Recently, I interviewed Dr. Heather Finley,  who explains why low stomach acid, sluggish bile flow, and post-food poisoning symptoms are often red flags in thyroid cases. She shares how conventional approaches miss the deeper causes behind SIBO, constipation, and nutrient deficiencies and how gut issues can slow thyroid hormone conversion. We also touch on practical tools like stool testing, mineral analysis, and even burp tests that offer insight when standard labs fall short. If you would prefer to listen to the interview you can access it by Clicking Here.

Dr. Eric Osansky:  

Let’s start out with a little bit more of your background. How did you start focusing on helping people with different types of gut issues? 

Dr. Heather: 

I always tell people, as sad as it sounds, I was born constipated. That sounds really dramatic. To be honest, I really don’t remember a time in my life where I didn’t have stomach pain or GI issues. I thought that it was normal until I realized in my teen years that not everybody has stomachaches every time they ate. Not everybody went a week without a bowel movement. It got me very curious about nutrition and health and so many things. 

I was also an athlete, a swimmer. I decided to go to college to study nutrition. Selfishly, I thought I was going to college to study nutrition from a sports nutrition perspective, thinking, I am swimming in college. What do I need to eat to swim as fast as possible? Maybe I can fix my gut issues in the meantime.

The reality is I ended up graduating college worse than I ever felt. I was so bloated, so constipated, having horrible GI issues, and felt like a complete impostor. I thought, maybe I am not getting something. Maybe I am in the wrong career. I don’t know what I need to do. I thought, how am I going to help other people if I can’t help myself? 

I started my first job as a dietician in the clinical setting in the hospital. Throughout that time, that furthered that belief of maybe I chose the wrong career, which just kept getting stronger. I am definitely in the wrong place. 

That’s around the time that my dad got really sick from colon cancer. Unfortunately, he ended up passing. That’s where the Hashimoto’s and hyperthyroidism came into play. This is where I started seeking out alternative methods for health after he passed. 

I believe there is a very strong grief and stress component to my thyroid diagnosis. My hair started falling out. My face was super puffy. I was so tired. I was falling asleep while talking to people. I could barely function. 

I remember going to my PCP and telling her something was wrong. “I do not feel well. Can we run a thyroid panel?” and basically being told, “You’re not overweight, so you don’t have thyroid issues. You’re probably just depressed, so you should take an antidepressant and go to therapy. You’re just grieving the loss of your dad.” I went to another provider and was told the same thing. 

I finally ended up at this other doctor’s office. They ran a thyroid panel. Not only did I have hypothyroidism, but I had Hashimoto’s pretty severely. My antibodies were super high. For the first time, I felt completely validated. There is something wrong. 

They were doing a little bit more of alternative stuff. They recommended supplements. That was the first time someone had recommended something besides MiraLAX. That opened my eyes to this other world. 

Ended up going back to school to get my doctorate in clinical nutrition with the goal of healing myself. It was more of an integrative program. That’s really where I learned to put the pieces together and realize that it’s all connected. Your thyroid, gut health, healing, energy, everything. I made myself my own case study and started integrating stuff with patients I was seeing. Here we are. It’s been quite the journey. 

Dr. Eric:

Sounds like it. I would say it’s hard to believe you went to two doctors who refused to do a thyroid panel, but I’ve heard that story before. People go to multiple doctors who are not considering thyroid. Sure enough, they eventually find someone who is willing to do a thyroid panel. In your case, the antibodies. Like you said, you were diagnosed with not just hyperthyroidism but Hashimoto’s. 

Going by the lack of some classic symptoms, they can’t tell how someone feels, but they look at you and say, “You’re not gaining weight.” When I dealt with chronic Lyme, I wasn’t having the classic Lyme symptoms, so the doctor wanted to refer me to a neurologist. I ended up seeing a functional medicine practitioner and got diagnosed with chronic Lyme. It happens with all types of conditions.

You mentioned the impact of stress and grief. Do you see that in a lot of the clients you work with as well, that relationship between stress and thyroid and the gut? 

Dr. Heather: 

We see it all the time. You can’t isolate these symptoms. I think people often shut down when you tell them stress is one of the reasons you’re having symptoms. 

The way I like to explain it to clients is stress is not just stress about your job or even a family situation. There are so many other things that cause stress on your body, including having imbalances in your gut; being overtrained, which I for sure was overtrained. I was running way too much. I was training for triathlons. I was overtrained and undereating. I wasn’t sleeping enough. All of those things, we always refer to it with our clients as a stress bucket. My stress bucket was overflowing, and I didn’t have any inputs that were decreasing stress on my body. 

It’s easy to think, if stress is causing my issues, I will never get better, without realizing there are a lot of things we can remove or improve in our lives to manage stress. Sleeping more, hydrating, eating enough, getting enough rest, doing things that are fun and having joy and pleasure in your life. It doesn’t always have to be meditation, like a lot of people think, or something that is unachievable or unsustainable. There is this huge stress component and not often in the way people think. 

Dr. Eric: 

Definitely agree with overtraining. That describes me as well prior to my Graves’ diagnosis: overtraining and doing some extreme dieting. You’re right, it’s not just emotional stressors but physical stressors we need to consider.

Since we’re going to be talking a lot about the gut, in your opinion, is it possible to heal Hashimoto’s without having a healthy gut? 

Dr. Heather: 

I don’t think so. At least I haven’t seen that. It’s so connected, as you know, as you talk about so well on your podcast. You have so many episodes on that that I’ve listened to in the past. 

It’s all connected. Everything in the body. One of the main ways that our body converts thyroid hormone is in the gut. You can’t isolate these things. We often see that it’s really bidirectional. Our clients who have undiagnosed issues, they stall when they’re working on their gut if they don’t realize they have thyroid issues, and they think the opposite is also true from a thyroid perspective. If you have a big gut infection, or if you have an absorption issue and can’t absorb nutrients from your food, it will be really hard to get to the other side. I even saw that with myself, too. 

Dr. Eric: 

You also have a quiz, which I checked out, “Why Am I Bloated?” The very first question you ask is have you ever had a food poisoning event? I wanted to talk about this. We haven’t spoken about food poisoning. A lot of people overlook this. Maybe it happened years ago, and they forgot. Maybe they just really didn’t think about it. There is a reason why this is the first question that you ask. If you could explain why you asked this question at all, let alone it being the first question on your quiz. 

Dr. Heather: 

There is this huge bucket that I’m sure many of your listeners have heard of before. It’s called IBS, irritable bowel syndrome. If you have ever gone to the doctor and told them you’re bloated, constipated, or having diarrhea, perhaps they have run some testing. Maybe they have done a colonoscopy or endoscopy or whatever, and everything has come back “normal.” They will lump you into this bucket of having IBS. It’s this bucket of, “We don’t know what’s wrong with you, but your bowels are irritable for whatever reason.” 

One of the most common triggers of IBS is food poisoning. Same with SIBO. What happens when someone has food poisoning is it damages the nerves of the migrating motor complex (MMC). Your MMC is like this after office hours cleanup crew. After you have left the office for the day, it’s the crew that comes in and takes out the trash and vacuums the floor, etc. 

That’s what it does in your gut. It sweeps things through to clean things out. You don’t want food or things sitting in your gut and fermenting and overgrowing and producing gases like methane gas and hydrogen gas. If you have had a history of food poisoning, especially if you have had a history of food poisoning that you can really identify. 

There is this one client that sticks out in my mind, and it’s relevant to when we’re recording this podcast, around July 4. She said, “I know what happened. I went to a July 4 BBQ, and I ate watermelon. It was bad. I have never felt the same way since.” A lot of people have that story.

People perhaps have had food poisoning, and they don’t remember. Maybe it was really mild. Either way, what happens is it damages the nerves of the MMC, which affects your motility, which is the movement of food and waste through your bowels and the body’s ability to clear stuff out. Things sit and ferment and slow down. It affects the whole process. Food poisoning is a very important thing to know about related to someone’s history. 

Dr. Eric: 

If someone’s digestive symptoms began after a food poisoning event, then that is definitely something they need to pay attention to. If they are having those bloating and gas symptoms that are so common with IBS and SIBO. When you do your health history, and you ask that question, “I never even thought about that. 11 years ago, I got food poisoning. Ever since then, I didn’t think about it until you asked that question.” Do you have that happen sometimes? 

Dr. Heather: 

Totally. We’ll have people say, “Oh, that reminds me. I traveled abroad, and I got really sick. Then I thought I was okay. You’re right. I haven’t been the same since.” Sometimes, they haven’t connected it yet. It triggers this process of- 

For us, knowing someone’s health history and timeline is really important because oftentimes, there is a triggering event like food poisoning or a really stressful period in their life, etc. It really is a domino effect for a lot of people over time. Maybe that was the straw that broke the camel’s back. What made your gut so vulnerable to that food poisoning? Not everybody that gets food poisoning ends up with really severe gut issues. We want to understand what happened before and after that as well that set you up for being susceptible to that, too. 

Dr. Eric: 

If someone tells you that their symptoms started after a food poisoning event, does that change your approach? Are you more likely to recommend a SIBO breath test? What would be some of the next steps? Do you do comprehensive stool testing on everybody? I’ll let you take over and chat about that. 

Dr. Heather: 

There are several things we can do and look at. I think it depends on somebody’s symptoms. A SIBO breath test could be helpful if their symptoms are looking like SIBO. 

Honestly, I prefer a comprehensive stool test, like you mentioned. It will look a lot more at the why. It’s one thing to know if you have SIBO, and that can be important. It’s part of the picture. We will still be asking the question of how these bacteria get in your small intestine when they are not supposed to be there. Is it a digestive insufficiency? Is it a motility issue? 

If someone says, “I don’t go to the bathroom every day,” or “I go to the bathroom, but it never feels like enough,” or “I am constipated for 3-4 days, and then I have diarrhea,” so they have overflow diarrhea, like a lot of our clients. A comprehensive stool test can be really helpful.

Even lion’s mane mushrooms can be really helpful for repairing the nerves. There are other probiotics and things you can do, but we love recommending things that are going to help turn everything back on. 

Dr. Eric: 

Let’s talk about constipation. You mentioned you were born with it. Did you take a lot of antibiotics when you were younger? I know I did. I would go twice a week in my teens and 20s. I don’t know if it was the antibiotics, but I took them pretty regularly when I was younger. You’re nodding your head, so it sounds like that was the case with you as well. 

