Recently, I interviewed Dr. Ben Weitz, and we talked about a functional medicine approach to thyroid autoimmunity. If you would prefer to listen to the interview you can access it by Clicking Here [1].
Dr. Eric Osansky:
Very excited to chat with today’s guest, Dr. Ben Weitz. We are going to be talking about a functional medicine approach to thyroid autoimmunity. Dr. Ben also will be discussing his personal experience with thyroid autoimmunity.
I am going to dive into Dr. Ben’s bio: Dr. Ben Weitz is a certified sports chiropractor and functional medicine practitioner. For more than 35 years, he has worked with professional sports teams. He wrote a book in 1998, The Back Relief Book, and has published several papers on the prevention of injuries and weight training. He is currently working on a book on longevity. He has a weekly podcast, Rational Wellness, which is now in its sixth year. This is devoted to all things functional medicine. His office is in Santa Monica, CA, and he sees patients for both functional medicine and chiropractic therapy. Thank you so much for being here, Dr. Ben.
Dr. Ben Weitz:
Thank you, Eric. Excited to be joining you and sharing some knowledge with your viewers.
Dr. Eric:
I was on Dr. Ben’s podcast. We had a great time chatting. I’m sure this conversation is going to be great, too.
Let’s get into your background. You started off doing sports medicine, sports chiropractic, which you still do. How did you get into the functional medicine side?
Dr. Ben:
I think it started because even prior to becoming a chiropractor, I got involved in bodybuilding. I started learning about how to change my body composition. How do I reduce my body fat? How do I eat in a way to maximize muscle mass and reduce body fat? I started learning how to change body composition. That got me interested in nutrition as part of my chiropractic practice. I thought, I can help other people to get in better shape and reduce their body fat.
One of the first things that happened while I was practicing chiropractic, I think my first year in practice, Dr. Jeffrey Bland gave this seminar for Metagenics. I went to that seminar, and it blew my mind. For those who don’t know, Dr. Jeffrey Bland is the father of functional medicine. He would give these seminars that your neurons in your brain were just tingling afterwards. At the time, he was working with Metagenics. Metagenics would often send somebody out the next week to explain what Dr. Bland was telling everybody. I got really excited. That became an annual thing. Every year, I would go to watch Dr. Jeffrey Bland. For me, it was like going on a pilgrimage to Mecca.
Dr. Eric:
That’s pretty cool. I didn’t know he was associated with Metagenics for a while. I went through the IFM training, and he is affiliated with them.
Dr. Ben:
He started the Institute for Functional Medicine.
Dr. Eric:
Exactly. Prior to that is when he was with Metagenics?
Dr. Ben:
Yeah. He started his own company, HealthComm, that made medical foods. They linked up with Metagenics, and he became the science officer for them. He did that for many years. Of course, he started IFM. Most people credit him as being the father of functional medicine.
The other thing is he would put out this monthly tape of information about functional medicine. It started out as PMU, Preventative Medicine Update. I would get these little cassette tapes. At the time, every car would have a cassette player. Eventually, they switched to CDs. I would get the CD and listen to it in the car. Eventually, it became a podcast. That was a sad day. I remember I still had paid for that year’s subscription. He said, “Sorry, we are going to have to refund you.” It was great. I used to love getting those updates from Dr. Bland every month.
Dr. Eric:
He has a wealth of knowledge. I miss those days with the cassette tapes. Not that I don’t enjoy the modern technology and podcasts, but it brings back good memories.
Let’s dive into autoimmunity. Can you explain at least some of the reasons why you think autoimmunity is so much more prevalent these days? Going back to the days of cassette tapes, 20 years ago, 25-30 years ago, wasn’t as popular. We have better diagnostics these days, but it does seem like there is a lot more people with autoimmune conditions.
Dr. Ben:
I don’t think there is any data to know 100% for sure, but I believe it’s most likely related to the modern diet, the modern food system where eating so much processed food and hybridized products, fruits and vegetables. So many of the foods are sprayed with pesticides, and animals are sprayed with chemicals. High levels of toxins that we’re exposed to in the environment, not only on our food, but in our air, our water. We are constantly getting exposed to toxic products that stress our immune system. They are in the chemicals we put on our skin. They are in the pots and nonstick pans we cook with. They are embedded in our furniture and car seats. The modern world is an assault on our immune system.
