The Dr. Hedberg Show

In this episode of The Dr. Hedberg Show, I interview dietitian Diana Rodgers in a discussion about plant-based diets, meat, and her upcoming documentary and book project Sacred Cow.  Speaking to Diana was a breathe of fresh air among all the misinformation out there about plant-based diets and meat.  We discussed the potential pitfalls of plant-based diets including protein and micronutrient deficiencies.  Diana covered important information about the true environmental impact of meat and how important grazing cows are to the environment.  You should come away from this interview with a better understanding of plant-based diets, meat, and it's environmental and socioeconomic impact.  I urge you to support Diana's Sacred Cow project and to look out for the upcoming documentary.

Full Transcript of the Interview:

Dr. Hedberg: Well, welcome everyone to "The Dr. Hedberg Show." This is Dr. Hedberg and I'm really looking forward to my conversation today with Diana Rodgers. She's a registered dietitian. And she's known as a real food nutritionist. And she actually lives and works on an organic farm near Boston, Massachusetts. She's an author. And she runs her own clinical nutrition practice. Her work has been featured in the "Los Angeles Times," "The Boston Globe," and "Outside Magazine." Diana writes and speaks internationally about the intersection of optimal human nutrition and environmental sustainability.

And she's the producer of the Sustainable Dish Podcast, which I highly recommend. And Diana is an advisory board member of Animal Welfare Approved, the Savory Institute, and Whole30. And her new film and book project "Sacred Cow" examines the environmental, nutritional and ethical case for better meat. And her website is sustainabledish.com. So Diana, thanks for joining us.

Diana: Yeah. Thank you so much for having me.

Dr. Hedberg: So I was really looking forward to this because there's this kind of avalanche of plant-based propaganda out there. There's been some Netflix documentaries, and some well-known movie stars, and medical doctors, putting a lot of information about this. And it's become a little frustrating and a little extreme. And so I wanted to bring you on to put the brakes on this a little bit and educate people. In fact, I saw this commercial the other day for Raid bug spray. And their big thing is that the insecticides are plant-based. So you're seeing this all over the place, plant-based this, plant-based that. So why don't we begin by just talking about some of the main dietary deficiencies in a plant-based diet? So I'm mainly seeing iron and iodine, B12. So can you talk a little bit about the micronutrient deficiencies, and potential protein issues with plant-based diet?

Diana: Yeah. I mean, I'd love to start with protein actually. I'm a huge protein advocate. And I looked into the recommendations for protein. Where did they come from? Why does everyone think we only need about 50 grams of protein per day, a little less for women, a little more for men? Like, where did that all come from? And turns out that they're really wrong, they're really low. And the recommendations for protein are based on the minimum that we need for basic survival. And they're also based on an ideal body weight of women at about 125 pounds, I think, and men at 154 pounds.

And so if we look at the average weight of our population, it's way higher than that. And so the 0.8 grams per kilogram of body weight is at, you know, where people think that we only need about 45 grams of protein for women, and about 54 for men are based on way thinner people than the average population. So in my clinical practice, I always start people at about 100 grams of protein, and nobody is eating that much protein. And it's really hard to get your protein from a plant-based diet for a few reasons. One is it's really hard to get it from plants, just because they're lacking in certain amino acids. So we don't really need protein, we need amino acids. And plants are pretty low in some of the more important ones for our health and for satiety. So it's just really hard to get what we need from plants. And it's also hard to get what we need from plants without over-consuming overall calories.

So for trying to get, let's say, 30 grams of protein from a piece of steak, that's about a 4-ounce piece of steak at about 180 calories. But you would need to eat about 700 worth calories of peanut butter to get the same amount of calories. So people, you know, think that they're all set with a little scoop of peanut butter instead of, you know, maybe some eggs or some sausage for breakfast. And that's absolutely not true. So, you know, if we are low in protein, we see all kinds of problems, number one, it's just really hard to feel full and you'll end up eating more calories. So protein is the most satiating of the macronutrients.

And we've got a problem today in America with overweight, obese, and type two diabetes. And upping protein can really correct a lot of those problems and especially for people who are stressed, have autoimmune diseases, are recovering from illness, growing, or are over 40. So that's pretty much every single person likely listening to your podcast. They have an increased need for protein. So double the RDA is a really great place to start, this 1.6 grams of protein per kilogram of body weight, which is, you know, at least 100 grams for women and likely much more. So upping your protein, getting it from animal sources will make you feel fuller, is a lower calorie way of getting your nutrients, so it's more nutrient-dense. And it's tastier than getting it from plants in my opinion. So that's the first thing.

And then as far as nutrient density, animals are way more nutrient-dense than humans per serving. So when we look at nutrient density, that's the amount of micronutrients you get per calorie of food. Things like lettuce actually, technically are quite nutrient-dense, you know, per calorie, but a serving of lettuce is really low in calories. And so you would need to eat, you know, 27 cups of lettuce to get the same nutrients you can get in a small piece of animal flesh. So when we look at nutrient density per serving, what we're seeing is way more nutrition from animal-based foods and from plant-based foods.

And I'm not saying that, you know, people should never eat plants, there's some benefits to eating plants for sure. And I personally am not animal-only eater. But definitely, things like B12, DHA, choline, iron, these are all things that are really hard to get from plants that are really easy to get from animals. And worldwide, B12 and iron are the most common nutrient deficiencies, especially in women. And so, you know, we're not gonna fix that with more salad, we definitely need more animal protein.

Dr. Hedberg: Right, right. I've been using about 1.5 grams per kilogram. So I've got to bump that up to 1.6 for most people...

Diana: Yeah. I mean, I think it's not a true science. Definitely, everyone has a different need, and we're not computers. And so, you know, I did a nutrient density challenge in January where I was trying to maximize my protein and micronutrients. And I was feeling really great about 140 grams of protein per day. And that's how much I weigh. So even as high as one gram of protein per pound of body weight can be really helpful. So it really all depends on the person.

Dr. Hedberg: Right, right. Yeah. When I was bodybuilding in the '90s, we consumed one gram per pound of body weight, but sometimes more than that. Sometimes 1.2, 1.5, we would go pretty high and felt great. So one of the things I always explain to patients is the fountain of youth isn't really all that much of a mystery at this point, at least based on the research that I've read. The increase in sarcopenia and maintaining muscle mass as we age can do more for you than almost anything that I've really ever read about. And as we age, we need actually more protein and we need to maintain muscle mass. And that's from what I've read, can significantly decrease all-cause mortality. So that kind of buttresses what you were just saying.

Diana: Totally. Yeah. I mean, the diet that I mentioned was actually a nutrient-dense protein sparing modified fast, and it was fantastic. I felt so amazing when I was doing it. So I know that's like a typical bodybuilder's diet. I'm definitely not a bodybuilder, but I ended up losing in one month, seven pounds and gained two pounds of muscle. So, you know, if we eat more protein and then stimulate our bodies to build muscle at the same time, we will lose fat and not just weight. So a lot of people will say, "Oh, I, you know, went plant-based and I lost weight," but likely they lost a ton of muscle. And we don't want to be losing muscle, especially anyone over 40 wants to be gaining muscle and preserving muscle mass as much as possible.

Dr. Hedberg: Right, right. Exactly. So one of the other things that's out there are a lot of these plant-based food replacements, like plant-based burgers, and plant-based drinks, and things like that. And the ingredients that I've seen, these are really low quality. Some of them have, you know, like canola oil, and a lot of other really bad ingredients. So can you talk a little bit about some of these plant-based types of products that are out there that are becoming more popular?

Diana: Yeah. And I have an issue with them on so many levels as an organic farmer. I mean, they're just separating people from their food producers more. They're not sustainable and cleaner although they're marketed that way. And they're certainly not healthier, and I would argue, not even more ethical. So, you know, things I actually looked up Beyond Burger on Walmart's website and compared it to you can get organic grass-fed beef at Walmart is probably not the same as getting it from, you know, your farmer up the street,...

Our discussion today revolves around a microscopic parasite called Blastocystis hominis, a case of hives and Hashimoto’s disease!

The case report was published in 2015 in The Journal of Infection in Developing Countries.  The report was entitled, “Eradication of Blastocystis hominis prevents the development of symptomatic Hashimoto’s thyroiditis: a case report.  The case involved a singular subject who was suffering from chronic urticaria (hives), angioedema (skin swelling) and overly soft stools who also showed signs of Hashimoto’s disease.

But before we delve into more details, let me provide you with some basic background information.

Background on Blastocystis Hominis

Blastocystis hominis is the most common protozoan parasite in humans with incidence between 5-75% depending on the country's level of development.  In the past, it had been considered as a non-pathogenic parasite. However, studies by the research teams of Katsarou-Katsari, et al. (2008), Valsecchi et al. (2004) and Vogelberg et al. (2010) showed that Blastocystis hominis infection is associated with chronic urticaria.

What is urticaria?

In general, urticaria is a very common skin disorder that can have immune, non-immune or idiopathic causes.  It appears as swollen, pale red bumps or plaques.