Dr. Heather: 

I was a child of the ‘80s and ‘90s where antibiotics were common practice. You get a mild ear infection, and here they are. I took a lot of antibiotics as a kid. I’m sure that did not help. That’s a big trigger for a lot of people, especially in the little years, where your gut is so vulnerable. 

One thing I probably have never shared publicly. I have three kids. One of my goals with my children- Obviously, if they needed antibiotics, and it was life-threatening, I would give them to them. One of my goals was trying to get to age two without antibiotics. So far, two out of three were there. My other one Is not quite two yet; she is only seven months. It’s amazing to see. 

My kids are super healthy. They rarely ever get sick. It’s incredible to see what fostering a healthy microbiome can do. It’s nobody’s fault. There was a lack of knowledge at the time. People didn’t know what the gut microbiome was when I was still a kid. The science is still really new, which is wild to think about. 

Dr. Eric: 

I agree. That’s a good goal for children. Adults, too, to minimize antibiotics. If they need it, I agree, but unfortunately, a lot of children, including myself, and it sounds like you as well, it’s very common. Many times, we took the antibiotics when we didn’t need them. 

What are some other factors? Low thyroid can cause problems with motility. SIBO, we mentioned. Are those some of the more common things you see in your practice? If there is anything else you’d like to mention when it comes to constipation. 

Dr. Heather: 

I would say there is a handful of things we commonly see, food poisoning being one of them. Definitely thyroid issues. We see tons of undiagnosed thyroid issues. It’s often a huge hurdle for our clients. 

They end up getting the right testing. We can run testing, but I can’t prescribe thyroid meds. It’s finding a provider we can work with there, or figuring out how we can do it from more holistic approaches as well for some people. The slower your thyroid, the slower your gut will be.

Another thing we see contributing to motility is stress. When you’re stressed, your body is not worried about clearing your bowels. You can see the opposite. You can have that gut-brain reaction of that dumping syndrome. Everybody probably has experienced that. You get nervous, and you start running to the bathroom. 

Chronic stress over time will slow the bowels because you are diverting blood flow away from the gut into your muscles because your body doesn’t know the difference between whatever stressor and actually being chased by a bear. 

Another thing that we see contributing to slow motility is upper GI related stuff. Low stomach acid, low elastase or poor pancreatic output, and poor bile flow. You need to be able to break down your food, and you need stomach acid enzymes and bile to do that. 

If we are seeing a disconnect with how someone is actually breaking down their food, specifically with stomach acid, your stomach has to fill with acid in order to empty. We see people who have been on PPIs or are chronically stressed over time, taking things that have lowered their stomach acid. As a result, everything downstream with motility isn’t working either.

The last thing I’ll mention, which is very common, is mineral deficiencies. Minerals are like the spark plugs for energy for our body. We need minerals to turn the electricity back on. It’s kind of a catch-22. You need minerals to make stomach acid, and you need stomach acid to absorb minerals. You often have both that you need to address systematically. Things like sodium, potassium, magnesium will help draw water to the bowels, but potassium will help those bowel muscles contract. It’s finding the right combination of things for people as well. 

Dr. Eric: 

Sticking to the topic of low stomach acid. There is not a great test to look for stomach acid. Do you just assume that most of your patients have it? Do you do things like the butane HCl challenge? When it comes to determining if someone has low stomach acid, what approach do you take? 

Dr. Heather: 

I am not a huge fan of the butane HCl challenge because I don’t want to irritate an ulcer or something that’s there that we don’t know about. That is a strategy you can do. 

We prefer the baking soda test. You’re consuming a quarter teaspoon of baking soda in water and seeing if you burp. If you burp within three minutes, likely stomach acid is okay. If you burp within 3-5 minutes, would say you’re halfway past. If you don’t burp, which is very common for our clients, likely you failed. 

We can also look at testing, too. We have some clients who are not doing that. The results were inconclusive. Obviously, it’s not a clinical test. It’s just an experiment. It’s something cheap and easy you could do at home.

Some things we look for on testing would be on a stool test, if we see really high fat in the stool, so if steatocrit is fine, that could possibly indicate stomach acid. If we see pancreatic elastase as low, that can possibly indicate stomach acid as well. 

On a hair mineral test, one thing we often see related to stomach acid is low sodium as well as cobalt being off. That can indicate perhaps some digestive insufficiencies. We can look at the baking soda test and also just look at symptoms. Does it feel like food is sitting in your stomach like a brick? Are you bloated 1-2 hours after eating? Do you have undigested food in your stool? Are your stools greasy, incomplete, etc.? Usually we are pulling from all of that and trying to figure out if someone could benefit from bitters or some kind of digestive support like butane. 

The most obvious thing on testing that I didn’t mention would be H-pylori. It’s the most common infection in the world, and it lowers stomach acid. If someone has H-pylori that’s really high, likely there is some issue there, so we want to address it. 

Dr. Eric: 

Also, they could go through your quiz. You ask some questions to point them in the direction to see if they have low stomach acid. You mentioned one of the questions when going through your quiz is greasy stools as well. You mentioned low stomach acid. Could that also be a sign? If you have greasy stools that stick to the toilet, also problems with bile flow? 

Dr. Heather: 

We do see that a lot in our thyroid patients. The gallbladder and the thyroid, you need bile to absorb fat soluble vitamins. We know that even Vitamin D is very important for the thyroid, so those two things can be connected. 

Greasy and sticky stool often indicate perhaps low stomach acid, but also does somebody have a gallbladder? Are they actually creating enough bile and surging enough bile? Is their bile flow stagnant and more sticky, sludgy bile? Do we need something to help improve that? They often go together. 

Dr. Eric: 

I would imagine you agree that there are too many gallbladder surgeries these days. Not to say there is not a time and place for them, but way too many people get their gallbladder removed. 

Dr. Heather: 

So many. I was even talking to someone today who told them they had a couple gallstones, so they took their gallbladder out 6-7 years ago. Now they are having recurrent SIBO and upper GI pain. I wish that wasn’t the case because I hear that all the time. We see a lot of clients a couple years after gallbladder removal that now have other GI issues. 

I always tell my students in my practitioner course that bile is the MVP of digestion. Without bile, nothing else works. It is an antimicrobial. It helps coat the lining of the small intestine to prevent bacteria from growing there. We need bile. We really need healthy gallbladders for that. 

Dr. Eric: 

I am bringing up this conversation because I also had coincidentally- Yesterday, my wife was asking me questions about the gallbladder. It turns out she knows someone whose 15-year-old daughter scheduled today, as we speak, so she already got the gallbladder surgery probably. 

I told her the gallbladder is not usually the problem. It’s usually a bile metabolism problem that could be affected by diet, oral contraceptives. I hate to see anybody, let alone someone that young, who for all I know, maybe they did see a holistic doctor, but my guess is they didn’t. They were developing gallstones. It’s a very young age to experience that. 

500,000 gallbladder surgeries in the United States a year, something like that. Some of those need to be done, but a lot of those could have been prevented. They often need to be done because they get to the point where it becomes an emergency situation. If the person was more aware of some of the factors that cause the bile metabolism problem- That’s why we’re having this conversation, to try to prevent people from, if at all possible, which many times it is, getting their gallbladder removed.

What are some other common gut issues that you see in your practice? Actually, before you answer that question, what are your thoughts on parasites? There are a lot of different perspectives with parasites. Some people treat everybody for parasites. Some people just do stool testing. I know you said you did stool testing, maybe not specifically for parasites. Maybe some people will see if the stool test come back positive for parasites, and they treat it. if it’s not positive, they won’t treat it. I want your perspective here. 

Dr. Heather: 

There is so much controversy over parasites. It’s interesting, especially on the online Instagram world we live in. You see some crazy stuff online.

We definitely have clients who have parasites. We see it on testing. I definitely don’t treat everybody for parasites. That being said, we have put clients on protocols for other things. They have paths of what look like parasites. 

Parasites are a normal part of our environment. Not all of them are necessarily going to cause tons of issues. Do you want to have a ton of parasites in your gut? No, absolutely not. It can be very easy to get terrified on the internet about parasites. Sometimes, when you see people posting about parasite cleanses and showing pictures, not everything they’re posting is an actual parasite although it might look like that. 

Yes, people do have parasites but not probably as much as the internet makes you think. Maybe that’s not as much of a problem as the internet makes you think. 

Dr. Eric: 

I would agree. It sounds like we’re on the same page. Not treating everybody randomly for parasites. In some people, they can be an issue. 

Dr. Heather: 

Totally. 

Dr. Eric: 

I’m sure you see a lot of things, but anything common in your practice as far as gut-related issues? 

Dr. Heather: 

One thing that I think is really important to mention, especially with the thyroid, is we actually see a lot of depleted gut microbiomes. Whether you have done stool testing before or not, for somebody listening to this, it’s very easy to go into a stool test, thinking, what bad bacteria is going to be on my test? I need to kill off all this bacteria in my gut, which certainly can be the case if you have SIBO or something else. 

A lot of times, we see clients where it’s really not an issue of too many “bad bacteria.” It’s actually an issue of lack of diversity in your gut, lack of resilience of your gut, a low gut immune system. The marker for that is secretory IgA. 

We see clients who have done so many elimination diets, so many gut protocols. As a result, their secretory IgA, which is like your gut’s bodyguard. It helps prevent things from residing in your gut that shouldn’t. It helps keep your immune system healthy and strong. That is super depleted, so that is why people are having so many food sensitivities and reactions. The lower your IgA typically, the more food reactions you have.

Part of that picture is there are keystone bacteria, like Bifida bacterium, Akkermansia. These are all keystone bacteria that are so depleted. Our gut has zero resilience. It’s easy to think that bad bacteria are to blame, or SIBO is to blame. The reality is that the gut needs some love. It needs some prebiotic fiber. It needs some good probiotics that will reside in the gut. It needs some production of short-chain fatty acids. It needs that to help reduce inflammation. 

If someone has Hashimoto’s and has antibodies, one of the best things you can do from a gut perspective is help feed good gut bacteria in your gut. When your good gut bacteria have food, they produce short-chain fatty acids. Those are anti-inflammatory to your body, your brain, your gut. It’s overall going to reduce inflammation; therefore, indirectly improving the antibody picture that you see. 

