Recently, I interviewed Heather Gray, and we discuss the need for a holistic approach to health, how gut health and emotional trauma influence Lyme disease, the challenges of getting a proper diagnosis, the significance of foundational health practices, the potential benefits of bioenergetics and frequency therapy, and more. If you would prefer to listen to the interview you can access it by Clicking Here.

Dr. Eric Osansky: 

I am very excited to chat with Heather Gray. We are going to be talking about Lyme disease, mold toxicity, frequency therapy, tying that all into thyroid health. Let me dive into Heather’s impressive bio here: 

Meet Heather Gray, a functional diagnostic nutritionist and bioenergetic practitioner specializing in supporting clients with chronic and complex illnesses such as Lyme disease, mold toxicity, and autoimmune diseases. With over 32 years of personal experience, she understands the struggles of living with these conditions and is dedicated to helping others find relief.

Heather’s personalized experience as a practitioner, podcast host, and author has helped countless clients reduce inflammation in the body and brain, improve gut health, and achieve optimal wellness. She helps her clients get to the root cause of their symptoms and take control of their health journey. Heather’s approach is not only effective but also empowering. Don’t let chronic illness control your life. You can achieve the health and vitality you deserve. 

Thanks for joining us, Heather. 

Heather Gray: 

Woohoo! 

Dr. Eric: 

That was a nice ending to that bio. If you have been in that situation- 

Heather: 

Written by AI. 

Dr. Eric: 

You do have quite the healing journey. You dealt with Lyme and other coinfections. We were chatting before this. You mentioned bartonella, babesia, and toxic mold, and multiple autoimmune conditions, like Hashimoto’s and Celiac. You can probably spend an hour going over your healing journey. We will incorporate it into this talk here. 

Heather: 

I have it down to five minutes. 

Dr. Eric: 

Five minutes? 

Heather: 

Yep. 

Dr. Eric: 

All right. Let’s give it your five-minute healing journey. 

Heather: 

I will keep an eye on the clock. I was basically born full of shit. How many people can relate to being constipated as a kid? That’s what started my journey of throwing Band-Aids at symptoms. The doctors were wanting to get me on laxatives and stool softeners, nasty thick oils down my throat. 

Hindsight’s 20-20. That was around the same year my uncle committed suicide and my grandmother died of breast cancer. There was a lot of childhood trauma going on in my life. I think that’s what kicked off my Celiac gene at the time. I was also eating a typical standard American SAD diet. We have the perfect storm starting to brew.

By the time I did get bit by a tick when I was 13, there was a lot of early childhood trauma. I had a leaky gut, so there’s a leaky brain. Already had some autoimmune in process. I was living in mold. People talk about having a detox bucket; I had a detox thimble. It didn’t take much for me to get sick and remain sick. 

It took until I was 34 years old before I finally got diagnosed with Lyme. I was diagnosed with everything under the sun. I had two suicide attempts, multiple autoimmune diseases by this time. I was written off as my labs looked normal, everything’s fine, it’s all in my head. I was called attention-seeking. Put all kinds of prescription drugs and dismissed.

The definition of gaslit. If you were to look in the dictionary, it’s a Lyme patient, it has to be. The CDC just recognized my disease as a real disease last year. Wrap your brain around that one. Something that’s plagued the majority of my life was just recognized by the CDC last year. That’s what’s the pain to purpose story is. That’s what got me on my path of healing. 

If I would have stayed in the Western med model, I’m not sure I’d still be standing here. They were throwing antibiotics at a body, throwing napalm at a body that hadn’t worked for over 30 years. I talked about not being able to poop when I was younger. I still wasn’t able to poop as an adult. 

You can’t go to war with a person’s body that hasn’t worked right for decades and still expect it to come out okay. That’s one of my biggest pet peeves in the Lyme world, especially: There are so many people focused on treatment, and they’re not focused on the whole person. You might get better that way, but you won’t stay better. You’ll relapse, and that’s another story. 

Less than five minutes! 

Dr. Eric: 

Very impressive. Wasn’t expecting to talk about chronic constipation. I dealt with it, too. I had two bowel movements per week in my teenage years and 20s. Diet played a role in that; being on antibiotics many times as a child and teenager I’m sure also played a role. 

How long did it take to get- I don’t know where you are today, if you are having regular bowel movements daily or if it’s just greatly improved. How long did it take you to get to the point where your bowel movements were dramatically improved compared to yesterday? 

Heather: 

My gut was the last thing to get dialed in. Sometimes, the amount of antibiotic use, the Celiac on top of it, just the amount of abuse that my gut has taken over the decades, I still struggle with it. I do coffee enemas once a week and have for the past seven years. On Friday morning, just like clockwork. I start off Thursday night with a castor oil pack. I do a coffee enema, going into skin brushing, into my sauna. It’s my 24 hours of detox. 

I still take magnesium at night. There are things I have to take to help move things along. It doesn’t really work by itself. It’s nice to be able to take a few of these little supplements and have things work properly. 

I have to take a little bit more when I travel. It never fails. The minute I get on the plane, everything stops. It’s ridiculous. I usually have to double down when I travel. I’ve learned these hacks now, and I’ve learned how to be in tune with my body. 

That’s one thing I teach my clients who I work with. Don’t ever let yourself go a day without going. If you don’t, here are some tools to move things along and dig a little deeper. Especially people with chronic Lyme and these autoimmune diseases, the gut takes a beating. 

Dr. Eric: 

Agreed. You went undiagnosed for a long time before you found out you had Lyme. What were some of the symptoms you experienced when you dealt with Lyme? Did you have some of the classic symptoms? When I dealt with Lyme, no bull’s eye rash, no evidence of a tick bite in my case either. You didn’t have the classic signs and symptoms either. 

Heather: 

I was 13 and remember picking a tick out of my stomach. My mom did it the wrong way; she did it with a lighter. We are now finding out that’s the wrong way to take out a tick because it will regurgitate what’s in its system because you have scared it. Then your chances of getting Lyme go up. 

I did not develop a bull’s eye rash. Only about 30% of people with Lyme develop that rash. My symptoms didn’t show up until about two years later. They showed up with my first stint in a psych ward for a suicide attempt. 

That’s part of the reason why I love educating. I love the fact that more and more is coming out about the gut-brain connection and how it’s not just a lack of neurotransmitters that cause these mental illnesses. It’s heavy metals, mold, Lyme, other viruses that cause brain inflammation. 

I wanted to start a movement. Instead of calling people crazy, saying, “Your brain inflammation is showing.” The minute you get that stigma slapped on you of being crazy, it’s harder to wash off. The louder you scream, “I’m not crazy!” the more they say, “That’s what a crazy person would say.” 

I got bit when I was 13. 15 is when my first suicide attempt happened. How much different would my life have been if they had dug deeper instead of throwing Band-Aids at symptoms and putting me on an antidepressant and sending me back home? It showed up with a lot of neurological stuff. The anxiety and depression. I was diagnosed bipolar. A lot of chronic, widespread pain. 

In the whole disease catalogue, there are only six diseases that have migraine and pain as a symptom. You’re not a hypochondriac; it’s not in your head. If you really have pain in your right shoulder one day and your left elbow the next, flag on the play, could be Lyme. My right knee would swell up to twice its size for no reason. 

I would have Lyme rage, which is really common with bartonella. The rage part of it is common but also common just to melt down. No logic, ugly crying, melting down for no reason. It was almost like an out of body experience. I could see myself above myself. “Heather, knock it off. Heather, what are you doing?” There was no control over the body; it was so bizarre. 

I was in anger management classes at 15 as well. People tried to give us the tools, and people were like, “Count to 10.” I try to explain to them, “There’s no buffer. Something happens, and I react. There’s nothing in the middle there.” Later, I learned a lot of it had to do with the brain inflammation and the Lyme rage. 

Gastrointestinal issues. Hormonal issues. I was living with about a level pain of 5-6 every day for years and years. When you get brought up on TV and see all these commercials, you start to think that kind of stuff is normal, so I never put two and two together that it wasn’t normal not to live with these everyday pains. 

It wasn’t normal to live with everyday bloating and gas. I used to carry Gas-X with me. I had some in my purse, I had some in my locker at school, and I had some in my car. Being Celiac and eating a standard American diet, my gut was a mess. I never put two and two together. These symptoms are common, but that doesn’t mean they’re normal. 

Dr. Eric: 

That is true. You dealt with those symptoms for around 20 years. You said you were diagnosed at 34? 

Heather: 

34, yeah. 27 years, I went undiagnosed. 

Dr. Eric: 

Wow. What approach did you take when you were diagnosed? Did you initially take more of a conventional approach? Did you jump into functional medicine? 

Heather: 

No, that’s all I knew. I went to a DEO, hoping he was going to be better. Not quite all Dr. Med. But he threw a bunch of antimalarial drugs at me, which holy shit, the side effects of those things are just horrific. Antibiotics, and he also added herbals on top of it. He totally went to war with the critters of my body. Not once did he ask me, “How are you sleeping at night? Are you pooping daily? What’s your diet like? What’s your stress level like?” None of those questions were asked.

After two months of dealing with that, I walked into my first Lyme support group, and it was just toxic. Those poor people were wearing that disease like a cloak of honor. They were really identifying with their disease. Intuitively, I could tell I am not going to find healing here. I knew there needed to be another way.

Then I heard the founder of FDN, Reed Davis, speaking on a podcast. It was Sean Croxton, Underground Wellness. I was a hairstylist at the time. I didn’t have a medical background. Reed talked about how to heal the gut, making sure your hormones are balanced and making sure your detox pathways are open. Intuitively, this makes sense. 

At the time, the program was $1,500. It’s up to $8,000 now, which is still totally worth it. I remember begging my ex-husband.

To go through the program, you have to do a couple labs on yourself. You become your first guinea pig. It showed my liver was extremely congested, and I had Blastocystis hominis, which is a pretty common parasite for people who have pets. An overgrowth of candida. All these things. It was so much more than Lyme. All that doctor was focused on was the Lyme. 

FDN is all about dialing in the lifestyle stuff, making sure that you’re eating properly and sleeping properly. Within 3.5 months, my life had completely changed. I had lost 40 pounds. I was sleeping at night. My hormones were balanced. I felt amazing. 

Dr. Eric: 

Awesome. When you work with clients, everybody’s different. No two clients have the same exact findings. Especially with co-infections, most people come in with not just Lyme, but so many other things, like bartonella, babesia, parasites, yeast overgrowth, etc. 

Heather: 

Absolutely. I go back and forth because a lot of the marketing gurus I worked with have these packages, which usually include the same functional labs and supplements and this kind of timeline. It sounds great and nice and all, but I found that folks with Lyme are really sophisticated clients. They have had to become their own health advocate for so long. They have already tried a lot of different things, so they already come with a lot of great pieces to their puzzle. A lot of times, the puzzle pieces might be out of order, or they are missing a quarter piece here that helps tie the whole thing together. 

I had to kick that to the curb and go with a more individualized approach to meet each person where they’re at. Sometimes, a person comes in and just needs some tweaking of their diet and a lot of tweaking with their mindset and nervous system. 

Or I have a client I am working with right now where we are starting over from scratch with how to eat, how much to drink, making sure you’re pooping daily. He’s doing amazing. I’m so proud of him. He’s one of the few where I tell him what to do, and he says, “Yes, ma’am.” No arguments, no whining, no victimizing, no nothing. He has completely turned his life around in three months, it’s amazing. 

Dr. Eric: 

Very cool. You mentioned you grew up on the standard American diet, as did I. In that case, changing one’s diet can sometimes have a dramatic impact. I’m sure you also experienced people who have already cleaned up their diet. They have already changed their diet and lifestyle. You need to dig deep or go beyond that. Maybe it’s a toxic mold problem, which you also dealt with, and you need to do something to remove the mold. 

Speaking of which, how common do you see that connection? Someone has Lyme who also has a mold toxicity issue. 

Heather: 

So common that I have to rule it out before we even start working on Lyme. There are usually three things I have people rule out before we can start walking down that path. 

One of them is cavitations. If you get your wisdom teeth or had a root canal done, Western dentistry is not different than a lot of Western med. There are a couple funky practices. They leave something behind and close it out. 

A root canal is keeping something dead around, taxidermy in your mouth, which is so bizarre. It causes an infection in your jaw, which is so close to your brain. My troops were scattered for years. They were trying to protect my brain from this low-level infection. No wonder it couldn’t keep Lyme in check. So having to check cavitations. 

They have to rule out mold. That was one of the things that I ran into. I said about three months later, my whole life completely changed. Then I hit a plateau. That plateau was because I was living in mold and didn’t realize it, so we had to take a couple steps backwards. I had to detox from mold. I divorced my husband at the time and moved out of the house, so that started to get better. 

I talked about the detox genes earlier. I have a detox thimble. Most people have stuff that their body will tag as mold for your immune system to take out. I’m missing that. Mold just keeps circulating. People could literally be out of a moldy house for years and still be experiencing symptoms of mold toxicity because it’s recirculating in their body. At some point, it starts to populate in their body. Now they’re the source of the issue. 

The third will be sleep apnea. No amount of amazing supplements or lifestyle changes are going to do any bit of good if you’re not getting enough oxygen at night when you sleep. That’s a new one for me. These little tracker devices- I don’t snore. I never in a million years thought I would have had sleep apnea. This thing was showing me that my oxygen was dropping to 83% at night. Legit brain damage level. That’s the next journey I am healing back right now. 

I just met with an ENT person yesterday after trying a couple alternative therapies. I have a wickedly deviated septum, and something else is happening. I don’t have the passageway to get enough breath in. Being in Colorado at a higher elevation kicks my butt. 

Dr. Eric:

Yeah. Based on what you just said, you want to rule those three things out. Do you refer people to a biological dentist and also have them test their house for mold and refer them to an ENT specialist? 

Heather: 

It usually starts off with a couple intake forms that I have that are ridiculously in-depth. I have found a lot of clinical correlation. If on their medical history form, they say they’ve had a root canal in the past or mercury in their mouth, your next visit is to a biological dentist. If they have a lot of symptoms that looks like mold and not Lyme, let’s talk about mold. Same thing with sleep apnea.

I got lucky. In my last client who came to me, he’d already had a CPAP, so he knew he had sleep apnea. I can often rule things out with the intake forms and their medical history and symptoms. Oftentimes, I need them to go somewhere else to get that taken care of. We can still work on the things we’re working on if it will help with the other stuff they are dealing with. But they won’t get completely better if that stuff isn’t addressed. 

Dr. Eric: 

With sleep apnea, they can see what their oxygen saturation is during the night while they’re sleeping. If they measure it and see it’s less than optimal, they can go see an ENT. 

Autoimmunity. How common is it for people with Lyme, toxic mold, also to have autoimmune conditions? Especially thyroid since the audience is thyroid. Hashimoto’s is the most common autoimmune condition. Do you see a lot of people specifically with Hashimoto’s? 

Heather: 

Absolutely. It’s so sad that people don’t realize that the majority of autoimmune out there is lifestyle. It sucks. A lot of their doctors are telling them, “You have to be on this biologic or this pill for the rest of your life, and there’s nothing you can do about it.” I reversed 2/3 of my autoimmune conditions. I no longer have Hashimoto’s or endometriosis. 

Celiac is a different one. My gut has just been through the ringer. Wheat is so toxic and inflammatory anyway that even if I were to reverse the Celiac, I’m not sure I’d ever go back to eating that kind of food because I know all the damage and havoc it causes between being heavy with mold, heavy with pesticides, genetically engineered to have more gluten, so our bodies don’t recognize it as food anymore. There are so many things about Western wheat that I just leave alone. 

Dr. Eric: 

It’s not as challenging these days to be gluten-free. We should be eating mostly whole, healthy foods, which are naturally gluten-free. If you want to indulge a little bit, you could have a gluten-free pizza or a cauliflower-crust pizza. Not that these are healthy options, but if you absolutely wanted to be gluten-free, compared to 10 years ago, when pizza tasted like cardboard, there is even paleo cookie options. 

You can make your own, too, which is the best option. Make your own paleo or AIP-friendly cookies and pastries. Now, if you walk into a Whole Foods, you have to be careful when it comes to reading ingredients. Just because it’s gluten-free, who knows what else is in there? The point is, it’s not as challenging as it was 10-15 years ago to avoid gluten.  

Heather: 

I like what you said. With processed foods, I find so many people just skip one crappy, processed, Western, standard American diet for a crappy, processed, gluten-free diet. Then they wonder why they’re not feeling any better. Sticking as much to whole, real food as possible. 

Not eating out as much, especially with all the seed oils restaurants are cooking with, which cause a lot of brain inflammation and inflammation throughout the body. We are making bad copies of fat-soluble things with a subpar product. Seed oils are horrible. I try not to eat out at all anymore. When I do, every single time, I pay for it.

There is only one restaurant in the three towns around me that have gluten-free, paleo, no seed oils, non-GMO, organic. It’s amazing. But it’s just sad. That’s one in a 60-mile radius. 

Dr. Eric: 

You just need to open up your own restaurant. 

Heather: 

I’ve thought about it. I’m a badass cook. I like to cook. I am a front of the house person. I’m an extrovert on steroids. To put me in the back of the house, cooking, no.

Dr. Eric: 

Let’s talk about different treatment options for Lyme. You’re big into addressing the foundations, which is important. Honestly, I was guilty: when I found out I had chronic Lyme, I jumped into ozone therapy, IV ozone, even though I knew that wasn’t necessarily a cure. I was terrified of being debilitated when it came to dealing with Lyme and bartonella. It helped. 

Even before that, I heard of people getting IV ozone, and a few months later, the Lyme symptoms came back. With antibiotics, they destroy the gut microbiome. There are people who are on long-term antibiotics for that. There are other treatment options like hypobaric oxygen, herbs, homeopathy. If you don’t address the foundations—heal the gut, reduce your toxic load, do things to manage stress and improve adrenal health—these other therapies aren’t going to be nearly as effective. 

I’ll let you take over as far as your approaches and your philosophy to treat Lyme.  

Heather: 

That was my experience. I’d get better for 3-6 months, a year, and then relapse. Then I’d clean everything up again. I would get better for 3-6 months and relapse. That happened about three times. 

It was right around 2020 that I was relapsing. I was gaining weight, getting reactive again, in a lot of pain. My brain was foggy. I was living in a moldy area. I also never dealt with the early childhood trauma. That type of trauma, the heavy metals, the mold toxicity, chronic disease, all these things act like trauma in the nervous system. They get stuck in the body. 

I was always such a great functional practitioner, doing my supplements and diet, being in bed on time, doing my coffee enemas. You want me to get in touch with my feelings? What are those? Who has time for that? I thought it was woo-woo, all the things. 