When the skin lesions appear within a six-week period, the patient would be described as having a case of acute urticaria.  Anything longer than six weeks, however, is clinically defined as chronic urticaria.

You may be wondering at this point what a parasite and a skin condition have to do with Hashimoto’s disease.

Existing research has revealed that chronic urticaria and the presence of anti-thyroid antibodies, or autoimmune thyroid disease, have some kind of association with reported prevalence from 12-29%.

How does the parasite Blastocystis Hominis trigger Hashimoto's disease?

A study conducted in 2004 by Pasqui et al. and a clinical review published in 2008 by Tan discussed how Blastocystis hominis activates specific Th2 immune cells that produce interleukins which are proteins that are important in the immune response.

The researchers in this study identified a deficiency of studies on the pathogenic role of Blastocystis hominis in the direct development of autoimmune disease. They then proposed that there may be a connection between this parasite and the onset of Hashimoto’s disease.

The Case Report on Blastocystis Hominis and Hashimoto's Disease

The 49-year old subject suffering from chronic urticaria, angioedema and soft stool consistency was found to have Hashimoto’s thyroiditis even though he had never exhibited symptoms of this disease before.

The patient’s physician had already prescribed an anti-histamine which typically resolves hives.  The patient also underwent a restrictive diet which did not contain any established allergens such as fish, cheese, dairy products, nuts, wild animal meat, vine, artificially colored products, etc.).

That did not resolve the urticaria.

What Lab Tests Were Done?

The patient then endured quite a battery of tests.  Those included:

Blood count

Differential blood count

Glucose

Urea

Creatinine

Minerals

C-reactive protein

…and over 25 other tests.

The patient even had an ultrasound of the abdomen which looked normal. In addition, the prick skin test was performed for 13 standard inhalatory and 15 nutritive antigens.  Everything was in reference range which indicated that nothing was amiss there.

Next, stool cultures for the presence of parasites Blastocystis hominis were isolated on three separate occasions.

The plan was then to focus on the thyroid and autoimmunity as hypothesized by the researchers so the following lab tests were done:

IgE (immune system antibodies)

TSH

FT3

FT4

Anti-thyroglobulin (Anti-TG)

Anti-thyroperoxidase (Anti-TPO)

What Did the Thyroid Lab Tests Reveal?

Total IgE was slightly elevated

TSH was elevated

FT3 were in normal range

FT4 was slightly decreased

Anti-thyroglobulin (anti-TG) antibody was elevated

Anti-thyroid peroxidase (anti-TPO) antibody was dramatically increased

Thyroid gland ultrasonography showed diffuse hypodense areas

The disorder of thyroid hormones, elevated anti-thyroid antibodies and thyroid ultrasonography suggested that the patient indeed had symptomatic Hashimoto’s thyroiditis!

The patient was then administered thyroid replacement medication (levothyroxine) in the dose of 50 micrograms daily for five days.

The thyroid medication was bumped up to 100 micrograms twice a week whereas metronidazole was given orally at a dose of 400 mg three times daily for 14 days to eliminate all traces of the Blastocystis hominis.

The chronic urticaria resolved within one week of treatment with the antibiotic and within two weeks, the parasite had been eradicated.  However, the thyroid medication had to be adjusted because the subject exhibited sweating, tremors and heat intolerance which are symptoms of hyperthyroidism.  Finally, after six months, TSH, FT4 and FT3 levels were normalized and anti-TG and anti-TPO levels were found to be decreasing which meant that the patient was becoming less and less autoimmune over time.

When the patient was followed-up four years later, there were no signs of parasite or bacterial infection and the patient was symptom-free with normal physical activity, while anti-TG and anti-TPO levels were declining.

The authors of this article demonstrated for the first time in literature that eradication of Blastocystis hominis can prevent the development of both symptomatic Hashimoto’s thyroiditis and chronic urticaria.

Relative Weaknesses and Strengths of the Case Report

As many of you have likely surmised, the small subject size of only one for this study is extremely small.  However, I would not consider it a weakness per se because this study was qualified as a “case report”. In scientific literature, when something is categorized as a case report, it is a unique situation and a small subject size is expected.  While the number of patients investigated in these types of descriptive studies may be only singular which would not allow for a controlled investigation, case reports are nonetheless significant because they are considered the first line of evidence where new issues and ideas emerge.

What was executed well in this case study was that there were exhaustive diagnostic tests performed which ruled out other conditions.  Tests that confirmed the presence of the parasite and measurements of thyroid function and thyroid autoimmunity were then isolated which helped establish the parasite’s connection to the onset of Hashimoto’s.  If you recall, levels of thyroid antibody were elevated when the parasite was still active in the body and manifested as urticaria, but when the Blastocystis hominis was killed off, those thyroid antibody levels decreased and levels of circulating thyroid hormone were restored to normal.

Additionally, a four-year follow-up period was plenty of time to affirmatively demonstrate that the Hashimoto’s disease symptoms did not return.  As the patient did not have any additional parasite exposure and urticaria, there were also no more lab findings that revealed an autoimmune hypothyroid condition.

Conclusions on Blastocystis Hominis and Hashimoto's Disease

The researchers in this case study concluded that in a susceptible host, Blastocystis hominis can set off an immune response which could ultimately push an individual towards autoimmune disease.

Taken one step further, the authors conclude that there is a connection between the parasite, the skin condition and Hashimoto’s thyroiditis!

The authors found that this protozoan is not so innocuous after all!  They recommend that when urticaria is present, it would be sensible for physicians to examine if Hashimoto’s might have developed in a patient.  If such is the case, immediate action would be required to eradicate the Blastocystis hominis and turn around the autoimmune thyroid condition so that the Hashimoto’s does not become a chronic issue.

I do stool testing on all of my Hashimoto’s disease patients and we often identify Blastocystis hominis as well as other parasites, viruses, H. pylori, and bacterial dysbiosis.  Once we eliminate these infections patients do get better so this is definitely something you don’t want to overlook if you have Hashimoto’s disease.

Are you doing everything right for your Hashimoto’s disease and hypothyroidism but still experiencing fatigue? A chain is only as strong as it’s weakest link and the b-vitamin thiamine is an important link in thyroid function and energy production that could improve Hashimoto's disease-related fatigue. Restrictive diets like the Autoimmune Paleo Diet, gluten-free diet, and ketogenic diet can possibly lead to a thiamine deficiency if there isn’t enough variety in the diet. Once this important vitamin becomes deficient, a number symptoms can appear as well as sluggish thyroid function.

An interesting study was published in the Journal of Alternative and Complementary Medicine entitled “Thiamine and Hashimoto’s Thyroiditis: A Report of Three Cases” which looked at thiamine deficiency and Hashimoto’s disease. The authors begin by stating that levothyroxine is the treatment of choice for hypothyroidism however some patients still complain of fatigue after taking this medication and their lab tests look normal.

How was this study done on thiamine and Hashimoto's disease-related fatigue?

The sample size was quite small at only 3 women with a diagnosis of Hashimoto’s disease and hypothyroidism. All of them were taking the prescription thyroid hormone levothyroxine. These women reported the following symptoms: fatigue, sleep disorders, depression, anxiety, chronic nervousness, memory loss, focus and attention disorders, cold intolerance, and dry skin.

The participants filled out the Fatigue Severity Scale which is a subjective questionnaire that assesses the severity of fatigue. They filled this out at the beginning of treatment and 20 days after beginning treatment.

TSH, Free T4, and Free T3 were tested all of which came back normal. TPO antibodies were also measured and these came back elevated in all three subjects. Additionally, thiamine levels were tested to identify deficiency but none of the patients were deficient in thiamine.

Two of the patients took 600mg/day of thiamine orally and one patient received 100mg injections of thiamine every 4 days. This was done for 20 days and then the patients reported their results.

What were the results of this study?

All three patients reported improvement in their fatigue levels. Patients 1 and 2 reported 100% elimination of their fatigue and patient 3 reported moderate improvement. Looking more closely at the numbers, patient 3 had the highest levels of TPO antibodies at 1,725 compared to patient 1 at 322 and patient 2 at 526. Patient 3 may not have gotten the same improvement as the other two patients due to her antibodies being so high. Elevated antibodies do correlate with symptom severity in Hashimoto’s disease so this is a possible explanation.

The authors do state that ongoing intake of thiamine should be accompanied by all of the B-vitamins in a B-complex form. This is because all of the B-vitamins work together and taking high doses of one without the other could cause problems over time.

Author discussion

Why would we see improvement in fatigue if none of the patients were deficient in thiamine to begin with? The authors explain that there could be issues with the transport of thiamine in the cell into the mitochondria where energy is produced. Or, there could be an enzyme defect in the utilization of thiamine. In either scenario, large amounts of thiamine would be required to make energy. So the issue could be genetics in these individuals who have difficulty utilizing thiamine thus requiring higher doses of the vitamin.

This is similar to those who have a vitamin D receptor defect and thus require more vitamin D.

