Recently, I interviewed Dr. Angela Mazza, and we talked about her book, Thyroid Talk: An Integrative Guide to Optimal Thyroid Health, what to include in comprehensive thyroid testing, the effects of thyroid disruptors, and more. If you would prefer to listen to the interview you can access it by Clicking Here.

Dr. Eric Osansky: 

I have a return guest today who I am very excited to chat with, Dr. Angela Mazza. Very excited to talk about her new book Thyroid Talk. For those who didn’t listen to her first interview, which I highly recommend, I will give a brief bio here.

Dr. Angela Mazza is the founder of Metabolic Center for Wellness in Oviedo, Florida, where she spends a great majority of her time caring for persons with autoimmune thyroid disease, thyroid nodules, and thyroid cancer. Metabolic Center for Wellness is the only center in central Florida providing the thyroid-saving procedure radiofrequency ablation (RFA) for thyroid nodules. Highly regarded for her individualized approach for thyroid care, Dr. Mazza empowers each person to achieve their unique goals by providing education, lifestyle management, and support. Thanks for joining us again, Dr. Mazza.

Dr. Angela Mazza: 

Thanks so much for having me, Dr. Eric. 

Dr. Eric: 

Really excited to talk about your book. Last time, you focused on a lot of things in your practice, including radiofrequency ablation, which is a very interesting procedure and something that can actually save people’s thyroid glands. We can chat about that here as well. What motivated you to write the book Thyroid Talk? 

Dr. Angela: 

There is probably a few things. We have been in practice for about nine years as well. As an integrative endocrinologist, I really feel like we are treating patients with thyroid issues the best they could possibly be treated. Traditional medicine falls short on a number of levels.

I got to a point a few years ago where I couldn’t take on any new patients. I was only taking on patients for procedures, like radiofrequency ablation and thyroid biopsies. We had people calling all the time, looking for new patient appointments. I felt so bad because I felt like these people were looking for help, and I’m not able to do that on a one-on-one basis.

Then I had people say, “You have to train other people.” We do some training. I lecture for A4M and societies like that. But I found there was a real need for solid information, like you give really good information to your listeners. It’s reliable, true information. There is a lot of false information out there. I’ll get questions all the time, like “Where did you even hear that from?” 

That’s around the time we started the podcast to help give reliable, good information regarding thyroid health out there. Organically, I started writing a book. I would sit down and write one chapter at a time. Let’s start with the basics. How is thyroid hormone made? How is it controlled? What does it do? I went through, and the book came together by itself. I was addressing questions that patients were having concerns about, or even other practitioners had questions about. It was really a labor of trying to help more people that I couldn’t one-on-one help myself.

Dr. Eric: 

What I love about the book is first of all, if someone has recently been diagnosed, it’s great because it does cover the basics. But if someone has been diagnosed for a number of years with Hashimoto’s or Graves’ or a non-autoimmune thyroid condition, they can still benefit from the book. There is some advanced stuff. You don’t have to go in order. 

If someone was recently diagnosed, it might be a good idea for them to start at the beginning and go through the whole book. But they certainly don’t have to. If someone wants to skip around and just learn about the thyroid-gut connection or other things we will talk about, they can do that. Like I said, I think it fits anyone with any thyroid or autoimmune thyroid condition. 

Dr. Angela: 

I wrote it for patients who are motivated to put the work in, even providers who want to learn more. They don’t know everything because we don’t stop learning when we finish med school. We want to help our patients live their best lives.

Integrative endocrinology, especially when it comes to thyroid, there is really no magic pill. Wish there was. There are so many things we can use to achieve better thyroid health. 

Dr. Eric: 

Definitely agree. Most people listening to this probably know the basics, as far as hypo versus hyperthyroidism, thyroid glands. For those who don’t, check out Dr. Angela’s book.

We will hit a number of different topics. The first thing I want to talk about is testing. As far as blood testing, what do you recommend for those with hyperthyroidism or Hashimoto’s? I guess we should backtrack a little bit. When people come see me, they have already been diagnosed with hyperthyroidism, etc. I’m guessing with you, that might not be the case. You’re an endocrinologist, so going to you with an undiagnosed condition, and then they get diagnosed. What type of patients do you see? Then the testing you typically recommend. 

Dr. Angela: 

You’re right on. A lot of patients who have been referred to me already have a preceding diagnosis of hypo/Hashimoto’s. Some are hypo after surgery or a procedure. Some are hyper, not specifically diagnosed as Graves’. When patients get sent to me for hyper often, there is not a clear diagnosis. That’s where a little more digging in comes along.

I do take care of patients with diabetes where we uncover thyroid issues all the time that were not uncovered before. We do catch some new cases or find ones that were probably there all along or were undiagnosed. 

As far as testing, I would have to say my go-to panel is TSH. I do want to say, and you and I are like-minded, TSH is not the be-all end-all. It’s an okay screening test, but it doesn’t tell us the full picture. 

Free T4, free T3. I do only test free levels because thyroid hormones do circulate bound by protein. What’s bound by protein is really not usable. That’s why I tend to look at the free levels because the total levels can be misleading, especially in women when they are premenopausal. 

I do check thyroid antibodies in pretty much everyone with any sort of thyroid issue. Thyroid globulin antibodies, thyroid peroxidase antibodies (TPO). I only check thyroid stimulating immunoglobulins (TSI) in someone I suspect is hypo. 

But I will tell you anyone who has positive antibodies for Graves’, almost all of them are positive for TPO. I never used to check that if I knew someone had Graves’ already. But if we can adequately bring someone back into a euthyroid state from Graves’, having those antibodies, you can tell if they are going to develop hypo down the line. 

Reverse T3, I do check quite a lot. It gives me a lot of information. Reverse T3 gets a bad rap, like it’s bad. But it tells us what’s going on in the body. It’s really a survival mechanism. If the body needs to conserve energy, mainly the mitochondria don’t have energy, we’re going to convert more T4 to T3. That gives me an idea of the mitochondrial reserve.

It also tells me if someone is on thyroid hormone replacement. If they are getting too much T4, we are going to use up our pathways to convert to T3 and start making too much reverse T3. That’s counterproductive.

The last part of my panel is I always check a random urine for iodine and creatinine. That way, I can extrapolate a 24-hour urine collection, which tells me if someone is getting too much or too little iodine. I am finding issues with iodine a lot. Not only not enough for some people, because we don’t eat as much iodized food, but having a lot of people who are taking thyroid hormone supplements, and they have a ton of iodine in them. That also can cause an issue. 

Dr. Eric: 

I want to talk more about iodine. With the panel, I agree. I test the free hormones. TPO, it’s interesting. Some of the research shows that anywhere from 60-80% of people with Graves’ have TPO antibodies. I didn’t when I dealt with Graves’; mine were negative. But I agree that the majority of people I see have elevated TPO antibodies. I’m sure you see some people with all three antibodies at times. Sometimes, TSI with TPO and thyroid globulins. 

Reverse T3, I stopped testing it in my hyper patients because almost everybody has elevated reverse T3 if they have hyperthyroidism. 

Dr. Angela: 

It’s going to be high. 

Dr. Eric: 

It does make a lot of sense if someone has hypo. I agree that reverse T3 can be helpful. 

A urinary test for iodine. Is that a 24-hour loading test? You said 24-hour iodine test? 

Dr. Angela: 

I’ll get a random because it’s a pain to do a 24-hour urine collection for everyone. It’s labor-intensive. I’ll get a random. It gives me a shout as to what the 24-hour urine collection is. You can extrapolate it out to a 24-hour, and it gives you a general idea. 

Dr. Eric: 

Like a spot test? 

Dr. Angela: 

Exactly. Super easy, inexpensive. It gives you a good idea of what’s going on with iodine stores. 

Dr. Eric: 

Do you see a lot of people with low levels of that urinary iodine?  

Dr. Angela: 

I do. A lot of people used to use iodized salt. Now everybody is using pink Himalayan salt and sea salt, which don’t have iodine in them. A lot of people used to eat iodized bread, but it’s not a regular staple in our diet as much as it used to be. A lot of places used to have iodinated water, but that’s not so much the case anymore.

Dr. Eric: 

If you see someone who is low in urinary iodine, do you recommend supplementation? Do you encourage them to eat more foods that are rich in iodine? 

Dr. Angela: 

I do try to do the dietary route. Even if you do a quarter of a teaspoon twice a week of iodized salt, that’s going to be enough for the week. Our body is pretty efficient at using iodine. We only need 100-200mcg a day. It’s a very small amount.

Dr. Eric: 

It sounds like you’re not advocating high dose iodine supplements. Just if someone is low, make sure you’re getting enough through food. 

Dr. Angela: 

I’ll once in a while do an iodine potassium supplement. It’s only going to be people who can’t have salt. Again, it’s only a couple times a week. It’s not a daily thing. 

Dr. Eric: 

When you see someone that is high in iodine on the test, is it typically because they’re supplementing? Or are they eating a lot of seafood or sea vegetables? I’m sure it varies. What do you typically see? 

Dr. Angela: 

It varies. It tends to be people who are doing extra supplementation mostly. I’ll get some really weird ones that are super high. It’s usually after they’ve had some sort of contrast study. I ask if they had that done. 

Dr. Eric: 

That’s a good point. If someone is doing an iodine test, that is a good question to ask, just to make sure they didn’t have any type of iodine contrast. Thanks for bringing that up.

I was going to ask you about serum iodine. What are your thoughts on testing for iodine in the blood compared to the urine? 

Dr. Angela: 

It’s just not as accurate. We have studies that support that. It’s not a really good plasma measurement. 

Dr. Eric: 

I agree. I figured that’s why you did urine because you’re not a fan of blood testing. 

Next question that you are probably not expecting me to ask. I know you mentioned thyroid globulin antibodies, and you mentioned thyroid globulin when going over some of the basics. As far as testing for thyroid globulin, I’m bringing this up because I don’t know if you know this- But you do deal with cancer. When thyroid globulin is really high, it can be an indication of cancer, but it won’t confirm it. Some studies show that it can be related to an iodine deficiency. Some also show that it can be related to thyroid globulin antibodies. 

I don’t test routinely thyroid globulin on my patients. I’m just curious if you test for it. What are your thoughts on that marker? 

Dr. Angela: 

Great question. Actually, I had that question come up today with a patient. Thyroid globulin is a substance of the thyroid itself. Thyroid globulin acts as a template for thyroid hormone assembly.

You’re right. In someone who has had total thyroidectomy followed by radioactive iodine for thyroid cancer, it will be a clue as to if there is a return to the thyroid cancer. If there is an elevation of thyroid globulin, it means that there are tissues. 

The question my patient had for me was I was following up with her after an RFA. Her primary care doctor had ordered a thyroid globulin level for her, and it was elevated. She said, “He said I have cancer.” No. This just means you have a thyroid. It may be a little bit higher, maybe normal range. I find that patients who have larger thyroids tend to have higher thyroid globulin, whatever that means. There is no point in ordering a thyroid globulin if someone has a thyroid. 

Dr. Eric: 

Like I said, I typically don’t, but some endocrinologists or other doctors do. Sometimes, they might mistakenly order that instead of the antibodies. Maybe it’s a lab error. Either way, if it’s on the panel and it’s elevated- 

Dr. Angela: 

It’s scary. 

Dr. Eric: 

To the patient. 

Dr. Angela: 

It’s on a number of panels. If you go on Lab Corps and order a thyroid panel, it sneaks in there for a lot of these panels. 

Dr. Eric: 

I didn’t know that. I see it sometimes. Maybe it is paired up with thyroid globulin antibodies on one of the panels. It’s reassuring to hear that if it’s elevated, the person probably shouldn’t stress out. 

Dr. Angela: 

Exactly. Great question. 

Dr. Eric: 

Unless they had a history of surgery and radioactive iodine and then monitoring it. Then you don’t want it to be elevated. Especially if they had a complete thyroidectomy, it should be 0 then? Or less than one? Undetectable? 

Dr. Angela: 

It’s usually undetectable or less than .1. It depends on the lab itself. Some assays will be less than one. We shoot for undetectable. 

One caveat with thyroid cancer patients is we are doing more conservative treatments for thyroid cancer now. Only half of the gland may be taken out. We leave the remaining gland in place. That would be a case of thyroid cancer where you don’t want to do a thyroid globulin check because it’s still going to be positive. That can be alarming to patients. 

Dr. Eric: 

Good to know. Just thinking on the topic for one other question. Last time we spoke, I think I asked you about RFA for thyroid cancer. At that time, it wasn’t approved. It hasn’t been that long since we chatted, so I’m guessing if someone has a cancerous thyroid nodule, is that something where you would not- 

Dr. Angela: 

It actually has been approved. 

Dr. Eric: 

Oh, it has? 

Dr. Angela: 

Yes. Pretty exciting. It’s very small, microcapillary, thyroid cancer. These are the cancers that our option before was either partial or total thyroidectomy, or observation. Just observation can be kind of alarming to a patient. They know they have cancer, even though it’s small. It’s 1.5cm or less usually. 

RFA was approved for the treatment of capillary thyroid cancers that are less than 1.5cm. They can be adequately ablated. It’s pretty cool. I think that’s a big advancement for RFA. 

Dr. Eric: 

That’s awesome. I’m glad I asked that. 

Dr. Angela: 

I’m glad you did, too. 

Dr. Eric: 

In chapter six, you spoke about thyroid disruptors. I was very interested. Before we started recording, I mentioned cadmium. Most practitioners don’t talk about cadmium in general. I know you also mentioned fluoride and flame retardants. Let’s talk about some of the different ones. 

Let’s start with heavy metals. Why did you focus on cadmium in that chapter? 

Dr. Angela: 

I don’t think we talk enough about cadmium. It’s present around us. I think cadmium doesn’t get enough credit in terms of bad things in smoking and cigarettes. 

Cadmium is really important because it affects our selenium levels. That’s the key thing about it. Selenium is really our protector of our thyroid. It contributes to antioxidants that help protect the thyroid. Thyroid hormone production is an oxidative process. It’s inflammatory. Selenium helps protect our thyroid from that inflammatory state. If we don’t have selenium, our thyroid is left unprotected.

If we have a lot of cadmium, it will prevent selenium absorption, so we are not going to have our selenium that we need. It’s kind of a vicious cycle. If we have too much cadmium, we won’t have enough selenium. Selenium is needed to get rid of cadmium. It’s a self-perpetrating cycle. Nonetheless, cadmium has been linked to growths on the thyroid, like thyroid nodules and even thyroid cancer. It all comes back to selenium for me. 

Dr. Eric: 

It makes sense. 

Dr. Angela: 

Any of the disruptors of thyroid hormone production and thyroid activation, even thyroid receptor activation, at any step of the way. They are really destructive.

Dr. Eric: 

You did mention other metals. Cadmium was the first one. You focused on it a little bit, but you did mention mercury, aluminum, lead. I forgot which other ones. You’re concerned with not just cadmium but the other ones, too. 

Dr. Angela: 

They’re all bad. It’s not to be scary. We’re exposed to things all the time. We can’t get away from them. We try to limit what we can. If you want to live in a bubble, you can’t get away from all the toxins we’re exposed to. If we can give our body what it needs to help detox and protect it as much as we can, then it gives us a fighting chance at offsetting the potential harm that these toxins can cause. 

Dr. Eric: 

How about fluoride? I had an interview about a year and a half ago with a medical doctor who briefly admitted that fluoride was a problem but didn’t want to talk about it. They were nervous about talking about it. You put it in your book, so I assume you won’t be nervous about chatting about it, how people should avoid it or minimize their exposure to it. 

Dr. Angela: 

I grew up in Delaware with fluorinated water. That was supposed to be good for us. It was good for teeth, bones. That’s what they said. Perhaps it does have some benefit there.

When it comes to thyroid, too much fluoride can actually decrease our thyroid hormone production. I mention in the book that if you put it in context to this, fluoride used to be used to treat hyperthyroidism. It used to be used to shut down thyroid hormone production. Too much fluoride does affect our thyroid hormone production, T4 as well as T3. That essentially leads to, whether it’s permanent or temporary, inadequate thyroid hormone production.

Dr. Eric: 

Do you recommend not only avoiding drinking water with fluoride but using a fluoride-free toothpaste? Do you use toothpaste without fluoride? 

Dr. Angela: 

Yes, I do. If we are exposed to so many chemicals, how much do we want to try to work on detoxing? We can expose ourselves knowingly to these extra toxins. I would go the fluoride-free route. 

Dr. Eric: 

I agree. I use fluoride-free toothpaste. How do you filter your water? What type of water do you drink?  

Dr. Angela: 

We have a water filtration system. There will be times where you can’t get filtered water, or you have to drink out of plastic bottles. Again, you try to minimize what you can. There is controllables, and there is non-controllables. If you try to keep your health as optimal as you can, your body is able to handle some of these toxins. It can get overwhelming and scary, and I think you can fixate. The last thing I want to do is cause people to get too scared of things. Just provide knowledge like you’re doing, and you can be aware of it. 

Dr. Eric: 

I agree. I can’t say I never drink tap water. If I’m out and about, I don’t buy plastic water bottles by the case to keep in my home, but if I’m somewhere, like a plane, where you can’t bring your own stainless steel water bottle. I can bring it, but it can’t have water from outside. 

Dr. Angela: 

You have to find a place to get it. 

Dr. Eric: 

I think we’re on the same page with that. Any other thyroid disruptors/endocrine disrupting chemicals you want to chat about? 

Dr. Angela: 

Those are the biggies. These chemicals can really just disrupt thyroid on every level. Be aware. That’s all. 

Dr. Eric: 

Let’s talk a little bit about thyroid/gut connection. I like that you talked about concerns with PPIs, acid blockers. You also brought up the betaine HCL challenge, talking about supplementing with betaine HCL. Do you see a lot of people with lower stomach acid in your practice? 

Dr. Angela: 

Oh yes. The tough thing is you have every other patient already on a proton pump inhibitor. It’s tough to work backwards because there are over 110 million prescriptions for PPIs. They are available over the counter. Everyone who thinks they have a little bit of stomach upset or bloating thinks it’s GERD-related. GERD does exist. 

But in our patients with Hashimoto’s especially, low hydrochloric acid tends to be the problem. If we put them on a PPI, it makes the problem worse. It’s better if I have someone who is not on a PPI to make the diagnosis. 

That’s where the betaine challenge comes into play. Just to mention, it’s more of a progressive challenge, to see- It’s not only a challenge, but it’s a diagnostic test. If you try it out, if you take 1 betaine HCL and feel a burn right away, that’s probably not the problem. It’s a progressive increase with the betaine to figure out what is the dose that is needed. I’ll go a couple months and then retest things out. If we don’t have HCL, we can’t break down food, which leads to nutrient deficiencies like B12 and iron. Iron is important for our thyroid again. We need iron for thyroid peroxidase.  

Dr. Eric: 

Also, it has antimicrobial effects, so you need stomach acid to keep not just bacteria, but potentially pathogenic microbes in check. 

Dr. Angela: 

Exactly. The tough thing is when we have this HCL acid, people who are on hormone replacement don’t absorb thyroid hormone very well. That in turn leads to poor absorption, which leads to hypothyroidism, which decreases gut motility, which is another self-perpetuating cycle. 

Dr. Eric: 

In the same chapter, you also spoke about the gallbladder and how especially people with hypothyroidism are more susceptible to having gallbladder issues.  

Dr. Angela: 

Yes. I think you will probably agree. I’ve had a lot of patients who have gallbladder surgeries in the past. “You don’t even need a gallbladder, so just take it out.” It serves a purpose. 

People with hypothyroidism have decreased cholesterol metabolism in the liver. That leads to super thick bile, which is stored in the gallbladder. The gallbladder can’t contract, which leads to gallbladder sludge. In worst cases, gallstones. That storage really serves a purpose. If we don’t have bile to go along with the enzymes for our pancreas, it’s tough to break down fats and proteins. It does serve a purpose. If we can catch that before the gallstones become a problem. Otherwise, it leads to unnecessary surgeries. 

Dr. Eric: 

Agreed. About half a million people get their gallbladder removed. I’m sure some of them are necessary, but who knows how many could have been saved if they addressed the cause of the problem. 

Dr. Angela: 

Sometimes, the threshold is very low for doing the surgery. If someone is uncomfortable, they take it out. I have seen more often recently patients who tend to have that same discomfort even when the gallbladder is out. It didn’t solve the problem. 

Dr. Eric: 

Again, that’s not addressing the underlying bile metabolism issue. 

We’re just going through all these different topics. You covered a lot in the book. Obviously, we can’t cover everything, which is why people need to read your book. I want to touch upon some different topics, so we can take a different approach than in the first interview, when we just focused on RFA.

Brain fog. What are some potential causes and solutions for brain fog? 

Dr. Angela: 

Brain fog is a super frustrating thing. I’m sure your patients complain of brain fog sometimes. “Man, I can’t complete a task. I feel like I’m not getting things done or not remembering things. My brain is not as sharp as it used to be.” 

Brain fog can be related to thyroid. It can be related to a lot of other things, so that’s the tricky thing about brain fog. You name it. Stress, dehydration, micronutrient deficiencies. We need all those neurons snapping, so they can work. They need the raw material to be fed. Anemia can cause brain fog. Infections. Medicines. Toxins. Biotoxins, like mold. Dementia. There are so many things that can cause brain fog, I don’t want to ignore them. But it is pretty common in folks with hypothyroidism.

Lots of times, if we get thyroid levels back on track, work on addressing root causes, decreasing inflammation. That’s what brain fog is, neuroinflammation, inflammation in the brain. That brain fog does improve. That’s when we’re healed with brain fog and even high antibodies. That’s where things like LDN are a good tool to use. 

Dr. Eric: 

Do you use it not only on your Hashimoto’s patients but also Graves’ patients? 

Dr. Angela: 

Yeah. I feel like it’s such a great immune modulator. It’s not an overnight fix, but it does really help bring down the inflammation from the immune standpoint. 

Dr. Eric: 

How long do you usually expect someone to be on LDN before they notice benefits? You said it’s not a quick fix. Is it something where they have to be on it for a few months to give it a chance to work? 

Dr. Angela:

I usually say give it at least three months before you notice a big change. Just hang in there. As long as you’re not having any problems, keep with it. It’s almost like the clouds part, and the antibodies start coming down. Once it starts working, it starts working. 

Dr. Eric: 

Next topic is cortisol. Did you mention saliva testing as far as cortisol? 

Dr. Angela: 

Yeah. 

Dr. Eric: 

That’s your main way of testing for cortisol in your practice? 

Dr. Angela: 

Yeah, that’s the main way. Cortisol is a tough one. Cortisol in general, it’s like stress. There is good stress and bad stress. Good stress doesn’t last long. Bad stress hangs in. That is what pushes you over the edge when it comes to disease.

The cortisol/thyroid relationship is a complex one for sure. We have too much cortisol; it affects TSH production, conversion of T4 to T3, not to mention cortisol is catabolic to the gut lining. It impairs intestinal permeability. 

I do cortisol testing pretty frequently and repeatedly in patients who I feel aren’t responding so well to thyroid hormone replacement as I think they should, or balancing thyroid hormone levels. Yes, I will do the four-point cortisol test to touch base and see where we’re at. If the cortisol curve is low, those symptoms can overlap with hypothyroidism: fatigue, not feeling well, lethargic. It’s tough to tell the two apart. If you bump up the medicine, you’re essentially making the cortisol lower because you’re metabolizing out the cortisol. You’re making that situation worse and not getting any better.

Dr. Eric: 

When I dealt with Graves’, I did a salivary cortisol test, and it’s something I commonly recommend as well. Do you use any Dutch testing in your practice? Sometimes I will do Dutch testing, which also looks at cortisol. If I’m just focusing on adrenals, I will typically recommend saliva. If I am looking more comprehensively at the hormones, then I will do the Dutch test. 

Dr. Angela: 

I agree. 

Dr. Eric: 

Epstein-Barr (EBV). Also dedicated an entire chapter to EBV. Why did you do that? In my book, Natural Treatment Solutions to Hyperthyroidism and Graves’, I have a chapter focused on infections. But you go beyond that and have a chapter on EBV. 

Dr. Angela: 

I find EBV reactivation to be such a hidden thing. I almost think of EBV as a nuisance. It’s a real pain because just when you think you have everything taken care of, someone starts feeling like the cyclical fatigue. Oh my gosh, this is EBV reactivation. 

I do screen for it a lot on patients who I feel like aren’t digging in deep enough, aren’t getting to the root cause, or aren’t getting the results we want. EBV is a tough thing because it has so many different phases. It will hang out in our system and reactivate when our bodies are less able to handle it, like in times of stress. If cortisol is up, that’s a time when EBV will reactivate. 

Plus I feel like it’s something that we can treat well naturally. It follows the same principles as trying to keep stress low, sleep, taking care of our bodies as far as nutrition. We have great natural supplements that really do help. Whenever there is something that doesn’t seem right, it’s gotta be EBV. 

Dr. Eric: 

For both Graves’ and Hashimoto’s, it could be problematic. Other types of viruses, too. EBV is the most well-known. That might have changed over the last few years since 2020, but still, EBV is a pretty prominent virus. 

I agree. You want to do things to manage your stress. Make sure you’re getting sufficient sleep. If necessary, there are some great natural approaches. You mentioned some of those in your book as well, like monolaurin and olive leaf and other antivirals. 

The final thing I want to cover with you is radioactive iodine. When we had our first conversation, I don’t know if we spoke about radioactive iodine. 

Dr. Angela: 

I think we did. 

Dr. Eric: 

I know I asked you about the radioactive iodine uptake test, which you weren’t a big fan of. I was happy to hear that because I am not a big fan of that either. 

Dr. Angela: 

I really hate that test.

Dr. Eric: 

It was good coming from an endocrinologist. Maybe our perspectives will differ on this, but I’m sure you prefer someone not to get radioactive iodine or surgery and save their thyroid. There is a time and place without question for conventional medical treatment. 

If I was in this situation, if I had to choose between one or the other, I can’t picture myself getting radioactive iodine. I would probably go with the surgery because I know some people get radioactive iodine and have no regrets, but in our Facebook groups, I hear some nightmare stories. Same with surgery, too. There is no perfect method. There are risks with surgery as well. 

What are your thoughts on that? If you had to recommend one or the other, do you have a preference? 

Dr. Angela: 

In my experience with radioactive iodine for Graves’, the thyroid cancer space is probably a different conversation. For Graves’- 

Dr. Eric: 

For Graves’, yeah. 

Dr. Angela: 

Specifically for Graves’. It’s almost a 50/50 shot. I find with radioactive iodine and Graves’, half the time, I will say it’s 40/40/20, or maybe 45/45/10. 10% of the time, maybe it’s in the sweet spot, and they end up normal. It’s like heaven. Perfect.

The other part, they become hypothyroid. They need to be on thyroid hormone replacement anyway.

Or that other part, it’s not enough, and they have to go through it again. You have to wait six months to a year to go through it again. You’re back on antithyroid medicine. That’s a problem. There is probably a reason why they couldn’t take antithyroid medicine, and they want the radioactive iodine. 

At least with surgery, you know you fixed the problem, and you’re done. Then you have to be on thyroid hormone replacement. If you became hypo from radioactive iodine, you will need to be on thyroid hormone replacement, too. 

It’s very patient-individualized. If we have to treat it, let’s just take it out and go from there if it’s that severe. It’s all patient-individualized. I wish there was a clear cut. 

Dr. Eric:

What do you see less complications with? Is it about even? 

Dr. Angela: 

I think it’s about even. I think with a really good thyroid surgeon, you will have low complications. With radioactive iodine, I find the biggest complications can be more short-lived. Then again, you don’t know years down the line what problems may occur with radioactive iodine. It’s tough. Do you think the surgery would be better? 

Dr. Eric: 

Well, it comes with its own set of risks. 

Dr. Angela: 

Right. 

Dr. Eric: 

You could get damage to the parathyroid glands, the laryngeal nerve. Like you said, a lot of it comes down to choosing a surgeon who has a lot of experience. To me, the thought, like all the precautions to take with radioactive iodine, in some countries, they even quarantine. In the United States- 

Dr. Angela: 

That’s what they used to do here. 

Dr. Eric: 

I know they don’t quarantine. Still, you can’t share the same bathroom. I don’t know. It sounds very easy. Just swallow this pill, and that’s it, compared to going through surgery, which is more extensive. 

I guess, hearing the stories from people who received radioactive iodine compared to people who received surgery, I don’t see a lot of those people personally. Usually, I see people who have the opposite; they are trying to save their thyroid and prevent those two. 

In the Facebook group, we have thousands of members, people who received radioactive iodine or surgery and will share their stories there. It sounds like there is more negativity when it comes to radioactive iodine. I have also received emails over the years from people saying, “I got radioactive iodine and never felt the same. I wish I didn’t get it.” I know there are people who get it and feel fine afterwards. We could say the same thing with surgery. 

In my personal experience, I hope I’m not faced with that decision. If I was, if I absolutely had to choose, I’m thinking I probably would try to find a surgeon who has a lot of experience and take my chances with the surgeon rather than receive radioactive iodine. Again, that’s just my opinion. 

Dr. Angela: 

It’s tough. You’re trying to foresee years into the future, too. 

Dr. Eric: 

Exactly. 

Dr. Angela: 

It’s not easy. If push comes to shove, and I have to present these options, I lay it out at the table and let the patient decide. Luckily, I don’t have to do that very often. 

Dr. Eric: 

At least you give them the option if someone needs to do it, where some endocrinologists will say one or the other and not even bring up the other option. That makes sense.  

Dr. Angela: 

I take care of patients not when they were under treatment for Graves’, but afterwards. I always hate to hear, “I wish I never did this. I wish someone would have told me.” Wow. I’m sorry. Let’s try to do the best we can now.  

Dr. Eric: 

That’s all we can do. 

We covered a lot. There is a lot that we didn’t cover that is in your book. For those who are interested, definitely check out Dr. Angela’s book. Anything else that you really wanted to cover? Did we cover everything you wanted to? Any last words? 

Dr. Angela: 

I want to thank you for the opportunity to review my book. I really appreciate it. I so respect you.

I want to encourage people who have thyroid issues or think they might have thyroid issues to pursue your own health. My goal with the podcast and the book and even the master class is to empower patients to know that they’re not alone in this. There are things that are in their control that they can work toward their health now and years down the line. That’s really what it is. We want to feel good now, but we also want our health to be good 10, 20, 30 years down the line. 

To encourage them to work with their doctor. If you feel like your doctor is not listening to you, it’s time to be proactive. I know it’s hard getting a second opinion, but go get one. This is information that you can use. I always love spreading good information. Just like you, Dr. Eric, it’s important to spread good information. There is a lot of scary things out there that aren’t quite right. 

If people want to check out my podcast, Thyroid Talk with Dr. Angela Mazza. Also, the book. We have an upcoming online master class called Thrive Through Thyroid. We have different modules that dig into diagnosis, symptoms, treatment for both hypo and hyper. We really talk about gut health. You’ll be sick about gut health, but you’ll be an expert on gut health. Stress, putting it all together. We even have some bonus modules like hair loss, weight loss, specifically Hashimoto’s, Graves’, some recipes.

I think the cool thing we put together with this master class is once a month, a live coaching session. I meet with everyone, kind of like this. We answer questions, field concerns. It’s like a thyroid community, so people know they are not alone in some of their struggles, because you’re not. 

Dr. Eric: 

Wonderful. Where is it best to buy your book?  

Dr. Angela: 

It’s on Amazon, so that’s probably the best way. 

Dr. Eric: 

Definitely check out Dr. Angela’s book, Thyroid Talk. Her podcast is amazing, so check that out, too. Also called Thyroid Talk. That thyroid master class, too. Thank you so much. This has been great. Really enjoyed reading your book. I think I enjoyed even more chatting with you about it. 

Dr. Angela: 

Thank you so much. I appreciate it. I want to applaud you for all the good work that you do.  

Dr. Eric: 

Thank you. Same with you. You’re doing a great job, too. Keep up the good work.

 

Recently, I interviewed Dr. Deva Boone, and we talked about how the parathyroid glands regulate calcium levels in your bloodstream, the role of calcium in the body, 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 Dr. Deva Boone, who is one of the most experienced parathyroid surgeons in the United States. Obviously, we are going to be chatting about the parathyroid glands, and we will talk about Vitamin D. 

Dr. Deva was the medical director and senior surgeon at the Norman Parathyroid Center until 2020 when she left to open the Southwest Parathyroid Center, located in Phoenix, Arizona. Thank you so much for joining us, Dr. Deva. 

Dr. Deva Boone: 

Hi! Yes, thank you for having me. 

Dr. Eric: 

Really excited to talk with you about the parathyroid glands. Can you give a brief background? How did you decide that you were going to focus on the parathyroid glands? Was it something that you knew when you were in medical school or upon graduating? Did you have a personal experience? 

Dr. Deva: 

It wasn’t really that. I went to medical school not even knowing I was going to be a surgeon. I thought I was going to be a neurologist. During my rotations in my third year of medical school, I really enjoyed surgery and decided to do general surgery. I didn’t really decide on parathyroids until the end of that residency. 

I really liked endocrine surgeons. I did a fellowship in endocrine surgery. Then I went down to Tampa to work with the Norman Parathyroid Center because they do just parathyroid surgery. I was really impressed with the set-up they had and the way they did the operation. I decided to focus on that forever. 

It is a really nice operation because you can really help a lot of people. A lot of people feel pretty bad beforehand, and they feel much better afterwards on average. It’s pretty satisfying to be able to help people with this operation. 

Dr. Eric: 

For those who are not familiar with the parathyroid glands, can you explain the function of them? 

Dr. Deva: 

Sure. The parathyroid glands are the forgotten cousin of the endocrine glands. A lot of people don’t know about them. They are right next to the thyroid. Your thyroid is this butterfly-shaped gland at the base of the neck. The parathyroid glands sound like thyroid because they have thyroid in the name, but that comes from the fact that they are right next to the thyroid. When they were discovered, we didn’t know what they were, so they were called “para,” next to, the thyroid.

There are four parathyroid glands. They are typically right around the thyroid, two on each side. They exist solely to regulate your calcium. If you think about it, there aren’t any minerals in your body that have a whole organ dedicated to them. They just regulate calcium. 

It’s also the only thing that you have four of. They are pretty cool. They are tiny. They are about the size of a grain of rice, each one of them. But they are really important because they regulate your calcium.  

Dr. Eric: 

Why do you need a separate gland to regulate calcium? 

Dr. Deva: 

When most people think about calcium, they think about bones. The Got Mlk? billboards. Calcium is really important for your bones. That is the main storage location of calcium in your body. Calcium is what makes your bones hard.

But the reason the parathyroid glands exist is really not to regulate your bone calcium, but the blood calcium. That actually is really important in itself. Your brain, your muscles, all your nerves depend on having a set level of calcium in order to function properly. For your muscles to contract properly, for your brain to have correct signaling, you actually use calcium during all of those processes. Calcium is necessary for that reason.

It’s necessary even in other areas where the electrical signaling is important, like your heart. When your heart beats, there is an electric signal going through it. Calcium is necessary for that. It’s necessary for blood clotting.

For all of these reasons, your calcium in your blood is kept in a very tight range. Sometimes, other things can vary, but your calcium typically doesn’t vary that much because your parathyroids are keeping it in a tight range, so your brain and nervous system can all function properly. 

Dr. Eric: 

You don’t want calcium to be too low or too high. That goes with any nutrient. When people focus on any mineral or nutrient, they are probably more concerned about deficiencies. They’re concerned about low calcium, which could be a factor in osteoporosis. What you see a lot in your practice is the opposite, elevated calcium levels. 

Dr. Deva: 

Yes. It’s interesting because low calcium is a problem, but what I see a lot more of is high calcium because I treat primary hyperparathyroidism. When the parathyroids have a problem, typically it’s not a deficiency of PTH, it’s that they have too much parathyroid hormone. The parathyroid glands are pretty simple. They make one hormone called PTH, parathyroid hormone. PTH is just regulating calcium, and phosphorous, but that’s a separate issue. You can think of it as doing one thing with one hormone.

When you have a really low calcium level, and this is important to understand, this thermostat concept. Your parathyroid glands’ job in life is to get that calcium up. They sense that. If you set your thermostat to 68 degrees, and it’s starting to go below that, your thermostat will sense that, and the heat comes on. It brings the temperature back up to 68, and the heating can turn back off. 

When that happens in your body, when the calcium level drops too low, the parathyroids turn on, make more hormone. The hormone then raises the calcium by doing a few things, like taking calcium out of your bones to put it in the blood. As the calcium rises and goes back up to the normal range, the parathyroids can turn off and make less hormone. 

If the calcium level goes too high for any reason, the parathyroids turn off. Just like if your temperature went up to 90, your heating should turn off. Your parathyroids are regulating things throughout the day. 

I do sometimes see people with low calcium because for whatever reason, they have a problem getting calcium. If they have issues with chronic diarrhea or any problem with absorption from a gastric bypass, that kind of thing, they can have problems keeping their calcium up.

When you have a problem with the parathyroids, typically you see a high calcium level. That is because when you have a parathyroid problem, most of the time, it’s due to a small, benign tumor in the gland. That tumor is acting inappropriately, meaning it’s making hormone even though it shouldn’t. That means that PTH continues to dump out and raise the calcium level. You end up with these high calcium levels.

Most people, when they see that, they actually think it’s a good thing. They look at their labs and are looking for deficiencies. If they see their potassium is low, they clue into that. If they see their Vitamin D is low, they clue into that. If they see their calcium is low, they might worry about that. If they see it’s a little high, they think that’s probably good for their bones to have more calcium because they have been taught that they should take calcium for their bones. If their calcium is on the high side, that must be a great thing. They don’t realize that’s as much a problem as having low calcium, possibly more. 

You really want to pay attention to keeping that calcium in range, not letting it get too low or too high. Your brain, nerves, muscles all want that calcium to be in a certain range. Anywhere outside of that range will cause problems. 

Dr. Eric: 

It’s a negative feedback mechanism, similar to thyroid. If you have low thyroid hormone, you have TSH, thyroid stimulating hormone, signaling to the thyroid to produce more thyroid hormone. Under normal circumstances, if serum calcium was low, you’d want to see the PTH high, signaling for the parathyroids to increase the calcium levels, correct? 

Dr. Deva: 

Right. The parathyroids do that through a couple of ways. One of the ways they get the calcium up is PTH actually stimulates the bones to release calcium. That is how patients with these parathyroid tumors get osteoporosis. You see that your calcium is high, but actually, your bones don’t have enough calcium. You see your bone density dropping. That is connected. The reason your calcium in your blood is high because it’s coming out of your bones. It wants to go back in. That is part of primary hyperparathyroidism, or having too much PTH. 

Dr. Eric: 

How common is primary hyperparathyroidism? 

Dr. Deva: 

Unfortunately, it’s more common than most people realize. A lot of people don’t even know what the parathyroids are. They don’t know what they do. 

Just to get to exactly how many, it’s hard to say. It does increase as you get older. It is more common in women. Probably even up to 1% of women over the age of 50 will get this. It’s most common in post-menopausal women. Having said that, I have had teenage boys with this, so it doesn’t mean that you can’t get it if you’re younger. There are a lot of people who get it younger and as men. About 75% of the patients are women, and the average age is probably about 60.

I think that gets into why the disease is underdiagnosed. If you think about it, it tends to happen in women who are around the age of menopause. A lot of the symptoms tend to get blamed on that. If you’ve gone through menopause in the last 10 years, and you start to tell your doctor that you’re tired and can’t sleep at night, the immediate thing is not to check your calcium, but to respond with, “This is probably menopause.” That is partly why the disease gets overlooked a little bit.

Another reason is that our labs give a very broad range for calcium. If you get your labs, and I encourage everybody to get their own labs, get the results, keep them for yourself in a file, so you have them and can review them. If you look at your labs, a lot of times, what you’re doing and what your doctor is doing is scanning down for anything that’s abnormal. They put an abnormal note or make it red. Often, you get so many labs that you’re just looking for that.

With calcium unfortunately, a lot of the labs give a range that is both too far on the low end and on the high end. It will say 8.5-10.5 is normal. Really, it’s more like 9.2-9.9 is the normal range. 10.0 can be normal. Once you get further in age, your calcium level shouldn’t be in the 10s. The labs don’t adjust for that. You end up sometimes with people who have had high calcium for years, but it didn’t register until the calcium went to 11. That’s part of the reason why.

