayenne pepper. 

You can also do what I love, which is what I call a belly fat-burning blend. We can talk about the amounts, as it depends on the amount of veggies you have. Cumin, coriander, salt, and pepper. Cumin has been proven to burn belly fat in multiple studies. 

If you are adding cumin to your day, you will burn more belly fat than if you don’t. Of course, you need to eat these foods we are talking about as well. Coriander is debloating, so it reduces water retention. That is really good. Cumin is a smoky flavor. Coriander is a fresh, tangy flavor. They are both neutral in terms of heat. You are really getting a nice compliment when you do cumin, coriander, sea salt, which is a little healthier salt, and black pepper. That is a really great combo. 

You can also add turmeric and cayenne pepper to that if you want some heat. Those are some levers you can pull. Those are some really great ones. 

If you want to have a couple blends that you don’t have to add separate things, I recommend using lemon pepper. It’s lemon as well as pepper. Have that with some salt. It’s really refreshing. Even black pepper actually helps you burn more calories than you would in a 20-minute walk. Having black pepper is really good. 

In addition, another spice blend is called garam masala. It is an Indian blend, but you can find it everywhere. It has a combo of a lot of the spices we talked about. It has some coriander. It may have cumin, depending. It has cinnamon, which actually goes well with it. It has a little bit of cloves. It nicely goes on everything. It’s a go-to spice blend. 

Put your veggies down on aa sheet pan. Spray it with cooking spray. Put a blend of this. You could do about two tablespoons total. If you put ¾-1 teaspoon of each of those spices I told you about, so you get to 1-2 tablespoons. Sprinkle some olive oil on your veggies, add the spices, and mix it with your hands if you want, if you are able to do that. 

Veggies that are really good are things like asparagus, red bell pepper, green bell pepper, broccoli. If you really want to go in a debloating direction, a really good combo is doing asparagus with coriander, salt, and pepper. Asparagus is very debloating in that it reduces water retention. So is coriander. 

If you mix those two things once a day for three days, you’re going to notice your bloating is going down. You will immediately need to go to the bathroom soon after you have that meal even if you didn’t drink anything because it’s pushing water out of your system.

This is real science. It’s chemistry in our bodies. We can use it to get our metabolism high, slim down, make our food taste good. All of those are important. We want our food to taste good in order to make this a sustainable lifestyle. 

Dr. Eric: 

I really enjoyed this spice conversation. I don’t think anybody has focused on some of the different spices. Glad that you touched upon them. 

Like I mentioned, over the years, there have been so many people who don’t want to eat vegetables and asked if they can have a veggie powder. I have to say it’s better than nothing, but it’s not the same as eating vegetables. 

It’s safe to say that many people haven’t tried to get creative with cooking. To be fair, it’s not like I’m an amazing chef who is creative. It doesn’t take a lot of creativity when adding spices. I have learned that. 

I use a number of ones you mentioned. I actually don’t use cayenne pepper; I do use paprika. Maybe I will try to get a little more daring and add cayenne pepper to my food. I do use coriander and oregano and thyme, which you didn’t mention. It can make a big difference to add some of these spices as well as some others. 

Nagina: 

Oregano is such a great flavor booster. It’s so good. It goes well with so many things. Same with thyme. All the spices we’re adding have benefits to them. They’re really good. 

This comes back to my concept of adding more. Instead of taking away, it’s more about adding more protein, more veggies, more spices. Making it taste delicious. Naturally, your body is not going to crave the foods that were keeping you stuck and keeping you feeling low energy. It will naturally start to transition when you’re consistent with this. 

Dr. Eric: 

Anything else that you wanted to discuss? Anything that I should have asked you that I didn’t ask you about boosting metabolism? 

Nagina: 

We talked about so many things, so that’s great. I could maybe touch on a bit more of the food combining, in terms of how to combine foods, just for a moment. 

I mentioned that if you’re going to have a higher sugar fruit, to pair it with peanut butter or nuts or a protein. Keeping that in mind when you are going to have a carb or sugar, definitely don’t have it alone. 

One of the biggest things I see is women will grab a banana and run. What I recommend is to have some with peanut butter. Only have half of the banana. You will be eating more with the peanut butter. You will be slowing your blood sugar spikes, so you won’t store as much fat, and you won’t need as much of that banana as you have something else as well.

The other thing is when you are eating something like pizza or spaghetti, you don’t have to avoid those. What you can do is make sure that you’re having a protein with it. You’re also having greens with it. Have a salad. What that does is lower your blood sugar spikes. Instead of your blood sugar going up and down, it won’t go up as much. It’s not going to need to come down as much, which means you’re not storing as much fat. 

A key way to do this is not to say, “I don’t ever get to have pizza or pasta.” Instead, have your pizza with some protein on it, so if you eat meat, having protein with it, or you can have a protein shake on the side if you don’t eat meat. Or having meatballs or vegan meatballs with your spaghetti. Have a salad first. 

When my family orders pizza, a lot of times, I make sure that I have my salad. I order a salad. I will often get a seafood salad, and then you have protein in the salad. Then I will have one or two pieces of pizza versus if I was only having pizza, I would have had three or four pieces. You really adjust naturally, but you are not getting as much of that spike.

In general, think about always adding on a protein or a healthy fat but then also having some greens if that makes sense for that meal. Then having your carb or sugar. You will see it will make a lot of difference. It’s just about educating yourself and understanding what these foods are and how to eat them together.

Dr. Eric: 

I always love talking about pizza. I will say that many of the people I work with, I tell them to take a break from pizza and pasta while healing. On a wellness basis, I can’t say that I never eat pizza. Usually a cauliflower-crust pizza. I do add protein, too. I just added cheese in the past but realized that’s a good way to add some chicken, for example. That’s something I try to do. You can definitely get some protein when someone is eating pizza.

For those who aren’t eating pizza now, maybe in the future, if/when you reintroduce pizza, try to have some protein as toppings, whether it’s chicken or something else. 

You did cover a lot of information. I really appreciate everything you shared. 

Nagina, can you tell people how they can find out more about you? Also, I know you have an upcoming five-day metabolism boost event. If you could talk about that as well. 

Nagina: 

Absolutely. You can find me at my website, MasalaBody.com. That is where I have lots of blog posts as well as a lot of success stories, if you click on Success Stories, of other women in midlife, women in their 40s-70s who have lost a significant amount of weight. You will hear about how it was so doable and sustainable, and now it’s a lifestyle, not a diet.

I would love to invite you to my upcoming five-day Metabolism Boost, where I will be teaching every day for five days in a live workshop. It’s completely free. I will be teaching how to boost your metabolism. 

The first day is about creating your metabolism boosting morning routine. I will talk about how to get your day started, what to add to your morning, so that you get your metabolism boost going immediately. 

I am also going to be talking about the four-part fat-burning food framework, where I teach you exactly how to pair your foods and the quantities of foods you need for lunch and dinner. 

Then I will be talking about how to get off sugar without feeling tired or restricted and show you how to combine your foods and how to prevent those blood sugar spikes so you can store as little fat as possible and really work on getting leaner and stronger.

I am so excited for the five-day metabolism boost coming up so soon. 

Dr. Eric: 

Thank you so much. This was so great. I really enjoyed this conversation. I found some of the information, especially the spices, valuable. I always enjoy talking about pizza as well. We don’t talk too much about pizza on this podcast, but sometimes we do. Thank you so much, Nagina. Really appreciate you taking the time to talk about boosting metabolism. 

Nagina: 

Thank you! 

Recently, I interviewed Dr. Campbell and we discussed her inspiration for writing The Blood Pressure BluePrint, the connection between blood pressure, oral health, and thyroid function, insights into proper blood pressure measurement, the importance of holistic approaches in healthcare, supplements that can help with managing blood pressure, and more. If you would prefer to listen to the interview you can access it by Clicking Here.

Dr. Eric Osansky: 

Dr. Campbell is a native Chicagoan and a graduate of the University of Illinois, The Kirksville College of Osteopathic Medicine, and the Medical College of Georgia. Board certified in family medicine for 30 years, she also holds certification from the American Board of Integrative Medicine. 

She is a solo physician especially interested in interdisciplinary collaboration, functional medicine, reversing chronic disease, cardiovascular disease prevention, natural treatments for high blood pressure, and the many oral systemic connections. 

She also enjoys live theater, gardening, healthy cooking, hiking, travel, and playtime with her husband and three adult daughters. 

Thank you so much, Dr. Campbell. Great to have you here. 

Dr. Ellie Campbell: 

Thanks, Dr. Eric. It’s my pleasure to be here today. 

Dr. Eric: 

I just finished reading your book. It’s an amazing wealth of information. There is a lot of topics that you could write books on. Blood pressure is one of those things where a lot of people think it’s basic: high blood pressure or low blood pressure. Obviously, there is a lot more than medications, which we’ll talk about. Really interesting. Some topics I wouldn’t have guessed would have been in the book, like oral health. Very excited to talk to you about this. 

I know I gave a little bit of your background with the bio. If you could dive a little bit deeper. What led you to write the book? 

Dr. Ellie: 

Thanks for the intro. I have bene a family physician for 30 years. One of my greatest joys is taking care of multiple generations in the same family. 

When Cheryl came to see me, she originally wanted to have a baby. She was 42 years old, and she’d had one child but wanted to have another. She was a little bit old to be pursuing this, but she went to fertility doctors. They all told her that her and her husband’s genes were incompatible with each other, and they could never have a baby. She went, “That doesn’t make any sense to me because I have a perfectly healthy kid. We did it once, so we can do it again.” 

To make a long story short, I worked with her using a functional medicine approach to her fertility, and we were able to get her successfully pregnant and have another beautiful baby boy.

At the end of that, she said, “You’re pretty good with hormones. I think my mother could use your help as well.” Now I am taking care of the two boys, the daughter, and now the grandmother. 

The grandmother comes to see me. She has high blood pressure, and we take care of that with medication and therapeutic lifestyle changes. She has high cholesterol, so I have her on medication for that. Now she wants bioidentical hormone replacement therapy, so she can keep up with her much younger boyfriend, go line dancing, drive four wheelers, play with the grandkids, and do all these wonderful things that this spunky grandmother did. I did all of those things. I was managing her standard of care the way everyone in the community does.

One day, Cheryl calls me, devastated. She was crying. She said, “Mother did not show up to work today.” I went to her house, peeked in every door and window, and discovered her crumpled on the floor next to her computer. She’d had a massive stroke, and she was paralyzed on one side. 

I felt devastated. I am the primary care doctor. It was my job to take care of her. Strokes are supposed to be preventable. We knew she had risk factors, but I thought we were managing them. She had an event anyhow. I felt somehow like my system had failed me. 

She joked with me that she was going into rehab, and it was going to take a lot of therapy to help her start dancing again. Dragging one paralyzed leg behind her was really challenging. 

About five days into her hospitalization, she had an unexpected but not that rare complication that happens in about 10-20% of strokes. That weakened blood vessel that had had the stroke burst. Dee had a brain hemorrhage, and she died. 

I felt like I had been punched in the gut. It was my responsibility to take care of this lady, and we failed her. The system failed her. 

I spent the next three years of my career studying everything I could about high blood pressure, high cholesterol, and stoke prevention. I finally feel like I cracked the code on it. Once I did that, I felt compelled to write this book, not only to help myself, but all the other patients I provide care for, and more importantly, to reach a larger audience. 

There are so many DIY things that people can do to get their blood pressure and their cholesterol under control, and reduce their risk for cardiovascular events, which are the #1 killer in our country. 

I was going to write a book. Spoiler alert. The #1 hidden risk factor to the #1 killer in our country and the problem that Dee had that I missed was a dental infection. It was a deep-seated dental abscess. Once I learned that, I wanted to write a book about how oral health can change your entire life. If you take better care of your mouth, you’ll take better care of your brain, your heart, your kidneys, your gut. You can’t have an unhealthy mouth and have a healthy body. 

I wrote this book about oral systemic connections. Nobody wanted it. I pitched it to 82 publishers, and nobody would publish this book. It was really boring. Fast forward. This was right before the pandemic. I Googled what were the health topics that people were really interested in? Blood pressure came up to be the #1 thing that people wanted to know about. The top 10, 10 years in a row. 

I thought that is indirectly connected to my message. I am going to flip it around. I will make it my message and teach people what they really need to know, which is they need to eat clean food, drink clean water, exercise, reduce stress, get good sleep, and have good oral health. If we get that message across, we will save so many lives.

I’m so grateful for you because those same fundamentals correct almost every chronic illness from hyperthyroid to hypothyroid to diabetes to obesity. If we get those fundamentals right, we can reduce the risk of every chronic disease and dramatically reduce our risk of the #1 killer in our country. 

Dr. Eric: 

I agree. Oral health is important. Even though I was surprised that you brought it up, I shouldn’t be because I talk every now and then about the importance of oral health. I interviewed my biological dentist Dr. Eric Kempter on the practice. I agree that having, whether it’s simply gingivitis, inflammation of the gums, but an abscess, an infection, mercury amalgams, there is a lot of issues we could have when it comes to the mouth. Most people think it just stays in the mouth, but it definitely doesn’t. 

Dr. Ellie: 

It definitely doesn’t. We know oxidative stress and inflammation are probably at the root of most chronic illnesses. Oral health is a primary driver of oxidative stress and inflammation. Beyond that, we now know we are supposed to have bacteria in us. We are a microbiome having a human experience. We need to have this microbiome. We use their genes to do all of our metabolic processes. We have to have a healthy microbiome. 

When we get unhealthy, and we have a pathogenic burden, these pathogens do nasty things to us by driving inflammation. There is one in particular I’d like to mention. It has a long name: Porphyromonas gingivalis, PG for short. This particular bacteria lives off of blood. When it gets into your gums as a pathogen, it makes a really bloody gum inflammation. When you floss or brush, you get pink in the sink. PG is often present when you have that gingivitis or periodontal disease. It makes that bloody mess, so it has fuel for its own self to live. 

Now, it’s really tricky. That PG bacteria buries itself inside the red blood cell and becomes a hitchhiker. Wherever in your body red blood cells go, which is everywhere, the PG can hitch a ride and land wherever that blood cell lands. Once it gets there, it secretes a little fatty molecule called phosphorylated dihydroceramide. It’s a wax. It’s a plaque. It makes plaque in your teeth. 