It’s sad to me, too, because in that industry, people talk about Lyme flares or autoimmune flares like they’re normal. They don’t have to be normal. There’s still an area they haven’t addressed, a part that’s not healed. The Body Keeps Score, that book was an intro for me into that world. Two weeks later, I was doing an ayahuasca journey. I have done four or five types of psychedelics. I have done neurofeedback, somatic experience work, breathwork, tapping in the name of healing that trauma from my nervous system. I wasn’t reactive. I could then heal. 

When we are stuck in fight or flight, that tiger is always chasing us, we are not in rest and digest, we can’t heal. A lot of gut issues is my nervous system stuff. I just got back from Dr. Drobot in Scottsdale, AZ, and he has some amazing machines to help calm the nervous system. There was one in particular that he did on me. “You see this number? It should be around 45.” Mine was 550. It pissed me off at first because I do so much work around this. 

Sometimes, it’s just so far gone that you need a bigger system reset in order to calm everything down. He has given me a breath app to do homework at home. There are a couple new supplements I’m taking to help calm the nervous system. I’m a type A, tightly wound person to begin with. It takes me a lot to get me to calm down. I realize how important it is. 

Speaking on those foundations, I put together an online course going over those very things. It’s amazing when we get back to the basics how well our body then takes over and knows what to do. It’s beautifully designed for healing once we remove the blocks out of its way. Making sure that you’re getting to bed on time, getting enough sleep. Making sure that you’re pooping every day, eating the right kind of diet, getting the right kind of exercise.

After I went through all the foundational stuff and really cleaned up my lifestyle and environment and detoxed my body, I didn’t have to treat the Lyme anymore. About once every six months to a year, I go to my doctor, who gives me IV silver. I have an ozone machine. I’ll do some vaginal. I’ll do them in my ears. Once a year, I do a round of herbs. My bioenergetic stuff, just to keep things at a dull roar. 

For the most part, I’ve never had to go back in and retreat. After I cleaned up, my body went, “Okay, I know what to do.” If I’m keeping things clean and healthy, my immune system works like it’s supposed to. I don’t drink. I don’t eat out. There are a couple sacrifices I make on a daily basis. I’m operating at a level that most even healthy people I know don’t operate on. I’m very blessed that having all these things I’ve had my whole life, that I’m able to have the energy, the brain power, the stamina to do what I do in life. 

Dr. Eric: 

That’s wonderful. I agree with you about incorporating the foundations with any health condition, not just Lyme. If someone has an autoimmune condition, without having Lyme or toxic mold, you still want to incorporate the foundations. With pretty much any chronic condition. I can’t agree with you more than that. 

Bioenergetics, I wanted to talk to you about those. Frequency therapy. I have told you that I have been intrigued but also on the skeptical side, even though I have the NIKKI. I got something called the Wave 1 along with the NIKKI. I have been thinking about Rife and all these other things. I have heard some great success stories. I have heard other people with Lyme and coinfections where it doesn’t help them. 

I’m at the point where if you didn’t tell me I had Lyme and bartonella years ago, I would not know. I feel pretty good. It’s hard. To me, I just got it because even though I feel pretty good with that, I got hit really hard with COVID a couple of years ago. That made me think twice. I’m not one who gets the flu or anything like that. That made me think twice about that. 

Talk a little bit more about how long you have been using frequency therapies. From listening to you on other podcasts, you have experiences with different ones than the ones you’re using now. 

Heather: 

Almost from the get-go. I don’t remember where I heard about Rife first. It’s so funny to me because I was just a silly hairstylist who didn’t have a background in medicine or physics. Anything along those lines. For some reason, when someone explained to me Rife, I was like, “Oh my god, yes. Where do I find this?” I found an acupuncturist in my town who actually had a Rife machine. I was feeling a lot better really quickly. It was amazing. 

From there, I branched out into all different kinds. The premise behind it is everything is frequency. We’re all energy. We can measure the heart’s magnetic field with an EKG. We can measure the brain with an EEG. If these things in our body aren’t talking to each other in concert, if they’re not in coherence, then we have disease. 

A lot of times, the bioenergetic field, if that’s out in a person, the supplements that they’re taking or a lot of these other therapies they’re doing, aren’t going to have its true potential because they are out on a bioenergetic level. We are energetic beings first and foremost. 

It’s sad because there is a lot of great machines out there that do really awesome with diagnostics, which you’re not supposed to say. I didn’t find a whole lot that helped move the needle when it came to actual “treatment.” 

I do the NIKKI. That one I’ve found to be really helpful. I dismissed it for six months because there is no way that works for that inexpensive. At the time, I was using the Nest machine, which was a $20,000 investment. Here comes the NIKKI, and it was at the time $1,500. I was like, there’s no way that works at that price. 

I got one, and it does. There is no diagnostic feature to it. it’s just a menu that you pick out of what you want to do. It’s where becoming a muscle tester comes in handy. I’ll muscle test the frequencies during the day. Should I be running inflammation or detox or gut health today? I run on a daily basis almost to keep everything at a dull roar. 

AO, I really liked as well. I’m thinking about getting back into AO. They have an awesome mental, emotional program that helps with that nervous system stuff that we talked about. They also have a cool, new watch that puts red light into your wrist and a methylene blue supplement. I have been loving playing around with methylene blue lately. 

It’s funny, when it comes to the frequency stuff. It was so controversial, and there was no standard of care. We had to think outside the box. Most of us have done some crazy crap in the name of healing. I have taken something called MMS, which is chlorine dioxide. I do coffee enemas. Silver in my veins. Bioenergetic stuff. 

Like I said, there was no real standard of care. There were no real answers. I knew that the Western medicine route was going to kill me if I kept doing it. The more controversial ozone rectal insufflation of ozone, these things work. The future of medicine is absolutely bioenergetic. I don’t think they’re quite there yet, but it’s getting close. 

Dr. Eric: 

How long have you been taking methylene blue? You said a few months now? 

Heather: 

Four or five months now. 

Dr. Eric: 

Do you think it’s helping? 

Heather: 

Huge. I remember the first day I tried it. You’re supposed to supercharge it with red light or get out into regular light because it’s a big word that I can’t pronounce right now. I’ll take it and wait 10 minutes and put my red light patch on my belly for about five minutes. All systems on. I could feel the energy coming back into my body, into my brain. It was amazing. My husband really loves it, too. 

Recently, I was hanging out with this Dr. Jon, his last name starts with an L. He puts it in his eyes. He has a bottle of blue eyes. I have been trying that. I am getting to an age now where I am presbyopic, where I am starting to need readers. My distance isn’t so great. I am not going down without a fight. I don’t want to wear glasses. I have been doing the methylene blue and the red light in the eyes to help. it’s actually helped out quite a bit. 

It’s a phenomenal antibiotic, antifungal, antimicrobial. It’s a great antioxidant. It’s protection against COVID and viruses. There is a lot of really awesome uses of methylene blue. I am not a big fan of the World Health Organization. They even have it on their list of the top 15 supplements that everybody should be taking. 

Dr. Eric: 

Interesting. You take it multiple times a day? Once a day? 

Heather:

I just take it once a day. If I have someone who has some chronic stuff we are working with, it might be multiple times a day. I take it in the morning. Usually only five days a week. Cycle on, cycle off. 

Dr. Eric: 

Do you think it would be just as effective if someone is listening to this, and they don’t have a red light unit, just to take the methylene blue? Is it worth taking without the red light? 

Heather: 

Absolutely. But you will get way more out of it if you can charge it. Even take it and stand outside in the sun. Take it during a time when there is sun outside. Just standing outside in the sun for five minutes. Or if you have an infrared sauna, take it and get in the sauna. 

Be careful with methylene blue. It needs to be pharmaceutical grade. Because it’s so new out there, there are a lot of people doing things wrong. It can be contaminated with heavy metals. Be careful that you are sourcing it from a good source that you know is clean and helpful. That’s the one caveat with it.

It’s sad because what it can do for depression and anxiety is amazing. It counteracts with SSRIs. Disclaimer there. 

Dr. Eric: 

Good to know. 

Heather: 

I took it. I was in a women’s circle where they were microdosing an hour later. I didn’t think anything of it. That microdose isn’t supposed to touch you, just to open things up. Because I had taken the methylene blue an hour beforehand, and it inhibits detoxing of this stuff, I actually had full-on tripped. While everybody else was sober in the group, I was full-on tripping. 

The teacher learned a lesson the hard way that day as well as I did. You better ask people if they have taken methylene blue before you do psychedelics because you can supercharge your experience. Not for the best. I’m always learning things the hard way. 

Dr. Eric: 

You also mentioned MMS. Do you still do that? 

Heather: 

I don’t have a need to. I still have bottles in my cupboard, but they are probably old and expired now. I need to throw them away probably. In the beginning, I felt like it really helped, but not anymore. 

Dr. Eric: 

You do the methylene blue just to keep up with the foundations. The frequency, wearing the NIKKI. Those are some of the main things you currently do. 

Heather: 

Silver and ozone. Herbs. 

Dr. Eric: 

You said the IV is silver. You also take it orally on a regular basis? 

Heather: 

Up my nose. If I feel like something is coming on, I will take it orally. I’m a big fan of silver. 

Dr. Eric: 

Very cool. I was taking silver regularly. It’s funny. Since I got diagnosed with chronic Lyme in 2018, I started taking silver. I did ozone as I mentioned. I took the silver, and I got upset because I got hit hard with COVID in January 2022. You know what? This silver is expensive. It didn’t prevent me from getting hit hard with COVID. Since then, I stopped taking it. 

Being a healthcare practitioner, getting exposed to so many supplements. I could take a break from one or two things. Maybe a coincidence, I haven’t gotten sick since then. There were other things, too. If anything, it taught me that I felt like I was doing a good job of maintaining my health. 

There were things I could have done better. It’s always a work in progress. Trying to reduce exposure to electronic pollution, the blue light, all these things, getting enough protein, all these little things that sometimes we don’t think about. Let alone trying not to get too stressed out. Even that single thing alone will make you more susceptible to viruses.

The last question I have for you is whether or not in your opinion, or maybe you have factual evidence about Lyme, whether it can be completely eradicated. Some people do think it can be completely eradicated, but I haven’t come across any evidence that shows that once you have it, you could get it out of the body. It is intracellular from what I can understand. 

Heather: 

If you catch it within the first year, I think there are pretty good odds of getting rid of it. Me, 27 years? Absolutely not. It is a part of me. There are so many practitioners who do not walk their walk. I have to. Literally. I take two steps off my Lyme, and I’m getting sick. It’s ridiculous. 

I’m grateful that I get to operate at this level. I just have to be careful. I was just telling you before we got on here that I recently traveled to eight cities in 10 days. I’m paying for it a little bit right now. There were a few slip-ups. I don’t normally drink. I had a drink. It was crazy how bad one drink messes up my sleep. It does mess up people’s sleep. These trackers. I am seeing all these red lines. At one point, the tracker is telling my phone to tell me to calm down. I was asleep. I normally get a 90 sleep score. It jacked it down to a 70. It was horrible. 

I have to walk my walk and keep my lifestyle clean, and I can operate at a really awesome level. 

Dr. Eric: 

Wonderful. Keep up the good work. Keep on helping others with Lyme, mold, and coinfections. 

Before we wrap up, for someone who has been suffering, whether it’s for a few months or many years like you, it’s really a good idea to work with an expert, someone like you who works with Lyme and mold on a regular basis. Before they do that, what are some words of advice you could give for someone who is suffering before they start working with a functional medicine practitioner? 

Heather: 

Not to give up. I get their frustration. Honestly, I was there. “What could you teach me? I have already seen 20 practitioners. No one has answers.” You have had 20 different things that don’t work. That’s awesome. Next: never give up. Keep digging. Keep looking. Keep being an advocate for yourself. You never know if that next person could have the answers you need. Never give up. 

Dr. Eric: 

That’s awesome. For those who might be interested in working with you, where can people find out more about you? 

Heather: 

I am @TheLymeBoss everywhere. I have two entry points. I have a freebie on my website, so if you go to TheLymeBoss.com, get a free cooking series. Real cooking for real life. I know how stressed out and how little time people have. You still need to get real food in your diet, so I teach you how to make delicious meals in 20 minutes or less. That’s free.

I have my foundations course, which I am giving your crowd a special $299 off with the code DOCTORE. Learn how to dial in your sleep. Learn how to dial in your diet. Learn these exercises to keep your nervous system calm. Learn how to detox properly. Learn how to set down the foundations at an inexpensive price. It took me years and years and tens of thousands of dollars to learn everything I put into this really awesome course. 

Dr. Eric: 

Thanks for the discount code. This was a great conversation. You covered a lot of different things. Some things I knew you were going to cover. Definitely want to talk about the frequency therapy. Didn’t expect you to talk about the methylene blue, which I was excited about. Talking about cavitations, oral health. This was an amazing discussion, and I appreciate you sharing with everyone. 

Heather: 

Thanks for having me. 

 

Recently, I interviewed Louise Digby, and we discuss the challenges women in perimenopause and menopause face in losing weight, how thyroid issues impact weight management, why she focuses on addressing underlying health imbalances, the need for adequate protein, fat and carbohydrates in every meal, how to manage sugar cravings, why we need to heal the gut, whether intermittent fasting works, practical steps for starting your weight loss journey, and more. If you would prefer to listen to the interview you can access it by Clicking Here.

Dr. Eric Osansky: 

I am very excited to chat with Louise Digby, as we will be talking about some of the different factors that can make it difficult to lose weight. There are definitely a lot of different factors. Very excited to have this conversation. 

Let me dive into Louise’s bio: Louise Digby is a registered nutritional therapist, women’s weight loss expert, and founder of the Nourish Method to lasting fat loss. Her clients come to her after struggling to lose weight despite eating well and working hard to burn the fat. Louise transforms her clients’ health by identifying and addressing each individual’s unique needs and imbalances, so they can lose weight, optimize their health, and rediscover their sparkle without restrictive dieting or the need for superhuman willpower. Thank you for joining us, Louise. 

Louise Digby: 

Thank you so much for having me. It’s great to be here. 

Dr. Eric: 

I’m really excited to talk with you about some of the different things that could make it a struggle to lose weight. A lot of people, as we both know, focus on diet and exercise. We’ll definitely talk about some of that. Many times, it goes beyond just cleaning up your diet and exercise. Before we do that, if we could get a little bit more of your background. How did you start focusing on helping other women lose weight? 

Louise: 

I graduated in nutrition back in 2012. When I first started, I was seeing everyone and anyone, whatever their health goal or problem was, be it IBS, depression, or eczema, you name it. What I found is that pretty much everyone who I worked with also wanted to lose weight as a side goal. I also had people come to me just for weight loss, not for any other issues or conditions. 

What was interesting was that the people who were focusing more on their health and addressing their underlying imbalances actually got way better results when it came to the weight loss side of things than the people who were just focusing on their weight and who were doing more portion control when trying to come up with creative ways to eat less and exercise more. 

I also noticed there was a particular group of people—women in their 40s and 50s—who were super disciplined and trying really hard to keep in shape and lose the weight but really not seeing very much progress at all. 

I ended up gravitating toward that particular area because it was a bit of a conundrum. It was really frustrating to see these women trying so hard and not really getting anywhere. That helped me to formulate my approach of looking deeper than just how much someone is eating and how much they’re exercising and uncovering the underlying imbalances that affect metabolism and hormones and cause weight to become stubborn, particularly around that time of perimenopause and menopause. 

Dr. Eric: 

One of the questions I wanted to ask you was some of the biggest mistakes women make when trying to lose weight. You mentioned trying to restrict calories, maybe overtraining. Any other common mistakes that women make when trying to shed pounds? 

Louise: 

What goes hand in hand with cutting calories and cutting things out is ignoring what your body actually needs. Your typical diet approach just looks at what do I need to avoid? What do I need to cut out? What are the bad foods? 

Instead, I find it so much more helpful and a much more positive experience to focus on what your body actually needs to thrive and function properly. Focus on what we need to add into the diet rather than what we need to take out, which might mean looking at: Are you getting enough protein? Are you getting enough carbs? 

So often, many of us go straight to cutting out carbs, but they have a function, they have a place. Taking them too low in some circumstances can actually make you gain weight. Making sure you have enough fat, and you are meeting your nutrient requirements are all key things we want to make sure we have in place so our body is able to repair and stay in balance. 

You also mentioned overtraining. This is a really key point because most of the women that come to me are trying really hard to lose weight. Sometimes, that looks like being in the gym every day, doing spin classes constantly, doing really long runs or lots of high intensity cardio. That can actually drive up your cortisol levels (stress hormones), which can lead to your storing more fat around your middle. Sometimes, we actually need to scale back the exercise a little bit and essentially take a much more gentle, nurturing approach to weight loss rather than the punishing, deprivation approach that we have been taught. 

Dr. Eric: 

That makes sense. I want to go back to the carbohydrates. You mentioned some people restrict carbohydrates too much. Obviously, a ketogenic diet is a proponent of doing that. Some people do okay with keto. Not to say people never lose weight when following a ketogenic diet, but it’s not a perfect fit for everyone. 

I want to talk about protein as well. When it comes to carbohydrates, does it depend on the person? Or for most of the people who see you, do you recommend not to go below a certain amount? 

Louise: 

It definitely depends on the person. Particularly if someone has a thyroid issue or if they are very highly stressed, then it’s probably not a great idea to take carbs too low. They are very active. It’s helpful to have at least some carbs in your diet. As to what that specific amount is for each person, it will vary, but I think avoiding taking it below 50-70g per day is best for most women I work with. Taking carbs too low is something that halts their progress.

Like you said, some people do quite well on the ketogenic diet. I have a lot of women come to me who have done well on the ketogenic diet, and then the progress is stopped. The weight has become ultra-stubborn. Just because you’re getting results initially doesn’t mean it’s necessarily the right approach for you in the long term. 

Some people have good success with taking a hybrid approach, where they switch between doing keto for a week and doing more of a low GL approach for a few weeks and then back into keto. That can work better. Also, if you know your thyroid is functioning okay. 

Dr. Eric: 

I agree. Even if keto is working, it’s not in my opinion a long-term solution. You don’t want to stay on keto for long-term. It’s not a permanent diet. Some people might have success losing weight. After a while, it might plateau. There are concerns about the effects on the gut microbiome if you follow keto for quite a long time. I appreciate you bringing that up.

You mentioned thyroid. If someone has a thyroid issue, you want to be careful about doing keto. I know you had some other episodes on other podcasts where you spoke about thyroid and weight gain. What relationship have you seen between those with thyroid conditions and the struggles they have with losing weight? 