Dr. Eric: 

I like that, the gut’s bodyguard. I haven’t heard that before. Secretory IgA, I see a lot of people with depressed secretory IgA. Want to get that to healthy levels. 

Getting back to the thyroid. What testing do you recommend? It sounds like you recommend the antibodies. Can you get specific? What antibodies do you look at? Reverse T3? 

Dr. Heather: 

We have a variety of people who come to us. Some with thyroid testing and some without. I really like to look at the whole picture, so I want to see antibodies, free T3, reverse T3. One of the common things that we see is low free T3. Is that something that you see in your practice? 

Dr. Eric: 

I work with Hashimoto’s, but I do see more people with Graves’. Obviously, the people with Graves’ usually have the opposite problem, elevated free T3. I do see a lot of people when their thyroid is so-called normal, where the TSH is within the lab range, which doesn’t always mean it is within optimal range, but T4 will also be looking okay. T3 is low. Maybe that person has a conversion issue. I’m not sure if that’s what you’re getting at.

When I don’t see a hyper patient with elevated thyroid hormones, it is common to see that T3 on the lower side. Many times, I’m sure you see this, too, where it’s within the lab range, but it’s not within that optimal range. That free T3 might be 2.3, which would be within most lab ranges, but lower than what we want to see. 

Dr. Heather: 

Yeah. Their TSH is normal. We have a client like this right now. Her TSH is actually lower than it should be because she is overmedicated. Her free T3 is still so low. There is definitely a conversion issue, where her free T3 is 2.3, like you said. As a result, she is super bloated; her bowels aren’t moving; her motility is definitely an issue; and she still has a lot of the symptoms of hypothyroidism because the conversion is not there. There is definitely some gut stuff going on, some stress-related stuff going on, some nervous stuff, mineral stuff, all the things. 

To answer the question, I got on a little bit of a tangent. Yes, a full thyroid panel, antibodies, free T3. Really helpful.

We also like to look at iron labs. Ferritin, iron. We do see a lot of low ferritin, whether that’s from the gut or something else.

Correlated with that, I love to do HTMA, hair mineral testing, because it helps inform the pieces of the thyroid issue, some of the pieces of the iron issue, and of course stool testing. 

Dr. Eric: 

Can you talk more about hair testing? That’s another controversial test. I do like hair testing, so I’m definitely in favor of it. There are some functional medicine practitioners who would dismiss it and say hair tests aren’t reliable. Why do you do hair testing on your clients? 

Dr. Heather: 

Honestly, I love stool testing, but my favorite test we do is hair testing. I have seen it change the game so quickly for so many people. 

Minerals are foundational to every metabolic practice in the body. Like I was saying earlier, we see a lot of clients who are so depleted. They have done everything by the book, except for the fact that their minerals are so depleted, so their body doesn’t have the manpower to do what it needs to do, from the thyroid perspective, from an energy perspective, metabolism, all the things. 

Hair testing is controversial. One of the biggest things you have to look for is a lab that doesn’t chemically wash the hair because that will alter the results. We use Trace Elements for hair testing. That is the only lab that I’ll use. It’s based here in Dallas/Ft. Worth, where I am. 

There are tons of research supporting hair testing. You just have to look for it. 

The reason I like it is because it’s a window into your last three months of mineral status. It’s a little different than blood testing. Your blood test will look at what your magnesium looks like right now in this moment in time. Your body will always push minerals to your blood to keep things “normal.” If you have minerals off in your blood, likely there is a very serious issue. If your potassium is really high or really low, you’re probably in the ER with some serious problems. 

The hair testing can help us predict and prevent patterns before they ever happen in the blood because your body will store minerals in your tissues, including your hair tissue. We can see patterns. 

The most important thing about mineral testing is you will look more at how the minerals are all interacting with each other versus one mineral itself. 

Seeing that magnesium is high or low isn’t as helpful as seeing, “Oh wow, your magnesium is in a loss pattern, but your boron is really low. That’s why you’re not absorbing the magnesium,” or “You are having to use so much magnesium to have a bowel movement because you’re constipated. Probably your sodium is really low, and your potassium is really low.” It can help you understand the clinical picture a lot better. 

Dr. Eric: 

I’m on board with hair testing. We have had a few others talk about hair testing. 

We jumped around and covered a lot of different things. Is there anything else related to the gut, the thyroid that I should have asked you? Anything else you want to say? 

Dr. Heather: 

I feel like we covered most of it. I’ll probably think of something right when we turn this episode off. 

Just to bring it all together, everything is connected: your gut issues, thyroid issues. Supporting your gut will support your thyroid and vice versa. Instead of isolating these pieces, it really is helpful to look at it all together. 

If you have bottomed out with your gut, and you haven’t explored your thyroid, that would be a really important piece. Vice versa as well. There can be a lot in your gut that can affect your thyroid, too. 

Dr. Eric: 

I do have one last question related to your health. As far as someone who deals with chronic constipation, what is a realistic timetable to get someone to the point where, if they’re only having a couple of bowel movements per week, they are having regular bowel movements? 

Dr. Heather: 

That’s so hard to answer. To be honest, sometimes I have clients who I think we are going to be in the long haul. This is going to take some time. And they see progress really quickly. The opposite, too. Sometimes I think this is super straightforward, and it’s just not. You start uncovering things.

I always tell people to expect about a month for every year they’ve had symptoms. I feel like that is not even the most helpful explanation. It can go so many different ways. The program I run is six months. The reason for that is because it does take time. Of course, there are people who see results a lot faster than that, and some people need longer. Doesn’t change overnight, especially when it’s related to chronic constipation. 

If there is a thyroid component, as you know, it can take a while to figure out the right cocktail of things that will work. It’s not always super straightforward. 

Just be gracious with yourself and the process if you’re on that journey. Trust your gut. That sounds really cheesy. If you feel like you’re missing something, get a second opinion or ask somebody. There probably is another piece there. 

Dr. Eric: 

How can people find out more about you, Dr. Heather? Tell them about your website and your podcast. 

Dr. Heather: 

Probably the easiest way to find me is on Instagram. You can look up my name, Dr. Heather Finley. My website is GutTogetherProgram.com. If you want to take the quiz, it takes you two minutes or less. You will get a short video after you get your results with some things you can do to improve whatever we determine is the cause of your bloating. Those are some good places to start. 

Dr. Eric: 

Sounds good. The quiz is 11 questions, and they’re pretty simple. It only took a couple of minutes to go through that. Check out Dr. Heather’s podcast as well. 

Thank you so much. This was really a great conversation. We covered a lot of different things related to both the gut and the thyroid as well as outside of those things, including hair testing, which does relate to the gut and the thyroid. Thank you so much, Dr. Heather. 

Dr. Heather: 

Thanks for having me.

In this episode, we’ll explore why that happens, the truth about remission, and the most common reasons relapses occur. I’ll share practical ways to calm symptoms naturally, when combining meds with herbs makes sense, and why addressing your immune system and not just your thyroid is essential for long-term stability. If you would prefer to listen to the interview you can access it by Clicking Here.

This episode is inspired by a message I received on Instagram. I’ll go ahead and read it and then respond.

It starts off by saying, “I have Graves’, and I just listened to you on The Root Cause Podcast,” someone else’s podcast. “It was so informative and helpful. There is so much out there about hypothyroidism and Hashimoto’s, but hardly I ever find any podcast or information on Graves’ and hyperthyroidism. It was awesome to gain some information. 

“I am diving deep now with a functional doctor on trying to stay off of methimazole and avoiding getting my thyroid taken out. I have managed before to be off of meds for over a year, and then it came back with a vengeance after I had my baby. Back on low-dose methimazole. Started taking Thyroid Calm, and it seems to help. I take it daily and skip some days with my meds. Eventually would like to be off for good.

“Also now working with a functional doctor on trying to see if there is any correlation with hyperthyroidism and high cholesterol. It’s always a deep dive.” 

Let’s start off by talking about Graves’ versus Hashimoto’s visibility. If you have been searching for answers about Graves’ or other types of hyperthyroid conditions, you probably have noticed there is no shortage on books, podcasts, articles on Hashimoto’s. When it comes to Graves’, there is not a lot of information out there, which is one of the big reasons why this podcast has a little bit more of a focus on hyperthyroidism and Graves’. A lot of the content also will benefit those with Hashimoto’s, but I don’t have a whole lot of episodes dedicated to Hashimoto’s. 

I do have a good amount of episodes dedicated to hyperthyroidism and Graves’ because out of all the thyroid-related podcasts out there, none of them that I have found have any episodes that focus on hyperthyroidism. The exception is those who have interviewed me, when I am on another podcast, talking about hyperthyroidism and Graves’. Other than that, typically, they are focusing mainly on hypothyroidism/Hashimoto’s. 

Why is that the case? There are a few reasons. One obvious reason is Hashimoto’s is a lot more common than Graves’. A lot more people have Hashimoto’s. In fact, I’m pretty sure that Hashimoto’s is the most common autoimmune condition, not just autoimmune thyroid condition. When it comes to Hashimoto’s versus Graves’, approximately eight times as many people are diagnosed with Hashimoto’s as with Graves’. 

I’m sure there are a lot more people who are undiagnosed with Hashimoto’s. You can be undiagnosed with Graves’ for a while, but it’s more common with Hashimoto’s. That’s one reason. 

The second is because most functional medicine practitioners have more experience with Hashimoto’s. That brings us back to the first point: There are a lot more people with Hashimoto’s. Even when I interview practitioners, it’s not uncommon for me to interview a practitioner who has their own Hashimoto’s journey. I have had a few with their own Graves’ journey. Even when the focus isn’t on thyroid health, when I’m talking about perimenopause or some other health condition, it is quite common for them to say, “I had Hashimoto’s.” It’s not as common with Graves’. 

Those are the two main reasons I would say that you see a lot more information related to hypothyroidism and Hashimoto’s, why Hashimoto’s content dominates. 