Dr. Eric:
I agree. There is no question that what we eat, the air we breathe, the water we drink are huge. It’s unfortunately not getting any better. The good news is that podcasts like mine and yours and many others are bringing more awareness, so people are becoming more aware. They are eating organic and purifying their water and trying to do other things to reduce their toxic load. Still, it’s an uphill battle.
You were diagnosed with Hashimoto’s. I’m imagining when it comes to working with people, not that you exclusively work with people with autoimmune conditions, but I’m sure you see a fair share of people with autoimmune conditions. Given that Hashimoto’s is the most autoimmune thyroid condition, I’m guessing that might be the most common autoimmune condition you see in your practice?
Dr. Ben:
I don’t know if it’s the most common one I see, but I know it’s the most common autoimmune condition. We certainly have tons of patients with Hashimoto’s.
I diagnosed myself. For years, I actually had an elevated TSH level. TSH is the hormone that is secreted by the pituitary to tell the thyroid to produce more thyroid hormone. If that is elevated above- People have different numbers, but 3 or 4. Some people say 2.5. Mine was around 7-8 for many years. I ignored it. Nobody paid any attention to it. I never had any symptoms, like fatigue, weight gain, or hair loss.
I like to run my labs pretty regularly, a couple of times a year. I do pretty detailed labs on myself. I had been monitoring it for a number of years. My TPO (thyroid antibodies) have been mildly elevated, but not excessive, say 100-120, in that range. Normal is below 30. Ideally, you shouldn’t have any thyroid antibodies. Not generally considered something to worry about. I basically ignored that for a number of years.
One year, my TSH level went up to 9. I was searching around for some strategies to help myself deal with that. I had been hearing about the high dose iodine concept for quite a number of years. It always seemed wrong to me, but there is one very famous naturopathic doctor. Is he a medical doctor?
Dr. Eric:
Brownstein? He’s a medical doctor.
Dr. Ben:
He’s been talking about these super high doses of iodine. I said, you know what? Let’s give it a shot. For people who don’t know, iodine is the backbone of the thyroid hormone. When they talk about T3 or T4 as the different thyroid hormones, T3 has three iodine molecules, and T4 has four iodine molecules. You have to have adequate iodine, or that can lead to thyroid problems.
For many years, before thyroid autoimmunity became the problem, the big problem for hypothyroidism in this country was that people had goiters from lack of iodine. The Midwest was considered the goiter belt. It was very common for people to have these enlarged thyroids because the thyroid would be working hard to produce more thyroid hormone. It’s all because the soil there was low in iodine.
Many years ago, the United States started adding iodine to our salt. We have iodized salt. That was done specifically to reduce hypothyroidism. We saw levels of goiter drop incredibly. At the same time, levels of autoimmunity went up. We’ve seen the same thing in Iran and other countries around the world when they supplement the diet with iodine, typically by adding iodized salt.
In this country, most people have enough iodine. But I, being a health care practitioner and fanatic for natural health, haven’t used iodized salt for years. There is really no super accurate way to measure iodine. There is an iodine loading test. You can do serum iodine. None of those are really considered super accurate. Maybe I don’t have enough iodine, I thought, because I had been using a pink Himalayan salt or sea salt, and I hadn’t used iodized salt for probably a decade or longer.
I started taking the Iodoral, which is a brand product. I took the one with 12.5mg of iodine, whereas the average multivitamin will have 150mcg, like 1.5mg of iodine. Unfortunately, my TSH levels went the wrong direction. They went up to over 25 from 9. I realized that wasn’t right. What to do next? Stop iodine. Stop eating seaweed or any other sources of iodine.
Then I did a stool test to look at my gut. I’ve had IBS symptoms off and on for years. Nothing too major. I found some things to work on in my gut, so I started taking some antimicrobials and worked on some other gut support.
At the same time, I had done a NutrEval, which is this comprehensive nutrition evaluation. The ingredient that came up that I lacked the most was zinc. I decided that I wasn’t taking extra selenium, so let me add some extra selenium.