Louise: 

Your thyroid is the master controller of your metabolism. It controls the speed of pretty much everything that’s going on in your body. If your thyroid is underfunctioning, or if it’s sub-optimal, then everything is going to slow down, including fat burning and energy production. 

What I so often find is that a lot of people, particularly women, have been to the doctors, have their thyroids tested, and been told it’s absolutely normal. Don’t need to worry about that. There are a few problems with that because the tests that are typically done at the doctor’s, particularly here in the UK, and I think it’s probably the same where you are, are very basic. 

They just look at TSH, which is the signal that your brain sends to your thyroid to tell it how hard to work. That is not actually testing the output of the hormones from your thyroid. Occasionally, if you’re lucky, you might get your T4 tested as well, which is your main thyroid hormone. Again, it’s still not enough information for us to see whether the thyroid is working properly. There are other hormones and factors that can be tested. It’s not a full picture. 

Also, the ranges that your doctors are looking at for your TSH and T4 are very wide. In terms of what is considered to be optimal, it’s a much narrower range that we should be looking at. Very often, people are coming to me with their thyroid being ruled out, but actually, their thyroid isn’t optimal. When we do a more in-depth test, we see there are other factors like T3 or antibodies that are not where they should be. That can have an impact on your metabolism and how your body burns and stores fats. 

Dr. Eric: 

Definitely agree about the optimal ranges. Most doctors aren’t paying attention to them. Same here with a lot of doctors just looking at TSH. Some do TSH and total T4 or free T4, but a lot of doctors still don’t do T3. Some will do antibodies. Usually, they’ll do antibodies maybe one time and won’t monitor them at all. 

As we both know, the treatment is usually the same regardless, for at least those with Hashimoto’s. Whether or not they have antibodies, it’s usually thyroid hormone replacement, if the TSH is outside of their lab reference range. 

Most thyroid conditions are autoimmune. The next question I have is about inflammation, as they are typically associated with inflammation. Does inflammation play a role when it comes to struggles with losing weight? 

Louise: 

Definitely, it plays a massive role. Inflammation is a term that we often hear banded about and never gets discussed in any real detail. Most problems, whether it’s a symptom or a condition, are usually underpinned or driven by inflammation in some way. It’s the same for stubborn weight. 

Inflammation can drive insulin resistance. Insulin resistance is something that can basically make it very difficult for us to get into fat burning mode. Inflammation can be disruptive that way. It can also be very disruptive to your hormones. There are many different ways in which our hormones are involved in how we burn and store fat. Inflammation is definitely a massive factor for many of the people I work with. 

Dr. Eric: 

When you say “hormones,” are you talking specifically about the sex hormones, like estrogen, progesterone, testosterone? 

Louise: 

I’m really talking about most hormones. Yes, the sex hormones. Also, your thyroid hormones; your blood sugar hormones, like insulin and glucagon. Your hunger hormones. Even your brain chemicals. They’re all involved one way or another when it comes to your appetite, cravings, fat burning, and speed of your metabolism, and inflammation can be disruptive to all of them. 

Dr. Eric: 

We spoke about thyroid. You mentioned cortisol earlier, like overtraining. There are emotional stressors that can affect cortisol and make it difficult to lose weight. You spoke about insulin resistance and the hunger hormone, like leptin, resistance. How about the sex hormones? How can the sex hormones influence weight gain?  

Louise: 

When it comes to the sex hormones, the common problem is there can be many different ways in which they are imbalanced. Particularly in women, as they become perimenopausal, estrogen levels often can become dominant. We can have too much estrogen in relation to progesterone. When we have high estrogen levels, that can be disruptive because it can interfere with the way that insulin works. It can interfere with our histamine levels. Histamine is involved in our appetite. That is one of the key ways in which it can drive weight gain. 

Progesterone is a very common hormone. As that declines as we go through that perimenopausal shift, or if we are very stressed, our progesterone levels can be suppressed and low. That can make us more anxious, and that can feed into things like comfort eating and those types of not so helpful eating patterns. Some of it is directly related to the way our body burns fat, and some of it is more psychological. 

Dr. Eric: 

In the UK, do you have access to the DUTCH test, where they look at the metabolisms of estrogen? 

Louise: 

Yes. 

Dr. Eric: 

Some people might have normal estrogen levels but have problems with the metabolism of estrogen, which can be a factor. 

Louise: 

Something that we see quite a lot. A lot of people would come to us with a blood test from their doctors that says that all their sex hormones are as they should be. Again, when you do a more detailed test that looks more at the tissue levels of your hormones and how you’re metabolizing them, there is a lot more information there to work with. 

You mentioning the DUTCH test reminds me I haven’t spoken about testosterone, which is absolutely key as well. Testosterone is the hormone that we tend to think about when we talk about men. It’s very key for women as well. It tends to decline over time, particularly during perimenopause and menopause. 

Testosterone is so important for us to maintain our muscle mass. Muscle is so important for helping us maintain a healthy weight because it’s metabolically active. The less muscle you have, the fewer calories you burn, whether you’re exercising or resting. The drop-off in testosterone can be a big issue as well. 

Dr. Eric: 

Sticking on the topic of muscle mass, protein. We spoke about carbs. Getting adequate protein is also important. What do you typically recommend as far as protein intake per day?  

Louise: 

It does depend on the individual. Generally, somewhere between 20-30g per meal of protein per day is probably good for most people. To clarify that, when I say 20-30g of protein per meal, some people think that means 20g of chicken or 20g of steak. 20g of protein, which might mean a 100g chicken breast or something like that. It’s not about the total amount of the food; it’s about the protein content within that. 

Dr. Eric: 

What role does the gut microbiome play when it comes to losing weight, trying to have a healthy weight? 

Louise: 

The gut plays a massive role in weight management. It’s involved in quite a few different ways. Your gut is very closely linked to your immune system. The vast majority of our immune system is in our gut. Your immune system is very much in control of inflammation in your body. If your gut isn’t balanced and happy, the likelihood is that you probably won’t have a healthy immune response. You will be more prone to chronic inflammation. Controlling or making sure that your gut is happy and healthy is important for supporting a healthy inflammation level in your body. 

The gut microbiome can very easily become imbalanced with too many bacteria that are not helpful and not enough beneficial bacteria. When the gut microbiome becomes imbalanced, we can have an increased production of toxins. Those toxins can be absorbed into our system. Our body has to eliminate them. The toxins can be damaging and can drive inflammation. 

Also, that extra burden on your liver, having to get rid of those toxins can also drive weight gain. Your body has a really clever way of helping to manage a high toxic load if your liver isn’t detoxing as efficiently as it should be. 

One of the ways in which our body protects ourselves from that high toxic load is to store toxins away in fat. Your body may actually slow down fat burning or even upregulate fat storage as a defense mechanism to protect yourself from those toxins. That is one very indirect way that the gut is quite linked to fat burning. 

The hormones as well. When we’ve used our hormones, we detox them. We process them via the liver, and then we eliminate them via the digestive tract. If there are imbalances in the gut, some of these hormones can actually be reactivated and reabsorbed into circulation, which contributes to imbalances. The gut is very important for those physiological reasons. 

There is also a very strong link between the gut and the brain. If your gut isn’t balanced, if it’s not happy, then that can impact your mood, your cravings, your energy levels. When we’re trying to eat well and maintain healthy habits, having a low mood, having low energy are things that are not helpful for that consistency. It also has an impact on the brain, which can be a massive barrier.

Dr. Eric: 

How about refined sugars? What impact do they have on the body, including the gut? 

Louise: 

Refined sugar has a massive impact on the body, starting with the gut. It can feed the less beneficial bacteria and yeasts in the gut, and that can lead them to overgrow and become a source of inflammation, toxins, and digestive issues. Sugar is definitely not a friend of your gut. 

If we have too much sugar in the diet, it can drive sugar spikes in your blood. It’s normal for your blood sugars to go up and down a little bit, but we don’t want to be having massive peaks and troughs in those blood sugar levels. When we have big peaks, that can drive up our insulin levels. 

To explain it in an overly simplified way, insulin is essentially a fat storage hormone. If we have insulin being released a lot in high levels in the blood, that will drive fat storage and make it very difficult for you to get into fat burning mode. Too many blood sugar spikes can be a problem for that reason.

After a blood sugar spike, there is usually a blood sugar crash. When our blood sugars crash or dip down too low, that is a time where we’re going to be craving sugar and carbs. It will be very difficult to use willpower to resist those cravings because what your body needs to restore the balance of your blood sugars is sugar and carbs. The cravings are pretty intense and very difficult to ignore.

Also, at that time, you might be feeling tired. You might be struggling to concentrate. You might be feeling irritable or hangry. The blood sugar ups and downs are a bit of a recipe for weight gain. 

Dr. Eric: 

What do you do if a patient comes to see you, and they have these blood sugar imbalances? Maybe they have insulin resistance, and they have these sugar cravings on top of that. Maybe they even have yeast overgrowth, candida overgrowth. 

You just said yourself it’s not always easy to say, “Okay, use willpower, and cut out the sugar.” Obviously, we want people to do that, and you will make dietary changes. Do you have people do that gradually? Do you recommend any supplementation to help with that? What is your approach when someone has these strong sugar cravings? 

Louise: 

Going back to what I was saying in the beginning in terms of focusing on adding stuff in rather than cutting stuff out. The first thing I’d want to add in is protein, making sure that someone is getting enough protein throughout the day, particularly at breakfast. If we can have a good intake of protein for our first meal of the day, ideally with some fat and fiber, that is going to be very satisfying and satiating. It will keep you full for hours. 

It will fill you up without causing an increase in your blood sugars too dramatically, which means you won’t have the blood sugar crash later on. That means that later on in the day, you’re not going to have the cravings and the compulsion to eat sugary things or carby things to pick up your blood sugars and your energy levels. 

Something as simple as getting protein into breakfast can make it so much easier to make better food choices without you even needing to talk about cutting out sugar or cutting out “bad foods.” That’s the first thing I would think about.

There’re also other things that impact your blood sugars. Not for everyone, but caffeine can be a driver of raised blood sugars. If you’re having a lot of caffeine in the morning, and you’re noticing a slump in the afternoon, where you’re reaching for sugars or that sort of thing, then it could be driven by the caffeine wearing off in the afternoon. Your energy levels plummet because of that.

I’d also be thinking about sleep. If someone is not sleeping properly, then their appetite will be bigger, and they will be more likely to crave carbier, sugary foods. It’s not all about what you eat; it’s also about making sure that you’re getting enough rest and getting good quality sleep. 

You’re also taking steps to manage stress because stress is a massive driver of cravings and wanting more sugary foods. Sometimes, it can be a driver because of comfort eating and wanting to self-soothe with those foods and distract yourself from what you’re feeling. 

If someone has more of a gut bacterial issue or a yeast issue that is driving their cravings, I’d still start with those other things I just mentioned. They might need a more targeted approach, which is focused on rebalancing the gut bacteria. That can involve lots of different things. 

With my clients, I run tests, so we can identify what those imbalances specifically are. Essentially, we want to get them to the point where they have a healthy level of beneficial bacteria and not too much of the other types of bacteria and yeasts. Their gut lining is nice and healthy, and they’re ultimately digesting their food properly. 

Dr. Eric: 

That makes sense. Start with adding more things. Make sure they get sufficient protein, healthy fats, fiber. Work on sleep and stress management. In some cases, maybe dig deeper with testing to see what is going on in the gut microbiome. 

You mentioned histamine earlier in relation to estrogen. I believe estrogen can inhibit the DAO enzyme, which could make histamine intolerance a factor, or at least a contributing factor. There could be other factors as well that can cause a histamine intolerance. How common do you see that in your patients?  

Louise: 

It’s definitely not a factor for everyone, but it’s fairly common. We see it fairly often. It can become more common in the age group that I work with, so women in their 40s and 50s, because of their estrogen levels increasing in the early stages of perimenopause. It is something we see, and we do have to be aware of. 

The interesting thing about histamine intolerance is that it can cause quite a wide range of different symptoms. It’s not always easy to identify it immediately. It is something we’re always looking out for. 

Dr. Eric: 

I want to talk about intermittent fasting. A lot of people are doing intermittent fasting these days. Some people do a 16-8 fast. Some incorporate 24-hour fasts. What thoughts do you have as far as using intermittent fasting as a potential tool for losing weight? 

Louise: 

I think it can be a tool; that’s the right word. It’s a tool that is suitable for some people but not for everyone. There is definitely loads of good research on it in terms of not only helping with weight loss but also helping with all sorts of other things, like the health of your brain, lowering inflammation, gut microbiome. 

Particularly with the age group that I work with, them being women, it’s something I’m very cautious around because fasting can exacerbate some problems. If you have underlying imbalances and are not supporting them, you haven’t gotten the core foundations in place, if you have a thyroid problem, if you’re very highly stressed, if your sex hormones are out of balance, then sometimes fasting could make that worse, essentially by driving up the stress hormones in your body.

If you are someone who has got a really good foundation in place, if you’re eating in a way that supports your blood sugar, your thyroid, then it can be a helpful thing to add in to enhance your results. When I use it with my clients, we tend to bring it in months into working with them, once we have done the other things that need to be done to properly support their bodies. 

As a general rule, I like most people to be having at least a 12-hour overnight. There is lots of good research on that, particularly for supporting brain health and helping to prevent cognitive decline. Some people will do well with extending that fast to 14 hours, 18 hours. 

I know some people, not any clients of mine, who only have one meal per day. Some people only do alternate day fasting, where they eat one day, and they don’t the next. It seems to work well for them. Those people are people who have a very strong foundation in terms of their eating a really good, balanced diet in the first place. 

Dr. Eric: 

If someone is alternating every other day, are they getting enough protein? Even if they’re not alternating 24 hours, but I’ve had people where they’re fasting for 20 hours every single day. Same thing. It’s a small eating window, so are you getting enough nutrients overall? On top of that, enough protein? 

It makes sense what you said. You don’t have everybody do intermittent fasting. If anything, usually you’re doing things to balance the thyroid, balance the adrenals, lower their stress levels, incorporating the foundations. Maybe having them do a minimum of 12 hours, which is reasonable to have most people do that. If you have people do 16 or 18 hours, you want to make sure they’re ready, and their body can handle it. That’s what it sounded like you’re saying. 

Louise: 

Yeah, exactly. 

Dr. Eric: 

Going back to exercise. We don’t want people to overtrain. What type of exercise do you typically recommend for someone who is trying to lose weight? 

Louise: 

It’s good to do a variety of exercises. All different types have different benefits. The thing I want to make sure people are definitely incorporating is strength training. 

Going back to muscle mass. We want to make sure we are taking steps to maintain muscle, if not build muscle, so we can make sure we are maintaining our metabolic rate. If we’re losing muscle, we are reducing our metabolic rate, which is going to, in the long term, lead to the weight going back on. Most of that weight going back on being fat tissue. Strength training is absolutely key. 

Gentle exercise as well: walking, swimming, Pilates, yoga, things that are good for us because they get the blood pumping, and they move our bodies in terms of mobility and strength. They’re gentle enough to support your body in relieving stress and lowering those cortisol levels. 

Dr. Eric: 

Variety, it sounds like. Weight-bearing exercise, resistance exercise are important, which I agree. 

Speaking of variety: going back to diet. We spoke about intermittent fasting and the pros and cons of keto. Do you, for most people, then recommend to have a good variety of plant-based foods as well? A decent amount of vegetables? Are you more toward a carnivore diet? It sounds like you’re not more carnivore. What dietary factors do you incorporate or recommend to your patients? 

Louise: 

Eating a diet that has a wide variety of different plant-based foods. Not necessarily vegetarian or vegan. I think it’s fine to include good quality animal protein into your diet. Making sure that we have plenty of plant-based foods and a good variety. Unprocessed as well. 

I don’t like to tell people to cut anything out because I think that we can still eat the foods we want to eat and be healthy and move toward our health goals. But one thing that I do feel we need to minimize as much as we can is ultra-processed foods. They are so devoid of nutrients. They are so addictive and moorish. 

The ingredients that are in them are made in a lab. They’re not even defined as foods. I can’t remember what the term that was coined was, but something like “food-like substances.” They’re ingredients that are incredibly highly processed. They turn your stomach when you read what they actually do to the foods to turn them into ingredients. They’re not familiar to our bodies, so they can be very disruptive to the microbiome and inflammatory. They don’t actually fill you up, so you are more likely to overeat with them. 

If you are going to limit anything in your diet, I would be looking at replacing those ultra-processed foods with whole foods. 

Dr. Eric: 

Makes perfect sense. Is glyphosate a big problem, or as big of a problem as it is here in the United States? I’m thinking maybe not. 

Louise: 

I don’t think it’s as big of a problem. It’s always difficult to know because a lot of our stats and facts come over from American research. We’re aware of it, and we recommend people eat organic, particularly organic soy and wheat, if they are going to have wheat. Avoid things like glyphosate. It is very concerning. 

Dr. Eric: 

Okay. Anything else that I should have asked you that I didn’t ask you? If not, for those who want to get started, what are some things they can do on their own? In a perfect world, they’d be working with someone like yourself. But if someone wants to get started, what are some steps they can take to get on the road to losing weight? 

Louise: 

The only thing I would add is we are obviously talking about a lot of these imbalances that can cause stubborn weight. These are not things that are a death sentence. They are not things that are going to stop you from getting to where you want to be. They are not an excuse either. They’re things that we can take steps to address. It doesn’t mean that you can’t do anything. It just means your approach needs to be a little bit different to what you’ve been taught in terms of dieting before.

In terms of what you can do to get started, I would make sure you are not overcomplicating things. A lot of people jump straight to things like fasting or meal replacements or supplements. Actually, it’s the simple things that make the biggest difference not only to your weight management but to your health and how easy it is to sustain those changes as well. 

We have been talking about making sure you are getting enough protein. That is the best place to start for most people. It sounds like a simple thing to do, but it can take a little bit of effort and planning to make sure you are getting enough protein into all of your meals. 

I would start there, alongside other simple things like making sure you’re drinking enough water, making sure you’re getting a variety of different plant-based foods in your diet, making sure you’re sleeping enough, taking steps to manage stress and relieve stress. Doing those things will probably put you ahead of most other people in terms of what people are doing to support their health. On top of that, I’d add in to do some strength training as well. 

Dr. Eric: 

Wonderful. Louise, where can people find out more about you? 

Louise: 

If you want to connect with me online, you can find me on Instagram or Facebook by searching @LouiseDigbyNutrition. 

My website is LouiseDigbyNutrition.com. On there, you can read about my Metabolism Masterclass that I run very regularly. It’s a free masterclass, where we go a little more into my philosophy and what I do with my clients to get results. 