My goal not just with the podcast but with everything I do is to focus more on hyperthyroidism/Graves’. Even with the books. I have written two books that focus on hyperthyroidism.  I have a book on Hashimoto’s as well. That probably will be the only book that I write that is dedicated to Hashimoto’s. I might come out with books that focus on both. I am pretty sure I will come out with others that just focus on hyperthyroidism. I have other pieces of content, like articles and a Facebook group. I have a Facebook group dedicated to both, but I also have a much larger Facebook group that just focuses on hyperthyroidism. 

Let’s go ahead and get back to the message. That was one point that the person brought up on Instagram. Also, the person said that they managed to be off of medication, and it came back with a vengeance. They started taking Thyroid Calm and skipped some medication. We’ll talk more about this. 

Why don’t I talk about relapse? I want to cover a few of these points in this message. The problem is that most of the time, they’re not doing anything to address the cause of the problem. Pretty much 100% of the time, the endocrinologists aren’t doing anything to address the cause of the problem. If the person is seeing an integrative endocrinologist, which there aren’t many of. I did have a couple on the podcast, Dr. Angela Mazza, who is in central Florida; Dr. Brittany Henderson, who is in Charleston, SC. There are not a lot of them. 

Most of these people weren’t in true remission. Most of these people were on antithyroid medication, usually methimazole, for a year and a half to two years. Then the thyroid hormones and TSH looked good, so they were taken off of the medication. The immune system was ignored. The endocrinologist didn’t recommend anything for the person’s immune system health, which is why most people eventually relapse. All they do is take the medication. Maybe they make some changes to their diet on their own. 

Remission doesn’t always mean resolution. Usually, it doesn’t mean resolution because it’s not true remission. Stress is a big trigger. 

This person also mentioned that it came back with a vengeance after having a baby. That also brings up post-partum thyroiditis, which is actually Hashimoto’s. It’s not Graves’. With post-partum thyroiditis, people have the antibodies for Hashimoto’s. During pregnancy, when a lot of people have Hashimoto’s, the pregnancy modulates the immune system, where it’s no longer attacking the thyroid. When the person gives birth, they get a flare-up of post-partum thyroiditis, which often presents as hyperthyroidism. In this case, even though this person has a history of Graves’, it’s also possible that this was post-partum thyroiditis as Hashimoto’s. 

Sometimes, what happens is it doesn’t happen right after the birth process, but months after. In that case, not to say it can’t be post-partum thyroiditis. Perhaps, in this case, it was the Graves’ relapsing. We don’t have enough information since it was just a comment on Instagram. 

Being a mom is very stressful. Sleepless nights or a few hours’ sleep. Everybody is different. Some get more sleep than others. Some might get 5-6 hours’ sleep. Others are not getting much sleep. 

Other stressors of course in life could be a factor. Becoming an expert in handling stress is important because that’s one of the biggest reasons why people relapse. 

The biggest reason is because they weren’t in remission in the first place. They never did anything to address the immune system component. But even people who do improve their diet and lifestyle and do testing to find their triggers, again, for those people who do relapse, stress is a big factor. 

As a reminder, I was diagnosed with Graves’ in 2008. I have been in remission since 2009. Thankfully, I haven’t relapsed, and I’ve had my share of stressors. Everybody is different. Even though I have had a good amount of stressors, I have also greatly improved my stress handling over the years. We also need to consider other stressors, not just emotional stressors, but overtraining or dealing with certain infections. There are numerous reasons why someone might relapse. 

I can understand that it can be incredibly frustrating when someone does relapse, especially if they feel like they’re doing everything right, and they’re in a good place. Then they feel like they’re back where they started. If all you did was take the medication and not do anything to improve your health, the good news is there is a lot you can do to improve your health.

For someone who has done a lot to improve their health, and then they relapse, that can get more frustrating. All you can do is get back on track. 

I hope I continue to remain in remission, but if I were to relapse tomorrow, yes, I’m sure I would be bummed out. I would go back to what I did years ago. Maybe not exactly the same thing, but I would take a similar approach. I wouldn’t have any regrets that I followed a natural treatment approach years ago, and I didn’t receive radioactive iodine or thyroid surgery. 

This person also mentioned Thyroid Calm. This person was back on low-dose methimazole now, and they take Thyroid Calm daily now, which seems to help. They skip their meds sometimes. That’s up to the person. I won’t say anything about skipping medication. 

When I dealt with Graves’, I didn’t take medication at all. This person is doing what I call the functional overlap, where you are using meds but also layering in herbal support, things like bugleweed or Thyroid Calming Formula. There are a few different formulas that have bugleweed, motherwort, and lemon balm combined. This is what this person is doing. 

The one thing I will say is these combo formulas, some of them can be really good, but bugleweed is the main herb that helps with the symptoms of hyperthyroidism. When someone is trying to rely more on the herbs than medication, and I am not telling anybody to do this, if someone is taking medication, it’s up to them to continue taking it or stop taking it. But if someone is taking medication, and they want to try to rely more on herbs, you might want to consider taking bugleweed separately and not a Thyroid Calming Formula. 

If a patient is working with me, and they are taking Thyroid Calming Formula, and it seems like it’s helping, I won’t tell them to stop. If they’re not taking anything, I am not going to tell them to start with the combo. When I dealt with Graves’, I took bugleweed and motherwort separately. I did not take lemon balm. If someone wants to take lemon balm, I recommend taking that separately. If someone is taking Thyroid Calming Formula or another variation, and it seems like it’s helping, or they already purchased it and want to give it a try, that’s fine. 

The problem with these formulations is they don’t have a lot of bugleweed because they need room for the motherwort and the lemon balm, too. Lemon balm might have some mild antithyroid properties, but it’s definitely not as potent as bugleweed.

Getting back to the person skipping medication. Obviously, people can do what they want. I have no control over this. Even with my patients, they will skip sometimes. Keep in mind, you want to be safe while addressing the cause of the problem. I can’t say I’m a big fan of people skipping the meds. I could understand if someone decides not to take it altogether. 

What I mean by that, not saying to stop it, but if someone is, like in my situation, where they didn’t start it to begin with, and they just want to take herbs. If someone is already taking medication, if it’s causing side effects, I could understand- You could go back to the prescribing doctor. You want to be careful. You want to be safe if you do choose to take medication. 

I know I sound like a hypocrite if I said, “Don’t take the medication” because I didn’t take it, and I work with people who don’t take it on their own, and people who do take it. I’m pretty open-minded. Like antibiotics, you either take them, or you don’t. You don’t take them every other day or once a day instead of twice a day. It’s similar with this. You will either take the meds, or you won’t. Don’t skip around and miss doses. 

If someone is going to take the meds and they will take something like bugleweed, which I can’t say all of my patients do this, but I do have patients who take both because they want to try to get off the medication sooner or later. I am not telling them to do this. 

Let’s say you’re taking bugleweed and methimazole. You will do a follow-up thyroid panel eventually. As that becomes more hypo, you will ask the prescribing doctor to reduce the dose of the antithyroid medication.

I also recommend taking them apart. Don’t take them right next to each other. Maybe 30-45 minutes apart. You can take them further apart. This is just the approach I take. There is nothing in the research that talks about taking methimazole and bugleweed at the same time. I don’t know of any interactions. There is nothing in the literature. You can ask a pharmacist. There is nothing I have seen or heard, and I have had people do it for many years. I usually have them space it out and not take one right after the other. 

In this case, this person is on a small dose, which is great. Regardless, even if someone relapsed and needed to be on medication, I wouldn’t look at it as failure. There is a time and place for medication. If someone is taking the herbs, and it’s not effective, and they need to be on medication, I would not look at this as failure. There is a time and place for medication. As long as you’re trying to do things to address the cause of the problem, while taking the medication, then that’s what’s important. 

Even when I took bugleweed and motherwort, those weren’t addressing the cause of the problem. Those are naturally managing the symptoms. If that’s all I did, I wouldn’t have restored my health. 

Those are some of the main points I wanted to mention here. It’s great this person is working with a functional medicine doctor. 

Is there any correlation with hyperthyroidism and high cholesterol? It’s another great question. High cholesterol is actually more common with hypothyroidism. I have some articles. I’m pretty sure I have a podcast episode where I talk about cholesterol and the thyroid. When someone is hypo, it’s more likely to cause high cholesterol. If someone is taking antithyroid medication, which is blocking thyroid hormone production, that might cause high cholesterol. 

It’s very sad because a lot of people who have high cholesterol are given a statin. The thyroid might not be looked at. I am not talking about people who are listening to this, but just in general. You might know someone who has high cholesterol, and they’re on a statin. You might want to ask, “Did you ever get your thyroid checked to make sure you don’t have a thyroid issue?” 

High cholesterol is not as common with Graves’. If someone has unmanaged hyperthyroidism, usually you will see lower cholesterol. Sometimes, it will get not crazy low, but I usually like to see cholesterol above 150. We don’t want to see cholesterol crazy high, but we also don’t want to see it crazy low. If someone has a cholesterol of 80, that’s too low. Cholesterol is important for forming the sex hormones and cortisol, and it has other important functions. 

If someone has hyperthyroidism, and they are taking medication but are still hyper, yet their cholesterol is still high, there could be other factors. A lot of inflammation can cause cholesterol to increase. Sometimes, eating a lot of saturated fat. If someone is following a carnivore diet, so they are eating a lot of animal protein, everybody is different. There are some people who can get away with eating animal protein, and their cholesterol and LDL will look fine. There are people who are eating a lot of animal protein, and their total cholesterol and LDL are very high. That could also be a factor. 

There are some genetics as well. I wouldn’t just rely on the lipid panel. You might want to look at some other markers, like LDL particle. I might have brought this up before, but I also have written some articles related to cholesterol and looking at some advanced lipid markers as well. Those are things that you might want to consider if your cholesterol is high. 

Finally, this person also said something that stuck with me. It’s always a deep dive. Honestly, that’s true. For most people, it’s complex. Graves’, other autoimmune conditions, even non-autoimmune hyperthyroid conditions, they can be challenging and complex. Healing isn’t always linear. 

People with Graves’, it will get discouraging because I want to see the antibodies, for both Graves’ and Hashimoto’s, decrease and eventually normalize. Sometimes, it’s like a rollercoaster ride, where you’ll take two steps forward and one step back. When you see that one step back, if the antibodies decrease, but then they increase, it gets discouraging, which I understand. If we see it consistently increasing, that’s not good. 