Author conclusions

“Our case experience with these 3 patients supports the hypothesis that the chronic fatigue and related disorders accompanying Hashimoto’s thyroiditis are manifestations of a mild thiamine deficiency that may be due to either a dysfunction of the active transport from the blood to the mitochondria or to structural enzymatic abnormalities likely caused by immune system factors. We deem that it would be

interesting to find out if other forms of hypothyroidism and the fatigue associated with them would respond to thiamine therapy in a similar manner to these cases.”

What is thiamine?

Thiamine is one of the B vitamins (B1) which is water soluble and very important for energy production. Thiamine is required to turn the carbohydrates you eat into energy as well as the utilization of amino acids and fats. Thiamine is also important for muscle contraction and nervous system impulses. Thiamine isn’t stored in large quantities in the body so we must get it constantly from the food we eat.

Magnesium is required for proper thiamine function so everyone should be evaluated for magnesium deficiency if they are fatigued and are considering thiamine supplementation.

Hypothyroidism and Hashimoto’s disease can lead to low stomach acid production but it has also been known since 1978 that thiamine deficiency can also lead to low stomach acid. Low stomach acid can lead to all kinds of gut issues and nutrient deficiencies. This makes thiamine extremely important for the digestion of proteins and fats.

What causes thiamine deficiency?

If you have gut problems then this can lead to malabsorption of thiamine. You may also be missing thiamine in your diet if you are following a restrictive diet for your Hashimoto’s disease. Alcohol is the most common cause of thiamine deficiency so that glass or two of wine you’re having every night combined with gut issues and dietary deficiencies could really zap your thiamine levels.

If you are exercising at a high-intensity on a regular basis this can lead to thiamine deficiency. Also, high-carbohydrate diets or binging on carbs can deplete your body of thiamine.

Coffee and tea can lead to a thiamine deficiency if these are consumed in excess. These drinks contain a compound that inhibits thiamine utilization. This could lead to a vicious cycle because many people drink coffee or tea to increase energy levels but their fatigue could be due to a thiamine deficiency.

Thiamine deficiency symptoms include:

Nausea

Headache

Irritability

Depression

Abdominal discomfort

Trouble digesting carbohydrates

The following foods are rich in thiamine:

Enriched, fortified, and whole grain products such as breads, cereals, rice, pasta, and flour

Beef liver, pork, poultry

Wheat germ

Blackstrap molasses

Dried milk

Legumes and Peas

Nuts and Seeds

So as you can see, if you’re following the Autoimmune Paleo Diet or other restrictive diet, you could be deficient in thiamine. Almost all of the above foods can’t be eaten on the AIP diet.

What should you do if you have Hashimoto’s disease-related fatigue?

If you’re taking thyroid medication and you’re still tired, you may benefit from thiamine supplementation but this should be done under doctor supervision. There are many reasons why you could be deficient in thiamine such as poor gut health as noted above. It’s important to work with a functional medicine practitioner who can do the detective work for you to get your energy turned around.

As with the vast majority of supplements, taking them isn’t a long-term solution. Figure out the causes and you can be virtually supplement-free. The connection between thiamine, Hashimoto’s disease, fatigue, and hypothyroidism is definitely not something you want to overlook.

If you want to take thiamine it is hard to find high doses as most products contain 50mg per capsule which would require 12 capsules a day. I recommend benfotiamine which is found in the product BenfoMax by Pure Encapsulations. This has 200mg per capsule so taking 1 with breakfast, lunch, and dinner for one month and then reducing to just one per day can work for most people. Remember to take a good b-complex with thiamine such as the B-Supreme from Designs for Health.

You can order BenfoMax and B-Supreme from Dr. Hedberg’s dispensary here:

In this episode of The Dr. Hedberg Show, I interviewed Andrea Nakayama in a discussion about strategies for healing Hashimoto's disease.  We talked about her "3 Tiers to Epigenetic Mastery" and how they relate to Hashimoto's disease and thyroid health.  Within the 3 tiers we discussed stress, gut health, infections, micronutrient deficiencies, adverse childhood experiences, SIBO, reproductive hormones, goitrogens, iodine, and all the various diets that people are following these days.

Andrea is a clinician but also a Hashimoto's patient so it was a real pleasure to get her insight and expertise on healing Hashimoto's disease.

Dr. Hedberg: Well, welcome everyone to "The Dr. Hedberg Show." This is Dr. Hedberg and I'm really looking forward to my conversation today with Andrea Nakayama. And she actually had me on her show, "The 15-minute Matrix," talking about infections and Hashimoto's disease. And she's extremely knowledgeable. She knows a lot about thyroid issues and Hashimoto's, which we're gonna get into today. So Andrea, welcome to the show.

Andrea: Thank you so much, Dr. Hedberg. I'm so pleased to be here.

Dr. Hedberg: So for the people who don't know that much about you, why don't you just give everyone a little bit about your background and what you're working on these days in functional medicine?

Andrea: Yeah, thanks for asking. I'm a functional-medicine nutritionist, and I've created a curriculum for practitioners where I train into the theories of a functional-nutrition approach, both the science and the art of working in what I consider to be the gap in functional-medicine or holistic-medicine approaches. So I have a school called Functional Nutrition Lab. We have about 4,000 graduates in over 65 countries at this point. And we also have a virtual clinic where we work with patients directly and serve, again, the underserved population. I think of the people we serve as the big bigs. They have big health issues and they've already made a big effort, sometimes working with the top doctors around the country. So that's the work that I do that I feel really passionate about. And I myself, I'm a patient. I have Hashimoto's. I have had quite a life journey that led me to uncovering my own autoimmune disease. And I manage it so that I can live the best life possible.

Dr. Hedberg: Let's jump into the what you call the three tiers of epigenetic mastery. And so, this is a kind of a system or approach to healing and functional medicine. So can you walk everyone through this approach that you've created?

Andrea: Yeah, absolutely. I definitely see, like I said, that there is a gap in functional medicine. And I am completely in service to the functional medicine model. I really believe that we have to see the person as a whole. We have to look at the roots. We have to work in therapeutic partnership. And we have to see through systems, a systems-based approach, both biological systems and understanding the web of interconnections, but also a systematic approach that allows us to work with those who are sick and not getting better. So if we honor the truth of bio individuality and see every single individual as unique in their own way, not just a diagnosis like Hashimoto's or like I experienced with my husband having a brain tumor, you know, he was treated like a brain tumor, if we're to see each individual and each patient as unique, we still need a systematic approach. Otherwise, we're constantly in the dark looking for solutions.

And that's why I created the three tiers to epigenetic mastery. I saw it as a way to teach into honoring the individuality of each patient. So the three tiers are, tier one, what I call the non-negotiables. Tier two, deficiency to sufficiency. And tier three, dismantling the dysfunction. And what I see in functional medicine is that we often go to the tier three approach. We often want to skip to the sexy infection or the thing that's happening in the body that may be one of the roots. And yet, there is so much terrain surrounding that root. There's the soil that we also need to address. So these are those three tiers. And we could look at them, in particular to Hashimoto's, and think through that lens. I also just wanna say that the three tiers are not necessarily linear. They are things that need to be addressed all at the same time. So it might not be that we're bypassing one to just look at one of the others.

Dr. Hedberg: Yeah, you bring up a good point about going after what might be on the surface. When I launched "The Infection Connection" in around 2010, 2011, I've gotten so many emails from practitioners who, you know, went through the training and learned how to treat infections like Epstein-Barr virus. And I'll get an email saying, you know, "I've been treating the Epstein-Barr and, you know, it's still positive and they're still not doing well." And then, I asked them, "Well, you know, what else are you really working on?" Because, I mean, you can go in and you can attack the virus and suppress it but if you're not really addressing the reasons why it's active in the first place, then you're not really going to get anywhere.

Andrea: Exactly, exactly. And we have to think about these three tiers again as the soil in which that root exists. And I think one of the mistakes that we're making in functional medicine is that there's so much focus on the root cause that patients are now seeing it as the quick fix. "If I get this test done, if I find the root and address that root, everything will be better." And they're not necessarily seeing that in a state of chronic stress or with certain deficiencies at stake, that it is very difficult to address that root, that it might not work. It might not actually be a quick fix. And I think that, again, is one of the mistakes that we're making.

Dr. Hedberg: Yes, let's build on that a little bit. I'm glad you're here to talk about this. And I had Chris Kresser on the show a few months ago and we talked a little bit about this as well because I have concerns about functional medicine. Sometimes it feels kind of like the Wild West. And, you know, you and I both train clinicians in functional medicine. And one of the issues is that you can take a patient with, say, Hashimoto's disease, and they can go to...let's just say you send them to 10 completely different functional medicine practitioners, you know. They could be people who are highly-seasoned, you know, well-trained, and you're still going to get variation in how the patient is approached. Even within functional medicine, there's gonna be preferences on certain labs that don't really make sense other than the practitioner just says, "Well, this is what I feel the most comfortable with." Or, you know, the supplements are gonna be highly variable and the types and the doses and the frequency. The diet will be variable.