If that blood cell lands in your brain, it can make plaque in your brain. That can lead to dementia and Alzheimer’s. If that PG bacteria lands in your neck artery, it can cause hardening of the arteries, corroded artery atherosclerosis. That leads to increased stroke risk. If that bacteria lands in the coronary arteries and makes phosphorylated dihydroceramide in that space, it makes plaque in your coronaries, increasing risk for heart attack. 

Where did that bacteria come from? Your mouth. I can’t have my patients have a healthy brain or heart if their dentists and hygienists aren’t helping me to make their mouth healthy as well. 

Dr. Eric: 

You of course recommend regular checkups. Do you recommend for someone to see a holistic, biological dentist? Or just as long as they are getting regular checkups. 

Dr. Ellie: 

I think that first of all, a dentist who is not holistic is generally not educated in the fact that the mouth affects the rest of the body. They’re focusing on this part. They don’t really think about all the other connections.

Furthermore, I have blood tests that I do as part of my routine cardiovascular prevention. I didn’t know about this when I was working with Dee way back eight years ago, but I know this now. I do something called the fire panel. It includes markers of oxidative stress and inflammation. 

One of them is called Lp-PLA2, Lipoprotein-associated phospholipase A2. It’s an enzyme. It’s made by white blood cells. When those white blood cells are in plaque in the arteries, and that plaque is inflamed, and those white blood cells are angry, Lp-PLA2 levels go up. 

Turns out Lp-PLA2 is also found in white blood cells in gum tissue. I have a leading indicator in my cardiovascular bloodwork that tells me, “Dentist, I have a patient I need to send to you because I did their heart bloodwork, and they have a clue that they have a dental problem.” If you’re not using a biological or holistic dentist, they may not be educated, and you will take them this bloodwork, and they won’t know what to do with it.

You not only need a holistic dentist, but one who has been educated in what these markers mean, what they need to look for, and most importantly, how to correct the problems once they found them. Because we know that these mouth bacteria that cause this inflammation and lead to the plaque and oxidative stress that lead to increased risk are not easy to get rid of. 

Of course, it requires good home hygiene. You have to be brushing your teeth and flossing and rinsing but not with the wrong mouthwashes because the wrong mouthwashes will decimate the good bacteria, actually raising your blood pressure, so we need to be careful about that. So good home hygiene.

Then a really good dental cleaning, often scaling and planing, deep cleaning. Those unfriendly bacteria are coming back in four hours unless you have done something to taint the terrain. We have to work with our biological dentist to talk about nutrition and pH and saliva flow and oral probiotics that are specifically targeted to help shift the balance of the unfriendly bacteria and chase them away and let the friendly bacteria that are supposed to live in our mouth flourish. That requires a complex, personalized, precision, individual medical dental care team working together. 

Dr. Eric: 

I want to discuss some other factors that can affect blood pressure. Before we do that, can we go over some of the basics, like what is considered to be normal versus optimal? How to measure blood pressure? 

Dr. Ellie: 

That is different. When I was in medical school, we were getting people by 160/100 if they were over 70. You have high blood pressure, it’s normal. Just because it’s common doesn’t mean it’s normal or healthy. It doesn’t mean you won’t have risks associated with that.

We now have determined that a normal blood pressure reading, believe this or not, is 119/79 or lower. That is a normal blood pressure. Even 120-129/80 is considered elevated. 

In the old days, we used to call that pre-hypertension, but they took that diagnosis away. We just call it elevated blood pressure. The new guideline for hypertension, you are officially diagnosed with hypertension at 130/80-139/89. That is stage one hypertension. 

If it’s 140/90 or higher, which was our old definition, that is now considered stage two hypertension, and a much higher health risk for the development of heart attacks, stroke, kidney failure, blindness, erectile dysfunction, and all of the other downstream organ damage that results from the pressure caused on those blood vessels from hypertension. 

Recapping, we want our blood pressure to be less than 120/80. If we are more than 140/90, we probably need to be under the care of a medical provider to get that targeted and under control. Certainly, many things are DIY. There are so many things that people can do to get their blood pressure under control. First, we have to know how to measure it properly. I was doing it wrong for years. 

We now have guidelines that tell us what is proper to measure your blood pressure. The first, most important thing is you’re not supposed to eat, drink, vape, or smoke 30 minutes before you go in to get your blood pressure checked. If you do that, the temperature changes. The physiologic processes of running digestion can alter your blood pressure. We are trying to standardize it, so everyone has the same guidelines, and we are comparing A to B to C to measure blood pressure. First, no eating or drinking.

Next, we have to make sure that the blood pressure cuff is the proper size, and it goes directly on your bare arm. You should not put your blood pressure cuff over clothing, especially not over a sweater. Even a T-shirt can affect your blood pressure five or ten points. A sweater can affect your blood pressure by 30 points and give you a false hypertension reading when all you really have is sweater pressure, and you don’t really have hypertension. 

The next thing, and this is a mistake that we made in my office for decades because I wasn’t smart enough to know better, and the CDC hadn’t published their guidelines until 2019. You have to have an empty bladder when you check your blood pressure. Your bladder has very sensitive pain receptors. When it stretches, it stimulates those receptors, and it can raise your blood pressure. A painfully enlarged bladder can raise your blood pressure for three hours after you check it. 

In my old days, we used to have the patients come into the waiting room, sit down. When they were ready to go back, we’d put them in the exam room, sit them down, take their history, check their blood pressure, and send them to the bathroom to get a urine specimen. 

We don’t do it that way anymore. They come to the waiting room and are escorted to the bathroom first thing, and they empty their bladder before anything else is done because we want them to have an empty bladder. It is a very important part of measuring your blood pressure. Most offices, including myself, don’t do it properly.

The next thing, once we fitted your blood pressure for the proper cuff, we want to make sure that your arm is resting at heart level. You are not holding it up. You are not dangling it down. It is resting on an arm rest at heart level. 

You are not allowed to talk. You are not even allowed to listen intently for five minutes. In our office, we always used to chitchat. How are you? How are the kids? How is the dog? How are things going? Hold on one second. Then we tell them to be quiet, so we can take their blood pressure. That chitchat can raise your blood pressure 10 points. 

Even intently listening to that really interesting conversation that is happening in the medical office next to you can raise your blood pressure five or ten points. No talking, no chitchatting, no active listening while you are trying to get your blood pressure checked.

The next thing is you have to be seated properly with your bottom to the bottom and back to the back and feet on the floor. If you are using your back muscles to hold yourself up, you can raise your blood pressure 15 points. If your feet are dangling, like you are sitting on the edge of an exam table, you can raise your blood pressure 10 points. 

I have a secret. I am vertically impaired. I am only five feet tall. I cannot sit in 90% of chairs with my bottom to the bottom and my back to the back and have my feet touch the floor at the same time. If your patients are vertically impaired like me, and you want to measure an accurate blood pressure, you need to offer them a foot stool to rest their feet, so their feet are not dangling, as dangling feet can raise blood pressure. 

Never check blood pressure on an exam table. If you are a dentist, and you are a wonderful dentist who is checking blood pressure in the dental office, the patient can’t be laying supine in the dentist chair to check their blood pressure. That is also not an appropriate way to do it. 

We did lots of things wrong when I was measuring blood pressure. Now that we have standardized it and follow these guidelines, we get much better, reliable data. We also want our patients to check their blood pressures at home with these guidelines, so they, too, can get proper blood pressure readings. 

Dr. Eric: 

Scary that there might be then some people on medication who are falsely diagnosed with blood pressure if they were doing multiple thing wrong. If they didn’t empty their bladder, if the doctor didn’t have them test with the bare arm. Maybe they were wearing a sweater or a T-shirt. If they weren’t resting for four or five minutes, if they just sat down right away. If they had three or four of these variables, maybe normally they would have had a blood pressure that is below the 120/80, but they read as higher. 

You would assume they wouldn’t give blood pressure medication based on a single reading, but if that is the way they measured every single time the patient came in and didn’t have them do it on their own at home the proper way, some people might be on medication when they don’t need it. 

Dr. Ellie: 

You’re right. We also know that there is a component of white coat hypertension. This is a very real phenomenon. There’s something psychological, emotional that happens to people when they see the white coats or the doctor’s office sign. Their blood pressure will go up much higher than it ever does at home. 

Those people deserve to have home blood pressure readings, just like we would never treat a diabetic based on a single reading of sugar that they get in our office. We should not really be treating hypertensive patients based on single readings we get in our office. 

We need a lot of data. We want home blood pressure data or even a 24-hour ambulatory blood pressure monitor, where they’re wearing a same monitor for 24 hours, and every few minutes, it gives a reading. It’s uncomfortable and hard to sleep with. 

But we can get a pretty decent reading with frequent at-homes. Sometimes, you’re stressed. Sometimes, you’re relaxed. When you’ve slept well. When you’re sleep-deprived. I want to see the whole gamut of readings. 

Just as there are some people who have white coat hypertension, some people have something called masked hypertension. These are people who are really good at getting into their zen before they go to the doctor’s office, and their blood pressure looks perfect. When they get home and have a spat with their spouse or get into traffic, their blood pressure goes crazy high. The only way we would ever know this is if they are getting home data. 

That is a message I want to bring to the audience: For anybody whose readings are not routinely 120/80 or less, they have a home blood pressure monitor and start checking some data at home. Get it at different times. Keep track of it. You don’t have to check every day or every hour, but you have to check some and keep the data going. 

Dr. Eric: 

How accurate are other devices? There are wrist cuffs compared to arm cuffs. 

Dr. Ellie:

So far, we don’t think they’re ready for prime time. They don’t seem to correlate quite as well. I think they’re getting better as our technology gets better. 

At this moment in time, I absolutely do not trust a phone app or a finger app. The wrist, maybe if you are holding it properly at heart level with your arm resting, maybe they are getting closer. I still think the gold standard is an arm cuff. 

Dr. Eric: 

Other causes of blood pressure. One that gets a bad rap and has for a long time is salt. If you could talk about that. 

Dr. Ellie: 

There are some people who are salt-sensitive. This is true. It’s not the majority of hypertensive patients. Furthermore, it’s been my clinical experience, and probably yours as well, that people who are nutrient-deficient, especially magnesium, potassium, manganese, iodine, are much more salt-sensitive. They eat a normal amount of salt, and their blood pressure goes up.

When we replete these micronutrients, they can handle salt, and it’s not such a problem anymore.

 I think every patient who has been newly diagnosed as hypertensive or has long-standing hypertension deserves a trial to see if they are salt-sensitive. Go two weeks with very low salt, less than 2g/2,000mg. That pretty much means you can’t eat anything from a box or a can. You can’t eat anything from a restaurant for two weeks. You are cooking your food at home, and it’s pretty bland, unless you use lots of spices. You can use turmeric and Indian spices and Mexican spices and Asian spices. You just can’t use salt. 

Take your blood pressure for two weeks with low salt. Then go heavy on the salt, and enjoy everything you like. Eat all the crazy salty stuff you want, and see what your blood pressure looks like. 

If you are one of those people who has a 30-point differential between the no salt and high salt diets, you are probably salt-sensitive. Make sure you get yourself on magnesium, potassium, manganese, trace minerals, zinc, and iodine. Make sure all those things are replete first. Then you can tolerate your salt most likely with no problem. 

Most people who are salt-sensitive are using the wrong salt. Just like we never in integrative medicine recommend that people eat foods made with white flour or white sugar, we want unrefined, natural, whole grains and unrefined sweeteners, we don’t want refined salt in a blue can that pours when it rains. That salt is highly refined. Sometimes, they add iodine back into it. Sometimes, they don’t. it’s highly refined. 

Let’s use natural salt, full of minerals. It’s usually pink or gray. It’s Celtic or Mediterranean. Those salts are often much better tolerated than the refined white salt in the blue box. 

Dr. Eric: 

I agree. That’s what I use. I use the more natural salts, either Celtic sea salt or pink Himalayan salt. Glad you mentioned that.

How about thyroid? A lot of the audience is thyroid. Some might think if someone has low thyroid hormone, they will be more likely to have low blood pressure, not high. Maybe vice versa, if they have hyperthyroidism. I can’t say I see that in my practice. There are definitely people with hypothyroidism with high blood pressure, and people with hyperthyroidism with low blood pressure or normal blood pressure. I’m sure you see the same in your practice.

Dr. Ellie: 

I do. I think they overlap a lot. I also think that probably there is more correlation between the underlying root causes. What is an underlying root cause of hypothyroidism? For many people, it’s nutritional or environmental or toxic. If we are living in a toxic soup, then our blood pressure is likely to be high, and we might have hypothyroid or hyperthyroid in that instance. 

We want to work on a lifestyle of detoxification. We want to work on a lifestyle that doesn’t bring toxicants into our body. That means looking at our home environment. What are our cleaning products? What are our personal care products? What are our foods? How are they prepared? When we lower our toxic burden, our blood pressure is easy to control. 

We have heavy metals. In heavy metal toxicity, you will often see thyroid dysfunction. I have seen hyperthyroid and hypothyroid from heavy metal toxicity. We work on chelating those metals one way or another, whether that’s oral, rectal, IV, however we are going to get these heavy metals out of the body. As we do that, the arteries get softer, and blood pressure is easier to control. The same underlying root causes for one condition can drive the other. 

Dr. Eric: 

Any other direct or indirect causes of high blood pressure?  

Dr. Ellie: 

Yeah. We have talked about the mouth. In Dee’s case, what caused her blood pressure to spike and caused her stroke was that she had a dental abscess. She actually had an appointment to have her tooth extracted a week after her stroke that killed her. She never made it. She never lived long enough to have that event. 

I know that if the dentists knew what a medical emergency this was, and how it was driving her oxidative stress, we would have been on either stronger antibiotics or done the procedure sooner. We would have intervened in some way. Neither of us were smart enough at that time in our careers to make that call. 

Now I’m smarter. Now when I see people with dental abscesses, it’s like a 911 dental emergency. We got to get you on anti-inflammatories. You want to take baby aspirin. We have to do things to get you prepared.