If we see a rollercoaster pattern, over time, it’s getting lower, that’s great. Obviously, if someone is gradually improving, their antibodies are gradually decreasing, with no setbacks, that’s even better. A rollercoaster effect is quite common. Setbacks are common. That’s why I talk about setbacks and roadblocks. Progress is not always linear. 

This person is working with a functional medicine practitioner, which is great. Work with someone who welcomes complexity. Don’t get me wrong. I definitely enjoy working with people who progress gradually without any setbacks or roadblocks. I have come to realize after working with people with hyperthyroidism for over 15 years, more times than not, there are going to be setbacks and roadblocks. 

Another reason why you want to work with someone who is experienced. If someone is just a newbie in practice, they have to learn somehow, but they might not be used to the setbacks and roadblocks. 

It’s great that this person is working with someone. Hopefully the person who wrote this message will do things to improve their immune system health beyond taking Thyroid Calm. This also shows this person has a natural mindset, not just relying on medication. 

Whether you’re dealing with Graves’ or a non-autoimmune thyroid condition, whether you’re on methimazole or taking bugleweed or Thyroid Calming Formula, again, this is a process that asks for patience. You want to receive the right support. 

Of course, the purpose behind this podcast- I have other resources as well beyond the podcast, like my books and my webinar. In my free webinar, I talk about the framework I use to help people with Graves’ or hyperthyroidism move toward long-time stability. It’s called “The Five Steps to Reverse Hyperthyroidism and Graves’.” 

I talk about how to avoid radioactive iodine and support your thyroid and immune system naturally; the forming categories of Graves’ triggers, including some hidden ones that often get missed; how to break the hyperthyroid cycle, which is true especially if you have relapsed after a period of remission; how to work with more complex situations like thyroid eye disease or those with toxic multinodular goiter. It’s not just about Graves’. This isn’t about quick fixes, but it will help you feel more grounded in what’s possible, what to focus on first.

If you haven’t checked out that webinar, you might want to do so. You can sign up at SaveMyThyroid.com/HyperWebinar. 

Thanks again for tuning in. Wherever you are on your healing journey, just keep looking beneath the surface. Sometimes, that’s where the clearest answers come from. 

I’ll end it on this note. Thanks for tuning in. Hope you found this episode to be valuable. Of course, look forward to catching you in the next one. 

Recently, I interviewed Dr. Joshua Helman, a Harvard-trained physician, who  exposes how dementia and Alzheimer’s stem from multiple interconnected triggers: environmental toxins, chronic stress, inflammation, infections, poor sleep, and even thyroid imbalances. He explains how cutting-edge brain imaging and comprehensive functional testing can identify the true mechanisms driving memory loss. 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. Joshua Hellman. We are going to be talking about dementia, Alzheimer’s, tying it into thyroid health a little bit. Let’s go ahead and dive into Dr. Hellman’s impressive bio here. 

Dr. Joshua Hellman is a Harvard-trained physician, licensed in 14 states. He holds two degrees in biochemistry, a bachelor’s degree from Harvard and a master’s degree from the University of Cambridge in the UK. His medical degree is from Harvard Medical School and MIT. He is board certified by the American Board of Emergency Medicine and the American Board of Lifestyle Medicine. 

He is the former and current medical director of Hippocrates Health Institute as well as Chief Medical Officer of two different Alzheimer’s reversal centers, Brain Power Clinics and Alzheimer’s Treatment Centers of America. He also worked at True North Health Center with a focus on fasting, so we’ll talk about fasting as well. Also, he recently launched a podcast called Alzheimer’s Breakthrough, which is wonderful.

His areas of interest span longevity, regeneration, vitality, toxins, mold, Lyme Disease, energy medicine, and breathwork. With a passion for applying biochemical knowledge to real-world challenges, he embraces a holistic approach that emphasizes the importance of diet and lifestyle for optimal health. Welcome, Dr. Joshua. 

Dr. Josh Hellman: 

Thanks, Eric for the great introduction. I really appreciate being here. We met over a year ago, and it’s cool to actually be doing this now. 

Dr. Eric:

I’m glad we connected here. It’s an important topic. When I invited you on the podcast, I mentioned that we haven’t had anybody focus on this yet. We might have mentioned it, tying it into other topics, but we haven’t had a dedicated episode on dementia and Alzheimer’s. I’m glad we have you here. 

I definitely want to get a little more into your background as far as why you started focusing on dementia and Alzheimer’s. 

Dr. Josh: 

Sure, that’s easy. When I was a teenager, my grandmother Eileen got Alzheimer’s. I saw how it was devastating not just for her, but for my parents’ generation. Now, they’re thinking, wait, this is Grandma Eileen today. What’s going to happen to us in 20-30 years? That left an imprint on me as a teenager. 

I was a nerdy teenager who was interested in studying biochemistry. What is actually really good is the basic fundamentals I started learning as a teenager, most of those have not changed. I can actually go back to that core knowledge and apply it to a complicated disease process like Alzheimer’s. 

Dr. Eric: 

Awesome. My grandmother dealt with dementia, and my aunt currently is dealing with Alzheimer’s. It’s something that affects many of us. How common is it? Is it something that has been increasing over the years? Have you seen a higher prevalence of dementia and Alzheimer’s? 

Dr. Josh: 

Unfortunately, unlike most other chronic diseases, it’s going straight up, the amount of Alzheimer’s. I think that’s because there are between 30-200 root causes for Alzheimer’s. Many of those have to deal with people’s lifestyles. People are not metabolically healthy like they were 40 years ago. 

Dr. Eric: 

Up to 200 causes? 

Dr. Josh: 

Yes, between 30-200 root causes. Anything from genetics to toxins to infections to hormonal issues like low thyroid, high thyroid, to not enough deep N3 sleep to head trauma. There are so many.

The reality is that in most cases, it’s not just one thing, which is why it’s been so challenging to come up with a cure or treatment if you will restrict it, like this one treatment or medicine is going to fix everyone. It’s such a diverse, heterogeneous disease process. 

Dr. Eric: 

I imagine it’s complex. Similar with what I work with. Graves’ and Hashimoto’s patients and non-autoimmune thyroid conditions, but especially the autoimmune patients, there is not usually one trigger or cause. It’s multifactorial, so it’s complex on my side as well. 

What is the difference between dementia and Alzheimer’s? Is Alzheimer’s a more advanced case of dementia? 

Dr. Josh: 

What I would say is dementia is a larger umbrella. Within dementia, you’ve got some cases of Alzheimer’s. Actually, in the United States, about 75% of adults with dementia, it turns out to be Alzheimer’s. 

When I am speaking to the general public, I often use the terms interchangeably, but they’re not. To be specific, if you get a stroke or major head trauma or cancer that spreads to the brain, all those things can cause dementia, but they’re not Alzheimer’s. That’s the distinction. 

Unfortunately, Alzheimer’s, the numbers are growing. We have seven million people in the United States with Alzheimer’s. The good news is there is hope. That’s frankly why I am glad to be on this podcast with you because there is hope. Unfortunately, most physicians in the general public don’t understand that there are specific things you can do to prevent and reverse Alzheimer’s at any stage. 

Dr. Eric: 

Glad you mentioned that. Even if someone has had it for many years, and it’s advanced, it’s possible to reverse it? 

Dr. Josh: 

It is. it will take longer and be more difficult because you are trying to regenerate a lot more as opposed to with prevention, it’s a much earlier in the process. The key information is that there is hope. It really upsets me when I hear people who have gone to their doctor, who said, “I’ll try you on this drug, but there’s really not much we can do.” 

Dr. Eric: 

Similar with Hashimoto’s. In most cases, they go to an endocrinologist and are told to take thyroid hormone replacement. Not to say there is not a time and place for that, but that’s the only treatment: take the thyroid hormone, even if it’s an immune system condition, not a thyroid condition. 

Same thing with Graves’. It’s either antithyroid medication, radioactive iodine, or thyroid surgery. Absolutely nothing is done for the immune system. 

Similar as you mentioned for Alzheimer’s or dementia. They don’t do anything for the cause, just manage the person’s symptoms. Thankfully, there are practitioners like you who actually look into the root causes. There is up to 30-200 root causes. 

The foundations. I know you mentioned sleep as being one of the- 

Dr. Josh: 

It’s not just one. It is the number one. When we analyzed thousands of different patients, the biggest risk factor for developing Alzheimer’s is not enough of this deep N3 sleep. 

Dr. Eric: 

Wow. Just focusing on sleep will help to prevent Alzheimer’s from developing. Obviously, if someone is already dealing with it, you try to do everything you can to help them with sleep. This must be a challenge. What is the average age of someone with Alzheimer’s? I imagine it’s in the 70s or 80s. Sleep declines with age to begin with. 

Dr. Josh: 

The scary thing is we are seeing it at younger and younger ages now. 

Dr. Eric: 

Wow. What is the youngest patient you’ve seen? 

Dr. Josh: 

I saw a woman in her 40s. It was a genetic case. Even the non-genetic cases, I am seeing it starting at the age of 50. 

Dr. Eric: 

How do you know? If someone has poor memory and is forgetting things, how do you come up with a diagnosis of dementia and/or Alzheimer’s? 

Dr. Josh: 

It’s really cool because when I went to Harvard Medical School 30-40 years ago, at that time, the only way to diagnose Alzheimer’s was an autopsy. You had to wait until the person died. The autopsy, you will harvest the brain and look at some of the cells and see the changes. 

Today, we have all these different technologies. There are different types of PET scans, imaging tests that can tell you. There are blood tests that can look at amyloid and tau. Those are the two that have revolutionized. 

To be clear, if someone is listening to this now, and they have, for themselves or a loved one or a friend, they’re noticing their brain isn’t right, one of the first things I would do is get an imaging test of the brain. You want to rule out that this isn’t from a stroke or a bleed or cancer. 

Dr. Eric: 

Makes sense. I have to put you on the spot and ask about thyroid because low thyroid hormone can also affect cognition. Before inviting you, when we were talking about this, I’m pretty sure you said you run a thyroid panel on everybody. 

Dr. Josh: 

100%. Exactly right. Because the thyroid hormone is important for every organ in the body, including the brain, if for some reason you have a very low thyroid level or a very high one, unfortunately, metabolically, the cells aren’t going to be acting well. If we are talking about the brain, the brain cells are normally metabolically very active. If they don’t have the thyroid hormone they need in the right range, there can be problems. 