I also looked at a genetic test that showed I had a couple of genes that make it difficult for me to absorb zinc. That made sense. Even though I had been taking some zinc, I realized I needed to take more zinc. Rather than take a big dosage at one time, I decided to take 15mg in addition to my multi and take it four times a day, possibly increase the absorption by taking it at different times of the day. I added the zinc.
My goal is to keep Vitamin D for most patients in the 50-70 range. Mine was in the mid-40s. I would get it up to 50, and it would drop back to 40. I live in southern California. I don’t get a ton of sun, but I do play golf. I do get a certain amount of sun, yet it is very difficult for me to get my Vitamin D level up. Let’s really hit the Vitamin D.
I experimented with different formulations of Vitamin D: fat soluble vs water soluble. I started taking between 5,000-10,000. 5,000 wasn’t cutting it for me, so I started taking 10,000 for a couple months, and then alternating between the two.
I got my Vitamin D level up. I got my zinc level up. I also added some magnesium and brought my TSH level down to 4.7. I had gotten in to see my primary care doctor. What I do before seeing my primary care doctor is doing my own lab work and bringing it into him.
The lab work that is allowed through insurance is pretty minimal. Most people don’t realize what they do to make the lab work look better. The typical lab work you’ll get from your annual physical is basically a chem screen, a CBC, and maybe a basic lipid profile. Now, a chem screen is a pretty basic test going through an automatic machine. It’s like 10-12 tests, something like that. They will put each test on a separate sheet of paper to make it look like it’s a lot of testing. They will do the same thing with the CBC. They will put each particular part of it on a separate sheet of paper.
Patients come in to see me all the time, “I had all of my labs done, so obviously, nothing’s wrong,” which nothing could be further from the truth. Of all the lab tests they could have done, they had this much done, but it looked like a lot.
I run my detailed labs and then bring them to my doctor. When my TSH had gone up to 25, he had seen me and said, “Why don’t you take some thyroid?” I said, “Look, I don’t mind taking thyroid if I need it. I would definitely take it. But even though my TSH is high, and I know it’s very high, so far, my free T3 and free T4 are still within range. Are they at the top of the range? No. I don’t have fatigue or any other symptoms. At this point, let me try to work on some of the underlying causes of autoimmunity. Let me try to promote better thyroid health.”
When I brought my TSH down, he just shook his head. He knew what he suggested, taking thyroid, I probably wouldn’t take it.
Dr. Eric:
You have never been on thyroid hormone replacement?
Dr. Ben:
I have never taken thyroid hormone replacement or even a prescription medication, other than a painkiller for a day or two after surgery.
Dr. Eric:
That is awesome. High dose iodine, I have my own experience with that.
Dr. Ben:
What happened to you?
Dr. Eric:
When I was not doing the functional medicine part and just the chiropractic, I still attended conferences that focused on nutrition. Standard Process seminars, as you are probably familiar with. They had some functional endocrinology seminars. Whenever they went to those seminars, they spoke about iodine and the thyroid, and they were high proponents of high dose iodine. They brought up Dr. Brownstein’s book, and I read it, Iodine: Why You Need It and Can’t Live Without It.
When I dealt with Graves’, I took high dose iodine just because that was what I learned prior to being diagnosed. My experience was fine. My TSH also didn’t skyrocket to 25. With Graves’, you get the undetectable TSH typically. I was doing other things like taking bugleweed, which is an herb with antithyroid properties. I took bugleweed before the iodine. Even before I took the iodine, things were kind of normalizing, and the iodine pushed it a little more toward that hypo side.
My experience was okay. It didn’t worsen my condition, or at least it didn’t seem like it. I have been in remission since 2009. Over the years, I saw good and bad with iodine.
Dr. Ben:
What would be the rationale to why iodine could help with hyperthyroidism?
Dr. Eric:
When you take high dose iodine, it has the opposite effect, where it can push someone more toward the hypo side. In fact, many years ago, some practitioners would use that instead of radioactive iodine. Sometimes, instead of antithyroid medication such as methimazole.