You can also read about my program, which is the Nourish Method, which is what we have been talking about in terms of when I do testing and put together a personalized action plan for each person to get them to their goals. 

Dr. Eric: 

Also, you have your own podcast, The Thriving Metabolism. 

Louise: 

Yes, that’s right. If you search for “The Thriving Metabolism” on any podcast platform or YouTube, you will find that there. We really delve into the subjects that we have been talking about today. 

Dr. Eric: 

Awesome. Thank you so much. This was a really great conversation. I’m sure the listeners learned a lot. I learned a few things as well. 

Louise: 

Thank you. It’s been great. 

Recently, I interviewed Dr. Jenn Simmons, and we discuss her personal experiences with breast cancer, the complexities of its detection and treatment, the root causes of breast cancer, how environmental toxins and lifestyle factors affect cancer development, innovative imaging technology for safer breast cancer screening, why you shouldn’t be afraid of estrogen, and more. If you would prefer to listen to the interview you can access it by Clicking Here.

Dr. Eric Osansky: 

I am very excited to chat with today’s guest, Dr. Jenn Simmons. We are going to be discussing breast cancer. It’s going to be a fascinating topic. Let me dive into Dr. Jenn’s impressive bio here: 

Dr. Jenn Simmons started her professional career as Philadelphia’s first fellowship-trained breast surgeon and spent 17 years as Philadelphia’s top breast surgeon. Her own illness led her to discover functional medicine. So enamored with the concept of creating health rather than killing disease, she left traditional medicine in 2019 and founded Real Health MD to help women along their breast cancer journey truly heal. 

Dr. Jenni is on a mission to help change the impact of breast cancer by empowering millions of women take control of their health and create the life they want. She hosts her weekly podcast Keeping Abreast with Dr. Jenn. She hosted the Breast Cancer Breakthrough Summit and is the author of The Smart Woman’s Guide to Breast Cancer and Recipes for Real Health. 

Dr. Jenni is currently opening Perfection Imaging Centers across the country, featuring QT imaging, an innovative technology that uses sound waves to create a 3D reconstruction of the breast without pain, compression, or radiation. This fast, affordable FDA-approved technology has 40x the resolution of MRI and will forever change the way that we screen for breast cancer. Definitely need to talk about that while we chat. Welcome, Dr. Jenn. 

Dr. Jenn Simmons: 

I actually think I can go home now. I think we’ve covered it. 

Dr. Eric: 

Got most of your background, so we don’t need to have you talk too much about it. One thing while reading the bio, you said you switched to functional medicine in 2019. What led to that transition to where you are today? 

Dr. Jenn: 

Thank you so much for having me on. It’s a pleasure to be here. I’ve been really looking forward to this discussion.

Like everyone else, I have a pain to purpose story. It was a very unpredicted pain to purpose story. When I was growing up, I really don’t remember a time where I didn’t know about breast cancer. It was truly the thread, the fabric, the tapestry of my family.

When I was a young child, I had a first cousin. Her name was Linda Creed. She was a singer/songwriter in the 1970s and 1980s. She was the songwriter for The Spinners and The Stylistics. I’m really going to age myself now. She was beautiful, brilliant, larger than life. She was the queen of Motown sound in Philadelphia. She was my hero. She wrote 54 hits in all. Her most famous song was “The Greatest Love of All.” She wrote that song in 1977 as the title track to the movie The Greatest, starring Muhammad Ali. It really received its acclaim in March 1986 when Whitney Houston released that song to the world. At that time, it would spend 14 weeks at the top of the charts. Only my cousin Linda would never know. 

Linda died of metastatic breast cancer just one month after Whitney released that song. I was 16 years old when my hero died. Her life and ultimately her death gave birth to my life’s purpose. I really thought what I took from that was going to be my destiny. 

Because breast cancer was so prevalent in my family, literally all the women in my family got breast cancer, I went into this field because I never wanted another woman, another family, another community to have to suffer the way that mine suffered. I also went in, thinking that this was inevitable for me, and I wanted to try to figure it out. 

I became a doctor, a surgeon, the first fellowship-trained breast surgeon in Philadelphia. I did that really well and for a really long time. I did it long enough for my aunt to be diagnosed and my mother to be diagnosed. About 10 years before my aunt was diagnosed, she developed Graves’. I was far enough into my career at that point that when she subsequently developed breast cancer, to at least say, “I wonder if there’s something there.” 

I’m about 15 years into my career. Arguably, at the top of my game. I’m running the breast program for my hospital. I’m running the cancer program for my hospital. I’m a wife, a mother, a stepmother, an athlete, a philanthropist. I have all these balls in the air. I fancy myself an expert juggler, until the day where it all came crashing down for me. 

I went from probably being one of the most high-functioning people you’ve ever met to I couldn’t walk across the room because I didn’t have the breath in my body. I spent three days with a really intensive workup because when your prize pony is hurt, you figure out what’s wrong fast. I find myself sitting three days later in the office of my friend and colleague and physician. He tells me I have Graves’, and I need surgery and chemo radiation. I’m going to be on lifelong hormone replacement. 

Though I knew that this was the standard of care, and though I knew that what he was telling me was what he knew to be true, and it’s what I knew to be true, something inside me said, “No, there’s more. There’s something more. Go find it.” 

I walked out of his office that day. He told me I was going to die. It’s not that I didn’t believe him, but there was this very loud voice compelling me to look further, to search for options, to investigate, to look beyond what we are so trained in conventional medicine to see. 

The truth is that people think of doctors as critical thinkers. I’m not exactly saying that they’re not, but even if you were, before you went to medical school, once you get there, critical thought is not rewarded. The critical thinkers, once you’re inside of the system, they’re the quacks, they’re dangerous, they’re all the names, the titles, the labels that people put on things that we don’t know or don’t understand and thus we fear.

I very much had blinders on. Even when I walked out of the office that day, I had no idea what I was walking into. 

I was very fortunate to land very early in a space where I’m sitting in a lecture hall, and a man walks on the stage, smiles his big toothy grin, and introduces himself as a functional medicine physician. At this point, I’m a doctor for 20 years, conventionally trained at one of the best medical schools in the country. All I could think of was, “There’s no such thing as a functional medicine doctor, so what is this quack talking about?” I’m still in that place. I’m still in that mindset. Then I remember I am sick, and I’m there for a reason. I check my ego at the door, and I tune in. Thank god I did. 

The man was Mark Hyman. Though he is very famous, in 2017, maybe not so much. I had no idea who he was. What he had to say over the next two hours would move me more than anything had before and maybe since. He would actually foretell not only what was going to happen to me, but what was going to happen to the rest of my career, what my goals were, what my aspirations were. Granted, I’m an early adopter. 

I left that day and enrolled in the Institute for Functional Medicine because I, too, wanted to practice root cause medicine. I, too, wanted to understand where disease was coming from, rather than managing symptoms. I wanted to heal for sure. A large part of the initial part of this journey was about me. 

Once I engrossed myself in the study of functional medicine, there is really no looking back. That’s a bell you can’t unring. I knew that I couldn’t stay and practice within the confines of conventional medicine because when I was there, I was part of the problem. I wasn’t part of the solution. 

When you are helping anyone through any chronic disease- I happen to be talking about cancer. We could almost talk about any chronic disease this way. If all you do is manage the symptom, and as a surgeon, all I was doing was managing the tumor. I was not in any way affecting the rest of their lives. I was maybe delaying a recurrence, or I was delaying the next manifestation. But I wasn’t doing anything to remove that inflammatory nidus that led to their disease. I wasn’t in any way intervening in the process that got them there in the first place. 

I decided where my place was in this world was to help millions of people recover from their disease, restore them to health, and maybe, just maybe, even lead them to the health that they never had their whole life. That became my goal. 

I’m still in clinical medicine. When I left surgery, of course my colleagues thought I was crazy, or I lost my skills or my mind or maybe all of it, I don’t know. 

It’s funny because it’s about five years since I left, and I went from the quack to, “I know you’re doing this, but if I were you, I would also go see Jenn Simmons.” I know I have arrived when the people at Penn are now telling their people to come see me, too. 

It’s been a journey. I don’t want to paint too rosy a picture in that my healing journey was not linear, and it was not easy. I got a lot worse before I got better. I am delighted to say that I did get better, and I am healthier now than I ever was my entire life. It really wasn’t until I got sick that I actually knew what it was to be well. 

Dr. Eric: 

Thank you so much for sharing that. It’s great that you’re able to save your thyroid, avoid the radioactive iodine, avoid the surgery, and keep that open mind. I try to encourage people listening to this who have hyperthyroidism/Graves’ as well as Hashimoto’s because as you know, with Hashimoto’s, it’s different than Graves’. Most endocrinologists will recommend thyroid hormone replacement, and that’s it. They won’t do anything for the underlying cause. Like you said, you could apply a lot of what you will be discussing today to other chronic health conditions. 

Let’s dive more into breast cancer. Can you talk more about the physiology of breast cancer? There are different types of breast cancer. Not all breast cancers are estrogen dependent. 

Dr. Jenn: 

I don’t even like that “estrogen dependent” word. First, it is a very heterogeneous disease. What makes it so heterogeneous is think about what brings people to that diagnosis. 

For everyone, it’s going to be different. Though we can look at the cells under the microscope and say, “This is breast cancer,” maybe this one has estrogen receptors on it, and this one has progesterone receptors on it, and this one has HER2 receptors on it, and some have all of them, and some have none of them. We can say all of that with uniformity. 

The thing that is not uniform is what got you in that place in the first place. Breast cancer is a normal response to an abnormal environment. It’s what is creating that environmental shift for people that leads to the disease state. We know If we sample the environment, the micro-environment around a tumor, it chemically looks different. 

What happens is that as we are exposed to any number of things in our environment, and these can be tangible things, they can be intangible things. They can be visible things; they can be invisible things. Stress, overexercise, underexercise, sleep deprivation, poor diet, chemicals, herbicides, fungicides, pesticides, pharmaceuticals, antibiotics, plastics, xenoestrogens, you name it. We are exposed to thousands and thousands of chemicals every single day in one way or another that have this effect on our cells. 

We all have an allopathic load that we’re going to be able to tolerate, a toxic load that we’re going to be able to tolerate. Once we all exceed our ability to tolerate that, whether it’s stress that put us over the edge, whether it’s a viral illness that put us over the edge, parasites, chronic metals, dental infections, it doesn’t matter what it is. When you reach your threshold, your body can no longer maintain that healthy environment. Our cells perceive that. Things like the thyroid, things like the breast, they are our canaries in the coal mine. Even minute environmental shifts, these are recognized as threatening to our cells. 

What do our cells do? They go into survival mode. Just turn it out. Just reproduce. It doesn’t matter if you make a mistake. All we have to do is survive. That’s what’s happening. That alone won’t lead to cancer. We do have an immune system that is supposed to recognize these rogue cells, these cancer cells, these cells that have gone into this survival mode in their infancy and destroy them before they can get mass, before they can form a tumor, before they can create a blood supply. 

The problem is that our immune systems are working overtime and have been working overtime for way too long. You can’t fight it at all fronts. If you have a war going on, you can maybe be a really good soldier for a little while. After a while, your army is just going to get exhausted, and that’s what happens where you have exceeded your toxic load. You’re having this environmental shift from the chemistry of what I call joy to the chemistry of stress. You’re getting DNA damage, and your immune system has been working overtime for so long that it just doesn’t recognize it. It goes unrecognized. Then it just grows from there. 

Whether that is an invasive ductal carcinoma, an invasive lobular carcinoma, hormone positive, hormone negative, HER2 positive, these are all silos that were created for the purposes of prescribing the thing, the pill, the chemo, the whatever. 

Cancer is not a chemotherapy deficiency. It’s not a radiation deficiency. It’s not a surgery deficiency. Cancer is this normal response to this abnormal environment. The key to all of it is figuring out where is that environmental shift coming from and helping to alleviate it. What do you have that you don’t need? What do you need that you don’t have? How can we shift you back from the chemistry of stress to the chemistry of joy? 

I don’t disparage people who want to undergo conventional therapy. I get it. You’re scared. This is what everyone is telling you to do. We all make the best decisions we can with the information that we have at the time. 

However, what I write about in my book and what I talk about all the time is that the very best thing that you can do if you get a diagnosis of any kind, unless it is actually an emergency, not it just feeling like an emergency but actually an emergency, is take a pause. Think about, “Is there a message here? What is my body trying to tell me? Can you work on that for a little bit?”

For most women, breast cancer has been in the making for three, four, five, 10 years. Your taking a month, two months, six months to figure out where this is coming from, what is driving this, and can I turn this around, that’s some really valuable information. 

I’m not saying you won’t need the conventional therapies. If you have a lot of tumor burden, and your proverbial sink is overflowing, you need to mop up the floor. That’s what surgery is. That’s what chemotherapy is. That’s what radiation is. There are times when I use those things. If someone has a bone metastasis that is causing a fracture, I send them for radiation. We have a situation that needs to be dealt with right now. I’m not going to solve the issue of what got you to cancer fast enough to relieve you of the pain. It’s very hard to heal when you’re in pain. 

That’s one of the major questions that I ask people: “Where is your pain coming from? Where is your emotional pain coming from?” We need to heal that. That’s a lot of where breast cancer comes from. It comes from prolonged suffering. Your heart’s hurting. Your brain is hurting. Your body is hurting. 

For me, the functional medicine part of it, the why is this happening, the root cause part of it, that is the end. That is the always. These are the questions that we need to be asking every single person whose body isn’t functioning optimally. Unlike conventional medicine, where inside of conventional medicine, we think of health as the absence of disease. You don’t need to go to the doctor because you’re not broken. 

Instead, what we need to think about is that health is optimal function. If you’re not functioning optimally, you ought to be working on doing that. This should be all of our pursuits: to function optimally and live as long as possible.

Dr. Eric: 

Definitely agree with that. As you mentioned, the overlap between thyroid autoimmunity. You mentioned the thyroid and breast being the canaries in the coal mine. I look at Graves’ and Hashimoto’s as more of immune system conditions. Not to say there is not a time and place for conventional medicine, whether it’s antithyroid medication to lower the thyroid hormones. In some cases, thyroid surgery. Either way, you want to do things to address the cause of the problem, the stressors, the traumas, the toxins, the infections. 

Dr. Jenn: 

It’s an “and,” right? There is nothing wrong with taking thyroid hormone replacement. I don’t want to say for a moment that there is anything shameful about doing that if you need it. But at the same time, you should be asking yourself, “Where are my thyroid antibodies? What’s driving that? What do I need to do? How do I need to change? What do I need that I’m not getting that my body continues to be in this state?” 

As you well know, most doctors aren’t even checking those antibodies. They’re not following those antibodies. They’re not thinking, “What is actively happening with my patient?” 

Most doctors that I see aren’t even measuring full thyroid panels. They’re getting a TSH and treating that. You can have a TSH in the normal range although right now, we have a range that 95% of people will fall into that we call normal. We know that 95% of us are not metabolically healthy. The thyroid gland and thyroid hormone is the center of metabolic health. When we use something like TSH to guide our therapy and determine who is and who is not, we are doing people a great disservice.

The most important factor in all of thyroid disease, as far as I’m concerned, is look at the person in front of you and ask them how they’re feeling. They’ll tell you. You can put a lot of people on Synthroid, and they don’t feel any better. If they don’t feel any better, and all you’re doing is treating that TSH, you’re not helping that person in front of you at all. 

We need a lot more thyroid-literate physicians, providers. I don’t mean to say physicians because I think there’s lots of providers out there who are doing really good work, and they don’t necessarily have an MD or DO behind their name. We need a lot more thyroid-literate practitioners. We really do. 

I think the last statistic that I saw was one in four people have thyroid disease. It’s an epidemic. We need to start to address it properly. Otherwise, we are really suffering as a society. We’re suffering unnecessarily.  

Dr. Eric: 

I agree. Speaking of statistics, do you know what the statistics are with regard to breast cancer? What percentage of women? Some men also develop breast cancer. 

Dr. Jenn: 

One in a thousand breast cancer cases are men. The statistics for breast cancer for the vast majority of my career were that somewhere between one in seven and one in eight women over their lifetime would get breast cancer. Those numbers are changing. Now, we have a one in three lifetime risk of cancer. It’s only going to get worse because of a little epidemic that the world experienced a few years ago. We’re starting to see the data come out of that.

I’ll tell you that before 2021, it was an absolute rarity to see breast cancer in someone in her 20s. Not so much anymore. I don’t want to say too much on that because I don’t want to take away from the focus of this discussion, and I don’t want to get it flagged and thrown out anywhere. We will be seeing a lot more information about how we’re going to have worsening cancer statistics, younger, more prevalent unfortunately. 

Dr. Eric: 

That’s interesting. I would think also, just our toxic environments, the xenoestrogens. Not to blame everything on estrogen, but there is a difference between- We could talk about this conversation now. I understand why you don’t like the term “estrogen dependent” because of everything else that’s setting the stage. The xenoestrogens, don’t they play a big role? 

Dr. Jenn: 

Absolutely. What we have to remember is that estrogen is the hormone of life. It’s actually when we lose our estrogen that we start to die. When you look at what happens with cardiovascular health after menopause, what happens with brain health, skin health, bone health, joint health, gut health, vaginal health, bladder health, literally everything we lose after menopause. That’s because estrogen is the hormone of life. 

Estrogen does not cause breast cancer. If you believe that estrogen causes breast cancer, you have to believe that women were put on this earth for the purposes of getting breast cancer. It’s ridiculous. 

If you believe that estrogen causes breast cancer, how do you explain the fact that the vast majority of breast cancers happen in post-menopausal women, not in pre-menopausal women? If you believe that estrogen causes breast cancer, how do you explain the fact that women who are pregnant have 10x the amount of circulating estrogen, and breast cancer during pregnancy is relatively rare? Estrogen does not cause breast cancer. 

That said, there are a number of compounds in our environment that mimic estrogen, that sit on the estrogen receptor and abnormally stimulate it. They have to be detoxified down the pathways that estrogen uses. The metabolites, the byproducts of that breakdown are very toxic. 

There is no question that these xenoestrogens are leading to an increase in breast cancer because they’re leading to an increase in DNA damage. They’re leading to an increase in gynecologic cancers. It’s not only breast cancer that is suffering as a result of this toxic soup that we’re all swimming in. We’re talking about plastics, antibiotics, antibacterials, antifungals, metallo-estrogens. The things that we used for metallic fillings for years and years are 50% mercury. Some even more. 