Dr. Eric: 

Makes sense. Whether you have low thyroid hormone or elevated thyroid hormone, again, hypo is more common than hyper, but a lot of people also have hyper. Either way, you want the thyroid hormones to be in balance. Glad we discussed this since most listeners have a thyroid or autoimmune thyroid condition. 

How about inflammation? Is that one of the root causes? 

Dr. Josh: 

Definitely. I would say that the inflammation is almost like a super umbrella. Many of the things I mentioned will cause inflammation, whether it’s infections, toxins, trauma. Almost all these things will cause inflammation. The really exciting thing is I have been offering an FDA-approved drug for compassionate use that turns down the amount of inflammation in the brain. We’re seeing improvement after just one dose. If you had to pick one category, definitely inflammation. 

Dr. Eric: 

I’m sure you’re familiar with this marker, quinolinic acid. Sometimes, I run an organic acids test, or the DUTCH test looks at it, too. I know there are other markers, too, but if you see that elevated on an organic acids or DUTCH test, it doesn’t automatically mean the person has dementia or Alzheimer’s. But is that a risk factor? 

Dr. Josh: 

It is. What I like to do is a specific test looking at active brain damage, specifically antibodies against different neurotransmitters or receptors in the brain. For example, you can find auto antibodies, antibodies against some of the dopamine receptors in the brain. Frankly, dozens of different ones. There are so many different tests. 

What I am normally looking for is evidence of active damage. If you have what’s called an IgM immunoglobulin, that normally goes along with active damage in the last couple months. 

Dr. Eric: 

If someone has IgM compared to IgG antibodies, kind of like an infection. If someone has Lyme IgM, that’s an acute infection, compared to IgG. It’s not the best comparison because chronic Lyme- Acute Lyme is better than chronic Lyme in a way. With the brain, it sounds like if you have those IgM, that’s not a good thing. 

Dr. Josh: 

Correct. It just gives you information. Hold on, there is evidence that this person’s immune system is attacking itself. Let’s take a step back and figure out how to fix this. 

Dr. Eric: 

What are some of these tests? Is it Vibrant Wellness that has the Neural Zoomer? Cyrex Labs also has a test that looks at antibodies against the brain. 

Dr. Josh: 

I like the Vibrant Neural Zoomer Plus. There are other ones, too. 

Dr. Eric: 

If you are suspecting someone has dementia/Alzheimer’s, do you automatically do it? Do you do it on all those patients? 

Dr. Josh: 

I offer it. What I find is some people want every test, and some people are like, “Just treat me.” It’s a test I like getting. To be up front, there are some people who just want to limit how much they’re spending. Of course, unfortunately, insurance often doesn’t cover these autoimmune tests. 

Dr. Eric: 

Makes sense. How about diet? We spoke about the importance of sleep. How important is it to eat an anti-inflammatory diet? 

Dr. Josh: 

It’s extremely important. You basically stay away from processed foods, foods that have added salt, oil, and sugar because those highly processed foods will cause damage to your blood vessels, including the blood vessels of your brain. We know the brain is a highly vascular organ. If you eat a meal that is high in salt, oil, and sugar, there is damage right after that meal that is happening to those blood vessels. 

Dr. Eric: 

Okay. Now you personally follow more of a vegan or plant-based diet. I am not a carnivore, but I eat meat. I eat a lot of plant-based food. As well. I am in favor of plant-based foods. Is there any research showing the benefits of any type of certain foods, like cruciferous vegetables or others, in brain health? 

Dr. Josh: 

There are. Specifically, if you are eating animal products that are on top of the food chain, there is normally higher levels of toxins, whether we are talking about heavy metals, plastics, pesticides. The concentration goes up as you go up the food chain. If most of your diet is meat or milk or fish, you are getting a much higher dose of these toxins. 

There is a huge benefit to decreasing inflammation if you have a high amount of fiber in your diet. There is zero fiber in animal products. If you’re eating plants, you are getting a huge amount of fiber. 

Dr. Eric: 

I agree with that. I am not a huge proponent of carnivore diet long-term. I know there is some potential benefits short-term in dealing with autoimmunity. I have had others come to me and say they follow the carnivore diet for their autoimmune condition and got great benefits. 

I agree, as far as the gut microbiome, the long-term impact of not having fiber-rich foods is a concern with carnivore and ketogenic diets. I think we’re on the same page. 

One thing I do want to bring up though, especially for those who are vegans and vegetarians, omegas are very important for brain health, too, especially DHA. What do you recommend for vegetarians/vegans? Algae oil? What sources do you recommend for omegas? 

Dr. Josh: 

Sure. I normally recommend DHA, EPA source from algae. That is my favorite. 

Dr. Eric: 

How important is stress management? What impact does cortisol imbalances have on the brain and potentially dementia? 

Dr. Josh: 

It’s huge. What I find normally when I am meeting with a patient is the story is things were going well until this stressful thing happened in their life, whether it was divorce or death or a new job or something like that. Then all of a sudden, their brain went downhill. Stress kills. We are designed to be around other people in communities.

Here is a funny statistic. Obviously, smoking, and alcohol for that matter, is not good for you. If you are socializing while you’re smoking, and that is basically the only way you socialize, the benefit of socialization outweighs the downside of smoking. I am not recommending anyone smoke, but we are wired to be a part of a small community. If you find someone highly stressed, by themselves, with no outlet, that is a huge danger. 

Dr. Eric: 

Makes sense. What are some of your favorite stress management techniques? Is it just as simple as deep breathing, yoga? Are there any apps you recommend? 

Dr. Josh: 

I like deep breathing. I like meditation. I like exercise. Exercise will often relax you. I like New Calm. It has an app. That definitely helps calming. There are supplements, whether it’s lavender essential oil. There are a lot of choices. Just try some of these and find out what works for you. Not all of them will work. The ones that work definitely do. There are guided meditations. So many choices. 

Dr. Eric: 

I agree. I tell people whatever you are willing to do. If someone prefers doing meditation, that’s great. If you want to do yoga and meditation, rotate. If you want to do New Calm or Headspace or Calm. There are so many options.

In autoimmunity, in the conditions I deal with, stress is a big factor. When I dealt with Graves’, stress was a big factor. It wasn’t just emotional stressors but overtraining as well. The physical stressors also could have a big impact. 

Getting back to diet. Let’s talk about fasting. Intermittent fasting, I imagine you recommend that. I’ll let you take over. What type of fasting are you recommending for brain health? 

Dr. Josh: 

What I would say is wherever you are on the fasting spectrum, start there. If you have never fasted before, intermittent fasting is very reasonable. Just skip breakfast. Have a limited feeding window, say from noon until 6pm, or whatever you can tolerate, whatever fits into your lifestyle. From there, the next progression might be eating only one meal a day. 

From there, I would say water fasting. At True North in California, we would do water fasting for up to 40 days under medical supervision. I don’t recommend people water fast on their own, certainly not for more than a few days. 

Dr. Eric: 

40 days? Wow. Have you done a 40-day water fast? 

Dr. Josh: 

No, I haven’t done 40. I have done 12 days. It was amazing. If you’re talking about stress, all my stress melted away. I thought that I was going to be super hungry, but actually, hunger normally goes away after the first two days. 

Here is another exciting thing. After a few days, you are super ketonic because your body is now burning fat for energy supply. People talk about a keto diet. To me, the best keto diet is just water fasting. You’re going to get very high levels of ketones. 

Dr. Eric: 

It might contradict what we mentioned before a little bit with fibers, but this isn’t meant to be a permanent diet. You do it for a period of time for therapeutic purposes. If someone is doing it for 40 days, after that, you would gradually reintroduce the plant-based foods? Can they right away go back to the same diet that they were on before? 

Dr. Josh: 

No. The refeeding part is the most important part. You can’t just go back to eating rich, fatty foods. Think about your GI tract, your stomach like a muscle. You have let it relax for a very long time. All of a sudden, you say, “Hey, I want you to start exercising really hard.” It won’t work. You go low, you go slow. You start with juices and some raw fruit. Easy things. Then you gradually introduce more complicated things to digest. 

Also, as a warning. If you have someone who is super skinny, doesn’t have excess body fat, they are not going to be able to water fast because they don’t have the fuel. What happens if you take someone like that and they water fast is they will break down muscle for fuel. You don’t want to break down muscle normally. 

Fasting is a very powerful way to optimize your body metabolically. I will say that historically, if you go back thousands or even hundreds of years, most of our ancestors had time periods where there was famine. Our body biochemically is designed occasionally to not have calories. 

That is why something called autophagy, where while you’re fasting, “autophagy” is Greek for eating yourself. Your body will recycle proteins that are deformed. I view fasting as a renewal state. Like anything else, it takes practice. If you have never fasted before, don’t feel bad. Try skipping one meal a day to start. 

Dr. Eric: 

Like you said, either skip breakfast or dinner. It’s not too bad when you do it that way. 

For those who might be listening and might be intrigued by a water fast, you would recommend medical supervision. If they are wondering about doing a juice fast for a week or 12 days or a month, does that have close to the same benefits, or not the same as a water fast? 

Dr. Josh: 

I don’t think it has quite the same, but it’s still extremely beneficial. Let’s be up front. Some of the people who stated planning to do a 40-day water fast, after say, day 13, their body is like, “No, I need some calories.” We will shift them to juice for a few days, and then see if we can get them back to water. This is a dynamic process.

To answer your question, I find if you’re doing a very long-term juice fast, it really depends on your medical issues. If you have medical issues, if you’re on a diabetes medication, you need to do it with the guidance of a physician who knows how to adjust things. The last thing I want to see happen is a diabetic who stops eating, and then their blood sugar falls. That’s really dangerous. 

Dr. Eric: 

Consult with a doctor. Probably not your primary care doctor because they probably won’t have the experience with long-term fasting. Someone like you or someone else who has experience with these types of fasts. Very cool. 

I can’t say I have done a prolonged water fast. I have done intermittent fasting. I have done 24-hour fasts. With both the juice fast and water fast, you are not getting protein. Is the justification risk versus benefits? It’s not meant to be a permanent diet. You’re doing it for therapeutic purposes for metabolic disease or brain health or something else? 