When you think about it, it doesn’t make sense. Iodine is important for the formation of thyroid hormone, so why would you want to take higher dose iodine? In some people, it definitely makes it more hyper. In some people, it exacerbates the autoimmune response. It definitely has risks, and it’s not the approach I take these days.
I am sharing my experience because it was similar to yours. I did the iodine loading test myself. It sounds like you didn’t do the testing; you just experimented. I did what Brownstein recommended: took the iodine loading test, and it showed I was deficient. Iodine does have the potential to lower thyroid hormones. The problem is in some people, it can do the opposite. In some people, it can exacerbate that autoimmune response. I have seen some people where it worsens thyroid eye disease, which is common with Graves’.
The approach I take today, I am definitely not anti-iodine. I have no problems giving a multivitamin with iodine or having people eat some foods that have iodine, whether it be some seafood or eggs.
As far as the high dose iodine supplement, I usually stay away from that as far as my patients, recommending not to do that. Same thing with sea vegetables. I am more cautious with them eating seaweed and kelp.
Definitely controversial. There is a book called The Thyroid Reset Diet, where the author recommends 200mcg of iodine or less per day. I’m not saying some people don’t need a real low iodine diet. It comes down to everybody being different. I do think the real high dose, because you mentioned you took 12.5mg. There are some people who have taken or are still taking 50mg, a lot higher doses.
Now you said you had a stool test done. Do you remember what the stool test showed?
Dr. Ben:
It showed basically dysbiosis. It wasn’t anything too dramatic. Overgrowth of some bacteria that shouldn’t be there and maybe some of the commensals lacking a little bit. I took some antimicrobials and followed them up with a gut repair program, so nutrients that specifically support gut health, which includes things like glutamine and mucilaginous herbs as well as taking probiotics and prebiotics.
I generally employ some version of the four R programs. I want to remove those foods that are causing problems. We want to replace digestive enzymes, maybe hydrochloric acid. We want to remove excess overgrowth of bacteria, parasites, protozoans, fungal overgrowth, and pathogenic bacteria, etc. Then we want to rebuild after that.
Dr. Eric:
When it comes to triggers, you have already spoken about some of them. You just mentioned parasites and other microbes. You spoke a little bit about food and environmental toxins, how those are a big factor with autoimmunity. Are those some of the more common triggers? Would you say infections in your experience are up there, maybe the top one or two? Or is it more food? Do you see multiple triggers? What do you see in your practice?
Dr. Ben:
I see multiple triggers. What we’re talking about are things our immune system reacts to, which then ends up causing our immune system to turn around and react to our own cells, organs, tissues, which is what we refer to as autoimmunity. When our immune system is attacking us instead of outside invaders.
You can basically break it down into food sensitivities, toxins, and infections. Those are the main categories. Unfortunately, we live in a super toxic world. Even trying to eat clean, stay away from toxic products, it’s impossible to do so completely. Everybody is going to have some level of toxins unfortunately.
Dr. Eric:
How about stress? Do you consider stress to be a trigger as well?
Dr. Ben:
Sure. We often see that as problems with adrenal function. Many of us have some level of chronic infections. As most of us now know, now that we are all experts on viruses, any virus you’ve ever had in your life, any cold, etc., remains in your body to some extent as the immune system remembers it.
What can happen is you can have some infection that the acute phase cleared, but it’s still smoldering at a lower level. Or some virus gets reactivated. One of the things we’ve seen with post-COVID is reactivation of some of these chronic viruses, like Epstein-Barr or herpes. Those can smolder at a low level, and that can play a factor as a trigger in autoimmunity.
The mechanism by which infections, food sensitivities, toxins, can lead to autoimmunity, the main understanding of how that works has to do with something called molecular mimicry. What that means is let’s say you have a food sensitivity to gluten, which is a protein found in wheat. Your immune system creates antibodies to gluten. Gluten is a protein, and that protein structure is similar enough to some of the proteins found in the thyroid, or the thyroid hormone receptor. Those antibodies, instead of attacking the gluten, attack your thyroid or thyroid receptors in the case of hyperthyroidism, or some other tissue in your body. Your immune system ends up attacking itself. That’s what autoimmunity is.