Oen of the probably #2 root causes that I have seen since I have been paying attention, and it’s also oral related, is sleep apnea. Many people have undiagnosed sleep apnea. I used to think I could look and tell. That person is morbidly obese. They have a size 17 or 18 neck. This Jabba the Hutt body composition. That person has sleep apnea. Often, they do, but not always. 

Some people who are very slender, very tall, very athletically fit have horrible sleep apnea. One of my patients came to see me after his heart attack. He is a very strong, very fit triathlete. He had undiagnosed sleep apnea. He had undiagnosed familial hyperlipoidemia. He had undiagnosed insulin resistance. We got to all those root causes to try to make sure he never has another event. 

Sleep apnea was a major contributor. His oxygen levels were dropping in the middle of the night down into the 80s. When that happens, one of the things that your body does besides waking you up at night to try to get some deep breaths to pull your oxygen level back up is that’s a physiologic stressor, and it raises your cortisol. 

If you ever do a cortisol test, and you have your morning cortisol nailed to the ceiling with these very high AM cortisols, that is an important clue to me that you’re likely being woken up in the middle of the night by something. That something is commonly undiagnosed sleep apnea. 

Most people with sleep apnea have obstructive sleep apnea. There is an obstruction in your airway. Either your nasal passages are clogged, your oral pharyngeal airway, their adenoids are too big. Their uvula is too large. Their palate is too soft. Their tonsils are too large. Or it could be down farther in the oral pharynx. 

In my case, when I was a teenager, they pulled four teeth out. I had an overbite. They put me in headgear to pull my overbite back and make my teeth straight. That was lovely, except for one problem. By taking four teeth out, they narrowed my airway 15mm. I had no room for my tongue except to stick it in the back of my throat. When I laid down in bed, not only would I snore, but I would choke off my airway. 

I developed sleep apnea as I got older. I developed a horrible snoring habit, which I didn’t know I had, but I found out when I spent the night with my sisters on vacation. When I asked my husband about it, he said, “You’ve been snoring for years.” “Why didn’t you tell me?” “I thought you knew.” 

We need to have a conversation with our partners about this. Let’s find out if each other snores. If you snore, get a sleep test. Not all snorers have sleep apnea. Not all sleep apnea patients snore. If you wake up unrefreshed, you need a sleep test. If you have ADHD, you need a sleep test. If you wet the bed, or your child wets the bed after around age five, you need a sleep test. These are often symptoms of not getting deep, restorative sleep. One of the reasons is sleep apnea. 

Some people have an upper airway condition, and they just need nose surgery, and their sleep apnea is cured. Some people need more than that. Some people do need CPAP. I don’t like to use CPAP as my first treatment of choice. I have about five other things we do before we ever talk about CPAP, except in the most severe cases. 

I would say sleep apnea is a very common and underdiagnosed trigger for hypertension. 

Dr. Eric: 

You said you are not against CPAP, but you try four or five other things prior. If someone has to be on CPAP, do you look at it as temporary, just for a period of a few months? 

Dr. Ellie: 

When CPAP was first invented, it was intended to be a temporary bridge until we fixed their underlying root cause. Sometimes, we put patients on CPAP, and they get deep, restorative sleep and lose 25-30 pounds without trying. For the first time in their life, they are not making high cortisol. They don’t have a steroid burden. They are getting deep sleep. Everything calms down. They are not trying to keep themselves awake all day by eating extra calories or caffeine, driving their metabolic function, insulin resistance, etc. Sometimes, CPAP makes them lose weight, and then their sleep apnea goes away. Sometimes, 6-12 months on CPAP, and they are cured. They don’t need it anymore.

 That doesn’t happen as often as I’d like it to, but it can happen. Often, when I see someone with sleep apnea who needs CPAP, I get them to see an oromyofunctional therapist. OMT is like physical therapy for the lips, jaw, and tongue. Sometimes, we can strengthen the soft palate. We can strengthen the lips and jaw. We can get that jaw pulled slightly forward, just by retraining. Those patients now don’t need CPAP the way that they used to.

In some cases, however, there can be a curative surgical procedure. For somebody like me, who had four teeth pulled, and they changed the shape of my jaw growing up, I was fortunately able to correct this wearing an oral device. It’s called a Vivos device. They put it in the roof of the mouth, and at the bottom of the jaw, there was a little key. I was advancing the key a couple of turns every couple of nights, spreading out my jaw. Painlessly, I might add. 

Both my upper jaw and lower jaw, over two years’ time, I was able to expand my jaw and get back most of the 15mm I had lost when they pulled my teeth out. I had to wear Invisalign to close up the spaces that had been made in my teeth by widening my jaw. Now, I have straighter teeth again and no snoring and no sleep apnea. For me, that was curative. 

If I had more moderate or severe sleep apnea, I might be on a CPAP while simultaneously wearing the oral device. 

The final thing is pretty drastic, but it’s curative in 90% of cases of sleep apnea. It’s paid for by every insurance. Most people don’t know about it. It’s called a maxillary mandibular advancement surgery. It’s a really big deal. They cut your jaw in half on the top. They cut your jaw in half on the bottom. They push everything forward. They do bone grafts and make extra room, so your entire face moves forward. Now your tongue and jaw move forward and get out of your airway. 

Is that my first or second or third choice? Not really. I would rather you had cured permanently your sleep apnea and not required to go to Tahiti with a CPAP suitcase than suffer from any kind of consequences of sleep apnea. If we can permanently cure it, and a surgery is the way to do it, it’s on the consideration table. 

Dr. Eric: 

Many cases, a last resort. But there is a time and place, just like with thyroid surgery. I am not a proponent of- It depends on the situation. 

Dr. Ellie: 

Sometimes, they need it. 

Dr. Eric:

Exactly. 

Dr. Ellie: 

I think a really important point that is often not emphasized is the preventative nature. If we go back 1,000-2,000-10,000 years, we ate really nourishing food. We had to rip the meat off of our bones. We hadn’t invented knives and forks yet. We were using our hands and teeth to eat root tubers and strip the leaves off plants to get to the soft bark and the nutrients underneath. 

That mastication, that chewing, that gnawing caused our cheek and jaw muscles to be really well developed. When we had really broad faces and broad jaws, we did really well from a perspective of not having a small, narrow airway that caused crooked teeth and obstructed airway disease.

Fast forward to today. What do we give our kids to eat? We don’t let them use a breast too often. We have them bottle fed. They don’t develop strong jaw muscles. We give them baby food that has already been pre-chewed. Babies do not develop the jaw muscles and grow their jaws the way that we need to. 

Pediatricians have a responsibility now to talk to our bottle-fed babies about jaw exercises. Giving their kids specific pacifiers, something called a Myo Munchie, for example, that works those jaw muscles. It gets them to use those muscles, so these kids can grow. 

We want to talk about an airway assessment before age five and make sure the kid doesn’t have a tongue tie, a lip tie. If a baby is not a good nurser, it is probably not the mom’s fault. It’s not that she is not good at this. The baby has a physiologic restriction because they were vitamin deficient during the pregnancy, or if they have this tether of tissue that is preventing the baby from getting their tongue in the right position. 

The proper position of the tongue resting is not how it looks in our anatomy books, which is on the floor of our mouth. The proper position of the tongue is resting on the roof of our mouth when we are sitting at rest or sleeping. If a kid or adult can’t get the tongue on the roof of their mouth, they have a problem. That can lead to sleep apnea, which can lead to hypertension. 

If we knew about it before the age of five, they wouldn’t ever need braces. Their jaws would be big. Their airways would be large. They wouldn’t have hypertension. We could prevent a whole litany of health problems in adulthood by addressing it in kids. 

Dr. Eric: 

This should be evaluated by a pediatrician over a dentist, or maybe both? 

Dr. Ellie: 

Ideally, it’s a pediatric dentist and pediatrician working together. Or a family physician and a pediatric dentist working together. Or a general dentist or general family physician who is particularly trained and educated in paying attention to this. 

Dr. Eric: 

How about certain supplements? I am thinking about licorice root. How concerning is that? I know if they have high blood pressure, it’s a concern. Is it a concern if someone has normal blood pressure? 

Dr. Ellie: 

Generally speaking, no. There is a component of glyceridic acid that is in the licorice supplement itself that is the problem. If it’s DGL, which is deglycyrrhizinated licorice, most people can tolerate that with no effect on their blood pressure. Most of the supplement companies make that DGL.

However, we do use licorice a lot. It’s a great sweetener. It’s an adaptogen. There are lots of advantages to licorice. Some people are very sensitive to it. I had one person develop profound edema. Gained 30 pounds of fluid and jacked up their blood pressure by taking licorice when we were treating something else. 

We do have to respect it and be careful and know about it, but it’s reversible if you stop the supplement and pay attention and change to something else. You can get rid of it with no permanent problems by taking a short course of licorice. 

Dr. Eric: 

Most of the focus has been on hypertension. When is it a concern with hypotension, when blood pressure is too low? 

Dr. Ellie: 

It’s a concern when it causes symptoms. Many people run around with blood pressure of 90/40, and there are no symptoms whatsoever. Often, these are petite people, adults who are under five feet tall, under 100 pounds. They have a blood pressure of 90/40, and that is perfectly fine. They are getting perfectly good blood flow to their brain. They don’t have any symptoms if they change positions.

But if they get weak or dizzy when they stand up, that blood pressure is too low for them. It’s likely an indicator of a problem. That problem might be mitochondrial, nutritional, thyroid, adrenal. 

Or we are seeing a lot of vascular damage post-COVID from postural orthostatic tachycardia syndrome, POTS. There is a lot that can be done to help those people. Retraining of their sympathetic/parasympathetic nervous system can be done, but it’s not easy to do. Often, they’re nutritionally not balanced either. Low blood pressure can be a problem when it causes symptoms.

That being said, if you have chronic kidney disease, and we are trying not to get you on dialysis, the lower the blood pressure, the better. It preserves the kidneys for a much longer period of time. As long as you are not having symptoms, and we keep your blood pressure low, that is what our goal is. 

Dr. Eric: 

I tend to be on the lower side. Sometimes, I will be 100/60 for example. I feel fine, so as long as symptom-wise I feel okay, I shouldn’t worry about it. 

Dr. Ellie: 

I wouldn’t worry about it. I would count yourself in the lucky box. 

Dr. Eric: 

Good deal. Let’s talk about some natural options. Of course, it comes down to addressing what you spoke about: oral health issues, thyroid, if someone is using refined salts instead of natural salts. I’ll let you take over. If someone is listening to this, what are some steps they can take to help with their high blood pressure? 

Dr. Ellie: 

In my experience, probably the #1 most common missing nutrietnt in hypertensive patients is magnesium. We have lots of different choices of magnesium out there. There is magnesium oxide, magnesium citrate, chelated magnesiums like magnesium glycinate or magnesium malate or magnesium threonate. 

In general, for the most part, I don’t like to use magnesium oxide. It’s the cheapest one. It’s available at every hospital pharmacy. It’s available at every drugstore. It’s not very well absorbed, and it doesn’t get into the cells the same way that one that is chelated to amino acid does. 

I would switch somebody if they are on magnesium to a magnesium malate or magnesium malate/glycinate combination. That is what I take myself every day. I take three capsules once a day. Every skeletal muscle cell requires calcium to make it contract and magnesium to make it relax. That is including the tiny muscles on the surface of our blood vessels. If they don’t have magnesium to relax, they will be stuck in a constricted state. 

Magnesium is often super helpful as long as it’s inside the cells and not in your bowels and being pooped out, like magnesium citrate tends to do. Magnesium citrate is a wonderful laxative but not really great for your blood pressure. That’s why I like the malate or malate/glycinate combos.

I take three every day. They don’t make me sleepy. Some of my patients find they’re so relaxing that they can’t stay awake if they take them. I take mine in the morning. That’s when I take my magnesium. As long as I take it daily, I poop like a champ and sleep like an angel. Magnesium is my miracle. If I am stuck on a desert island, and I can only bring one supplement, I am bringing magnesium. That’s a simple one.

What if you really do have hypertension, but you don’t want to go to a medical doctor? You are going to be very diligent about checking your blood pressure and keeping your target above 120/80 or maybe 130/80. If you have end organ diseases, if you have heart disease, if you have diabetes, if you have kidney disease, if you’ve had a stroke or a heart attack, you probably should really aim for those lower readings, 120/80. If you have never had a problem, we can be a little softer with you. We can go up to 130/80 and not have to take anything for it. 

What’s one of the best things you can take? One of the biggest bang for your buck supplements is hibiscus. It’s that pink flower that we see here in Georgia growing all over the place in the summertime. If you make a tea and drink hibiscus tea, hot or cold, you can make hot tea or sweet tea out of it. Everyone in Georgia drinks sweet tea in the summer. 

I recommend you sweeten it with xylitol, not sugar. Xylitol is a polyol often made from birch bark. It also happens to be a prebiotic that supports oral health and lowers blood pressure just a little bit. 

Hibiscus tea, three servings a day, can lower your blood pressure 20-25 points. It’s one of the biggest bang for our buck nutritional supplements. I really do like hibiscus.

There are many others. One of the common ones we think about is hawthorn. Both the berries and the root have antihypertensive properties. They also act a little bit like a beta blocker, so they tend to slow down a fast heart rate. If you’re one of those people who tends to run at 90-100 blood pulse rate, as well as high blood pressure, hawthorn berry might be a really good choice for you to help get both things under control.

There are many other supplements we can use. Ginger for example and cardamom. Parsley. These all have antihypertensive therapies. Each one will typically lower your blood pressure. Some are around 2-5 points, except for hibiscus. Hibiscus is the big bang for our buck one, in the 20-point range.

One thing I do want to mention is mouthwash. Traditional mouthwashes like Listerine that make that really napalm clean in your mouth have been shown to raise your blood pressure up to 5-7 points and persist for many hours after you use that mouthwash. Why would that be? How could that possibly affect something? 

In the 1990s, there was a Nobel Prize awarded to three doctors for the discovery of a gaseous signal and molecule called nitric oxide. I like to call this “the miracle mouth molecule” because it has so many downstream effects. 