All of these things that we barely think about in the course of our day. We get up in the morning, and you make your cup of coffee with your Keurig. You’re basically pouring hot water through a plastic cup and drinking it. If you’re doing that and drinking out of plastic bottles and cooking in nonstick pans, and you eat a fair amount of seafood, you’re basically eating a credit card every week. Would you voluntarily eat a credit card every week? 

Dr. Eric: 

Definitely not. 

Dr. Jenn: 

Definitely not, right? These are the invisible toxins that we don’t think about because we don’t see them. They’re having profoundly negative effects on our health. 

Now, the place where the hormone-driven cancer came from is there are narratives created for many purposes. A lot of times, we create narratives to sell pharmaceuticals, make the story easier to understand, make it seem logical and acceptable. This is one of those instances. 

Do the majority of breast cancers have estrogen and progesterone receptors on them? Yes, they do. Do normal breast cancer cells have estrogen and progesterone receptors on them? Yes, they do. That’s how they listen to cell signaling. That’s how they do what they’re supposed to do. When you have a breast cancer that has estrogen and progesterone receptors on it, it means that it’s not too far a departure from normal. It’s trying to maintain those normal signaling methods. 

We do have an upregulation, meaning that we make more. Usually, we make more because there is not enough estrogen or progesterone out there. Your cell is just looking to survive. It’s just trying to figure out how can I get back? How can I keep up? It’s the tumor cells that don’t have estrogen and progesterone receptors on them that have really mutated from normal. They are no longer following these hormonal signals, these normal pathways. They have really gone rogue. 

To me, I don’t think that we should be thinking about hormone positivity like that. After all, in pre-menopausal women with a hormone positive cancer, what is being recommended? Tamoxifen. It’s a form of estrogen. We don’t talk about that, but that’s what it is. It’s a form of estrogen sitting on the estrogen receptor. Like estrogen, it’s protective in the breast. Not so much in the uterus. In the uterus, we have a problem with tamoxifen. That’s why women on tamoxifen have an increased risk in uterine cancer because it’s not protective in the uterus. It’s stimulatory in the uterus. 

I don’t think that the whole story is being told to people. They’re not given the ability to understand the whole truth in a way that they can truly make informed decisions. That’s another reason why I wrote my book, The Smart Woman’s Guide to Breast Cancer. I wanted people to be able to understand what is breast cancer? What do all of these things mean? How do I read my pathology report? How does this make sense to me? Then what are these treatments that you’re proposing? What do they actually do? Do they actually benefit me? What is that benefit going to be for me? What else can I do? What can I do to actually take control of my health? What can I do to reverse this or make it better? When people know the real numbers and have the real information, they make very different decisions. 

Dr. Eric: 

I agree. I want to switch gears and talk about screening. I know you’re not a big fan of mammograms; I’m not either. I want you to talk about mammograms, thermography, whatever you’re willing to talk about. 

Dr. Jenn: 

Yeah. I don’t know if there are a lot of people left other than the manufacturers who continue to be big fans of mammograms. It’s a miserable procedure. Anyone who’s had one will attest to it. 

Women in general do what they’re told as long as it’s for the good. We will sustain a lot of pain, a lot of discomfort, a lot of anguish, if we know it’s for the good. If we didn’t, the population would be over because no one would voluntarily go through childbirth. 

Mammograms, we have been told for 50 years, save lives. Women dutifully go and get their mammogram every single year. It’s a lovely theory. It just doesn’t happen to be true. We’ve known this for a very long time. 

The mammographic screening program started out in the early 1970s. It started out built on this premise, this understanding, this belief that breast cancer growth is both linear and predictable if you found breast cancer small before it reached this critical size at which time it would be more likely to metastasize. We could save lives and save breasts. It’s a lovely theory. 

Breast cancer growth is neither linear nor predictable. A cancer is what it is. A breast cancer is what it is from the very beginning. If it’s going to be an aggressive breast cancer, it’s an aggressive breast cancer from the very start. It doesn’t matter how early you find it. This person is going to have a difficult battle with this disease. There are breast cancers that are very unaggressive, and it almost doesn’t matter what you do. These people do fine. And everything in between.

By 1978, we knew that there was no survival advantage to screening with mammogram. We knew that. Yet we continued to do it. We continue to do it today. As a result, we cause thousands of breast cancers every year from the radiation. Thousands. And we treat thousands of women for breast cancer that never needed to be treated. 

No matter how many mammograms we do every year, the same exact number of women die of breast cancer every year. The same exact number. We are not impacting the bottom line. No matter how many mammograms we do every year, we have the same exact number of women who present with aggressive disease. 

We know from the Swedish studies where they looked at two populations of women. They looked at women who screened for breast cancer and women who didn’t. The thing is, both of these populations had equal access to care and access to equal care, in that they both had access to good care. When we look at the two groups, there is no difference in survival from breast cancer. The difference is incidence because they treated a lot more women for breast cancer in the screening group than the group that didn’t screen. 

We have known for decades that screening with mammogram doesn’t save lives. How about if it doesn’t save lives? How about if it saves breasts? That’s important, right? If it saves breasts, that may be reason enough to do it. 

Unfortunately, as it turns out, if you give a woman a diagnosis of breast cancer, that’s all she hears. Many women will opt for mastectomy not because they need it, but because they’re afraid. We know statistically speaking, there is no survival advantage to doing mastectomy over lumpectomy. None. Yet we’re not saving breasts. Women are so terrified of dying that they somehow think that if they remove their breast, they will have a lower chance of dying. The statistics do not support that at all. 

We’re not saving lives, and we’re not saving breasts. Like Switzerland, it is time to abandon our mammographic screening program. We are not helping women. We are hurting women. We’re hurting them to the tune of hundreds of thousands. It’s not insignificant. 

The women that are getting overdiagnosed and overtreated are shortening their lives and diminishing the quality of their lives. If you are treated for a breast cancer that didn’t need to be treated, the 40,000 women a year with DCIS, non-invasive disease, I hesitate to even call it breast cancer. DCIS stands for doctor carcinoma in situ. These women would never have died of their disease. Never. Then we treat them like they have breast cancer. The treatments for breast cancers are not benign. The scars from mastectomy run deep. Lots of women with DCIS end up with mastectomy. 

The antihormonal treatments that are given to address DCIS for prevention, these lead to the acceleration of heart disease. They decrease mental capacity. They decrease cognition, interfere with sleep. These are all really important things. They accelerate bone loss. They cause pain, discomfort, depression, anxiety. These are really serious things that lead to premature death. 

A woman treated for breast cancer is 2-3x more likely to die of cardiac disease than someone who isn’t. We are not helping these women. We are hurting them. Hurting them to the tune of hundreds of thousands every single year. It’s unacceptable. It’s really unacceptable. 

Now, I never like to present a problem without offering a solution. I’m going to say that women in general don’t want to sit by idle. They want to do something. 

I’m a huge believer in self-breast examination. Everyone should know what their breasts feel like, what their breasts look like, so if there is a change, you’re able to recognize that change and intervene. If you’re going to have a breast cancer that is clinically relevant, you’re going to be able to detect that lesion before it is meaningful, unless it is an aggressive cancer. If it’s an aggressive cancer, screening with mammogram wouldn’t have helped you anyway. I fully believe in self-breast examination. However, there are a lot of people that want to do more. 

You mentioned thermography. I love thermography as a tool to find inflammation, to screen for inflammation because that’s what it is. It gives off a heat signal and shows us areas of the body that are inflamed. What it is not is a screening tool for breast cancer. That’s where thermography got a bad rap.

I use thermography very frequently in my practice to look for inflammation. But I do not use it as a screening tool for cancer. 

If you’re going to use it as a screening tool for cancer, it has to be paired with another modality like ultrasound. It should be done by someone who does both so that they can interpret these images and correlate these images in real time. That’s one way to go. 

Is ultrasound a sensitive modality? No. It’s sensitive enough, but will it miss a lot? Yes. Is it operator dependent? Yes. Is it the perfect screening tool? Not by a mile. But it is one screening tool. 

MRI for a while was thought to be the great hope for screening, especially in dense breasted women or high-risk women or that kind of thing. 

The problems with MRI are many. First of all, it’s time-consuming. It’s expensive. It’s uncomfortable. 

The biggest problem with MRI from my perspective is that it uses gadolinium. Gadolinium is a heavy metal. Whenever you put a heavy metal in the body, it’s going to be stored. It’s going to be stored at the expense of something else, something you need. It’s going to cause organ damage to the kidneys, brain, bones, the places where it’s stored. Gadolinium is a real problem. We cannot expose healthy women because that’s what the screening population is, right? 

That’s my biggest objection to mammogram. We’re taking healthy women and radiating them. For MR, if you’re using MR for screening, you’re taking healthy women and exposing them to gadolinium every year, heavy metal. It’s not the right thing to do. MR is not the solution. 

I’m very excited about technology that is coming out of the United States. It’s called QT imaging. It uses sound waves transmitted through a water bath that creates a 3D image of the breast with 40x the resolution of MRI, all without pain, compression, or radiation. 

There are only a few centers offering it right now. I will be opening up a center in the suburbs of Philadelphia in July or August 2024. I hope to open them all across the United States. God willing, someone will take on this charge in other areas of the world. I’m only one person; I can only do so much although I do dream very big, and I aspire to open somewhere between 50-100 of these. This is without question going to be the focus of the next 10 years of my life. I know everyone wants it tomorrow, and I’m doing the very best I can. 

This will forever change how we screen for breast cancer. The reason is not because of the high-resolution images, because although that alone would be enough, this is the only functional imaging available in that you can bring someone in and screen them, find a lesion, and bring them back in 60 days, reimage them, and measure doubling time. We know cancers have a doubling time of less than 100 days. Things that are not meaningful have a greater doubling time. This allows us to say, “You do not have a lesion that needs intervention. Come back in a year.” 

This avoids the unnecessary biopsies of which of all of the breast biopsies we do every year, 75% are benign disease. 75% of biopsies are done unnecessarily. Yet once you ring that bell for a woman, it never gets unrung. She thinks she’s high-risk. She goes into a different category. She has to wear this sign. I’m trying to avoid that, so we can avoid so many unnecessary biopsies and we avoid overdiagnosis and overtreatment. We are going to save hundreds of thousands if not millions of lives this way. 

Will it eliminate breast cancer? No, of course not. Do we need to work really hard to make sure that people are practicing all the things that we know prevent breast cancer? We still need to be loud voices out there. We still need to be out there as shining lights, helping to guide people. But we can change this very broken system. We can change it now. 

Dr. Eric: 

That’s wonderful. The QT imaging will prevent unnecessary biopsies, so there will still be biopsies done. As you mentioned, 75% are benign. Hopefully-

Dr. Jenn: 

We are going to biopsy the things that need biopsy rather than biopsying everything. 

Dr. Eric: 

Makes sense. Before we wrap up, we have to talk about healing. What are some of the things you recommend when it comes to healing? Obviously, addressing the cause of the problem that we discussed earlier. 

Dr. Jenn: 

There are pillars you want everyone to put in place. How everyone got here is going to be different, and everyone is going to need to address their own stuff. If it’s trauma, if you have a history of root canals and have chronic infections in your mouth or receding gums or metal amalgams or maybe parasite infections or food sensitivities. Whatever got you to this space is going to be your story.

However, we all need to eat and weigh that nourishes us. For everyone, that will be different. The diet that is right is not going to be the diet that’s right for you. 

What all of us can agree in this wellness space is that processed foods are not good for anyone. I don’t care if you have disease, if you don’t have disease, if you’re healthy or not, processed foods are not good for anyone, and they are having a negative, detrimental effect on your health. If it has one ingredient, came from nature, and a three-year-old can tell you where it came from, it’s probably safe to eat. Otherwise, leave it. 

I also believe that we should all be eating low glycemic diet. What that means is minimal to no grains. Grains are the seeds of grass. They are meant to be consumed by ruminators. Ruminators have a very long, redundant gastrointestinal tract. In comparison, we have a relatively short gastrointestinal tract. If we never ate another grain again, we would suffer no nutritional deficiency. I really don’t believe in putting things in your diet without benefit. 

Now, I get a lot of pushback about my no grain diet. You can take it for what it’s worth. You can think I’m a quack. You can think I’m crazy. You can think whatever you think. “Where am I getting my fiber?” I’m just telling you what I believe. 

I think that if you’re actively cancering, you should be on a whole food, plant-based, grain-free, low glycemic diet. If you’re not actively cancering, it shouldn’t look much different than that. We should spend most of our time in a place that really nourishes us. A whole food place that nourishes us. 

At the same time, I think there is a time to eat and a time to fast. I think that there is a fasting practice for everyone. I think there is very good reason why fasting is built into almost every religion there is. I think that it changes. There are times of the year that you will fast in one way and times of the year you will fast in another way. We are all tied to circadian rhythm. That is another element that should be incorporated because fasting is truly the quickest way to healing. 

We need to move our bodies, or we’re going to lose our bodies. What movement looks like changes. Lots of people do really well on pure cardiovascular exercise when they’re in their teens and 20s and maybe even 30s. As you approach your 40s and 50s, you really need to start thinking about muscle mass and maintaining muscle mass. That means they have to lift heavy things. As you get into your 50s and 60s, you also need to maintain flexibility and balance because that’s what connects the mind and the body.

How you exercise matters, and it changes. Making sure that you’re moving your body every single day in a way that benefits you. Overexercise is bad. Underexercise is bad. We have to get this right, Goldilocks. We have to get this right. 

We have to figure out a way to manage stress healthfully. Stress is always going to be there. We are not getting rid of it. It’s going to be ever-present. It’s not the stress that matters. It’s the effect that we all allow the stress to have on us. The impact that we allow the stress to have on us. 

Everyone is capable of developing a toolbox to be able to deal with the stressors in their lives. For some people, it’s going to be meditation. Some people, it’s journaling. I have a very good friend, Marcel Pitt. She is a dancer. That is how she manages the stress in her life. 

Having more than one or two things in your toolbox is important. Building your toolbox to be resilient, to allow yourself to be in control of what comes in and what has an effect on you. 

Is that going to eliminate the stressors of life? No, of course not. There will still be deaths. There will still be sick people. There will still be divorces and new jobs and moves and all the things that we know can have profound effects on our health. The better we are at dealing with them, the better our health will be as a result of them. 

We have to prioritize sleep. Sleep is where the healing happens. If you’re not sleeping, you’re not healing. Making sure that you’re doing the things during the day that set you up for healthy sleep. Making sleep a priority and protecting that. 

We talked about the toxins and eliminating as many toxins as you can, especially those xenoestrogens. They really profoundly negatively affect your health.

 Also, having detoxification practices. Making sure that you’re sweating, that you’re peeing, that you’re pooping, that you’re consuming filtered, clean water to help to flush toxins out of your system. Getting plenty of fiber in your diet. Bowel regularity is really important. 

Lastly, living a connected, heart-centered, purpose-driven life. I think it’s important to say that god put us all here with a unique purpose. My purpose is not yours, and your purpose is not mine. I am never going to be the best version of you, and you are never going to be the best version of me. We’re not supposed to be. We are only ever supposed to be the best version of ourselves. 

You don’t have to be saving the world. You don’t have to be changing the world. That may be my purpose, and that’s okay, but it’s not yours. Whatever your purpose is, as long as you’re living it, that’s okay. That’s what you’re supposed to be doing. That is where you get that internal joy, that internal reward that leads to health. 

Putting that picture together for yourself, that’s what you can do. That’s where the power lies. We have to remember to stop giving away our power because health happens at home. It doesn’t happen in a doctor’s office or a chemotherapy suite. It doesn’t come out of a pharmaceutical container. It doesn’t happen in a radiation suite. Health happens at home with all the things that you do to drive your health. 

Dr. Eric: 

That was amazing. So much good information. Thank you so much for sharing. 

Dr. Jenn: 

My pleasure. 

Dr. Eric: 

Before I ask you where people can find more about you, for those who are tuning in, what’s your new book? 

Dr. Jenn: 

This is The Smart Woman’s Guide to Breast Cancer. It’s available on Amazon. It really is for any woman because this is information that you want, information that you need, and information that you’re going to want to share with your mother or your daughter or your best friend or your neighbor. Definitely pick up that book. 

If you are looking to work with me, my website is RealHealthMD.com. All of our programs are there. 

If you want to hear more from me, I have a podcast called Keeping Abreast with Dr. Jenn. We put out new content every week. 

I have a weekly blog on my website. You can follow me on all the social channels @DrJennSimmons. 

Lastly, please come visit us at Perfeqtion Imaging. It is just in the suburbs of Philadelphia. If you want to schedule your QT scan, go to PerfeqtionImaging.com. We will see you there real soon. 

Dr. Eric: 

Wonderful. Thanks again, Dr. Jenn. This was an amazing conversation. I even learned a lot. 

Dr. Jenn: 

My pleasure. Thank you so much for having me.

Recently, I interviewed Dr. Brittany Henderson, and we discuss her integrative approach to thyroid care, the differences between thyroid nodules and cysts, diagnostic criteria, toxic nodules, subacute thyroiditis, the role of iodine in thyroid health, conventional treatment options, minimally invasive alternatives like alcohol ablation and radiofrequency ablation, and more. If you would prefer to listen to the interview you can access it by Clicking Here.

Dr. Eric Osansky: 

I am super excited to chat with Dr. Brittany Henderson, as we are going to talk about thyroid nodules, thyroid cysts. It’s going to be a great conversation. 

Let me dive into Dr. Brittany’s bio here: Dr. Brittany Henderson, M.D. is a dual board-certified physician in both internal medicine and endocrinology. She is a thyroid expert working to bridge the gap between functional and conventional medical approaches to thyroid care. 

It’s a short but sweet bio. Welcome. Thanks for joining us, Dr. Brittany. 

Dr. Brittany Henderson: 

Thank you. I’m excited about the conversation. 

Dr. Eric: 

Let’s get a little bit more into your background. I always appreciate a brief bio compared to spending five minutes on a bio. We were chatting before this, and I know there’s a lot more to your background to what motivated you to become an endocrinologist. You don’t only help people with thyroid nodules and cysts, but you do things that are different compared to a lot of endocrinologists, including overall taking an integrative approach. How did you make that transition, that you would do things differently than most endocrinologists? 

Dr. Brittany: 

I was conventionally trained. I am an MD by training. Did the classic T32 fellowship at a major institution. Did basic science research in thyroid. Ended up joining the faculty. My focus has always been on the thyroid. A lot of that goes back to medical school and residency when I had a lot of good influences as far as endocrinology. I have a chemistry background; I really liked it.