From a functional medicine perspective, in addition to helping control the symptoms initially, we want to find some of these underlying triggers and remove as many of them as we can.
Dr. Eric:
Exactly. Sometimes, it’s challenging to do that. Sometimes, it’s challenging to find the triggers. But I agree. We need to do our best as functional medicine practitioners.
Speaking of finding triggers, when it comes to viruses, a lot of people, if not most people, have Epstein-Barr. Would you agree that just having Epstein-Barr doesn’t mean it’s a problem? A lot of people with thyroid and other autoimmune conditions have it where it’s not an issue. Would you agree with that?
Dr. Ben:
Sure. We typically test for antibodies to Epstein-Barr rather than just seeing it. When it comes to infections like Epstein-Barr, just the mere presence of the virus is not the problem. The question is to what extent is your immune system mounting a response to Epstein-Barr? To what extent are you actively forming antibodies? Therefore, rather than measuring whether there is Epstein-Barr in the system, we typically measure antibodies. Then we look at whether there is a sufficient amount of antibodies that it looks like Epstein-Barr is potentially having a factor on your health.
Dr. Eric:
Then parasites. If they show up on a stool test, do you always address them? Does it depend on the parasite?
Dr. Ben:
Like everything related to health, especially functional medicine, there are controversies about parasites. One of the controversies is are any parasites actually commensal? I know some people will be aghast. What do you mean? A parasite is a good thing? Well, it turns out that in societies where worms are endemic in people’s guts, autoimmunity is much less prevalent. One of the theories about autoimmunity is that our immune systems don’t have enough to do because we grow up in this sterile environment. People who have parasites, their immune system is busy taking care of those and less likely to react against us.
There are certain parasites that will show up, particularly protozoans, like Dientamoeba fragilis, D-fragilis, and Blastocystis hominis. There are prominent people in the functional medicine world. I’ve had discussions with Jason Hawrelak, who is one of the top experts at the microbiome and publishes Probiotic Advisor, which is a great resource for information on probiotics. He feels that most patients with either of those parasites/protozoans are essentially commensal. You don’t need to go after them.
In my case, if I see Blastocystis hominis, it depends on what’s going on. I’m going to consider it as something we might want to target. I’ve had a number of patients where I think getting rid of Blasto was a major factor in restoring their health. I think it depends on the patient.
There are a lot of things that are controversial. For example, H-pylori is a bacteria that is found in the stomach. It can be found on a stool test. I interviewed Dr. Steven Sandberg-Lewis, who is one of the world’s top functional medicine gastroenterologists. He says in most cases to leave it alone; don’t even test for it.
I recently had a patient who has had chronic reflux for years. We’ve done all kinds of things. Now that we saw it on a stool test and targeted it, his whole life has completely changed. This reflux that he has had for his entire life is now gone. His life is so much better, just using some herbs that reduce H-pylori. I think it depends.
Dr. Eric:
I agree. I think we share the same perspective. I think you know I also interviewed Dr. Hawrelak. We had that conversation about Blastocystis as well. Nirala Jacobi, who lives pretty close to Dr. Hawrelak, focuses on SIBO. She also shared that perspective on the podcast about Blastocystis.
I’m with you. With H-pylori, same thing. If someone is experiencing reflux or heartburn, I say to treat it. In the research, there is a correlation between H-pylori and Hashimoto’s and Graves’. Correlation doesn’t always mean causation. It’s not like I’m recommending triple therapy antibiotics. Like you, I’m taking more of a natural approach with herbs. It’s not like we are wiping out all of the good bacteria.
If we see it, and someone comes to see me with Graves’ or Hashimoto’s, which is typically the case, and it shows up, I won’t hit it hard. I don’t have prescribing rights, and you don’t either. Even if I did, with the knowledge I have now, I wouldn’t recommend antibiotics or in the case of parasites, metronidazole or flagella. I still take more of an herbal approach. There is controversy with that, and I’m glad we’re on the same page.
What do you do to lower your toxic burden on a daily basis?