As they were trying to turn their nitric oxide discoveries into a commercially available pharmaceutical, they were trying to make a blood pressure medicine. One of the things that nitric oxide does is opens and dilates blood vessels, thereby lowering blood pressure, which is a nice thing. They had this supplement, Sildenafil, they were trying to manufacture for blood pressure. It wasn’t working very well. They were getting real disappointed. 

Man after man in this clinical study was coming in, “Guess what happened to me? I haven’t been able to get an erection for years. Since I started taking your blood pressure medicine, I get a good erection in the morning.” They discovered that this medication had nitric oxide benefits mostly in the pelvic floor, much more so than in the peripheral arteries. They turned it into Viagra. It was based on this nitric oxide research. 

We now know that if we do the pathways a little bit differently and not try to trick Mother Nature and use Mother Nature’s nitric oxide instead of the drug company’s artificial one, we can get really big benefits. 

Nitric oxide is made in every cell in your body, but it’s predominantly made by cells in the floor of your sinuses. There is an enzyme that is made in your tongue by friendly mouth bacteria. This nitric oxide synthase is annihilated when you use mouthwash. We want to use only mouthwashes that have been shown not to affect nitric oxide and make sure we’re supplementing with the things that drive nitric oxide pathway. 

That includes nitrite-containing vegetables. Beet root and arugula are two of the biggest, most common ones. Leafy greens in general. 

Supplements. Berkeley Life has one. N1o1 has one. They contain a little bit of B vitamins and some citrulline and beet root extract. They can be used to help our bodies make more nitric oxide. 

As an aside, about 50% of Viagra non-responders, if they pre-treat with a nitric oxide lozenge, like Berkeley Life or N1o1 and then take Viagra, it works. Little tip and tidbit for controlling blood pressure but also increasing nitric oxide is to use these nitric oxide tablets. 

I recently had the blessing and opportunity to go to Peru. I was in Cusco at 12,000 feet, where altitude sickness is a major problem. In part, your oxygen level is lower, and your cells don’t carry oxygen as well. Nitric oxide will improve the oxygen carrying capacity. 

I use those nitric oxide lozenges for myself to prevent my altitude sickness. I don’t have any issues with blood pressure, but I didn’t get altitude sickness when I used my nitric oxide supports. It’s a nice thing to have in your tool chest at home. 

Dr. Eric: 

Interesting. I didn’t know there were nitric oxide lozenges, so that’s pretty interesting. How about CoQ10? What impact can that have on blood pressure? 

Dr. Ellie: 

We know there is an age-related decline in CoQ10 levels. This is one of our body’s natural antioxidants. There are different amounts in different organs in our body. 

Our heart is one of the ones that has the most rapid decline in CoQ10 levels as we age. Utilizing CoQ10 to get those levels up to 20-year-old or 30-year-old levels can really make a difference in the resiliency of our heart and can lower blood pressure as well. You get five or seven points of blood pressure lowering by supplementing with CoQ10. It’s also heart-protective. 

We know the same pathway, the HMG-CoA reductase pathway that turns mevalonic acid into cholesterol, that is the pathway we block with statin drugs. That same pathway makes CoQ10. When we block the production of cholesterol using Lipitor or Crestor, we also block the production of CoQ10. A consequence can be high blood pressure. 

Supplementing with CoQ10 can reduce muscle aches and headaches and fatigue caused by lowering CoQ10 but can also improve blood pressure. CoQ10 is another great supplement to include. 

Dr. Eric: 

You shared a lot of amazing information. Really appreciate it. Before we wrap up, is there anything else that I should have asked you that I didn’t ask you? Any last words that you have? 

Dr. Ellie: 

Where can you get my book? The Blood Pressure Blueprint. It’s on Amazon on e-book and paperback. It will be coming out in 2024 as an audiobook. 

Dr. Eric: 

We were gonna get there, to where people can find out more about you. Definitely check out her book. 

That’s great that it will be on audiobook. I listen to audiobooks. If it was on audiobook, I probably would have read it. As of recording this, there is only the print edition, so I wanted to read it before our interview. Appreciate you sending me a copy. Highly recommend reading it or listening to it later. 

Can you remind people of your website and anywhere else people can find you? 

Dr. Ellie: 

Sure. I see patients in Georgia. I am accepting new patients. I am very proud to report that since I cracked the code on this root cause resolution approach to managing hypertension and cardiovascular risk reduction, we have had zero heart attacks or strokes in any patient for seven years. 

I am taking new patients, even if you have already had a heart attack or stroke and don’t want to have another one. But you have to come to Georgia to see me. I can only see patients face to face the first time; we can do remote visits after that.

CampbellFamilyMedicine.com in suburban Atlanta. That is my practice.

The website for the book is just getting started. There is not a lot of information other than links to all the podcasts I have been on if you think I tell interesting stories or like what I talk about. There are a bunch of podcasts on TheBPBlueprint.com. 

If you want me to come to your event and speak, DrEllieCampbellSpeaker.com is another website where people can find me. 

Dr. Eric: 

Wonderful. Thank you so much, Dr. Ellie. Appreciate you taking the time to talk about blood pressure. I’m sure the listeners learned a lot, and I learned a few things as well. 

Dr. Ellie: 

Thank you for having me. I appreciate it. We all work together. Everybody has their little niche. None of us can do everything. No cardiovascular prevention program is complete without a medical doctor, dentist, and hygienist on the team. We really have to work with interprofessional, interdisciplinary collaboration.

Another point, something I didn’t mention is chiropractic adjustment. I have seen many people normalize their blood pressure once we get their spine and posture in alignment. Don’t forget about that, too. 

Dr. Eric: 

Definitely glad you mentioned that. My background is as a chiropractor. 

I agree. Working as a team and not just relying on a single healthcare practitioner, because no one practitioner has all the answers. You have a lot of knowledge. I do, too. 

Dr. Ellie: 

Then we’re better. 

Dr. Eric: 

Exactly. Thank you again. This really has been a great conversation. 

Dr. Ellie: 

You’re so welcome. 

Recently, I interviewed Dr. Sandi and we discuss the role of health coaches in managing chronic conditions and thyroid health, Dr. Sandi’s career journey and why she founded the Functional Medicine Coaching Academy, the scope of health coaching and how it differs from a medical provider, the importance of individualized treatment protocols, collaboration between health coaches and medical professionals, mind-body medicine techniques, and more. If you would prefer to listen to the interview you can access it by Clicking Here.

Dr. Eric Osansky: 

I am super excited to chat with today’s guest. We are going to be talking about health coaching as well as mind/body medicine. I am excited to chat with Dr. Sandi Scheinbaum, who trains people to become functional medicine health coaches. It’s going to be a great conversation. Let me finish up her bio that I just started here: 

Dr. Sandi helps practitioners and businesses hire health coaches because she believes that health coaches are key to combating chronic disease and reducing healthcare costs. As founder and CEO of The Functional Medicine Coaching Academy, a collaboration with the Institute for Functional Medicine, Sandi is a leader in the field of health coaching education. Thank you so much for joining us, Dr. Sandi. 

Dr. Sandi Scheinbaum: 

Thank you. It is a pleasure to be here. 

Dr. Eric: 

Let’s dive in with your background. I’ve listened to some of your other podcast episodes. I know you haven’t been doing this your whole career. You have another career in the background. You used to do clinical psychology, I think? 

Dr. Sandi: 

Yes. Where I started is not where I am ending up. I started back in the very early ‘70s in education. I was in special education, and I spent some time training teachers for how they can work with children. We talked about children with special needs at the time, learning disabilities, behavior disorders. 

That led to an interest in stress management. I was doing workshops for parents, teachers, kids. I did relaxation tapes. I taught kids how to get a calm, quiet state. 

As a result, I went back and got my doctorate in clinical psychology. For close to 35 years, I was a psychologist. I was kind of a renegade psychologist. Mind/body medicine did not have a name at that time, but I was teaching people breathing techniques. We didn’t call it “breathwork” back then. 

The approach that I used was integrating all of these ways of thriving: cognitive behavior therapy, which is where you identify thoughts that are irrational and change those; mind/body medicine; relaxation strategies; and working with people with physical conditions, like migraine headaches, for example. 

Then I learned about the Institute for Functional Medicine. I went through their training program. I was in the first class to get certified. I was the only psychologist. Now there might be a few more of us. It was really eye-opening to learn about functional medicine. I was putting those principles together with the principles from positive psychology, mind/body medicine, cognitive therapy, principles that I knew were so effective in working with my clients as a psychologist. 

I was encouraged to start to train people who were health coaches. There were coaches coming to me. They had trained in other programs. They said, “We just don’t feel confident as health coaches.” I had a co-founder, and we approached the Institute for Functional Medicine. They thought it was a great idea. They had wanted to have a school to train health coaches for some time. The right people didn’t come along.

Together with IFM, we built the Functional Medicine Coaching Academy. That’s my mission, my passion today: training as many people as possible of all ages all around the world because we really need health coaches to help people live happier, healthier lives. 

Dr. Eric: 

I agree. Before we get into that, you said you were the first class for the IFM CP. What year was that? 

Dr. Sandi: 

That was back in 2013, a little more than 10 years ago now. 

Dr. Eric: 

We have a few things in common. First of all, many listening to this probably don’t know this, but I actually got my bachelor’s in psychology. Then I switched to chiropractic. Long story, but I went to Queens College in NYC, got my bachelor’s in psychology, then decided to change careers. I also eventually went through the IFM certification. It was three years later, 2016. That was eight years ago now. 

I definitely agree that health coaches play a key role. They help combat chronic diseases, including thyroid conditions, which is what this podcast focuses on, helping people with hyperthyroidism and Hashimoto’s. As you know, I started using health coaches. I didn’t tell you how long, but it’s been about 5-6 years since I started using them. They not only help to fill in the gaps, but they also help to free up more time, which allows me to see more people and help more people with thyroid and autoimmune thyroid conditions.

Let me have you take over. Why is there such a dire need for health coaches? 

Dr. Sandi: 

Today, people are suffering like never before. We are seeing skyrocketing rates of metabolic conditions. It’s been estimated that only 7% of adult Americans are considered metabolically healthy. So many people have chronic conditions. We are talking about type 2 diabetes. We are talking about the rise in neurodegenerative conditions, dementia, Parkinson’s, which is just off the charts, like we have never seen before. 

We are also seeing our children affected. When I was in special education, back in the early ‘70s, it was considered very rare to have a child with autism. In fact, I supervise student teachers, and for an entire county, this was the northern suburbs of Illinois, there was only one class for children with autism, where they would pull them out of the regular classroom. There were so few children. We are talking about the incidence being extremely rare. Now, it’s very common.

We are also looking at skyrocketing rates of anxiety and depression. Unfortunately, there is a huge shortage, particularly mental health professionals. That is where coaches can really step in. They are not psychotherapists; they are not psychologists. They do not diagnose any medical or psychiatric conditions. They don’t do psychotherapy. They help people with emotional wellness, with regulation of their emotions, and be listeners. First and foremost, that’s what health coaches are trained to do. That’s what they are the experts in: listening. 

When you feel heard and understood, and you have that relationship with your coach, that alone can be very healing. You end up leaving that conversation feeling better. When you combine what coaches can do in terms of encouraging you and guiding you for behavioral change and changing habits, like perhaps, you are moving more throughout the day, going out and taking walks, that is a great antidepressant, for example. There are so many reasons that health coaches are needed now.

We also have a doctor shortage. Good luck trying to find a new primary care doctor. My thing is health coaches are the new primary care. Why do I say that? It’s because lifestyle should be first. That is the first line before you consider anything else. What about someone’s day-to-day habits? What kinds of foods are they eating? How are they moving throughout the day? What’s their sleep like? Their stress level? Their relationships? Those are the areas that health coaches can address. 

Dr. Eric: 

Just to confirm, I know you’re not saying that health coaches are going to replace one’s primary care doctor. I agree with you. We want to focus on diet and lifestyle. Typically, when you go to a PCP, many times, they will just give a prescription. There is a time and place for that, but for many people, arguably, everybody needs to eat well. They want to be active. Mind/body medicine, which you’ll talk about, is important. I don’t know of any PCP who will sit down with you and talk about mind/body medicine, let alone eating a healthy diet. There are some functional medicine doctors who practice primary medicine and I’m sure do that. On average, you’re not going to expect that when you go to a PCP. 

Especially if someone is going to have to wait three months, four months, six months, during that time, if you do need to see a medical doctor, go to the ER if it’s an emergency. But if you are waiting to get a physical, why not see a health coach? We will talk about what they can’t do specifically, but as far as listening to you, giving you encouragement, maybe reviewing what you’re doing from a dietary and stress management perspective. Help to hold you accountable. I don’t know if you want to further expand on what they can do, but I definitely want to talk about what differentiates a health coach from a medical doctor or other practitioners. 

Dr. Sandi: 

Absolutely. We refer to this as their scope of practice. At the present time, health coaches do not hold state licenses. They are not licensed medical providers. That’s why they don’t keep medical records. 

They are not the ones who provide a diagnosis. A health coach is not going to diagnose you with hypothyroidism. They are also not going to have a treatment plan for you. They are not going to prescribe medication, or even things like supplements. They do not write out a meal plan. 

There is a but here. Many health coaches do hold those licenses. We actually have medical doctors who train with us. If they have that license, if they are a nurse practitioner or a registered dietician in addition to being a health coach, that would be different. 

Health coaches, unless they hold that license to practice medicine for example, do not order labs. They do not interpret labs. They are the educators. That’s a very important role. Somebody might get a lab result back. Increasingly, we are seeing people going to direct to consumer lab companies. They are getting assessments and results. The health coach doesn’t say, “Based on this, you have a Vitamin D deficiency.” “Looks like you are type 2 diabetic.” They are providing the education about what each test means. “Here’s your hemoglobin A1C. This is what this test measures. What are your thoughts about this?” You might see changes, like it was at 1 a year ago, and now it’s at this point. A health coach asks the right questions. “What are your thoughts about it?” That leads to how can we work together to change some of the behaviors that might be driving these lab results? That’s where the health coaches intervene. 