Dr. Josh: 

Great point. It turns out that the average American is not protein-deficient today. it was different 100 years ago. Today, for most people, they are not protein deficient. It really shouldn’t be a concern if they are just drinking some juice or water for a period of time.

There are a few people who have had gastric bypass or for some reason with mold toxicity, they can’t absorb calories. They are already starting off protein deficient. No, I wouldn’t recommend fasting in that scenario. 

Dr. Eric: 

When I dealt with Graves’, I probably wasn’t a good candidate because I was down to 140 pounds. I lost a lot of weight. In that situation, for people listening who have hyperthyroidism and are losing a lot of weight, maybe not a good candidate. 

I am not asking for specific advice. For Hashimoto’s patients, have you had them do prolonged fasting? 

Dr. Josh: 

Yeah. The exciting thing is while they’re fasting, often, their symptoms go away. The tricky thing is when you start refeeding them, if you’re giving them things like gluten or high inflammatory foods, the symptoms can come right back. 

To me, learning from that is some of this inflammation is actually determined in the gut. If you cut out the food, there is basically nothing in your gut to support your microbiome. It’s amazing how your microbiome in the gut determines so many different things, including the brain and hormones, etc.  

Dr. Eric: 

Environmental toxins. You mentioned mold. There are mycotoxins from mold. There are so many other toxins and toxicants, like microplastics and heavy metals and glyphosate. We could go on and on. 

Dr. Josh: 

Sure. 

Dr. Eric: 

I imagine those are also playing a role in the increased prevalence of dementia and Alzheimer’s. 

Dr. Josh: 

They are. Just to put a magnifying glass on a few of those areas. It turns out many of the toxins you mentioned are fatty toxins. This means that once they get into your body, they like going to fatty tissues, not just around your belly or bottom, but also the brain’s extremely fatty. Even fattier is the myelin sheath, which is responsible for nerve conduction. It turns out that it’s worrisome, these fatty toxins. 

#2, plastics. As you mentioned, we are seeing higher and higher amounts of plastic in people’s brains, especially with dementia and Alzheimer’s. We don’t know exactly how the plastics are getting into the brain and why they preferentially want to get into the brain. 

One theory is that there is something special about the nose and what’s called the olfactory or first cranial nerve that goes from the nose back into the brain. 

Stay tuned, but for that reason, I strongly recommend people try to cut out as much plastic exposure, including clothes. Most of the clothes out there, unless it’s organic, natural fabrics, it’s made out of polyesters and other plastics. Unfortunately, how long do we wear our clothes for? 10-12 hours a day or longer? That is a perfect way to maximize exposure into your body. Some of the plastics end up in your brain, which is not a good thing. 

Dr. Eric: 

Good points. Sometimes, we overlook the basics, like the clothing we wear. Just wear 100% cotton, and that would solve that. Easier said than done when you already have your wardrobe. You might have to make some changes. Even if you do those gradually, from this point on, try to buy cotton and not polyester. Like you mentioned, that could make a big difference. 

Dr. Josh: 

Agreed. 

Dr. Eric: 

Years ago, I don’t hear as much these days, so I don’t know if it was more theory than what was in the research. When talking about toxins, specifically heavy metals, at least in the past, they spoke about a relationship between aluminum and Alzheimer’s. Now I don’t hear a lot about toxins, but the type 3 diabetes that is more blood trigger-related. Is there that relationship as far as you know between heavy metals such as aluminum? 

Dr. Josh:

Terminology. Aluminum on the periodic table is way at the top. It’s a metal, not a heavy metal. It’s still super toxic to the brain. Specifically, we find aluminum in amyloid plaques. Where do people get aluminum from besides aluminum foil? Unfortunately, one of the largest sources is drinking water. The very last step in most public water purification systems is to add aluminum to the water to remove the particulate matter, like leaves and other things. Great, you got rid of the leaves, but now you put in a neurotoxin, aluminum. There is also aluminum in some vaccines and other things like that. 

Dr. Eric: 

I did not know that. It’s not considered a heavy metal, but just a regular metal. 

Dr. Josh: 

I would call it a light metal, like lithium. 

Dr. Eric: 

It’s still a neurotoxin. Are all heavy metals health concerns? 

Dr. Josh: 

They are, but some are worse than others. Mercury and arsenic are more concerning. Cadmium. It’s pretty scary. 

Dr. Eric: 

Is arsenic considered a heavy metal? 

Dr. Josh: 

Oh yeah. 

Dr. Eric: 

Just want to make sure since I thought aluminum all along was a heavy metal. You have two degrees in biochemistry, so I will trust what you said. 

Dr. Josh: 

It’s still toxic regardless of where it is on the periodic table. 

Dr. Eric: 

Good to know. We know in order to prevent it, a lot of the things that we already discussed, incorporate those foundations, diet, stress management, making sure you are getting sufficient sleep and regular movement and exercise, reducing your toxic burden. 

When someone is dealing with a more advanced case of dementia or Alzheimer’s, they still need to do what we mentioned. In that case, would you recommend for them to see a practitioner like yourself? How much can they actually do on their own? 

I know in the case of my aunt, it would be my cousins who would be taking care of her. The person who has the dementia/Alzheimer’s wouldn’t be taking responsibility for their own health in that situation. What kind of advice would you give to someone who is more advanced in dementia or Alzheimer’s? 

Dr. Josh: 

What I would advise is get more than one opinion. Unfortunately, many doctors out there will just say, “This is so advanced. Sure, we can start you on a medication like Aricept. It will start the descent downward a little bit, but there is no hope.” I always say, “No. Because it is so advanced, we just need to work harder.” You need to find a doctor like myself who is willing to work harder, someone with functional experience who is willing to look at every strategy, not just a narrow, this is what the FDA says, or this is what the Alzheimer’s association recommends, so that’s what I’m going to do. 

Dr. Eric: 

There is hope, even in advanced cases of Alzheimer’s. I know you mentioned earlier when I asked if it was possible to reverse it even in advanced cases. Coming back to that, it sounds like no matter what stage you’re in, like you said, it will take longer if someone has been dealing with it for many years. No matter what stage they’re in, there is hope. 

Dr. Josh:

 Just to be clear, many doctors won’t even enroll people in studies if they’re advanced. “You’re too far gone to even try a drug that could decrease inflammation or other therapies.” That’s why I think it’s important to get more than one opinion. 

Dr. Eric: 

With your approach, obviously you want to do what you can to address the root causes. You’re also mentioning there is a time and place for medication to reduce inflammation. I agree. When I dealt with Graves’, I was able to avoid antithyroid medication and took an herbal approach. Quite frankly, I work with people who need to take antithyroid medication for whatever reason. It’s one of those risks versus benefits. Same thing with any health condition. 

Dr. Josh: 

It has to be personalized. For example, if you happen to have high levels of toxins, then often what we will do is something called total plasma exchange, where we will filter the blood, remove the toxins in the blood, and put human albumen in the other arm. It’s a personalized approach. 

Dr. Eric: 

Do you recommend any functional medicine testing, like stool panels? I mentioned earlier the organic acids test or the toxins test. Do you just assume people have a high toxic burden? What is your approach here? 

Dr. Josh: 

I like doing them. As I mentioned, they’re expensive. If someone is willing to do it with me, I’ll not just test for heavy metals, but also for infections, whether that’s Lyme, herpes virus. 

As an aside, it turns out that if you have an active herpes infection, that will increase dramatically the amount of tau tangles in your brain. Tau tangles are one of the risk factors that we see in Alzheimer’s. 

I will look at infection panels. I will look at forever chemicals. Like you mentioned, glyphosate or roundup. I will often do an advanced genetic panel because it’s not just APOE or APOE 4. There are many other mutations that will either decrease or increase your risk of getting Alzheimer’s.

The cool thing is depending on where that mutation is, often there are medications or supplements that can be tailored directly to you based on your own unique genetic background. There is only one way to do that. You have to have your genetic data first. 

Dr. Eric: 

That is a different type of genetic testing than what’s out there. There are other genetic panels? 

Dr. Josh: 

To be clear, it seems like most neurologists or primary care doctors are just testing for APOE or APOE4. That’s important data, but it’s ignoring 100+ other important genetic mutations that will affect your risk for getting dementia.  

Dr. Eric: 

You do like comprehensive genetic testing that looks at those risk factors. Also, they look at genetic variations related to detoxification for example. You’re doing a comprehensive genetic panel, is what I’m getting at. 

Dr. Josh: 

Exactly, for the patients who are willing to do it. It’s an expense, but yes. 

Dr. Eric: 

You mentioned herpes being a risk factor. You’re talking about herpes simplex then? 

Dr. Josh: 

Yes. Herpes simplex, herpes complex, specifically an active herpes infection, whether you have a cold sore. Sometimes, people can have a herpes infection in their brain and not realize it, or other parts of the body. These herpes viruses or even chicken pox, they’re tricky. They can hide in nerve cells and only come out to play when your own immune system gets shut down. 

Dr. Eric: 

Epstein-Barr and cytomegalovirus, they are members of the herpes family. They can also be a problem? 

Dr. Josh: 

Exactly right. It’s a similar thing. Most people already have exposure to those viruses, and they’re latent. They’re hiding in nerve cells throughout your body. They normally don’t come out to play unless and until your own immune system has trouble working. When your immune system can’t keep these viruses under control, they’re like, “Hey, the coast is clear. Time to play. time to spread and multiply.” 

Dr. Eric: 

All right. Lyme and bartonella. I know you mentioned Lyme briefly. Those could be potential factors, too? 

Dr. Josh: 

Yes. Sometimes, we find Lyme present within Lewy body dementia. It is my belief. Again, I can’t prove it unless we do autopsies. It is my belief that infections are one of the important causes. 

Dr. Eric: 

We covered a lot. Often, I’ll ask if there is anything else I should have asked you that I didn’t ask you. I asked you a lot of questions. But still, anything else you’d like to cover before we start wrapping this up? 

Dr. Josh: 

Sure. In terms of hope, we have many other treatments besides decreasing the inflammation or getting rid of toxins. We also have IV therapies, light therapy, oxygen therapy, many different therapies. Because we are dealing with more than one process, normally, it’s a gradation, like an orchestra. You put it all together. 