I also think a big part is that a lot of patients are having these symptoms that are non-specific, and they go to their doctor, and it’s blamed on age or menopause. 

Dr. Eric: 

Can you talk more about the ranges? You mentioned that as we get older, you shouldn’t have a calcium level that’s higher. The serum calcium should decrease as you get older? 

Dr. Deva: 

Yeah. Children actually can have pretty high calcium levels. Their calcium levels, and this is in U.S. ranges, mg/dl. Their calcium levels are often in the 10s, even up to 11. Then it drops as you get older. In your 20s, a lot of people will have calcium levels in their 9s or 10s. In your 30s, maybe you can have some calcium levels in the low 10s, but it drops with time. By the time you get to age 40, most of your calcium levels should be in that 9s range. As I said, mid- to high 9s. 9.2/9.3-10.0. If you’re outside that range, usually it indicates a problem. 

Dr. Eric: 

If it’s above 10, especially above age 40- 

Dr. Deva: 

Or 10.0. It does get tighter as you get older. If I see a 40-year-old with a 10.1, I want to check things out. That’s not definitive yet. If I see an 80-year-old with a 10.1, and they have a PTH that is either normal or high, that is primary hyperparathyroidism. 

There is no clear cutoff with the age thing. It’s not like you wake up at 40 with a different calcium level. It slowly happens over time, and everybody is a little different. In general, if you’re 60 years old, all your calcium levels should be 10.0 or under. You don’t want it too low, but you don’t want it to go above 10.0. 

Dr. Eric: 

If you see it above 10.0, as you mentioned, then you order a PTH test to see if that is elevated. If that’s elevated, then that’s typically indicating hyperparathyroidism. 

Dr. Deva: 

That’s the most common scenario, high calcium and high PTH. Interestingly, you don’t need the high PTH. That is why I went over the thermostat analogy. Think for a second: If your house is 90 degrees, and your heating is on low, but it’s still on, that’s a problem. Your thermostat clearly is not sensing that it’s 90 degrees. It should have kicked in, and the heating should be off. 

It’s like that with parathyroid glands. If you have a calcium of 11, and your PTH is in the normal range, that’s an inappropriate response. Your parathyroid glands should turn off. All of your normal parathyroid glands are turning off. You’ll have a very low PTH level if something else is causing the high calcium. If you have a PTH that is normal range with a high calcium, that is usually primary hyperparathyroidism.  

Dr. Eric: 

We were chatting a little bit before. A lot of people who are listening to this have hyperthyroidism, be it Graves’ or toxic multinodular goiter. Some people with hyperthyroidism will have an elevated serum calcium as well. The way to know if it’s related to the thyroid or if it’s hyperparathyroidism is what you just said. If someone has hyperthyroidism, their serum calcium is 10.2, so you look at PTH and see if it’s elevated or normal. It should be on the lower side normally. 

Dr. Deva: 

Exactly. You look at the overall picture. There aren’t that many things that can cause high calcium first of all. Most of the time, if you’re going to place a bet on someone with high calcium, you will bet they have primary hyperparathyroidism. That by far is the most common thing.

There are these scenarios with hyperthyroidism where you do get high calcium levels. With all of these issues, I want to see the history. Some of these patients had high calcium before they developed hyperthyroidism. Doesn’t seem like that was probably it. When some people’s thyroid disease is particularly active, their calcium can rise. That can be true of something like sarcoidosis, too. If they have very active sarcoidosis, they will see the calcium rise. Once it’s treated, the calcium goes back to normal. 

That is true of the thyroid as well. If you are under in control, if you haven’t had many issues, your labs will typically go back to normal. Tracking those over time—the calcium, PTH, and Vitamin D levels all together—is the best way to figure it out.  

Dr. Eric: 

You mentioned Vitamin D. Vitamin D also in some cases can cause elevated serum calcium, correct? 

Dr. Deva: 

Yes. Vitamin D is one of my favorite topics because it is intimately related to calcium and parathyroid hormone. A lot of people really like Vitamin D. A lot of people take Vitamin D. I take Vitamin D. But there are things you need to know about Vitamin D.

First, it’s not really a vitamin. Your body does produce it. Second, it’s a hormone. You have to treat it like any other hormone. We know when we’re talking about sex hormones or steroids which are hormones, we know you have to treat those carefully because they can have these systemic effects. But Vitamin D doesn’t always have that reputation because it’s a supplement people can buy over the counter. It’s sometimes not treated with the same respect.

Vitamin D is essential. It is really essential for calcium metabolism. One of the main things that active Vitamin D does is help your intestines absorb calcium. If you have a severe Vitamin D deficiency, you won’t be able to absorb calcium appropriately. This can lead to things like Ricketts. This is how low Vitamin D causes issues. You’re not absorbing the calcium or properly handling the calcium. 

The way that it’s involved with the parathyroid is part of the way they get your calcium level up. Remember I said they sense that low calcium and turn on. They make more hormone. Part of what that hormone does is stimulate the activation of Vitamin D that happens in your kidneys. 

Your Vitamin D exists in multiple forms in your body. This is really confusing, too, but we’ll keep it simple and just talk about the inactive form and active form of Vitamin D. To activate that form, you need PTH and an enzyme, which is just directly stimulated by PTH. PTH ramps up the conversion of inactive Vitamin D to the active Vitamin D, which then goes to the intestines and helps your intestines absorb calcium. That is one way it will raise your calcium level. 

The way this gets confusing, even for doctors as well. I have to explain this to doctors all the time. When you have a parathyroid tumor, you will end up with a low Vitamin D level and a high calcium level. You should not treat that. That Vitamin D is not real exactly. What they’re measuring is the inactive form. That is the form that we measure on people. If I say, “I want you to get Vitamin D checked,” and I check off Vitamin D at the lab, they will draw the inactive form, Vitamin D 25 hydroxy. That is the form that is really accurate for most people. It indicates your overall Vitamin D status better than the other forms. The other forms tend to break down more easily, and they are not as easy to measure.

Now we can measure the active form. We do sometimes. But in most cases, we don’t because it tends to break down quickly. It’s not a good assessment of your overall Vitamin D status.

Inactive Vitamin D is accurate for almost everyone. But it is not accurate for people with primary hyperparathyroidism. Go back to what I said about PTH. It activates the Vitamin D. Your inactive form drops because it’s getting converted to the active form. If I measure the active form in primary hyperparathyroidism, you will see it’s actually high. Your inactive form is low. 

We only measure the inactive form. Because of that, most patients with parathyroid disease will get diagnosed with Vitamin D deficiency, and they will automatically be prescribed Vitamin D. 

Why is that a problem? If your calcium is already high, and you start taking more Vitamin D, you can raise your calcium into a dangerous level by taking more Vitamin D. It is a little bit complicated. 

Basically, if you see a low Vitamin D, don’t immediately treat it. You want to know your calcium level as well. If your calcium level is high, you don’t want to take it.

The thing that is really confusing—stop me if I am talking too much because I love talking about Vitamin D—is that when you’re deficient in Vitamin D, that causes your calcium level to be low. That low calcium will then stimulate your parathyroids and raise your PTH. This is as separate condition called secondary hyperparathyroidism. Your parathyroids are active but only because they have to be because you’re not getting enough calcium. They get activated and make more PTH to try to get the calcium up if you have a severe Vitamin D deficiency. In that case, you want to treat that with Vitamin D. That will help get your calcium up and bring your PTH down.

The place where doctors get confused is they see the high PTH and low Vitamin D. They ignore the calcium and give you more Vitamin D. That’s not going to solve the underlying problem. The underlying problem is a parathyroid tumor. 

Dr. Eric: 

Just to clarify, with someone who does not have primary hyperparathyroidism, you do recommend the 25 hydroxy Vitamin D test, like the inactive form, as far as testing.

Dr. Deva: 

I do. For most people, that form is the most accurate and the easiest to get. If you just order it from the lab, if you just check off Vitamin D, that’s the one you’re going to get. I do recommend that.

There are two populations where it’s not accurate: primary hyperparathyroidism and sarcoidosis. They also have an abnormal conversion to the active form. There are those two scenarios where it’s not going to be as accurate. But for almost everybody else, I would track the inactive form. 

Also, all of our recommendations and studies are done on the inactive form. We don’t have a lot of data on how to interpret or what to do with the active form and where to adjust it. When we are talking about guidelines, we are talking about the inactive form. 

Dr. Eric: 

I agree. I test the inactive form, 25 OH Vitamin D. 

Taking too much Vitamin D can increase serum calcium. What do you like to see Vitamin D levels at? Some will say at least 50 ng/ml. Some will say between 60-80. Every now and then, someone will say greater than 80.

Dr. Deva: 

Yeah, this is really controversial. I do love this topic. First, remember that I have a selected patient base. The people who come to me are people generally who are worried about their parathyroids and typically have high calcium levels. 

I will just say that when I see the high calcium level, I always check the PTH and Vitamin D levels. If the Vitamin D level is very high, there is a pretty good chance that is causing the high calcium, as long as the PTH is in the normal to low range. 

What I have them do first is stop the Vitamin D. Now you’re wondering what level of Vitamin D do I see it? I see it happen over 50 ng/ml. Now, lots of people can tolerate a Vitamin D of 60 and not get high calcium. Those aren’t the patients I tend to see. I tend to see patients where when it’s over 50, they end up with calcium levels pushing into the 10s. It’s not always recognized by their doctors as high calcium, but I know that’s a high calcium, and it will cause symptoms of high calcium. 

I typically recommend people keep it in the 30-50 range, unless they’re using Vitamin D to treat something else. I always encourage people to treat any supplements as a medication. Have a reason why you’re taking it. There are people who are taking higher doses of certain vitamins in order to treat a condition or try to mitigate a condition or alleviate a condition. That is okay. As long as you know what you’re taking and what the risks are. 

With Vitamin D, the thing you have to know is there is a risk that your calcium will go too high. If you’re on high doses of Vitamin D, if your Vitamin D level is 70, there is not a lot of evidence that it really is beneficial to be 70 versus 50. But if you wanted to do that and keep it there, all I would say is watch your calcium level and make sure it’s not going into the high range. 

There are people who can tolerate Vitamin D levels of 80, and their calcium level is normal. Then there are people who have a Vitamin D level of 60, and their calcium level is 10.5 as a result of it. They’re going to get the symptoms of high calcium. You have to tailor it. There isn’t one amount for everybody. 

In general, I encourage people to keep it in the 30-50 range because we have a lot of evidence that Vitamin D deficiency, meaning true deficiency, like under 15, does cause problems. We likely have problems with under 30. That’s not as clear; the evidence is not as good. I think it’s reasonable enough to say there may be issues with under 30. 

Keeping it in the 30-50 range is a nice medium for me. I don’t see it causing high calcium. I think you’re probably getting most of the benefits from Vitamin D in that range. That’s where I stand on it. I know I’m going against a lot of other people. That’s because I see these effects. I see a lot of patients come to me with high calcium, and I do have to caution them to keep it in the range. If you don’t want to keep an eye on your calcium all the time, 30-50 for Vitamin D is a good range. 

Dr. Eric: 

30-50 is where you like to see it. 

Dr. Deva: 

That’s my opinion. 

Dr. Eric: 

If someone insists on having it where the level is 50 or greater, you would say to monitor the serum calcium to make sure that it’s not elevated. If it’s elevated, it very well might be due to Vitamin D. There is a chance someone could have hyperparathyroidism if someone is taking too much Vitamin D. It could be a combination of both. The first thing is to look at serum calcium. 

Dr. Deva: 

Exactly. Sometimes, it is. Sometimes, Vitamin D will uncover parathyroid disease. Maybe the tumor was growing. As you take more Vitamin D, it easily slips into the 10s. That can be early parathyroid disease. I do see it where it starts going into the 10s.

I also see it happen over time. Remember Vitamin D is a fat-soluble vitamin. The longer you take these high doses, the more it’s collecting up in your body. It can take a while for it to drop even if you stopped entirely taking any. 

I see these people who will be on these very high doses. What I consider a high dose is 5,000 units a day, which is what a lot of people are on. If you take that for a short period of time, it is unlikely you will see bad effects from it. if someone is on it for 10 years, and then they didn’t get a high calcium level for the first few years, and it took a few years for the calcium level to start rising. They are thinking they have been on this for so long that this can’t be the problem. But it could be. You see those effects add up over the years. 

Dr. Eric: 

Based on what you just said: Let’s say someone is taking Vitamin D, and their Vitamin D levels are 60 or 70. Then their serum calcium is over 10. Would you recommend for them just to go ahead and test PTH just to make sure it’s not high? You would say probably stop the Vitamin D anyway. Is another option to stop the Vitamin D and wait a few months because it could take quite a while for that to drop significantly to impact the serum calcium, if that is indeed the cause of the elevated serum calcium? 

Dr. Deva: 

I don’t want to miss a parathyroid tumor. I will have them recheck labs with calcium, PTH, and Vitamin D. Typically, when the Vitamin D is causing it, the PTH will be on that low end of normal. I do have patients where their calcium is 10.5, their Vitamin D is 70, but their PTH is 100. That’s primary hyperparathyroidism. The PTH level is not responding appropriately to that calcium. I know that’s a parathyroid problem.

If on the other hand, the PTH level is 25, on that lower end of normal, that is more consistent with Vitamin D. I do have them stop Vitamin D regardless, whether it’s primary hyperparathyroidism or not because your calcium is high. The high calcium is what is causing most of the symptoms with parathyroid disease. You want to stop the Vitamin D. You want to stop it and repeat labs. 

Three months is the earliest I will recheck. If it’s that high because you have been on high doses for many years, it may take six months for it to drop below 50. That’s what I’m looking for. Once it gets below 50, that’s when I see the calcium drop back to normal. That’s what I have people do. Sometimes, it takes six months, but it will happen. 

Dr. Eric: 

Talking about primary hyperparathyroidism, if someone has a benign adenoma, is there any natural options out there? When it comes to hyperthyroidism and hypothyroidism, I’m all about trying to improve the health of the immune system, address the cause of the problem, as are many other functional medicine and natural health care practitioners. Any other options besides surgery when it comes to benign adenomas? 

Dr. Deva: 

Sure. I will first say I am a huge proponent of lifestyle medicine and modifying your lifestyle, your diet, in order to treat and prevent disease. For the thyroid, that makes a lot of sense. As I mentioned earlier, I am not a huge fan of surgery for Graves’. I think that should be the last resort option after you’ve tried other things to control your thyroid. 

Having said that, there are some things where surgery is just necessary. For parathyroid tumors, there really isn’t any lifestyle modification that you can make that will affect it. It is a small tumor. It’s benign; it’s not a cancer. It’s a small tumor growing inside the parathyroid gland. There is nothing that will get rid of it or cause it to go away without taking it out, at least anything we have right now. The only treatment is removing this. 

In that case, it makes sense to have the operation because it does have such a huge effect. You can cure it. For most people, once you take the parathyroid gland disease out, your other glands react normally. Then you prevent all of the potential medications you might need to take later on down the road if you had left it in place. A lot of people with parathyroid disease get high blood pressure, cardiac arrythmias, fatigue, constipation, reflux. They end up on all of these other medications to try to treat the symptoms of this when really a simple operation can cure it and prevent these complications. 

Dr. Eric: 

Prior to going live, as you mentioned, we were talking about Graves’ and how you recommend not having surgery as a last resort. There is a time and place. One thing you mentioned with surgery of the thyroid is complications are common. With parathyroid surgery, it all comes down to choosing the right surgeon, too. 

Same thing with thyroid. You wouldn’t want to get thyroid surgery from someone who just did 10 thyroid surgeries. At least I wouldn’t want to go to someone who was not experienced. Obviously, you focus on that. Can you talk more about potential complications, like the risk factors of this surgery? 

Dr. Deva: 

Especially with something like Graves’, that is my main reason for not wanting to push for surgery because the complication rate is high. Actually, one of the big complications with surgery for Graves’ is hypoparathyroidism, meaning all the parathyroid glands can be injured during the operation. That is a serious, can be lifelong complication that can be very hard to manage if you don’t have any parathyroids.

The reason it’s more of an issue than with other thyroid operations, because not all thyroid operations are equal. Surgery for Graves’ is one of the riskier ones because of all that inflammation around the thyroid. It makes it very difficult. I have operated on Graves’ thyroids. They are hard to deal with. They are very temperamental, they bleed easily, and they’re stiff. It’s hard to get around them.

For all those reasons, when you do a Graves’ thyroid and take it out, it is very easy to injure the parathyroid glands around it and not even realize it. And also injure the nerve that controls your voice. For all those reasons, I say try to treat it medically or with lifestyle medicine, even radioactive iodine, before I would recommend surgery. 

There are patients who need surgery for Graves’, and they should get it. If you do that, go to a surgeon who just does thyroid operations. There are people who really specialize in this and are mostly doing thyroid operations or solely doing thyroid operations. That’s who I would want doing my operation.

Parathyroid surgery tends to be a very safe operation. It has some of the same risks as with thyroid surgery and with any other operation. Any time someone takes a knife to any part of your body, there is a risk of bleeding. That is true for parathyroid disease, like any other operation. But it’s pretty low. There is always a risk to those nerves that control your voice. Again, pretty low risk. Finally, there is a risk that you would injure or remove all the parathyroid glands. Typically, you’re trying not to do that. In general, it is a very safe operation. It lasts under an hour. It’s usually about half an hour to see all the glands.

With this as with other operations, you do want to get someone who is experienced in this. A lot of general surgeons are credentialed to perform thyroid surgery and parathyroid surgery. It doesn’t mean that you would want them doing your parathyroid or thyroid operation. 

Parathyroid surgery can be pretty hard if you’re not experienced in it. Those glands are a grain of rice. It could be a grain of rice that is stuck to the nerve that controls your voice. You really don’t want someone inexperienced digging around in there. You want someone who is going to be able to evaluate it and remove the tumor safely and quickly in order to reduce those complications, get you out of the hospital. It’s a same-day procedure. It’s a very safe operation in general, as long as you have someone experienced doing it. 

Dr. Eric: 

If you had to take a guess, how many surgeries have you done? 

Dr. Deva: 

I’ve done at least 4,000, which makes me the most experienced person in the western U.S., I think. I’ve only done parathyroid operations for the last 10 years. That’s all I focus on. 

To me, I wouldn’t want a surgeon who just did this operation once a week to do my operation. A lot of the guidelines will say that you’re an expert if you do 50 a year, which is about one a week. That is not very many. To get good at this, you have to do a lot of operations. That means specializing in the area, which a lot of surgeons aren’t doing. 

I will say the thing I do differently is I look at all four parathyroid glands in the operating room. It’s the most accurate and reliable way to actually assess the parathyroid glands. Scans and imaging studies are so often wrong with the parathyroids because they are so tiny to begin with. You can’t see normal glands. You can’t even see small tumors. 

I have a lot of patients who have completely negative scans. This is weird to think about because when I say you have a small tumor, most people are thinking, “Okay, you know that because either you see a lump or feel a lump or see it on the scan.” If I say you have a tumor, you are thinking about a scan or a lump you have on your arm.

With parathyroid disease, it’s not like that. I can’t feel it on your neck. We can’t see it on imaging studies, even with the most advanced imaging studies we have. They may not show up. You have to base it on the labs. I know from your labs, you have a parathyroid tumor. It’s a little weird. “I don’t see anything on the scans, but I know you have a parathyroid tumor. If I look at your parathyroid glands, I will be able to figure it out.” That means going in there and being able to find all four safely and quickly. 

For most surgeons, they often won’t do that. They will rely solely on imaging, so they will only operate if they have a positive scan. They will only go after that gland. That does lead to a lot of patients needing further surgery in the future. I avoid that by looking at all four parathyroid glands during that one operation, so it’s a one and done procedure. 

Dr. Eric: 

Thanks for bringing that up. That’s really important to know. If a surgeon relies on finding it on a scan, and it’s there, but it just doesn’t show up on the scan, then that person will be continuing to have the symptoms associated with elevated calcium levels, hypercalcemia. Eventually, they will probably get the surgery when they get a second or third opinion. 

Dr. Deva: 

They find another surgeon, yeah. 

Dr. Eric: 

Exactly. You shared a lot of information, Dr. Deva. Is there anything else I should have asked you that I didn’t ask you? Any last words that you have for those who might be suspecting that they might have an issue with the parathyroid glands? 

Dr. Deva: 

I think that’s covering a lot of it. It’s a lot of information in a short period of time. If your fans don’t know much about the parathyroids, it’s overwhelming.

My advice to all people is to get your own medical records. Get your lab results. Look at them yourself. If you’re having symptoms, get a second opinion. Read through your results yourself. Do your research. 

Some doctors don’t like patients looking up their illnesses on Google. I’m fine with it. I think that’s great. You can learn a lot online and through reading. A lot of my patients figure this out themselves because they’re really tired and have headaches every day and can’t figure out why. They finally get their lab reports themselves and see that their calcium is high, and it has been high, but nobody has mentioned it. Then they finally find me online and get treated for it and feel better. 

It’s one of those things where your doctors may miss it. This is one where they often don’t take it as seriously, or they will give a “wait and see” attitude, to just watch it over time. You really need to take control of your health. Remember that nobody is going to care about your health as much as you do. You need to advocate for yourself. 

That is definitely true with Graves’ as well. There are some things we learn for Graves’ that I have learned are not true and disagree with and have changed my practice based on that. 

Take control of your own health. 

Dr. Eric: 

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

Dr. Deva: 

My center is Southwest Parathyroid Center. Go to SouthwestParathyroid.com to find me. 

Also, I have my own Facebook page and answer a bunch of questions there. 

You can go to ParathyroidQAndA.com, where I answer a lot of questions, too. Any question about parathyroid disease. 

Dr. Eric: 

Wonderful. Thank you so much, Dr. Deva. Really appreciate you taking the time to talk about the parathyroid glands, hyperparathyroidism, and Vitamin D. 

Dr. Deva: 

Sure. Thank you for having me. If people have questions, they can always reach out to me through my website.

 

Recently, I interviewed Dr. Christine Smith, and we talked about exploring the biochemistry of injury and how this relates to thyroid health. 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. Christine Smith, as we are going to be discussing three types of injuries that can play a role in the autoimmune thyroid experience, be it you have Graves’ or Hashimoto’s or probably even a non-autoimmune thyroid condition. 

Let me go ahead and dive into Dr. Christine’s bio: Dr. Christine Smith is a functional medicine practitioner and doctor of chiropractic with a background in cognitive neuroscience. She specializes in holistic injury recovery and optimization to help active people come back stronger, recover hidden injuries, and prevent reinjury. She does this by teaching clients how to use recovery time as a gift to restructure lifestyle priorities and become their own health authority through education rather than medication. Thank you for joining us, Dr. Christine. 

Dr. Christine Smith: 

Absolutely, thank you for having me. I’m excited to be here. 

Dr. Eric: 

I’m excited to chat with you about these injuries. When talking about injuries, I think a lot of people will think of just physical injuries, but I think this is going beyond that, and that’s why we’re talking about three different types of injuries.

Before we talk about this, can you get more into your background? How did you decide to focus on helping people with different types of injuries? 

Dr. Christine: 

Yeah, absolutely. I feel like that’s a deeper question than average. It came through a journey of my own experience and of understanding the power of the mind and healing, and the power of energy and understanding the frequency that your body is putting out. 

In chiropractic, we talk a lot about the tone of the nervous system. I consider it like an instrument, and that’s how I talk to clients when I do body work. It’s like tuning an instrument, making sure there are no sharp points or flat points, bringing everything back to harmony, and understanding the mind/body connection. 

That’s how I got the specialization in cognitive neuroscience. I had my own experience with a lot of stress and anxiety, and my chemistry was off. No one had talked to me about diet and lifestyle. I was really confused, following the conventional methods, and it was getting worse. I saw this body worker who did some touch therapy and reset my nervous system. After that, I had this shift in my perception of the world. For the first time in 20 years, my system had exited fight or flight.

It was this whole new way of being. You can almost feel it in your cells when something like that happens. It’s like you have been at a loud concert, and you walk out, and it’s silent. You have this shift. Understanding those things made me realize there are different kinds of injuries. 

Also, in chiropractic philosophy, we talk about thoughts, traumas, and toxins. These are the things that stress your body. Thoughts are general stressful thoughts. Now, it’s really different than when we were being chased by tigers. Now that tiger is a bill or an exam or a work project or an upset partner or friend. Those things are ongoing and chronic and go over time. 

We have this big stressor over time that is coming from our own mind. It literally changes the chemistry of the body. A divorce or losing your home, that is a mental injury. It creates a really similar cascade biochemically as breaking your leg or tweaking your shoulder or hurting your lower back at the gym. 

There is also a chemical component. All the toxins that we deal with in our environment and all the things we can be exposed to, all of these add up to what’s called allostatic load, which is the overall capacity for your body. If you have a bunch of mental stress going on, you won’t have as much capacity to get injured or heal quickly or deal with a chemical exposure. If you just had a big chemical exposure, you will have no emotional resiliency to deal with the stressors in your life.

That is how I explain things to people and why I got into understanding things through injury. If I can help people understand the cascade that happens in your body with a cellular injury, this is how we prevent disease. If we can catch it early and allow the cell time to heal and recover, just like if you tweak your back at the gym, you won’t deadlift the next day. It’s the concept of giving the body to recover. Each of these injuries requires different kinds of recovery. Depending on what’s going on with your life and which one is most prevalent for you, that tends to change my approach to care. 

That is how all of this came into being: understanding how physiology works and then going through my own experiences in my life, where trying to approach things from a single point of view just wasn’t working. We have to take into consideration all of these other modalities that exist and understand that all of our chemistry on a personal, custom level is different, and what’s going on in our life is different. You can have two people who just went through the same intense mental stress experience at work, but one of them is also dealing with a mold exposure at home. A different one also just hurt their shoulder. They are going to have different responses and different capacities for dealing with it. 

That’s a good summary of an answer to that question. Let me know if I can expand. 

Dr. Eric: 

I think you did great. Obviously, the shoulder injury would be an example of a physical injury. The exposure to mold would be more of that cellular injury. 

Dr. Christine: 

A chemical injury. 

Dr. Eric: 

Same thing with stress and other types of trauma as well. 

Dr. Christine: 

Stress and trauma, I consider them mental injuries. It’s happening on a biochemical level. All of these are happening on a biochemical level. 

If we really break it down and get a little nerdy for a second. When I was studying biology, I realized that in order to understand biology, I had to understand chemistry. In order to understand chemistry, I had to understand physics. To understand physics, you have to understand quantum physics, which leads you back to energy and frequency. Really everything is frequency. All of it comes down to that. 

If you understand chemistry in the way molecules and atoms work, they work with electrons in certain fields that are called valence shells. Depending on the organization of those energetic particles, that’s how you get matter or sound waves or the visual light spectrum or anything tangible versus not tangible. 

Energy and frequency are what make up matter and the state of that matter. If we have thoughts, that is frequency and energy coming for our neurological system that is being turned into chemistry. If we have a physical injury, that is two pieces of matter interacting to change matter because of the force of the frequency they interacted with. If we are dealing with chemistry, that is a certain chemical organized into a certain pattern that emits energy that affects other molecules.

This is why frequency medicine or things like meditation can affect a physical injury. When you start diving into this world, you understand that our modalities of care are so far beyond a pill. I think that’s really important for people to understand. If you’re just looking for a pill to fix your ill, it usually doesn’t always work out the best. 

I will find when I am working with people in care, if they have been through some kind of mental injury and are coming in with physical ailments like gut, because gut is tied to everything, if I start giving them a bunch of nutrition and supplements and capsules, and they are still in a mentally injured state, their cells are in a cellular danger response. They’re almost stiffer. The membranes change when our cells are in that energetic frequency state of a cellular danger protective response. We can’t absorb nutrition correctly because our nervous system isn’t in the right state to send the correct signals to the cells to absorb and utilize it. 

For that client, I start with physical body work to get their nervous system tuned and toned, so it’s sending the right frequency signals to their cells, so they can absorb nutrition in order to heal. If I just give that patient nutrition, they might get better, but we usually hit a plateau. 

If I can get my clients working with their mental game, and their mental stress, which I find is a huge component of pretty much any autoimmune condition, and it’s very well dived into the book When the Body Says No by Gabor Maté. It’s this concept of a mental injury that is creating a chemical cascade can actually contribute to your autoimmune reaction because if your mental state is that you are in a state of defense against your environment or the universe, your immune system responds and goes, “I should be on defense, too.” 

If we can help people understand you have to address your mental state and bring you back into a state of feeling safe in your environment, and then we have to address your nutrition or toxin component, what’s floating around in your system, then we can address the physical component of how all of those affect that. That is the key to healing. 

Dr. Eric: 

Awesome. Just to summarize those three different types of injury: There is physical injury, mental injury, and biochemical injury, which is not exactly the same as mental injury. 

Dr. Christine: 

Yeah, that’s how I think of it and how I explain it to clients, so we can understand we are always addressing the chemistry, the mental output that is affecting the chemistry, and the physical impact from the environment. 

Dr. Eric: 

How does this relate to inflammation? With inflammation, if you have physical trauma, you can get inflammation. If you want to talk about the difference between acute and chronic inflammation. With biochemical injury, you can also get inflammation. I’m also thinking that with mental injury, you could also get inflammation. If I’m wrong, correct me. If you could elaborate on that. 

Dr. Christine: 

You are so right. Step two of everything we were just talking about. Everything we were just discussing is the insult, the activity that instigates a response in your body. Inflammation is the response. It’s a healthy response. We’re supposed to have it. It’s how our cells repair themselves and rebuild. 

Chronic inflammation is a dysfunctional response. We can absolutely get this from a mental injury. 

Let’s use a real-life example. Let’s say that your dog passed away. Then you went through a breakup or a divorce. It’s all adding up. You’re mentally stressed. Then you get into a fender bender. You get that nasty whiplash. “Ugh, I’m fine, whatever.” You’re dealing with the car, with insurance, with the divorce. All of a sudden, you get hit with some virus. Now you’re sick and dealing with it. Or even a mold exposure in your home. You get some kind of environmental insult. We’ve had emotional, physical, and now chemical. 

All of a sudden, your health just tanks. You don’t understand what’s going on. You’re feeling bloated and have brain fog and can’t sleep and have headaches and are feeling sluggish. “What is wrong with me?” This is happening over the course of time. 

Before that, you probably had some other stressors. Maybe you were in school or had a huge project at work that was on your system. Or you go through societal stresses that have been happening over the last few years. Those accumulate into this as well. 

This is how we hit that wall of our injuries. All of this comes back to inflammation because that’s how our body responds. We have that original stressor of- Grief really is what those situations are. Grief is an emotional injury, and that can come in many forms.

When we have this emotional stressor, we put out an inflammation response. In that inflammation response, part of what happens is just our normal immune response: our tissues become more permeable. This is how our immune cells move through the tissues to repair the site that needs it or respond with healthy, acute inflammation. When this happens, we can also get some gut permeability. Let’s say we are really stressed out. Now we’re eating things that maybe aren’t totally great for us because they’re comfort foods. Our gut’s permeable, and it’s leaking through while also feeding our bad gut bacteria.

The other part of an emotional injury that people often don’t realize is there are dysbiotic Gram-negative—meaning they put out nasty chemicals—bacteria in our gut that feed and grow when your stress hormones are present. They actually have receptors for things like cortisol. That is Yersinia, E. coli, and stuff like that. When you’re stressed out, you grow bad bacteria in your gut. And your gut’s leaky. And now you’re maybe eating a bunch of gluten, which acts like a rake on the soft tissue of our gut and creates holes and irritates the gut lining. Then this stuff starts leaking through. Then it starts going into our blood stream. Now we have what’s called a subclinical level of endotoxemia, meaning we are accidentally poisoning ourselves in small amounts from the inside out.

Our immune system freaks out appropriately because all this stuff is in the bloodstream that’s not supposed to be there. Now we have a hyperinflammation response. In this, our body is trying to take care of these things, but we get a secondary injury from the immune response. When you have bad guys on the battlefield, you go take care of them, but the battle damages the battlefield. Now our immune system responds by trying to clean up the battlefield. It sends a whole bunch of neutrophils and acute responders, and that’s part of the Th17 pathway. 

All of these responders come, and they are trying to heal the area. In doing so, and still fighting off the bad guys, they’re releasing this chemistry to protect us that is accidentally creating more damage to the area. We get another immune response of more acute responders coming to the area to repair it while also accidentally damaging it at the same time. We get stuck in this cycle of chronic inflammation. Our immune system is trying to repair us, but it is accidentally damaging us in an effort to protect us from our environmental exposures. That is how we get stuck in a state of chronic inflammation.

If we can’t move out of inflammation and into the stage of what’s called proliferation, where I call it assimilation, meaning building stuff and repairing it. Then we move into remodeling, which is like testing it out and stressing it in a good way and making sure the tissues are strong. If we can’t enter into that stage, we stay in that inflammatory stage, which is essentially a breakdown stage. Whatever area this is happening in, that organ is going to start to break down.

This is why different people can have completely different responses to a very similar exposure. What is your Achilles heel? What are your genetics? I don’t consider genetics fate. I consider them blueprints that we have tendencies towards. We have an environmental exposure activate them, including stress. Stress will activate dormant genetics. With these, this is how we get the outcome of whatever is happening to our body, which might be a thyroid condition or gut condition or anxiety. 

When I had my stresses, I had no idea it was coming from my gut. I had no gut symptoms. My gut symptoms showed up in my brain. Your gut symptoms might show up in your thyroid. Someone else’s gut symptoms might show up in their liver, and they have problems detoxing. If you have genetics where you have problems detoxing, and you get this environmental exposure, it will be a much bigger burden on you than this person who has different detox genetics. That is why some people are super affected by mold, and others aren’t. 

That is how inflammation plays into this whole game. It’s a piece of everything. It depends on if our body can make it through a healthy injury cycle with that cell, or if that cell gets stuck in a state of inflammation and breakdown. 

Dr. Eric: 

You gave a lot of good information there. I like what you said about the absence of gut symptoms doesn’t rule out a gut problem. I’ve come across many people over the years with no gas, bloating, pain, and regular bowel movements, and still, it is possible to have a leaky gut in that situation. It’s still possible to have dysbiosis in that situation. 

You also mentioned the Th17, which is associated with autoimmunity. If someone is stuck in that chronic inflammatory cycle, that can set the stage for different autoimmune conditions, not just Graves’ and Hashimoto’s, but MS or RA. 

The example you gave, a lot of practitioners might just focus on the gut if they realize that the person has a leaky gut, but if they’re not addressing that mental injury, let alone the physical injury, because you gave an example where someone had all three, a lot of times, as functional medicine practitioners, we’re just focusing on that cellular component, that biochemical injury component. As you mentioned, you really need to take a whole-body approach. 

Dr. Christine: 

Absolutely. Just in a short way of saying it: If your mind is in a state of feeling like it’s under attack, or another way of saying it is a victim mindset, your cells are going to be in a danger response, which means they are not going to be in a healing response. They have to be in one or the other. They can’t do both at the same time. That is why getting your mental game corrected I think is just as important as any medication. Your brain is the most powerful drug you will ever have. 

Dr. Eric: 

When it comes to addressing that, especially the mental injury, is it more than just blocking out time for mind/body medicine, assuming there is at least a component of that? In preparation for this episode, I listened to some of your other interviews, and you’ve spoken about meditation. I’m guilty of using it broadly, too. I heard you talk about different types of meditation. I also wanted you to talk about that. It’s a two-part question: What do you do in general, maybe besides meditation? Also, if you could elaborate on your definition of what meditation is. 

Dr. Christine: 

That’s a great question. One of the easiest ways to define meditation that also identifies the purpose behind it, which I think people talk about these different ways to do it and what it looks like. It’s time for your body to feel safe and enter a creative state, and a building state, and a repair state. We have to make that time to feel safe. 

That can come in a variety of different forms. It can be a walking meditation. It can be a sport you like doing. It can be sitting on a cushion. It can be doing it in a group. It can come in a variety of forms. All of them have different benefits. 

If you’re an antsy person who cannot sit there for 15 minutes. “This is a waste of my life.” We should work on that perspective because it’s self-care. You’re going to the gym for your brain. When you sit down, and you have that anxiety, that is the point of meditation, is facing it and sitting with it and realizing that it’s not you; it is separate from you. It is usually the energy of society putting these burdens on you that make you think that self-care is a waste of your time. 

If you can start to sit there and be curious about it, then you start to see these mental patterns you get caught in. No wonder you’re stressed out all the time. “I think self-care for 15 minutes is a waste of my life. Okay, how can I shift my perspective on this?” 

When you start to become conscious about your own thinking patterns, you can shift your perspective. That perspective is what has to shift for you to feel safe. You can really do this in any environment. That is the whole idea of Victor Frankel’s book Man’s Search for Meaning. He wrote that from a concentration camp. It’s this book about the experience of your perception in whatever you’re in. There is a lot of different approaches to it.

I really love Joe Dispenza’s work. He is leading the forefront on research in meditation and how you can literally change your entire gut microbiome in seven days as a novice meditator with no other changes in your life. Just from meditation. Pretty darn cool. They’re even showing that in the blood of advanced meditators, they produce proteins that prevent viruses to enter cells. All of this research is being peer-reviewed and going through all the things to get published. It’s pretty phenomenal research. 

The idea is when you go into meditation, and enter this state of safety, you completely change the chemistry you’re putting out. Maybe you’re doing that on a walk. Walking meditation can be really powerful because you are practicing this state with your eyes open in your active waking life. You can go meditate for 20 minutes and feel really great in the morning. “Ah, this is so nice.” You open your eyes and go back to your old patterns immediately. Then the rest of the day, you’re in that stressed state. 

Your meditation is not totally gonna matter. It’s nice. It’s a Band-Aid. You have to practice it in your life. That’s the idea. It’s just like you go get fit at the gym, so you can do activities in your life. You don’t get super fit to sit on the couch. We get fit in our mind, so we can apply it to our life. When you realize you are slipping back into your old patterns, that is when you mentally snap the rubber band on your wrist. “This is what I told myself I wanted to feel today this morning.” You choose your emotions throughout the day.

That is another component of meditation: setting time aside to practice how you want to feel, so it’s familiar to you, so you can activate those neural pathways through the rest of your day. It’s this choice of how you want to feel in your life.

I had gotten into that work for many years. I slipped out of it. This happens to everybody. It’s a lifelong practice of coming back to yourself. That’s another way I describe it to people. it’s simply coming back to you and who you choose that to be. Shaking off the energy of everything else and everyone else. Figuring out your own true core center. Sometimes, when you really dive deep into it, you realize that you doesn’t exist. We’re all just part of this energetic field. Essentially, little pieces of the universe experiencing itself. That’s when you dive into the more existential component of that meaning for life. 

The way I really got into this is I was that person in my own form that we were talking about earlier: huge emotional stressor, huge societal stressor, then a toxin exposure, and then someone going too hard on my gut with supplements and my gut getting messed up. All of a sudden, my health just shut down. 

I didn’t know about the mold exposure until later. I found it and realized it was the gasoline on the fire, which is usually what an environmental exposure is. Whatever fire is going on in your body, it pours gas on that fire and explodes it all. 

I became allergic to food and supplements. I was a functional medicine practitioner who couldn’t use supplements. That was a very frustrating time. In that, what can I do? My brain also wasn’t working at that time. 

I think the mental component of illness is something that isn’t always discussed, along with the concept of an identity crisis. When you’re a very active person, all of a sudden, something shifts dramatically in your life, and you can’t do the things that make you feel like yourself. That in itself is a mental injury and needs to be talked more about in health care, as well as the identity crisis of illness.

In that, I was like, “Okay, what can I do? I can’t exercise. I can’t eat healthy foods. I have been to all the other routes.” I turned to meditation. I went really deep into it. I realized that because of the accumulated effect of things that happened, I was in a state of not trusting the universe. I was in a state of defense on a mental game level, even though it was subconscious. When I took time with my subconscious and see my thought patterns that were coming up, I was able to realize the mental state I was in and work on it.

There is meditation where you are very focused on a certain thing, and you’re going inward and paying it really close attention. There is mindfulness. You take a raisin and feel every single indent of the raisin. It’s taking time to be in peaceful presence with whatever you’re doing.