There are programs that say, and you might see this advertised, “Become a health coach in three months. You can order labs!” That is not true. You can do that, but it is out of your scope of practice. You didn’t go to medical school to learn about the rare medical conditions that you might not be able to pick up.

What we do is look at all of the things that a health coach can do and not get into those territories that are out of their scope. The value is in collaboration, which you referred to earlier. Our health coaches are collaborating with the medical doctors. They might have clients, and they might have a consult with a medical doctor who is the expert in ordering and interpreting those labs for example. 

Dr. Eric: 

That’s exactly how it works in our practice with the health coaches. They don’t actually order labs or give recommendations when it comes to supplements or even diet. Initially, I consult with the coaches when it comes to each of the patients. The patient has a pretty good idea of what diet to follow after that initial consultation with me. The health coach may review the recommendations. Same thing with supplements. The recommendation for supplements comes from me; the lab orders come from me. 

I agree. I know there are coaches out there who are doing those things. You’re saying that they shouldn’t be doing them. If they are just a health coach, and they are working on their own and recommending labs and supplements, that is out of their scope of practice. 

Dr. Sandi: 

Correct. 

Dr. Eric: 

You mentioned asking the right questions, so that’s important. Being a good listener is important. Those are some good, important qualities of a health coach. 

You mentioned also the duration. You gave an example of if someone just went through a three-month coaching program and ordered labs. Forget about the ordering of labs. Let’s talk about the duration. There are different lengths of programs. Three months is on the shorter side. I don’t know if there are any real certifications that offer it that quickly. I’d be a little bit nervous about seeing someone who just went through that, unless if they were trained also by a doctor. Let’s talk about the program from IFM. I think it’s a 12-month program, right? 

Dr. Sandi: 

Yes. Our program is 12 months. The reason is because human lives are at stake here. In order to have the skills, in order to have exposure to all of the nuances that have to do with when you have an encounter with another individual, it takes time to feel confident and also to learn things like motivational interviewing, like appreciative inquiry. 

Let me backtrack. Health coaching came from life coaching. Think of it like a spinoff from life coaching. Where did life coaching come from? That came from psychotherapy. Specifically humanistic psychotherapy, which was very big when I trained in the late ‘70s/early ‘80s. 

It was Carl Rogers, for example, gestalt therapy. This notion of client-centered, where you as the therapist are not in the driver’s seat. You are not telling that person what to do or what’s wrong with them. You are listening. The conversation goes in whatever direction that client wants to go. You have an unconditional positive regard for that individual. 

Where does this become problematic in health coaching, with a health coach who does not have that kind of rigorous training such as what we provide? Maybe they went to a course for three or four months and learned from an expert in many coaching programs that are established there. There is an orientation. Everybody should be paleo or keto or whatever their orientation might be. As a coach, what’s going to happen is you’re going to come out of that program, “I’m a vegan.” “I’m paleo, and everybody should be. That’s the healthiest way to go.” 

Now, you are taking your belief system, whatever that might be, and even on an unconscious level, you are communicating that. This Is what the client should be doing. That’s not unconditional positive regard. That’s not client centered. 

Health coaching, following this humanistic approach from psychotherapy, means that you are sitting with that individual. For that encounter, you are so mindful. That is your whole world. You are asking the right questions, so that client has that aha moment. “Yeah, what I am eating or not eating, maybe that is impacting how I’m feeling in my energy level, so I think I will give this a try.” But they come to that conclusion. It’s not the health coach telling them. 

They can be the educators. They can give their opinion, but only if that client wants it. It’s never forced on them. 

Dr. Eric: 

That makes sense. The timing of this question is good because I just came out with a book called The Hyperthyroid Healing Diet. Despite the name of the book, it’s not just one single diet. There’s three different diets. One of them is similar to an autoimmune protocol. Another one is similar to a standard paleo diet. Let’s say if the health coach is going over these diets, they wouldn’t say, “You have Graves’ or Hashimoto’s. You should follow an autoimmune protocol.” Rather, they should say, “These are the options. Many of our patients may be following autoimmune protocol, but some of them follow these other diets. Ultimately, it’s up to you to make the decision.” Would that be accurate? 

Dr. Sandi: 

Absolutely. It would be, “Here are the diet plans.” You are giving those because they are created by you, Dr. Eric, the expert. Then you encourage the client to be the detective, or possibly to go back and think about in the past: When did you feel best? If you eat these particular foods, what happened in the past? How did you feel the next day? They might have some insights into that. Or they might say, “I never did well, or I could never stick with a food plan that had this food.” “I don’t like the taste of it.” They will arrive at that decision.

Also, more importantly, they are going to arrive at where they want to start. A perfect example is the elimination diet. This was a diet that was developed by the Institute for Functional Medicine, and our coaches are trained in how to guide people through it. You eliminate for 3-4 weeks those foods that are likely to trigger a reaction. It can be challenging because you’re asked to give up coffee and chocolate and so many foods and beverages that you may depend on.

We actually did a randomized control trial with IFM. It was published in the peer review journal Medicine. This was for medical professionals going through IFM’s initial training course. They were asked, it was volunteer, to try the elimination diet. If they were going to be teaching it to be recommending to their patients, it would help to have that personal experience. It was hard for them. “How could I give up my coffee?” 

We paired our graduates for five sessions of coaching. The group that got the coaching, the compliance went up. The waiting room control group that just got the PDF guides to the elimination diet did not do as well in terms of their compliance. It does increase compliance.

With that individual, be in the driver’s seat. What does that mean? They might tell you, “This is when I’m ready to start. I’m not ready to start.” Or, “This is what I can do.” Perhaps, it’s starting very small, and the coach will ask, “How can I help you?” Often, it’s accountability. “We will chat again next week, and I will ask you how that went, giving up your coffee.” Or maybe it was, “I am going to do half decaf.” That was what they could tolerate. 

It’s always listening to the client. Where do they want to start? When do they want to start? What are going to be the potential obstacles? How can I support you? 

Dr. Eric: 

Great points. Everybody is in a different place. Some people might be used to eating fast food every day, and they may not be ready to start a strict elimination diet. People work with me all the time, and they have already done it on their own. They have made a lot of dietary changes. It does depend on the person. Some people may be ready to do it, except for coffee. Or maybe the dark chocolate. Usually, it’s coffee, if anything that they don’t want to give up. It might be, “Let’s compromise. Ultimately, it’s up to you.” 

A health coach can’t say this. I guess I could say, “This is the diet I want you to follow.” Even if I say this, it’s up to the person ultimately. I won’t follow them around their home. Ultimately, it is the person. 

If I say my preference is for someone to follow an autoimmune protocol or a paleo diet, then that is part of the health history, too. Usually, the person will say, “I don’t know if I can give up my coffee.” Then we might have a conversation.

Honestly, them and the health coach, that’s where they get into a deeper conversation with that. That’s usually what I have the health coaches talk about. Sometimes, they will bring it up to me. “Do I have to give up coffee? Do I have to give up gluten?” I will give them my opinion but also say they could talk to the health coach about that.

What you said, I completely agree with. 

Dr. Sandi: 

Nine times out of ten, it’s what you don’t want to give up, what you’re resisting, that is probably doing you in. If they say, “I can’t give up bread,” that’s probably the culprit. Same with coffee. Maybe now with people having Oura rings, they might notice, “Let’s do an experiment.” Could you go a couple days? What would happen to your sleep? Are you getting better sleep? They have that aha moment. “Oh my gosh, I did see that connection. I think I can do this now.” 

Dr. Eric: 

Excellent point. If someone is a little bit hesitant, “I can’t just give up coffee,” and they are drinking two or three cups, or the gluten, then you’re right. At least that is one of the things that they probably need to take a break from or eliminate. That’s an excellent point.

I wanted to talk to you about the different ways that health coaches are used. In my practice, a lot of it is one on one. There are group options, too. What do you see other practitioners do? Even maybe some health coaches who have their own practice. As far as seeing people one on one. How many sessions do they typically see on average? Is there a recommended number of sessions? How does it work for health coaches who help people in a group setting? 

Dr. Sandi: 

Sure. First of all, how they can work is multiple ways. It can be in person. They can come into the office. We even have some coaches who make home visits. They help with pantry makeovers for example or hands-on cooking, if they have that background. 

Most of the time, it is now increasingly remote. Health coaches, because they are not licensed by the state, and they don’t have the regulations as many practitioners do only to work in the state or states where they hold a license to practice, as non-practitioners, they are not bound by that, so they might be in Illinois but seeing someone in California or any part of the world. That allows practitioners who have health coaches to expand their reach because their health coaches can practice out of the state, as their own medical license may have more restrictions. 

They can be one on one. Increasingly, they can see people in groups. I love groups. We teach people how to do group coaching. In group coaching, the community is the healing element, the medicine. We feel like we’re not alone when we’re in a group. When we are with others, “If this person can change, I can, too.” There is that social modeling. The impact of going along because you are in the group with the group norms, so you’re more likely to change. It is a wonderful way of working. 

There are a lot of practices that are insurance-based, and this is something that can be billed through insurance. There are ways the doctor or nurse practitioner can take people out of the group for breakout sessions, where they have that individual time, and they bill for that through the health insurance system. The coach is facilitating the group.

We have found the sweet spot for the number of sessions to be around 5-8 sessions. That’s enough time. Often, there is some check-ins. Again, because it’s client-centered, how do you want to check in? Some people will say text or email or a phone call. It’s highly variable how many sessions. The average tends to be around 5-8. 

That depends on what’s going on. Depending on the chronic condition, etc. Sometimes, people may work on one issue, and when that’s resolved, they want to work on something else. 

Dr. Eric: 

I’m sure you’re familiar with HIPAA and patient privacy. That’s been a concern. I do group coaching calls. The way I do group coaching calls is they don’t interact with each other. I just finished a five-day challenge, which was not for patients, just the general public. Everybody was on Zoom, and we had a Facebook group. Everyone was interacting. They’re not patients of mine. 

When I do a group call with patients, they’re not seeing each other or communicating because I’d have to have their permission to do that. Is it similar with health coaching, where you would have to get everybody who joins permission that it’s going to be in a group setting, and they will be interacting? 

Dr. Sandi: 

Yes. It’s usually best if you are a practitioner and want to run a group. You have that first session with somebody. It’s a private session to explain why coaching in a group is a good choice for them. You go over the rules of engagement. One of the most important rules is you are going to abide by HIPAA. 

I should point out, because health coaches are not what’s called “covered entities,” they don’t hold medical records, so they are not legally bound by HIPAA. But they are ethically, morally bound. Through the National Board for Certification for Health Coaching, NBHWC, if you are a board certified health coach, you abide by the rules of that professional body. That includes abiding by confidentiality. You are not going to disclose anything that is revealed in your health coaching session. That’s a given.

When you have a group, what you would do, if you are leading a group, is go over the rules, just like a classroom. You want to speak in a courteous way. There would be no talking over somebody else. You want to be respectful of others’ opinions. These are the standard classroom rules. 

A big rule is that what is heard in that setting stays in that room. However, because each individual who is in the group, you have no personal control over them. Somebody may go out and post something on social media. That’s very rare because what happens is the group, they become close with one another and honor bound. You would go through those rules every time that you start the group, just to remember that what we share stays in our group room. People do abide by that. 

But it is not legally bound. Somebody who goes out and inadvertently discloses something, they are not legally bound. They are just private individuals; they are not medical practitioners violating HIPAA. 

Dr. Eric: 

Okay. Any other roles that you see health coaches play besides what you mentioned, one on one, either in person or remotely, or working in a group setting? 

Dr. Sandi: 

If you’re a primary care doctor, your health coach might be in the session/visit. They are the ones assuring that people understand what is recommended. They understand the diagnosis. Some practices use health coaches that way. 

Increasingly, we are seeing health coaches being the patient advocate. If you are going through the conventional medical system, you may feel overwhelmed, especially people who are not technically/computer-savvy. They can’t just call up the old-fashioned way. Maybe they had a primary care doctor who they would just pick up the phone, the receptionist answers, you make an appointment. That’s old school. 

Now you call, and it’s this huge medical conglomerate, and you are feeling lost in this system of talking to robots. It’s very stressful. A health coach can help you with that.

If you are a health coach and have your own business, they might help you with referrals to specialists, for example, finding a functional medicine doctor. If you are dissatisfied with the care you’re getting, suppose your medical team is in one of these huge hospital conglomerates. You feel you are given seven minutes, and they’re ignoring what you really wanted to discuss. A health coach can help you find that right practitioner, or they are the ones who are your primary contact. They can help you navigate this increasingly complex medical system, where you just feel like a number.

Dr. Eric: 

A lot of different roles that health coaches can play. I want to talk with you a little bit about mind/body medicine. Before we do that, is there anything else that I should have asked you that I didn’t ask you about health coaching? Anything you have a burning desire to talk about that you didn’t talk about? 

Dr. Sandi: 

Well, I should say that if anybody is listening, and they are thinking, “Gee, I think I would like to be a health coach,” we need so many health coaches because of people getting sicker and sicker. This is a career. If you are a practitioner and learn health coaching skills, it brings meaning and purpose to your life. 

You are personally transformed. We know that. Every session, it is client and coach who are personally transformed. It’s not like you are the teacher if you are the coach, and the client is the learner. You are both the learners. You’re learning that person’s story, and it’s also a personal transformation and a process.

Dr. Eric: 

Toward the end is when I ask how people can find out more about you. I am going to ask you to do it now also. FunctionalMedicineCoaching.org is the website for people who are interested in learning more about becoming a health coach. 

Dr. Sandi: 

Yes. 

Dr. Eric: 

Wonderful. Mind/body medicine. What is your definition? 

Dr. Sandi: 

Well, this was a saying that I started to describe way back in the late ‘70s: What’s real in the mind is real in the body. That is mind/body. You can’t separate. Every thought, every emotion that you have is going to be inflammatory or anti-inflammatory. It goes to the cellular level. 

That was just a wild hypothesis back then. Today, we have the advanced technology to show that that happens. It affects our microbiome. It affects our cellular functioning. 

What you imagine, the power of imagery, the power of what you are experiencing and how you are defining your circumstances, goes so far in terms of your physical wellbeing. It’s remarkable how many ways that you can impact your physical health. 