Dr. Ben:
Examine the way you lead your life. Look at your house. Look at your clothes. Look at things you put on your skin. Eat organic as much as you can. If you are worried about the costs of organic, you can go to the Environmental Working Group. They give you lists, the Dirty Dozen. These are the ones that are most sprayed with pesticides. If you can eat these particular foods, like an apple or a blueberry- Blueberries grow close to the ground. They are not only sprayed with pesticides, but they are sprayed with fungicides and probably herbicides. At least eat those foods organic. Personally, I try not to eat anything that is not organic. That’s #1.
Use safe personal care products. Don’t cook with Teflon. Don’t store food in plastic. Don’t use plastic wrap. Don’t use aluminum foil. Use glass containers.
Try to lead a healthy lifestyle as much as you can. Don’t drink tap water. We use a reverse osmosis multi type of water purification system at our house.
Don’t use toxic cleaning products. Don’t use toxic products to wash your clothes. Don’t even give toxic cleaning products to your housekeeper if you have one. They will spray it all over the place.
Don’t hire a guy to spray pesticides all over your house. Find ways to deal with it as much as you can naturally. We’ll use a natural orange oil to kill bugs if we feel like we need to. Same thing with your pets. Try to avoid giving them toxic chemicals. Try to avoid having carpet in your house. Don’t buy a mattress that is sprayed with flame retardant chemicals. Don’t use toxic air fresheners. Those are some of the most toxic. Those are the things I’m thinking about.
Read labels. Start learning what are the terms that you want to look for. Anything that says it has perfume or fragrance in it, it has phthalates. You don’t want to eat it. Don’t buy anything plastic.
Drink water out of a glass or steel water bottle. People use these plastic water bottles, and then they worry about if the water bottle is going to get hot in their car or something. That water bottle has probably been sitting in the back of Costco or some warehouse in 100-degree weather for a long period of time before you even got it. Don’t drink from those.
Dr. Eric:
Great points. I also drink reverse osmosis water. Do you do saunas?
Dr. Ben:
We have an infrared sauna at my house.
Dr. Eric:
Wonderful. I do saunas as well.
Dr. Ben:
I go to the gym and sweat as well. Sweat is a way to help detoxify you. I periodically do a detox program a couple of times a year.
Dr. Eric:
Like a 21-day or two-week one?
Dr. Ben:
I will typically do like 10 days. I will do UltraClear RENEW and supplement it with liposomal glutathione and take some binders.
Dr. Eric:
All right. I have a question about Vitamin D. You said you like to see the levels between 50-70. You do the 25 hydroxy Vitamin D test, correct?
Dr. Ben:
I have done the 125 as well.
Dr. Eric:
What are your thoughts on the 125?
Dr. Ben:
Have you heard about the Marshall Hypothesis?
Dr. Eric:
Yeah. Have you had Dr. Eric Balcavage on your podcast?
Dr. Ben:
No.
Dr. Eric:
He has a book The Thyroid Debacle. He was talking about 125 hydroxy on my podcast. You probably are familiar with Dr. Ben Lynch, who wrote the book Dirty Genes.
Dr. Ben:
Yeah.
Dr. Eric:
When I attended one of his seminars a number of years ago, in either 2016 or 2017, he was supporting 125 hydroxy. When I was going through my master’s in nutrition, they were saying not to do that because of the parathyroid gland’s compensating. Typically, you will see 125 hydroxy elevated often when 25 hydroxy looks good or low. You can’t rely on 125. His perspective, Dr. Balcavage, was that it’s not true.
I’m like you. I will take 5,000 IUs of Vitamin D daily because I rely on the 25 hydroxy. Even when I went through IFM, that is what they also were talking about, 25 hydroxy, not the 125. It’s just an interesting perspective.
Dr. Ben:
You know what? I went through a period where we were running a 125 on every patient a number of years ago. We were using this one lab that had all these markers and included the 125. I did that on 100+ patients, and it was hardly ever elevated. I think it’s a very rare thing that that happens.
The concept is you are converting all of your Vitamin D to the active form, 125, so therefore your 25 always looks lower than it should. You don’t really need to take more Vitamin D. That is the concept that you’re talking about.