There is meditation like Dr. Joe Dispenza’s work. I find it’s very much an expansion, going outward. It’s going so far outward with your energy that you forget that you as an individual exist. You connect with this greater field of energy in this place of complete peace. When you enter that state of peace, and they’re still coming to understand how all of this works. I don’t know if we’ll ever fully understand it. This is energy far beyond us that is really complex, and what created us in the first place. It’s going back to that state of oneness and sitting there and almost charging yourself with this healthy frequency from the universe and letting that imbue all the cells in your body, so they resonate at a healthier frequency. 

That might have been a bit of a long-winded and complex answer. This is why I love it so much. When I finally realized that and did this work, my immune system calmed down. I was able to eat food again and use supplements again. It took me a couple months. Nothing else had worked. I was at the point where I’d lost a bunch of weight, and my hair was falling out. It was not great. That is what turned everything around for me and got me back to the point where I could use functional medicine to do the rest of the cleanup I needed to do.

I still go in and out of my practice. I try really hard to have a super good practice. It’s amazing because I know how good it is for me, but I still find days where I resist it. That resistance is my old patterns. It’s like we can almost get addicted to our emotions of anxiety because they’re familiar. The unknown is scary. 

That is the idea of meditation. It’s like sitting in this unknown place and becoming comfortable with the unknown and not trying to predict anything in the future, so in your own life, you can be comfortable without being in anxiety. If you fall out of your practice, you’re probably being affected by your old patterns. 

The #1 thing you need to do is go back and sit with yourself, so you can figure out what’s pulling you out and what you’re trying to protect. That’s really where they all come from. Your patterns are just trying to protect you. It’s time to go inward and feel safe and understand your own mind and patterns without the influence of anybody else. 

Dr. Eric: 

That’s really interesting. Usually when someone has food sensitivities to supplements, it’s usually coming from the gut. In your case, you didn’t focus on the gut, but you focused on the mental injury, which in turn helped with the gut, if I’m understanding correctly. 

Dr. Christine: 

That is correct. I didn’t have the option to focus on the gut. I couldn’t. That is where I gained a whole other level of respect for it. Understanding the capacity of the mental state to heal the body. Your body is amazing, and there are so many stories of people doing absolutely unreal things. 

There is a woman in one of the Joe Dispenza workshops who through meditation—and this is a single case, but this happened—regrew her ablated thyroid. Proven by imaging. 

Your body is capable of amazing stuff if you give It incredibly clear instructions. But you have to be very clear on what you want. You have to give instructions in energy, not words. Your body doesn’t understand words. If you just sit there and affirm all day, that’s not going to work. You have to work with the subconscious. 

There are different tools for that. Sometimes, you need help. I do a modality with clients called PSYCH-K. it’s a way to use neurological postures to imprint a subconscious belief in a way that your subconscious mind understands, and your body can respond. Your subconscious mind is 95% of the mind; it’s what runs the body. If your 5% up here is saying you’re healthy, but you’re not feeling it energetically, your body won’t respond to that. Energy and the feeling of it is the most important piece, which is hard and takes practice.

Dr. Eric: 

You said that it was called PSYCH-K? 

Dr. Christine: 

That’s one of many modalities. Bruce Lipton really likes it. He is another person who is mildly similar to Joe Dispenza; he has a book called The Biology of Belief. And Dr. Joe has a book called Becoming Supernatural. Both books are great places to explore these concepts. 

Dr. Eric: 

He has a number of different books. I went on Audible and saw that he has at least four or five. 

Dr. Christine: 

Yeah, Dr. Joe has four. I think he’s working on another one. Dr. Lipton also has a couple.  

Dr. Eric: 

Do you do any testing in your practice? Before I pressed the record, I think I heard you say that you either did AK (applied kinesiologies). I don’t know if you still do a lot of muscle testing in your practice, or if you do more functional medicine testing, or a combination of both.  

Dr. Christine: 

All of the above. Why would I not use a tool that’s present to me? I love lab testing. I think it’s incredibly important. I think it can miss things. I think understanding your tools is probably the hardest part of being a functional medicine practitioner. There are a lot of trainings where people can go through and understand functional medicine concepts, which is just lifestyle concepts. If you don’t understand physiology, the labs, and the supplements, you’re at a loss.

There are a ton of labs I use. It depends on the case. Ideally, I’d love to see all the labs all the time. You have to do what’s realistic for people. Depending on what comes up in a case, I will prioritize labs in a different order. 

I also like actionable labs. There are a lot of labs you can do that tell you what’s wrong, but they don’t tell you how to fix it. I really like labs that show me what’s going on with you nutritionally. I also really like things that show me inflammation levels. You can see those on a classic blood lab with CRP and ESR. I consider things like cholesterol and homocysteine as inflammatory markers, which I think is a little non-traditional. It tells me that the system is off. I consider homocysteine a much more important cardiovascular/inflammation marker than cholesterol. If you have high cholesterol, it’s telling me your body is trying to repair something. What is your body trying to repair? I need to find that thing.

I prefer functional tests. I’ll run food sensitivity tests. Even though they change, and there are arguments about them, I want to know the #1 immediate thing I can do that is free for you to get your inflammation down. Rather than me putting more supplements into your mouth, it is me helping you take poison out of your mouth. Things your body is reacting to poorly, which is not always something you’d expect. 

Sometimes, it’s foods you don’t expect, like eggs. I love eggs. Eggs are great. They have great nutritional quality. I find a lot of the time in inflammatory responses in autoimmune people, they have a sensitivity to eggs along with classic ones like gluten, dairy, and sugar. I’ll see what the immediate thing we can change in your life is to start getting inflammation down while making up the rest of your plan.

I also love to run gut tests. There are labs that are run, like classic gut tests that look at infections that might kill you. I’ll make sure you’re not having some horrible infection. I like to look at the subtle things. Do you have any parasites that are lingering that we need to take care of? Those can get missed on those labs. I’ll come back to why I like muscle testing here.

I also like looking at the gut biome and understanding the distribution of your gut bacteria, getting really specific on what probiotics are right for you. Or if your gut is even ready for a probiotic. That’s a mistake people make. They think probiotics are the answer, and they will take a bunch of them. They’ll wonder why they’re bloated. 

If you take probiotics too early before your gut lining is ready, you can actually cause more inflammation. People forget that they have inflammatory effects. They are a killing agent that knock out bad bacteria and take their place. Understanding the order of operations of things is where the labs can come in. How inflamed are you? Do I need to work on your gut lining first? Are you ready for a probiotic? 

I’ll run other labs like autoimmune or hormones. Sometimes I will look at neurotransmitters, but I often find that’s tied back to gut. 

It depends on what’s going on with the client. I think functional lab testing is valuable. I had a client the other day who is struggling with some cognitive decline. Their neurologist was like, “Let’s put you on this Alzheimer’s medication.” I asked if I could run some functional tests first. I ran a toxin screen and a gut panel. He had an amoeba and high levels of lead and mycotoxins. Okay, let’s work on getting these out of the system first and see if the cognition improves. Then you can decide what to do with the conventional route. He might not even need the medication. He might have brain fog because he has a bunch of infections and lead he is dealing with. We are going to address those first. That’s an example.

Muscle testing is highly undervalued. I know it’s argued in different communities, which I understand because it is more of a subjective method. It’s working with the electrical neurological system of the body. It’s a way to essentially ask the body questions simply by learning how to speak its language. Lab testing is like translating the body’s language into something we can read. Muscle testing is translating our language into something the body can read.

It’s using a strong muscle as an indicator because your muscles should be able to be strong. Now, if you are holding your arm out, and someone is pushing down on it, and then you step on a tack, you’re not going to be focused on your arm. You will be focused on the tack. The arm will go weak. That is the concept of muscle testing in a simplified way. Stress a piece of the body, see if the strength of the body changes. 

This can be done in a number of different ways. You can do direct wiring testing. If I have you put your shoulders out, and I push down on your elbow while you turn your head to one side, and that arm goes weak, it lets me know that your C5 nerve is disrupted, and I should probably address that segment of your neck. That’s a direct way to look at it.

If we are doing it with nutrition, if I have you put your arm out, and it’s strong, and then I push upward on your stomach, and it goes weak, that tells me that your stomach has slid above your diaphragm a little bit, and we might need to pull it down. That is the idea of a hiatal hernia. I can’t tell you how many hiatal hernias that are non-surgical. People have had reflux and GERD for 10 years, and I pulled their stomach down, and it’s gone. Nobody does this work anymore. I don’t understand why. 

Touching your organ, if you are trying to heal an organ, touch that organ. Massage it. Love it. It’s the concept of where attention goes, energy flows, and blood follows. Give that organ love and attention with physical touch. Physical touch has also been lost from care. When you are working with someone, you are also close to them. You are physically present. That kind of energy, that kind of space-holding also has its own healing component. 

Then you can get more complex and subtle with muscle testing. You can use it to address energetic fields. If you can use that indicator muscle and bring a supplement into someone’s field, or you can have them put it in their mouth, you can see if that supplement weakens a body or strengthens it before they even have to swallow it. That’s cool. With sensitive clients, I love this. It’s a way to get very specific on what supplements their body responds to versus not, instead of a guessing game of trying something and seeing how it goes. We can get specific that these things will be okay for their system.

You can even do it with mental thoughts, which is how PSYCH-K works. If you bring up that stressor mental thought to your system, your body will respond in a way that’s weaker because it’s a stressor to your system. Then you can go through thinking patterns and subconscious thoughts and figure out which ones the body is strong to and which ones the body is weak to. Then you can figure out what the actual thing is that’s stressing out your system. 

I was just working with a client the other day who is working on fertility. We are helping her brain get on board with this. We went through a couple statements of, “My body is healthy enough to become pregnant.” It was strong to that. We finally got to, “I’m not too old to become pregnant. I’m young enough to become pregnant.” That’s what her mind was weak to. That’s what we worked on.

If you can help the subconscious mind get over these little hiccups that it has, then that’s a component of healing for the body. That’s how you can heal a physical ailment, chemical ailment, or mental ailment. I won’t even say “ailment,” but a thing you’re working on, a stress point. 

That’s where muscle testing is quite beautiful. Labs, we check every couple months because they’re expensive. Muscle testing, we can check all the time throughout our appointment. Different practitioners have different approaches. But I have a kit with vials that have been energetically imprinted with the resonance of certain enzymes in the body. We can literally sit there, and I can muscle test through an entire blood panel through the energetic vial kit in our office, which is great for when people are financially restricted.

Again, it’s a subjective measure, which is when I love to back it up with labs. It’s pretty cool when you do muscle testing and go through everything subjectively. Then you run the lab, and it’s all the same stuff.

For the skeptics out there, I understand. I come from a research background. I worked in many research labs. I’m all about data and numbers. When I was learning this, I remember saying to a friend, “I don’t feel ethical using something that I can’t always fully explain to my client.” They say, “If you have something that works, and you’re not using it because you can’t explain it, that’s unethical. You’re depriving your client.” Ooh, touché. Okay. With that, I became more open-minded. Now I have seen it work over and over again. 

That is ultimately what made me go to chiropractic school instead of going to school to become a neurologist. I worked in this integrative practice where he was essentially using muscle testing components for functional medicine. I watched people who had been sick for years get better in three months. I needed to understand what he was doing. That led me to chiropractic school, as he was a chiropractor. 

Chiropractic school doesn’t always cover this stuff. That was stuff I learned outside of it. The concept in chiropractic school is the mental component that goes with all of this, which is constant vitalism instead of pathology. Our conventional model works in pathology, which Is let me find what’s wrong and shut it down. Chiropractic and muscle testing and these kinds of concepts work more in the realm of vitalism, which is let me figure out what’s right with your body and how to support it. 

Dr. Eric: 

I don’t practice AK, but a number of years ago, I went to a conference where they were pretty much teaching that. An instructor said that when it comes to muscle testing supplements, it’s a lot more accurate if you do put it in the mouth. I wanted to get your opinion. A lot of practitioners will just have their patients hold the bottle and then do the muscle testing, probably because it’s a lot more convenient. You’re not using up supplements that way. What are your thoughts on that? 

Dr. Christine: 

In the very traditional AK training, you should put the supplement in your mouth, or have it touching the skin in some way. I have small vials that have supplements in them, so I will have that person hold that vial. Sometimes, we’ll take the supplements out if I am not getting a clear read. 

I have seen enough practitioners who are incredibly successful at helping people in what they do that don’t put it in the mouth where it still works. To me, that all comes back to the concept of the energetics and frequency, and everything in the world has its own bio field, including that supplement in your hand. You’re testing the bio field. As long as it’s not being blocked by some kind of material, I think you’re usually in the realm of it working. 

It’s always best and most accurate to put it in the mouth. I have seen both of them work though. 

Dr. Eric: 

Very cool. You covered a lot of information here. Is there anything else you’d like to chat about? Anything I should have asked you that I didn’t ask you? 

Dr. Christine: 

I love your audience. I love thyroid. I think it’s a really cool organ. I know when you’re going through a health issue, it’s really easy to be angry at your body. If there is one thing that I really want people to work on, it’s this concept of seeing your body as your best friend that just got injured. 

If your best friend just twisted their ankle during a marathon, you wouldn’t be mad at them for running slower. You’d be encouraging them and helping them and giving them water. It’s this idea of seeing your body as this friend that’s going through a hard time. 

All of a sudden, your energy shifts from being mad at your body from not working to, “Oh my gosh, I’m so sorry you’re going through this. How can I support you?” That energetic shift is how we start to create the biochemical shift. 

I find the thyroid intriguing because I consider it the sentinel of the body. It’s this very sensitive organ that is essentially your fuel manager. If something is off with your energy and your fuel, it’s a check engine light. It’s an indicator of go look at the rest of the body and see what might be irritating this very sensitive organ. Versus throwing pills at the organ and thinking it’s working now. 

We have to remove the irritant and the instigator, which is where it all comes back to gut and infection and environmental and mental stress. You could have done all the things and the detoxes. “My house is completely free of any environmental toxin. I do everything cleanly.” You still live in this mental state of being judgmental and feeling under attack by everybody and resentful toward other people in your life. That’s just as toxic as any cleaner or hormone-disrupting BPA chemical. It’s working with that component and understanding your thyroid is this indicator. 

That’s where the deeper work can really start. I’m a huge fan of retreats and making time for yourself to go and do a deep dive with yourself. It’s really hard to do those deep dives into your day-to-day lives. Taking some time for yourself, even if it’s two days, to go on a yoga retreat or health and wellness retreat or an energetic deepening spiritual awareness retreat. There are tons of these. Take some time to explore that side of yourself if you never have. The thyroid is very telling.

Also, if you’re working on your thyroid and doing all the medications, and it’s doing okay, but you’re still exhausted and can’t figure out why, check out your mitochondria. It’s what the thyroid works on. The signal from the thyroid goes to the mitochondria to produce energy. If the signal is going out, but the factory can’t receive it and produce the outcome, that’s the thing that needs to be checked out. 

Understanding that your body is this beautiful, dynamic system. All of these little symptoms or things you might be dealing with are just indicators. That’s how your body speaks to you. Starting to have this relationship with your body, “If you’re talking to me, something’s wrong. How can I love you?” Shifting into that relationship instead of being mad at your body for its illness. I think that’s the last thing I make sure people get from this. 

Dr. Eric: 

Wonderful, thank you. How can people find out more about you, Dr. Christine? 

Dr. Christine: 

I provide a ton of free education online. They can go to my social media, @DrChristineSmith. I have a YouTube as well, where there is a bunch of free education. Depth Wellness is my channel. That’s also my practice. 

If you want to learn more about services, or explore other things, because I try to provide things at every level for people. If you want education, go check out those resources. If you want a deeper dive, I have some online courses and guided meditations I created for my clients. I use those as packages for people. Sometimes people just want the meditative component. 

There are online courses I do. I will run another group course in February. It’s five weeks where I guide people through not just how to cleanse your body, but how to cleanse your mind and environment at the same time. Understand the physiology behind how this works. Create a new relationship with your body. I call that one Reclaim Vitality. There are other options. That website is DepthWellness.com. That will have links to everything else that you can check out. Reach out any time. 

Dr. Eric: 

Appreciate you taking the time to discuss the different injuries. I learned a lot. I’m sure the listeners did as well. Thank you. 

Dr. Christine: 

Thank you. Thanks for having your podcast. I think it’s important for people to have resources to learn about themselves.

 

Recently, I interviewed Dr. Wendy Myers, and we talked about the impact of environmental toxins, especially heavy metals like mercury, on thyroid healt. 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 Dr. Wendy Myers, as we will be discussing the impact of environmental toxins on your thyroid health. 

Let me go ahead and dive into Dr. Wendy’s bio: She is a naturopathic doctor and founder of MyersDetox.com. She is an anti-aging, heavy metal detox, and bioenergetics expert as well as the #1 best-selling author of Limitless Energy: How to Detox Toxic Metals to End Exhaustion and Chronic Fatigue. Dr. Wendy is the host of a top 100-rated podcast The Myers Detox Podcast, about protecting your health with detoxification. Thank you so much for joining us, Dr. Wendy. 

Dr. Wendy Myers: 

Thank you so much for having me. 

Dr. Eric: 

Very excited to chat with you about toxins and the way they impact the thyroid. You could start out with your own thyroid-related story. If you could give your background and how you started helping others focusing on helping people with environmental toxins. 

Dr. Wendy: 

Right after I had a baby, I noticed I was having a lot of different issues going on. I made the mistake of going vegan for about six months, and I had a lot of stress prior to getting pregnant. All of these stressors caused me to eventually develop some thyroid issues. A lot of people who are vegan inevitably have thyroid issues. 

Heavy metals and toxins play a huge role, especially mercury, in promoting thyroid issues. I’ll get into that. I was very mercury-toxic because I had a lot of fillings removed when I was 21 improperly. I think that knocked my thyroid out and caused depression and gut issues and many other things that I dealt with in my 20s. 

I was living this healthy lifestyle after having a baby. Then my health took a huge nosedive. I went to the doctor and found out for the first time I had low thyroid function; I was hypothyroid. All my other hormones were low as well. Toxins interfere with our sex and stress hormones as well. 

One of the big reasons so many people have thyroid issues, which we’ll talk about, is because of pesticides and heavy metals and mercury. I’ll go into detail about the exact mechanisms by which heavy metals cause thyroid issues. 

I was very dismayed to learn I was having all these different issues, that my body was going awry. It’s so easy for people to mark these things up as getting older. Your thyroid or other hormones become imbalanced. It’s not just because of aging. That can certainly play a role in it. But it’s more the toxins we’re exposed to, and our diet and lifestyle as well. 

Dr. Eric: 

It’s safe to say that’s why we have a greater incidence of people with thyroid /autoimmune thyroid conditions. The environment is not getting any better when it comes to these heavy metals, pesticides, and other toxins.

Dr. Wendy: 

No, it’s only going to get worse. We have 140,000 chemicals that have been developed right now. There are about 40,000 in use. That’s a lot. There are dozens of metals being drudged up around the planet for various uses. They get into our air, food, and water. They are being removed from the earth’s crust. 

Look around you. There is metal in everything you’re touching. More importantly, we’re breathing all this stuff in. The #1 way we become toxic is actually breathing. There is also chemicals in our food, toxins in our shower water. Even if you’re filtering drinking filtered water or spring water, you’re getting exposures in the shower. It sounds really depressing. We are getting exposed in a lot of different ways. 

There are different things people can do to remove these toxins from their body that are creating roadblocks to function in all the different organ systems, including the thyroid. 

Dr. Eric: 

Let’s go into some of the mechanisms as far as how heavy metals and other environmental toxins impact the thyroid. Even if you want to expand on that in the immune system, not just thyroid autoimmunity, but there are a lot of different autoimmune conditions like MS or RA. Environmental toxins have an impact on these as well.

Dr. Wendy: 

Most chronic health conditions will have a heavy metal or chemical as an underlying root cause, if not outright causing it. We can say that about diabetes or heart disease or high blood pressure or any kind of chronic health condition. There is a toxin that we have seen in the research that is contributing to it. 

As far as thyroid functioning, there are a lot of different metals like mercury, lead, cadmium, and nickel that reduce thyroid function in a few different ways. What they do is cause enzyme inhibition. The enzymes are involved in the production of thyroid globulin, which is the storage form of thyroid hormone. 

They interfere in amino acid absorption, so toxic metals like arsenic, aluminum, tin, thallium negatively impact the absorption of tyrosine in the gut. Tyrosine is required for the manufacture of thyroid globulin. If you have low tyrosine, you will have low thyroid globulin. If you take proton pump inhibitors, you will have the same problem with tyrosine absorption. 

We also have issues with energy production that is required for iodine uptake. Our thyroid hormones are made of iodine. If you have any toxins, which are all of them that interfere in mitochondrial energy production, you will have a problem taking in that iodine, if you even have enough. 

Most people are deficient in iodine. I take 15mg per day of iodine. Most people are not getting any iodine in their food. A lot of people are avoiding fish or not eating that much. They certainly are not eating seaweed. Where are you getting your iodine? People typically need to supplement with it. 

When we are talking about specific heavy metals, mercury is a huge culprit. It’s one of the #1 culprits in interfering with thyroid function. It has an affinity for the thyroid gland. Mercury gets stored in the thyroid gland. It can also take the place of iodine, which is a crucial component, the main ingredient in creating thyroid hormones. The T3 hormone, which is three molecules of iodine, and T4 molecule, which is four molecules of iodine. 

When the mercury gets into the thyroid gland, you could have a sensitivity to mercury. Your immune system could launch an attack on mercury, and your thyroid gets taken out as a side effect. We can see people losing thyroid tissue because their body is trying to attack the mercury. You can develop a sensitivity to anything in your body: any food, heavy metals, etc. You will have more increased symptoms as a result of that mercury versus the next person, who has the same amount of mercury but doesn’t have an immune response to it.

When we are talking about our pituitary gland, it’s like the master gland. It’s signaling to the hypothalamus to make more TSH, which tells our body to make more thyroid hormone. Mercury interferes in this feedback loop, telling the body to make T4 and then communicating that to make more TSH. 

In the hypothalamus, mercury can deposit in there. When this happens, the TSH manufacture can be inhibited. 

Additionally, in the blood, mercury can inhibit the conversion of free T4 to free T3. Mercury poisons enzymes like deiodinase, which convert free T4 to T3 in blood circulation.

That is a very small glimpse of one heavy metal and what it’s doing to the thyroid. This is not accounting for the dozens of metals and the thousands of chemicals. If anyone wants to do a deep dive on how chemicals affect the thyroid, I have 180 different research citations on how pesticides and other toxins affect the thyroid. It’s no wonder today that so many people are on thyroid hormones or have undiagnosed thyroid issues that are resulting in resistant weight loss, depression, and other issues related to low thyroid hormone production. 

All of this can apply to people who have hyperthyroidism as well. Different toxins can cause general malfunction of the thyroid, either high thyroid hormones or low thyroid production. 

Dr. Eric: 

Or they can impact the immune system, which most cases of both hyper and hypo are autoimmune. Most hypothyroid conditions are Hashimoto’s, and most hyper conditions are Graves’. The heavy metals, including mercury, can impact the immune system. That’s another mechanism. 

When you talk about mercury, are you concerned about both methyl mercury that is in fish as well as inorganic mercury, which is in silver fillings? Is there one that you’re more concerned about over another? 

Dr. Wendy: 

They’re all problematic. We don’t need mercury of any type in our body. The inorganic and organic are both problematic. 

What’s really more problematic is testing. A lot of testing doesn’t distinguish between the different types, so you don’t know which one to go after. Quicksilver Scientific has a great test called the Mercury Tri-Test, which will tell you about the different types of mercury you have. But that’s just one toxin. 

Testing is great. I recommend heavy metals testing. Sometimes, people have weird metals that require specific nutrients to remove them. Any kind of detox program is going to go a long way, like sweating or ionic foot baths or coffee enemas or liver supports. Minerals go a long way to removing a lot of the toxins that people have, regardless of what type of metal it is. There are different types of arsenic and mercury. We can all get them removed with a good detox program. 

Dr. Eric: 

I listened to a few of your podcast interviews and heard you talk about ionic foot baths. I do sauna regularly. Supplementation is something that I do and recommend. I can’t say I have much experience with ionic foot baths. Is that specific for heavy metals, or is that good for all different types of environmental toxins? 

Dr. Wendy: 

I like them because they are good for all different types of toxins. Plus they get rid of radiation in your body. Infrared saunas also kill cells affected by radiation, which is a big problem in our environment right now. 

I love ionic foot baths because they are easy to use, and anyone can use them. They don’t take up a lot of space. You don’t get sweaty and gross. I love infrared saunas, believe me. I love sweating. I love doing them. But the ionic foot baths are really easy to do, and I think people can be more compliant with them. You can do them while at your computer or watching TV. Little kids or sick people or old people can do them. Not everyone can do saunas or has the space for them. 

Dr. Eric: 

That’s a good point. I work with a lot of people who have hyperthyroidism. Some of them have an elevated resting heart rate, which is common with hyperthyroidism. They might not be a good candidate for sauna since that raises heart rate. They may want to wait until things are more stable before going into the sauna. 

I use the sauna now three times a week. When I was dealing with Graves’ and active hyperthyroidism, I wouldn’t have wanted to go into a sauna because my resting heart rate would sometimes get in triple digits. Definitely a believer in sauna. Thank you for that explanation with the ionic foot baths. 

Dr. Wendy: 

On that note, there is a lot of garbage out there. I really like the HEALTHandMED IonizeMe Maxx 5. You can do a code Wendy6, for a 6% discount. 

There is a lot of expensive foot baths and a lot of cheap ones on Amazon that are not worth even bothering with. You have to have a really strong one. Most people have to do 400 hours of foot baths on average. That’s a lot of time invested. If you get a really cheap one, you might have to do 2,000 hours. You will be doing it and not improving how you’re feeling or your symptoms and think it doesn’t work when it’s just the foot bath you bought. So you have to be careful with that. 

Dr. Eric: 

For someone who is a new patient or client, do you have them do the ionic foot baths every day? 

Dr. Wendy: 

It depends. Some people might not be able to handle every day. I would start with a few a week. I used to do two hours a day, but I have been detoxing for a long time. I have been doing stuff for 15 years. I wanted to get to my 400 hours as fast as I could. 

You also have to replete minerals. They do pull minerals out of you. Everywhere there is heavy metals, there is also minerals you could be detoxing, so you have to replete those for every foot bath you do. Take a bunch of sea salt and water or coconut water or something like that. 

Do it a few times a week. You can eventually work up to every day or a couple times a day, two in a row.  

Dr. Eric: 

It’s similar to a sauna. When I do sauna, I definitely replete minerals. I didn’t realize that with ionic foot baths, it’s the same thing.  

Dr. Wendy: 

Yeah, same deal. 

Dr. Eric: 

Thank you for that code. 

We focused on heavy metals. How about other environmental chemicals? How concerned are you about pesticides or herbicides? There’s glyphosate, flame retardants, and so many other chemicals. A lot of them do affect thyroid, at least indirectly. Glyphosate could affect the gut microbiome, which could in turn set the stage for Graves’ or Hashimoto’s. 

Dr. Wendy: 

If people really want to go in depth and look at the research, I have that article on my site, “The Pesticides and Chemicals That Impact the Thyroid.” That goes in deep. 

These chemicals in general poison enzymes, things like hydroxylase enzymes. That will negatively impact the ability of the body to produce all different types of hormones in the body. The glyphosate is essentially an antibiotic, killing gut bacteria. Different pesticides are very estrogenic and interfere in the production and balance and conversion of our sex hormones. All of it creates this domino effect in the body to weaken the body, our immunity, our hormone production; stress the body, the adrenals, the thyroid, our blood sugar balance. Every organ system in the body is affected, our neurotransmitter production, our brain function. It’s pretty devastating what all these pesticides, herbicides, insecticides, and other chemicals are doing. 

It’s not only what we’re breathing in the air; we’re getting it in our food. Even in organic food, 7% of that is contaminated with chemicals. We’re getting it in our beauty products. We have a lot of exposure. 

I think there is so many loved ones we know that are on five or more medications or are chronically ill and are not getting better. This is a huge underlying root cause that is not being looked at by the conventional medical community. It’s my passion and mission to educate the public, educate the medical community. 

The research I have done over the last 15 years, these chemicals and toxins are huge roadblocks to our organ systems functioning, huge contributors to so many health issues. It’s shown in the research that lead alone is responsible for 17% of all-cause mortality. This is a quote from Dr. Joe Pizzorno, who is on my Heavy docuseries that is coming out soon. 

I don’t think people understand the huge impact that heavy metals and chemicals are having on their health, their loved ones’ symptoms and outcomes. There are very simple, holistic, natural ways that don’t have side effects that people can do to dramatically improve their symptoms and outcomes for them and their loved ones and their family.

Just another example, diabetes, the #1 cause of diabetes is heavy metals and chemicals. Namely, arsenic. It dramatically interferes in our pancreas’ ability to control our blood sugar. There are a thousand other examples I can cite. It’s not just our thyroid that is being affected, though I can cite dozens of examples of mechanisms of how it’s being affected. 

When you look at the obesity epidemic, 2/3 of people in the U.S. alone are obese. There is so many mechanisms by which heavy metals and chemicals are interfering in liver function, blood sugar control, sleep, appetite, and gut bacteria that contribute to obesity and resistant weight loss. All the chemicals and additives in the food as well. 

With people who are dealing with weight issues, another passion of mine is communicating to people that it’s not necessarily your fault. It’s not just calories or carbohydrates consumed. There are a lot of toxins that are throwing a wrench into people’s weight loss efforts. It can be resolved and remedied, doing detoxification strategies. Not only for weight loss, but for so many other chronic health conditions as well. 

Dr. Eric: 

I don’t know if you have read the book Clean, Green, and Lean, focusing on the impact of environmental toxins on weight gain. I wrote an article a number of years ago on the term “obesogen.” Without question, for those who are struggling to lose weight, that is an excellent point. A lot of people focus on diet and exercise and won’t consider at all the impact of these environmental toxins. 

Dr. Wendy: 

One clue that toxins might be a problem is if, say, after I had a baby and was trying to lose weight, the amount of effort that I put in, going to bed hungry, working out 68 hours a week, injuring myself because I was pushing so hard, low carb, all the stuff I was doing. I should be an Olympic athlete if I was doing this in my 20s. I realized then something innately was wrong in my body. It wasn’t working how it used to work, and I was only 37 at the time. That is what propelled me to do all this testing, which is when I found out I had low thyroid function.

If you are struggling with your weight, and you are doing everything right, and you seem like you are killing yourself, you want to be looking at getting some heavy metal or chemical testing and doing some detox. I assure you, no one’s exempt. It’s impossible living on the planet we are on right now and not be breathing in or eating or showering in toxins every single day. 

Dr. Eric: 

I think your favorite test is hair testing? 

Dr. Wendy: 

Yeah, I love the hair mineral analysis. It’s really easy and cheap to do. Anyone can do it. I like to start with that. I usually will recommend the full picture, looking at hair, urine, and stool. Just a hair mineral analysis is enough to design a good detox program for someone that will work perfectly adequate for them. 

Dr. Eric: 

What are your thoughts on chelation therapy? I kind of know your thoughts, but I want for others to hear them. I have heard you talk about chelation on other podcasts. 

Dr. Wendy: 

Heavy metal chelation, like what a lot of functional medical doctors would offer for detox support, has its place for sure. If you go to your functional doctor, that’s what they will recommend typically. It’s almost like dropping a nuclear bomb on an anthill to get rid of it. It’s not the place that you start. 

It certainly has its use case if someone has a life-threatening heavy metal toxicity. If they have life-threatening mercury or lead toxicity, yes. We have to get it out of the body right away.

The problem with chelation is it doesn’t go deep enough. Realistically, you will only be able to do so many of those in a row. Maybe 10 sessions in a row. It will be very expensive. The body is not going to release heavy metals that it’s using. It’s not going to release heavy metals that it’s using for various things, like cadmium being used in the arteries to repair them, or in deeper places in the body, like the brain or the liver or in the bones. The chelation is not going to get to these deep, buried toxins.

What you have to do is facilitate the body’s natural ability to detox. It needs minerals. It needs magnesium. Any time you take a ton of calcium, you will displace and push lead out of the bones. That is just one example. If you take a ton of zinc, you will displace and push out cadmium from the body. That takes months, if not years. 

Chelation is not going to do that, though it does have its place. It’s not something I ever actually recommend to any of my patients, and I never have.

Dr. Eric: 

Balancing the minerals, correcting mineral deficiencies is very important when it comes to detoxification. You mentioned sauna, the ionic foot baths. How about diet? How important is eating a healthy diet? I don’t know if you recommend a plant-based diet, not vegan, but cruciferous vegetables. Is that not sufficient to support detoxification? 

Dr. Wendy: 

No, you can’t detox just with diet alone, definitely not. You can’t just detox with juicing. I try to drink one juice a day because it’s very mineral-rich. That’s another way to get a lot of minerals.

I recommend a paleo diet for the majority of people. There is a bell curve. Everyone is different, what diet they should eat. 

If you think about it, over millions of years, we evolved eating meat. There isn’t any denying that, no matter what ideation or saving the planet or other arguments for various plant-based diets. If we’re talking strictly along the lines of health, then it’s a diet including animal proteins, for not just the sulfur-containing amino acids in our liver, but also for the different types of fats that comprise the membranes of our brain. 25% of our brain is cholesterol. 

You are not going to fare very well over a period of time completely eliminating animal foods out of your diet. I know. I have been there. I was vegetarian for a while and then vegan, and definitely paid the price in my health and brain function, which all disappeared as soon as I started eating animal protein again. 

I do know some people who seem to do okay on vegan. That’s very few people. Very few people. But I just don’t think most people can long-term deal with the severe nutrient deficiencies in that diet. Certainly, their detoxification ability will be compromised. 

A lot of people can fare on a very well-designed vegetarian diet. But the majority of people are going to do best on a paleo or paleo-based diet that includes animal protein. 

Dr. Eric: 

I agree. I follow more of a paleo diet. As far as patients with Graves’ or Hashimoto’s, many times, I’ll have them follow a paleo or AIP diet. Some people will be vegetarian or vegan, but if someone asks me what I recommend, it’s more of what you said. 

Dr. Wendy: 

I generally find people fare better and feel better with more energy, and symptoms magically disappear once they start incorporating some animal protein, if they haven’t eaten that in a long time. 

If you want to know the top five detox foods, I would say #1 is broccoli sprouts. They are amazing. Then onions, garlic, ginger, and some cruciferous vegetables, and egg yolk. It has lots of choline in it. Very good for detoxification. 

Dr. Eric: 

Awesome. I want to talk about your documentary. Anything else you want to cover first? Obviously, there is a lot to cover. You and other experts will be talking a lot during the documentary. Any last words before you dive into the documentary? 

Dr. Wendy: 

A lot of people out there are going down different rabbit holes trying to figure out how to improve their symptoms or how to address their thyroid or how to address another issue. I think people need to pull back. Usually, any health issue they have, it’s really a systemic issue. Everyone also has heavy metals and chemicals. There are some people out there who are unbelievable detoxers genetically. Grandma who smoked until she was 100, she probably has pretty good detox genes. That might not be you. It might be. 

A lot of people are exposed to a lot of toxins, so this needs to be on your radar. It needs to be part of your health protocol, things you do on a daily basis, doing daily detox. I assure you, it’s an underlying root cause of your symptoms: fatigue, brain fog, weight loss, a diagnosis, whatever it is that’s annoying you. Toxins are exacerbating it. When you remove them, you are removing all the roadblocks to your body functioning better. 

I urge people to start taking the power back in their hands because they are not going to get this information at your conventional medical doctor’s. They won’t do heavy metal testing. They won’t know anything about it. Even if they do, they don’t know how to detox you. 

You need to educate yourself about this because there are very simple things you can do that are incredibly effective, and the research stands behind them. Infrared sauna, 40% reduction of mortality from all causes, using it five days a week. You can’t argue with that. Very simple and pleasurable things you can do on a daily basis to get rid of these toxins causing your health issues. 

Dr. Eric: 

I am only using the sauna three days a week, and I thought I was doing good. I need to add an extra two days per week to get to that 40%. 

Dr. Wendy: 

With three times per week, there is a 25% reduction. You’re not short changing yourself; there are still benefits. 

Dr. Eric: 

Cool. Let’s talk more about the upcoming documentary, which is free. What can people expect when they attend the docuseries? 

Dr. Wendy: 

My documentary is called Heavy. I interviewed 100 different experts on the topic of how heavy metals and chemicals cause various health issues. We are focusing on a few. 

We are focusing on how toxins cause brain health issues, like brain fog and dementia. Dementia is a huge problem, and it’s totally reversible. Not every type. Alzheimer’s and other ones have amazing researchers talking about how these are induced by toxins, and they are reversible if caught early enough.

We talk about weight, obesity, and how toxins are contributing in so many ways, throwing a wrench in so many organ systems and other body systems to produce the result: 2/3 of people in the U.S. are obese, and it’s a growing problem around the world. It’s not just diet; it isn’t. In China, they are eating thousands of billions of pounds of rice every year. India, same thing. Everyone in the world is eating tons of carbohydrates, and they are not all obese. It’s something more than that. It’s the chemicals in our environment that have grown exponentially since the ‘80s and ‘90s. 

We also talk about hormones—sex, stress, and thyroid—and how chemicals are negatively impacting those.

We talk about energy. We talk about how toxins are interfering in mitochondrial functioning. 

We have videos about how toxins affect digestion. 40% of people have digestive issues. It’s amazing how much toxins can destroy our gut microbiome, our gut’s ability to absorb nutrients. 

We have one on anti-aging, how toxins are causing aging, which is a big passion of mine, to educate on that.

We have other videos as well. There will be seven videos that are available for free during the free viewing period, which begins on February 15. I’d love for you guys to join me. There are experts like Dr. David Perlmutter, Dave Asprey, Chris Kresser, Dr. Chris Shade, Dr. Jill Carnahan. There are 100 experts, like Dr. Joe Pizzorno, founder of Bastyr University. Dr. Jeffrey Bland. So many others who are coming together to help educate you about how toxins are causing so many different health epidemics and what you can do about it. 

Dr. Eric: 

Wonderful. I look forward to tuning in. Your website is MyersDetox.com. Your podcast is The Myers Detox Podcast. Anywhere else where people can find you? 

Dr. Wendy: 

My website is great. I’m on all the social media, @MyersDetox. 

Dr. Eric: 

Thank you so much, Dr. Wendy. You shared some great information. I’m sure that many listening to this will want to learn more. Definitely sign up for Dr. Wendy’s documentary. You said Heavy is the name? 

Dr. Wendy: 

Yes, the documentary is called Heavy. 

Dr. Eric: 

Again, thank you so much for your time. 

 

Recently, I interviewed Dr. Tabatha Barber, and we talked about how fasting and faith can help shift your body into a parasympathetic state. 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. Tabatha Barber. We are going to be talking about her new book Fast to Faith. We are going to be talking about hormones. Thank you so much for joining us, Dr. Barber. Appreciate you being here. Really excited about your book. We are going to be talking about fasting, how fasting impacts hormones, and your experience with Hashimoto’s. Thank you so much for joining us. 

Dr. Tabatha Barker: 

Thank you for having me. This is such an important conversation. I think so many women are going to benefit from this. 

Dr. Eric: 

I definitely agree. Let’s talk a little bit more about your background. You are a functional OB-GYN/gynecologist. What prompted you first of all to write this book? Also, most gynecologists don’t practice functional medicine. How did that journey begin? 

Dr. Tabatha: 

It’s a long, convoluted story. I’ll shorten it up. Essentially, I got pregnant in high school, and I had a very traumatic delivery. Out of that experience, I had a come to Jesus moment, where I realized that God wanted me to help other women not go through what I went through. 

I was a high school dropout; I went back to school and got my GED. I became a doctor. The idea was I was going to help women have a voice and a choice in their care, and not have to suffer and go through what I went through. Unfortunately, the medical system is not set up for health or wellness, either for the patient or the doctor. 