I mean, you know, the patient with Hashimoto's, they could go to 10 practitioners and there's not going to be 10 identical diets for that particular patient. You know, one practitioner might be, you know, on the keto train or autoimmune paleo, or vegan. I mean, we have difficulty with some kind of standardization and I can see why conventional medicine can be very skeptical of what we do. So how do you see that whole issue and how do we move forward in the right way with developing some kind of consistency across practitioners?

Andrea: Yeah. I mean, I think scope is very very important. And I like to say I train the allied functional medicine practitioner. And the truth is that there isn't one diet for any individual no matter what their condition. Let's say, we're talking about brain tumors and we know the research shows that a ketogenic diet can be beneficial in this situation. If that brain tumor patient is in the midst of going through treatment, chemotherapy, radiation, surgical intervention, it might not be the right time for a ketogenic diet. We cannot just look at situations in relation to a diet. And this is, again, where I think the allied functional medicine practitioner comes in to really assess who is this patient, where are they. And diet is not just a handout. We really need to understand what is this person capable of in their life and what is the necessary intervention right now, and where is it tiered.

So somebody getting a handout or being sent to a blog post or a Pinterest page with autoimmune paleo may not be appropriate for them given the other stressors in their life. And this is, again, where I see the need for a practitioner who can work with the reality that that individual is in, and not just say, "This is the right diet. This is the right test." I like to say all information that we gather from the patient is true but partial. And that's why, in our practices, we do very very deep assessment. And that assessment includes what I like to call the story where we look at the antecedents, triggers, and mediators. The soup, where we look at the biological function, and the skill, where is this patient right now and what are the necessary next steps that will take them on this journey towards healing as opposed to saying that there is a quick fix.

So we need to, through a tier-one approach, those non-negotiables, those are gonna be individualized. And I think that is how we honor the practice of functional medicine. We say that we are looking at the whole person and that it's an individualized approach and all information is true but partial. And the best partner on the case is the patient. And it's our job to educate the patient to be their best partner as opposed to us sitting in the seat that we're the god or the goddess with all the answers.

Dr. Hedberg: Right, right. So, as you said in the beginning, you're a patient as well and you have Hashimoto's. So why don't we dig into that a little bit because a lot of the listeners have Hashimoto's. And so, where,...

In this episode of The Dr. Hedberg Show, I interview Melissa Gallico about fluoride.  We talked about where fluoride comes from, why it was added to our water supply, how to know if your water is fluoridated, how to filter fluoride, other sources of fluoride, the fluoride-acne connection, the fluoride-thyroid connection, how to detoxify fluoride with iodine, and how to petition your local legislators to remove fluoride from your water supply.  I was not aware of the fluoride-acne connection so this was an enlightening podcast that everyone should listen to who has acne or a thyroid issue.

Dr. Hedberg: Well, welcome everyone to the "Dr. Hedberg Show." This is Dr. Hedberg, and really looking forward to the interview today. I'm talking to Melissa Gallico. And Melissa is the author of the book "The Hidden Cause of Acne: How Toxic Water Is Affecting Your Health and What You Can Do About It," and also a book called "F is For Fluoride: A Feasible Fairy Tale for Free Thinkers 15 and Up." She's a former military intelligence officer, Fulbright Scholar and intelligence specialist at the Federal Bureau of Investigation where she instructed classes for FBI analysts at Quantico, and provided analytics support for National Security Investigations. She graduated with honors from Georgetown University, and she has a master's degree from the University of St Andrews in Scotland. So, Melissa, welcome to the show.Melissa: Thank you so much for having me.

Dr. Hedberg: Yeah. So I heard you on the...first I heard you on the "15-minute Matrix" podcast, and was really interested in what you were talking about. I've studied fluoride a little bit over the years, but just mainly related to how it affects the thyroid. But why don't we just start out with some basics regarding fluoride and fluoridated water? So can you talk about why fluoride was added to the water? Why did they do that, how did it happen, and how can people tell if they have fluoridated water?

Melissa: Sure. So in the mid-20th century, dentists started...well, originally, they noticed that fluoride caused brown stains on teeth, and it's a condition called dental fluorosis. So that's where they started studying fluoride and its effect on tooth enamel. And eventually, they started developing a theory that, you know, too much fluoride is bad for your tooth enamel, it causes this cosmetic staining, but maybe a little bit of fluoride is actually good for your tooth enamel and makes it stronger and prevents cavities.

So that's the theory behind why they add it to the water supply today. They've been doing it for over 70 years. And they just think of it as adjusting the fluoride level to, like, this optimal dose that helps prevent cavities. And that's what I always assumed it was, I always drank fluoridated water, and I used fluoride in my toothpaste, and I had the treatments at the dentist. I never really thought about it. But when I got older and I realized that fluoride was affecting my health in negative ways, I looked into it more. And I looked into the history and realized that behind that very nice story that I believed and that I, you know, told myself and just assumed was true, there's actually a very deep pollution scandal there.

And people are always surprised when I talk about pollution and fluoride, because we've forgotten that fluoride was the leading form of air pollution at the time the science was being developed in the mid-20th century. It's a common element in the earth's crust. So when we started these large-scale mining operations for things like aluminum or phosphate, these companies were emitting just toxic amounts of fluoride into the atmosphere, and it was causing a lot of lawsuits. So the fluoride would go into the atmosphere, it would end up on the grass, poisoning cattle, poisoning crops, and the people that live nearby as well.

So those lawsuits led to, you know, these big powerful corporations hired lawyers, they had like a fluoride lawyers committee to take care of this problem. And they had their own medical advisory board and they just poured tons of money into all the premier research institutes to find studies that would show that fluoride is safe, not only is it safe, but it's actually good for you. So that's where that science came from, it was very biased science, really one-sided science, that was being used in court to refute these lawsuits. So that's the deeper story of why we add it to our water, or where that came from.

And then your other question was, you know, how to tell if the water is fluoridated. The easiest way is to call your local water provider and just ask them if they add fluoride to the water. Ask them what the fluoride level is. Right now, the government recommends 0.7 parts per million fluoride. So that's when it's artificially fluoridated. It's usually around 0.7. It can be naturally-occurring, and that depends on if those rocks that, you know, when we started building these deep water wells, they can sometimes contain natural fluoride contamination as well. So you can ask your water provider is it natural? Is it artificial? Natural is not quite as bad because the artificial fluoride can have a lot of other contaminants in it as well, including arsenic and aluminum and lead as well. But if it's naturally occurring, it's still not ideal. So you wanna look for something that is more in line with the mean fluoride content of fresh water, which is 0.05 parts per million. It's 14 times lower than what they're artificially adding to the water supply.

Dr. Hedberg: And... Go ahead.

Melissa: I was just gonna say, another way instead of calling, you can also Google the name of your town and "Water Quality Report." Your town is required to provide this annual Water Quality Report. Sometimes they send it out each year with your bill, and it'll have it listed on there, the fluoride level. So if you see ND, which means not detected, you're in really good shape. But you might see something closer to 0.7 and then that means it's probably artificially added.

Dr. Hedberg: I was very excited to learn when we moved that our local water supply is not fluoridated. So it can be kind of a pain to filter it. So if someone finds out that they have it in their water supply, there are filters available. Can you talk a little bit about those and what you recommend?

Melissa: Yeah, I've never recommended one certain filter because there are a lot of different ones you can use that are effective at removing fluoride. I've always told people reverse osmosis is very reliable. A lot of people don't like it because it does waste water. So for every gallon that you purify, there's like a couple gallons that are wasted and that's where all the contaminants go. And some people also don't like it because it removes a lot of things that you do want in the water like beneficial minerals. But it is one reliable option, and some people will add the minerals back in or just, like, make sure they have a really mineral-rich diet. So reverse osmosis is relative inexpensive, and it's a decent option for drinking water.

But if you want a whole house filter, there are a few companies that are making bone char filters, and they are very effective at removing fluoride from the water. They are used in parts of the world where high amounts of fluoride is really endemic and it causes a lot of problem. It accumulates in your skeletal system, and can lead to a lot of like joint and bone disorders. So bone char, because it, you know, attracts fluoride so much, is actually a really good filter. So if you find a whole-house bone char filter, that can remove it even from your bathwater and your shower water.

Dr. Hedberg: Yeah, and a lot of the companies out there that make filters are offering fluoride attachments or fluoride filters now, at least as far as what I've seen. So there are a lot of options out there. So that's one thing I was gonna ask you specifically. So do you recommend that even the water that we shower in be filtered of fluoride or just drinking water is the main concern?

Melissa: Drinking water is definitely the main concern, so that would be the priority. A lot of people are really sensitive to it. That's how I got into all of this, discovering my sensitivity. So for me, washing my face in fluoridated water is really not a good idea. I have a pretty strong reaction to it. Some people can't even wash their hands in it. I can luckily do that. So when I'm, you know, eating out at restaurants and things, it's not as difficult. But some people really can't even shower in it or wash their hands in it. So in that case, you know, you definitely want the whole-house filter.