Dr. Eric: 

A two-part question: What type of mind/body medicine techniques do you recommend? What do you personally incorporate? 

Dr. Sandi: 

It always starts with breathing. We hear a lot about breathwork. Sometimes, some of the strategies out there can actually be detrimental if you perhaps are prone to panic and anxiety. You can induce a panic attack if you are working some of the breathwork where you are hyperventilating. 

The easiest, most effective way is to notice where your breath is coming from. Put your hand on your stomach. Put your hand on your chest. Are you initiating with the diaphragm, where you push your stomach out, the slow belly breathing? James Gordon talks about it, a soft belly breathing. You become aware of where you’re breathing from. 

Then you become aware of how fast you’re breathing. Is it very fast or slow? I have taught this to thousands of patients as a health psychologist. 

Then it’s using imagery. As you feel the breath, what images occur to you? Whatever direction your mind goes, that is what is at the moment. It can also be an image or sensation where you imagine the warmth of that breath. 

Where does that lead? It leads to warmth in your heart. That is actually a heart math technique for better heart rate variability. As you take these slow, deep breaths through your belly, and as you exhale, you imagine they’re warm. That warmth is flowing through your heart. Now you’re sending a warmth through your heart out to all parts of your body.

I personally love a strategy which is again very old. I don’t see it very often, but it is autogenic phrases. This is in a nutshell self-programming. What does that mean? You repeat some things over to yourself, maybe 2-3 times. “My feet feel loose and relaxed. My hips and thighs are feeling loose and relaxed. My breathing is slow and regular. Warmth is flowing down my arms into my hands and fingers.” You keep repeating these. It can be whatever you think about, whatever areas need a bit of extra love. 

I go through this. I might focus on my adrenal glands. I talk to them. Or I am talking to for example my digestive tract. Imagining all of the good bugs in the microbiome and giving them some love. That is the power of imagery. 

Some people use external imagery, like imagining a beach, mountains, whatever appeals to them. This is so personalized. It’s not one size fits all. 

There is progressive muscle relaxation, another very tried and true technique. It was developed in the ‘20s by Edmund Jacobson. You are taking each body part and squeezing and tightening as hard as you can. When you release, you release as much as you tightened. 

I did that for kids. They loved it. They tighten up and squeeze. You’re holding your breath. Then you let go. These are very simple strategies that you can incorporate into your daily routine. 

Dr. Eric: 

I heard you mention heart math. Do you utilize heart math on your own or with clients? 

Dr. Sandi: 

Yes. I used to use it quite a bit. In fact, I trained back in the day when it was first established. You’re impacting heart rate variability, which is movements between each heartbeat. It has been highly correlated with a quieting response. 

Dr. Eric: 

I use the Inner Balance pretty regularly. The emWave for my computer. Not that you need to use both of them. One is sufficient. 

Another two-part question. Do you utilize mind/body medicine every single day? Is it 3-4 days a week? When you do utilize it, how long is an average session? Is it spread out throughout the day, where you do it for five minutes, three times a day? Or a single session of 20-30 minutes, whatever technique you end up using? 

Dr. Sandi: 

I do it the same way I approach exercise, as snacks throughout the day. I might have a longer session as well. I was never one to meditate for 20 minutes a day, just sit there and see what comes. I am very full of zest and hyper, so that never worked. I need something more structured. 

I might do a meditation walk for example. Or I take ballet class. That is a very meditative state as far as practicing relaxation techniques. Perhaps if I am out in the sun and feeling the warmth, that is going to lead to a few moments of going through this. If I am sitting in a sauna, I might go through that round of autogenic phrases. 

Most importantly, it’s throughout the day. If something happened that was potentially stress-producing, like before recording this podcast, I always like to check, “Do I have the call-in?” I checked on my phone, and I didn’t see anything. It could have been that moment of stress, like, “Oh no, what if I don’t have the link, and I’m late to getting on for this interview?” Luckily, I found it on my computer, so it was all good. 

That is where I said to myself, which comes through cognitive behavioral therapy. I consider those relaxation strategies as well, “So what if I don’t have the link? I have Eric’s email. I’ll get it.” Or, “Okay, what if I can’t get ahold of him? What if I’m late? What is the worst thing that can happen then?” 

Often, you take it to the nth degree. Is this worth dying over? At my age, I’m 74. I hear almost every day my contemporaries who have passed away. Really, it’s that perspective that is also very important to practice. “Will this matter in five years, 10 years? Will I remember this?” We tend to upset ourselves and get into that stress response over things that are relatively trivial in the long run. 

I wear a CGM. For me, what causes those blood sugar spikes is not the foods I am eating as much because I eat a really healthy diet, but it is those variations in terms of potential stress that is going on.

Dr. Eric: 

I am glad you said that about spreading it out throughout the day. I think some people get the impression that you have to do it 20 minutes. Just like some people exercise. When I exercise, it is all at once. I try to move throughout the day, but if I am doing weightlifting, it is usually blocking out whatever time, an hour, to do the weight lifting. It’s not spread out throughout the day. Some people think it has to be the same with mind/body medicine, that you have to have larger chunks. 

What I encourage people to do is get into the routine. If you are not doing it, just start with five minutes. Don’t try to do 15-20 minutes at a time. It will be more difficult. I’ll start that routine to begin with, and some people stay there. It’s really about getting started.

I’m glad you didn’t say people should be doing 20-30 minutes a day consecutively. Some people, it’s fine if they do that. If some people are already doing that, there is not one way that everybody should do it. It’s different. 

I’m glad you gave your perspective that someone can do smaller chunks, 5-10 minutes, multiple times per day. That can just be as effective as blocking out 20-30 minutes to incorporate mind/body medicine. 

Dr. Sandi: 

I used to teach people to take 30 seconds, a minute in between emails. You set a timer. Or the times when you most need it, let’s say you’re in an airport and waiting for your luggage to come off the carousel. Instead of checking your phone, do some shoulder rolls and breathe at the same time to let go of tension. It’s often when you most need it that you can just do this quick relaxation response. 

Dr. Eric: 

I agree. Thank you for sharing. Anything else on mind/body medicine before we wrap this up? 

Dr. Sandi: 

It is the most powerful tool. It is really something that you have within you because your mind and body are always interacting, but they may be producing a stress response. They can be turned around to produce a profound healing, relaxation response.  

Dr. Eric: 

I agree. Going back also to what you said about the CGM, you notice more the stressors than the diet because you’re eating a pretty clean diet. But the stress also can affect blood sugar, adrenals. I’m glad you mentioned that. 

This was an amazing conversation on both health coaching as well as mind/body medicine. As far as people finding out about you, I’ll let you take over. Your website or anything else you’d like to drive the listeners to, feel free to share. 

Dr. Sandi: 

FunctionalMedicineCoaching.org is the website. If you’re on Instagram, my personal is @DrSandi. @FunctionalMedCoach is our main Instagram site. Those are the main places that you can reach us. We’re also on Facebook, Functional Medicine Coaching Academy. 

Dr. Eric: 

Thanks again, Dr. Sandi. I really enjoyed this conversation. I learned some things, and I’m sure the listeners did as well. 

Dr. Sandi: 

Thank you so much.

Recently, I interviewed Dr. Jen and we talked about the role of peptides in thyroid health, benefits for autoimmune conditions, the use of specific peptides for managing inflammation and supporting patients with mold exposure and stealth infections, how peptides can be a part of your stress management strategy, the importance of high-quality sourcing for peptides, broader implications for health and longevity, and more. If you would prefer to listen to the interview you can access it by Clicking Here.

Dr. Eric Osansky: 

I am super excited to chat with Dr. Jen Pfleghaar, as we are going to be talking about peptides. Of course, relating them to thyroid health. Let me go and dive into Dr. Jen’s bio here. 

Dr. Jen Pfleghaar is a double board-certified physician in integrative medicine and emergency medicine. She attended medical school at Lake Erie College of Osteopathic Medicine. She went on to residency at St. Vincent’s Mercy Medical Center for emergency medicine and spent one year flying with Life Flight as a flight physician. Dr. Jen now works at local emergency rooms in a community and office in Perrysburg, Ohio, practicing integrative medicine and medical aesthetics.

She is a graduate from the University of Arizona Andrew Weil Center for Integrative Medicine’s Fellowship program. Dr. Jen loves speaking and lectures to physicians at conferences, including the American Osteopathic Association. She hosts The Integrative Health Podcast with Dr. Jen. 

Her own health history of Hashimoto’s, which is now in remission, sparked her interest in integrative medicine, and she is very passionate about helping patients with chronic disease and teaching them how to let their body heal itself. 

She is a published author of the book Eat, Sleep, Move, Breathe: A Beginner’s Guide to a Healthy Lifestyle. She is a board member for Invisible Disabilities Association. Her hobbies include spending time with her husband and four children, being in nature, weight lifting, wake surfing on the Maumee River, and reading the Bible. Thank you so much, Dr. Jen.  

Dr. Jen Pfleghaar: 

Hi, thank you, Dr. Eric. So nice to be here. 

Dr. Eric: 

Excited about this. You spent one year flying as a flight physician. Is it as exciting as it sounds? 

Dr. Jen: 

Yeah, it was really fun. Whenever I see Life Flight fly over the helicopter, I think back to the days where I put on that jumpsuit. You come out of the helicopter and walk toward danger and help people out. It was a lot of fun. You’re there to fix what they can’t fix and to get people to where they need to be, to trauma centers. We would stop in the middle of the highway. Pretty cool flying with really talented pilots. My life was in their hands. 

Probably wouldn’t do it anymore now that I have a bunch of kids. But it was a really fun time in my career. 

Dr. Eric: 

Definitely sounds like it. We’re going to be chatting about peptides. Before we get started, how did you start learning about peptides? Of course, at the end, we’ll talk about your Peptide Summit, which I recommend for people to attend. How long have you been working with peptides? What led you to start recommending them to your patients? 

Dr. Jen: 

About 2018, I started to look into peptides. What are these? People are using them; they’re working well. Then I got cold feet for about six months because we had heard that the FDA was going to take them away. I don’t want to learn this whole new language. As we dive into the names of these peptides, it’s like a different language, a lot of alphabet soup. I got a little bit of cold feet. 

Then I joined this peptide group on Facebook. One of my colleagues, Dr. Rose, runs it. I decided to dig into peptides and get some education on them and start using them. I want to talk to the compounding pharmacists about them. 

I was just so happy I did. It just levels up some of the struggles patients have getting to that extra 10% of wellness. Or if it’s a really sick patient, and they’re doing all the things they can, sometimes it just moves the needle a little bit for them. It’s been really great to bring it into practice. 

IF you’re listening and look up “peptides,” it’s a gray area right now. The FDA just put 22 more peptides on this class 2 list for pharmacies. Compounding pharmacies aren’t making certain peptides that we were so used to having. Most of these are the injectable forms. We’re in a weird area right now with peptides. 

The good news is we are going to talk about oral peptides that we can take. They are looked at more as nutraceuticals and supplements. Those aren’t going to go away. That’s the good news. 

Dr. Eric: 

That is good news. Unfortunate about some of the injectables. It sounds not all of them. You said 22 specifically, and I know that could change. 

Dr. Jen: 

Yeah. The definition of peptides. What is a peptide? There have been some big names out there that have recently done podcasts and YouTubes on peptides. Let’s go over the definition. 

Peptides are chains of amino acids, usually about 4-50 amino acids. When you get higher than that, then you get proteins. Less than 4 amino acids, technically these are bioregulators. 

With peptides, people are like, “Oh, peptides. They are starting to get this weird, biohacking name.” No. We have peptides in our body naturally. Insulin is a peptide. Oxytocin, which is the love hormone, which breastfeeding women need, that’s a peptide. When we are getting dramatic talking about peptides, no, we make them in our bodies. The peptides we are talking about today, most of them are found naturally in our body also.   

Dr. Eric: 

Let’s dive into some of the benefits of peptides. This audience consists of people with thyroid and autoimmune thyroid conditions. Why would those listening to this be interested in peptides to improve their health? 

Dr. Jen: 

What these peptides do is go into your body—whether you take them intranasally, injection, orally—and they turn on and off genes in the body. It’s not like they’re going in there and disrupting things or forcing different pathways and having side effects. They’re working with your body, turning on and off genes, which is pretty amazing. 

That’s why I love peptides so much. They have pretty good safety profiles. Some of them, you have to be careful with certain things going on. Most of them are very safe. 

If we look at the studies, most studies are animal studies. The reason for that is it’s hard to get clinical trials done. They cost a lot of money. Usually, they are funded by drug companies. 

These peptides are really hard to patent. Some of them are starting to patent, and they’re turning them into actual drugs. One example is Thymosin alpha 1. Thymosin alpha 1 is a thymic peptide. Our thymus sits about here on the chest, and it is an organ that is really good for our immune system. It really is going to modulate immune health and our immune system. This is something that goes away as we age. 

These thymus peptides are really good at modulating our immune system. Thymosin alpha 1 is one of the ones that is amazing for autoimmune diseases. It was also in many studies. You can look them up on PubMed with COVID-19 and Thymosin alpha 1. They were using it a lot in China in the hospitals there. The patients were getting Thymosin alpha 1 injected daily when they tested positive, and they were doing really well. That was a great one when we could still get it in the U.S. to use for autoimmune diseases, like Hashimoto’s, and COVID-19, which was an immune dysregulation, when the cytokine storm would take over, and that’s when people would really get sick. 

About two years ago, the FDA said no more. Compounding pharmacies can’t make this anymore. it was really frustrating for a lot of us that were using it. Our patients were doing really well with autoimmune diseases. It was helping them get better faster, to go into remission faster. Now it’s a biologic pharmaceutical. I think it’s about $20,000 a month or something like that.

Dr. Eric: 

Wow.  

Dr. Jen: 

It’s a little frustrating. That was the first step that happened with the FDA, how they’re classifying some of these peptides. Now though, some creators, Dr. Kent Holtorf is one of them. They took the Thymosin alpha 1 and made thymogen, which is an oral peptide. That is going to have some of that thymus response, too. 