Apparently, that happens in sarcoidosis, maybe one other autoimmune disease, and not in the common autoimmune diseases that we know. I don’t know. After running that 125 over 100 times, I didn’t see it elevated.
Dr. Eric:
Interesting.
Dr. Ben:
That’s my experience. It’s always better to test rather than guess. We have to be judicious about how many tests we are going to run because these functional medicine tests are out of pocket for the patients. We use a lab that gives them a discount price, but it’s still out of pocket. I try not to do tests that don’t change what I do clinically.
Dr. Eric:
That sounds good and makes sense. That’s what all practitioners should do. There is no reason to do testing if you’re not going to do something based on the test results.
Dr. Ben:
Absolutely. I do think it’s better to test than to guess.
Dr. Eric:
Agreed. I definitely like testing. Not overdoing it but looking to try to find answers.
Dr. Ben:
There are so many people who don’t even know. I picked up a guy a month ago, and he had no idea he had thyroid problems. His thyroid antibodies were over 500. And he was so grateful that I told him that he had hypothyroidism. He is doing great now. There is no way we would have known. He had no clue.
Men typically don’t even get their TSH measured. It’s not part of your chem screen or CBC. It’s just not done, especially for men, because hypothyroidism is much more common in women. Men with hypothyroidism are not often picked up. The only way we would have picked that up is because we included that in our testing.
Dr. Eric:
I agree. It’s unfortunate that the medical model, they just do the basics, the bare minimum, whatever insurance will cover.
Dr. Ben:
That’s the whole thing. That’s the thing that nobody talks about. The health care system is controlled by insurance companies. Unfortunately, that’s the case. Insurance companies want to pay for the most minimal amount of testing possible. If your primary care doctor starts ordering a bunch of tests other than what the insurance companies recommend, they either won’t pay for it, and the patient gets stuck with a big bill, or the doctor will get threatened by the companies.
Dr. Eric:
One more question I have for you: Do you test people for a leaky gut, or do you just assume that people have a leaky gut?
Dr. Ben:
I typically do include zonulin as part of the gut test. There are a couple ways you can test for leaky gut. As far as I’m concerned, I think the most accurate is the old test we used to do, which as the lactulose mannitol test. That test involved drinking a solution of lactulose and mannitol. That was the best way to determine a leaky gut.
Since we hardly ever do that test, I include zonulin as a marker in the stool test. I’m gonna assume that most of my patients who have gut problems have a leaky gut. If you run food sensitivity tests, and the patients come up with 30 different foods that they’re sensitive to, you can assume they have a leaky gut.
Dr. Eric:
You brought up another question. In that case then, if you do a food sensitivity test, and someone shows up with 30 foods, do you not tell them to avoid the foods? Do you focus on healing the gut? Or do you heal the gut by telling them to avoid those 30 foods?
Dr. Ben:
It depends. If the patient is there primarily for gut health, or we are just testing the gut because it’s part of something else. Sometimes what I’ll do is look at those numbers. Depending upon the test, only ask them to take out the foods that are the highest range.
I tend not to do a lot of food sensitivity testing because I find those tests not as helpful, partially because sometimes one of two things happens. They react to everything, or they react to nothing, except like oysters, and they don’t even eat oysters. Either one of those are not clinically helpful. I have not found most of the time food sensitivity testing that helpful. But some of the patients want to run it. Sometimes we are searching for answers, so we’ll do it.
I also think so many people react to gluten and dairy that I know can be helpful to test, especially if it will reinforce to the patient why they shouldn’t eat it. A lot of times, we just ask them not to eat gluten or dairy.
Dr. Eric:
I do the same thing. I’m not a big fan of food sensitivity testing. I have people go on an elimination diet and have them avoid gluten and dairy.
Just because you brought up that scenario, I wanted to ask. I don’t do a lot of food sensitivity testing, but if someone tests for 30-40 foods, and a lot of them are healthier foods like broccoli and avocado and asparagus. If someone does it on their own, and if they come back, I will tell them to avoid the higher foods. You spent the money on it. Depending on the test, if it’s a scale of 1-5, and they are a 5 for avocados, I will tell them to avoid avocados to play it safe. Typically, it does relate to the gut, and that is what we need to do.