Dr. Hedberg: So let's just talk about some other common sources of fluoride other than the water. I know there's some in certain teas and then also dental products, can you also talk about those? Do we really have to worry about using fluoride-free toothpaste and things like that?

Melissa: Yeah. So I never knew how much fluoride was making its way into my daily life until I realized that I was having this skin reaction to it. So that became kind of like my barometer where I was able to root out all of these different sources of fluoride. Just once I knew that that was the reaction that my cystic acne was caused by fluoride, I could go back and say, "Okay, what did I eat in the last 24 hours?" Because it's a very immediate reaction, and then that's how I learned that things like chicken soup can be very high in fluoride. And that makes sense because, you know, chickens are consuming feed that is covered in fluoride-based pesticides, and that fluoride accumulates in their bone, just like it would if, you know, we were consuming fluoride and it accumulates in our bones. So if you're making soup out of chicken bones, and those chickens had eaten high amounts of fluoride on their feed, or in their water,...

In this episode of The Dr. Hedberg Show, I interview Jill Grunewald on the best foods for healing Hashimoto's disease and Alopecia.  Jill has an excellent cookbook called the Essential Thyroid Cookbook with many excellent recipes to help you heal.  We talked about all the various dietary approaches out there for autoimmune disease including their pitfalls and how to get around feeling worse.  We also discussed the autoimmune paleo diet, ketogenic diet, low-carbohydrate diets, ferritin, and hypothyroidism.  And we even got into the controversial topics of iodine, goitrogens, and vegan and vegetarian diets.  I really appreciate Jill's common sense approach to these topics so this is one interview you definitely don't want to miss.

Dr. Hedberg: Well, welcome, everyone, to "The Dr. Hedberg Show." This is Dr. Hedberg, and I'm excited today to have Jill Grunewald on the show. Jill is a functional medicine certified health coach, and she's the founder of Healthful Elements. It's a thyroid health, Hashimoto's, and alopecia specialist, and co-author of the number one bestselling "Essential Thyroid Cookbook." She successfully guided her clients and students with hypothyroidism and Hashimoto's to health and vitality and has helped many of her alopecia clients reverse their devastating hair loss. She has a unique online program for the alopecia community called Reversing Alopecia, and that will actually launch this spring.

So Jill actually had Hashimoto's, and it's been successfully managed since late 2008, without the use of thyroid medication. She's actually suffered from alopecia herself, off and on, since about the age of 13, and, after becoming one-third bald, has kept her newfound full head of hair. And in her coaching practice, she not only specializes in Hashimoto's and alopecia but also Graves' disease, adrenal dysfunction, and perimenopause, menopause. And she has an upcoming book, "Reversing Alopecia," and that will be published in the fall of 2020. So, Jill, thanks for coming on.

Jill: Thank you so much for having me. I'm flattered to be asked.

Dr. Hedberg: Right. So I thought this would be great for our listeners because a lot of, you know, the patients that I see with Hashimoto's disease and alopecia, when we start making dietary recommendations, that can be somewhat difficult for people to make a big transition. And so, sometimes, we start slowly with just a few restrictions. You know, we wanna meet the patient where they are and not overwhelm them and create additional stress. So you wrote this book which is obviously gonna be very helpful to these patients. Can you talk a little bit about what makes your thyroid cookbook unique?

Jill: Yeah. So, Lisa Markley, my co-author, and I both, we were aligned on a lot of things, but we take a "food first" approach. She's a registered dietitian. She's also had Hashimoto's. So it's been our philosophy to have a food first approach even before we conceived writing this cookbook. And as you know, Dr. Hedberg, over the last several years, there's been a proliferation in various diets that help people to reverse many forms of autoimmunity, not just Hashimoto's, not just alopecia, namely paleo or autoimmune paleo or autoimmune protocol, this specific carbohydrate diet. And we're not against those diets, certainly. So we specifically chose not to make the book adhere to any of those dietary philosophies,

In this episode of The Dr. Hedberg Show, I interview Dr. Izabella Wentz about her new book, "Hashimoto's Food Pharmacology."  We had a great talk about Hashimoto's disease, Dr. Wentz's Hashimoto's healing journey, foods that can help heal Hashimoto's disease, green smoothies, bone broth, and some recipes that can help heal Hashimoto's disease.

I highly recommend all of Dr. Wentz's books and her new book will help you make food easier and healthier so you can heal your Hashimoto's disease.

Dr. Hedberg: Well, welcome, everyone, to "The Dr. Hedberg Show." This is Dr. Hedberg, and I'm very excited today to have my good friend and colleague Dr. Izabella Wentz on the show. She has been on the podcast before, and I am excited to have her on today. So, Dr. Wentz, thanks for being on.

Dr. Wentz: Thank you so much for having me, Dr. Hedberg. I'm a huge fan of your work, and it's an honor to be here with you.

Dr. Hedberg: Great. So for those who don't know about you, why don't you just tell everyone a little bit about yourself and what you've been working on and your new book that's coming out?

Dr. Wentz: Sure. So, I'm a pharmacist by training and, in full disclosure, I wasn't interested in the thyroid until I became diagnosed myself with Hashimoto's after almost a decade of some pretty confusing symptoms. So I had fatigue, and I had pain all over my body, acid reflux, hair loss, brain fog, and you pretty much name the thyroid symptom, I had it, but it had gone undiagnosed.

I was a pharmacist and was super excited about taking medications for my thyroid once I found out that I had a thyroid condition, but unfortunately they only helped a tiny bit. At that point, I realized there was something else going on in my body, and I wanted to figure out if there was anything I can do to help myself, one, feel better and two, potentially reverse the condition, and that's sort of how I became a Hashimoto's expert/human guinea pig was really through my own journey with Hashimoto's and having a lot of different symptoms that nobody seemed to be able to solve.

My official bio is that I am an author of multiple books on Hashimoto's. One of them is "Hashimoto's Thyroiditis: Finding and Treating the Root Cause." This was published in 2013. And then "Hashimoto's Protocol: A 90-Day Plan for Reversing Thyroid Symptoms and Getting Your Life Back." So this has been really my life's work is to help people with Hashimoto's take back their own health. After being able to do so myself, I have a brand new book coming out, "Hashimoto's Food Pharmacology." And this is really focused on nutrition, nutrition protocols, and then healing recipes to help people really kind of do it themselves.

I know that there is a lot of forward movement for thyroid health in the world of functional medicine, but not everybody has access to an excellent functional medicine provider like Dr. Hedberg, for example. And there is a lot of things that people need to do in their own day-to-day life to take back their health and part of that is nutrition. So my new book is focused on helping you take back your own health and being your own nutrition guru when you have Hashimoto's.

Dr. Hedberg: That's fantastic. So most of my listeners have Hashimoto's. So, for those who don't really know that much about it, can you give us kind of an overall view of what exactly Hashimoto's is, and all the different statistics related to that?

Dr. Wentz: Sure. So Hashimoto's is probably the top autoimmune condition, the most common autoimmune condition worldwide. For those that don't know what it is, it's actually the immune system starts to recognize the thyroid gland as a foreign invader and begins to launch an attack against the thyroid gland, and this eventually leads to the thyroid gland not being able to produce enough thyroid hormone. And it really goes along with a lot of different symptoms. So people will have problems with brain fog, they'll have problems with weight gain, they'll have problems with fatigue, a lot of times they'll have hair loss, cold intolerance. And really when we think about what the thyroid does is it generates heat and energy within our bodies, and dictates the metabolism throughout our entire body.

So anything could be affected whether this might be, you know, loss of hair from our scalp or cold extremities or potentially having easy bruising on the skin because we're not...our metabolism isn't working properly. These are just some potential thyroid symptoms.

Looking at the statistics, we seem to have more and more cases of Hashimoto's every year. It's not just because we're diagnosing it more, it also seems to be more prevalent. You know, different statistics are out there, anywhere from one in three or, you know, one in five women may have this condition at some point in their lives.

Dr. Hedberg: Yeah. So there's 300 million Americans, I believe, at this point and about 35 million have Hashimoto's so that's huge, and probably more than that, like you said, because a lot of these women and men go undiagnosed. So as you said, you have Hashimoto's and so I've read your books and you have this journey that you went through. There's probably people listening who are kind of in the beginning of that journey, or in the middle of it, so can you talk about what you went through and, you know, your signs and symptoms, the diagnosis, and the treatments that you went through?

Dr. Wentz: Wow, yeah. So I started off having symptoms, you know, the further I look back, probably as early as, you know, three years old, I started having panic attacks. I was exposed to Chernobyl when I was living in Poland, that's where I grew up. And then kind of things calmed down again until about puberty when I started having a lot of symptoms of depression. My mom was a pediatrician and she thought there was something going on with my thyroid, but we went to have it tested, and everything came back normal. I kind of was always one of those kids that intended to be a bit moody.