That’s what I’ve been using in my patients with autoimmunity issues going on. When I think it’s the right time to use it, I will give them thymogen, and that will help. It’s not as good as what we used to have, but it’s still helpful. 

When we talk about peptides, we’re just trying to use what we have available right now. The doctors that are out there using peptides, we’re trying to go with the flow, not be discouraged by the ones we can’t use, and just look forward to what we can use and how to work them into our patients’ protocols. Are you using peptides currently in your practice? 

Dr. Eric: 

As of now, no. I’m not using them. This is the first episode where we’re focusing on peptides. I have had some others where they talk about peptides along with other things. This episode is just focusing on it. 

With the previous episodes, they would talk about Thymosin alpha 1 as an option. It’s been a while since I had anybody talk about peptides. I should probably have you or someone else come on once a year because it sounds like it’s evolving. Hopefully, the thymogen will be available for the foreseeable future, but you never know. Or maybe something else will come along that’s better. 

Dr. Jen: 

Exactly. Along with the thymus peptides, there is also Thymosin beta 4. That was injectable. Those were used together. A lot of people use that for cellular repair. A lot of athletes use that. It’s a thymus peptide, so it’s good for autoimmunity.

That one, same thing. Can’t really get it anymore. There is something called TB4-FRAG, so it’s a fragment of that Thymosin beta 4. It’s oral also. That is another one for autoimmunity, which is really helpful to calm everything down. 

There are some oral peptide companies that put those two together, the Thymosin and the TB4-FRAG. Those would be a really good regimen for someone. 

I like to be aggressive with new onset Hashimoto’s, when we have just discovered it, to try to put it in remission really quickly, so maybe they don’t have as much damage to their thyroid gland. Also in those hard chronic cases, where there are all those other layers, like Lyme would be a good one. Those two peptides would help maybe because it’s focusing on that immune system and rebuilding that. That is some of the ways you can just use the oral ones. 

It’s sad we don’t have the injectables, but we’re just moving forward with technology. The oral peptides actually do really well. Not everyone likes to give themselves shots. I find it’s a little easier for patients, even though patients do get pill fatigue, too. 

Dr. Eric: 

With the Thymosin and TB4-FRAG, they can be used for any autoimmune condition? Are there any autoimmune conditions they shouldn’t be used for? 

Dr. Jen: 

You’re not using them long-term. That’s another thing with peptides. You’re going to cycle them. You don’t want to be on the same peptide all the time. You want to work with someone who knows how to cycle them, usually for about three months, see what happens, and then reassess. 

Another favorite peptide that is also a good peptide for thyroid, Hashimoto’s, Graves’, all those autoimmune diseases, Crohn’s- There are a lot of studies with BPC 157 and Crohn’s. BPC 157, body protection compound. It’s actually made in our gastric juices. That’s how it was discovered during those polyp experiments. BPC 157 is very good when you take it orally for healing the gut, healing gastric ulcers, Crohn’s, IBS. Anything with inflammation, BPC 157 is great.

It’s also great for tendon healing and ligaments. That’s the injectable version. Now that we can just take it orally, that’s another one where we don’t have the injection available anymore. They say it still helps with their tendons when they take it orally. 

I found the injection works a little bit better when it’s closer to the site of injury. I had an injury with my left shoulder. I could not do shoulder presses. Now it’s healed, and I used BPC 157 to help heal and repair it, especially as we’re aging.

I’ve also had patients who have had chronic pain in their joints from playing football in high school. We put them on two months of BPC 157 and cycled it. They were able to get out of bed, and they were feeling a lot better. It’s a great peptide. 

Interestingly enough, it is banned by the NFL and all of those professional sports, which is interesting because I don’t know how you would test for it. Maybe there is a drug screen that I don’t know about. 

I’ve spoken with orthopedic doctors that were more conventional. “I don’t know what that is.” Of course you don’t because what’s your goal as a surgeon? It’s to go to surgery, not to avoid surgery. That’s why I think a lot of these, if they were used consistently by all of medicine, it would probably make people really well and would cut back on hospital stays, surgeries, all of that. 

BPC 157 is available to take orally. 500mg, once a day. Great for gut health, like I said. Sometimes, it’s paired with Larazotide, which is another peptide, but it’s also a pharmaceutical. It helps with gut health and repairing the gut lining, those tight junctions, and also modulates zonulin a little bit. I’ve seen them in combination before. 

I’ve had patients who have had chronic diarrhea, Crohn’s, all of these horrible GI things recovering from GI viruses, illnesses, really recover well with the BPC 157. I always keep it with me when I’m traveling because you never know if you are going to get food poisoning or a virus somewhere. That’s a good one to take with you when you’re traveling, too. 

Dr. Eric: 

How about with H-pylori and/or parasites? Can that be beneficial at all? 

Dr. Jen: 

It would help with the inflammation. I don’t think it’s really going to take care of the H-pylori or the parasite. 

Dr. Eric: 

It’s not an antimicrobial. 

Dr. Jen: 

That would be LL-37. That one is injectable. We can’t get it right now. That was a great antimicrobial, anticandidal. That one was injectable. In really hard cases, I would pull it out as a big gun. A few human studies on that one also. 

Back to BPC 157. It’s like a different language. BPC 157, if you write that one down, I feel like it’s talked about a lot. It also could be compounded into eyedrops. You can put it into wound cream. 

I have compounded it for a patient with a really bad scar wound. He was at the misfortune of a couple urgent care visits, where they totally messed him up. We got him on some BPC 157 and GHK-Cu (copper) peptide cream, and it healed beautifully. 

They can make BPC 157 in all these compounds. The eyedrops were really cool. Some studies with corneal healing on that. I’ve had patients with dry eyes. One patient had dry eyes post-chemotherapy, and the BPC 157 was the best thing that had ever worked for him. The downside is the eyedrops are really expensive to get compounded. Those are a little pricey. 

Dr. Eric: 

You said that with the BPC 157, there was another injectable peptide you could take along with it that can help with gut healing. Can you also take the BPC 157 with the TB4-FRAG or Thymosin? Is that something you’d want to cycle, where you’d go back and forth between the two every few months? 

Dr. Jen: 

You can stack them. You’d also want to take a break and cycle. It depends on the patient in front of you. Say someone comes in. I usually start with gut health. I usually look at their GI Effects or stool study or organic acids test, if they have mold or candida. I will tailor it to that. And their symptoms. If they are having a lot of gut inflammatory symptoms, like diarrhea, bloating, pain, we might want to change their diet first. Make sure they’re getting sleep. We might want to add on a peptide. 

I talk to them about it. “Here’s all the things we can do.” First, what can they afford? What are they comfortable doing? 

If there is an H-pylori or parasite or candida or SIBO, we will take care of that first. Then layer in peptides in there, like BPC 157. After we fix their gut, then I usually do the Thymosin and the TB4-FRAG after that. 

Peptides work better when you’re optimized. Say someone is a mess, and they’re not willing to work on anything. If you throw some peptides at them, they might be like, “This isn’t doing anything,” and they spent all this money. I have noticed once you optimize a patient a little bit more, then add on the peptides, it’s like icing on that cake. They work so well. 

These are basic things like nutrition, sleep, and stress. I never want patients to waste money obviously because these kinds of things aren’t covered by insurance, but they work well. Optimizing those things and adding on peptides a little bit later as a therapy is sometimes good. 

Unless they are in a crisis, and you want to throw the kitchen sink at them. Or while you’re waiting for test results, it wouldn’t hurt to put them on BPC 157 to calm things down. 

Another good peptide for inflammation is KPV. This is actually a part of alpha-melanocyte stimulating hormone, α-MSH. This one is great because it’s so good for inflammation. This will be the one that’s paired with BPC 157. It will add another layer of calming inflammation down. 

I love this product for mold patients. Really helpful. They’re often low in α-MSH anyway because of all the narcans. This will be really helpful with them. I’ve had some patients where giving this intranasally, they really liked it that way. They felt it calmed down the inflammation in their head that they felt. You can also take it orally. 

I like to take this every once in a while if I am feeling more inflamed. Sometimes, I take it with PEA just to help with inflammation, too. KPV is a great one. Really like that. 

I’ve had some mold patients who will stay on that for a couple months at a time. Then we will take a little break. Then they might go back on it. I really like that one.

With your autoimmune patients, thyroid, Graves’, of course that will help a lot, too. Usually, these patients are the ones who have underlying mold going on. In your area, where are you at again, Eric? What part of the country? 

Dr. Eric: 

North Carolina. 

Dr. Jen: 

You probably see a decent amount of mold, right? 

Dr. Eric: 

It seems like it’s increasing. I am also more aware of it. I can’t say I test everybody for mold. Maybe five, six, seven years ago, I wasn’t doing urinary mycotoxin testing at all. Now, I’m more aware of the situation and will do that if necessary. Have them test their house for mold. 

Even though I’m in North Carolina, I also work a lot with people from all over the place. I don’t think there’s any place that’s safe from mold. Some places will be more susceptible, but I’m sure people even in places where you wouldn’t suspect mold might have cases of mold. 

Dr. Jen: 

I also feel like building material now is so cheap. It’s just cardboard. It’s all mold food. You have one little leak, one slow drip, and then mold. I am so paranoid about mold because of what I see in my office. 

Last Christmas, we were out of town, and there was a freeze. One of our pipes burst. The water went down to our basement. It had been about 24 hours since it had happened. We looked at the water use charge, and it was tons and tons of gallons. 

I was freaking out to my husband. “It all needs out right now.” Everyone thought I was being a little crazy. “Here, she’s being crazy again.” “No, I’m not.” 

Guess what? There was mold all over the drywall in the basement because it was a bathroom going down to a bathroom. There was already mold formed within 24 hours. We got it out, but it was a reminder with all of these houses that there are floods or hurricanes or standing water. That has to come out. Unless it’s plaster, which is cement basically, it’s going to have mold, and you will get those VOCs and mycotoxins.

What that does is messes with your immune system. It hurts your gut health, makes you more susceptible to different autoimmune diseases. 

I really enjoy talking about mold because I feel like it’s not talked about enough. A lot of people suffer from it. Peptides are really helpful with mold. They are a really good tool in the toolbox if you are working with mold patients or are a mold patient.

Dr. Eric: 

It goes without saying that if you have a mold issue, KPV can help, but you of course have to address the mold problem. You can’t just take the KPV. I guess you can do that, but it’s not going to have optimal benefits unless you get rid of the source of the mold. Assuming you have mycotoxins in your body, do things to detoxify them from your body as well. 

Dr. Jen: 

Absolutely. When you’re just buying time, figuring out if you’re still living in the mold or it was an old exposure, I have a lot of patients with that. They are waiting to get their house inspected or get an ERMI tester, whatever they’re going to do. Or they can’t get out of it for a while. That’s where things that help with inflammation or calm things down are good. Maybe your brain fog will get better. Binders supporting liver health. All those can be helpful. It’s pretty devastating for sure. 

Dr. Eric: 

How about stealth infections, something like Lyme or bartonella. Would the KPV be beneficial?  

Dr. Jen: 

Yeah, I would put that in the mix. These patients are usually really inflamed. You’d use the thymus peptides. You could also add on BPC 157, KVP. Those would be helpful. 

Other ones that are hard to get right now, Semax and Selank will help with brain, like brain fog and ADHD sometimes. Biohacking, people use Semax a lot for neurocognitive health. Those are nasal. Once again, those are harder to find now. We have to be a little patient. Sometimes, those are also used with these patients if they have really bad brain fog. They’re nice to use. 

Dr. Eric: 

Any peptides that can help with stress, adrenals? Obviously, you have to block out time for stress management and improve your stress handling. Any support specifically for adrenals? Anything you would recommend, maybe not directly supporting adrenals? 

Dr. Jen: 

For stress, you can use different peptides. The Semax, Selank. 

It’s not really a peptide, but DHH. It’s from the magnolia bark tree. It’s really good for calming anxiety. It’s almost a Xanax derivative. Similar action. I’ve had patients say that to me. I like DHH-B a lot. 

One that’s really cool that’s an oral peptide is 5 amino 1 mq. Because it’s a mitochondrial peptide, it really helps with energy and mood. I would think that would be a good one. It’s working on all the mitochondria. I would think that would help the adrenals, too. 

I have patients who really love it. I have them stay on it for a few months. Then I suggest to take a break for a month, and they can go back on it. Maybe I’m being a little bit conservative with that. It’s just a mitochondrial peptide, so it’s boosting energy to all of the cells. It’s helping with that cellular energy and the pathway we get our energy. 

That one, you can take up to three times a day. I usually tell patients once or twice. You don’t want to take it too late in the day because it can be more stimulating. It also has a little bit of thermogenesis effects, so weight loss and pilosis. I would say 10% of patients don’t like it or don’t notice it does anything. The rest of my patients really love it.

I’ll use that one when I’m traveling more. If I’m going across time zones, instead of coffee, I’ll use that to support my body. That one is the closest in the peptide world.

For the adrenals, one thing you can do is go on a bioregulator for the adrenals. A bioregulator would be a good choice. Bioregulators, which are those four or less amino acids, they are basically purified amino acids from animals. They’re purified down and put in a capsule. You take the capsule. Same thing as peptides, going in and turning on and turning off genes. 

Bioregulators came from Russia, Dr. Khavinson did most of the studies for that. Started out doing studies on the Russian Navy because they were going away to war and coming back very ill, not looking well. They started using bioregulators on them. Great safety profile. Used more and more for longevity.

I really like using Thyreogen, which is the thyroid bioregulator. I usually do pair that with an adrenal bioregulator. As we know, thyroid and adrenals really play off of each other, so it’s really great for patients, maybe if they are just on the verge. Their thyroid needs more help, a little bit more reserve. 

I also use it for patients that have Graves’ and Hashimoto’s. Bioregulators are not a stimulant; they are not going in there and revving things up. They are going in there and repairing those genes. That is a great one. I love bioregulators. 

The awesome news is toward the end of May/June, we are going to be able to get bioregulators a little bit easier. They have been really hit or miss because of supply chain, because of what’s going on in Russia and Ukraine. It’s really exciting that they are going to be available. It’s been so hit or miss the past year. It’s been a little bit frustrating for me and patients. “I want you on these bioregulators, but we can’t get them right now.” They’re out of stock everywhere. 