I just listened to my patients. That’s what it boils down to. Thyroid care in the U.S. is not done well. Actually, thyroid care internationally is not done well. By that, people don’t know how to diagnose it well. People don’t know how antibodies affect thyroid symptoms for people. They don’t know how to dose medication correctly. There are millions of people on thyroid medicine; I think it’s one of the most prescribed medications in the U.S. Over 20-25 million prescriptions a month. 

The conventional medicine world, it’s a one size fits all approach. Everybody gets on the same medication, and you’re just supposed to be well. But that isn’t the case in real life. A lot of the recommendations from the American Thyroid Association are very outdated.

I just felt drawn to help people in this field really try to do thyroid care right by looking at a full thyroid panel and dosing things appropriately. In our practice, we also integrate thyroid ultrasound for all of our patients. We really think it’s important, just like a stethoscope for a cardiologist. 

We need to see the thyroid itself, see the how the gland looks, blood flow, whether or not there are cysts or nodules. Those are things that you can’t always detect via physical exam. There are nodules that sit far back, and you can’t feel them. I never want to miss a cancer. I always want to make sure we know exactly what’s going on with the full picture because thyroid care is complicated.

I started listening to my patients. I did a lot of my own research. I started integrating a lot more functional medicine into my practice. Integrating supplements, vitamins, lifestyle measures, gut microbiome work, looking at food intolerances. All of those things are so important. Wellness and decreasing systemic inflammation, which helps the autoimmune process and the nodules, too.

That’s what we do. We try to do thyroid care right. I think there’s only one right way to do it. That’s what we’ve integrated both into our brick-and-mortar practice in Charleston, South Carolina and our online practice. 

Dr. Eric: 

Wonderful. You do ultrasounds on every patient who walks through your door? 

Dr. Brittany: 

Yeah. 

Dr. Eric: 

That’s good. I was diagnosed with Graves’. When I spoke to the endocrinologist, she palpated my thyroid and said she didn’t think there were nodules. She actually didn’t recommend an ultrasound. I asked her for one specifically. “It’s not that I don’t trust your palpation skills, but I’d still feel more comfortable.” I was paying out of pocket, and that might have been part of the reason, too. They are not crazy expensive paying out of pocket for the ultrasound. 

Dr. Brittany: 

It’s so much information. It’s so worth it. If you have somebody who knows how to interpret it correctly.  

Dr. Eric: 

Exactly. I’m with you that it’s probably a good idea to get that thyroid ultrasound. If you have a thyroid problem, it makes sense to look at it. Apparently, there are some doctors, even endocrinologists, who don’t order ultrasounds on all their patients. 

Dr. Brittany: 

In the same vein as the stethoscope used for hearts, people image the heart all the time. They do echos, cardiac caths. Same thing. When you have a thyroid condition, to look at it, structurally, it’s important. 

Dr. Eric: 

I agree. For those who are unfamiliar with thyroid nodules and thyroid cysts and the difference between the two, can you explain what thyroid nodules are and how they differ from thyroid cysts? 

Dr. Brittany: 

I get that question all the time, whether a thyroid nodule is a nodule next to the thyroid or within the thyroid. A thyroid nodule is an accumulation of either fluid, which is what a cyst is, or cells—which is what a nodule is. It’s more of a solid component—within the thyroid gland. 

Within the structure of the thyroid gland, you can get these little bumps. You can sometimes feel them. You can feel them on your own self if you look into the mirror, drink a glass of water, and swallow. When you swallow, the thyroid moves. Sometimes, you can feel it. The thyroid sits right at the base of your neck before your sternum. Not always though. You don’t always feel thyroid nodules.

The reason that people get these is because of gland inflammation typically. The thyroid gland receives blood flow just like every other organ in the body. When there is inflammation within the thyroid itself due to Hashimoto’s, Graves’, trauma to the thyroid, or if the thyroid is not functioning properly, like if someone has iodine or iron deficiency, or lots of chemicals in the environment can increase the risk for these nodules to occur because of inflammation of the gland, the gland doesn’t drain the way it’s supposed to. 

The cells don’t behave the way they’re supposed to because they’re inflamed. Because there  not continuous, normal drainage pathways, you can get an accumulation of fluid within the thyroid itself, which is a cyst, or you can get a proliferation or expansion of thyroid cells, which is a nodule. Those thyroid nodules can have gene mutations, which means the cells start behaving erratically or irregularly. That can lead to thyroid cancers or thyroid precancers. 

Dr. Eric: 

How common are thyroid nodules? I imagine in your patient population, it’s common because a lot of people come to see you specifically for that problem. There are other cases as well. Just in the general population, do you know the percentage? 

Dr. Brittany: 

Yeah, it’s super common. It goes up with age. I always tell people 30% of 30-year-olds, 40% of 40-year-olds, 50% of 50-year-olds, and so on. They have done autopsy studies, where they found up to 80% of people who die, especially in their 80s, have thyroid nodules. They just pass away with them. They never know about them.

The good news is 95-99% of them are benign. They are not cancerous. There are cancerous thyroid nodules, and it is one of the fastest-growing cancers in the world. Women get thyroid nodules much more commonly than men do. When men have thyroid nodules, we take it a lot more seriously because they are more prone to cancer, and more prone to aggressive forms of thyroid cancer. We don’t know why. 

Dr. Eric: 

That’s interesting. I know in general, or at least I’m pretty sure in general, most thyroid cancers- There are four types of thyroid cancers, I believe. Two of them are not aggressive, and most people have the non-aggressive forms. I did not know that men with thyroid cancer, not all the time, but are more prone to having the more aggressive forms. Whether it’s a woman or a man, you have to look at certain characteristics of the nodules.

Let’s talk about that. How do you determine who gets a biopsy and who doesn’t? 

Dr. Brittany: 

If you have a simple thyroid cyst, meaning a fluid accumulation with no solid component, typically, those are benign. Almost always. But they can be really annoying and can cause issues. We can get into that in a little bit. 

When we look by thyroid ultrasound, we use several criteria to figure out who gets a biopsy or which ones we can just follow with serial ultrasound. The first criteria is the American Thyroid Association and the American College of Radiology have determined how big does the nodule have to be before you recommend a biopsy? It’s either one centimeter, usually the lowest size. 

It depends on the echo texture of the nodule, meaning on ultrasound, is the thyroid nodule dark, hypoechoic, or bright, hyperechoic? Or is it mixed solid cystic? It just depends what it looks like by ultrasound. 

We have different criteria for size based on how it looks. How dark is it? How big is it? Does it have suspicious features? Does it have calcium deposits in it? We call those microcalcifications, which is a sign for cancer. Or linear calcifications, ram calcifications. There are different types of calcium deposits.

We also look at blood flow. Follicular nodules or follicular carcinomas, which is one of the more common cancers, can have a lot of blood flow by doppler on ultrasound. That is a more aggressive sign as well. Versus papillary thyroid cancers, which don’t necessarily have blood flow.

We also look at the edges. If a nodule is very round and smooth versus a nodule that is very irregular-looking or growing into muscle or trachea or other things. There are lots of criteria we use. 

Ultrasound is the most sensitive modality to look at this, better than MRI and CT scan, which is why we use it in the practice. It’s so easy and cost-effective. It doesn’t expose anybody to radiation, and it gives us a lot of information. 

Then we recommend biopsy or serial ultrasound to monitor for growth. Even benign nodules can grow with time. 

There is so much that has come out in the last 5-10 years for personalized medicine to figure out risk stratification for patients and how aggressive might a cancer be versus how not aggressive a cancer might be. A lot of that is using genetic testing. There are genetic tests we use when we do a biopsy, which can tell us if the nodule has a gene mutation that is suspicious for cancer or not. 

There are so many decision pathways. Really, it’s come a lot farther than what we used to do, which was just to suggest everybody have it removed. Before you remove a very important endocrine gland, which is really hard sometimes to dose and get right and mimic with our imperfect human medicines, it’s worthwhile to get a second opinion or a third opinion or really figure out if this is the right course of action before making a dramatic decision like surgery. 

Dr. Eric: 

Makes sense. If you do a thyroid ultrasound and detect nodules, you don’t just decide that the person doesn’t need a biopsy. It sounds like you do follow up with another ultrasound in the future. I don’t know if you do that across the board, to make sure the nodules aren’t getting bigger. 

Dr. Brittany: 

We do. Usually, it depends on the size of the nodule and the appearance as to how often we follow that. Primarily, it’s about a year that we look.  

Dr. Eric: 

Okay. Usually, a year. Any indication sometimes for six months? 

Dr. Brittany: 

If it looks hypoechoic, or dark, or it has suspicious features, and it’s smaller than a centimeter, we will recommend a closer follow-up, like the six-month mark. If there is a nodule that is actively growing, and we have a fearful patient who isn’t a fan of needles, which who is? But sometimes, we will do a closer follow-up in 3-6 months to make sure we are on top of it.

If someone does have a thyroid cancer history, we always look by ultrasound every six months for the first two years and then every year after that. 

I we see anything like lymph nodes, which thyroid cancer primarily goes to lymph nodes when it spreads somewhere, then we either recommend biopsy of the lymph nodes or serial ultrasound surveillance every 3-6 months, depending on the aggressiveness of the original tumor. 

Dr. Eric: 

When you do a biopsy, you also do genetic testing as well, just to determine what type of cancer it is? 

Dr. Brittany: 

Yes. There are three ways a nodule can come back after a biopsy. There is benign, which is the most common; cancer, which is the least common; or in the middle, indeterminate. That happens about 10-20% of the time. It just means that the cytologist can’t say 100% there is a benign nodule here because the cells overall look good, but there are some funny features. They’re either bigger than normal or inflamed-looking or have some suspicious features for thyroid cancer. They can’t say either way.

In that situation, we collect a special test, which basically runs all of the known gene mutations for thyroid cancer and gene fusions and other things. Then we can tell somebody, “You had an initially 10-20% chance of cancer. We ran this gene test. It’s telling us that you have a genetic mutation in the tumor that says that you have a 50/50 chance or a 95% chance of cancer.” 

That really helps us to risk stratify people and give them a good idea of whether they should have half the thyroid removed, the full thyroid removed, lymph node dissection, depending on the aggressiveness of the mutation. We run that mutation as well for suspicious for thyroid cancer patients. It does help with understanding how aggressive the tumor might be. 

Dr. Eric: 

If someone comes back with a biopsy, and you conclude it’s benign, you don’t do the genetic testing. Is that correct? 

Dr. Brittany: 

Yes. 

Dr. Eric: 

Just wanted to clarify. What are toxic thyroid nodules? 

Dr. Brittany: 

Toxic thyroid nodules are just nodules that are overactive. It sounds terrible. It actually feels terrible for people because the thyroid is then no longer under the control of the brain and the pituitary system, which is the master gland. That is supposed to be tightly regulating thyroid hormone production. 

Sometimes, if thyroid nodules have been there for a long time, they develop mutations that affect the TSH receptor. Instead of allowing the pituitary gland to signal with a TSH, signal to the thyroid nodule to produce thyroid hormone, the thyroid nodule starts producing thyroid hormone all the time by itself because it hits the on button for the TSH signaling and just always is producing thyroid hormone. 

It doesn’t produce thyroid hormone in a good way. It just basically spits out thyroid hormone randomly whenever it makes some. That can feel like a person is having hyper symptoms, hypo symptoms. They can feel terrible. It doesn’t feel good.

Over time, especially in older patients, people can be at a higher risk for osteoporosis because of the thyroid secreting extra hormone. They can have a higher risk for atrial fibrillation or heart arrythmias because of that. It really contributes to all of the symptoms of thyroid: heart racing, heart jittering, anxiety, insomnia, weight gain, fatigue, brain fog, all of the different hypo and hyper symptoms because of the thyroid nodule behaving irregularly. 

Dr. Eric: 

Whereas just a regular thyroid nodule or cyst are quite common, is it safe to say that toxic nodules are not as common? 

Dr. Brittany: 

I would say that’s probably true. By the way, most toxic nodules are benign. They are not cancerous typically. Some can be, but most of them are not. 

I see those primarily in regions where people grow up with not as much iodine, or they have had long-standing iron deficiency. That is because the nodules typically have been there for a very long time. Those patients who are nutrient deficient many times will have them from childhood or teenage years. They are the ones who typically develop them. 

But of course, there are many factors and variables. We don’t know every single variable that predisposes a person to have a toxic nodule. 

You can by the way have more than one. You can have a toxic multinodular goiter, which are many nodules that are overactive. Typically, these are patients who grew up not eating seafood or seaweed. They grew up in the mountains, where they didn’t have a lot of fresh fish or iodine exposure. Or they have had a lot of heavy periods as women and haven’t eaten a lot of red meat, so they’re iron deficient. Those are the people I see most often. 

Dr. Eric: 

Hot and cold nodules. Do you do the uptake test at your clinic? 

Dr. Brittany: 

Not at the clinic. Usually, a nuclear medicine department at a hospital is who does that. There are some free-standing clinics that do it, but not very many.

A thyroid uptake scan is a scan where the person ingests iodine. It’s not radioactive iodine. It’s just iodine attached to a radiopharmaceutical, so they can actually image the thyroid. 

What it’s doing is concentrating primarily in hot nodules and not in cold nodules. Cold nodules are nodules that do not pick iodine up very well. Those are nodules that don’t make thyroid hormone. 

With a scan, you can actually figure out is a nodule hot on one side of the thyroid and then maybe cold on another side of the thyroid? That can help you understand if a person has hot nodules, do they require treatment on one side of the thyroid gland? Do they need their whole thyroid removed if there are hot nodules all over the place? It can really help you identify where the problem is.

We use thyroid uptake scans all the time, not just for nodules, but for a form of Hashimoto’s called Hashitoxicosis. For Graves’ patients, it is helpful when it’s helpful. Even if it’s normal, sometimes it doesn’t completely rule out a problem. For toxic nodules, it is a helpful test. 

Dr. Eric: 

Good to know. For those with Hashitoxicosis, Graves’, you recommend for that category of patients to get the uptake. 

Dr. Brittany: 

Yes, those are the people it really helps with. Or people who have something called acute or subacute thyroiditis, which is where you get a viral infection like COVID, for example, and your thyroid spits out all its thyroid hormone. You get really hyperthyroid. The uptake scan will look like low uptake on the scan because it’s been completely destroyed by the virus, really by the immune system. We see that occasionally as well. 

Dr. Eric: 

Speaking of subacute thyroiditis, just curious, what is your treatment approach? Usually, they’re transiently hyperthyroid but eventually become hypo. I know some endocrinologists are hesitant to give antithyroid medication because they know eventually the person will become hypo. At the same time, you do want to do things to manage hyperthyroid symptoms. I don’t know if you recommend antithyroid meds or a beta blocker or another approach. 

Dr. Brittany: 

Antithyroid meds in subacute thyroiditis don’t work because they work primarily on stopping the thyroid from making thyroid hormone. You could use PTU because it stops T4 to T3 conversion, but I don’t usually do that.

For someone who has subacute thyroiditis, we just treat symptoms. We put people on beta blockers to treat heart rate issues. We put people on prednisone if there is pain. It’s really waiting it out and letting the disease take its course. Typically, people will become hypothyroid, but many of those people can go back to euthyroidism. They can go back to normal thyroid function. It takes a little bit, 3-6 months. It’s a thing. We see it not very infrequently. 

Dr. Eric: 

You mentioned iodine. Very controversial in the world of thyroid health. You mentioned that it could be a factor when it comes to thyroid nodules and even toxic thyroid nodules. I guess your approach, when it comes to iodine, because there is a lot out there. Some practitioners recommend massive amounts of iodine supplementation. Others recommend the opposite, to restrict iodine supplementation. It depends on the practitioner. It’s not just hyperthyroidism; some suggest that with Hashimoto’s, too. What are your thoughts on iodine and hyperthyroidism, Graves’, Hashimoto’s? 

Dr. Brittany: 

Iodine is one of the micronutrients that follows the Goldilocks rule. It has to not be too much or too little; it has to be just right, and it’s patient-specific.

With thyroid nodules, most of the time, I recommend the recommended daily allowance of iodine. Unless somebody is iodine-deficient, and you can measure that typically in the 24-hour urine iodine. It doesn’t make sense to check serum iodine levels in people because it’s transient. If you eat something that has a big load of iodine, your serum levels will go up acutely. Then the iodine is transferred into cells. Serum level doesn’t mean anything.

A urine level can be helpful. People who are iodine-deficient, people who don’t eat seafood or are vegans or vegetarians, they tend to get thyroid nodules and goiters or enlargement of the thyroid because the thyroid is working overtime to try to make thyroid hormone with only having a little bit of iodine to make it. 

In those situations, we do recommend a little bit higher dose of iodine. By that, I don’t mean 12,500mcg. 300-500mcg short-term, and the recommended daily allowance for adults in the U.S. is 150-250mcg. Higher for breast-feeding or lactating women.

In autoimmune thyroid disease, it depends. We know there is an effect called the Wolff-Chaikoff effect in Hashimoto’s. The thyroid tissue is being attacked by the immune system. Too much iodine in a patient who has Hashimoto’s can stun the thyroid tissue and actually make it not produce any iodine, just stop completely. 

We know that too much iodine can actually worsen some of the Hashimoto’s antibodies, like thyroid globulin antibodies, which can get tagged with iodine and alert the immune system to worsen the autoimmune attack on thyroid.

In those situations, we don’t recommend an excess amount of iodine. I never recommend super low iodine states. I don’t think that really helps to reverse things. A recommended daily allowance, 150mcg, whether it’s through a vitamin or normal exposure is fine. 

There is data as well to show that Graves’ patients, hyperthyroid patients do take iodine. Their glands are overactive, so they take the iodine, and their thyroid glands make tons of thyroid hormone. In order to help get Graves’ into remission, usually we do try to restrict too much iodine. We try to avoid it or reduce it. 

In those situations, a lower iodine diet for a short time might help get into remission. Once remission is achieved, normal iodine intake is probably fine. That’s my approach. 

I think it’s really highly personalized medicine. It depends on the patient’s clinical picture. I don’t have a lot of patients where I use a ton of high doses of iodine to try to help. 

Dr. Eric: 

That makes sense. For thyroid nodules, the same approach. I don’t know if it depends on the situation. As far as there is a chance that in some cases, not all cases, iodine deficiency can be a factor for thyroid nodules. I don’t know if you recommend- You mentioned sometimes urinary iodine testing to see if that might be an underlying factor. If it is, you don’t go to massive amounts of iodine, but maybe have them take a little bit more. 

Dr. Brittany: 

If they’re deficient and have a thyroid goiter or multiple nodules that are not toxic, just normal, it makes sense to go ahead and give them more iodine. Maybe not a crazy amount, but higher than the recommended daily allowance.