Until I was about 18, I ended up having a Epstein-Barr virus in my first year of undergrad. And after that point, I just could not get out of bed for months, I was exhausted. And that kind of started off my thyroid journey, the official journey for trying to seek out what was going on. Because the things prior to that were, you know, stomachaches and they were maybe some moodiness, but I just thought that was a normal part of being human. It wasn't, you know, until I started getting the fatigue and that was followed by irritable bowel syndrome, eventually acid reflux, hair loss, palpitations, panic attacks, let's see what else, carpal tunnel in both arms. I had all of these different things kind of "small annoying things that were just breaking my body down," I started to look for answers and trying to figure out, "Okay, what is going on with me, why am I like this, why do I have to sleep 12 hours when everybody else can, who is my age can sleep for seven to eight hours and be bright eyed and bushy tailed, and why am I losing hair, why am I always so cold?" And that eventually led me to figure out I had Hashimoto's through going to numerous doctors and asking for different tests.

And I started on thyroid hormones which I thought were gonna be, you know, my cure-all, right? And within a few weeks, I started to feel better slightly, so I only needed one sweater instead of two sweaters in Southern California. And then I was able to sleep for, you know, 10 or 11 hours instead of 12, so that was an improvement, but then I still had the carpal tunnel, but I still had acid reflex, IBS, and all of these other things going on. And I really just started to peel back the layers one by one. I was a research pharmacist for people with the rare conditions at the time, and I was helping these people take back their health through some unusual means that weren't part of the standard of care, spending a lot of time in the research world, and decided to do the same thing for myself.

And I have tried a lot of different things, some of them were scary and silly, some of them didn't work. Coconut oil did not cure my thyroid, unfortunately, but the things that did work were gluten and dairy removal. Within three days, I was able to eliminate the carpal tunnel syndrome, the irritable bowel syndrome, and all of the bloating and the acid reflux. And I had those conditions for, you know, anywhere from, like, 1 to 10 years.

And so that was a really, really big component of what helped me. I eventually went on to treat some infections that I had in my gut and reactivated Epstein-Barr virus, and looked at toxins and just did a whole body makeover through functional medicine, but really the corner store of what got me to heal was focusing on my diet and nutrition. And it was simply removing some things that were not working for my body and then adding other things that my body was deficient in.

Dr. Hedberg: Right, right. Yeah, that's an interesting journey that you went through and you got everything in balance. And then you wrote your first book and then your most recent book is "Hashimoto's Protocol" and that was a, it's a 90-day plan for getting better. A lot of people get better following that. A fair amount of the new patients that I see, you know, they've read your work and they're already doing better just following that. But now you have another book, "Hashimoto's Food Pharmacology." And so this is focused more on food and the term we use is "food as medicine," and how did you, you know, come up with this idea of writing a book just focusing on food pharmacology?

Dr. Wentz: One of the big things is, you know, one of my big goals and I have a bit of an eclectic background as a pharmacist, what I worked in, a bit of consulting research as well as public health and really looking at how do we get this information out to people so they can help themselves. And,...

In this episode of The Dr. Hedberg Show, I interview Dr. Terry Wahls in a discussion about how to heal Multiple Sclerosis.  We had an excellent discussion about how she overcame Multiple Sclerosis, her research into MS, The Wahls Protocol Diet, the causes of MS, how the gut and the microbiome influences autoimmune disease, the Paleo diet compared to the Wahls Protocol and much more.

If you have MS or know someone who does, please share this episode and transcript of the interview below.  It may be the turning point for you or a loved one by following The Wahls Protocol.

Dr. Hedberg: Well, welcome everyone to the Dr. Hedberg Show. This is Dr. Hedberg, and I'm very excited today to have Dr. Terry Wahls on the show. So, Dr. Wahls is a Clinical Professor of Medicine at the University of Iowa. She's the author of the book, "The Wahls Protocol: How I Beat Progressive MS Using Paleo Principles and Functional Medicine," and also the cookbook, "The Wahls Protocol Cooking for Life: The Revolutionary Modern Paleo Plan to Treat All Chronic Autoimmune Conditions." You can learn more about her work from her website. It's terrywahls.com. That's terrywahls.com. And she hosts "The Wahls Protocol Seminar" every August where anyone can learn how to implement the protocol with ease and success. And she's on social media. You can find her on Facebook, Terry Wahls, M.D., Instagram, Dr. Terry Wahls, and on Twitter, @TerryWahls. And you can learn more about her MS clinical trials by reaching out to her team via this email, it's [email protected], and I will paste that link and e-mail on drhedberg.com in case you wanna contact her that way. So, Dr. Wahls, welcome to the show.

Dr. Wahls: Hey. Thank you so much for having me.

Dr. Hedberg: Great. So, just for the people out there who don't really know your story, can you tell us a little bit about what you went through and your MS story?

Dr. Wahls: Sure. So, I'm an academic internal medicine doc, very conventionally trained and conventionally practicing, being very skeptical of diets, supplements, complementary and alternative medicine. But God has a way of teaching us, so in 2000, I was diagnosed with relapsing-remitting multiple sclerosis on the basis of a history of dim vision 13 years earlier, and a new problem with my left leg. I had lesions in my spinal cord. So, I knew I wanted to see the best people in the country, take the newest drugs, and so I went to the Cleveland Clinic and saw their best people, took the newest drugs, and steadily declined. I'd had one relapse in the next year involving my right hand. And I continued to gradually decline.

By 2003, I had declined enough that I now needed a tilt-recline wheelchair. I took Mitoxantrone. I adopted, yeah, actually the year earlier, the paleo diet after being a vegetarian for 20 years, but as I had already mentioned, I did continue to decline and was in the wheelchair, took Mitoxantrone, continued to decline, then took Tysabri, continued to decline, then was placed on CellCept. And at that point, in 2004, it's quite clear to me that I'm likely to become bedridden, quite possibly demented, and quite possibly suffer from intractable pain related to poorly controlled trigeminal neuralgia.

And so, I start reading the basic science again, and I began experimenting using a variety of supplements targeting my mitochondria. And what I discovered is that my fatigue is somewhat less, the speed of my decline is slowed, and I'm really immensely grateful because now my docs have told me I have secondary progressive MS, that there's no more spontaneous recoveries, and so I'm grateful just to slow my decline.

Now, the summer of '07, I'm so weak I cannot sit up anymore. I have a zero gravity chair, where my knees are higher than my nose. A staff, resident clinic's there. I work in the Institutional Review Board reviewing research protocols that way. And I have another chair at home. And it's getting more and more difficult to function. My chief of staff tells me that he's re-assigned me to the traumatic brain injury clinic come January, and I realized what he's really doing is putting me in a circumstance where I'll have to finally take medical retirement because that's a job that I won't be able to do.

So, you know, things looked very bleak in the summer of 2007. But that summer, I discovered electrical stimulation of muscles, and I get my physical therapist to add that to my exercise program. And I discovered the Institute for Functional Medicine. And I take their course on nerve protection, which by the way is pretty tough in the midst of my brain fog. But I get through that. I have a longer list of supplements.

And then in the fall of '07, I had this really, you know, radical idea that, you know, I should be redesigning my paleo diet based on the supplements that I was taking to maximize those particular nutrients. And if I redid my diet that way, I'd probably pick up more supplemental nutrients that we haven't even identified yet that are really going to be helpful for my brain. So, that's more research. It takes a few months to get that figured out. And I remembered December 26th, I'm really starting this new way of eating.

And so, the middle of January, I now go to the traumatic brain injury clinic. That first week, I'm just watching my colleagues, you know, run the clinic. Then the next week, so now I've had a month of my new eating plan, I've had a couple of months of the e-stim, and I discovered that actually I can do this task. I can, you know, drive my wheelchair to the clinic and stand up, examine folks, sit down, make their notes, and at the end of the week, I'm like, "Well, actually I could do that." And I was quite surprised. The end of three months, I'm beginning to walk around the hospital with a cane, and at six months, I'm walking around the hospital without a cane. At nine months...you know, and I would say I'm still just taking each day at a time. I don't really know what this means because I've fully accepted that progressive MS is progressive, that there's no recovery that's possible. And so, I'm not sure what this stuff means.

And then at nine months, I get on my bike, and it's the first time I've tried to do that in over six years, and I bike around the block. You know, my kids are crying, my wife is crying, I'm crying, and that's when it's very clear to me that the conventional understanding of progressive multiple sclerosis and probably relapsing-remitting multiple sclerosis is incomplete. And then at 12 months, I do a 20-mile bike ride with my family. So, this really changes how I'm thinking about disease and health. It changes how I'm practicing in my primary care clinics with the residents and then in traumatic brain injury clinic. And so, I am focusing more and more on diet and lifestyle. And of course, this will ultimately change the focus of my research as well.

Dr. Hedberg: So, quite a story. Now, there had to have been a period where when you first got the diagnosis, were you...do you think that that was a traumatic experience for you getting that and experiencing it, and how did you deal with the trauma of finding out you had MS?