About 10 years into my practice, I found myself miserable. Here I thought I was living into God’s purpose for me. I had done everything I was supposed to do. Yet I was barely surviving. I had chronic back pain. I had Hashimoto’s that was uncontrolled. I had depression and heart reflux and IBS. All these drugs I was on. All these diagnoses. I reached my breaking point and realized this isn’t sustainable. I’m not actually helping women long-term. I can’t continue on this. 

I started down the path of figuring out how do I heal myself? That’s how I found functional medicine. I realized what I was doing was a lot of band-aid medicine. I was helping people relieve their symptoms, but I wasn’t really figuring out what was causing it. I was giving birth control pills for heavy periods and mood swings and acne. That was the end-all, be-all treatment. Or I would do surgery. 

A lot of women are surprised to hear that OB-GYNs are actually surgeons. I spent four years learning how to do a hysterectomy four different ways, how to do C-sections and deliveries and procedures. I didn’t study hormone imbalances and all the intricacies of the endocrine system and how our gut health impacts our overall health. We look to OB-GYNs as hormone experts, but they’re really not. They’re surgeons. 

I found myself in this dilemma of how to really care for women. It wasn’t until I healed myself with functional medicine that I realized what I needed to be doing. About a year and a half ago, I got a download from God. I can’t explain it any other way. He made it clear, “You have a new purpose. You fulfilled that. You’re supposed to be doing what you’re doing. Now we have a new plan. You have to write this book. You have to create this program. You have to teach women how to love themselves again, how to love their bodies back into healing.” 

All day, every day, I was seeing women complaining about their bodies, hating their bodies, feeling frustrated. At war with their bodies because of pain, because it wouldn’t do what they wanted it to do, because they couldn’t release extra weight. They didn’t look the way they wanted to look. All the things.

That Is really what I’ve been focused on the past 15 months: bringing women the truth. The functional medicine, everything I learned, I poured it into this book, so women can really start to understand what the heck is going on in their body. Why don’t I recognize myself anymore? Why do I have Hashimoto’s or some autoimmune disease? Why are my hormones out of whack? Why are my adrenals tanked? I explain all of that.

The cool thing is I just lay out a plan that is free and easy, because fasting is free, on how to really get back in tune with your body and listen to it again. That is where the magic happens.

Dr. Eric: 

Very eye-opening. OB-GYNs, not a surprise that they don’t focus on the gut, that they don’t have a lot of knowledge about leaky gut, healing the gut. When you said that they’re not hormone experts, because a lot of people have the perception that they will go to their OB-GYN and ask them for a hormone panel, not that some of them won’t order it, but for you to say that they are more surgeons than hormone experts I think will surprise a lot of people. 

Dr. Tabatha: 

I had very minimal training in how to handle a menopausal woman. I was definitely trained on what preventative tests to order, like a colonoscopy, a mammogram, a lipid panel to test your cholesterol. 

I was explaining this on a podcast earlier today: The medical system was created out of an acute care problem. We were trying to treat infections and save people’s lives and do lifesaving surgeries and things like that. The whole world of medicine comes from the idea of pathology and disease. It doesn’t come from a standpoint of health and wellness. 

We’re just looking to the wrong people for answers about how to get well, how to reverse disease. That’s not what doctors are trained to do. They honestly don’t know that. I didn’t know that. I was really well trained. That’s not what you learn. 

It wasn’t until I went on and got a ton more training that I actually started to understand and comprehend the idea that I was practicing Band-Aid medicine. If you came to me with typical symptoms of thyroid disease, my only solution was Synthroid. That’s honestly all I knew. Or you need to go have your thyroid removed, if it’s acting up and overgrowing. 

As a surgeon, we are taught to remove the offending organ. The uterus is bleeding too much; just remove it. The gallbladder is creating stones; just remove it. The appendix is inflamed; just remove it. That’s the mentality. It breaks my heart that I used to think that way and practice that way.

I wasn’t until I had failed my back surgery, and I was laying in bed for seven days. The third or fourth day, I realized I hadn’t eaten at all. Why am I not hungry? Why don’t I even care about eating? Then I remembered when I was doing my surgery rotations, one of the first things we learned as a student was how to write NPO orders. We would tell the nurses, don’t feed this patient who just had surgery. You cannot feed them until we give you an order, and then you can feed them. As surgeons, we know that fasting is part of the healing process. My body was doing that innately. It was not wanting to eat because I was trying to recover from this back injury.

I’m laying in bed. I can’t do anything else except talk to God. I got so much clarity that week. Wow, when I stop giving into all my bodily cravings and desires, and just let my physical desires drive everything, my mind can open up. I can actually reestablish that connection with my creator and get so much clarity, and I can heal. 

You know this. When we eat, we need resources. It requires energy and supplies to break down the food, digest the food, absorb the vitamins and minerals from the food. It’s a very active energy-heavy process. If you’re eating all the time, you can’t heal and take care of other things throughout the body. If you fast, you can divert those resources to where they need to go. It’s a pretty incredible process. 

God said, “Teach people how to do this.” That is the innate intelligence of your body to heal. 

Dr. Eric: 

I agree. When it comes to fasting, there are different types of fasting, like 16/8 fasts, 24-hour fasts, three-day water fasts. What do you practice yourself? What do you typically recommend to patients? 

Dr. Tabatha: 

Great question. My program is 40 days long. I developed it after listening to my patients over and over and watching them work with the nutritionist and seeing where they were struggling. Time and time again, women would tell me, “I can’t fast. It’s too hard. That’s too long.” They would have symptoms. 

What I realized was they were stuck in sugar burning mode. They were eating a lot of carbohydrates and using that immediate blood sugar to get through their day, for their energy. Whatever was left over, they would store it as fat. That’s what we do. 

Women aren’t eating enough healthy fats and protein, one because we were told fat makes you fat for decades, which is absolutely not true. Women are afraid to eat healthy fats. When you use fats to burn fuel, you are satiated longer, so you’re not as hungry as quickly. You don’t ride the hangry rollercoaster of the blood sugar issues. You can go into ketosis, which sets you up for success with fasting. 

The process of fasting, we have to retrain our bodies how to do the innate intelligence it was designed to do because honestly, when we were created forever ago, we didn’t have grocery stores on every corner. We didn’t have access to unlimited foods 24/7. We didn’t have DoorDash and all this crazy stuff. Our bodies know how to go quite long time periods without food. How to feast, how to famine again. 

All you have to do is break up with snacking, break up with sugar, get back down to your normal three meals a day, and then you can start to shrink your eating window. Then you can start to drop off a meal and go only a dinner and maybe a lunch, or do a 24-hour fast. 

It’s like learning how to run. People don’t just get up and run a 5K very often. The ones that do, that’s pretty awesome. Most people do a couch to 5K. They get the training manual and every day, they slowly increase what they’re doing and add onto it. 

That’s fasting. You have to retrain your body on how to burn fat for fuel instead of sugar for fuel. We use all of it. We begin by getting into ketosis and burning fat for fuel. We play around with that eating window. 16/8 is the most common. That’s where most people feel good long-term and have long-term benefits. 

I don’t think our bodies were created to eat 24/7. They just weren’t. You should not. It’s too hard on the pancreas; it’s too hard on the body. You should be eating in a 6-8-hour window on a regular basis. Then we can add in longer fasts, depending on your goals. Are you trying to lose weight? Are you trying to get mental clarity? Are you trying to heal from an injury or reverse a disease process? What is your motivation behind it? I teach all of that in the online version of my program. 

It’s been such a game-changer for women. Nobody is talking about this! People are like, “Well, we can all fast the same. You should be able to do it.” People feel like a failure if they just can’t get on board with the trend and do it. It’s not a trend. It’s actually how God created your body to function. You just have to remind it what to do. 

Dr. Eric: 

It’s more about losing weight. Obviously, fasting can definitely help people to lose weight. You mentioned healing overall. It could benefit people with all different conditions. Most people listening to this have autoimmune thyroid conditions. You dealt with Hashimoto’s, so I imagine fasting is a big part of patients you see with Hashimoto’s. 

I would say that most people who fast, at least initially, a lot of people are doing it to lose weight, but it goes way beyond just losing weight, if I understand you correctly. 

Dr. Tabatha: 

If you do it right. Weight loss is a side effect. It’s a benefit of getting healthy. I’m hearing a new trend where people are poo-pooing fasting if there is any kind of thyroid disease. “Oh, you shouldn’t fast. You have an autoimmune condition. Or you have hypothyroidism.” That’s really not true. That is not how our physiology is designed. It’s actually beneficial for people with thyroid conditions and autoimmune conditions.

The key is to do it in a way that your body doesn’t think you’re starving. We know that thyroid, being the master gland it is, is trying to regulate all of our resources. It’s taking in information from our adrenal glands, our gut, our immune system, our sex hormones. It’s trying to keep everything in balance. It affects your thermostat, your metabolism, how quickly your bowels move, how quickly your hair grows. It affects everything. It responds to all the stimuli coming in, the environmental stimuli, the internal stimuli. It decides who gets the resources. 

This is what I love explaining to women: Your thyroid doesn’t just become sluggish and fail you. Your thyroid is actually protecting you. It’s doing its job a lot of the times. When it’s shifting resources, or “downregulating,” I call it, where you kind of look like you’re going into a hypothyroid picture, and nobody is checking your full lab panel. 

Your reverse T3 is really high, and your free T3 is really getting on the lower end. It’s because your thyroid is responding to something that’s happening, either a gut imbalance, an infection, heavy metal exposure, a virus you just got, an autoimmune attack on your thyroid. If you can just remember that your body is working for you, and it’s doing its best to actually keep you in balance and protect you, and stop being mad at it, then you will be able to know what it needs and pull it out of that situation. 

When I see women coming to me with hypothyroidism, and they have gained weight, they immediately focus on losing the weight. We have to figure out why is your thyroid downregulating and sending out resources elsewhere? It’s because you have gut dysbiosis that we need to treat. When you treat those root causes, a lot of times, I see the thyroid shift and go back into balance because it’s no longer worried or trying to treat this infection or deal with something else. 

You have to start listening to your body. We do this as children. We are strong with our intuition. We hear what our body has to say, but we get trained by grownups to ignore it and cover it up with medications and over the counter stuff. Just think of it as a nuisance. 

When your body is giving you little signs in the beginning—your skin is a little dry, you’re getting a little constipated, your brain isn’t functioning very well—we just keep ignoring all the symptoms instead of going, “Hmm, I wonder what’s got the thyroid angry. Maybe we should evaluate why is the thyroid shifting how it’s functioning.” When we do that, we can figure out the root cause and treat it. Oftentimes, we can finally release the weight.

Part of it is that fasting stops all of the stuff happening in the gut. The gut is the end-all be-all. It’s where all disease and health begin. If you’re constantly feeding your gut, and you have leaky gut and autoimmune conditions, it’s like fuel on the fire. It’s taking lighter fluid and shooting it at the tiny little embers, and it starts to flare back up again. You get the food sensitivities all angry again. You get the leaky gut going again. You get the immune response flared up. You’re driving more thyroid dysfunction instead of actually giving it all a rest. 

Fasting is one of the quickest ways to heal your gut. If you really want to calm things down with an autoimmune condition or thyroid condition, you want to incorporate fasting. That gives your body the ability to divert resources over and start healing. 

It can start doing the process of autophagy, meaning we have cells that we send out through our body that eat and kill other bad cells that need to leave. They need to be done and gone. If that process doesn’t happen, those cells sit there, and they go rogue and turn into cancer and disease. We have to give that autophagy a chance. We are just continuing to spiral down with more conditions and more conditions. 

Dr. Eric: 

Fasting is important for overall health, especially for gut healing. Like you said, we might need to go beyond that. If you have gut dysbiosis due to some type of infection or other imbalances/other triggers, we need to address that. Fasting helps with the gut. 

You’re known as the Gutsy Gynecologist. What is that connection between the gut and the hormones? 

Dr. Tabatha: 

I first started noticing this as a surgeon. I did a lot of stage IV robotic endometriosis surgery. Endometriosis is where the cells inside the uterus that grow every month in response to estrogen grow and then bleed, which is what’s called a menstrual period. These cells get outside of the uterus into the abdominal cavity, and they can start to grow on top of the uterus, the ovaries, the tubes, the side walls of your abdomen and pelvis, on your bowels and bladder. It was my job to go in as a surgeon and try to separate all the adhesions and the scarring that was taking place. The bowels and bladder and ovaries were growing together essentially from this disease process. 

It was never taught to me that the gut was involved at all, but it was obvious looking through the robotic lens that how is the gut not involved? The gut is literally scarred to these pelvic organs, and I’m sitting here peeling bowel off and taking down adhesions for two hours at a time. The gut has to be involved. 

When I started studying functional medicine, I really began to understand that all of the things happening inside the intestines, the lumen, the tube where the food is being digested and broken down and turned into stool, those processes, chemical reactions are happening. They don’t just stay in the lumen. They cross through that one cell layer into our bloodstream and through the serosa out into the abdominal cavity. 

If you have inflammation in your gut, you’re producing cytokines and interleukins and all the bad stuff that we heard about through the pandemic in your gut. They’re seeping into the pelvis the same way that the pelvic stuff is seeping into the gut. It’s impossible to heal endometriosis without healing the gut. It’s impossible to stop fibroids from growing and fertility scarring and issues like that without healing the gut. As long as you have inflammation processes and chemical reactions happening from all the bad bacteria and the overactive immune response, you just can’t stop it. 

When I made that connection, it was lifechanging for my patients. As soon as I started with the gut first, so many of their GYN problems just went away. We weren’t dealing with them directly. All the painful periods; the crazy, heavy, irregular periods; the disease processes, they start going away once you heal the gut. 

It’s way more in depth than that. There are certain bacteria that live in our intestines that will make an enzyme called beta-glucuronidase. This enzyme cuts the garbage tag off of the estrogen that we are trying to remove from our body. If I’m done using my estrogen that I just made, I want to get rid of it. I put a methylation group on it, send it through the liver, send it to the urine and stool for removal. This enzyme from the bacteria will cut it off and help you reabsorb it through your intestines. 

Again, I believe it’s our body’s innate intelligence because almost every single day, I see menopausal women with really high beta-glucuronidase levels. I think their body is trying to reabsorb as much estrogen as possible because they are so low in estrogen, and estrogen is protective.

We also see that with fat cells. Women get so angry that they gain five or 10 pounds at menopause. Every woman almost. That is your body’s way of protecting you because you no longer have enough estrogen to protect your heart, bones, and brain. Fat cells make estrogen, so we add some more fat cells to bump up your estrogen, just enough to give you that protection. 

We look at this like our body’s failing us. Our body hates us. Why is it doing this? That’s not what’s happening. That’s what’s supposed to happen, unless you go on hormone replacement therapy, and then that little belly fat you gained goes away because your body doesn’t need to make estrogen. You’re taking it. 

You have to understand and believe that your body is always working for you. It’s not working against you. It doesn’t hate you. We just don’t understand it. 

Dr. Eric: 

You mentioned beta-glucuronidase. It sounds like you do comprehensive stool tests to look at not only to see if they have dysbiosis but see if they have an elevated beta-glucuronidase. Do you also use dried urine testing to look at the estrogen metabolites? 

Dr. Tabatha: 

Every day, yep. I love when women do my Healthy Her program. You have to take a comprehensive approach. You have to see what’s going on in the gut. You have to see how your hormones are being metabolized. You need to see what your adrenals are doing. You need to look at that 24-hour cortisol pattern and see how are your adrenals handling your daily stress in your life? 

It isn’t until you see all of these pieces of the puzzle to see the picture clearly. Then you can start to understand, “Oh, that’s why my thyroid’s behaving that way. This is what’s going on.” “This is why I went into premature menopause.” “This is why I’m infertile.” Absolutely. 

I try to get most women to do my program, which is stool testing, food sensitivity testing, Dutch, hormone, and adrenal testing, all upfront. 

Dr. Eric: 

I’m glad you brought up adrenals because one question I have for you related to fasting: Any concerns with the adrenals and fasting? If you look at a Dutch test, and someone has cortisol levels that are sky high or depressed, along with, say, depressed total DHEA, should that person fast, or should they avoid fasting? 

Dr. Tabatha: 

That’s a great question. This is one of the biggest things that I address in the program because it comes up time and time again. Either women have no idea they have an adrenal issue. They have never heard of this. Or they have a Dutch test, they know what their 24-hour cortisol panel looks like. 

I would say the only real concern is when you are in stage III adrenal dysfunction. We used to call it “adrenal fatigue.” You look at your pattern, and it’s flatlined. You don’t have a nice cortisol awakening response the first 30 minutes of waking up in the morning. That means your body is losing resiliency. It’s losing its ability to respond to and give you the cortisol production that it needs to function. 

Fasting is a little bit of a stressor. It’s a good stressor. The same way exercise is a stressor. Moderate exercise is good. Triathlon training, that’s probably excessive and bad. You have to think about it that way. 

Fasting is a good stressor, but not in someone who doesn’t have the resiliency to be able to respond appropriately. If your cortisol is flatlined, you want to start with getting a more ketogenic diet and really shrinking up your eating window. Then staying there and making sure you’re having high feast days, where you’re reminding your body that you’re not starving because your thyroid will respond. 

If you eat low calorie day after day after day, it will say, “She’s starving us to death. Let’s turn down this production here. We can’t lose any more weight. She’s going to starve us.” You have to make sure you’re eating enough when you are eating. That’s where a lot of women are falling short. They’re trying to calorie-restrict while also fasting. That’s not the most beneficial way to do it. 

I would say if you haven’t had Dutch testing, you don’t know what your adrenals are doing. Ask yourself some basic questions: Can you get out of bed in the morning? Can you get going without coffee? Are you requiring naps during the day? Are you pretty much sleeping at night? If those things are really messed up, you probably want to get your adrenals tested. 

Dr. Eric: 

Just to clarify, if someone does have that low cortisol pattern, it sounds like it’s a good idea to fast, but you want to make sure that you’re getting enough nutrients, calories, and protein during that eating window. 

Dr. Tabatha: 

Right. And you really need to start loving your body and giving it rest time and helping it restore and repair. It’s in a state of severe stress. What we are trained to do is push through, keep going, drink more caffeine, get more sugar, do whatever it takes, take stimulants. That is not the answer. 

I go through this in the book. We have two parts of our autonomic nervous system. We have this sympathetic, fight or flight. If you’re afraid, you’re going to run. If you’re stressed out, you’re going to fight. There is the parasympathetic, rest and digest. You can’t be in both stages at the same time. 

Adrenal fatigue is you were in sympathetic/fight or flight for so long that you can’t even function anymore. Now you have to be in parasympathetic to heal. I don’t want anybody to get to that point. The more you pull yourself over to the parasympathetic nervous system and really nurture that side of you, the quicker you’re going to heal. 

To me, fasting with faith is one of the quickest ways to get into parasympathetic mode because you’re meditating on scripture, you’re trying to listen to what God has to say for you. You’re slowing down and understanding that you don’t have to figure it all out. You don’t have to carry all the burdens. God’s got you. He already has a great future lined up for you. You need to trust in him. 

When you start reading that truth, the words of the Bible, you really can shift into that parasympathetic nervous system and start to heal. It’s beautiful and incredible. Women’s DHEA levels will increase. DHEA is like our anti-aging, keep us young and healthy hormone. We need that. So often, we start to get it really depleted in that stressed out, over-adrenaled state.

I was just thinking about this this morning. Everybody used to say, “How are you?” You would say, “Good. Fine.” Now the answer is, “I’m really busy.” Like it’s a badge of honor, something to be proud of. God does not want us to be busy and overly productive. We don’t have to earn our salvation or our place. We have to take a step back and just relax a little bit. Realize that we are worthy just because we are. We don’t have to produce and perform and do all the things to earn our place. 

I think we get stuck in this busy mindset. I hear this every day from women, “But I can handle it. Everybody’s doing it. That’s just life.” Okay. Your mind can handle that stressed out life, that overactive life, that busy life. But your physiology can’t. Your thyroid can’t. Your adrenals can’t. Your gut can’t handle it. Your physiology still responds with a chemical reaction every time you are in a stressful, sympathetic state. 

That’s just the truth of it. You study rats and pigs and people. That’s just the response that happens. You get a stimulant. We release cortisol. We release epinephrine. We release cytokines. All these inflammatory processes happen. Then our mind is like, “Oh, that’s fine. Don’t worry about that. We got it.” The physiology already happened. The inflammation already happened. We just killed all the good bacteria. We just caused our leaky gut. It just happened. It doesn’t matter now. 

We need to be more mindful about how we’re living and take some authority and responsibility over the fact that what we are doing all throughout the day is completely impacting our health. We have way more control over it than we want to admit. We want to think doctors are the answers. Doctors are going to help us and save us. Really, your body is totally created to heal. 

I tell people as a surgeon, I will cut your skin open and fascia and muscle and pull the baby out and sew everything back up with sutures. I know it’s kind of graphic. I didn’t actually heal you shut. I literally put some suture in there to approximate those tissues, so that the muscle of the uterus laid next to each other. 

If those stitches broke, you weren’t healed shut. Your tissues have innate intelligence that they grow back together. The cells regrow together. That is what we are not believing in anymore. We are not believing that our body has any ability to heal or do what it’s supposed to do. I really want women to understand that there is so much more of it in their control than they realize. 

Dr. Eric: 

We’re essentially assisting with the healing. Like you said, it’s innate intelligence. 

Today, I had two patient consultations. We were talking about why the endocrinologist can’t be more open-minded. They bring up a diet for cases of Graves’ or Hashimoto’s, “No, diet won’t do anything.” You need the thyroid hormone replacement, or in the case of Graves’, antithyroid medication or radioactive iodine. So negative when it comes to diet. 

There is an underlying cause behind everything. Like you said, our job isn’t really to fix the person; it’s to give them the guidance and have their body take over, that innate intelligence. I’m glad you spoke about that.

Parasympathetic, I want to talk a little bit about that. When it comes to spirituality, religion, and the overlap between that and mind/body medicine. For example, when I have a conversation with a patient, I ask them what they’re doing from a stress management perspective. If their response is praying every day, which is important, do they need to go beyond that? Your book talks about that probably, and you’re talking about that now. How much do they have to incorporate mindfulness? How much overlap is there between religion and meditation and yoga? Anywhere you want to go.   

Dr. Tabatha: 

If your listeners are anything like me, I was raised Catholic. I had a lot of confusing messages being in religion and in the church. I really pulled away from it for a long time. I always knew that I believed Jesus Christ did walk the Earth, and he was my savior. I had that belief in the back of my head. I treated God like he was a genie in a bottle. I would just wish and pray and wish and pray. Why won’t it happen? I’m waiting for things to magically happen within the same day of me asking for it. That’s a really scarce mindset and a weak and fearful way to live. 

I don’t believe that’s strong faith. I had to learn to actually trust God and believe him before I see it. We always want to see and then believe. You actually have to believe and then see it. When I shifted how I was praying, and I shifted to a state of gratitude, like thank God first, and then come to him with my issues and requests, that was a gamechanger. 

That changed everything because what I realized was you can’t be anxious and worrying and in a state of gratitude at the same time. Just like you can’t be in fight or flight and rest or digest at the same time. If you are staying, “Thank you, God, for this incredible body that got up and went to Pilates this morning. Thank you for my sweet dog giving me attention when I get home. Thank you for the warm cup of coffee that I’m drinking right now,” you can’t actually be worrying about stuff at the same time. 

You start to shift the chemicals that are created in your body and how you feel. When we are in a state of gratitude, we produce oxytocin, which is our love hormone. It actually helps us feel good. We produce more serotonin and melatonin and all of the good chemicals. 

When we are in a state of anxiety and worry, we tend to remember past events. As soon as we remember something, our brain is hardwired to feel those feelings and create those chemicals again. 

Say you got in a really big fight with somebody. Somebody did you wrong. You could probably relive that in your head right now and feel all those feelings and get the heart racing and get sweaty and get jittery and pumped up, like you gotta talk about it. You’re making chemicals from that thought response, those feelings. 

What I teach women is in order to change your body, you have to change your mind. It all comes back to Romans 12:2, “You have to renew your mind in order to be above any of this physical reality that you’re suffering through.” Your brain is a computer. Your mind is a computer program. It’s just doing what you’ve trained it to do. Unfortunately, most of the programming was done when we were young, or it’s done subconsciously without much of our thoughts. Paying attention is just happening to us. People say things, and we record them, and we play them over and over and over. We create these new nerve pathways that just get ingrained and driven deeper. 

It’s not until you start to make new pathways and think new thoughts and break those old thought patterns that you can create new chemicals to send a new signal to your cells that are healing and health-restoring.

It all does begin in your mind. Anything that happens in the world, somebody wanted to create an airplane and get us to fly. That had to first happen in his mind before he developed the airplane physically. If you want a healthy body that isn’t overweight, that isn’t in pain, that isn’t exhausted, you have to first envision it in your mind. 

I do this whole thing called Future Gazing with God. I walk women through the process of figuring out: What are they struggling with? What don’t they like? How do they see themselves? Then I help them envision, “Imagine seeing yourself through God’s eyes, through your creator, who has plans for you. Imagine what he sees you as. How can you get to that woman of your dreams that you envision yourself becoming?” 

Then we work backwards. What is that woman doing every day? How is she waking up in the morning? How is she moving her body? What choices is she making about food? How does she manage her stressors? When you get that kind of clarity, you can start creating new thought patterns and reprogramming your mind. That will change your behaviors, and that will change your body. 

It’s a lot. I get it. But it’s life changing. It’s transformational. Watching women go through this has just been the most rewarding thing I’ve ever done. It lights me up.  

Dr. Eric: 

I asked you that question because it happens a lot. I’ll talk about stress management, and a woman will typically say, “I’m praying, and that’s my form of stress management.” I always give a positive response because I think that’s great and is helping, but it sounds like many times, they do need to go beyond that, to go deeper to get into that parasympathetic state. 

Dr. Tabatha: 

Unfortunately, a lot of prayer is actually bad repetitive thoughts. It’s a negative feedback loop of worrying and praying and asking God to fix something that he doesn’t necessarily want to fix. He might want to be teaching you a lesson. He might be showing you all kinds of doors you’re supposed to be going through. You are so stuck in that symptom that you can’t see it. Sometimes, we have to get a fresh, new perspective. 

When I was so overworked as an OB-GYN, I worked in a small town. I was on call every other night. I was exhausted. I couldn’t remember my patients’ names from the delivery the night before. I literally could not remember stuff. I had to rely on my assistant. 

That was really eye-opening for me to understand that none of that was ever going to change until I decided that it was no longer something I was going to tolerate. I was going to put some boundaries in place. I was going to shift my mindset about things. I believed I was supposed to be exhausted and overworked. I was trained to think that you hold your bladder and don’t eat and just struggle through and keep on going, and you always put the patient first. That was my mindset. That was my belief. 

It wasn’t until I realized God gave me this body, and I am not honoring him by treating it like a garbage can. I need to shift and change how I’m treating myself because that’s going to be sustainable. You cannot continue to pour from an empty cup. You just can’t. 

It wasn’t until I shifted my internal mindset to believe that I can have boundaries. I can work less. I can sleep more. My patients will survive if someone else takes care of them. I had to shift so many beliefs. Once I started to do that, and started focusing on me and my health and my body, that’s when everything changed. A lot of people need a new perspective unfortunately. 

Dr. Eric: 

I definitely agree. Dr. Tabatha, you shared a lot of great information. I know people are probably really excited to read your book. Before you talk more about where they can get it, is there anything else that I should have asked you that I didn’t ask you? Anything else that you want to talk about? 

Dr. Tabatha: 

I just want people to know that you’re never too far gone. I had a 70-year-old woman do the online program for Lent last year. She had uncontrolled diabetes at 70 years old. She had a wound that wouldn’t heal because her blood sugar was so elevated. Her hemoglobin A1C was 8.5 going into the program; that is really uncontrolled. She decided she was going to give it a try. 

She didn’t believe that she could do the whole thing, but she started believing she could at least do the day. We took it day by day. By the time we got to an extended fast, she was like, “I think I can do this.” She completely did it. She felt so empowered. It absolutely shifted everything. 

This is a woman with fibromyalgia and chronic pain and non-healing wounds, everything you can imagine. A list of drugs she was on. By the end of it, her hemoglobin A1C was down in the 6s. She was out moving her body like she hadn’t in years. 

She was the greatest example to me because she thought she was too far gone. She was believing the lies, “It’s too late. I can’t heal. My body can’t change at this point.” I was a little skeptical. She was 70. That is a lot of comorbidities, right? I know it works in 40- and 50-year-olds. Man, did she make me a believer. 

I love that story. The fact that I had Hashimoto’s at 17, and my antibodies were sky high. Now, they’re down in single digits. You can reverse stuff. Your body wants to be in homeostasis. 

It wants to heal. It is always trying to heal. It’s in a constant state of healing. It’s only us interfering that it gets into a state of not healing. If you just shift and choose to believe, and know with all your being- Just as the sun rises every morning, you know the sun is going to rise. Just know your body is going to heal. Your mind will start to find those solutions and those opportunities for healing. 

Like listening to the podcast today. “Oh my gosh, I’ve never thought of fasting. Let me try this. Let me see.” God gave you a new possibility. That’s what I would say: You cannot give up hope. 

Dr. Eric: 

Wonderful. Where is the best place people can get your book?  

Dr. Tabatha: 

Go straight to FastToFaith.com. Right now, if you get the book, we’re giving awesome bonuses with it. We’re giving $20 to the supplement store. We’re doing extra scripture bonuses. I am doing a really awesome master class where I am doing a deep dive called Ultimate Transformation. It’s only for the people buying the book right now. I’m really excited about that conversation. You get to interact with me one-on-one and ask questions. All that good stuff.

Dr. Eric:

Once they buy the book, they get access to that master class you mentioned? 

Dr. Tabatha: 

Exactly. They just put their order number in, and we’ll send it to you. 

Dr. Eric: 

Check out Dr. Tabatha’s amazing podcast, The Gutsy Gynecologist Show. Also, there is a free guide, The Gutsy Gynecologist’s Guide to Balancing Your Hormones. This was a wonderful conversation, Dr. Tabatha. Thank you so much for your time. Appreciate it. Best of luck with your book. I’m very excited about it and think it’s going to do amazing. 

Dr. Tabatha: 

Thank you. I’m so honored that everybody just took the time to listen today, and they stayed with us. Thank you so much.

 

Recently, I interviewed Dr. Kristi Tompkins, and we talked about the significance of managing stress, the importance of individualized dietary plans, the interplay between hormones and thyroid health. 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. Kristi Tompkins, as we are going to have a comprehensive chat on hormones, including hormone stressors. I am going to dive into Dr. Kristi’s bio: 

Dr. Kristi Tompkins is a naturopathic doctor, functional medicine practitioner, and transformational coach. Having treated a variety of clients over the last 15 years, her specialty is helping women to become more aware, adapt, and thrive during the perimenopausal and early menopausal years. Integrating a blend of personalized lifestyle medicine, brain-based coaching, and mind/body healing, Dr. Kristi enjoys encouraging and empowering her clients to make better choices in their health and their lives. Thank you so much for joining us, Dr. Kristi.

Dr. Kristi Tompkins: 

Thank you, Dr. Eric. So happy to be here with you.

Dr. Eric: 

Before we talk about hormones, can you give a little bit more of your background? How did you start focusing on helping women with hormones? 

Dr. Kristi: 

I trained as a naturopathic doctor, so I have a doctorate degree in naturopathic medicine up in the Pacific Northwest at Bastyr. In medical school, you learn about treating everybody: men, women, children, all the different health conditions. 

After I graduated, I started working with an integrative medical doctor. He would now be considered a functional medicine doctor, but very much integrative. Trained as an MD but integrated a lot of botanical medicine and nutrient therapy. He also had a specialty in hormone replacement therapy, bioidentical hormones, hormone testing for men and women. 

Early on in my practice, working as a naturopathic medical doctor, I learned about how to diagnose, how to test, how to read the functional labs, how to prescribe bioidentical hormones for women going through perimenopause, which is anywhere from 4-5 years up to 10 years before menopause, leading up to when their period stops, on how to help them holistically but also with bioidentical hormones.

Same thing with men. Prescribing hormones, not just bioidentical hormones, but also thyroid hormone as well. 

It also happened to interest me. I’ve had an interest in women’s health for quite a number of years, just based on my own female hormonal symptoms that I had many years ago when I was in my teens and 20s. I naturally gravitated toward women’s health. 

At some point, I moved from the Pacific Northwest back down to California, where I’m from, and I started a practice there. It was back to general medicine again, treating a variety of people. It’s been probably within the last 4-5 years that I have really narrowed my niche on women’s health, specifically perimenopause. I still treat a variety of people with different conditions. That seems to be something that really calls to me. 

It’s that time in a woman’s life where there is a lot of changes that are happening with her body. Of course, life changes as well around her. There is a lot of things that happen that women don’t necessarily direct or pinpoint it to, “This might be related to my hormones changing or menstrual cycle changing in preparation for menopause.” It tends to take a lot of women by surprise, the weight gain, the hormone changes, the sleep, the mood, vision changes, and thyroid changes. 

I want to help take out the mystery and the confusion and the stress of these symptoms and help women feel more empowered as their body is inevitably going through these changes, so they feel a lot more confident and in control, as much as they can during that time. 

Dr. Eric: 

You mentioned a number of different symptoms. Would you say these symptoms associated with perimenopause are normal, or would you say they are common but not necessarily normal? 

Dr. Kristi: 

Great question. I would say it’s both. It depends. If you throw in unhealthy foods or pro-inflammatory foods, and you add in chronic stress and environmental exposures, and the list is infinite, that will affect not only the entire body, but it will also affect the ovaries, uterus, communication between the brain, the pituitary gland, and the ovaries. It will affect the cycle indirectly or directly. 

Things like changes in their menstrual cycle, like heavier bleeding or a shorter cycle, where it’s a shorter time in between. Women are starting to notice more headaches right before their period maybe, mood changes, sleep changes. Some of those things can be mild, but they can also be exacerbated and worsened through some of those other stressors in our lives. 

That’s where personalized lifestyle medicine, stress management, exercise, meditation, mindfulness, treating the whole person can help everybody, but it can really help women as their body is having the dip in hormones. Having this dip throws them off balance. They don’t feel like they can adapt to life changes as well, just with the hormones dropping anyway, but then you add in all these other factors that makes it worse.

Some of the symptoms can be normal, like skipping periods. Maybe you skip a few months in a row, or maybe it ends up being 21 days in between your cycle. That’s pretty common as you’re approaching that time when the period stops. That can actually be worsened by things that you are doing in your life that you’re not aware of, or maybe you are aware of. What you’re eating or what beverages you’re consuming or how much sleep you’re getting. That can throw that over the edge. It can be a fine line between “natural” symptoms and exacerbated symptoms. 

Dr. Eric: 

Makes sense. You’re going to get some symptoms regardless of how healthy of a lifestyle you live. The problem is that many people don’t live a healthy lifestyle. If you’re eating a lot of refined sugars and gluten, and you’re stressed out all the time, that almost definitely will lead to an exacerbation of symptoms.

Let’s talk about some of these stressors. Starting with stress itself, let’s say if everything else was perfect. Overall eating a very healthy diet, doing things to minimize exposure to environmental toxins, which we can get into more of. If everything else was in alignment, but the person was in a state of chronic stress, how dramatic of an impact can that have on one’s health? 

Dr. Kristi: 

As you and I both know, a little bit of stress sometimes can be to your advantage. That acute stress, the stress of writing a book or starting a business. There can be “good stressors” in our lives. Sometimes, that pushes us to grow and change and evolve in our life. Usually, that is considered maybe more of a positive excitement, something new. 

Then there is the chronic stress of financial stress, maybe the stress of relationships or divorce or something happening with your children. There are a million different types of stressors. Sometimes, there is a lot of internal stress. Probably more than sometimes. There is a lot of perception of things that may or may not happen, or maybe recounting stories from however many days, weeks, months, years ago that we’re still reliving. 

A lot of times, our emotional/psychological distress comes from within. That can be the same type of stressor as anything outside of us. That puts our body into a higher focus on the sympathetic nervous system. If there are more of those stress hormones, there is not a lot of time or opportunity for growth, repair, relaxation, restfulness, absorbing your nutrients, creating new hormones, and creating new proteins. There is a static interference between the stress hormones and our other nutrients, neurotransmitters, and hormones in our body. The body can’t thrive. It can’t expand if it becomes too constricted, too inflamed. 

The body is pretty fantastically wise and resilient. It can usually help you. Your body really does have your back. Over time, if you’re constantly in that fight or flight, feeling threatened or feeling like you might be attacked from an ancestral perspective, like if you are going to die, it puts you in that state of chronic stress hormones. Your body can’t really grow in the way that it’s supposed to. 

That is when a lot of cells start to change. They become different, and the organs change. The body is trying to adapt, but it’s maladaptive over time. That is when you start to see illnesses and diseases set in. There is a whole assortment of those. The body is trying to adapt with you, with the stress, but that is not a normal state. Blood sugar, blood pressure, weight changes, changes in the brain, changes in your skin, changes with your hormone levels, changes with your thyroid. 

That is when people wake up. They have all these symptoms, “Wow, I feel terrible.” Maybe it’s been gradual over a period of time. “I’m just tired all the time. I’m achy. I’m not sleeping well.” “I’m chronically congested and have this mild achiness throughout my body. I don’t know what’s going on.” Then it gets to be really bad. That is the body’s way of saying, “We need to get your attention. Something has been off for a period of time.” That is usually when people seek out care.

Fortunately or unfortunately, a lot of people go to their regular, conventional doctor for a prescription, for help. Sometimes, that can be helpful, lifesaving in emergency cases. Sometimes, that can be incredibly therapeutic. It’s a very limited amount of tools in the toolbox. Whether it’s medication or somebody running a lab test that comes back “normal,” a lot of people are sent away going, “Okay, the problem is still here.” In some cases, “I feel worse.” The root cause wasn’t addressed. 

For a lot of people, they don’t understand that they might be part of the root cause. Their own internal overreaction to stress or life, they might be part of the problem. Not to point fingers and blame them, but to show people what you’re doing in your life might be contributing to how you’re feeling. There is a lot of personal accountability and empowerment that you can share with your patients or clients, that you can make these changes in your life in so many different ways, so your body can get back into that balance again. It’s not constantly in the fight or flight stress, so it can actually heal. 

Dr. Eric: 

One of the strategies you recommend is doing mind/body medicine, meditation, yoga, and other techniques? 

Dr. Kristi: 

A lot of people feel, “I can’t meditate. I have too much going on in my life and brain.” That’s a lot of people. That’s why they call it meditation practice. You don’t exercise one time. You don’t have one healthy salad, and you’re good. You really do keep going. 

It’s the whole person perspective, healthy eating, moving your body, strengthening your muscles. It’s taking whatever supplements, nutrients that you need. Cultivating healthy relationships. It’s that mind/body connection, whether it’s meditation, breathwork, yoga. There are other ways to meditate. Listening to music and focusing on your breathing can work wonders at calming the nervous system.

The whole point is not only to calm your nervous system or regulate it, because we don’t always want to be in the parasympathetic or always in the sympathetic. It’s more about the balance and regulation. 

Oftentimes, meditation can also help you make changes in your life. It can help you shift your thinking and shift the beliefs you’ve had about yourself and your life. It can help you shift your emotions in a way. 

A lot of times, you can make positive changes in your life, in your habits, or get rid of self-sabotaging habits and beliefs, and actually create new things in your life. You’re continually growing. You’re letting go of the old ways of living and doing and thinking and being, but you’re moving toward more of a positive, expansive way of living. 

That also naturally resets the body back to homeostasis, where it’s actually functioning normally. It’s got many different benefits to it. 

Dr. Eric: 

If you could talk about some of the other stressors, the other factors that can cause imbalances in your hormones? 

Dr. Kristi: 

I would say a big one is the food that you put into your body. Whether it’s alcohol or too much caffeine or sugary beverages, pro-inflammatory foods. My undergrad is in nutrition, and I know you have a heavy nutrition background as well. 

Putting these foods into your body once a while is okay, but when you put these foods into your body over time, chronically, and your body reacts in a way that actually causes the immune system to be overactive, so foods that your body is like, “What is this? I don’t totally recognize this. Yes, this is food, but I don’t know what to do with this. I don’t know how to break it down. I’m perceiving this as something foreign or potentially a threat.” 