Toxic nodules have been shown in the literature that after a high iodine load, they can really start revving up. They use that iodine to make lots of thyroid hormone. That can actually cause “thyroid storm” or excess hyperthyroidism. I have never seen that. 

Usually, a thyroid storm is reserved primarily for Graves’ patients. It is theoretically possible in a big thyroid nodule that is toxic, that it uses iodine load to make a lot of thyroid hormone. I usually don’t recommend high iodine loads for people with toxic nodules. 

Dr. Eric: 

Let’s talk about treatment. As far as conventional treatments, regarding most endocrinologists, most of them don’t need treatment. Most are benign and won’t do anything. if they meet the criteria of certain characteristics that you discussed, typically, it’s partial or not as common to see partial thyroidectomies. A lot of times, with cancer, it’s understandable. Sometimes, I see in cases where someone is benign, but it’s a really large thyroid nodule, they will recommend for the person to get surgery. Is that the conventional approach? Either surgery or no surgery? 

Dr. Brittany: 

I would say that’s true. I would say that most cases, a conventional endocrinologist will recommend total thyroidectomies for most people. Knowledgeable endocrinologists who specialize in the thyroid will make a less aggressive approach to this. They will recommend more of the hemithyroidectomies if it is a benign nodule. If it is a big nodule causing a person to choke or feel like they’re choking, they will recommend just half. If it’s a low-risk thyroid nodule, meaning we did the biopsy and have the genetic test and know that the mutation is typically low risk, we will recommend half of the thyroid. I think that’s the better approach. 

That’s the approach that we take in our practice. We always try to preserve as much thyroid tissue as possible because it’s a big deal to take out the thyroid gland. We used to just say, “Oh, it’s fine. We have Synthroid.” Replacement medicine is not the same as your own endogenous endocrine gland, which controls everything. There are thyroid hormone receptors in every bodily system. Before removing a very important organ, it makes sense to think through that. 

Even in thyroid cancers, for example, in my practice, if it’s intrathyroidal, meaning it’s not growing outside the thyroid, and I don’t see a lot of lymph nodes—I always do the ultrasound before surgery to make sure I know what to tell the surgeon as far as if there are any lymph nodes underneath the thyroid that have cancer or over to the side in the lateral neck, and how to direct them as how to perform the surgery correctly. It’s very important that the surgery be done right the first time.

Even for thyroid cancers that are within the thyroid, they don’t have a lot of lymph nodes present, we sometimes recommend hemithyroidectomy. I don’t always recommend a complete thyroidectomy, even if it’s a higher stage or there are a couple lymph nodes present. I love to be able to preserve thyroid function for patients and minimize the amount of tissue that we’re removing. 

Dr. Eric: 

That’s wonderful. There aren’t a lot of endocrinologists who do that. It’s good to know that if absolutely necessary, you will recommend a complete thyroidectomy. There is a time and place for that. You will do everything you can to try to preserve some of the thyroid tissue and recommend a partial thyroidectomy if you feel that’s warranted. 

I didn’t realize in cancer, too. Probably just because the approach is usually to remove the whole thyroid gland. I don’t hear about endocrinologists who try not to do that, so that’s great that there’s that option. 

I wanted to talk about alcohol ablation. That’s something that most endocrinologists don’t do. That’s something that you offer. Can you discuss what alcohol ablation is, when it’s indicated? 

Dr. Brittany: 

Along the same lines, we like to use minimally invasive approaches to care. We want not to disturb regular normal thyroid tissue. If I see a thyroid that looks beautiful, and it’s working optimally, I don’t want to remove it. 

Even for thyroid cysts. If it’s a simple cyst, meaning it’s just a pocket of fluid, and we see that on ultrasound. That is how we figure out if it’s a cyst. The best way to approach that, the most effective way without disturbing any thyroid tissue or having to go on thyroid medicine lifelong, is a minimally invasive approach called alcohol ablation therapy, or sclerotherapy. 

Not every endocrinologist does this. There are very specialized endocrinologists who know how to do it throughout the U.S. I think they have some at the Mayo Clinic. There are some specialty practices. Very few people are trained on how to do it unfortunately because it’s a very effective treatment option for thyroid cysts. It’s very low risk as far as any complications. 

The way that we do it is we drain the thyroid cyst. If you have a cyst, your endocrinologist can just drain it. They can just take a needle, stick it in the thyroid cyst, and drain the fluid. Many times, in big thyroid cysts especially, which are causing people to feel like they’re choked or you can see it, that cyst fluid just comes back. The reason it comes back is because the cyst probably has been there for a long time and has a thick wall that stops fluid from being allowed to be drained. It just fills back up.

With alcohol ablation or sclerotherapy, we do the same thing. We drain it. But at the same time, we will inject the cyst with pure alcohol, ethanol. One of the side effects is feeling a little bit weird. That doesn’t usually happen. It stays within the cyst wall, so you shouldn’t feel any effect from that. The alcohol kills off the blood supply to the cyst wall, so the wall involutes within itself over time, and the cyst goes away. 

I just had a patient that we did this on a couple months ago. This person came back yesterday to my clinic actually. He had a huge cyst. Trouble swallowing. Had it drained multiple times, and it just kept coming back. 65ccs, which is a big nodule. That is a lot of fluid in somebody’s neck. This is not a big space. We did the alcohol ablation, one round of it. He came back yesterday, and it’s down to less than 2ccs, 96% volume reduction. No symptoms. Doesn’t see it anymore. Completely normal thyroid function. Not having to be on thyroid medicine.

That is a very easy, minimally invasive way to take care of this. Conventional doctors, if it comes back after it’s been drained, will recommend surgery. That is not the right approach to these cysts. This is such a better option for people. 

Dr. Eric: 

Anything you can do to save the thyroid. Sounds like low risk, too. Are there any contraindications? 

Dr. Brittany: 

I always tell people the main complication would be if the alcohol leaks outside the cyst and causes pain at the site or theoretically affects the nerve that goes to the voice, so you get hoarse voice. That would be transient. It would come and go. I have never seen that ever. The cyst fluid stays within the cyst, so the likelihood of it leaking out should not happen. 

Most patients don’t have any pain with it because there is no nerve endings within the thyroid, so it doesn’t hurt. It takes about 15-20 minutes, and you’re off to the races. Really minimal side effects, if any. 

Dr. Eric: 

You’ve been doing this for quite some time, correct? 

Dr. Brittany: 

I have been doing this procedure for almost 10 years with my practice. We do it regularly. We have people who fly internationally to come see us to have it done. It’s hard to find people in your local area who know how to do it or know how to do it well. It’s so easy, and it’s so effective. It should be the standard of care honestly. 

Dr. Eric: 

Is it just for cysts, or can it help with nodules as well? 

Dr. Brittany: 

It’s just for cysts. Sometimes, I have people if they are interested send their images to me, and I can look at them on a secured email, so I can make sure it’s a candidate before they travel. It usually is just reserved for cysts, not solid nodules. 

We do use it for some isolated thyroid cancer lymph nodes. Usually, that is best reserved for older patients who are not surgical candidates. Surgery to remove a cancerous lymph node is probably better. It does work effectively for cancerous lymph nodes as well if someone only has one or two. If they have lots, surgery is better. 

For solid nodules, somebody could consider something called radiofrequency ablation, which is a different minimally invasive option for these solid nodules. Solid nodules can’t be drained. They are full of cells. They are usually more vascular, so they have a lot of blood flow. 

With radiofrequency ablation, the way that works is the needle tip has a positive and negative electrode. The physician will place that needle tip within the solid nodule, and the positive and negative electrode cause heat. They are thermal ablation, pretty much. That heat kills off the blood supply from inside out and causes the nodule to involute and go away. 

It’s more invasive, a little bit, and a bigger, longer procedure than the alcohol ablation. For people who have solid nodules and don’t want surgery or want to preserve thyroid function or have a toxic nodule, which is the overactive nodule, radiofrequency ablation can sometimes be a minimally invasive option to fix that. 

Dr. Eric: 

Okay. Alcohol ablation is for cysts. If you have a solid nodule, then maybe look into radiofrequency ablation, including in some cases, toxic nodules. That’s great. 

Unlike draining a cyst, when you use the alcohol ablation, it’s unlikely to come back? 

Dr. Brittany: 

It’s unlikely to come back although if you start with a cyst that is really big, and by that, I mean over 20ccs. That’s the cutoff in the literature. If it’s over 20ccs, it’s more likely to need a couple courses of alcohol to kill it off. That’s because those bigger cysts have thicker walls. The alcohol doesn’t always get throughout the whole cyst wall, and it can still accumulate. Usually, it will go down after the first treatment. 

With those huge cysts, I can do up to three treatments. By that point, it will usually have shrunk enough that the patient says, “This is great. I don’t have any symptoms anymore. Even if it’s still there a little bit, it’s okay.” We can always do it down the road again. For most nodules, it works the first time. 

Dr. Eric: 

You just gave an example of a patient. I think you said it was 65ccs. It went down to 2ccs. What’s the follow-up procedure? Is it a few weeks later that you reevaluate? 

Dr. Brittany: 

Usually, I give it a good 2-3 months before we reevaluate with the ultrasound. The patient should notice an improvement the minute they leave the door. They should notice that it’s gone, that they’re able to swallow again, that they don’t feel like they’re being choked. That should persistently get better. 

The thyroid cyst over time involutes, so it takes about six months to see the final result. I usually look at that halfway mark. I’m happy when there is at least a 50% volume reduction in the cyst. Usually, we’re getting 80-90% reduction. It’s still going to be there. It will have involuted enough that it’s not going to do anything. Sometimes, it goes away completely. Those are really good results. 

I always tell patients after you’ve had that procedure, when you have had another endocrinologist look at it with an ultrasound, they will say, “Oh my gosh, this looks terrible. You have thyroid cancer.” You just have to know that it looks involuted. It doesn’t look like nothing. Education of outside providers that are not comfortable or familiar with alcohol ablation by the patient even sometimes is helpful to prevent additional workup that is not needed down the road. 

Dr. Eric: 

It’s great to have an alternative. In this situation, if that person went to a conventional endocrinologist with a 65cc cyst, they will probably be told to get a thyroidectomy. Is that correct? 

Dr. Brittany: 

Yeah, most of the people who come to see us have been told to get a total thyroidectomy, or at least a hemithyroidectomy, and they don’t want to lose their thyroid, smartly and after some research, they decide to pursue another opinion. It is usually a great option for people. 

Dr. Eric: 

You covered a lot. Is there anything else that I should have asked you that I didn’t ask you? Anything else you want to share when it comes to nodules or ethanol ablation? 

Dr. Brittany: 

We are happy to look at cysts if patients want me to look at their images. I usually want to look at the images. 

Also, if people want to learn more about thyroid nodules, goiters, iodine deficiency, iron deficiency, or anything thyroid, we just launched a new online patient course. It’s a six-week, learn at your own pace, patient course directed to people. Everything from what is the thyroid? Where is it located? How do you feel with thyroid nodules? How do I know if I’m on the right thyroid medicine? We talk about all of that. We talk about Hashimoto’s, Graves’, antibodies, lifestyle measures, all of it. it’s called Everything Thyroid. If people want more education, they want to be more knowledgeable about their thyroid issues, I think it’s a good starting place as well. 

Dr. Eric: 

You have a brick and mortar in Charleston, SC. That website is CharlestonThyroidCenter.com. 

Dr. Brittany: 

That’s right. 

Dr. Eric: 

A virtual practice, MyThryoidDoctor.com. Yes? 

Dr. Brittany: 

That’s right, yes. The virtual thyroid practice, we see patients in select states all throughout the Southeast. We’re in the Carolinas, Tennessee, Virginia, Florida, Georgia. We are also licensed in Minnesota and Arizona. If patients are located in those states, or their loved ones are, they can see us and get our professional opinion and treatment from us online without having to come in person. 

Dr. Eric: 

Sounds great. Any other places? Instagram, Facebook? I don’t know if you’re on social media. 

Dr. Brittany: 

Our biggest presence is on Instagram. We provide videos all the time about thyroid care, thyroid nodules. We have a whole series on thyroid ultrasound and nodules on our social media. You can follow us, @DrHendersonMD. We’re also on TikTok and Facebook.  

Dr. Eric: 

Thank you so much, Dr. Brittany. This was amazing. You provided some great information when it comes to nodules. I’m glad you’re also trying to help save people’s thyroids through the alcohol ablation. Keep up the good work. I’ll definitely have to have you back on the podcast in the future. 

Dr. Brittany: 

So much fun. Anytime we can spread awareness and knowledge for people and help change the course of their health, I’m all for that. That’s great.  

Dr. Eric: 

I agree. Again, thank you so much. 

Dr. Brittany: 

You’re welcome. Thanks for having me.

 

Recently, I interviewed Dr. Jessica Drummond, and we discuss her journey into women’s health, the complexities of endometriosis, its symptoms, the challenges in diagnosis and treatment, integrative management approaches, the relationship between endometriosis and thyroid health, why it’s crucial to find a skilled surgeon, non-surgical options for managing endometriosis and more.. If you would prefer to listen to the interview you can access it by Clicking Here.

Dr. Eric Osansky: 

I am excited to chat with today’s guest, Dr. Jessica Drummond. We are going to talk about endometriosis. It should be a fascinating conversation. Let me dive into Dr. Jessica’s impressive bio here: 

Dr. Jessica Drummond is the founder and CEO of the Integrative Women’s Health Institute. For over two decades, she has worked with women with complex chronic illnesses such as endometriosis, pelvic pain, painful bladder syndrome, and vulvodynia. She has educated practitioners in over 60 countries. She takes the root cause innovative approach to healing in collaboration with her clients and students. Welcome, Dr. Jessica. 

Dr. Jessica Drummond: 

Thank you so much for having me. It’s a pleasure to be here. 

Dr. Eric: 

It’s a pleasure to have you here as well. Looking forward to talking about endometriosis. Before you explain what endometriosis is, for those who are unfamiliar with it, let’s go a little bit deeper into your background. How did you start helping women with endometriosis as well as pelvic pain, painful bladder syndrome, all these complex chronic illnesses? 

Dr. Jessica: 

I became a physical therapist first. I graduated from physical therapy school back in 1999. I thought I would work in orthopedics and sports medicine, which I did. 

Within the first year, I became really interested in women’s health specialty physical therapy, which at the time was a lot of focus on an orthopedic approach to things like athletes in pregnancy. I had one patient who had breast cancer surgery and then had shoulder issues. That evolved. Women’s health and pelvic physical therapists do that kind of work still. But we also did a lot of work around incontinence and pelvic organ prolapse and birth injuries, which are actually surprisingly similar to orthopedic injuries of intense athletics. 

My most challenging patient population were those who had chronic pelvic pain. Back in that time, in the early 2000s, we didn’t have a lot of options for therapies. Many of our clients were either struggling with opioid addiction or had to have nerve stimulators surgically implanted. None of these things worked very well. Our physical therapy tools were also limited. 

At that time, in 2003, my oldest daughter was born. I had what I understand now, being a functional medicine practitioner and clinical nutritionist, it was a reactivation of EBV. I had intense fatigue and what we used to call adrenal burnout. I was wiped out, which was surprising for me because I had been an active, athletic physical therapist. Now, I’m a new mom and trashed. 

I learned the tools of clinical nutrition and functional nutrition. I eventually went back and got a doctorate in functional nutrition. I was board certified in health coaching. I really slowed my practice down to start looking at what could be some of the root causes of these chronic pain conditions. Since they’re also hormonally related, as I was working with women’s health and menstrual health, endometriosis has some of that menstrual, cyclical relationship to the pain. 

If we could, from more of a nutritional, biochemistry standpoint, start to have more tools than just opioids and nerve stimulators and pelvic PT, which in some cases were helpful and some cases were harmful and in some cases were just not enough, that’s where I really began to sub-specialize in more complex chronic pain conditions. 

Dr. Eric: 

Thanks for sharing your background. Let’s dive into endometriosis. For those who are unfamiliar with it, what is it? How common is it? 

Dr. Jessica: 

It’s very common. The underlying cause of endometriosis is a combination of genetic predisposition, so 1/9 female fetuses are born with endometriosis cells pre-birth. We know that there is some genetic predisposition. Then there is usually some kind of immune dysregulating trigger. It’s a chronic inflammatory condition. In some cases, there are autoimmune markers that can be elevated. There are a lot of autoimmune comorbidities. Hashimoto’s, Celiac, things of that nature. 

It’s common in people with uteruses. Roughly 1/9-1/10 of people with uteruses have it. The tissue that is similar to the tissue that lines the uterus, which is called the endometrium, grows outside of the uterus. By definition, this is a disease that is systemic. These lesions are often in the pelvic cavity, so around the ovaries, the fallopian tubes, the bowel, rectum, bladder. These lesions can also grow anywhere else. 

I think of it as a benign cancer. These lesions can grow through the diaphragm, on the lung. They can be a cause of collapsed lung. They can grow in joints. There have been case studies of endometriosis lesions on the knee, inside of the nose. It really can be anywhere. 

The original theory was that there was a retrograde menstruation that pushed cells out of the uterus in the wrong direction during the menstrual cycle. Things would get inflamed from there. We know that’s not true because we know these cells can be there from birth, but they are similar as the lining of the uterus. 

One important thing to note about that is because by definition, these lesions, little growths that are like cancer but not cancerous, they have their own hormone supply. They create their own blood supply. They hijack the immune system to sustain themselves. They are by definition outside of the uterus. Hysterectomy is not a treatment for endometriosis. 

There is a sister condition, if you will, called adenomyosis, which is similar types of lesions on the uterine muscle, so inside the uterus. That could in some cases be treated, and the current standard of care is it could be treated by hysterectomy. Endometriosis is not treated by hysterectomy. 

Dr. Eric: 

From what I understand, based on your explanation, endometriosis itself is not an autoimmune condition, but it’s common for it to be present in other autoimmune conditions. You mentioned Hashimoto’s and Celiac. 

Dr. Jessica: 

We don’t really know for sure whether or not endometriosis is autoimmune. It’s absolutely inflammatory. It does have some features of autoimmune diseases. It’s a combination of a disease state that is autoimmune. In some cases, maybe all cases, chronic inflammatory, and genetic. 

Dr. Eric: 

Okay. Is it something that’s commonly misdiagnosed, where a woman will be having it for many years before someone finally hopefully is able to diagnose it? 

Dr. Jessica: 

Yeah. The standard delay of diagnosis is 12 years. For most women, it presents in prepuberty, around 8-12 years old, as gut issues, digestive issues, bloating, what’s known as endo belly in the endometriosis world but is really SIBO or SIFO, an overgrowth of bad microbes in the small intestine. The menstrual pain can present and be irregular early on. At any time, too. It’s not always cyclical pain. 