Dr. Ben:
One of the big issues has to do with the fact that after being in practice for so many years, I realize that what we say can have a big impact on people’s lives. I know that some of my patients listen to me a lot more than my wife does. They will sometimes take what I say to their grave.
I’m careful about taking food away from people. In my mind, sometimes, I’m thinking we will take it out for a few months and then test it back in. Depending upon the patient’s mindset, if they are feeling better, I have a number of patients who don’t want to bring any of those foods back. They end up with a very limited diet. That’s not healthy either.
I think we need a diverse diet with a lot of different colored fruits and vegetables, healthy fats, quality proteins, etc. I don’t think we want a limited diet. If the person has any tendency toward anorexia, if they are very thin, I’m really cautious about taking food away from people. We do it when we need to. We try to do it for short periods of time and try to emphasize the importance of bringing the foods back. If they have a reaction, then maybe take it out.
Dr. Eric:
That makes sense. Is there anything else you’d like to discuss? Anything that I didn’t ask you that I should have asked you? Do you want to do a summary? If someone is wondering if they have autoimmunity-
Dr. Ben:
You didn’t ask me what the earth speed velocity of a pigeon is. Just kidding. That’s a joke from Monty Python. I’m sorry for not being serious.
Dr. Eric:
That’s fine. I’m not a Monty Python fan, so I didn’t get it. You can definitely kid around on this podcast. You don’t have to be 100% serious. Dr. Jacob Teitelbaum, have you spoken with him?
Dr. Ben:
I have not.
Dr. Eric:
You’re familiar with him though? From Fatigued to Fantastic, it’s a pretty popular book.
Dr. Ben:
No.
Dr. Eric:
If you want to have a real funny conversation, he’s a real funny guy. It was a good conversation, too. But I was laughing throughout the podcast.
Dr. Ben:
Hopefully not with arcane jokes that nobody gets.
Dr. Eric:
Do you want to cover anything else? Or give a summary of what are the most important things someone can do if they have been diagnosed with an autoimmune condition?
Dr. Ben:
For people who are dealing with some level of autoimmunity, and people don’t even know they have autoimmunity. A lot of people have hypothyroidism, and they are given Synthroid. End of story.
We know in the United States the majority of cases of hypothyroid are related to autoimmunity. Patients go to rheumatologists and are given some drug that lowers their immune system, and I think we have all learned that having an immune system that doesn’t work very well is not a great thing, especially when there are dangerous viruses around or cancer, etc.
I think we have to spread the word that there is a reason why your immune system is attacking yourself. It’s just not acceptable to simply take a drug that suppresses your immune system. Look, I totally understand that there are autoimmune diseases like Crohn’s or ulcerative colitis and others that can be life-threatening. There is a place for these drugs. But even patients who take those drugs should see a functional medicine practitioner and work on trying to find the underlying triggers, why your immune system is attacking yourself.
Your immune system is not designed to attack itself. It’s designed to attack pathogens, foreign invaders, etc. It should not be attacking your own cells, tissues, and organs. If that is happening, take whatever drugs may be necessary to control the symptoms. As you have been able to show, even a very serious condition like hyperthyroidism, which can damage your heart, can often be controlled just using herbs and not taking the dangerous drugs. Other conditions may need to take those immune-suppressing drugs. Try to work on the underlying triggers.
Talk to your doctor after working on removing as many of those triggers as you can. If you can’t possibly reduce the dosage or wean yourself off those immune-suppressing drugs, overall, you will be healthier by not having your immune system suppressed.
Dr. Eric:
Thank you for summarizing that. Where can people find out more about you, Dr. Ben? You have your podcast and your website.
Dr. Ben:
Check out Rational Wellness Podcast. You can see the video version or listen to the audios. You can go to my website, DrWeitz.com. You can find out more information about me, my clinic in Santa Monica. I’m available for consultations for functional medicine and chiropractic.
Dr. Eric:
All right. Thanks again, Dr. Ben. It was great chatting with you about autoimmunity.
Dr. Ben:
Thank you so much, Dr. Osansky.