It creates this cascade of inflammatory cells that react to the foods or beverages. That can cause a dysregulated immune system, but it can also cause a lot of symptoms like pain, congestion, inflammation, hormone imbalances, and things to become more swollen. Sometimes, we get these benign tumors throughout our body because of things that have gone awry over a period of time. 

That in itself is a stressor. It can affect the gut, the digestive function in the body, the liver, your skin, your joints, your muscles. That over time can cause problems in each organ system. Ultimately, it affects the entire body. 

I think that is not so much the biggest surprise to people because people know if they eat the wrong foods, they’ll gain weight or have heartburn, or they’ll get IBS. A lot of people don’t make the connection between their autoimmune disorders or female hormone or male hormone symptoms or conditions or their skin or chronic headaches or chronic respiratory symptoms. They don’t make the connection between the foods you’re putting into your body, even if you might think they’re healthy. 

A lot of people eat foods as part of their family ancestry, part of what they know. If they’re eating those foods that maybe were relevant to a different generation, but now they are eating this food today, which may or may not be processed, and you add in their own biochemistry and life stressors, things are different. It’s really showing people not only through testing but through spending time with your clients and asking questions. I want to understand not only what their current symptoms are but what their past medical history is. What has led them up to this point? 

If you get rid of those “stressors,” the diet, certain foods and beverages, again, the body has a chance to calm down. That nervous system can regulate. The immune system, the gastrointestinal system can now regulate. 

It’s a pleasant surprise for a lot of people if they are not already doing that. Getting rid of those foods. Often, it’s not just, “I think this is healthy for me.” It’s an addiction. There is a lot of comfort foods out there that people choose because they’re stressed, or it’s “Why change now? I’m this age, so I will keep eating these foods because that’s what I’ve always done. These are my staples.” That can affect the body. 

Showing people that the stress in their foods might be contributing to their own symptoms. They can make those changes to help the body heal. 

Dr. Eric: 

What dietary approaches do you have in your practice? Do you tell someone to eat whole, healthy foods, like following a paleo diet? Or do you have them follow some type of elimination diet? Do you do food sensitivity testing to see what foods people are reacting to? 

Dr. Kristi: 

It comes back to the individual person. Not to say that if they love ice cream, yes, keep eating a bunch of ice cream every day. 

I personally and professionally love the paleo diet. It really does have this beautiful assortment of different macro- and micronutrients. Proteins, healthy carbohydrates with fruits and vegetables, healthy fats. Not as much emphasis on grains, starchy vegetables. 

There are different variations of a paleo diet. I know some people are following the ketogenic diet or a vegan diet. Maybe they have a little bit of grains every day. It’s case by case. There are some people who can eat grains or sweet potatoes. They can have red meat or pork. Their body might process that really well. 

There are other people who can follow a paleo diet, for example, but it might need to be modified based on their inflammation, weight, digestive system, age. There is a big difference between a younger male who is in his 20s versus a 50-year-old, menopausal woman. The metabolic rate is different. The caloric demands are different. It depends on your activity level, your body mass index (BMI), and other factors. I love the paleo diet as a general guide. 

To answer your question, I do food allergy testing. I do gut testing. I do hormone testing. I do nutrient devaluation testing. I do DNA testing. There are a lot of different tests. I have been in practice for a really long time. I have run pretty much every single functional lab out there, it seems like. I have tailored that to a certain array of labs that I really feel accurately capture what’s happening in the body. 

I love doing a whole custom panel, like a comprehensive metabolic panel for men or women, which really looks at the thyroid, the liver enzymes, the advanced cardio-lipid panel. Looking at all that data in relation or in addition to their symptoms, in addition to their preferences. If somebody is not into kale, that’s okay. You don’t have to eat kale. If they’re not into eating quinoa, you don’t have to eat quinoa. I try to meet them where they’re at. 

I give them the guidance and data and recommendations and insight as much as I can. “If you continue eating this, you will probably have these same symptoms.” I try to work with them as best I can. I realize it’s a process. I had major food allergies when I was younger. I didn’t realize it. I didn’t even know what the term “food allergy” meant. Looking back, I had a lot of that. I didn’t understand that was affecting my body, and I was doing that to myself. That was affecting my hormones. 

It took me a period of time to really make those changes to my diet. Now, I notice, because I have done so much work on myself physically and emotionally, that when I eat those foods, I know when it feels off. I know I have those symptoms right away. A lot of people don’t realize that they feel so bad or miserable all the time because they are eating it day in and day out. They don’t realize the connection there.

It is mostly paleo. If they’re vegan, that’s okay; I work with them. If they prefer to have a higher caloric intake, based on their individual preferences, I do try to work with them. It’s not a cookie cutter approach to any person. Again, I do try to give them my best recommendations to help them heal. 

Dr. Eric: 

Sounds good. I like paleo as well. If someone is a vegan/vegetarian, it sounds like you will make modifications if necessary.

Dr. Kristi: 

Yeah, I want to add to that though. You brought up a good point. If someone is vegan or vegetarian, and they are specifically not having any animal protein. I know there is a lot of vegetarians who will eat dairy or gluten. We know there is protein in dairy and gluten grains. 

If I feel that somebody’s health is adversely affected because they’re vegan, like thyroid. That’s a big one I see a lot. I have seen this many times over the years with men and women. If they are vegan or vegetarian because they chose it, or their partner is eating that way, so they will do that, too, because it’s easier. Or their partner is giving them a hard time for eating chicken or steak. If I see it affecting the person’s thyroid level or energy or testosterone, or their ability to repair and heal and thrive, I will point that out. I don’t do that a lot, but I’ll point it out from time to time. 

Your body might actually function better with this type of protein from turkey or chicken or seafood. You might have this assortment of amino acids that you’re now absorbing, so you can produce these basic building blocks. Using food as your medicine, food can be your therapy. Reminding people that we’re eating for a reason. Yes, we’re eating to live, and we’re eating for enjoyment. We’re also feeding our body with the things that it needs to rebuild and repair. I have mentioned that to a few people over the years, and it’s amazing that when they start introducing maybe in small amounts, their body is able to heal. 

Dr. Eric: 

You mentioned protein. Is there a specific amount of protein that you recommend for people to consume? 

Dr. Kristi: 

I don’t do that. I don’t do a lot of macronutrient numbers. I really think it’s based on the person’s metabolic rate, how much you’re exercising. There are so many factors involved.

I tend not to overrecommend a lot of protein because sometimes, people get too much. I know that’s a very common topic these days: making sure you are having enough animal protein. I get it. We do need those amino acids for certain reasons in our body. 

I have seen some women in my practice who are doing more of the ketogenic, higher protein and higher fat, and limited carbs. Maybe it’s 20-30g or less of carbs per day. I see that change their lipid levels, and I see it change their mood. It changes the gut. Sometimes, there can be adverse effects. Again, it might be mild. 

I usually don’t give people a gram of protein per day to eat. I put it back to them. If you love chicken, seafood, turkey, that’s great. If you love to have steak a few times a week, your body seems to be taking that in and absorbing it well, then keep doing that. 

I tend to think that people overdo it quite honestly with the amount of protein. They overestimate the amount. If your body is getting too much, it’s going to excrete it or store it, or it can cause other problems. 

I give general recommendations to people. I give them a guide.

Dr. Eric: 

I’d like to talk about testing. You said you do a good amount of testing. I don’t know if you do all the tests on everybody. You mentioned gut testing and DNA testing. Can you talk about what tests you recommend on most people? If there are other tests that you recommend, depending on the person? I don’t know if you recommend genetic testing for everybody or just a subset of your patients. Same thing with gut testing. If you test for not only sex hormones but adrenal hormones, do a saliva test or dried urine test? 

Dr. Kristi: 

As I mentioned, I’ve run almost every test on clients over the last 15 years in practice. There is so many. There are almost too many possibilities out there on what can be evaluated with the body. 

There are certain programs I have in my practice that I have built in the last few years. I have a six-month program called Elite that contains a lot of cool features. It includes all the testing in the program. 

I do food allergy testing. I have been doing it for so many years. Sometimes, I think about getting rid of that test. I personally love it. Professionally, I love it because it’s a blood test, and it’s showing an IgG and IgE antibody or immune globulin reaction to those foods. It seems to be very sensitive. I have looked at other food sensitivity panels over the years, but I keep coming back to this one. There are certain favorites I have. We tend to think of gluten and dairy and the common foods that are talked about so often today, but there are other foods like green beans. 

You asked me earlier about food elimination. If I see certain foods that might be elevated, maybe in the moderate to high category, or simply based on what they shared with me. I do know certain tests are very accurate, or there can be a false negative, where it doesn’t show much, but I am suspecting they might still be sensitive to a food. I will have them get rid of it for at least a month if not longer. Some people are okay with that; other people have a really hard time. 

If it’s the holidays, I don’t usually have people get rid of eight foods right before Thanksgiving and Christmas. If you really want to start cutting back, maybe start at the beginning of the year. Really clear this out of your body, so you will feel much better. Usually, they’re on board with that.

The food allergy test, anywhere from 100-200 foods. People love it. They love that kind of data. That’s the one test they are super fascinated by. It shows them what’s happening when they put these foods into their body.

I also do that custom comprehensive metabolic panel. All the different systems, the livers, the kidneys, the reproductive hormones. I love to look at the sex hormones on a serum level, but I also do the Dutch test, which is part urine and part saliva. I love to compare those two because there are sometimes certain test markers, certain hormones that are more sensitively picked up on a blood test compared to urine or saliva. Pros and cons to every test.

It also looks at all the different thyroid markers, the antibodies, the advanced cardio-lipid markers, Vitamin D, iron, FSH, LH. It’s something I’ve put together myself as a custom panel. Based on my years of experience. It’s so simple. It’s just a simple blood test that I order through Quest, but it shows so much. 

I love to do the Dutch test, as I just mentioned. Looking at reproductive hormones, sex steroid hormones, corticosteroid hormones. It’s part urine, part saliva. It shows that cortisol awakening response and that Circadian rhythm tendency or influence and how the corticosteroid hormones will affect the reproductive hormones. 

That’s usually done at a certain time of a woman’s cycle. If she is not bleeding anymore because she is menopausal or had a partial hysterectomy or a Mirena IUD, which is pretty common for a lot of women, to have an IUD and not get their period anymore. That’s another topic. The Dutch test can be done. If you’re not using a period, it may not be as sensitive.

I love to do stool testing. This is in the Elite program I have. I do the Genovva GI Effects. There is a one-day or three-day. I have a mid-tier six-month program that will still incorporate many of those labs, but it might be quite the expanded, detailed nature of some of these other labs. They have other modifications, other smaller versions of these labs, too. 

The GI Effects, I love because it looks at the healthy gut bacteria, potentially disease-causing bacteria, candida, yeast, protozoa, parasites, inflammatory markers, digestive markers, absorption markers. It’s what your body is excreting. Nobody really likes to do that test. It’s not the most favorite one to collect for. It does show quite a bit of data.

The last two would be a nutrient devaluation, which looks at how well your body is absorbing your proteins, amino acids, antioxidants, vitamins, minerals. And the organic acids, which is what we excrete in the urine as a way to show a deeper level of what’s happening biochemically, metabolically within the body.

The DNA test, I have recently started doing that one. I know it’s been around for quite a while. That one is in the Elite program I have. I love it because it shows these detailed reports that accompany- It’s a very simple salivary collection that shows genetic potential or susceptibility that is not a diagnosis by any stretch, as you and I both know. 

Epigenetics plays a big role here. You can influence not only what happens to your body, but you can also make changes now, so you may not be at a higher risk for certain things developing. You may need to make some modifications along the way. I like the detailed nature of the reports that accommodate the different body systems.

Those are the types of tests I love to order. Based on my history of having been in practice for so many years. I’ve run SIBO testing and heavy metal testing and all sorts of different valuations to see what’s happening. I think it’s easy to go down that rabbit hole. 

For some people, that more one-on-one care, where it’s somebody coming in for a variety of different health conditions. My practice or business has now focused more on women’s health and hormones. I have chosen certain labs that I feel best reflect or best show what’s happening in the body. 

The patients love it. They love the data. They like the one-on-one connection as well. I do spend a lot of time with my clients. But they love the data. They are always curious about what each test will show. “That’s why I’m feeling so tired. That’s why my body feels so inflamed. That’s why my eczema flares up when I eat these foods, and I’m under a lot of stress.” People find it really interesting. 

Dr. Eric: 

Can I ask what company you use for genetic testing? 

Dr. Kristi: 

I use the DNA Company. 

Dr. Eric: 

Since you use Genovva for the GI Effects, where you talk about Nutreval, is that what you use for nutrient testing and organic acids testing? 

Dr. Kristi: 

Yeah. There is a lot to this. That’s why I have a six-month program. People meet with me consecutively for six months. My practice is completely virtual, so I do a screen share. We go over all the testing. The testing procedure itself can be complex for some people. I can always go over that with them directly. 

Fortunately, each lab has collection instructions on their website. Genovva has completely revamped everything, but they have a beautiful description and summary and tutorial of how to go about collecting. Same thing with the Dutch test and some other tests. This can be overwhelming. 

I usually tell all my clients, “You don’t have to do all this testing right at the beginning.” I have a three-month program, where they meet with me for three consecutive months. That doesn’t include any testing. That way, they get to pick and choose which labs they want. It’s less involved, and it might just be one or two tests, especially for younger clients under the age of 30. They don’t have a lot of serious health problems, so they often choose the three-month program.

The lab testing shows a lot of data, but it can be overwhelming. I usually tell people, “Let’s have you do one or two tests per month” to break it up. I am giving them a specific, personalized treatment protocol to go with each appointment. They are following the treatment, making changes to their diet, getting the supplements. Now they are doing testing. The six months is a good start. It seems like a long time, but that’s just the beginning of them making substantial changes in their life and body.

From that point on, they can continue to work with me on a monthly membership basis. If they feel like their body has healed, and they feel like they have a really good handle on the resources and information and guidance that they have received, they can now go on their own. That happens a lot. “I had no idea my body was reacting in this way. Now that I know what to do, I can take this with me and move forward.” 

Some people need more help. I have clients who have been working with me for 10-15 years. I have some five-years. I have some who go through the program, feel great, and move on. 

It can seem like a lot. I am there to guide them the whole way. The communication, the interaction is really key here. That’s what I love about functional medicine, naturopathic medicine. There is so much more care and attention involved in somebody’s healing versus “Here’s your medication, here’s your pill, send you on your way, come back in a few months.” I don’t think that delivers the best resolution for people with regard to their health.

Dr. Eric: 

I agree. I want to talk to you quickly about bioidentical hormones. Obviously, you do this testing to try to find out the imbalances they have and make recommendations to correct those. For hormones, especially the sex hormones, like progesterone, estrogen, testosterone, when do you recommend bioidentical hormones? Are there times when you don’t recommend bioidentical hormones? When you try to correct the hormones through diet and lifestyle.

Dr. Kristi: 

Another great question. Coming back to an individualized approach to each person, that’s why I love the lab tests to show what’s happening in the body. I have been doing this for a while. I can often assess what’s happening in the body based on their symptoms. “Oh, I bet they are not producing enough progesterone in the second half of the luteal phase of their cycle if they are still menstruating.” “I’m suspecting their testosterone is too high or low. Maybe their estrogen is too high.” Based on their symptoms. Having spoken to thousands of patients by now. 

I like to use the lab test data, the blood tests, the comprehensive panel that looks at the sex steroid hormones, plus the Dutch test. Sometimes, they don’t need to do both. Sometimes, doing one or the other is sufficient for me or them. 

For some clients, I will prescribe all three: estrogen, progesterone, testosterone, especially if they are post-menopausal. If they are post-menopausal and having hot flashes and night sweats and trouble sleeping and low libido and all sorts of other estrogen deficiency symptoms, I will prescribe all three. 

I love prescribing to compounding pharmacies. I have been working with compounding pharmacies for over 15 years now. I love them. They really do work with the doctor and the patient to get the right dose. 

I learned from this doctor up in the northwest, Dr. Jonathan Wright. I learned about how to really lower the dose, so it’s not so high. I see a lot of other doctors and practitioners that are prescribing a cookie cutter recipe of hormones for every client: Here is the estrogen patch or pill. I think that often gives the female too much, and now she is gaining weight or having adverse symptoms. I think it should be tailored. 

I don’t prescribe high doses of hormones usually. The application site matters. The amount of cream, the concentration of the hormones. Sometimes, I use bioidentical oral hormones. Sometimes, I use progesterone, based on her symptoms. Sometimes, I will just use one hormone, and I won’t use the other two. Sometimes, it’s just twice a week instead of consecutive days in a row. Maybe it’s only two weeks out of the month. 

That’s where that personalized care for each person comes into play. “This is what I have always done. Here is your recipe. Here you go. Pick it up at the pharmacy. I’ll see you in two months.” I want it to work for her. 

That is the benefit of working with somebody like me, where there is a program. If you’re having a reaction to something, you can send me a message and say, “Hey, my body isn’t responding well to this.” “I don’t think this is enough. I think we need a higher dose because it’s not fully addressing.” That’s where that adaptability of “Let’s use this hormone. Let’s take this hormone out. It sounds like your body may not need that quite yet. It’s causing a reaction.” I typically use a variety of bioidentical hormones if I feel it’s a good fit for her. If not, we tried it. Maybe we reduce the dose. 

I use botanical medicine. I love botanical medicine, herbal supplements, nutrient therapy, diet/lifestyle. It’s going back to the whole person. It’s not just take this pill for your night sweats, and take this pill for your sleep. It really is looking at the whole person and giving them a recipe. It’s a personalized treatment protocol for that person, men or women. I don’t see a lot of men in my practice like I used to. It really is a personalized approach to giving her what she needs and knowing that that can change over the course of several months or years. 

Dr. Eric: 

It sounds like you do like bioidentical hormones, but you don’t give the same dosage or hormones necessarily to everyone. I like that you said that you’ll tend to give lower doses. If someone needs a higher dose, I’m sure you’ll give it. It sounds like there are practitioners out there who give the same dose to everybody. It doesn’t make a difference to the person. Probably also giving all three hormones to everybody as well. More cookie cutter. If someone needs a higher dose, you will give it. You won’t give every single person a high dose of all three hormones. Some people might just get one hormone. It really does depend on the person. 

Dr. Kristi: 

If a woman is getting acne breakouts because I gave her testosterone to help support her libido, or getting chin hair or having hair loss, that is not going to make her a very happy woman. She doesn’t want those reactions. That’s where you cut back. 

There is a dance between what is the right amount to help you with your symptoms, and what is the amount that is going to cause adverse side effects? Same thing with progesterone and estrogen. It’s really tuning in to each woman to ask the right questions, so it can be changed. It should be. 

Going back to compounding pharmacies, I love that I get to modify the dose, send it over, and it’s usually a better fit. It is more personalized for the client as well. 

Dr. Eric: 

Dr. Kristi, you have covered a lot. Is there anything that I should have asked you that I didn’t ask you? Anything else you’d like to talk about? Any final thoughts or advice to give to the listeners? 

Dr. Kristi: 

We did cover quite a bit. I know your specialty is thyroid. I would say that with women’s health, I’m sure you’ve encountered this over the years, having thyroid health be your specialty. That tends to be more common in women. 

A lot of times, with the hormone changes that a woman will experience, that will sometimes affect her thyroid in a way that will either lower the thyroid hormone or sometimes raise it. It can change the thyroid markers and levels in her body, so her metabolic rate is different with the hormone changes, which can change metabolic rate. Of course, thyroid tends to change for a lot of women in their 40s as well. As we know, it does change in the second half of everybody’s life.

That’s where focusing on diet and exercise- Muscle strengthening raises your overall metabolic rate and mitochondria. That helps with everything. Why is my thyroid off right now when I am going through perimenopausal changes? Why is my thyroid off when I am going through this stressful time in my life? Bringing that piece in, too, and making sure that gets normalized. 

You have probably found this before. When you work with somebody to treat the whole person on every level, as much as you can, the thyroid can correct itself over time. it can often regulate. 

In working with me over a period of time, a lot of times, they are able to come off their thyroid hormone completely. It surprises me to this day still. It surprises them. They feel too revved up on it because their body is functioning at an optimal rate and working more efficiently, so they don’t need it anymore. If you don’t need it, you don’t need it. That’s with anything. If you don’t need a medication or extra supplement or a higher dose of bioidentical hormone creams, and you can come off of it, I think that’s a win. That’s one last piece I wanted to add in.

Dr. Eric: 

I agree. Quick question: Do you recommend desiccated thyroid, or is it more levothyroxine for thyroid hormone replacement? 

Dr. Kristi: 

It depends. There are some people who do really well with the desiccated. I know there have been some changes with the desiccated thyroid availability in the last few years. I have a lot of clients who have been on desiccated over the years, and they do well.

I have some who don’t. It just makes their body feel worse. We do either the standardized prescription levothyroxine Synthroid. Sometimes, I will do a compounded version of synthetic T3/T4. I do that for some of my Hashimoto’s patients, working with everything else in their health. That goes back to the case by case. I want to make sure I am giving them the right medication, so it works well for their body. As much as I love the natural T3/T4, some people overreact to that. It varies from person to person.

Dr. Eric: 

Where can people find out more about you? You mentioned your programs. If someone is interested in joining one of your programs, can you mention your website? I also know you have a podcast. If you want to bring up social media, feel free to do that as well.

Dr. Kristi: 

My website is DoctorKristi.com. I am on Instagram, @DoctorKristiTompkins. I have a Facebook group called Perimenopause/Menopause Like a Goddess that you can join, all about hormones. We talk about a variety of different women’s health issues.

I have a new podcast that I just launched called Fire, Soul, & Grace. It’s going to be a lot of different episodes on women’s health, hormones, functional medicine, mind/body medicine, meditation, ways of healing the body, and ways to optimize your health and life, and uplevel your health, too. Really excited about that. If you go to FireSoulAndGracePodcast.com, that will reroute you back to my website. Lots of great guests I have on my podcast coming up. 

I have been so excited to be here with you, Eric. 

Dr. Eric: 

Same here. Thank you so much. I’m sure the listeners learned a lot. As usual, I learned some things as well. Appreciate you taking the time to share your thoughts on hormones.

Dr. Kristi: 

Thanks, Eric.

 

Recently, I interviewed Dr. Florence Comite, and we talked about healthy longevity and hormone optimization. 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 Dr. Florence Comite. We are going to be talking about precision medication, optimizing hormones. It’s going to be a really fascinating call here. 

Let me go ahead and give Dr. Florence’s bio here, as Dr. Florence Comite is a clinician, scientist, and innovator in the field of precision medicine. She is world-renowned for her expertise in predicting, preventing, and reversing chronic disease and the disorders associated with aging. 

In 2005, Dr. Comite founded the Comite Center for Precision Medicine and Health, where she practices a clinically proven, academic approach to personalized health care, structured as a clinical trial in Groq Health, a mobile app with science-backed AI and ML-backed systems to identify treatment and lifestyle changes to reverse and prevent the diseases of aging.

Groq Health, a revolutionary new app that delivers personalized precision medicine to reverse biological aging. It’s currently in beta testing. The application offers Dr. Comite’s patients highly personalized health care that interprets their genomic, metabolic, phenotypic, and digital health data into individualized action plans. The AI-powered app is being developed with the intent to expand the impact of precision medicine and empower people to take control of their health. Check out that app. 

I think I listened on a previous podcast that it won’t be out until sometime in 2024, which we are pretty close to as of recording it.

Very excited. Thank you so much for being here, Dr. Comite. 

Dr. Florence Comite: 

Appreciate being here. Florence is fine. Can I call you Eric? 

Dr. Eric: 

Without question. 

Dr. Florence: 

Great. Since we’re both from Brooklyn and Queens, I think we’re related probably. 

Dr. Eric: 

Florence, can you dive a little bit into your background? When you graduated from medical school, were you a more conventional doctor? Did you always want to be more integrative, functional medicine? Give more of your background. 

Dr. Florence: 

I’d love to. I actually did start when I graduated. Maybe not quite in the way we’re thinking. My father asked me when I graduated medical school, “Can you now help me be healthy?” I looked at him a little confused and said, “Medicine is about treating disease.” He said, “That doesn’t make sense. Shouldn’t you try to keep people healthy?” I said, “That’s a great idea.”

I think I went through training subsequently after graduating from Yale. I stayed at Yale doing residency in internal medicine and hit several fields: a deep dive into adult specialty, pediatrics, and women’s health, which also incorporated men’s health but more from the fertility point of view.

Then I was at NIH, where I became a clinical scientist and worked hard to look at research and how you bring a research, scientific mindset. I did a lot of research. I published a fair amount. I went back to Yale and stayed on the faculty for 20 years.

I began to realize about 20 years ago that we all start aging in our 30s. Why don’t we pick up on that and stop disease from happening before you get symptoms? That started me on this path of proactively wanting to stop people aging, which is a big risk factor for all diseases. I felt like if I could stop aging, it would also stop chronic diseases of aging. 

If you think about it, diabetes for example is one great disease that happens more often than not as people get older, like in their 40s, 50s, and 60s. It’s really beginning way before that.

I felt that if people could stay physiologically younger and healthier the way my dad described it and wanted for himself, that would be a gift. Why get sick if you don’t have to? That’s how my work began in this field, from scientific and clinical applications. 

Dr. Eric: 

You still to this day then do quite a bit of research? 

Dr. Florence: 

I do. In fact, the center that I started in New York in 2005 was an outcome of that. What I designed was something we now call at this Comite Center for Precision Medicine and Healthy Longevity as an individualized study of each human being. We think of it as n of 1. 

Most of medicine is population research, where you are looking at thousands if not millions of people. Then you are applying it almost as a one size fits all, not individually to each human being. 

That came at the same time I had this epiphany. I was giving a dinner club at Yale. Why do we begin to fall apart in our 30s? We’re fine up until then. In our 30s, fertility. Men begin to get heart attacks in their late 30s if they have a proclivity to that. Women start more easily than men putting some weight around the middle, slowing down. In some ways, energy becomes a factor. Osteoporosis. That just begins to accumulate as you hit each subsequent decade of life.

I knew at the time being an identical twin that my twin and I were not exactly alike. I was always interested in genomics. It was around that time that the whole genome was described, looking at DNA. I felt that it wasn’t ready for prime time because you couldn’t really peer into function at a dynamic way. 

I began to study metabolism and endocrinological, hormonal optimization to see how we stop people from getting older at the cellular level. How do we keep them in the best shape they can be in, which generally happens, not everyone but most people in our 20s? That is prime time.

I felt like if we could keep people physiologically in their 20s, or no more than 30, we wouldn’t be doing the Abby Hoffman thing, where we’re getting old in our 30s. Effectively, we are. Many of us blame it on having children, a family, being really busy, trying to make it in our career. Even if we did exactly the same thing as we did in our 20s- Marathoners or triathletes are great examples of it, but they still have heart attacks. Why? Those questions occurred to me. 

Along with the fact that each one of us is unique. My identical twin and I are not even alike. For example, I could live on sushi and sashimi, and she doesn’t like fish at all, except for mackerel, which I always forget to say. We grew up eating herring, which is mackerel. It’s a very strong fish, so it’s unlike tuna and salmon and all the rest of that delicious stuff. 

She is an amazing gardener. I can’t garden. Our teeth and eyes are different. Our guts are different. It didn’t make sense to me. If we’re identical twins, what’s changing? 

What occurred to me at the time is it’s expression of genes. That’s what my research has been about for the last 15 years. How we define n of 1. What’s right for you, Eric, might not be right for your brothers, if you have brothers. I don’t know if you have siblings. Or your cousins. Even if the genes look alike, they don’t always act alike. That’s identical twins.

Dr. Eric: 

That is tying into precision medicine. Everybody is different from what you’re saying. Not everybody requires the same diet. Not everybody requires the same stress management skills. We could go beyond and beyond. Supplementation. Maybe you could give a better definition of precision medicine. 

Dr. Florence: 

Exactly. You got it right. I can delve a little deeper. The word “precision” for me comes from data. To me, without data about a human being and how they act at the cellular level, metabolically, hormonally, what their thyroid is doing, what their brain is doing, what their ovaries or testes are doing, you can’t tell people apart necessarily. 

The data is what I think of as the personal health story. Instead of what we typically do in conventional medicine is very reactive. You have to get sick, and then we’re good at it. We jump all over you. That is reactive medicine. To me, it’s about being proactive. 

I’m actually, unlike you, not trained in functional medicine although a lot of my functional medicine colleagues and friends think I know functional medicine. To me, the root cause of disease, which is the core of functional medicine, has to do with the etiology and how genes are expressed. 

Precision to me is data married to somebody living life: how they sleep or don’t sleep, what their exercise is like, what they are willing to do to put effort into eating maybe a little differently. I don’t believe in suffering. If we get this right, we’ll live even longer, maybe to 120 or 150, in great shape and enjoying life. It’s not about suffering to do everything perfectly. It’s not about fasting all the time or living on paleo or keto. It’s about what’s right for that singular human being. 

The Comite Center has been called a living n of 1 lab, meaning that it is really about a collection of people and data and people who want to invest in their health and own their own health trajectory. How do we stay healthy for the rest of our lives and never get diabetes or have a heart attack or Alzheimer’s or a stroke or cancer or osteoporosis? That’s really what precision is about to me. The data to put into play actionable interventions that are fit for that specific human being, if that makes sense. I hope it does.

Dr. Eric: 

It does. I guess you are going with the Groq app that’s coming out. Getting even deeper into genomics. I assume now, these days, you do genomic testing on patients? 

Dr. Florence: 

Yes, we do. I felt about a couple of years ago that we were beginning to reach a time where we could use genetic variance, meaning if your genes aren’t exactly functioning right, what are those variants telling us? 

Can you detox mercury? I found out that I’m not a great detoxifier. That puts me at higher risk for certain kinds of cancer and accumulating bad toxins like mercury, which is at 38 for me when you want it less than 10. My twin sister is undetectable because she doesn’t live on fish the way I used to. 

In one year, I was able to bring it down after identifying it. I didn’t learn until a couple of years ago when I looked at gene variance that we now have operational at the living n of 1 lab, which is the Center, that I knew that I don’t detox well. I need to be able to be careful what I do.

Another example which I’m not too good at, so I hope your audience can appreciate, as they may feel the same way. I don’t have Celiac, which would make it hard to digest gluten. It’s ubiquitous out there in every slice of pizza and great bread, which I could live on, too. Yet it’s hard for me to be gluten-free. I go through periods where I try to be my best at it. That inability to detoxify also affects me. There are lots of examples of that. Yes, we’re in genomics. 

What Groq is, because you have connected the dots, is really taking a component of what we do at the center and delivering it to everybody on a virtual medical platform, using an app for people to be able to upload their own data to get a continuous glucose monitor to measure sugar, for example; to look at their bio markers and their five key ones, which I’m happy to jump into, that have come out of my research and make a difference in every single one of us. 

We are all born as men and women with genes that may not be perfect. When they come together, it creates a unique human being. By figuring out how we live life and what we do, we can change your future state of health by stopping chronic disease and reversing aging, which people stop me when I say that. We have the data to prove it. I don’t know how much you’re into that, but I’m happy to point you in the right direction to hear more about it.

Dr. Eric: 

I’m definitely interested. I would love to talk more about the biomarkers. 

Before you dive into those, quick question: When it comes to reversing aging, I assume the earlier you make these changes, the better. For someone like me, who is 53, and someone else who might be in their 60s or 70s, is it ever too late to reverse the aging process? 

Dr. Florence: 

Great question. No, it’s not. If you look up RejuvenationOlympics.com, which is a site that was started by someone who has gotten out there because he is spending millions on his own health to try to reverse aging in every cell in his body. He is in his 40s, Bryan Johnson. Have you seen or heard about his work? 

Dr. Eric: 

I don’t think so.

Dr. Florence: 

He created a website. I’m not sure if it’s a business, Blueprint.com. He also set up this site called RejuvenationOlympics.com. You’ll see that people are listed there who have reversed aging. As such, we are 25% of the leaderboard. Peter Diamandis and some of the other folks who believe in extending health and longevity are also part of it. 

The Comite Center is 25% of the change. The top 20 of a couple of thousand people who have found it and uploaded their data. I am very proud of that because it’s independent validation, looking at biological aging. That is the point I want to make.

It’s far easier if you’re younger. Your system has more to it. You can burn the candles at both ends as a teenager and 20-something. It gets harder as a 30-something. It gets even harder every decade. Then I have seen 70-year-young people twice as healthy as 35-year-young people. It’s completely up to that n of 1 individual and what’s going on below the surface, in their health story, how they live life, their family history, the choices they’ve made. All of that is reversible and changeable.

With the exception of some genes that are known to be autosomal dominant, meaning they will express no matter what. A good example might be BRCA. 88% of people have a certain kind of BRCA gene that causes breast cancer, prostate cancer, and a few others. They are more likely to express it. It depends on how they live life and what they are doing to treat it.

There are other conditions that are supposed to be autosomal dominant that are not. Lewy body Parkinson’s, which Robin Williams had. Nobody diagnosed it. One of my cousins had it and sadly died at 70. You start with dementia and then get signs of Parkinson’s. Sometimes, it’s not diagnosed. It wasn’t in my cousin for about 20 years. It wasn’t in Robin Williams either. He was able to cover it up as an actor really well. 

Most things though, believe it or not, are reversible. If you catch it at an early age, and even later, if you’re willing to put in some effort in juggling your life. Everybody has to make those decisions. 

I told you about me and gluten. On the other hand, I’m at high risk for macular degeneration, which is an eye condition where you don’t have central vision. My father had it. I inherited the gene, as did my twin sister. It turns out that by limiting Vitamin A and not overdosing on Vitamin A in certain fruits and vegetables that I love, it will help me avoid macular degeneration because it helps to precipitate macular degeneration. By using sufficient amounts of Vitamin D and making sure I absorb it.

That’s kind of interesting, isn’t it? Vitamin A is great for the eyes. Tomatoes, anything red, red peppers, carrots. All three of them, I can live on. I munch on tomatoes all summer. I mentioned my sister is a gardener, and so was my mother. We grew up eating tomatoes like they were apples. They are a fruit, but we think of them as a vegetable. 

I avoid a lot of Vitamin A now. I try to do it more in moderation. Instead of three packages of two pounds of carrots in the chicken soup I make, I try to limit it to one package of carrots. It’s sweet. I like sweets. That’s an example.

When you look at the Rejuvenation Olympics website, to go back to your question about being too early or too late, where the right time is, it’s never too late or too early. The age range for our clients (we don’t call them patients because we want them healthy, and in Groq, they’re members), is 15-73. You can see the span is great. We want it to be for everybody. 

I think if people own their own health—that’s what Groq is about—then they won’t get sick in the same way. They will be able to protect aging and their health and their money. Being sick costs a lot of money, not only compromising life. That’s what should be stopped. I believe it can be in this century. 

Dr. Eric: 

That’s awesome to hear. It’s very interesting about Vitamin A. I would have thought the opposite, like you mentioned Vitamin A is known for eye health. If you have the gene that predisposes you to macular degeneration, you’d want more Vitamin A, not only through food but maybe supplements. It sounds like it’s the exact opposite, where you want to limit it. Beta carotene sources, not just active Vitamin A. Very interesting. 

Dr. Florence: 

You’re exactly right. There was even a study years ago in the New England Journal, where if you take Vitamin E, but only one type, it increases cancer. I like to keep people aware of what their nutrient makeup is. For example, you know as well as I do that fat soluble vitamins can be dangerous. Too much Vitamin A causes hair loss as well. You could overdose on Vitamin A. 

It’s confusing out there. You go into any pharmacy, and how do you choose what supplements are good for you? 

We believe in looking at the specifics that make up you as a human being to figure out if you actually need D to pull in more calcium and strengthen your bones, but D is also a hormone that is fat soluble. You can’t overdose on D almost. Most of us have too low D. I haven’t met a person with D that is greater than 50. A lot of people are in the 20s or even in the teens. We want Vitamin D levels to be 60-80 as a sweet spot. 

It’s really good not just for calcium and bones, which we all know. But it’s actually a hormone that affects every cell in the body and protects the immune system, brain, heart, thyroid. You want to be able to know these facts to be able to apply them for yourself. 

Dr. Eric: 

Same here. I see a lot of people deficient in Vitamin D. Most people are lower. I’m guessing Vitamin D is one of those top biomarkers that you mentioned earlier that you are going to discuss? 

Dr. Florence: 

It actually isn’t. Here’s the thinking around it. Vitamin D is really important. The one group of people you want to be careful of is people who are stone formers and make calcium. That can be genetic. It can also be from dehydration and not drinking enough water. If you have it in your family, it makes the odds higher.

Vitamin D presumably is low in everyone. You can’t get enough from the sun. We have lost that ability. Darker-skinned people even more so. The data I have read and interpreted over the years has shown that if you want to absorb Vitamin D from the sun, you have to be nude for an hour near the equator, and you can probably get some Vitamin D. I follow people who live in NYC and go to Florida during the winter. I have only seen one person increase their Vitamin D level from sun alone. 

You really need to take a supplement. That would be something that everybody should take, but not a lot of it. Maybe 1,000-2,000 a day of D3. We believe it should be taken with K2 because otherwise, you don’t channel the D or the calcium into bone. You need the K2, which acts in a coagulation sequence. 

There are some complexities around that because if someone is on a blood thinner, you have to be careful when you take it. Vitamin D with K2 at a certain level and a certain kind of K2 is important to have enough calcium in bone, not to get the calcium in breasts or the heart or precipitating in the prostate or anywhere else in the body. That’s a good combination.

It’s not one of our top biomarkers because it is ubiquitous. I’m sure your followers who have had their Vitamin D measured have seen how low it is. Sometimes, the doctors don’t know that a Vitamin D of 30, just because it says it’s okay on a Quest or LabCorps range is fine. It’s not usually adequate. There are many people who have osteopenia and are at risk for osteoporosis who should have more calcium in their body as well.

We don’t actually prescribe calcium ever. I haven’t done that for 20 years. There is no need. If you have adequate D, you will mobilize calcium from your gut. Make sure you have calcium in your diet. Does that answer your question with a little bit more frills? 

Dr. Eric: 

It definitely does. Just to confirm, do you like to see in most people, if not everyone, the 25 hydroxy Vitamin D levels to be at least 50? 

Dr. Florence: 

At least 60 actually. 60-80. If they go up to 100, no problem. In people who are at risk of forming calcium stones, sometimes people know they have kidney stones, but they don’t know what kind. If they have had an immediate family member—a father, a mother, a sibling, even a child—just be aware that they need to undertake Vitamin D. Don’t take too much; take less. 

People who don’t have stones can take 5,000 international units a day. People who have stones in their family or they themselves have produced a stone, I’d be careful and make sure to take 1,000-2,000 daily, no more. Make sure that they drink a lot of water to the extent that their urine is clear, that it looks like water. Forget counting. If you know that you’re peeing, and it looks clear, that’s a good sign. You’re staying hydrated, which helps to stop precipitation of stones.

Dr. Eric: 

That sounds good. I could talk more about Vitamin D for a while. Definitely want to hit some of the other points, including those top biomarkers. Why don’t you talk about those five? 

Dr. Florence: 

There are five that we found are most critical in everybody. This is the part we based on research in that there is no one person I’ve seen, and I’ve seen thousands over the years who actually metabolize sugar effectively who aren’t on a trajectory to become diabetic at some point in their life. It could happen in their 30s or their 90s. That’s because it’s survival.

The five key biomarkers speak to hormonal optimization, cholesterol, and all the carbohydrate markers that can tell a person what’s happening today, and where they are headed for the future. No one wants to become a diabetic. It’s not a fun thing. If you can stop diabetes in your tracks, you’re stopping the risk of heart attack, stroke, even Alzheimer’s. You’re stopping the risk of kidney disease or eye disease, skin disease, things like neurological disease, like paresthesias of the hands and feet, which I have seen precede diabetes in people who don’t even know they are prediabetic or diabetic. 