Dr. Wahls: Well, you know, before I entered medical school, I was an athlete. I did some long distance running, and I was a black belt in taekwondo. In fact, I competed nationally in full contact sparring, getting a bronze medal in the national competition for the Pan-American trials. So, I always valued physical activity and athletic activity even during medical school and with my kids. We're physically very, very active.

And so, when I was diagnosed, that was difficult. And part of me was relieved, like, "Okay. I'm not being a slug after all. This explains why my workouts have been getting suddenly more difficult." So, there's a part of me that was relieved that way. And then being sort of the, you know, very ambitious individual, once I was diagnosed, I did what many physicians do. I started reading the scientific literature, and that's when I saw that, you know, within 10 years of diagnosis, a third will need a wheelchair, walker or cane, and one half will be unable to work due to severe fatigue. And so, I was just getting more and more upset. My wife sat me down and said, "Terry, you got to stop reading the literature. And it's just getting you upset. We'll find the best people in the country. Let them take care of you." You know, and actually, that's part of how I, you know, started at the Cleveland Clinic and gave them all of my responsibility and let go of reading the literature.

But then, as I was getting steadily worse despite seeing the best people, despite taking the newest drugs...and I'm having to reimagine myself first as no longer an athlete, then I was no longer able to do the activities of daily life and contribute to, you know, the various family responsibilities and having to reimagine like, you know, how am I gonna teach my kids resilience, and fortitude, perseverance? I thought I was gonna be doing that by teaching them athletics and wilderness travel, but that was no longer possible. And so, those were very challenging times because I had to keep reimagining who I was and how I could contribute to family life, how I could contribute to my children's growth.

Dr. Hedberg: Right. And this was a huge transition obviously with your conventional medical training, learning about functional medicine and nutrition and you're doing that in your clinics now, have you...and you talked a little bit about this at IFM, can you tell everyone just kind of the pushback that you have from conventional medicine?

Dr. Wahls: Sure, sure. So, my colleagues are just thrilled to see me suddenly walking around again. And so, they're very excited. My chair of medicine is so impressed, and he is actually a rheumatologist. So, he gives me the job of getting a case report written, and I go like,...

In this episode of The Dr. Hedberg Show, I interview Dr. David Brady about how to overcome Fibromyalgia and his new book The Fibro Fix.  We talked about the history of fibromyalgia diagnosis, the causes of fibromyalgia, the difference between "Classic"  Fibromyalgia and "Pseudo" Fibromyalgia, treatment strategies, supplements for Fibromyalgia, and much more.  If you have Fibromyalgia or know someone who does, this is one interview you definitely don't want to miss.

Dr. Hedberg: Well, welcome, everyone, to "The Dr. Hedberg Show." This is Dr. Hedberg, and I'm really looking forward to the conversation today. We have Dr. David Brady on. And if you look at the history of "The Dr. Hedberg Show," we've actually never had a repeat guest. And so, Dr. Brady is gonna be the first repeat guest. Our last podcast discussed the GI map stool test from Diagnostic Solutions. So, I urge you to check that out.

So, for those of you who don't know Dr. Brady, he really is the foremost authority on properly diagnosing and treating fibromyalgia, which is what we'll be talking about today. He's been featured in top media outlets like "Elle" and "NPR." And he's also published in leading peer-reviewed medical journals including "Open Journal of Rheumatology and Autoimmune Disease and Integrative Medicine," a clinician's journal. He's published chapters on fibromyalgia in definitive medical textbooks, including "Advancing Medicine with Food and Nutrients" and "Integrative Gastroenterology." He has presented at prestigious medical conferences, including the Annual Symposium of Functional Medicine and the Integrative Healthcare Symposium.

He is in private practice at the Whole Body Medicine in Fairfield, Connecticut. And Dr. Brady is also the Director of the Human Nutrition Institute at the University of Bridgeport, as well as the Chief Medical Officer of Designs for Health and Diagnostic Solutions Laboratory. So, Dr. Brady witnessed his own mother suffer through the ringer of the medical system. So, Dr. Brady is uniquely passionate not only as a doctor, but also as a patient advocate.

So, his website, more specifically for his book, we'll be talking about today is fibrofix.com and then his practice website is drdavidbrady.com. So, Dr. Brady, welcome to the show.

David: Dr. Hedberg, thanks for having me back. I didn't realize I would be the first repeat guest, so that's quite an honor, and thank you.

Dr. Hedberg: Yeah. So, I'm looking forward to this. Let's really dig into fibromyalgia. And so, you know, you witnessed your mother going through the medical system and then you became very interested in fibromyalgia. Is there any particular event that really got you interested in this condition?

David: Well, I got an interest in sort of integrative medicine, as we would call it today, or like just routes of care and ways of looking at healthcare conditions, particularly complex chronic conditions that were not the, you know, real standard orthodox way of doing things or standard of care probably because of that experience with my mom growing up. I mean, my mother battled breast cancer most of my childhood, and double mastectomy, got radiation and chemo, and all that stuff back in the '70s when it was even more brutal than it is now.

And she found some of her best outcomes and best quality of life, unfortunately it was toward the end, with some providers who were doing more sort of integrative complementary medicine type of stuff. So, it really opened my eyes to that. And even though I originally went and became an engineer and worked in aerospace and stuff, I always had a sort of a desire to come back to dealing with the human condition, and I had originally thought I would use my sort of engineering background, and biomechanics, and things like that, and to go into research, you know, in biomedical research.

I had the engineering background, I was looking for ways to get the medical, clinical background. And I looked into a lot of different routes and books, more reasons than we probably have time to go into. Mainly one of the really good biomechanical background, I ended up first on the chiropractic college. And when I was there, I really took a left turn.

I had some mentors there that were really into, you know, dealing with chronic complex internal disorders from a different way, you know, and it came from some of the old chiropractic nutrition sort of influence. So, there's a lot of interventional nutrition, dietary and lifestyle medicine changes, botanical medicine, and kind of what we would today call like naturopathic medicine. But I was immersed in it when I was down there. And even in my hospital rotations and all of that, I was always looking at disorders from, you know, how can you do this in a different way? I mean, how can you treat this without nine drugs, right? Or if you're gonna use the meds, how can you make them, you know, work better and how can you complement them?

So, that got me into functional medicine and clinical nutrition, and then I went back to, you know, medical school and studied naturopathic medicine, and the rest is history. But the fibromyalgia stuff really started when I got out of chiropractic school and first went into practice because I started getting these patients' neck that were really difficult patients, you know. And what I learned about fibromyalgia in chiropractic school and later even in medical school is not very much. What I did learn turns out it was wrong. It was often talked about by the presentor or lecturer in sort of a questioning way or almost a condescending way, you know, is this really real? Is it all made up in people's heads? You know, all that kind of baggage that went along with it for so long.

But when I got out into practice, I realized these people are real, they're not making it all up, they have better things to do with their lives than to make this all up, but they also weren't all the same. There was a lot of different stuff I felt coming in under that label. And I thought even with the little I knew then that it was very dirty diagnosis. By that I mean, it was really a whole lot of different things all being called the same thing. And, you know, in medical school, one of the first things you'll learn is proper diagnosis you have to cure. So, unless we can accurately figure out what these people really have and stop just calling it all the same thing and, you know, well then we'll never gonna find the right treatment.

So, I realized that I was willfully and adequately prepared to deal with these patients. And I realized, even though they had a lot of achiness and they complained of muscle pain or they have fatigue, and they had anxiety, and they couldn't sleep or they didn't feel like they ever sleep even after they did, they have a lot of drug problems, I realized even back then this is not a muscle problem, right? This is not a musculoskeletal thing. This is a central nervous system issue.

And so, I started studying it on my own, literally going into the medical literature which as, you know, back then it wasn't as easy as doing a PubMed internet search. I had to go to the medical library. I had to dig through card catalogs. I had a blow dust off journals. I had a copy of them with borders, you know. That's what it was. And I read everything I can get my hand on. I found a sort of compatriot, some kindered colleague soul, kind of, person that was also really into myofascial pain working stuff, named Michael Schneider. He was a chiropractor then. He went to become a PhD. He does a lot of incredible integrative medicine research, more on musculoskeletal disorders at the University of Pittsburg.

But we started, kind of, getting together on this quest, and over time we became experts ourselves, not only by reading and teaching ourselves but by actually reaching out and meeting the world's experts in fibromyalgia, and then we went on to, you know, do a lot of publishing, do some research, wrote lot of textbook chapters, things like that. So, we, kind of, made ourselves experts over time because it didn't happen in school, I can tell you that.

Dr. Hedberg: Right. And I do remember that first paper I think that was published in "JMPT," I remember reading that, and it gave a really great overview and, you know, diagnostic algorithm. It is a different way to look at fibromyalgia than I had been exposed to. And then there was a follow-up paper, I think, and Dr. Pearl was an additional author there.

David: Right. Yeah. 2001 was the first one, and 2006 was the follow-up paper to that first paper. Yeah. So, it's a while ago.