For adrenals, I would definitely try the bioregulator. Of course, we want to remember the other tools in our toolbox, like making sure you’re getting good sleep, turning off blue light at night, making sure you’re eating well, balancing the blood sugar. Also, we can’t forget adaptogens. Adaptogens are so great for our adrenal glands. 

Dr. Eric: 

I agree with you there. With bioregulators, they’re also administered orally? 

Dr. Jen: 

Yes. That’s the great thing. They are administered orally. They get absorbed really well. They’re so little, so they just cross right over. Your body doesn’t even have to digest them. I’m a big fan of bioregulators. 

Dr. Eric: 

You might have mentioned this earlier, but I’ll ask anyway. With peptides and bioregulators, if you take injectables, it sounds like you need a prescription. If they’re oral, does that mean you don’t need a prescription? 

Dr. Jen: 

Yes and no. Things are changing. Most peptides, I will do a prescription and get them from a compounding pharmacy. There are oral ones, like the TB4-FRAG and the thymogen that you can get as nutraceuticals, supplements. Some of the companies, you can just buy them. Some, you need to buy through a healthcare provider. 

Similar to supplements, you are going to want to make sure that you are going to high-quality sources. You don’t want to just get them from wherever. Now, with the injectables, what has happened is people can’t get them anymore from the compounding pharmacy, so there is a few other countries, like China or Russia. They are ordering these vials. You don’t know what you’re getting. You want to make sure that your company has a certificate of analysis, that they are testing batches. This is the stuff the compounding pharmacy does to make sure you are getting what you’re really getting.

When we talk about peptides, I guess we should talk about the weight loss peptides, Semaglutide, which is Ozempic; Tirzepetide; Mounjaro; Zepbound, all the different names. Wegovy, another one. Every compounder is making these. 

You want to make sure that you are getting it from a high-quality place. They are testing the batches. You’re injecting this into your body. We don’t want to inject things that shouldn’t be there. Peptides are good things, but you need to make sure you are getting them from quality sources, similar to supplements.

I can dive a little bit into those GLP-1 agonists. You can’t turn on your phone without getting an advertisement for them, right? My friend texted me and said, “Costco is now offering these GLP-1s.” You can do an online visit and pick it up at Costco. What do you think about these? I’m curious what your thoughts are. People are really one way or the other about these, I find. 

Dr. Eric: 

Yeah. First of all, I didn’t know that. I do have a Costco membership but did not know that you could get peptides through them. I guess certain ones, like GLP-1. Probably can’t get BPC 157 through Costco. 

Dr. Jen: 

No, just these. 

Dr. Eric: 

When it comes to weight loss peptides, keep in mind, I’m not recommending them to my patients as of this recording. I guess it sounds too good to be true. You’re the expert, so I imagine, just like you mentioned with the other peptides, it’s not just a matter of taking the peptides and losing weight. You need to eat a healthy diet, manage your stress, get sufficient sleep. If you just take them alone, maybe they do help to some extent. If you combine them with a healthy diet and lifestyle, I imagine they work even better. 

Dr. Jen: 

This is the thing. First, we don’t want to do any harm. I want to cycle peptides still. I don’t want to put the gas on this pathway all the time. There are natural GLP-1 things that we can do. Berberine is a slight GLP-1 agonist. Akkermansia is a slight GLP-1 agonist. It’s a gut bacteria. There are different things that activate this pathway.

It’s an injectable. You are activating that GLP-1 agonist pathway. You will be feeling fuller longer. It slows down gastric emptying. It does have an effect on the brain. We know it affects that brain pathway. It’s going to be helping your body create more insulin. It’s also going to stabilize blood sugar more. It really has a good place. 

I’ve been using GLP-1s before all the celebrities were. I’ve been using them in select patients. What do we do first? We work on the habits we talked about: sleep, nutrition, etc. We fix their gut health. We balance their hormones. We balance their thyroid. Sometimes, I have them wear continuous glucose monitors. We really try to do things before the peptides. 

Sometimes, they are doing all the things, and they just need a little bit of help for a few months. Most of my patients are on the Semaglutide or Tirzepatide just for a few months. 

When you are going on this, I tell them you need to eat enough protein, and you need to be lifting weights. One of the side effects is muscle loss. Once you hit 40, you lose 1-2% of your muscle mass a year. Or you can. So you really have to fight that. It’s harder to gain muscle, too, when you get in your 40s, 50s, 60s, 70s. I really tell them we have to make sure you’re maintaining muscle, eating protein, and staying hydrated.

One thing that can happen is patients will go to a med spa and go on these shots. They’re dosed really high right away, so they’re super nauseous, so they can’t even drink water. They’re throwing up. They go into kidney failure or have kidney damage. We don’t want that.

It’s nice to get it compounded because you can titrate up really slowly as opposed to the dosing that the pharmacy has. 

Right now, the compounding pharmacies are still not able to compound this medication because it’s on back order in so many places. It’s just exploded. I don’t think people just should be on Semaglutide or Tirzepatide 24/7/365 and then not change their actual habits. When they get off of them, they gain the weight back. Their blood pressure goes up. Their cholesterol and triglycerides go up again. 

We know this from the actual studies. There are so many studies that show this again and again. The drug company is saying, “You have to stay on this forever. You have to pay for this forever.” Yes, maybe in a type 2 diabetic that isn’t going to change their lifestyle. But I don’t think that’s good either. I think they should really weave in lifestyle to that. 

A lot of the times, when someone is on a GLP-1 and GLP-1 GYP, which is Tirzepatide, we can put them on something like Tesamorelin, Sermorelin, which is a growth hormone releasing hormone. That could help them with that building. Those are a group of peptides. They are not growth hormone; they are growth hormone releasing hormone. They tell your body to release more growth hormone. As we age, our growth hormone goes down.

One thing with these peptides is you do want to make sure there is no active tumors. You want to check IGF-1 levels and make sure they are not too high. These are great peptides that can really help boost muscle mass. 

I have a patient that was a mold patient and post-vaccine injury. He lost so much muscle mass. He was so weak. After we treated the mold, “How do you feel about going on a growth hormone releasing hormone? Let’s get some of your muscle mass back up.” He was in his 50s. That’s really important to his health to have muscle and for his hormones. He was good with it. He really did well on it. We had him on it for a few months. It really got some of this strength back, got him motivated. He just kept improving from there. 

This is why peptides are so beautiful. We live in such a toxic soup bowl. There are so many things that we have to heal from that no one had to worry about 50 years ago. They pair nicely with integrative, functional treatments, to elevate and get patients better faster. It’s really fun. 

Dr. Eric: 

They do sound amazing. One other question I have for you is do you take any on a wellness basis? If someone is in a relatively good state of health. I think you said you take some peptides earlier, which isn’t a surprise since you’re a peptide expert. 

Dr. Jen: 

It’s really fun to biohack. The growth hormone secreting hormones, I did that for a while. I sleep really well on them. I took a break though. Maybe I’ll start that back up this month. I don’t know. I sleep really well when I’m on them. 

That’s something you cycle five days on, two days off. I usually do Monday-Friday and then take the weekend off. Those are a lot of fun.

One peptide I didn’t talk about yet is GHK-Cu peptide. I mentioned it for a second with wound healing. I have never taken this one injectable; I’ve heard it’s amazing. That is another one that was on that list, so I’ll just talk about the topical, which you can still get compounded and over the counter. 

GHK-Cu is another peptide made in our body. This does decline as we age. I love it for skin. I use it on my skin every day. It helps with fine lines, wrinkles. It really supports that outer skin layer. Your skin is not going to get as dry. 

It helps with redness. While I am working on their gut health, too, because we know rosacea is gut health. I put patients with rosacea on the copper peptide cream, and they have thrown away four prescription bottles from their dermatologist of junk. It’s crap what they give their patients. They use the copper peptides and are like, “Wow, this works better than all of those prescriptions.” “Yeah, isn’t that crazy?” Not really, but… 

Anyway. That one’s great. It helps with crepey skin. Such a fun peptide. Really good with wound healing. 

It was funny. Well, it wasn’t funny, because I got mad at my son. He got sunburned when we were in Mexico for spring break. I had my copper peptide serum for my face, and I was putting it on his sunburn. It actually does help with DNA. DNA damage, UV protection. 

There is a study they did on GHK-Cu. It either upregulates or downregulates more than 50% of up or downregulation of about a third of our genes, 32%. This is a peptide that is going in there and affecting almost a third of our genes. It’s really cool. I really love that one. 

If you dig into the research with GHK-Cu, really cool things they were doing in rat studies with hemorrhagic stroke, like reversing symptoms. Amazing, crazy cool studies. I wish they would keep on studying. We’ll see. 

I don’t know where that peptide is going to end up. I think it could do beautiful things. I don’t know what the FDA wants to do with it. I wish I knew. That’s a great one topically if you’re not using it topically. 

Some people will say, “I have peptides in my skin care.” No, you probably have these weak collagen peptides. This is GHK-Cu. If you go to my website or Instagram, there are a bunch of companies I love for that.

Another peptide, I actually just learned about a few months ago, and I take it every day. It’s a plant derived peptide. There is this company called Nuritas. They use AI technology to find plant peptides. It’s a company in Ireland. Such cool stuff they’re doing. They’re rolling out 1-2 new peptides a year. They do clinical human studies on these peptides. This is so cool. I geek out. I get so excited about it. 

The one is called PeptiStrong. It increases muscle synthesis. It supports MTOR. It also affects myostatin, so you’re not getting that soreness post-workout. I take it in a blend in an oral capsule. You need 2.4g of it orally to stimulate the muscle synthesis. It helps retain muscle basically. 

The studies they did were on patients where they immobilized a knee and did muscle biopsies. The patients taking the PeptiStrong maintained more muscle and muscle mass while they were immobilized than the controls. 

Also, it showed it was helping with osteoporosis and increasing bone density. If my patient’s taking a GLP-1, I’m offering and recommending for them to take this and lift weights and eat protein. 

Also, my post-menopausal women, I want them to take PeptiStrong. 

Talking about cool stuff with this, they’re talking about putting it in soup at nursing homes to help with keeping that muscle. We know muscle is a longevity organ. It helps with insulin sensitivity. You need to be able to lift yourself up off the toilet. It decreases falls. Really cool stuff. I’m really excited about that one. I take it every day. 

BPC 157, like I said, on and off. It’s rare for me to get stomach issues, but when we did go on vacation, I don’t know if I got gluten bombed or something that last day. My stomach was a mess. This is so weird for me. I’m not used to this. I took some peptides. Within 24 hours of some peptides and some supplements, I was fine. 

I like to keep it all handy. What else do I have in my fridge? I’m trying to think. The BPC 157 injectable, I do have that still because I got it before the FDA said no more. I have that for when I have some tweaks and injuries. I was thinking about putting more in my shoulder to get it a little stronger. 

Those are the peptides I take right now. I think it’s fun to try them. I always like to try things before suggesting them to my patients if I can. Some things I don’t need, but there are so many great things out there.

Are there any peptides that you want to try now? 

Dr. Eric: 

Oh yeah. 

Dr. Jen: 

First on your list? 

Dr. Eric: 

You mentioned the PeptiStrong. I have been working out for a long time and lifting weights. I haven’t gone heavy until the last year. I’ve been focusing more on muscle mass. I hired a personal trainer for both myself and my wife. I might want to take PeptiStrong for a few months. You said you take that every day, but is that still something you cycle? 

Dr. Jen: 

This one, I spoke with the creator of it at the Peptide Summit. He said you didn’t have to cycle this one. I probably still would just take a break from it for maybe a week or two depending. The plant-based peptides coming out, it’s pretty cool. It’s really exciting. It’s a nutraceutical; it’s a supplement. We’re good to weave them into our protocols. 

Dr. Eric: 

This is awesome. I learned so much. I’m sure the listeners learned a lot. It has motivated me to try peptides and eventually recommend them, too.

Before we wrap things up, I want to talk to you about your summit. But is there anything else? You shared so much information, but anything else you want to say? 

Dr. Jen: 

With peptides, I would say to make sure you’re working with someone who knows how to use peptides and when to use them. You don’t want to waste your time and money. There is an art to using peptides. That comes with experience of using them on patients. Most of them have a safety profile. There is a lot of oral peptides now, which is also really exciting. 

Dr. Eric: 

Quality- Like you said, with supplements, it’s important. Peptides, just as important. You want to make sure you’re safe, even though that’s another thing we didn’t really talk about, the contraindications. You mentioned earlier that they are relatively safe, correct? 

Dr. Jen: 

Yes. 

Dr. Eric: 

Definitely work with someone like Dr. Jen, who has a good amount of experience with peptides. Definitely more experience than myself. You just blew me away with the knowledge you have.

If you could tell people where they could find out more about you, your website. Tell them about your podcast, and of course, if you could talk a little bit about this upcoming summit. 

Dr. Jen: 

Awesome, thank you. The best social media where I hang out is Instagram. My handle is @IntegrativeDrMom. I have a YouTube that is the same handle. 

My podcast is The Integrative Podcast with Dr. Jen. My website is HealthyByDrJen.com. That is my main one for health coaching. I Have a brick and mortar called PflegMed in northwest Ohio. The website has a lot of blogs. 

May 21 starts the Peptide Summit. This is with DrTalks. If you guys are subscribed to Dr. Eric’s newsletter, he will send out some information. It is free to attend. You will be blown away by the experts there in peptides. It is amazing. You will learn more than you’d want to know about peptides and a lot about longevity and biohacking. It’s such a fun summit. You’re going to learn from the experts. Some of the names we have on there are amazing. I had so much fun at each interview and learned so much. I know if you guys enjoyed this podcast, you’ll really enjoy this summit. 

Dr. Eric: 

I look forward to learning more. I’m going to make sure to register for it and check out the talks. Thank you so much. This was really amazing. I learned a lot, and I’m sure the listeners learned a lot. I appreciate you taking the time to talk about peptides, Dr. Jen. 

Dr. Jen: 

Yes, of course. Thank you so much for having me.