The millions and millions of people around the globe with prediabetes or diabetes is to me an understatement. It’s actually everyone. It’s a survival gene. If we couldn’t put on weight when we fasted or when there was a famine or when there was the Holocaust, we wouldn’t be able to pass on those genes because the folks who lived through being cavemen/cavewomen, which all of us must come from that era, had a survival winter that may not have fed them. Those genes are ubiquitous. There are at least 1,500 variants of sugar, metabolism, types of genes. We all have combinations of them. 

We measure fasting sugar, fasting insulin, and hemoglobin A1C. I can talk more to the complexities and combination thereof if you’d like. 

But the other two biomarkers that relate but also have other impact is free testosterone and what we call cholesterol risk ratio. That looks at a ratio of total cholesterol and HGL, or what a lot of people think of as “good cholesterol.” The lower that ratio is, if it’s less than 2, the safer you are. These are values that we consider critical biomarkers. In other terms, we call them lab tests. But biomarkers to me are data that help us define the state of your health today and where you’re headed tomorrow. 

Dr. Eric: 

Cholesterol risk ratio, less than 2. How about those other markers? The fasting insulin, hemoglobin A1C, etc. 

Dr. Florence: 

Fasting sugar or glucose, after an overnight fast, sugar should be between 70-80. That is a pretty tight range, but that’s optimal. That means your body has no insulin on board. Insulin should be undetectable, or less than 2 as well, which is the dimension of detectability in the lab studies. 

Both of them speak to how well you manage and metabolize glucose in the system. We don’t need any insulin if we haven’t eaten for 8-10-12 hours. Actually, we don’t need insulin if we haven’t eaten for three hours. If we have too much insulin on board, even greater than 2, 2-5 is sort of target range but not optimal. Anything over 5 speaks to insulin resistance, which means the insulin has been overused in a way, and it’s not working as effectively as it should. 

You really want fasting sugar to be between 70-80. Insulin should be undetectable at less than 2. Then when you eat, insulin does go up. It should mirror glucose. There are ways of eating to do that. Glucose should stay below 120. 

Now, there are reasons glucose might shoot out higher to 150 or 180. They include some good reasons, like exercise. There are patterns that have to be interpreted. But if you eat a banana, and your sugar goes to over 200, that’s a risk factor. The fructose in a banana is not compatible with your system. It doesn’t mean you never eat bananas, but maybe there is a way you eat bananas that keep your sugar below 120. Between 70-120. 

I didn’t mention this, but you don’t want your sugar to go below 70 either. That is a risk for diabetes. Sugar needs to be maintained in this tight zone to keep you optimal and to prevent chronic disease from appearing and sticking with you for the rest of your life. Sugar damages every cell of the body.

We have another trick to it that your followers may be interested in. That is we use continuous glucose monitors (CGMs), so people can really see, like I mentioned with a banana, and test it themselves. They can see singular foods, like what they might eat, what that does to sugar, whether it’s a carb or protein or fat or fiber. Then they can start mixing foods. 

One of the ways we know that we can keep insulin and sugar in parallel together and protective of your health is by starting with a protein before you eat a carb, any carb. Protein, high fiber, or healthy fats, like avocado, olive oil, those in balance will keep your body’s absorbing and metabolizing sugar in a way that’s the healthiest and optimal. 

Dr. Eric: 

If you have an undetectable insulin, and your fasting glucose is between 70-80, is it safe to say that your hemoglobin A1C is most likely looking good? This should also be on the lower side. 

Dr. Florence: 

That’s a great question. It is, with one exception. If your sugar and insulin shoot up in patterns that are not healthy, like after a meal. Let’s say you sit down and have steak and potatoes and green beans with a nice salad on the side. You have your steak that fits in the palm of your hand, so it’s the right amount of protein. You want to have at least 20-30g of protein at each meal. It should add up to at least a gram of protein per kg per day. A kg for those who may not know is 2.2 pounds. If you weigh 60 kilos, which is about 130 pounds or something of that nature, for the women out there, you want to take in at least 60g of protein a day. That would be 20 at each meal if you’re a three meal per day kind of person. If not, keep track of it. 

You absolutely want to see what your sugar does after that. That’s where the CGM can come in handy. I’m sure you’ve heard of all those companies that prescribe CGMs and follow your food. It’s not as simple as food alone, as you’re probably getting the idea from all the information I’m pouring out there. 

If I’m doing too much too fast, tell me, Eric. I’m a New Yorker. We speak very fast here. You can relate. You’re more measured, so I’m impressed. 

If you eat food, and your sugar jumps up to 250 having mashed potatoes, that’s a problem. You could look perfect fasting, but not necessarily what we call post-paranal, which means after food. 

Here’s another tip: I don’t actually call diabetes “diabetes” anymore. I almost try never to call it “type 1” or “type 2.” Type 1 is an immunological disorder, and that is very different than what we think of as type 2. 

I actually call this a disorder of carbohydrate metabolism because it is. All of us have one in one way or the other. As I mentioned, it is Darwinian. It’s about survival. If we couldn’t put weight on our bones and fat on our bones when times are lean, we don’t live through those times. Those genes don’t get passed down. 

We owe it to our ancestors for why food is plentiful. There are golden arches on every street corner right? We can have those delicious French fries although they used to be more delicious; I have tried them recently, and they are not so good anymore. I think they made them healthier. I’m not sure, but I’ve heard they’re different.

It’s easier to put on weight. It’s easier to put on weight in our mid-30s and beyond because our hormones are shifting. You have to be careful. In order to be careful, you have to know what your body is actually doing. The more data you have about how you personally function, the better off a person is going to be. They will be able to judge accordingly. 

Does that mean you avoid all food all the time that causes your sugar to go up to 180, 200, 250? Whether it’s a banana or a bowl of ice cream or a cookie or cake? Absolutely not. There are some people who can eat a banana, and their sugar stays at 80 or 100. There are some people who eat a bowl of ice cream, and their sugar stays at 110. Remember, ice cream has some protein in it. 

There is a study out of Israel from the Weizmann Institute that showed very clearly, they compared two people out of the thousands they studied. I think they studied 1,600 or so. One person, sugar went sky high on a banana but didn’t do anything with a cookie. The other person had a cookie, and it went sky high, but the banana didn’t do a thing. It’s about learning about you individually as a human being, that whole n of 1 concept.  

Dr. Eric: 

That makes a lot of sense. Do you currently use a CGM on yourself? 

Dr. Florence: 

All the time. It’s right here. I have to feel for it because they’re so tiny. I can show it. I don’t know if people want to see it. Don’t look at my triceps though. They’re not the best. I work on it, but I’m convinced I was born without triceps. I am only kidding, but it’s so hard. See it right there? 

Dr. Eric: 

I do.

Dr. Florence: 

My sister has amazing triceps because she did more swimming than I did years ago. I don’t swim because it gets your hair wet, and it’s hard to dry it when your hair is long. That’s one excuse anyway.

I love rollerblading, and she doesn’t rollerblade. She has great triceps, so she is able to wear sleeveless clothes and look much better than I do. I guess as an identical twin, I probably can get great triceps. So far, I’m working on it. It’s a work in progress.  

Dr. Eric: 

I’m sure you’ll get there. Tying into muscle mass, free testosterone. Testosterone is important for muscle mass. Protein also, which you mentioned. Free testosterone, another one of those biomarkers. What’s an optimal range for that? I guess it probably differs with men and women. 

Dr. Florence: 

It does, but we do have optimals. There is a spectrum, and we judge according to somebody’s health, how they feel, what they’re presenting with. In men, it’s a little easier than women. We women, as you men probably know, are very complex. Each woman is really her own thing. 

In men, it’s still the n of 1, but you can look at change in men as they age over time. It’s more linear. In men, beginning in their 30s, just like women, testosterone falls by 1-3% a year. We women have far less testosterone than men. That’s why we’re at higher risk earlier in life for osteoporosis and fracturing our wrist or shrinking or curvature of the spine or hip fracture later in life. You’ve seen plenty of men walking around hunched over a walker because they have severe osteoporosis, and their spine has collapsed. 25% of all men and women will be osteoporotic. Men, it starts about 10 years later than women.

Women’s testosterone should be between 6-30. I’m talking about free testosterone. Why we women also put more weight around the waist, women who do everything pretty much perfectly and maintain their weight, frequently, they’re 35-45, and they come to see me because they have put on 2, 3, 4, 5, 6 pounds, which is almost nothing for some other women. In these women, they look great, they have done everything, they work out, they eat as well as possible, or they are just gifted genetically, which is a thing. That’s because their testosterone is low. 

I think of a woman I just saw and spoke to a couple weeks ago, Sarah, who was in fabulous shape. She was turning 43, and she wasn’t happy because she had put on five pounds, and her clothes didn’t fit her right. We put her on testosterone. We also found out at the time that she was osteoporotic, and that was only by doing a bone density test, which I recommend strongly for everybody at least starting in their 20s but definitely in their 30s, when you can make a real dent in growing bone. Within weeks, her weight had dropped. It was definitely related to the fall in testosterone because everything else was pretty much in the sweet spot. 

You really want to raise testosterone. Most women come in at less than 2, sometimes less than 1, which is tiny. We have 5-10% of what men have. In men, you want it over 180. I am talking about free testosterone, not total. I’ll tell you why in a second. 

In her case, she went from 1-12 over a period of weeks to months. Her weight dropped almost immediately. She was doing other things she should be doing. When I say that, it’s not just eating protein, which I mentioned at least 1g per kg. For the 60kg women, let’s say it’s 60g. It could be more if you’re heavily into resistance training, which is a good thing because that’s how we grow muscle. 

Those are the three elements that can really make a difference for aging. Without enough muscle, you can become sarcopenic. That allows disease to creep in, either from the outside in, like with COVID for people who have comorbidities and diabetes, or had heart disease. When they were sick, they didn’t have enough muscle and more fat and more visceral fat, so they got sicker, and they died more often than people without it. 

If you were prediabetic, it was 8x as likely for you to die from COVID because of the comorbidity than if you didn’t have diabetes or prediabetes. 

Testosterone, 6-30, free. Other labs may have other levels. Depends on the units that get measured. We happen to use Quest. LabCorps might measure it a little bit differently. Everybody could be a little different. You have to look at where that is in terms of optimal. 

Make sure you’re taking adequate protein in your meal daily and doing resistance training at least 2-3x a week.

Dr. Eric: 

Sticking to the topic of hormones, can you discuss the difference between hormone replacement versus hormone optimization? Does everybody with low testosterone or estrogen or progesterone need hormone replacement in your opinion? 

Dr. Florence: 

Let me start with what is hormone replacement, and what is hormone optimization? First, I started feeling uncomfortable with hormone replacement right from the beginning as an endocrinologist and a reproductive endocrinologist. Hormones was a very deep field of mine along with peptides. I did a lot of research in my earlier years at NIH and Yale in children who had early puberty, using peptides, and in adults, women with endometriosis and fibroids. 

With respect to that, we are not Mother Nature. We can’t do what Mother Nature does and cause a woman- Week-to-week, women’s cycles change. Women’s symptoms change. In men, it’s more every hundred days, every three months, their system evolves. Sperm takes that long to be made. Testosterone goes up and down with response to what we call a negative feedback loop in the body. There is more consistency in it for men. That shifts as men hit their 30s and 40s when they don’t release as much testosterone. Their brain doesn’t recognize it. They are not making enough. In women, it shifts as well based on their ovulatory cycle, or if they are on birth control pills.

To me, optimizing hormones means we can start addressing what Father Time starts taking away from us. In our 30s, testosterone begins to fall. Even before menopause in women and andropause in men starts hitting us, where ovaries stop performing. You can’t make eggs. Men start drifting downward with their testosterone, but they are not recognizing it. Their brain hormones are low. They can make testosterone, but their testes are not being told, “This is how you make testosterone. This is the hormone.” Hormones start falling, particularly LH and FSH.

The optimization is how do we limit risk and improve health? The risk/benefit ratio to me is how I apply doing clinical research with dealing with a singular human being. When we do research, we look at risk/benefit for a whole group of people. How can we get them healthier by any intervention we’re doing or testing? How do we prevent side effects? 

Hormonal optimization is limiting side effects but increasing response. What is the best benefit? As I mentioned with Vitamin D or the hormone D, that is what we do when we look at people at risk of stones. We don’t want them to have stones, but we want to maximize their health. We compromise on the dose of D. That’s the same way I approach any hormone, including testosterone, estrogen, progesterone, prednisone, DHEA, DHT, etc. That is how we look at hormonal optimization. Does that make sense? We want to get the best out of it with the least risk. If that’s what we need for that person. 

Dr. Eric: 

Yeah, that makes sense. One thing I heard with men and testosterone, because you said it starts declining in their 30s. Would you be cautious about giving a male in their 30s or 40s testosterone? I heard if they are still thinking about having children, you would not want to give testosterone. 

Dr. Florence: 

Actually, the opposite. Would you think twice about testosterone if a man wants children? The most common way of giving hormones in this country for now, maybe in the world, is testosterone itself. I have a unique approach to it. I actually use a hormone which is a peptide hormone, not a steroid hormone, called HCG. Have you heard of it? 

Dr. Eric: 

Yeah. 

Dr. Florence: 

HCG, Human Chorionic Gonadotropin. It acts like the hormone that comes from the brain, LH, which I mentioned earlier. It tells male testes to make testosterone. It triggers the lytic cells in the testicle and says, “Hey, wake up. It’s time to make more testosterone. You’re drifting to sleep.” The brain is not paying attention to low circulating testosterone. 

That hormone actually increases fertility. We use it to help men become fertile. Testosterone can suppress the testes itself because you’re giving the hormone. You’re giving the hormone, the testes looks around, and says, “Hey, you might not need any testosterone because it’s on board already.” 

It’s not perfect that way. Actually, men still make sperm. If it was perfectly shutting off the testes, then you’d be able to use it as a birth control. We have never been able to use testosterone as a birth control because it doesn’t really shut down. 

For safety reasons, I would not give men testosterone if they were trying to conceive children. But a lot of men in their 30s are not. If they are at risk, which is less common than your 40s or 50s or 60s, we judge it accordingly based on those biomarkers. 

If your T is low, whether you’re 35 or 45 or 55, we are going to look at starting with HCG if the rest of the numbers fill that pattern. I can give you examples. There is a whole group of men that we treat who has Ashkenazi Jewish background, or they’re Indian and Asian, that have very early heart attack and stroke in the family. A lot of times, relatives, men and women, died early, like by 60, of heart attack or stroke. They were sick beginning in their 40s. We have a whole group of people we treat gingerly, looking at risk/benefit to make sure that we don’t let them go down the path of having a heart attack at 40 or 45 and die in their 60s. 

in fact, the very first person who tried Groq in February 2021 was somebody who had that history whose father was Ashkenazi and mother was Puerto Rican. His numbers looked like a 50-something-year-young man. Maybe this time, year-old man. He was already expressing symptoms of low testosterone, which we hear about, or hypogonadism, meaning his testes weren’t producing enough. His numbers were tested three times. They were quite low. His free T ranged from 50-70 instead of over 180. He was putting weight around the middle. He had less energy, less libido. It was completely reversed within a few months. 

Dr. Eric: 

Wow. Before we start wrapping things up, can you talk a little bit about thyroid? What do you test for in your practice with your clients? 

Dr. Florence: 

Yep. I do. I can. Thyroid is an important hormone as well. Our thyroid gland sits around our neck. It’s kind of like a bow tie, I guess. A little knot in the middle, but with two wings. 

80% of people have abnormal thyroid function. As we age, it’s clear-cut. You can’t just measure TSH. You have to measure free T3 and free T4. Again, that system is interactive. We create TSH from our brain, the pituitary. The hypothalamus at a higher level makes TRF, thyroid releasing hormone, which tells the pituitary to make TSH, thyroid stimulating hormone. That in turn tells the thyroid to make T4. Interestingly enough, T4 is converted to T3, and T3 is the active thyroid hormone. 

If you don’t measure TSH, free T3, and free T4 together, you don’t know the relationship. The range for TSH is 0.4-4 or 4.5. It’s a humongous range. Insurance companies sometimes only want that number, but you can have a high TSH or a low TSH, and your thyroid, your free T3 and free T4 can be abnormal, not the range we want. We look for a free T3 of 3-4ish. We look for a free T4 of about 1-1.5. The balance has to be there. 

I have seen lots of variations on that theme. I think we’ve come too far in a way. Sometimes using lab tests. I have seen many women and men who complain of classical thyroid symptoms like hair loss, weight gain or loss, constipation, ends of the eyebrows losing hair, slowing down in their thinking, or speeding up heart rates. Those are variations on the theme of high thyroid/low thyroid. 

In women, it’s actually interesting. It’s the opposite. If your menstrual cycle is too heavy, it’s usually related to low T3. If it’s high, you have higher thyroid hormones, you can stop your menstrual cycle, or you have a very light cycle. 

You know better than me, I’m sure, that thyroid affects every cell in the body as well. It affects the brain for cognition and memory. It affects the heart for rhythm, muscle, and conduction. It affects muscle and bone. 

Being in that optimal range for all three. I pay attention more to free T3 and free T4 than TSH because that could be anywhere. 

The final thing is if we do see a disruption, particularly where we suspect something called Hashimoto’s thyroiditis, or an inflammatory process that is immunological, we will look at antibodies as well. That is an autoimmune form of thyroid disease. Does that help? 

Dr. Eric: 

It does. It’s important not to look at just TSH. I’m glad you test for the thyroid hormones, free T3 and free T4. If you’re suspecting autoimmunity, you will also look at antibodies. 

I’m sure there is so much you could cover. Anything that I didn’t ask you that you wanted me to ask you? 

Dr. Florence: 

I’ll add one more thing for thyroid. I know we have to wrap up because it’s been fun, and we might be even over the hour. 

With thyroid, be aware that you need to know what your free T3 is. A lot of folks do reverse T3. I don’t find it as helpful, except maybe when people are ill. 20% of people can’t convert T4 to T3. That is why if they are already taking thyroid hormone, but it isn’t doing as much as they hope, like Synthroid is the most common, which is a T4 or generic type, then they need T3. 20% of people cannot convert genetically T4 to T3. That is the active hormone. 

Last words on this interview: I think everybody could take care of their health, so they become knowledgeable with not that much data. If they can follow along and really invest in their health, it will pay off in spades. Getting sick is very costly and not much fun. By understanding more about your personal history, your family history, your exercise and sleep, even your restorative stuff like yoga or meditation, which turns off cortisol, one can really preserve their health and actually get younger biologically as they age longitudinally and chronologically. 

I just hope we can deliver this to everybody by scaling the Comite Center through the virtual app Groq Health. 

Dr. Eric: 

Speaking of which, can you let people know where they can find you? Also, how can they get on the waitlist for that app since it’s not officially out yet? 

Dr. Florence: 

They can find me on Instagram, Twitter/X, and LinkedIn, @DrFlorenceComite. We are posting there. We also post on Comite Center on Instagram, Facebook, and Twitter. 

Groq Health, as far as signing up on the waitlist, it would be going to GroqHealth.com. The link may not be working right now, but we are trying to fix it. We have close to 20,000 people already signed up. 

A little tidbit: Groq Health is out there on Android. We are collecting anybody who signs up, so when we are ready to open it up to direct to consumer, which will happen sometime in 2024, anybody who signs up on an Android will be at the top of the list. With the iPhone, you need an invite. With an Android, you don’t. You can go to Google Play and download the app. 

Dr. Eric: 

Good to know. Whether you have an Android or iPhone, Android, you’re on the top of the list if you sign up. iPhone, you need an invite. Either way, they will visit GroqHealth.com, correct? 

Dr. Florence: 

Yes.  

Dr. Eric: 

Wonderful. Thank you so much, Florence. This was an amazing interview. I really appreciate you taking the time to discuss how to reverse aging and optimize hormones. 

Dr. Florence: 

I appreciate it. You clearly know your stuff. It was great talking to someone who is an educated, informed physician who can help sort out these thorny questions for people. I think it’s really hard to understand medicine. We are so complex, all of us. Thanks for having me. 

Dr. Eric: 

Thank you.

 

Recently, I interviewed Megan Roosevelt, and we talked about her story, from initial symptoms and diagnosis to her decision to forgo conventional medication in favor of natural methods, the importance of personalized care, the role of nutrition in supporting thyroid health. 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 today’s guest, Megan Roosevelt. We are going to have a conversation about Graves’ Disease. Megan, like myself, took a natural approach to Graves’. Very excited to chat with Megan.

Let me dive into her bio here: Megan Roosevelt is a registered dietician, nutritionist, author, photographer, videographer, founder of Healthy Grocery Girl, and creator of The Thyroid Balance course. Megan takes a holistic approach to wellness by focusing on the whole body in addition to nutrition. Megan is a mom of two and passionate about helping people live their healthiest life. Thank you so much for joining us, Megan.

Let’s get a little bit into your background. You have a very popular YouTube channel, Healthy Grocery Girl. If you could talk about how long you have had the channel for? Then we’ll lead into your Graves’ condition, which I think was in 2015. Let’s start with Healthy Grocery Girl. How long have you had the channel for? 

Megan Roosevelt: 

If you look at the channel, I registered the channel in 2010. Probably about 10 years ago, I really started actively creating content once a week for my channel. I did that for many, many years. Then I had my daughter. Even after having her, I was like, okay, I can keep up with this. Then I had my son. Then there was the pandemic. Then I was like, I can’t keep cranking out a video every single week.

My channel has slowed down over the past few years as priorities, my energy, my time has shifted a little bit, now having two small children. I love YouTube. It’s such a great way to connect with so many people. I do post on YouTube. I have actually been posting again more frequently. I would say I really have been involved in creating content for our channel for about the past 10 years.

Dr. Eric: 

Wonderful. How long have you been a dietician for?  

Megan: 

13 or 14 years. I don’t remember the exact year that I passed my test, got my credentials. I believe 2009 or 2010. Somewhere around there.

Dr. Eric: 

Makes sense. Before the channel began, since the channel was around 2010.

Megan: 

Yeah, I got my credentials as a dietician and tried the traditional RD route of more clinical work. I did a little bit of that, applied for a lot of things, and realized that wasn’t the best fit for my personality, so I started my own business. That has evolved to so many things over the years. I became a dietician first, did clinical work, then did personal nutrition coaching. Then it’s just evolved into what it is now. 

Dr. Eric: 

One other question with Healthy Grocery Girl: How long did it take for it to really take off? You have a really popular channel. I forget how many subscribers you have. Was it something that right off the bat, six months into the channel, or did it take a number of years? 

Megan: 

It was never super fast. I have never been someone who has created anything, and it’s gone viral. It’s always been consistent, slow growth. But I would say that when I started my YouTube channel, I guess it would probably be around 2014/2015/2016. 

I feel like in those years, YouTube was still kind of fresh and new. That whole YouTuber persona, I feel like I got into the YouTube space. Instagram existed, but that was still new. Snapchat was new. There was no Instagram stories. Back then, if you wanted to watch video content, you went to YouTube, because there wasn’t video content on Instagram yet. I got in kind of early there, and that definitely helped with the growth. Just like anything, if you join something once a lot of people are doing it, then it’s a little bit harder to get started. It’s just been a slow build over the years. 

I have been doing it for 10 years. I think I have 124,000 subscribers now. In the grand scheme of things, I’m not actually that big. A lot of people have millions of subscribers. I have never created something, and it was just like boom, super popular. Just like our health, it’s consistent, showing up, and that’s how there is improvement.

Dr. Eric: 

I found you through at least one of your Graves’ videos—you have a few of them out there. With me, I was diagnosed with Graves’, and then I had my YouTube channel and website. With you, you already had the Healthy Grocery Girl channel, and then you were diagnosed with Graves’. Then you were faced with is it something you want to share with everybody, which you did. I don’t know if that was a tough decision. Do I really want to go on video and reveal this to everybody? Which you did. Let’s talk a little bit about that. It was 2015 that you were diagnosed? 

Megan: 

I think 2016. It was around that time, very close. I think it was the end of 2015. Technically January. I went back and looked at my channel yesterday. When was I exactly?

The story there is that my husband and I were ready to start a family. After a year of not getting pregnant, I thought, it’s been a whole year. It’s probably a good time to meet with a fertility doctor. I had done bloodwork within that year, and everything was fine. When I met with a fertility doctor, that’s when the tests came back that my thyroid was off. Before we could even move forward, because we were thinking about doing IVF or other options, with any fertility options, he said, “You need to meet with an endocrinologist to fix your thyroid first.” That’s when I met with her and did some other testing and was diagnosed.

It was really disheartening because I’ve always been, out of my family and my circle of friends, the healthiest person. Even with my channel, I was like, am I a fraud? You almost feel as someone who is a health professional, somehow you should be immune to health conditions. That’s just not realistic because we’re humans. 

It was very vulnerable for me to share that content. I feel like the first round of videos that I shared, maybe people were like, “Wait, this is so different than your normal content.” I think the video that has gone the most, I wouldn’t say viral but that has gotten the most views and is the inspiration for this course that I’ll talk about later that I created, because I get messages from people every single week. I just sat down and shared my story more, just like at my kitchen table. 

When I was going through my health struggles, it was so comforting to hear from other people who have been where you are at and hear what they have done, not to feel so alone in the journey. Sharing that video, it’s very vulnerable, but at the same time, I feel like we have to do that because we need to be able to humanize ourselves and help other people. If there can be something good that has come out of this not good thing, maybe it can help other people with their journey.

Dr. Eric: 

I think it was that video that I found. Later on, I found out there were some others that were done earlier. I forgot how I found you. I was probably just doing random searching for Graves’ Disease. Sometimes, I see who else is out there. Glad you shared your story.

Can you talk about some of the symptoms you experienced? If I recall, it wasn’t crazy symptoms. A lot of them were more subclinical.

Megan: 

Yeah. It’s interesting because that was a really stressful time of my life. Sometimes, when we’re stressed, it’s hard to know, am I feeling crummy because I’m stressed and experiencing this hard thing in my life? Or is it something else? 

I didn’t have bulging eyes. I didn’t really have a bulging neck. I felt pretty good other than being incredibly stressed because it’s so hard when you want to start a family, and you are not getting pregnant. Every month, it’s this rollercoaster of emotions. 

My main symptoms for me were anxiety. I have always been an anxious person, but it was a very heightened time of anxiety for me. 

Also, rapid heart. I could feel my heart beating faster. I got a blood pressure cuff because when I was home, I was fine. Everything was normal. It was like my heart rate would easily elevate, and I would become very anxious. If I was waiting at the doctor’s office, and they were late because most doctors’ appointments are, my heart would beat fast, and I’d get really sweaty. Anything that was uncomfortable for me, it was heightened. Instead of being a little bit agitated, I felt very anxious and stressed. It’s a stressful situation, too. 

I remember waiting at the endocrinologist’s office, and I would go in the back room and get toilet paper and cold water and was trying to cool myself down. It was such a stressful time. My body was also super stressed as well. Those are my main symptoms: anxiety and the rapid heart rate. 

That was one of the reasons that I didn’t really suspect anything was wrong because I didn’t really have any other symptoms besides those.

Dr. Eric: 

I definitely had overt symptoms with the elevated resting heart rate and palpitations. In my case, I can’t say I had crazy anxiety, but everybody experiences different symptoms. Did you lose any weight when dealing with Graves’? 

Megan: 

I was very thin back then, but I’ve always been a person on the thinner side. I’m only 5’2”, and now I’ve had kids. Your body is completely different after children. In general, I am a smaller-framed person. But I was definitely much thinner. I do think I did lose some weight. If I didn’t have Graves’, I would maybe be 5-10 pounds heavier. When I look back at pictures, that whole time, oh yeah, I was really thin. In general, it’s not like I was 50 pounds lighter or something. I’m a small person. I’m only 5’2”. I was probably my thinnest when I had Graves’.

Dr. Eric: 

I brought it up because one of the classic symptoms is weight loss. Some people actually gain weight though; not everybody loses weight. For some people, it’s more extreme. I weigh more than you, so I lost 42 pounds. For me, that’s a lot. With you, you would probably vanish away based on what you described as far as being petite. Even 5-10 pounds, 15 pounds, when someone is petite, is a lot of weight. 

Let’s talk about antithyroid medication. When I dealt with Graves’, I also had a decision to make. I did not want to take the methimazole, which is commonly prescribed. I have worked with a lot of people who have taken it. I don’t tell people not to take the medication. You’re also not a medical doctor, so I’m sure you don’t tell people not to take it. It’s a personal decision. 

Like you, when I dealt with Graves’, I had no idea what would work and what didn’t work, so I took the herbs, bugleweed and motherwort. I had no idea if they would help, but I wanted to give it a try. If I had to take the medication, I would take it, but I wanted to try to avoid it if at all possible. I think you have a similar story with that, right? 

Megan: 

Absolutely. A lot of the things you’re saying, I can relate to. When I was diagnosed, I felt like I was this body coming into the office, being given information. There was no customization. Even in the office, at that appointment, where I was sweating, she took my blood pressure and said I needed blood pressure medication. I think I was 30 then around that time. I was still young. I’m not taking blood pressure medication. It’s completely fine when I’m at home. It was just so quick. “You’re in my office. Your blood pressure is elevated. Here’s your medication.” The pharmacy is telling me to pick it up. I didn’t want this medication.

With my options then, I could have radiation, surgery, or medication. I am a dietician. I was at that time. I know how powerful food and nutrition can be in our health. Out of curiosity, because thyroid health at that time was so new to me, I asked her, “Is there anything I can do nutritionally?” She said, “Nutrition has nothing to do with it. These are the three options.” I said, “Okay, thank you. I’ll think about it.” I left, and I didn’t believe that was the only way. 

I went to the library and checked out every book I could find on autoimmune conditions, thyroid, everything. I first needed to learn more. Before I say “Okay” and sign up for these things, because I didn’t feel super awful, I felt like I had a little bit of time. Everybody will be different. I at least had a couple weeks to make a decision. Let me take a moment to learn what’s out there. 

I read and read and read and read. All these light bulbs started going off, connections of things. I think I wanted to meet with a naturopath and talk about this more. That’s when I met with a naturopath. This is probably bad to say, but I feel a little bit self-conscious, like an annoying patient, because I come with so much information. I read this, and I read this, and I really feel like I try to be a partner in my health, not just be like, “What do you think I should do?” and try that. 

Working with her, luckily, a lot of the things she was recommending, testing that we did, it was all aligned with what I was reading about. For me, just like you said, I have never felt like I would never take medication. If I absolutely needed it, and if that’s what’s best for me, then I would do that. Why don’t I try a natural option first and see? I never want to live with regret. Let me just try it. If it doesn’t work, and my body won’t respond to anything natural, and that’s the only thing, then I’ll do medication. But let me try these other options. 

I was very determined. It wasn’t just me in this picture of getting my body healthy. I wanted a family. I wanted a baby. I have to get healthy to start my family. I was very motivated by that. I decided not to do medication. I’m grateful that doing all of the things that I did, I was able to have all my numbers come back to a normal range and get pregnant and have my daughter and then go on to have my son. 

I don’t know if you want to talk about what I did in more detail because I don’t want to ramble on too much. But that’s my response about medication.

Dr. Eric: 

We’ll talk more about what you did. I do want to say it’s very common for endocrinologists to have that response when someone asks about diet and lifestyle, saying diet is not going to help, that there is nothing natural that you could do. It’s pretty much the options you mentioned: medication, surgery, or radioactive iodine. I’m glad based on your background, you decided not to have iodine or surgery.

I definitely want to talk to you about diet. Everybody is different. I think you probably would agree that there is not a single diet that is a perfect fit for everyone. Prior to the diet that you followed for Graves’, I’m pretty sure you were following a plant-based diet. I forget if it was vegan or vegetarian. I’d like to talk about the diet you were following prior to being diagnosed with Graves’, and then the diet you were following while you were dealing with Graves’, and then your current diet as well.

Megan: 

Nutrition, that’s what I do as a dietician. How I was eating didn’t cause my Graves’. It’s important that we don’t think of this label of this diet is the reason or the cure because it’s not that simple. How I was eating before is not negative, and it’s not like because I was eating that way before, it caused my thyroid condition. This is my story of what I’ve been eating.

Prior to that, I was vegan. I actually feel really good when I eat that way. I feel very energetic. Amazing digestion. I feel my best when I’m eating lots of plant-based foods, fruits and vegetables. I love to eat. For me, eating really healthy in that way, you can eat more. It was wonderful because I could have this huge bowl of food for dinner with all this stuff. I was eating vegan. 

But I stopped eating dairy when I was in college because I actually ended up going to the ER. I was pretty stubborn about giving up dairy, as I feel like a lot of people can be. I had bad digestive issues. I went to the ER for it once. This was in college. I actually met with a dietician before becoming one. She said, “Maybe you’re lactose-intolerant.” I never thought about that before. I apparently am. Cutting out dairy has been huge for me. I haven’t had dairy in a really long time.

I was still eating gluten. That was one of the things I changed. I followed this six-month, very strict diet as part of my protocol for my thyroid health. Doing different tests is what catered to why I ate how I did. 

I did some food allergy testing. I did have some foods that were higher allergen foods, but not because I was actually allergic to them. It was thought because of my leaky gut and my gut dysbiosis that they were causing more of an inflammatory response. For the six-month protocol, I stopped eating those foods just to give my body a rest from anything that was causing inflammation. 

What was interesting is pretty much all the foods on that list that were in the red for being an allergen, this was my grocery shopping list. This is the main foods I eat every day. That was tricky: don’t eat almonds. I can’t remember the other things on there, garlic and peanut butter and some basic foods. I ate peanut butter every day. I paused those. 

I also tested for candida. I was trying to eat a very low sugary, starchy diet. For six months, I didn’t eat anything with added sugar. If I had sugar, it was a little bit of fruit, and I stuck to low sugar fruits like green apples and berries. 

I started out eating more paleo because that is a lot of autoimmune things that you come across on the paleo side. Very against grains and legumes. It was the opposite of how I was eating. 

Similar to meeting with the endocrinologist, my gut was like, “I don’t like this. It doesn’t feel right for my body.” I don’t like a lot of animal protein actually. I have never eaten a lot of red meat. I have never even liked anything pork-related, even since I was a little kid. It didn’t feel right for my body. I remember being on a walk with my husband and crying about the food. This was so hard. It’s so hard to eat so different than how I’m used to. I don’t even like what I’m eating. I just have to do this my own way. I have to make a custom plan. I want this to work. I want to eat the foods that are going to help my body, but I also have to enjoy what I’m eating, and it can’t be adding so much extra stress onto my plate that the net stress is also negative for my health. 

I did more research on things. I remember deciding to add in some beans and grains, but being mindful of how much I’m having. Maybe I have no more than half a cup of rice in a day, or grains. Maybe that’s oatmeal. Let’s starve off the candida. 

I did incorporate some more animal proteins back into my diet. I still eat those to this day. Fish and chicken. At the time, on my food allergy list, there was no eggs, so I wasn’t eating those during those six months. It’s kind of a blend of paleo but also very heavy in plant-based diet. For those six months, I was really mindful of sugar and starches as well. 

So many people in my family, “I don’t know how you ate that way.” It was very strict. I ate a lot of the same things. I didn’t eat out at any restaurants for six months. I was always making my own things. When we’d go to a family member’s house, I would have my own food. I was so laser-focused on healing body, having family. That was my focus. 

Eating this way is not supposed to be how you’re supposed to eat forever. It was this plan of getting my body functioning back into a good place. Then it was an elimination diet. It was reintroducing foods back in. Because I have been pregnant, so I was a lot more lenient with what I ate when I was pregnant. 

Now, how I eat is pretty similar. I still eat gluten-free and dairy-free. It is more of that blend of paleo, plant-based. I really focus on lots of vegetables, lots of fruits. I do eat nuts and seeds and legumes. Gluten-free, whole grains. Very low sugar still. I don’t deprive myself from things. I don’t really like sugary things, like I don’t crave cake. But if I want a brownie or something, I’ll make brownies at home. I really focus more on whole foods, organic. 

Just full circle, back to what you said at the beginning of your question. It’s really important to learn about your body and what works well for you. We do ourselves a disservice when we take a label and follow all the rules of that label and eat just like somebody else does or what worked for them. What are your triggers? Are there certain foods that when you eat them, you notice it gives you a headache or digestive distress? Maybe you don’t have to eat completely paleo and avoid these certain things because maybe that’s not what’s best for your body. 

I think this journey of my nutrition personally has really been learning about letting go of labels and making a unique custom diet that really has helped my body not only with my health, but it helps me be healthy, it is foods that I enjoy, and it’s also maintainable and sustainable. It doesn’t feel like I’m on this strict diet. 

Dr. Eric: 

Thank you for sharing that. It sounds like you were on a real strict paleo, really closer to autoimmune paleo because you said you weren’t eating eggs. Initially, no grains or legumes. Did they tell you to avoid nightshades initially? 

Megan: 

Possibly. I don’t remember that. I may have. It was very strict. I felt like I had a very small list of what I could eat at first.

Dr. Eric: 

Then you made a transition, listening to your body into a modified paleo, where you are having some grains, some legumes. Still mostly plant-based, so you are eating some meat, but still predominantly plant-based. That’s what I recommend for most people, too. 

If you’re familiar with a carnivore diet, pretty much mostly meat. Carnivore diet is all animal-based protein. The approach I take is typically more plant-based and also getting enough protein and eating meats, not just loading up and just focusing on meat and very little vegetables and fruits. Sounds like you are incorporating some of that. You’re no longer vegan, but you’re still predominantly plant-based. 

Megan: 

I feel really good when I eat a lot of plant-based foods. We try to make meals like soups. If last week’s soup was a lot of vegetables with chicken, then the next week I will do a bean and veggie soup to mix up some lunches. For dinner, some nights, we’ll do salmon, sweet potatoes, and asparagus; we’ll do things with chicken. I do incorporate beans and gluten-free grains, but I really try to focus- I think that’s one area that everybody lacks in, is more vegetables. Vegetables, vegetables, vegetables. Here is the protein, but how can we add vegetables? We try to have two different vegetables at dinner. In my smoothies. The more veggies you can add in the day, the better.

Dr. Eric:

I didn’t know you’re a smoothie person as well. You drink your smoothies, too? 

Megan: 

Every day. I sometimes think I should mix things up, but I just love them. I have been drinking them for breakfast for a decade straight.

Dr. Eric: 

I do, too. Like you, I load it with vegetables. A long time ago, I didn’t like vegetables, so they were more fruit-based, and I would add lettuce. It did take time before I added in as many vegetables as I currently do. Now I definitely enjoy them.

One more quick question with diet: I’m curious. With legumes, beans, do you prepare in a special way? Do you soak them? Do you use a pressure cooker for them? 

Megan: 

We really like our Instant Pot. I use that a lot for cooking because it’s so fast. All my soups, I make in there. I go back and forth because I’m a mom of two small children and run our business. The ideal situation is I would buy my beans and soak them and cook them. When I’m feeling like I have the energy and time for that, I do that. I also will get beans at Whole Foods, so the Tetra Pak of beans. I rinse them really well, and those get cooked really well in the Instant Pot. 

My kids love beans. We eat so many beans in my house. We’re a huge bean family. It’s great. The kids will want beans with salad dressing for lunch, and they eat that. We go through so many black beans. But they’re so good for you. Those are some of the ways we prepare beans.

I will say I do notice that certain beans cause my stomach to feel a little bit more gaseous. It’s important to know what beans work for you and how they’re prepared. The more you cook them, the easier they are to digest. Different beans can impact different people’s digestion differently. 

Also, if you’re not used to beans, the motto of introduce them slow and then grow from there. My kids could eat a cup of beans easily and have no issues with them. If you’re not used to that, if you don’t eat beans at all, and suddenly you’re eating two cups of beans a day, that may cause issues for you. You could start with adding a couple of tablespoons of beans to your salad or soup. Our body can adjust to the fiber. 

It’s also good to be mindful. I know that when I eat a lot of these beans, sometimes my stomach doesn’t like those as much, but I have no issues with these beans. One of the best things we can do is be so aware of what works well for our own body.  

Dr. Eric: 

Well said. Thanks again for sharing that. 

Let’s talk more about the testing. You said you did candida testing, food sensitivity testing. I also heard you say elsewhere that you did heavy metal testing. Of course, blood testing. You had if I recall not only the antibodies for Graves’ but also the antibodies for Hashimoto’s, correct? 