Dr. Hedberg: Yeah, yeah, but it's still applicable even today, everything that you guys wrote back then and...

David: Well, it is. And that was an interesting...you know, we realized that most doctors, and even today this is true, doctors getting out of medical school, chiropractic school, wherever, are coming out willfully and adequately trained in fibromyalgia and many of these, you know, hypervigilance central sensitivity driven disorders. They just don't know how to deal with them. They have a lack of knowledge, but not a lack of arrogance. So, they end up telling patients, you know, that's all in their head. And since they don't have the answer, there must not be one kind of thing and that's unfortunate.

So, we tried it and we recognized that. And we tried to publish in primary care journals, and journals that chiropractors would read, and journals that other kind of, like, primary care people who see people directly, you know, off the street as the first point of contact with a health provider, to try to get them to understand a little bit more how to properly tease out what is the real what we call classic fibromyalgia, this hypersensitivity, hypervigilance type of disorder versus what most of the people who get told they have fibromyalgia have,...

In the last several months, we’ve examined how certain supplements such as vitamin D, genistein, cordyceps and inositol impact Hashimoto’s thyroiditis. Today, we’re going to investigate how dairy—in the form of lactose—affects Hashimoto's disease. Specifically, I’m going to be addressing these two points:

 

1. How avoiding dairy helps Hashimoto’s disease

2. How dairy affects the absorption of thyroid medication

Background

Before launching into our discussion, let’s talk briefly about lactose intolerance and what happens in the body when one has a sensitivity to lactose, the naturally occurring sugar in dairy products.

Lactose intolerance is a disorder of the small intestine that results from reduced lactase enzymatic activity that in optimal situations would break down lactose into the simpler sugars: glucose and galactose. The papers published by Montalto et al. (2006) and Lomer et al. (2007) examined this condition in great depth.

Behind-the-scenes, what you find in lactose intolerance is that lactose cannot be readily digested by the body. Lactose begins to accumulate in the small intestine which then leads to bacterial overgrowth, gas formation and an altered intestinal environment which may cause damage or injury to the intestinal villi. As you may recall from high school biology class, villi are the tiny structures lining the intestinal wall that allow nutrients to be absorbed.

What’s problematic for those with Hashimoto’s disease is that lactose intolerance, by impairing intestinal absorption, could disrupt the circulation of thyroid medication.

This has serious implications so let’s go to the first study that examines how restricting dairy consumption could help Hashimoto’s disease.

The first research article I reviewed was published in the journal Endocrine in 2014 and was entitled “Decrease in TSH levels after lactose restriction in Hashimoto’s thyroiditis patients with lactose intolerance.”

The authors had noticed that existing research on the prevalence of lactose intolerance in patients with hypothyroidism was lacking. There were also no studies on the effect of restricting dairy/lactose consumption in Hashimoto’s patients who took thyroid medication (which we shall refer to as ‘LT4’ moving forward). The authors carried out this study for a twofold purpose:

1. to determine the frequency of lactose intolerance in patients with hypothyroidism and

2. to examine the effects of lactose restriction on thyroid function in Hashimoto’s patients with lactose intolerance.

How was the study done?

Eighty-three patients with Hashimoto’s thyroiditis who had taken L-thyroxine (LT4) over a minimum of three years were initially enrolled. Lactose intolerance tests were then administered to all subjects.

The researchers found that lactose intolerance was diagnosed in 75.9% of the patients with Hashimoto’s. If you think about it, that’s a pretty large percentage of the Hashimoto’s test population.

For this study, patients who used the following medications were excluded:

Raloxifene

Bile-binding acids

Cholestyramine

Orlistat

Colestipol

Proton pump inhibitors

Any preparations including iron, aluminum or calcium

Additionally, patients with the following conditions were excluded:

Pregnancy

Diabetes

Celiac disease and/or other related alimentary tract disorders such as occult or overt inflammatory bowel disease

Previous bowel resection surgery

The 83 patients were split into two groups: one group consisted of 63 patients with lactose intolerance.

The remaining 20 patients had no lactose intolerance.

Both groups were put on a dairy-restricted diet with particular emphasis in the morning.

The thyroid medication (LT4) was taken while fasting and subjects had to wait one hour before eating.

What lab tests were measured?

Levels of TSH, fT4, calcium and parathormone (PTH) were measured in all study participants both at the beginning and the end of the study.

Over the course of the 8-week study, due to a lack of follow-up of some subjects and constantly changing TSH levels in other patients (hence, fluctuating LT4 dosages), the final study size was reduced to a total of 50 patients with 38 in the lactose intolerance group and 12 in the control group (no lactose intolerance).

What did the researchers find?

The level of TSH markedly decreased in both the euthyroid and subclinical hypothyroid patients with lactose intolerance following the dairy-restricted diet. What was notable was that the level of TSH in patients without lactose intolerance did not change significantly over the 8 weeks.

The levels of PTH, fT4 and calcium also did not change significantly in either group.

What is the significance of the TSH levels dropping dramatically in the lactose intolerant group?

By restricting dairy products (with lactose being the ‘offending’ ingredient), the researchers were able to demonstrate that lactose restriction allows the small intestine’s absorption of thyroid medication to be improved, thereby reducing the need for higher or increasing doses of LT4!

Another implication of the findings is that lactose intolerance really needs to be considered in hypothyroid patients who have experienced the need to increase LT4 doses, those who have had irregular TSH levels and/or those who are resistant to LT4 treatment. If you recall, 75.9% of the patients recruited in this study were found to be lactose intolerant. The researchers determined that restricting dairy has a beneficial effect on Hashimoto’s patients because all of them are dependent on a thyroid replacement medication, whether it’s Armour®, Nature-Throid®, NP Thyroid®, Synthroid®, Levoxyl® or some other brand. The study showed that avoidance of dairy allows enhanced absorption of the medication that is required in Hashimoto’s, therefore reducing the potential for vacillations in TSH levels that would necessitate different doses of thyroid medication to be administered.

The authors were also the first in scientific research to show that there is a high rate of lactose intolerance in patients with Hashimoto’s disease!

Conclusions:

A dairy-free diet led to a decrease in the TSH level without the need for alteration in the LT4 dose.

What were some of the weaknesses of the study?

1. The sample size was fairly small with only 38 in the lactose-intolerant group and 12 control patients.

2. The study was of limited duration—only eight weeks. They also attributed the lack of major change in fT4 levels to this relatively short follow-up period. They hypothesized that a more notable change in the level of fT4 could have been observed in a longer-term trial.

So, in this study, the authors found that the level of fT4 did not significantly decrease after lactose restriction even though TSH dropped significantly.

Would this partially contradict the conclusions drawn in this study in any way?

I would tend to say no.

Existing research has supported that hypothyroidism can cause small changes in the T4 level but larger changes in the level of TSH. However, the changes are smaller when the T4 levels started out within the normal range.

The authors of this study went on to explain that the reason for the lack of significant change in the fT4 levels may be that the fT4 levels in the subjects were normal at the beginning of the study. Adding the short study duration makes it plausible why fT4 was not significantly changed.

3. The thyroid medication contained lactose. The authors believed that if a lactose-free thyroid medication were available, the results of the study would have been even more dramatic in demonstrating the beneficial effects of restricting dairy in those with Hashimoto’s who have a medically-necessary dependence on thyroid medication.

Taken as a whole, however, the findings of this study are still truly remarkable because they show the prevalence of lactose intolerance in patients with Hashimoto’s disease and the researchers successfully demonstrated that restricting dairy in the diet led to a decrease in the level of TSH in those patients with lactose intolerance.

The significant implication of this latter finding, according to the authors, is that by lowering the TSH, it may decrease the need for LT4 treatment. Furthermore, the researchers showed that in the case of hypothyroid patients with higher LT4 dose requirements, irregular TSH levels and a resistance to LT4 treatments, lactose intolerance should be considered while making a diagnosis.

The Negative Feedback Loop in Thyroid Disease

I’m going to pause here for a second. For those of you who are joining us for the first time or who have only recently begun listening to the podcasts, I‘m going to touch briefly upon the negative feedback loop which can clarify the relationship between TSH and T4. When you read about TSH levels going down, is that a good thing in Hashimoto’s disease?

The answer is not a simple “yes” or “no”. We have to consider the context in which the TSH levels have decreased. The body always aims for balance as it strives to maintain homeostasis.

The TSH and T4 relationship can often be confusing to people because a lower level of TSH does not correlate to a lower level of circulating thyroid hormone but in fact, the opposite is seen. Explained in other words, in a person with an underactive thyroid gland, the blood levels of T4 will be low, so the TSH level will end up becoming elevated. Essentially, the thyroid has not produced enough thyroid hormone. The pituitary recognizes this via the hypothalamic-pituitary axis and responds appropriately by secreting more TSH (thyroid-stimulating hormone) in an attempt to force more hormone production out of the thyroid.

In this particular study, a lowered TSH meant that the patients were getting more than sufficient levels of the LT4 medication absorbed just by limiting