Some key red flags are those digestive issues, fatigue, and intense menstrual pain or intense pelvic pain outside of menstruation. Because this disease is systemic, there could also be pain or other symptoms pretty much anywhere in the body. 

Ideally, the time for diagnosis would be roughly middle school, maybe early high school. Unfortunately, it’s a surgical diagnosis at this point. We don’t have any easy blood markers. It doesn’t always show up on imaging. The only way to diagnose it truly is with a skilled orthoscopic surgery, which is another reason why often the complete diagnosis can be delayed. It is even possible to be diagnosed in perimenopause, menopause, or beyond. It gets complicated because each case can present differently. 

Yes, unfortunately, often women are misdiagnosed with things like IBS or SIBO without underlying the endometriosis driver or menstrual pain. They’re often just brushed off and given hormonal birth control to try to quiet the symptoms, but it’s difficult to get good, early diagnosis of endo, even now. 

That number from the start of my career 25 years ago has only declined three years. It used to be 15 years to diagnosis; now it’s 12. 

Dr. Eric: 

It’s still a long time. I didn’t know the relationship between endometriosis and SIBO. If someone gets diagnosed with SIBO and has underlying endometriosis, that person might take rifaximin or herbal antimicrobials, which might temporarily help, but it’s not going to resolve the SIBO unless the endometriosis is resolved, correct? 

Dr. Jessica: 

Yeah. That is really challenging. Like I said, it’s known as endo belly in the endometriosis community because you’re exactly right. The SIBO or SIFO could be treated either from an integrative or a more conventional perspective. 

Imagine if you have little lesions growing on and anywhere around the small or large intestine. You’re going to have motility issues. You’re going to have little pockets where the fungal or bacterial overgrowth can thrive. That can always remain, even if those lesions are surgically removed because sometimes, you then have little areas of adhesions or inflammation. 

Sometimes, a combination of really skillful integrative therapy for SIBO and SIFO, including bowel function and gut microbiome, and skilled excision surgery, which is the robotic surgery that removes those lesions from the root, then you can sometimes eradicate endo belly, but it can be difficult. 

We often have to manage it with things like pelvic or visceral physical therapy, rotational movements, breathwork, things that help with motility, like ginger and artichoke. Then a kind of occasional, maybe quarterly or semi-annually support with those antimicrobial herbs. A lot of times, it won’t stick because there’s that structural change to the gut. 

Dr. Eric: 

Makes sense. There is some train of thought. Maybe that’s not the case currently, but I’ll let you share your thoughts. Endometriosis, being an estrogen dominance condition, problems with estrogen metabolism could be a factor or even the main factor in the development of endometriosis. What are your thoughts on that? 

Dr. Jessica: 

In 2018, we had a great study out of Belgium that showed that endometriosis lesions, about ¼ of them had estrogen upregulation in the receptors. ¼ had progesterone upregulation. ¼ had both. ¼ had neither. The challenge is that multiple kinds of these lesions could be in the same person. 

Yes, some endometriosis lesions are “fed” by estrogen in the same way that you can have an estrogen-provoked breast cancer. Only about ¼ of those. It makes sense as to why some women do well with estrogen suppressive therapies. Anything from GNRH agonists to hormonal birth control to an integrative or functional approach to support reducing estrogen, better metabolizing estrogen. 

But that’s not really the driver of the condition. It’s part of the condition. In some cases, it’s actually progesterone that is the problem. In some cases, both. In some cases, neither. 

I really think of endometriosis as more of a structural immune disorder than hormonal. Depending on the age of the patient, usually if we can optimize the gut microbiome in the immune system, the hormones- We want them to be in balance for the whole system. 

We have started having interesting conversations about endometriosis and perimenopause and menopause. The original thought was absolutely avoid giving these women hormone therapies. But there should be an individualized conversation around using hormone therapies if women have significant menopausal symptoms because they’re not always going to exacerbate the endometriosis. Even if they do, there is a cost benefit analysis of that. As you and I know, we do things like support the liver, support the gut microbiome, support bowel function, support the detox pathways. It’s not necessarily problematic to the endo. 

It’s not 100% of the time that estrogen suppression or even support of estrogen metabolism will help with endometriosis. It’s about 25% of the time. Same thing with adding hormones. Sometimes, that’s appropriate; sometimes, it will really exacerbate the symptoms. 

Unfortunately, there is no quick test for that. If any given person’s lesions have that histology is after taking the lesions out, after surgery and doing histology on them, but by then, it doesn’t matter because the lesions are out. We have to do this from a trial and error perspective. 

Dr. Eric: 

That’s interesting. You said 25% involves progesterone upregulation. In those cases, at least in some of those cases, giving progesterone might actually exacerbate. Like you said, if you’re taking a whole body approach, if someone is only given progesterone, maybe that might be problematic. If you give them progesterone and are doing other things like supporting the liver and the gut microbiome, then maybe not. 

I’m sure you’re familiar with the DUTCH test. A few years ago, with the different metabolites, I recall during one of their lectures, they were saying that endometriosis is commonly characterized by elevated 16 hydroxy metabolites. Based on what you said, maybe in some people, that’s a pattern. If someone has perfectly normal metabolites, or if they have elevated 4 hydroxy, and their 16 hydroxy looks fine, you can’t use that to rule out endometriosis. 

Dr. Jessica: 

Absolutely not. It’s not a diagnostic test. I would say I see both. Sometimes, I see people with perfectly normal estrogen metabolism. I actually would say that I more commonly see 4 hydroxy estrogen because it’s an inflammatory condition. Both of those, elevated 16 or elevated 4 could be problematic.

For me, looking at a DUTCH test in women with endometriosis, the most important and first thing I will look at is the cortisol curve. It’s very difficult to help them heal in an environment of autonomic dysregulation. Optimizing nervous system regulation really helps with everything else. 

We do know that some particularly anti-inflammatory, antioxidant supplements, things like quercetin and resveratrol and curcumin in the right people can be very helpful. In many women with endometriosis, especially those who have significant pain with their condition. Not everyone does. Some people have very silent endometriosis until they struggle with fertility or until they hit perimenopause or menopause. Different things can trigger the disease in different people. 

For me, I think more about the immune system than the hormone system. Thinking about how all of these systems interact, the nervous system, the immune system, digestive function, then the gut microbiome. 

Dr. Eric: 

You said silent endometriosis, so you can’t just go by symptoms. When it comes to symptoms, you mentioned SIBO, like GI symptoms, bloating, gas, pretty common. Pelvic pain. Would you say those are the two most common symptoms, the pelvic pain and GI symptoms? 

Dr. Jessica: 

Yeah. GI symptoms, pelvic pain, menstrual pain. If a period is taking a woman or girl out of work or sports, if you have to be in bed one day a month, that’s a big red flag. If you need pain medication every single month, that’s a big red flag. 

It’s genetic. If a person’s mother struggled with endometriosis or infertility or pelvic pain or menstrual pain, a lot of times, the older generation of women weren’t appropriately diagnosed, especially if they were able to have children. Look for those red flags of women in the family either not being able to have children or having really painful periods. 

That is where it can become a bit of a gaslighting situation. You have a nine-year-old girl who has really painful periods. Every woman in her family is like, “This is just how it is for us. It’s fine. You’ll be fine.” Painful periods. 

Painful sex. Especially pain with deep penetration. It’s common that’s deeper in the cervix and the connection posteriorly by the rectum. That’s a very common place for endometriosis to grow. Painful sex with penetrative sex is a big red flag. 

Also, with the menstrual pain, it’s beyond pain. It can also be diaphoresis, like sweating, dizziness. POTS or any kind of dysautonomia is common with endometriosis. 

There are two sets of what we call terrible triplets, common comorbidities in endometriosis. One set is bladder pain, so endometriosis with painful bladder symptoms. It’s not just pain, it could be urgency, frequency, things like that. It is common for endometriosis to grow on or around the bladder. Then vulvodynia, so pain at the very opening of the vulva. That is one set.

The other set is endometriosis with mast cell activation syndrome (MCAS), so a lot of histamine issues, redness, heat, feeling allergic to everything. Can’t tolerate a lot of foods. Hives is really common. Plus dysautonomia, which might mean you have been dizzy your whole life. You’re a person who can’t skip breakfast, or you’re feeling like you’re about to pass out. Purely diagnosed POTS or another form of dysautonomia. Hypermobility. If you’re double jointed or you went into dance or gymnastics because you’re very flexible, that’s a big red flag for that kind of constellation of presentations. MCAS or histamine issues, dysautonomia, and hypermobility. 

Dr. Eric: 

Sounds like it could be pretty complex, which falls into your bio, dealing with complex conditions. It’s not just endometriosis itself, but MCAS is pretty complex. 

Dr. Jessica: 

Most people with endometriosis have a lot of these things, not just painful periods. 

Dr. Eric: 

It’s not a two- or three-month process as far as getting their health back. Some of these people might take in excess of a year to get their life back? 

Dr. Jessica: 

Yeah, I would say in an ideal situation, we have about three months to get the body strengthened in terms of nervous system regulation, good digestive function, calm some of the inflammation, balance the immune system. 

Then they would have skilled excision surgery, with someone who specializes in endometriosis and is just really skilled at finding those lesions and cutting them out from the root robotically. Then it’s about a six-week to six-month acute recovery from the surgery and about 6-24 months for full recovery back to all activities, no more fatigue, much less pain, fertility more optimized. 

There is a window of opportunity post-op where the immune system is more balanced from an autoimmune standpoint, where fertility improves significantly. There are these windows of opportunity, depending on what the person’s goal is. Are they experiencing pain? Are they experiencing fertility issues? Are they most stressed by their digestive problems? What are their key problem areas? Then we can set up a plan that helps prepare for and recover from surgery.

Now, not everyone has to have surgery or chooses to have surgery. It is an elective surgery. The vast majority of the time, endometriosis is not life-threatening. There are some rare cases where it is, such as when it’s growing on the lung or things like that. The vast majority of the time, it’s not life-threatening, but it is dramatically quality of life-threatening, as you can imagine. 

When possible, at least having an assessment by a skilled endometriosis excision surgeon is a good part of the healing experience. Not everyone has to or chooses to have surgery. It depends on a lot of factors. 

Dr. Eric: 

Okay. Let’s say someone does choose to go through the surgery. You mentioned the first three months, you’re doing things to support the body, the gut microbiome, the autonomic nervous system. Trying to do things to optimize their health. If you do that, and then they get the surgery after that, you’re still doing things to optimize their health. 

I think you said it’s six months post-recovery. Is there still a risk of the lesions coming back? It does depend on the skill of the practitioner, which is why you said you want to make sure they choose someone who knows what they’re doing.  

Dr. Jessica: 

Yeah, it depends a lot on the surgeon. Even the best surgeons will tell you that sometimes, the lesions come back. Either they missed something, or something grew back. It’s hard to say.

I’ll say that surgical techniques have dramatically improved. When I was first doing this back in the early 2000s, it was very common for people to have 16-20 surgeries, almost a surgery every year for their entire child-bearing years. Now, I would say that the majority of people have 1-2 surgeries max in a lifetime. Sometimes, three, depending on the complexity of the recovery or if there were multiple organ systems involved, or if a general surgeon needed to be called in. It’s much more common to only need one good surgery in a lifetime. 

Depending on where a person lives, that can be challenging to access. In the United States, almost all of the surgeries are out of network. There is not good billing support. Because of how complicated these surgeries are, it’s very difficult to get them covered by insurance. In the United States, they can be very expensive. 

Outside of the United States, there can be long delays to accessing them. In Canada or the UK, where there is socialized medicine. There are challenges with surgery no matter which country you’re living in. 

It’s still worth trying to hold out for a skilled surgeon because another non-skilled surgeon can set you up for needing more surgeries. 

Dr. Eric: 

Makes sense. Even if someone has to wait a little longer to see a skilled surgeon, it’s probably better because seeing one that is not as skilled, maybe you’ll get some relief, but there is a greater likelihood that you’ll need multiple surgeries. With a skilled surgeon, still no guarantee that you won’t need another surgery, but less likelihood that you will. Makes sense. 

I know you said a lot of these women have autonomic nervous system dysregulation. MCAS, hypermobility. I assume some don’t have all that going on. It’s still not a simple case of endometriosis. I guess, if they’re not having the autonomic dysregulation and MCAS, is it not as long of a journey in most cases? Is it still something where you can expect a similar process? I guess the process would be similar, but the duration. 

Dr. Jessica: 

Yeah, the recovery would be easier. It’s interesting: I was just talking on my podcast to one of the top endo surgeons. Her episode is coming out in July or August of this year [2024]. We both noticed, since almost everyone has been infected with COVID at this point, almost everyone I’ve talked to, if not everyone, with endometriosis in the last four years post-COVID infection do have all three of those things as well. 

It may be that we are dealing with a new environment now where there is a large pathogen overload. I’m not sure what we’re dealing with now when it comes to endometriosis, but I have very rarely met a simple case in the last few years. 

Now, that also could be because the work that I do is pretty specialized. Same with her. We often see the most complicated of cases. It is hard to say. 

If I was working in a hospital based pelvic rehab practice, there may be occasions where we find a “simpler” case of endometriosis. Let’s say there are very visible lesions. They’re in the common places. A person has a skilled surgeon. They’re eating an anti-inflammatory diet. They’re doing a lot of stress management. They already have a healthy heart rate variability. They exercise. Their cycles become more regulated. Maybe they’re younger, they’re only in their 20s or early 30s. 

Absolutely, we can see a more simple, complete recovery, which could look like six months or so, just with some pelvic floor downregulation. If that person is already doing a lot to take care of their gut microbiome and balance their immune system, and they’re already a meditator or something like that, then yes, there is a wide range of complexity. 

As I said, there are people who do have silent endometriosis who don’t even know they have it until they struggle with fertility. There absolutely could be people with no symptoms of endometriosis who maybe aren’t interested in having children. You can have the genetic predisposition and also not express endometriosis. 

I had a patient in my practice last year who had an identical twin sister who did not have endometriosis. There is certainly a wide range of expression for sure.  

Dr. Eric: 

Similar with autoimmune conditions. You could have identical twins, one who has Hashimoto’s or another autoimmune condition, and the other twin is perfectly fine. Environment does play a big role.

For someone who chooses not to get the surgery, what other options do they usually look into? Could things like visceral manipulation help? It won’t get rid of the lesions completely, but maybe to get some relief. I imagine some people try acupuncture. 

Dr. Jessica: 

There are some nutrients to stabilize the lesions. Quercetin is helpful. Some of the other anti-inflammatories. 

Doing a nutrient program to support gut microbiome and immune health and lower inflammation in combination with pelvic floor physical therapy, which does have really strong evidence to support its effectiveness for quality of life and pain management. Pelvic floor physical therapy, including visceral mobilization, including things like cardiosacral, which is helpful for nervous system regulation, all of that can manage, and in some cases, people don’t need surgery. I have seen that happen in some cases.

In other cases, their symptoms are managed enough that they choose not to have surgery. I had a patient probably eight or nine years ago who was about to have surgery. She decided she wanted to try to get pregnant first, which there is a cost benefit to getting pregnant pre- or post-surgery. She decided she wanted to try to get pregnant. She did get pregnant, and her symptoms were quieted. Sometimes, pregnancy, because of its impact on the immune system, can reduce the symptoms a bit temporarily. 

She was pregnant. She nursed. She had that one child. She chose not to have any more children. She was going to have the surgery after that, but she felt, given everything she had done to get herself healthy, optimize her fertility, optimize her gut health, she did have some symptoms, but they felt manageable enough to her that she chose not to have the surgery. She had the one child that she wanted. Her quality of life was okay. She just continued to really take care of her health, and she was fine without surgery. 

That may change in the future, but at this point, this is what her decision was. It worked well for her. 

Dr. Eric: 

That’s awesome. One of the questions I was going to ask is since most of the listeners have a thyroid or autoimmune thyroid condition, the relationship between endometriosis and thyroid health and thyroid autoimmunity. 

You earlier mentioned Hashimoto’s being more common in those. That’s one potential relationship. Another one I could think about is gut issues are common. Part of that triad of autoimmunity is that increase in intestinal permeability, which SIBO can potentially lead to. That could potentially be a link between autoimmune conditions. I don’t know if you know any other relationships. 

Dr. Jessica: 

I agree with you. Commonly, autoimmune diseases tend to copresent. Endometriosis in many people does have autoimmune factors, things like elevated ANA in some people. Those are the kinds of markers we can measure declining post-surgery. I agree with what you’re saying. Some of these risk factors for both could contribute to people having both at the same time. 

The other thing I would look at is what is their HPA axis? How much neuroinflammation are we dealing with? If they’re under either emotional stress, because it’s very stressful to live in chronic pain. In fact, we’re hosting a viewing of a new movie called Below the Belt, which is about people with endometriosis trying to navigate the healthcare system. You do the same kind of thing. Complex chronic illness, navigating the healthcare system is horrible. That in and of itself is very stressful, which can then impact the thyroid because you have the HPA axis out of whack. 

You have the brain, where the HPT axis originates. Anything that causes neuroinflammation or emotional stress, which is a condition where at any moment, you can be in really intense pain, that is very stressful, especially when you go to the emergency room, and they say you’re fine or a drug seeker or whatever. That can certainly contribute to thyroid issues, just dealing with low grade or high grade chronic stress for 12 years. 

Dr. Eric: 

I see that in a lot of patients with dysregulation of the HPA axis. A good point about the neuroinflammation as well.

You covered a lot of information. Anything that I should have asked you that I didn’t ask you? Do you want to summarize anything before we wrap up? 

Dr. Jessica: 

I would say that if someone is struggling with pelvic pain, even if it’s not cyclical, even if it doesn’t seem to be related to your estrogen, especially if you also have digestive issues, because about 90% of people with endometriosis have some kind of digestive issue ask about it, it’s hard to be diagnosed because it’s such a vague condition and has a surgical diagnosis. Especially if there are any genetic clues, it’s something to start looking at. 

Dr. Eric: 

Wonderful. Dr. Jessica, where can people find out more about you? 

Dr. Jessica: 

Our website is IntegrativeWomensHealthInstitute.com. We also have the Integrative Women’s Health podcast. Our Instagram is @IntegrativeWomensHealth. We share a lot of information about endometriosis, perimenopause, menopause, and other women’s health conditions. You can find more about that there. 

Dr. Eric: 

Thank you so much. I’m sure everyone learned a lot. I definitely learned some new things related to endometriosis. Appreciate everything you shared. 

Dr. Jessica: 

Thanks so much for having me. I appreciate it.