Megan: 

Yeah. I did a lot of testing. Huge bloodwork panel testing. We did the heavy metal testing. I did not do the hair analysis; it was urine-based. I did a chelation therapy, these capsules I took. I forget the duration. It was quite a few weeks. That is how I did the chelation of the heavy metals. 

I had two on the high side that were kind of odd. We couldn’t figure out why I had those. One of my theories is I was drinking tap water at the time in Los Angeles County. That has also been something I have switched and never looked back: drinking filtered water. You never know exactly what’s going to be in your tap water. 

I did food allergy testing, candida, heavy metal testing. What was the other thing you mentioned? 

Dr. Eric: 

Blood testing, the thyroid panel, thyroid antibodies. 

Megan: 

Yes, and the antibodies for Graves’ and Hashimoto’s. I had Graves’. Had my kids, and everything was fine. After my son, I just felt awful. There is post-partum awful, but there is “Am I supposed to feel this way forever?” 

After both children, it’s what’s true of my body: I would always gain a lot of weight after my kids were born. Part of it was nursing. I feel like my body liked to hold onto fat afterwards to help me produce breast milk for them. I’d have these babies, I’d lose some weight, and be like, “Yay, I’m losing some baby weight.” Then I would gain 10-15 pounds. 

Part of that was I swung the other way. I know that you can also have post-partum thyroiditis. Because your hormones are so wonky after having a baby, and if you have a history of a thyroid condition, like your body can be all over the place. For me, I got tested and swung to the hypothyroid side after my son. That was a little bit like, okay, here we are again. If this was Graves’, I knew exactly what to do. I know the herbs. But it was interesting because I have now been on both sides. I have done the natural thing again to get back into the normal range. 

For me, I know stress has been a huge trigger for me. It probably sounds like a broken record of what is true for you? For me, when I look at this journey of my thyroid, what preceded each of these times when my thyroid was out of balance? I went through very stressful situations prior. I was very stressed out about getting pregnant. My best friend at the time passed away. That was very stressful. I had all this stress, and our thyroid is so easily impacted by stress. After my children, being sleep-deprived, nursing a three-month-old is exhausting. Sleep deprivation is exhausting. There is the pandemic. My body was not happy. I’ve really had to learn how to help my body. It’s interesting because if someone is like, “Oh, I have hypothyroidism or hyperthyroidism,” I’ve had both. I know what it feels like on either end. 

As of today, I do bloodwork to check up on it. I’m grateful to be in a good spot now. 

Dr. Eric: 

That was my next question: Do you do regular blood work? Is it once a year to make sure everything is in check? 

Megan: 

With my son, I was going more frequently. I don’t know why. I think I was working on my hormones, too. I wanted to check on those. Being a woman, having thyroid issues. Traditionally, it’d be every six months. If I feel like I’m really wanting to monitor something. 

Once things are well, the last time I checked my bloodwork was almost a year ago. I’ll do an annual appointment with my doctor and have everything run again. If everything is good, then I’ll do it a year later. If I feel off, then I’ll ask to go check it. 

But I like not to. I like going a whole year and having a healthy year. I don’t want to keep getting blood draws. When I had Graves’, it was so many blood draws. Who enjoys getting their blood drawn that often? Now, it’s about once a year as long as everything is good. 

Dr. Eric: 

Sounds good. Do you do other tests like Vitamin D or CBC? Not just the thyroid but other tests as well. 

Megan: 

I do the complete blood count, Vitamin D. I check my iron because my iron has been low. It can be really common for people with hypothyroidism and being a woman to have low iron levels. That’s important to check, too. If you feel exhausted, and your hair is falling out, and these other things that can be symptoms of hypothyroidism, it’s good to check your iron and ferritin levels. 

I have also been checking my hormones, like my estradiol. Coming off of nursing my kids and pregnancy, I had my kids pretty close together, back-to-back. For about four years straight, I didn’t have any break. I was either pregnant or breast-feeding for four years straight. There was no pause in between because they overlapped. I got pregnant with my son while I was still breast feeding my daughter. I breast fed her through my first trimester. My body had four years or more of not being in a place where I could just focus on myself and heal. My body is for my children. It took me a while. It took me at least 2-3 years after my son was born to feel really good again.

I am healthy. I am sleeping better. My anxiety is better. My hormones are better. That was something else I was keeping my eye on. Vitamin D as well. I think those are the main ones. I do check other things as well because they can also impact thyroid health. 

Dr. Eric: 

How about supplements? Besides the herbs to manage your symptoms, do you remember some of the other supplements you took? Are you still taking some of those same supplements? 

Megan: 

When I had Graves’, I did a tincture combination of bugleweed, motherwort, and lemon balm. I really liked that. Sometimes, you take things and don’t notice a difference. I hope this is doing something. But with that, I noticed a difference with my anxiety because the lemon balm is so good for your nervous system and calming you down. I did that with the Graves’. 

What else did I take? I took a higher dose of Vitamin D, which is also why I was doing blood work so frequently, to monitor that. I checked my liver levels to make sure things were good there. 

I can’t remember off the top of my head. I know there were other ones I took for gut health. Maybe L-glutamine was possibly one. 

Dr. Eric: 

Did you take a probiotic? 

Megan: 

I’m sure I did. It’s funny because it was so long ago, and it wasn’t the most joyous time of my life. There are certain elements of it that my brain does not want to hold onto. 

I know there is a video on my YouTube channel where I sit down with my basket of everything I’m taking and go through it. If anyone is interested, there is a video of that. 

Now, I take a multivitamin. I take Vitamin D. I do a fish oil supplement. Although there is no scientific research to support seed cycling for women’s cycles and hormonal health, I notice a difference with it. I also do that with my fish oil. I do fish oil the first two weeks of the month. Then I do evening primrose oil the second two weeks of the month. The evening primrose oil is beneficial in women’s menstrual cycles. Even if it’s not directly thyroid-related. If women have sore breasts before their period, that can also be beneficial for that. 

I also have gotten really into other calming herbs. I feel like while I’m not a credentials-qualified herbalist, I am in my heart. I drink lemon balm tea. I love holy basil or tulsi. I have a tincture with a combination of ashwagandha, rhodiola, and tulsi or holy basil, which is all really good for calming your nervous system. 

I also like lion’s mane, which is something else that can help. Anyone that has mild anxiety or depression, it’s really good for brain health. I feel like there is the core vitamins and mineral staples. Off of that, because I know stress is such a huge trigger for gut health imbalance, thyroid health imbalance, I really have incorporated a lot of natural things that can support my nervous system. 

I tend to run on a more anxious level. I really have learned over the years what can support me to chill out a little bit. There are so many great herbs that are really helpful and calming for you. I do magnesium. I have a magnesium powder that I put in my tea at the end of the night, which helps me sleep really well.

Dr. Eric: 

Before you talk about your course, I have two more quick questions. One question is is there anything that I should have asked you that I didn’t ask you? The second question: If you had to do it all over again, is there anything you would do differently? 

Megan: 

Good question. This has gone by fast. It’s already time to say goodbye. 

One question that you didn’t ask that would be good to briefly talk about is it’s not all about the food. Sometimes, we can put a lot of pressure on ourselves to eat so perfectly and eat all the right things. That alone is the thing we need to work on when our health is so holistic. Food is important, but it’s one piece of the puzzle. 

Thinking about our personal products, what we use from deodorant to shampoo to conditioner, if you’re a woman, makeup or hairspray, if they are filled with a lot of chemicals, parabens, fragrance, endocrine disruptors, those things can all impact your health. Slowly, because it can be overwhelming, make the swap to natural products that are better for you. 

What we cook with, preferably over a nonstick pan or Teflon pan, something like cast iron or stainless steel or glass. Switching away from so much plastics. If you drink out of a plastic water bottle, switch to stainless steel or glass. If you put your hot food in plastic Tupperware, switch to glass food storage. There is a lot we use in our everyday life that sometimes we don’t think about how it could be impacting your health. 

Filtered water versus tap water can be really beneficial. The fluoride and chlorine in nonfiltered water can have a negative impact on our thyroid health. Filtered water is good. 

One of the biggest areas that for me I find has been so impactful is also the mental, emotional, and spiritual side of our health. We tend to want to have all these things to do, checklists, rules. If I just eat these foods perfectly, and if I just buy the right products and supplements, then it’s going to fix me. 

But if we have a lot of emotional distress, unhealed trauma, or if we’re constantly stressed and anxious, there is a whole truth to the brain and gut connection and how stress can impact our gut health. That has been something I have had to really work on. I know food is so important, but it’s been so profound to see how much it’s benefited me. I have seen over the past few years, like I feel like a different person than I was years ago from my stress response. 

We can’t always control stress. It’s not like we can just avoid or eliminate stress. But we can help our body have a better response to the stress. When there are stressors, do I have systems in place so that I can help my body calm down from that? I can learn to meditate, go on a walk, make myself a cup of lemon balm tea or chamomile tea? What tools do I have to help me reduce my stress? 

Also, things that can help us to have more resiliency and a better response to stress. I know I’m a person of faith, so my relationship with God and making time for that has been really beneficial for me to not feel so alone in my health journey and feel like it’s all not on me to fix this. That has been huge. 

Meditation has also been really powerful for me. I meditate every day. Learning breathwork and learning how to chill out, take a pause, and how to breathe. If you’re feeling like your mind is racing, you’re worried about things, being able to help your body calm down and move into more of that parasympathetic nervous state, so we are not always in fight or flight. 

If you have a health condition, it’s stressful and overwhelming. If you’re working on it, it can be chronic stress. You’re worried about your health every single day. What are my daily non-negotiables that I do to help my body not be so stressed? Help my emotional health and mental health. 

It really is holistic. This whole picture of all the things we do. Nothing is too small. We may think going on a little walk or switching my deodorant to a better one that doesn’t have aluminum in it, or it’s not an antiperspirant. Drinking an herbal tea, is that going to make a difference? But it does. Every little thing we do all together is going to support our health. 

I think it takes pressure off of us feeling like the diet alone. If I just eat these perfect foods, it will fix everything. It’s not just one thing. It’s your whole health. Your thyroid journey, it’s not like doing things for a couple months, and then it’s fixed. It’s a whole lifestyle shift. Especially if you are someone who wants to go the natural route, I think of all the things I’m doing every day are my medicine. I would take medicine if I really needed to. For me, the way I eat, how I support my emotional/mental/physical health, these are all my things. My time in nature, they are all medicine for me, that’s helping my body be in a good place. As a reminder to people to look at the whole picture.

Dr. Eric: 

I agree with pretty much everything you said. Stress was huge when I dealt with Graves’, and for a lot of people, it’s big. It’s great that you mentioned the importance of mind/body medicine. I do meditation every day.

Really, I’m so glad you mentioned that there is more than just diet. I say that all the time. Diet is a piece of the puzzle. It’s important, but it’s just a piece. It’s one thing for me to say it, but then also having other people say it, especially a dietician. You focus on food, yet you’re saying that it’s important, but there is more than just diet. 

Megan: 

I think you had one other question, but I probably talked too long, and I forgot.

Dr. Eric: 

If you had to do it all over again, your Graves’ journey, is there anything you would do differently? You had a great outcome, so maybe you would do everything the same. 

Megan: 

I really can’t think of anything I would do differently. We do our best. We all do our best, and that’s all you can do every day. I know in the past, I did the best I could. Sometimes, I wonder, should I have tried this or that? I think we get worried about making the perfect choice with everything. Even working with a health professional, a lot of health is educated guesses about what will work well for your body. Knowing that it is a journey, and I’ve been on a journey. I try the best I can. I don’t really think I would change anything. I am very grateful that the things I have implemented, I saw improvement for sure.

Dr. Eric: 

I agree. With Graves’, I can look back and say, if I would have done this differently, maybe I would have gotten better sooner. But it’s all part of the journey. Our experience helping others, too. 

Let’s go ahead and talk more about your Thyroid Balance course and anything else you’d like to talk about. What can people expect from the course? 

Megan: 

I’m very excited about the course. The inspiration for this course came because of that video I shared on YouTube, where I sat down and shared my story. I received so many people being like, “What do I do? I need help.” I can’t help you through Instagram DMs. There’s so much. “All you have to do is this one thing, and that’s the fix.” I can’t do that. 

I have so much information that I wanted to make a course. That’s what I’ve done. It’s a self-paced video course with 12 video modules broken out into different topics. 

Testing. What should you get tested? Interpreting your results. Understanding what your test results mean. 

Supplements, nutrition, reducing your toxic load, stress. We go through the holistic picture of all the different things.

Learning about your thyroid in the course. What is my thyroid? Where is it? What does it do? What is its function? What are other systems that the thyroid impacts, and what other systems impact the thyroid? All of the things we can do to help support thyroid health from a holistic, functional medicine perspective.

That course is available. You can go to our website, HealthyGroceryGirl.com, to find it. Also, HealthyGroceryGirl.com/ThyroidBalanceCourse. Everything is there about the course. 

I have two additional resources I created that are complements to the course. One is an e-cookbook, with 50 recipes that support thyroid health but also gut health and liver health because they are all connected.

The other resource is a meditation packet. As I mentioned, meditation has been so powerful for me. I really enjoy it. I created a guided meditation packet. It’s five guided meditations, me talking in a much calmer, I’m not shouting at you like I am now, voice. Very soothing music. 

They are different types of meditations. One helps you as you are trying to fall asleep. Another is good if you have a lot of health anxiety or a busy mind. If you ever feel like you have these decisions to make, and your mind can’t stop racing. There is a good meditation for that. There is a meditation specifically for thyroid health. They are all these guided meditations that help the body calm and take a pause and recenter, reduce our stress, support thyroid health better.

Those are what I’ve created to help people on their thyroid journey. They’re on our website, HealthyGroceryGirl.com, for anyone who is interested.

Dr. Eric: 

That’s for not just people with Graves’, but also people with Hashimoto’s or hypothyroidism, as well? 

Megan: 

It covers both hyperthyroidism and hypothyroidism as well as the autoimmune versions of those. Any of those imbalances you have, whether you have the autoimmune version or not, hyper or hypo, it covers it all. Also, it really dives into liver health, gut health, adrenal health, hormonal health as well because really working on those, you’re going to help thyroid health as well. 

Dr. Eric: 

Thank you so much, Megan. I really do appreciate you taking the time to share your thyroid healing journey. I’m sure the listeners learned a lot. It brought back memories from when I was dealing with it, too. It’s rare that I speak with someone who has a similar journey. Thank you so much.  

Megan: 

Thank you for your time. Thank you for making this podcast and resource. You haven’t had this podcast long enough that it would have existed when I had Graves’ originally. I feel like when I was first diagnosed, what do I do? I felt so alone. It’s so wonderful that you have this for people to be a guide.

Dr. Eric: 

Thank you. It definitely wasn’t around when you were diagnosed with Graves’. Thank you. I appreciate that.

 

Recently, I interviewed Dr. David Jockers, and we talked about a comprehensive chat about fasting and its impact on thyroid health. 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. David Jockers, as we are going to be talking about fasting. Let me go ahead and dive into Dr. Jockers’ impressive bio here: Dr. David Jockers is a doctor of natural medicine who specializes in functional nutrition and natural health strategies. He is the founder of DrJockers.com, a website designed to empower people with science-based solutions to improve their health. DrJockers.com has gotten over one million monthly page views and is considered one of the most well-researched and easy-to-read health websites in the world. 

Dr. Jockers’ work has been published in various popular media outlets, including ABC, Fox News, The Hallmark Channel, Home & Family, and The Dr. Oz Show. Dr. Jockers also hosts the popular Dr. Jockers Functional Nutrition podcast. 

Thank you so much for being here, Dr. Jockers.

Dr. David Jockers: 

Absolutely, Dr. Eric. Great to connect with you here.

Dr. Eric: 

For those who have not checked out his website, it is amazing. I don’t know how you put so much great content. How many articles do you have? Hundreds? Probably thousands at this point? 

Dr. David: 

Yeah, probably 1,500, something like that.  

Dr. Eric: 

If you are looking on almost any topic related to health, you could probably find it on his website. Definitely check out DrJockers.com. 

Before we dive into fasting, can you give a brief background? How did you get into what you’re doing now? How did you get into the fasting world? 

Dr. David: 

Growing up, my mom was studying to become a naturopath. I was an athlete growing up. That is how she influenced me to eat healthy. My older brother had acne; I didn’t want acne. She said, “He’s eating too much sugar. He’s eating too much processed chocolate bars and candy.” I started avoiding that. 

I wanted to perform better in baseball. I was a baseball player. My mom said, “You have to eat kale and your protein. You have to get these nutrients into your system.” Whatever would help me perform better, that’s what I was going to eat. I didn’t like kale, but I was swallowing down kale. She helped inspire me from that perspective.

When I got out of high school, I got really into fitness. I was a personal trainer. I would eat 6-7-8 meals a day. I was always thinner, so I wanted to bulk up. I was eating healthier than most people out there that I knew, but I was eating lots of processed foods. Lots of processed protein bars and protein shakes. 

I was eating from the time I woke up until the time I went to bed, and I ended up developing irritable bowel. I overwhelmed my digestive system. I would have cramping and bloating. I went through a period of time where I lost about 35 pounds because I couldn’t absorb nutrients. I was still eating a lot and trying to exercise. Of course, I’m 21 years old, so I think, Well, I just gotta work out more and eat more. I finally hit the fan and realized, Wow, I really need to make changes.

I started reading some different books. I actually had a local guy at my gym who was a chiropractor. He said, “You should really think about becoming a chiropractor.” He was into nutrition. He said, “You should really consider coming off of grains.” This was back in 2003. Nobody was talking about that. But he turned me onto DrMercola.com. 

I started reading that website. He talked about a no-grain diet, so I came off grains. I made a lot of changes in my diet. I was more of a plant-based eater, so I started eating grass-fed meats and prioritizing healthy animal products and healthy fats. It definitely changed my health big-time. I got my energy and life back. 

I went to chiropractic school. I had this vision of creating a natural health center, impacting community wellness. That’s what I did. When I graduated from chiropractic college, I opened a clinic right out of school. That clinic became successful. 

I realized I was working way too much, had no balance. I was living in my clinic for the first two years while I opened it up. I couldn’t get a business loan; it was right after the economy had crashed in 2008. I was working 80 hours a week, stressed out, and eventually bought a house close to my clinic. I started creating a lot more mental, emotional balance. 

I also developed skin cancer, which was the kind of cancer that killed my grandfather. He died from metastatic melanoma. I grew up in Florida on the beach. Been sunburned more than somebody should be. I had those risk factors. I was sleeping under the power panel in my storage area of my clinic. I was showering across the street at a 24-hour gym without water filtration. I had an X-ray processor in my main bathroom that I was using, which was a chemical-based processor. I was breathing in toxic chemicals all the time. I overloaded my toxic bucket. For me, that’s how I expressed: it’s been digestive issues or skin cancer. I’ve also been able to heal those. 

I actually started practicing intermittent fasting and extended fasting in my journey of healing. When I first started practicing it, I’d never heard the term. Back when I made my diet changes in my early 20s, I realized, because my blood sugar was a lot more stable, I wasn’t hungry in the morning. I was always busy. I had clients early or school early. I started drinking a lot of water early in the day. Then I would not be hungry. 

I wouldn’t get hungry until sometimes 2pm or 3pm, and then I would start eating. I would eat in a condensed window from 3pm-8pm. I would eat a good amount of food during that period of time. Then I would wake up the next day and fast or just hydrate throughout the day up until the afternoon again. I realized I felt significantly better. That was a cornerstone part of my healing process. That was back in 2003/2004. I’d never heard the term “intermittent fasting.”

When I developed skin cancer, I went on what I knew was more of an intensive fast. I went on a five-day fast as part of my healing. That was much more intentional. That was right around the time when I started hearing the term “intermittent fasting.” It’s something I’ve looked at and studied in detail, and I’ve practiced myself, too. 

Dr. Eric: 

That’s some story. It sounds like you have been fasting for about 20 years now. You mentioned you learned about going grain-free when you discovered Dr. Mercola’s website. Just out of curiosity, are you still grain-free? Is it every now and then you have grains? 

Dr. David: 

I am not 100% grain-free now. I spent years being grain-free. I don’t eat many grains obviously. With the kids, we’ll have some Ezekiel bread from time to time. Fortunately, all of us are very healthy. In general, we are gluten-free. In general, my kids will be like, “Oh, we’re having gluten?” I tell them, “This is the better gluten.” Occasionally, we will have some Ezekiel bread or something along those lines. 

It’s rare. I am on a lower carbohydrate diet. I get most of my carbs from fruit, which I eat a lot of. Sometimes some root vegetables. Basically, a very clean template as a whole.

Dr. Eric: 

Can you talk about some of the definitions? What is the difference between fasting in general compared to intermittent fasting, for those who are unfamiliar? 

Dr. David: 

It’s kind of like this blanket term of fasting, intermittent fasting. All of us do some level of fasting. Fasting is just going without. You can fast from entertainment. There are a lot of things you can fast from, not just food. For the purposes of this conversation and natural health, we talk about fasting from food.

Basically, the way that I look at it is it’s within a 24-hour period of time. We call it “time-restricted feeding,” or TRF. Sometimes, the term “intermittent fasting” will come in as well, as synonymous with TRF. 

After two days, there is another thing that takes place inside of our bodies. If we’re fasting inside of a 48-hour window, we’re still producing stomach acid, bile, pancreatic enzymes to prepare for the next meal. After about 48 hours, we stop producing those. 

If you’re doing a three- or four- or five-day fast, it’s wise to reignite the digestive juices, so you can digest your meal effectively when you do break your fast. Your body is conserving energy. It’s saying: I don’t need to eat right now. I’m not eating, so I need to put all the energy I would normally put into producing these digestive juices, which is very energy-demanding. It takes a lot of energy for us to produce stomach acid, bile, pancreatic enzymes. Instead of that, we’re diverting that energy into healing and repairing. 

As we start to introduce food, we want things that will help to reignite digestive juices. A lot of times, I’ll tell people to make your food very aromatic. You’re smelling it. Use a lot of herbs: basil, oregano, thyme, rosemary. Bone broth, something liquid-based that you don’t need much digestive juices for, but tells the body, “Food is starting to come in. Calories are starting to come in.” 

With a shorter fast, within 48 hours- For example, I do a 24-hour fast every week. I don’t do any of that stuff. It’s a good idea to take a little apple cider vinegar or drink some broth before a meal. That’s always a good idea. 

However, I can do a lunch-to-lunch fast, eat lunch on Wednesday and fast until lunch on Thursday, and not need to worry about if you are going to be able to produce enough stomach acid or digestive enzymes. I can eat a normal meal and feel great afterwards, as opposed to if I do a three-day fast, you can overwhelm your system. You want to have that knowledge beforehand, so you start to gradually reignite and reawaken your digestive system, not break it with this huge meal. 

Dr. Eric: 

When you say a three- or four-day fast, you’re talking about a water fast. All they are doing during those days is drinking water? 

Dr. David: 

Typically, water. Maybe herbal tea. Maybe black coffee. Basically, no calories. 

Dr. Eric: 

Okay. 

Dr. David: 

I always recommend no sweeteners, or at least minimal sweeteners. The benefit there is you get a dopamine reset as well. For many of us, even in natural health, we are using stevia or monk fruit, and we are having a dessert or sweetening up liquids or eating fruit. All of that triggers dopamine. If we go several days without any sweet flavors, that helps us reset the dopamine pathways in our brain. We are more sensitive to the natural flavors of food when we reintroduce food. 

Dr. Eric: 

That sounds good. Make sure you could have herbal tea or green tea, but you don’t want to add even stevia or monk fruit, let alone something like honey or maple syrup. 

Dr. David:

Ideally, for the best benefit. 

Dr. Eric: 

You said you do a 24-hour fast once a week. Pretty much on a daily basis, are you doing 16 hours of intermittent fasting? 

Dr. David: 

Yeah. On a daily basis, 16-18 hours. Sometimes a little bit longer. I’m usually eating my meals between 1-7pm on a daily basis. I typically work out before I break my fast. Usually, I’m working out at 12:30/1pm, and I might finish that workout at 1:30pm and break my fast around 1:45-2pm, somewhere in that range. I have a really good meal. Sometimes, I will have a high protein snack in between. Then I will have a great dinner with my family at roughly 6pm. 

Dr. Eric: 

I think it’s safe to say that when many people start intermittent fasting, a lot of people are doing it to lose weight. That’s certainly one benefit. Are there other benefits of intermittent fasting? 

Dr. David: 

I would say that’s the most common benefit. There are incredible longevity benefits to it. I have personally never tried to lose weight at any point in my life, yet fasting has become a cornerstone part of my lifestyle.

When I had IBS, fasting helped me heal my gut lining. When you think about it, the gut lining is only one cell wall. All the mechanical stress of food coming through there, putting stress on that one cell wall. That cell wall needs to be very strong, very resilient. 

When we are constantly eating and putting that mechanical stress, I compare that to if you have a sprained ankle. If you continue to walk and run on it, obviously, it’s not going to heal properly. You need time to rest. Fortunately, the gut lining heals a lot quicker than all the cartilage and avascular tissue in our ankle or joints. We don’t need quite as much time to heal our gut lining as we do to heal the joints. 

Sometimes, just taking 24 hours, we get a rise in intestinal stem cell production. Even a 16-hour or 18-hour fast, a lot of people will notice big improvements in their overall digestion on a daily basis. One of the reasons for that is the healing. Actual time away from mechanical stress going through there, allowing that intestinal lining to heal.

Another great benefit is it actually helps to improve the diversity of the microbiome. Most microbiome researchers out there will say the more diverse your microbiome, the healthier you are. That’s what the research has shown. The greater number of species of bacteria in our intestinal system, the healthier we are. 

How do I create diversity in my microbiome? One way is to eat a diverse array of different vegetables. These plant-based foods have various fibers in them. Each type of fiber or prebiotic nutrient that is in these different plants helps to feed and favor the growth of certain types of beneficial bacteria in our gut. If you are only eating the same 10 foods, you are not going to have as diverse a gut microbiome as if you were to eat 30 different types of foods. That sort of thinking really predominates in microbiome research. There is a lot of truth to that. 

However, fasting is the opposite. It’s been shown to improve diversity. You’re not eating anything when you’re fasting. You would think everything is going to die. What we have found is in the gut, there are different layers of bacteria. You have your primary feeders and secondary feeders. 

Primary feeders live right above the mucosa. Right above the intestinal lining, you have this thick coat of mucus. That mucus is where the immune component of the intestines are, the secretory IgA. That mucosa protects that single cell gut lining wall. Super critical that we have healthy mucosa there. 

Inside the mucosa, there is bacteria that live in there. We call those the secondary feeders. Those bacteria not only like to eat polyphenols and fibers, but they also can survive on the mucosa itself. They can actually eat the mucus itself as a fuel source to stay alive. 

One of those secondary feeders is called Akkermansia muciniphila, which means “mucus-loving.” This bacteria has been highlighted by microbiome researchers as what they call a “keystone bacteria,” meaning the levels of Akkermansia muciniphila in your gut are going to be related to your risk of developing chronic inflammatory conditions. If Akkermansia goes down, your risk of developing chronic inflammatory conditions goes up. If Akkermansia goes up, your risk goes down. 

How do we favor the development of Akkermansia in our gut? Turns out that intermittent fasting is one of the best ways. When we are constantly eating, we are overfeeding the primary feeders that sit on top. They are eating a lot, and they are growing, and populations are thriving. When their populations are thriving, they are not allowing nutrients to get down deep into the mucosa. They are not allowing for the proper ecosystem for Akkermansia to be able to populate and thrive.

When we actually take longer periods of time between meals, now the primary feeders die down. They are still there but not at higher than normal proportions. Now, when we do consume food, that food is going to get into the mucosa, where Akkermansia can now feed. It will eat the polyphenols and have healthy, balanced levels. 

To make more sense, in my front yard, I have an apple tree and a blueberry bush. The apple tree grows, and it grows quickly. It grows to the point where it blocks sunlight from getting to the blueberry bush. Every year, we have to pay somebody to come out and trim the hedges on the apple tree, so we get blueberries. Otherwise, we don’t get any blueberries. We love the apple tree. We love the apples. They are beneficial for us. But if we don’t trim the tree back, then it blocks the key nutrients in the proper ecosystem for the blueberry bush to develop properly. 

That is the same thing that intermittent fasting is doing in our gut. It’s creating the right ecosystem for the proper diversity of the microbiome. The more diverse and beneficial our microbiome is, the better our immune system is going to function, the better we are going to break down and absorb nutrients from the food we are consuming, the better we are going to release and get rid of toxins. 

We say that good bacteria help to eat toxins and produce B vitamins and all different types of key post-biotic nutrients thar reduce inflammation in our system. The bad microbes will actually eat nutrients, and then they will poop out toxins that inflame us and cause unwanted problems. The more we can create that healthy, balanced, diverse microbiome, the better. Intermittent fasting is one of the core strategies to help optimize the diversity of the microbiome. 

Dr. Eric: 

I don’t know if you do stool testing at all in your practice. If someone does a comprehensive stool test or even a gut microbiome test, and they have a lot of low bacteria, and perhaps even low Akkermansia, because now some stool panels will test for that, is it a fair strategy to incorporate intermittent fasting based on what you said to try to increase those numbers? Maybe that’s not the only strategy. Maybe you do want to make sure you are getting enough fiber and prebiotics. Quite frankly, I never thought about incorporating intermittent fasting to improve the gut microbiome. 

Dr. David: 

I understand. Some level of intermittent fasting should be in everybody’s plan. I call it a fasting lifestyle. It’s part of a healthy lifestyle, like exercise. For example, I just had a flu last week. I work out six days a week. I’m in great shape. When I had the flu, I couldn’t work out. I needed rest. 

There are seasons where you may not fast quite as much as other seasons, depending on what your overall stress load is. Some level of TRF/intermittent fasting should be a cornerstone player in every single person’s healthy lifestyle approach. Same thing as exercise. Should be a part of what you’re doing on a regular basis. 

Yeah, you are going to want to make sure you are getting the right amount of fiber for your body type. I don’t know if this has been your experience, Dr. Eric, but in my experience, some people really thrive on very high fiber, high phytonutrient diets. Other people, lower levels of fiber and FODMAPs and plant fibers in their diet. You have to find where you’re at on that spectrum. 

You’re looking for your fiber threshold, in a sense, trying to get it from real, whole foods and find where the level of fiber hat you really thrive on is. That may be a lot different than your spouse. They may thrive on 20g of fiber more than you. You get your gut inflamed and bloated when you are consuming that much fiber.

Eating the right types of foods obviously, and then also incorporating intermittent fasting, stress reduction, good sleep. All the things we talk about should be at the foundation of your lifestyle. 

Dr. Eric: 

I agree with you that everybody is different when it comes to fiber consumption, the amount that they need. 

Who isn’t a candidate for intermittent fasting? Is there anybody who should not fast? 

Dr. David: 

When it comes to an overnight fast, pretty much everybody can do that. Roughly 10-12 hours, overnight fast, at the baseline is really for everybody.

A pregnant woman may need to consume something overnight. My wife was able to fast 10-12 hours overnight without any issues with all of our kids, and they were all super healthy. As we start to push that fast to 14-16-18 hours, pregnancy is not the time. Pregnancy, you’re growing and developing.

My kids have no issue. They typically fast 14 hours overnight. They have no issue as long as they’re consuming plenty of calories during their eating window. For most kids, it’s not like we’re trying to compress their eating window or do something intentional there.

High-level athletes, if you are training 2-4 hours a day, it’s not a season to be trying to tighten your eating window.

Type 1 diabetics, until they get really good at understanding where their blood sugar is, because there are type 1 diabetics who do regular intermittent fasting and feel great. It’s not something they’d want to jump right into. They need to be really good at understanding where their blood sugar is and how their body is responding to various foods they are consuming.

People who are very underweight. They need to understand the amount of calories that they are going to need and the amount of foods they are going to need. That’s one of the biggest mistakes they make. They feel good when they’re fasting, so when they get back to eating, they don’t eat enough. They are used to eating smaller meals maybe. They are not consuming enough overall calories, enough overall protein. 

That’s one of the key caveats. When you’re eating, you eat really well. You want to make sure you are eating until you are fully satiated and not try to undereat. A lot of people are in this diet culture where they say they are going to eat only 200 calories a meal. They go from six meals to three meals. Then they are just consuming 200-250 calories in a meal. They are not getting the overall amount of calories that they need. 

When you are in a period like that, where you have too low calories for too long a period of time, that will affect your metabolic rate. Talk about thyroid. It can affect thyroid hormone production and conversion. Sex hormone production as well. Cause a lot of unwanted symptoms. 

You have to make sure that when you eat, you’re eating really well. Eat good foods, and eat plenty of them. When you’re not eating, you’re not eating.

Dr. Eric: 

Getting enough protein is important I would imagine as well. 

Dr. David: 

I recommend 30-50g of protein per meal. Now you’re only eating 2-3 meals per day, but you’re consuming 30-50g of protein per meal. 30 at the minimum. Roughly about 10% of most proteins is branched-chain amino acids: leucine, isoleucine, and valine. Those branched-chain amino acids stimulate muscle protein synthesis, the development of muscle tissue. Roughly about 3g or so, depending on your size, of leucine per meal is what we call the leucine threshold, which stimulates muscle protein synthesis. Leucine is the most abundant branched-chain amino acid and the most important for muscle protein synthesis. 

A smaller individual may be fine with 20-25g of protein in a meal. If you’re under 110 pounds or so. For most adults, just to be on the safe side, I recommend 30-50g of protein per meal. Protein is very satiating. That is going to make you feel much more satiated and keep your blood sugar stable and balanced, so you can go longer periods of time and feel great between meals.

To get 30-50g, you may need to readjust. You may have been used to consuming 10g of protein. You need to understand what that really looks like as you’re setting up your meals. If you do 30-50g of protein in a meal, you will feel great. Fasting is going to be a lot easier. 

I obviously recommend adding in some fats. If you are eating real foods, most protein foods come with some fats. Let’s say a chicken breast doesn’t. Add some olive oil or some avocado, so you are getting some healthy fats with it. 

I recommend 15-30g of healthy fats. These are general ranges. Some people can do larger amounts, like I can do much larger amounts of fats and proteins in a meal, and I feel great. When other people eat a lot of fat in a meal, they feel awful. If you don’t have a gallbladder, or if you have really clogged bile ducts in your biliary ducts in your liver gallbladder system, and are not releasing bile effectively, you may feel bad. You may feel more nauseous, have more gut issues, feel really itchy when you consume higher amounts of fat.

This is where a lot of people go wrong when they go on a ketogenic diet. They are told to keep layering on the fat. Add more butter to that. Eat a whole avocado with that meal. For some individuals, they feel great when they do that, and others don’t. They are not metabolizing that fat effectively. 

Find out what you feel best with as far as the amount of fat you are going to consume in that meal. Stick in that range. For most people, it will be somewhere between 15-30g of healthy fats, coming from extra virgin olive oil, avocado, grass-fed meats, pasture-raised eggs, grass-fed butter, something along those lines. Combine that with the protein. 

Then you can round out your meal with vegetables. I like to get a lot of colorful foods in my meal with fruits and vegetables. 

If you get your proteins and fats down right, that will give you the natural satiety that you need, which will keep your blood sugar stable and make it a lot easier to fast and keep you at a very high energy throughout the day, functioning at a really high level, and keeping your inflammation down. 

Dr. Eric: 

Pretty much it sounds like you’re recommending for people to listen to their bodies, especially with fat consumption. Maybe they need some additional support if they had their gallbladder removed for example. That goes beyond this conversation. Appreciate you sharing that. 

When someone is, let’s say extremely restricting calories, you mentioned how it might negatively affect thyroid and/or the sex hormones. As you know, most people listening to this have a thyroid or autoimmune thyroid condition. If someone is doing everything right, not restricting calories, making sure they are eating sufficient protein and healthy fats, are there any concerns with someone who has a thyroid condition?  

Dr. David: 

There are none. In fact, fasting is one of the best things to help reduce overall inflammation, to help the body get rid of senescent immune cells. Whenever I think about autoimmunity, where the immune cells are starting to attack our own tissues, those immune cells are really dysfunctional, so our body has to constantly recycle cells. It will recycle immune cells constantly. 

However, if we are not good at recycling and getting rid of older, damaged, dysfunctional cells, that is a skill that the body has. As people age, if they don’t create the right environment, they are not going to be able to get rid of these cells. Therefore, those cells will start to produce, and the things they are doing are not in alignment with our best health.

One of the best ways to get rid of senescent cells—that is the term we use for old, aged, dysfunctional cells—is through fasting. When we fast, we lower our blood sugar and insulin levels. Once insulin gets below a certain threshold, it tells the body to go into healing and repairing. 

When insulin is elevated, it’s saying, “Let’s build and divide. Let’s create more cells. Let’s store.” When insulin goes down below a certain imaginary threshold that could be different for each individual, all of a sudden, the innate intelligence that runs our body says, “Now is the time to heal and repair. Let’s get rid of all the different damaged proteins that we don’t need. Let’s break those down. Let’s take the raw materials and create new, healthy cellular organelles; new, healthy mitochondria; new, healthy Golgi apparatus; new, healthy RNA. Let’s get rid of these old, damaged cells.” 

Now, we start to repair and refresh the body. The problem is that most people are in a constant state where insulin is above the threshold, so they are in this constant state of building and reproducing cells, and they are not getting enough time to clean and repair. Because of that, we build up all this trash in our system, all these damaged cells, and those damaged cells can release all different types of inflammatory compounds, histamines, antibodies for certain individuals. Based on our genetics, we will have our own unique expression. That is where the problem is.

Outside of that, fasting needs to be a key component for anybody who is trying to heal from chronic inflammatory or autoimmune conditions because it moves that switch. It moves us back into healing and repairing, and that creates the environment we need to heal and repair properly. 

Dr. Eric: 

A lot of people listening to this have Hashimoto’s. On top of the autoimmune component, they are trying to lose weight, so fasting can have multiple benefits.

Maybe a little bit of a different story for some people with Graves’. You mentioned weight loss. If someone has hyperthyroidism and is losing a lot of weight, maybe they want to do things to improve their health first before incorporating fasting. 

You’d be amazed as to how many people with hyperthyroidism, including Graves’, actually gain weight. I know on the surface this doesn’t make sense. If someone has that increased metabolism, you’d think just about everybody loses weight with Graves’, but that’s not the case. If someone is gaining weight, from the standpoint of the autoimmune component, whether it’s Graves’, as long as they are not losing a lot of weight, or Hashimoto’s, or RA, it sounds like if anything, it would be beneficial for that autoimmune process.

Dr. David: 

Absolutely. Even somebody who is losing weight, actually taking that period of time between meals. When I had IBS, I started doing this, and I was way underweight. It helped me gain weight. When insulin goes down, not only do we heal and repair, but we absorb nutrients more effectively when we do consume food. When someone is very underweight and is eating a lot, it’s because they are not absorbing nutrients. They are creating this vicious cycle of inflammation. That inflammation is not allowing them to get what they need from the food they are consuming, so they need a reset. That’s what fasting offers.

Also, when we fast and insulin goes down below that threshold, another hormone called human growth hormone (HGH) becomes elevated in our system. HGH and insulin are antagonistic. One of HGH’s main functions is to protect lean body tissue. HGH helps increase circulating leucine levels, which is that branched-chain amino acid that tells the body to hold onto muscle tissue, bone tissue. 

I was very catabolic. I was eating plenty of food, but I couldn’t gain weight. My body was breaking down its own muscle tissue, bone tissue, joint tissue because my environment was wrong. When we create the right environment, now the HGH is elevated, saying, “Protect muscle tissue. Protect bone tissue. That is precious tissue. We are going to leave that alone. Instead, we will break down fat for fuel while this individual is fasting.” That is the environment we want, so we need that reset.

We also need to make sure, when we are eating within our eating window, that we are consuming plenty of quality calories, blood sugar stabilizing calories, and providing the nutrients that we need to build new tissue. Good, high protein. That is key. 

Even if somebody is underweight, even if we are just starting with a 12-hour overnight fast or a 14-hour fast, and trying to consume 3-4 meals in that window, and trying to make those meals as easy to absorb as possible. Maybe protein shakes, broth, things like that, in the early stages, while those individuals have broken ankles. It’s really hard for them to walk, to consume and absorb nutrients from a lot of solid food. We might even need more liquid nutrition for those individuals as we are healing and repairing that gut lining, so they can absorb the proper amount of nutrients from real food.

Dr. Eric: 

I’m glad you brought that up as far as the duration of the fast, too. Just about everybody should be going at least 12 hours. Even 14 hours is not too long when you think about it. If someone stops eating dinner at 6pm, and they eat breakfast at 8am, which is fairly early, that’s 14 hours right there. Maybe if someone is losing a lot of weight, maybe they don’t want to start out with a 16-hour or 18-hour fast. But 12-14 hours isn’t too bad.

Dr. David: 

Whenever somebody is losing a lot of weight, you have to look at their diet. They may be eating a lot, but they may be eating a lot of saltine crackers, a lot of foods telling their body to be more catabolic. Are they eating steaks? Are they eating grass-fed beef? Are they getting their protein amount right? That is one of the big things I want to look at. Are you getting enough protein? Are you getting enough healthy fats? 

When you start to make those diet changes and incorporate fasting, we get their environment switched back to this place of healing and repair, and they are able to absorb nutrients. 

Dr. Eric: 

I want to switch gears and talk about foods that can break a fast. I had questions about green tea and herbal teas. MCT oil. Even coffee. Without any sweeteners, even the natural sweeteners, if you just have black coffee, regular black tea, green tea, herbal teas, are all those safe to drink? 

Dr. David: 

Good question. Somewhat personalized. The general statement would be that none of those break a fast. The caveat here is if you consume something, even black coffee, and it increases cravings. 

Black coffee is a performance enhancement tool, meaning you should feel great after you drink coffee. Some individuals feel more anxious, jittery, or have increased cravings. When they consume it, their body is having an adverse immune reaction to it. For that individual, that will break their fast. It’s a stressful event. But for most people, that’s not the case. 

When we start to add in sweeteners, that is when more cravings start to develop. If you are noticing an increase in cravings as you’re fasting, that’s a sign your body is having trouble with blood sugar and burning fat for fuel. It’s having a metabolic flexibility event. 

Normally, we are burning glucose in our bloodstream. We eat a meal and have extra glucose. We have glucose tied up in our muscles and liver. Our body starts to metabolize that and break it down. After a certain period of time, insulin comes down, and we start to burn fat for fuel. 

Now, our brain continues to run off sugar, but a lot of our muscle cells and other cells are running off of fat and glucose. Then we get to a point where we don’t have a whole lot of glucose available, even to provide the needs for our brain. Then our body will take stored body fat or fat from our diet and create ketones. 

It brings the fatty acids to the liver and creates a smaller molecule. Fatty acids can’t cross the blood-brain barrier; they’re too large. Ketones are a smaller molecule, a breakdown product of fatty acid metabolism. Those are able to get into the brain and be used as an energy source for the neurons.

Also, ketones are what we call an epigenetic modulator. In a sense, they send signals to different functions in the body. One of the signals that they’ll send turns off what we call the neuroinflammasome, or the inflammasome in general throughout our body is this inflammation amplifying system. It amplifies the message of inflammation throughout the whole body. Ketones can turn that off. 

They also help to regulate the glutamate to GABA balance in our brain. Glutamate is the excitatory neurotransmitter. It’s like hitting the gas pedal, so it helps us think sharply and quickly, have great memory. GABA is the brakes, which help us be more calm, relaxed. 

When we have too much glutamate, which is common when we have neuroinflammation, then we end up with anxious thoughts. We end up with a lot of nerve cell death, which can cause things like depression. The ratio of glutamate to GABA and how ketones will help balance that will help keep us where we’re functioning, where we’re still thinking sharply and quickly, but we are also able to calm our thoughts and be in a very calm physiological state. 

This is where we normally should be. When we’re fasting, we should have lower levels of inflammation throughout our body and our brain. The ketones shut down the inflammasome. Then this optimal glutamate to GABA balance. We should be able to thrive and feel great and be able to perform at a very high level. 

In fact, a lot of people who have done extended fasts have talked about greater intuition, greater foresight, spiritual breakthroughs, emotional breakthroughs. Linking that back to what’s happening physiologically that can contribute to that, it will be the lower levels of inflammation, the better metabolic flexibility in the neurons, the optimal glutamate to GABA ratios. They will allow that individual to have an enlightened state. 

Some great benefits there. We can get a lot of those benefits while we are intermittent fasting. For example, I haven’t eaten anything since 6pm last night. I feel great, as I’m doing this interview. I feel really mentally clear, mentally sharp, not hungry. That is because ketones are elevated in my bloodstream, so my neurons are able to run off of those. They are also utilizing glucose for energy to help me think sharply and quickly. I have that metabolic flexibility, where I am burning fatty acids, ketones, and glucose as energy sources. That is a sweet spot, where we are good at burning all three fuel sources.

Dr. Eric: 

It’s close to noon our time, so it’s been close to 18 hours. You said 6pm last night. You said you’re still feeling good, not dying to have something to eat. Even though a 16-hour fast is sufficient to help with that glutamine to GABA ratio? 

Dr. David: 

Yeah, it is. The key there is it will be different for each individual. It depends on your insulin sensitivity. The better your baseline level of insulin sensitivity, the less you need to fast to get those benefits. 

For example, if I eat a meal, and let’s say this meal is not very blood sugar stabilizing, it will throw off my blood sugar. Let’s say my insulin goes way up, and it takes 12-14 hours to come down. Then I will get less of the ketone production before I break my fast. That’s 16 hours. Does that make sense? 

As opposed to if I eat a much more blood sugar stabilizing meal. My insulin comes down 6-7 hours after that meal. Now, my body is already burning fat. It’s already producing ketones. Now, I have a lot more time to get the ketones elevated in my bloodstream before I break that fast again. 

Dr. Eric: 

That makes sense. I know we have to wrap things up, but I want to make sure: Is there anything else you’d like to discuss? Anything I should have asked you that I didn’t ask you? 

Dr. David: 

No, this has been a great interview. We talked a little bit about autophagy, this process where the body will break down old, damaged cellular organelles and take the raw materials and form healthy cellular organelles. 

The most well-known are called mitochondria, in a process called mitophagy, where we are breaking down the old, damaged mitochondria and forming new, healthy mitochondria. This is critical for the overall functional wellbeing of every cell in our body. Ultimately, at the end of the day, our quality of life is going to come down to the amount of high functioning, stress-resilient mitochondria within the cells of our body. 

For most individuals out there, because they are not cycling through feeding and fasting, they are not providing the environment for healthy mitochondria. Instead, they’re providing an environment where they have a whole bunch of senescent, old, damaged, dysfunctional mitochondria within the cells of our body. Their overall cellular genetics goes down. Their overall inflammatory load goes up. Their overall oxidative stress load goes up. Their resilience in life goes down. We want to have great resilience. We want to have our mitochondria primed for stress as well as possible. Primed means they are ready, prepared for any sort of stressor because stress comes in life.

 By making sure our body has time throughout the week to get rid of all of the older, damaged mitochondria, mitochondria are constantly being damaged and rusted just from metabolism, from producing energy, from all the different stresses that we experience. We just have to get rid of those and build new, healthy, stress-resilient mitochondria. The more of those stress-resilient mitochondria, the better we will adapt to the stressors we face throughout our life, and the better we will be able to function and perform. That will also create a healthy body that is primed for longevity as well, so we are ready to live 80-90-100 years disease-free. 

Dr. Eric: 

When we think about mitochondria, obviously what you eat is important. Basic eating well, stress management, getting sufficient sleep. The fasting component of it is fascinating. 

We covered a lot, Dr. David. You shared a lot of great information. But the good news is he has an upcoming Fasting and Longevity Summit. If you could take a minute or so to talk about that? 

Dr. David: 

The Fasting and Longevity Summit, myself and Dr. Joseph Antoun, who is a Ph. D and researcher, we interviewed a wide range of different natural health experts and got their best strategies for having success with intermittent or partial or extended fasting as well as everything to do with longevity: hyperbaric oxygen, good nutrition, stem cells, all these biohacking strategies that people can be doing to help support their overall health as they age. 

Not only are you going to learn about how to prevent or reverse chronic disease, but how to stay disease-free and age with those great stress-resilient mitochondria, like I was talking about, so you can thrive into your 80s and 90s. 

Dr. Eric: 

That’s awesome. There will be a lot of talk about fasting, but it sounds like it goes well beyond that, so other components help with longevity, too. 

Besides the summit, check out Dr. Jockers’ website, DrJockers.com. Your podcast as well, The Dr. Jockers Functional Nutrition Podcast. I don’t know if you want to direct them toward social media at all. 

Dr. David: 

I’m on YouTube and Instagram as well. If they want to look me up, Dr. David Jockers.  

Dr. Eric: 

Dr. David, I appreciate your time. I’m sure the listeners learned a lot about fasting. I learned some things as well. 

Dr. David: 

Wonderful. I enjoyed my time with you here, Dr. Eric. Appreciate all the great work you’re doing.

 

 

Recently, I interviewed Dr. Jennifer Roelands, and we talked about the perimenopause and its connection to thyroid health. 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 Dr. Jennifer Roelands. We are going to be talking about hormones with a focus on perimenopause. 

[Some audio issues during this bio reading] Let me go ahead and dive into Dr. Roelands’ impressive bio: Dr. Jennifer is a double Board-certified OB-GYN and integrative medicine doctor. She is a consultant, an educator in the women’s health space, and did her integrative medicine fellowship at Andrew Weill Integrative Medicine Center. 

As a fellow sister and sufferer of hypothyroidism, she is passionate about helping women heal their PCOS and advocating for themselves in the health care system, using a whole-body approach to women’s health. She believes the key to healing is a personalized approach for each person because we are all unique. She serves her patients holistically by integrating each patient’s individual complexities and similarities *audio cut* from multiple vantage points of functional, holistic, and integrative medicine. 

When she is not working with patients, she is an avid hiker, foodie, and the go-to math guru for her four energetic kids. Thank you so much for joining us, Dr. Jennifer.

Dr. Jennifer Roelands: 

Thank you so much for having me. I’m excited to be here.

Dr. Eric: 

Excited to chat with you. Just curious, how old are your kids? 

Dr. Jennifer: 

I have a 16-year-old, a 14-year-old, and two 12s. Two twins. 

Dr. Eric: 

You are the math guru, so I was trying to see what type of math. Is it some type of calculus in there, too, or not yet? 

Dr. Jennifer: 

There is. He is starting to outgrow my math skills because I have to go look things up again. What was that thing again? It’s been a while. We are getting to a point where he might have to go to the Khan Academy. 

Dr. Eric: 

Or hire a tutor. 

Thanks for being here. If you could talk a little bit about your background. You are an OB-GYN. I assume you weren’t integrative right from the start? How did you make that transition into being a functional medicine practitioner? 

Dr. Jennifer: 

Like most of us in this space, I had my own health struggles, my own health journey. I was a traditional OB-GYN for several years. I already had a child, and I was working on trying to have a second child. I suffered from infertility. I couldn’t get pregnant. I was not able to get pregnant. I had done a basic workup on myself with my OB, realizing that nothing really came to an answer as to what was going on.

Ultimately, I ended up having to see an infertility doctor. On that journey, we discovered I had Hashimoto’s that was hindering my ability to get pregnant, which is an interesting story as it is. The screening test, the TSH, did not pick up my Hashimoto’s. It was my thyroid antibodies that they realized were very high. Anybody who possibly has Hashimoto’s, and you’re looking to get pregnant, being on Synthroid or levothyroxine is important is aiding in the fertility journey.

Once I was able to conceive that son, I started having all the typical thyroid symptoms. I was exhausted all the time. My hair was falling out. I just felt awful. No matter what I did, even with Synthroid, I was still suffering from all these symptoms: weight gain, constipation, all the ones you hear related to hypothyroidism. 

It forced me to say there has to be something I don’t know. There has to be some piece of the puzzle that’s missing here. I told my patients all the time, “Just take this medication. Things are going to be great.” Here I am on the other side, going, “Things are not great. I am drinking 4-5 cups of coffee a day. I know I have a newborn, but this is excessive.” 

That led me down taking a lot of integrative nutrition courses and realizing nutrition actually matters. In medical school, we are not taught that. We literally have a month of nutrition. I started connecting the dots and realizing that it was bad medicine not to talk about what we are eating and how food helps your conditions. How can food be medicine? 

My own personal struggles with Hashimoto’s, and after that, when I was diagnosed with PCOS, made me think of medicine as it has to incorporate these diet/lifestyle/other things into what we do for treatment. I did the fellowship in integrative medicine, so I could offer more tools to my patients to make sure they are treating or preventing their illness. 

Dr. Eric: 

You mentioned how it’s important for people to take thyroid hormone, which is true. If someone needs it, it’s important for them to take it. Now the difference is you are doing more than that. A lot of medical doctors just give the Synthroid, the levothyroxine, or whatever they are giving, and say, “That’s it. That’s the treatment.” Being integrative, of course, you look at other areas. That’s great that you made that transition to help others.

Let’s get into the hormones. A lot of people have hormone imbalances. Perimenopause is a little bit tricky just because it is that transition between pre-menopause and post-menopause. What are some of the common symptoms? What are normal symptoms compared to maybe not normal but something that women typically experience, like hot flashes, for example? I know we chatted a little bit before this, and you’re in perimenopause. Maybe you could talk about some of the symptoms you might be experiencing, or maybe the symptoms you’re not experiencing but many of your patients experience. 

Dr. Jennifer: 

Sure. The key part of perimenopause is these symptoms can happen 10 years before you hit menopause. We define menopause by one year without periods. It’s this day that just happens on one year and one day, and all the balloons start falling, and the rainbows come out. You have made it to menopause. It’s an interesting definition.

Up to that, 10 years before, people can be experiencing perimenopause. Perimenopause can be broken down typically into three stages. For context, if you are going to go through menopause in your late 40s, you could be experiencing these symptoms in your late 30s. Oftentimes, many women don’t recognize these things are starting to happen.

The first stage of perimenopause is when progesterone is really starting to drop. You are not ovulating consistently. You don’t have cycles where you are getting as much progesterone produced. During that time, that 10-year transition, progesterone starts to decline, decline, decline until it’s low enough to where you do not generate a cycle, which would be in menopause. 

Symptoms that are associated with that drop in progesterone are difficulty getting to sleep and difficulty staying asleep. Progesterone works at the GABA receptors in your brain to calm your brain down to get you to sleep and stay asleep. Women will often say, “I have been waking up at 4am. I go to bed, but I wake up ready to go as if it’s time to start a workday, and I can’t get back to sleep.” 

Progesterone also works at the GABA receptors in the heart, so some women experience fluttery situations, as if they had two cups of coffee, but they didn’t. Even sitting at rest, you feel this tachycardia feeling, this racy heart. It goes away. 

It can often make anxiety worse, so that you feel very anxious, or edgy, like their personality. Women will often describe it to me as, “I typically don’t yell at my kids this much, but I am yelling at my kids really easy. Or I saw a sock on the ground and am like, ‘Who put that sock on the ground? Why would someone do that?’ I am overreacting to things that most people would feel is just a sock.” But feeling that edginess or that anxiety.

Women who are already sensitive to progesterone issues, who may have a history of PMDD or PMS, may have low moods. They feel the effects of feeling down, like real pronounced PMS-type symptoms.

Progesterone can also sometimes be responsible for joint pain, feeling achy in the morning or getting injured more commonly than what you’re used to.

As we transition to the second stage of perimenopause, unfortunately, estrogen doesn’t just decline, but it rollercoasters up and down, up and down, on its way down, ultimately to where it’s low enough in menopause where you don’t have cycles. 

Those are how women describe most of what they feel: “This week, my breasts are tender and killing me. Next week, they’re not.” “This week, I’m an emotional mess, crying at the Bank of America commercials. Next week, I’m not.” “This week, I’m waking up with night sweats and hot flashes. Sometimes, I’m not.” “Sometimes, I am in a super good mood. Sometimes, I can’t get myself going and am in a funk.” “Sometimes, I have brain fog and memory issues, like what’s my neighbor’s name? What’s going on? I missed deadlines. I missed the kids’ parade I am supposed to go to.” 

Those are the sorts of up and down effects that happen as estrogen slowly goes down. The brain is telling the ovaries, “Can you please make estrogen?” The ovaries are saying, “We are working as hard as we are going to work.” Sometimes, there is a peak of it, as more is able to be made, and sometimes there’s not. That’s the way it works.

Eventually, they get low enough where they are both too low to produce a period. Then you hit that menopause definition, where the ovarian hormone production is so low that you can’t cycle. 

Women can have all of these symptoms, leading up to menopause. There is more than 80 symptoms associated with perimenopause. They can be those usual ones I mentioned, but they can also be unusual ones like skin changes. People notice rashes or eczema flares or things that can change. Their skin becomes more wrinkly and saggy and not as luxurious as it used to be. 

Healing can change, where they are not healing injuries as fast, or joint pain. Even some unusual ones like itchy ears or itchy skin can happen. Dental changes. 

If you realize that every cell in our body likes estrogen, you can imagine that every system can also be affected in perimenopause by the lack of estrogen. There can be all kinds of different symptoms associated with this.

I always tell women if you feel off, if you feel like nothing has really changed. “I have the same diet/lifestyle situation, but I just don’t feel right,” it’s time to go talk to someone, especially if you are over 35, about maybe some of these hormone changes are starting to affect your life.  

Dr. Eric: 

When it comes to testing, it sounds like it might be challenging, especially during that estrogen rollercoaster, because your estrogen might be low one time and then higher another time. Do you bother testing at all? How do you get around that? 

Dr. Jennifer: 

I don’t routinely test every perimenopause woman because of exactly what you said. The other thing is the range of normal for premenopausal women is 20-200 for estrogen. You could imagine that a lot of women are told, “Your labs are normal.” It could be that last week, my estrogen was 200, and today, it’s 20. Yes, it’s “normal,” in the normal range, but that doesn’t mean it’s normal for what I feel like.

I try to discuss with women the pros and cons of testing. I will do testing if someone is on HRT, and we are trying to figure out if we are optimized. If you’re still having symptoms, one may be lower than the other. We may need to use it for a data perspective. But I don’t test everyone in perimenopause because the data can often be confusing. 

Dr. Eric: 

How do the adrenals affect sex hormones in general, including during perimenopause? 

Dr. Jennifer: 

The precursor to all sex hormones is cholesterol. It starts at the top. Then we have prednisolone. Then we can make these divisions between the androgens and progesterone. When you are losing sex hormones, the body says, “Where can I get them? I’m asking the ovaries to do it, and the workers are saying, ‘No, thank you. We only work from 8-12. That’s all you’re getting from us.’” 

The other ways the body can do that is something called cortisol steal, which is making more cortisol to flush it this direction. We know that in the peripheral tissues, you can get testosterone to be converted to estrogen with aromatase. Because of that, it’s trying to think, “Where can I get these sex hormones from? I can’t get them from the ovaries because the factory is only open from 8-12. Potentially in other tissues, like with fat cells, I can potentially get testosterone to convert to estrogen, so I need to increase my testosterone. I need to do it from another location to do that.” 

Unfortunately, some people’s cortisol does go up. The cortisol can cause all kinds of symptoms. We know this mid-abdomen weight gain happens in perimenopause. Anxiety for sure can get much worse. People have worsening sleep issues related to cortisol. Often, you feel like you’re eating a little better, you’re exercising, and something isn’t working. It can be this adrenal piece that is derailing the rest of the crew in the hormone balance. 

Dr. Eric: 

Do you test the adrenals, either in the blood or saliva or dried urine testing? 

Dr. Jennifer: 

Yeah. Conventional medicine, there is not very good tests for this. If you went to Lab Corps or Quest, and I am not picking on them, but a traditional office typically uses those labs. You can do a 24-hour urine cortisol or an 8am cortisol, but it’s not helpful. What is more helpful is having these points in time, like you are describing, with saliva or urine testing.

If I do do cortisol testing, I typically like the Dutch test, only because- I don’t know if you’ve ever done the saliva test, but it’s a lot of work to sit there and spit in the tube four times. I have done it before, and I think I’m good. I will just pee on this piece of paper; it’s much faster. I typically do the Dutch test. 

I like the way the Dutch also gives me sex hormones and cortisol. You not only see the production, but what happens in the body as the metabolism of those hormones. If I order it, I typically order the Dutch test because I find it to be the most useful test for that.

Dr. Eric: 

Personally, I have done both. Years ago, when I was dealing with Graves’, I did saliva testing because I don’t think the Dutch was available then. When I became aware of the Dutch around 2016/2017, I did it. It’s a pretty easy test. I don’t personally remember struggling with saliva, but I know people do struggle to generate enough saliva. It’s a good point. 

Cortisol responds to stress, so if someone is doing a saliva test, and they are stressing out trying to generate enough saliva, that could be a potential cause for an elevated cortisol if you do that first thing in the morning. If I see a big spike, I will ask someone, “Were you stressed out about something?” I’m glad you mentioned that. 

Dr. Jennifer: 

Maybe more women have those issues, I don’t know. I know I sometimes get emails that are like, “This is a lot of work. I don’t think I can do this test.” Rather than having to reorder a new test- If you had to choose between one or the other for just straight cortisol testing, saliva is in my mind the better test. I almost always look at the bigger picture with both. Usually for me, the Dutch is the better test.

Dr. Eric: 

I don’t know if you do Dutch testing in perimenopause. The hormones can be inconsistent, especially during that second stage. How about the estrogen metabolites? Are those worth looking at during menopause? 

Dr. Jennifer: 

The reasons I do them during perimenopause is someone could be on HRT and still struggling with the issues. You don’t want to miss the cortisol piece. Upping the hormones may not be the answer, as it may be a cortisol problem. You have to address that.

Especially with someone who says, “I can’t get going. Afternoon is terrible.” In my mind, it’s this radar going, “We need to have a cortisol picture.” In perimenopause or post-menopause, I will put that cortisol piece in there.

For the perspective of the metabolites, I have a wide range of patients. Some patients are interested in things like HRT or bioidentical hormones, and some women want to do it completely with food, lifestyle changes, and supplements, with no hormones. For those patients, the metabolism is completely important for me. If we are going to optimize nutrition and supplements, we need to know what happens to the estrogen they make. Where is it going? Which pathway? The detox pathways in phase one or phase two of the liver, what’s going on there? How can I then help them optimize what’s going on? 

Certainly, genetics can be important, too. Nutrigenomics, to understand what pathways may be a problem. If you’re going to try to do it from food and lifestyle changes, then that really helps you understand someone’s biology of what’s going on. 

Dr. Eric: 

Do you do any nutrigenomic testing in your practice? 

Dr. Jennifer: 

I do. I order the 3X4 test for people who want it. I have been starting to look at some other smaller panels specifically as opposed to a bigger picture because that can be an overwhelming report. You have to be focused. You don’t want to hand someone a 70-page report and say, “Here you go.” I tend to try to focus on what we are trying to solve from that perspective.

For someone who wants to avoid hormones at all costs and wants to optimize it from nutrition, it’s very useful. Or like a breast cancer patient who wants to know, “What can I take for these hormone symptoms if I’m not allowed to take HRT in any way? What are my options from a more natural perspective?” That can be useful to understand the metabolism of what hormones are there. 

Dr. Eric:

Speaking of giving hormones, in the case of someone who is open to receiving HRT, let’s say the Dutch test shows low estrogen but high 4-hydroxy estrogen metabolites. In that case, is it safe to give bioidentical estrogen? Would you want to address the estrogen metabolism problem first? Can you give bioidentical estrogen while addressing the estrogen metabolism problem?  

Dr. Jennifer: 

I often will talk to them about both pieces of the puzzle and assess what is the best thing for them. For example, I had a patient, very similar scenario to what you’re describing. Her quality of life was so incredibly affected by the low estrogen. She was not getting out of bed. She was not working. She was struggling with day-to-day life. 

In my mind, in order for people to make those changes long-term, it’s hard to do that if you can’t get out of bed. From that perspective, I took the bigger picture and said, “This lady needs to start feeling better. Let’s give her some estrogen back. Let’s start incorporating these changes that need to be made from a long-term sustainability perspective. I gotta get her feeling good.” I can’t tell someone to go outside in the morning light and eat cruciferous vegetables if they’re not even getting out of bed because they are so low in mood.

Some of that has to do with the situation going on with the patient and where they are in their journey to make changes. Sometimes, it’s a matter of getting someone to feel better with HRT. Then let’s understand you and how we can make these changes. 

To be honest, being an integrative doctor. I never give HRT and not talk about the other stuff. With any other thing in the world, if I gave someone Synthroid or MP thyroid, I don’t do it without saying, “By the way, how’s your gut? How’s your sleep?” To me, it’s just a Band-Aid of the issue. You’re restoring the hormones, but there are still these other factors that can derail them at any moment. I try to address all those pieces as well.  

Dr. Eric: 

That makes perfect sense. Let’s say you recommend bioidentical progesterone and estrogen to someone. At the same time, you are improving their adrenals and gut health. Do you sometimes see where a person may not need as high of a dose because you are addressing other bodily systems?  

Dr. Jennifer: 

Yes. We always start low anyway to see how someone feels to begin with. That is where I use bloodwork sometimes. I’ve had patients who I have put on the patch, and they are at the mid-dose patch and feel nothing. Hormone testing is very effective there. What is their estradiol on this patch? Maybe the patch is not the right option for them. Maybe they require more. That is what I sometimes use lab testing for.

Certainly, the healthier you are in general, if you’re taking an oral pill, and your gut is better, then the absorption will be better, so the effects will be better. It is important to put the bigger pictures together as well.

If someone has a high stress/high cortisol problem, you can’t out-estrogen them. You can’t pour enough estrogen, and it will all work out. They all work together. These hormones are like a symphony. I can make the bass player play way louder, but no one will hear the violins. They all have to work together.

Dr. Eric: 

It’s true. If you give bioidentical hormones but are not showing them what they can do to better manage their stress and make sure they are getting sufficient sleep and eating a healthy diet, they might get some symptomatic relief from the hormones. Like you said, there is a time and place, but you also want to incorporate the other diet and lifestyle factors. I agree with that.

Let’s get back to the thyroid. You have a history of Hashimoto’s. I’m sure you see a good number of people, mostly women, who have Hashimoto’s. If you don’t mind me asking, how old were you when you developed Hashimoto’s? 

Dr. Jennifer: 

I’m 46, and my son is 14. So 33/34.

Dr. Eric: 

I work with people with Graves’ and Hashimoto’s. I see people in different ages. I see people in their 20s struggling with thyroid autoimmunity. Sometimes, I see children and teenagers. We see those in perimenopause, menopause. Some wonder, can those hormone fluctuations serve as a trigger? Is it just a coincidence when someone develops Hashimoto’s or Graves’ during perimenopause or menopause? Is there a relationship in many cases? 

Dr. Jennifer: 

It’s not a medical term, but there is a term that has been established by a lot of people who take care of thyroid people, something called “thyropause.” This same part of the brain, the FSH that tells the ovaries what to do, is secreted from the TSH. We know it’s the same area. The beta subunits of both of these molecules look very similar.

When the changes happen, the pulsivity of the FSH is getting messed up because of perimenopause. The brain is constantly trying to tell the ovaries, “Could you please make more and do what we’re asking you to do?” The ovaries are saying, “We’re doing our best. This is not happening.” The feedback comes back, and oftentimes, that disrupts the TSH connection. The TSH tells the thyroid, “You should make more T4.” T4 gets converted to T3.

When I start noticing people having abnormalities in their thyroid labs and are in perimenopause, I am doing thyroid antibodies to see if it’s truly Hashimoto’s, or hypothyroidism of maybe some other reason. You can imagine if someone is having perimenopausal changes and cortisol disruption and blood sugar imbalances and gut health issues, potentially, change in the thyroid can happen, and it’s not truly Hashimoto’s. It’s not an autoimmune issue. Those are two different things. Most hypothyroidism is Hashimoto’s, but not all of it. Not every single person has Hashimoto’s. 

The autoimmune people tend to be a little bit different than the people who have hypothyroidism that are not autoimmune. I often will want to know if their sex hormones were fixed, and we redid their thyroid panel, what is the result? Is it the sex hormones throwing them off, or are they truly actually developing a thyroid problem in their 40s? That’s the typical perimenopausal age. 

Dr. Eric: 

That makes sense. When it comes to diet and thyroid autoimmunity, I was listening to one of your podcasts. I heard you talk about autoimmune paleo (AIP), which I was impressed. I commonly recommend AIP. You had some good things to say about it. I think that was a few years ago, so I don’t know if you still feel the same way. 

If you do, or even if you don’t, can you talk about diet? Most people I chat with would agree there is not one diet that fits everybody perfectly. I am not saying AIP is a perfect fit for everyone with Hashimoto’s or Graves’ or autoimmune conditions. I think it makes a good elimination diet as a good starting point for many people. Would love to hear your thoughts on that. 

Dr. Jennifer: 

For people who are struggling with thyroid issues, particularly if they have gut health issues, that can be defined by testing, but it can also be defined by someone who is telling you they are having IBS-type symptoms or constipation issues or bloating. They have pizza, and things go off the rails. 

I am not being more integrative or functionally driven. I don’t test everybody for everything all the time. If a patient tells me they don’t poop in seven days, I don’t need to test them for gut health problems. I know they have a gut problem. 

Oftentimes, I’ll talk to them about AIP to figure out what is triggering the inflammation in the gut? What is causing the leaky gut, the inflammation that is occurring in the gut, to try to distinguish what nutrition plan works for them? You could be somebody who is a functional medicine doctor who tests these and does food sensitivity and a GI Map and all these functional tests. Or you can use an AIP diet to let the patient figure out what are the things that are triggering their inflammation? Taking out the common allergens or antigens that cause inflammation. Then introducing them back. 

It is a slow process. It is a learning process. You have to be patient with yourself. You can get constipation if you didn’t have it. Things can happen with your bowels. What you are ultimately doing is calming down your gut by removing those things that are causing the issue. Then figuring out things by reintroducing these food groups back slowly. Which one is causing you the most grief?

It doesn’t always have to just be GI stuff. Some people do AIP because they get bad eczema flares or other autoimmune symptoms, and they want to figure out what is the food that is causing them those problems? 

For patients who find that AIP is just too hard or strict or too much for them to follow, then I often talk to them about just a paleo diet. It’s an anti-inflammatory diet. Following more of a paleo protocol to get rid of those things that are causing them issues. You could even put them on an elimination diet. There are a lot of ways to do this. 

Most of the time, when I am deciding how to work with a patient, I ask them, “What are the obstacles to changing what you do? If I tell you that you can’t have gluten, dairy, nightshades, alcohol, can you do this?” I don’t want to set you up for failure. I want you to succeed. If you can’t, let’s talk about what if we just got rid of gluten for three weeks? Sometimes, we make a modified protocol. I’m sure you do this with your patients as well. It depends on what they are capable of doing.

Dr. Eric: 

Exactly. There are some people who are already following an AIP diet before they become a patient, just because they have heard me or others talk about it. You’re exactly right. There are some people where giving up gluten or their morning coffee are big struggles, so let’s do baby steps with them. Can you start with gluten, and we will worry about everything else, the dairy, the nightshades later? 

I also take a similar approach. If someone is willing to follow a standard paleo diet, where they could eat eggs, nuts, seeds, but avoid everything else that is part of AIP, that’s great, too. There are some people where we just start off with gluten-free, see how they do. I think we do take a similar approach when it comes to diet.

Dr. Jennifer: 

Izabella Wentz is a big person in this field with thyroid. I understand her ideas of yes, most people with thyroid problems will need to be off of gluten and dairy. We know that because of the types of cells, where they’re located in the gut, tend to cause problems with people who have thyroiditis. 

And this could be for women with PCOS or anything. You can’t just pan across the board and say everyone with thyroid has to do this, that it works for everybody. There is so much more complexity to people’s medical problems. I tend to like AIP or paleo to weed out the things that are causing problems as opposed to just putting everybody on the same protocol. 

Dr. Eric: 

Quick question with AIP. Do you consider ghee to be acceptable? Clarified butter as part of AIP. 

Dr. Jennifer: 

I do, yeah. I have a lot of patients who do that. 

Dr. Eric: 

That is considered dairy, so it’s controversial. There are some AIP advocates who allow it, and others who don’t. I wanted to get your opinion on that. 

Dr. Jennifer: 

I think working with women for 15 years, maybe part of it is also I am not a big diet person. I don’t like that word. If you tell me you will put me on a diet, I want whatever you tell me I can’t have. Same thing with weight loss. It’s about finding the foods that love you back. Let’s find the foods that are actually going to be the ones that work for your biology and create that as an eating pattern as opposed to a diet, per se. 

I do know that sometimes, women (and men, too, because I do see men as well) get stuck in this- I have had patients who are on an elimination diet for two years and came to see me. This is not what you’re supposed to do. You’re supposed to be eliminating and reintroducing. You don’t want to narrow your scope too much, so you end up with a nutrient deficiency. Make sure you find foods that are working for you and not eliminating everything. Do you know what I mean? 

Dr. Eric: 

Yep. I definitely do. 

This ties into hormones, too. Not necessarily talking about food. Do you also talk to patients about avoiding plastic water bottles because of xenoestrogens as hormone disruptors? Overall trying to reduce their toxic load? 

Dr. Jennifer: 

I do. I talk a lot about lifestyle factors. What do you put on your skin, your beauty products? What do you use to clean your house? Plastic water bottles, toxins in general. Where are you eating out? 

I also talk about things like getting the morning sun, Circadian rhythm syncing. I also talk about intermittent fasting. I also talk about mind/body and how important it is to have some sort of way to activate the parasympathetic response. It can be things like tapping or meditation or journaling. All of that gets put into my treatment plans. 

It doesn’t matter what we are talking about. Could be perimenopause or PMS. Let’s talk about what are you doing for these other aspects of your life, too? Nobody is a one size fits all. There are different approaches for different patients depending on what they feel resonates with them. I do bring into those other aspects as well, the lifestyle changes.

Atomic Habits is one of my favorite books. I am not sure if you’ve read it or not. I am always talking about these small changes. Small changes that lead to habits that ultimately become part of your life. 

Dr. Eric: 

I did read that book a few years ago. Good book. I can’t remember if I read it or listened to it because I listen to a lot of audiobooks.

Circling back to gut health. You mentioned that sometimes, you do testing, and sometimes you don’t, which describes myself, too. I can’t say I recommend a comprehensive stool test on all my patients. Let’s put it this way. If someone is following AIP and has gut symptoms, and then they resolve, maybe you don’t do a GI Map or other stool test because their gut is feeling better just with diet. In what situations do you recommend testing, such as a GI Map?  

Dr. Jennifer: 

I probably order more food sensitivities than GI Maps. Oftentimes, a patient may or may not want to do that long protocol to figure it out. They’d rather start with some baseline of what’s going on. Or they are doing it, and it’s not working, and they are still having problems. Therefore, they are trying to narrow down what is it that is causing them to react? I definitely do more food sensitivities. 

GI Maps, I sometimes see some outside the box things like Lyme and mold and unusual things that happen. I will be more apt to order GI Maps for those patients. Treatment has to come from a lot of different angles to figure out what order works to treat first. 

For a standard thyroid patient, I will order that if they are already doing an elimination diet or AIP or paleo, and it’s not working. What is the missing piece here? 

Dr. Eric: 

Makes sense. With food sensitivity testing, just so I’m clear, you do that if someone finds AIP too restrictive, and they don’t want to follow that diet. You will do a food sensitivity test instead of an elimination diet to see what they are reacting to? 

Dr. Jennifer: 

For those patients, or someone with a lot of skin issues. They want to know what they have to start eliminating from their diet, and they don’t want to do the slower, figuring it out technique. I will get that testing. If it lights up all these dairy proteins, we are going to eliminate dairy. 

Whenever you do a food sensitivity, you have to keep in mind that some of these things are mildly positive. It depends if you are doing IgA, IgG, IgE. There are different types of testing. You should never just order it on your own and go off whatever it says. You have to make sure someone is helping you guide through what type of test you got. 

They now have these direct-to-consumer tests. Patients can order their own tests. They have to interpret them themselves. I do find it sometimes gets confusing with the test they ordered. It can sometimes give you some basic ideas of where to start with getting rid of certain foods. 

If it’s hard for someone to think about taking something out of their diet, sometimes giving them data on themselves helps to say, “Hey, looks like you have a lot of dairy issues. Why don’t we get rid of dairy and see how this goes?” For some patients, they like to see their own data to make changes.

Dr. Eric:

 I agree. Sometimes, seeing is believing. 

Dr. Jennifer: 

Like CGMs. I use a lot of continuous glucose monitors on perimenopause women. They see their data, and they go, “Okay, this is the type of food that loves me back. This is the food that does not love me back. Let’s make some changes.” I tend to like that personal data to figure out how can I, for lack of a better word, hack my own biology or understand my own biology? 

Dr. Eric: 

Which food sensitivity testing do you use? Do you do all three you mentioned? 

Dr. Jennifer: 

It depends on what it’s for. I use different ones. I’ve used Vibrant Wellness before. I’ve used Genovva. I use them the most because I find their company is a little easier to work with. 

The type of testing depends on what we are looking for. Most people with IgE issues already know they have an allergy to something because that is an immediate reaction versus IgG or IgA, which are more of what we are talking about, the gut issues that someone might not necessarily connect the dots that eating pizza causes a gluten problem. Therefore, they should not eat pizza. Some people can’t connect those because when you are eating pizza, you are also having cheese and sometimes wine or beer. They may not always connect the dots as to what is the actual thing causing problems. The IgG and IgA testing is typically what I will do in those scenarios to understand the group that may be the issue. 

Dr. Eric: 

When someone does an IgG test, and they have a few dozen positive findings, and a lot of those are healthier foods. There is the thought that that could be because of an increase in intestinal permeability, leaky gut. Do you still have them avoid those foods, or just have them avoid the foods on the higher side of positive? 

Dr. Jennifer: 

I start with the higher side of positive and talk about the fact that this is not forever. Because it says you can’t have it right now, that doesn’t mean you are forever not allowed to eat it. That’s an IgE type reaction. I first talk about this is this moment in time, what’s going on with you. Some of these things that are more milder may very well be something you can tolerate in a couple months. We have to get your gut healthier and not have this leaky gut, so you can tolerate these types of foods. 

You see these people who have non-Celiac gluten sensitivities sometimes heal their gut and tolerate things later on. It’s just that at the moment, there is so many things causing reactions in their gut that they can’t tolerate those things in general. 

Dr. Eric: 

You covered a lot here. Anything else that is worth mentioning, or you’re burning to get out as far as helping women with hormones and perimenopause? 

Dr. Jennifer: 

I think the most important part is your symptoms are real. If you feel like something is off or wrong, or you just don’t feel like yourself, it’s very common that women are told, “Ugh, it’s part of getting older. Suck it up, buttercup.” Even by physicians, they are told, “Suck it up, buttercup. You’re not in menopause. There is nothing I can do.” 

That is incorrect. HRT doesn’t happen when you hit menopause. It can be used for anybody. You can use it on a 20-year-old who has PMDD. It’s not magic that happens, and certainly nutrition and lifestyle changes can be at any age.

Often, I hear women who are dismissed. They are saying, “My mom said I went through it, so you can go through it. My doctor said it’s not a thing until you hit menopause. My friends say HRT is for the weak.” I try to tell women the most important message is: If you feel like something is wrong, and you want help, then find the person who is going to listen to you. Find a provider who is going to hear what you have to say. 

It very well may be a hormone thing and not you. I have had patients who say, “It might just be me. I might be mean right now.” No, it’s probably your hormones. It’s okay to reach out. Let’s talk about these things and figure out if it’s perimenopause. 

Dr. Eric: 

Well said. Thank you for sharing. Where can people find out more about you, Dr. Roelands? 

Dr. Jennifer: 

I’m on Instagram, @DrJen.MD. I also have a virtual practice. I see patients in 10 states. I am licensed in 10 states. My website is WellWomanMD.com. You can go there or on Instagram and find me.  

Dr. Eric: 

Thank you so much. Appreciate your time. I’m sure the listeners learned a lot about hormones, especially related to perimenopause. A lot of what you cover, regardless of age, they can benefit from. 

Dr. Jennifer: 

Thank you for having me.