I understand people out there are hearing this one supplement or this one magic thing will help. No, it normally is not just one thing. 

For example, omega 3s. I definitely recommend people with dementia supplement omega 3s. I like algae oil, up to 3g. I also like lion’s mane. You can find on my website some of my favorites. 

The key thing is it normally is not will be just one thing. That is what you hear often. People promote their one supplement. That’s not going to be enough normally. 

Dr. Eric: 

You mentioned oxygen. Were you referring to hyperbaric oxygen? 

Dr. Josh: 

Yes, hyperbaric oxygen. You could also use ozone to bust up biofilm if that is present in the brain. We use nano bubbles, basically really small oxygen bubbles that will get in through the skin if we put your feet in the nano bubbles, or have a bathtub-type situation. Oxygen is your friend.

Another thing that has been really helpful is exercising with oxygen. There is something about that seems to strengthen and release something called BDNF, brain derived neurotropic growth factor. What BDNF does is it establishes new neurons and neural connection synapses. 

Don’t stop at just one or two therapies or options. 

Dr. Eric: 

All right. Thank you for this conversation. This was awesome. Where can people find out more about you, Dr. Josh? 

Dr. Josh: 

It’s easy. DrJosh.com. My email address is just DrJosh@DrJosh.com. I’m on social media under GreenBrainsMD. It’s probably easiest to find me at my website. I have a weekly podcast on reversing Alzheimer’s. If you want to hear from lots of other experts on this topic, that’s a good place to go. 

Dr. Eric: 

Awesome. I’m glad we had this conversation. Definitely check out Dr. Josh’s website, his podcast. If anybody listening knows someone dealing with dementia or Alzheimer’s, feel free to reach out to Dr. Josh as well to schedule a consultation. 

One other thing: I imagine for something like this, would they have to come in person? Do you do telemedicine? How does this work? 

Dr. Josh: 

I do telemedicine. Obviously, there are some procedures like filtering someone’s blood with total plasma exchange. Have to do that in person. I have many clients in the states I am licensed in or coaching using telemedicine. That’s powerful. 

I’m not looking to replace anyone else’s doctor, but I am here to provide help and hope. Unfortunately, as I mentioned, this information really hasn’t gotten out yet. That’s why I’m grateful that you’re willing to host me today. 

Dr. Eric: 

It was a pleasure. It was wonderful having this conversation. I’m sure many of the listeners will find it to be beneficial. If you didn’t catch on, I learned some things as well. Thank you so much, Josh. Appreciate having you on. Looking forward to spreading the word and sharing this episode with my followers. 

Dr. Josh: 

Awesome. Peace and plants. 

Dr. Eric: 

Thanks again. 

Recently, I interviewed Alexandria,  who’s antibodies were high, her gut was off and surgery was on the table. She was told she had the antibodies for both Graves’ and Hashimoto’s in 2017 and initially followed conventional advice, including methimazole. But after facing the possibility of thyroid removal, she explores deeper root causes. If you would prefer to listen to the interview you can access it by Clicking Here.

Dr. Eric Osansky: 

I am excited to do another Save My Thyroid health audit, where we’re chatting with Alexa. Alexa, thank you so much for joining us. 

Alexa: 

Thank you for having me. 

Dr. Eric: 

Yeah, I’m excited. You submitted your application to do this audit. Diagnosed with both Graves’ and Hashimoto’s back in 2017. 

Alexa: 

I knew about the Graves’. That was what I was diagnosed with. I came to find out later it was also Hashimoto’s as well. 

Dr. Eric: 

All right. That was about eight years ago. Curious, when did you find out about me? I was around back then. I don’t know if you have been following me for a while or if you just came across me. 

Alexa: 

I was digging and digging, trying to find another option than removing my thyroid after the first few years. Maybe around 2019/2020 is when I found you online. It took a while because, and I know you have mentioned before, there is not as much info about Graves’. 

Initially, I followed along with the doctors and what they prescribed for me to do as far as taking the medication. In my mind, I thought I was pretty healthy. I’ll probably be one of those people that it will just go into remission on its own. That didn’t happen for me. Of course, after a couple years of treatment is when they started suggesting permanently removing my thyroid. There has to be something else. 

Dr. Eric: 

There are definitely other options, which you know now. I’m glad you looked into other options. I’m glad you found me. 

You have been on methimazole ever since 2017? I know you are taking it now. 

Alexa: 

Pretty much. I’ve had some gaps, where I was doing really well. They were able to wean me off of the medication. Then I had to go back on it because I wasn’t treating the root cause. There have been some periods, 4-6 months, maybe max, where I have been off of the medication. For the majority of these past eight years, I have been on it. 

Dr. Eric: 

Has it been a lower dose? What are you currently taking? 

Alexa: 

I’m currently taking 5mg four days, and 10mg for three days. 

Dr. Eric:

5mg four days a week, 10mg three days a week. Also, you made some dietary changes. You recently cut out gluten? 

Alexa: 

Yes. I have done that a couple times as well. I have done AIP for some time. That is probably when I was able to lower my antibodies the most. Then I fall back into- I have a little bit of this and that here and there, and then it starts to creep back up. 

Removing gluten, I just tried that during Lent the previous year, and I saw a change in the way I felt. I’ll still do mostly gluten-free throughout the years, but then this time around, I started a little bit earlier. I started right at the beginning of March, where I have been gluten-free. I try to be grain-free the majority of the time as well. 

Dr. Eric: 

How long were you following AIP for? 

Alexa: 

I want to say close to at least three months if not longer. I went from 18 or so with my thyroid antibodies down to about 2.19, I want to say. 

Dr. Eric: 

That’s really good. It’s not easy to stay on AIP. It’s not meant to be a long-term diet. Maybe you needed to be on it a little longer. 

Are you grain-free because of what you learned about grains? Do you feel better when you’re not eating grains? 

Alexa: 

I feel better. My goiter has never been super large. I don’t know if you can see it. I feel like it goes down as well when I avoid grains. Particularly oats, which I was trying so hard to keep in. it doesn’t work for me. Then the gluten is hard. That’s the hardest one for me to give up. I do notice a difference. 

Dr. Eric: 

You’re still consuming dairy? 

Alexa: 

Yes, I do in smaller amounts. For years of my life, I didn’t consume much dairy because I always felt sick after eating it. Then it’s this weird tradeoff. If I am not eating grains to fill me up, then I am eating more dairy. Maybe that’s the next thing that needs to go.  

Dr. Eric: 

Everybody’s different. Usually, I have people take a break from the common allergens. You did do this with AIP. You avoided it. Possibly consider doing it again.

When was the last time you had your antibodies tested? 

Alexa: 

It’s been a while. My doctor doesn’t check for them that often. At least the last three times I have been, I haven’t had them done. 

Dr. Eric: 

Did you get it tested in 2024 at all? 

Alexa: 

Yeah, it’s been at least six months. 

Dr. Eric: 

You put down the three biggest challenges: gut issues, which you said they’re improving; shortened periods; and the goiter. Also with grains and gluten-free, it’s better. The gut issues are better. Is that with grain-free and gluten-free, too? 

Alexa: 

I believe so. I also saw a functional medicine doctor around 2021. I was taking butane HCl. I took something that clears out SIBO. 

Dr. Eric: 

The antibiotic Rifaximin? 

Alexa: 

Yeah. That did really well. I took colostrum to help heal my gut. That actually was probably about the same time, where my thyroid antibodies were going down as well. It was probably a mixture of all those things. 

Dr. Eric: 

You mentioned you saw a naturopath for the butane HCl. I was talking about the gut issues. You said that they were- That’s why you brought up the butane HCl and the Rifaximin. The SIBO relates to the gut. 

Alexa: 

That is probably when it was the best. Being mostly grain-free and gluten-free is definitely helpful, but I think I probably need to do some of those supplements as well. 

Dr. Eric: 

Did you test for SIBO? Did you do a SIBO breath test, or did you go by symptoms? 

Alexa: 

I did the breath test. 

Dr. Eric: 

That showed you were positive for SIBO. 

Alexa: 

Yes. 

Dr. Eric: 

Did you retest to confirm it was gone? 

Alexa: 

I did not. 

Dr. Eric: 

Any other functional medicine testing you did back then, like a stool test or saliva test? 

Alexa: 

I did the stool test. I did not do a saliva test. I felt like I did at least three. I did the blood test. IgG? IgE? 

Dr. Eric: 

Food sensitivity testing? 

Alexa: 

Yes. I did that as well. I avoided the top things on my list. It was flax seeds, chickpeas. For the most part, I still to this day avoid those things. I don’t know if I still am sensitive to those or not. 

What I did find when I did AIP though was sensitivities to other things that did not show on that list at all. Gluten didn’t show up on that test, which I was so happy about at the time. When I decided to give it up, I saw changes in the way that I felt. I know you have mentioned that before. That test may not be the most accurate or helpful. 

Dr. Eric: 

You were eating gluten at the time you did that test? 

Alexa: 

The sensitivity test? 

Dr. Eric: 

Yes. 

Alexa: 

Yes. 

Dr. Eric: 

You need to be eating the food for it to be accurate. If you’re gluten-free for three months, we would expect it to be negative. If you were eating gluten, and it was negative. It’s definitely not a perfect test. People can have false negatives, false positives. There are other issues with gluten. It’s not just being sensitive. It can affect permeability of the gut. 

Alexa: 

Right. I think that’s what’s happening with me. 

Dr. Eric: 

It sounds like you had a lot of success focusing on gut health between AIP, taking butane HCl, colostrum, Rifaximin for the SIBO. Do you remember how long you were on Rifaximin for? 

Alexa: 

I felt like it wasn’t that long, but I don’t remember the exact time frame.  

Dr. Eric: 

30 days or something like that? 

Alexa: 

Probably. 

Dr. Eric: 

When you had SIBO, do you remember having constipation or loose stools? 

Alexa: 

Yes. I feel like especially then, I was having more sensitivities where I would have diarrhea. I haven’t had that at all in more recent years. Certain things would trigger. Soy was one of the first things I noticed that would give me diarrhea, so I stopped eating that. Then maybe some gas and bloating, but I didn’t think that was not normal. It wasn’t necessarily that I knew something was going on with my gut. 

I’ll give you a bit of background. I always had stomach issues as a kid. They originally wanted me to start taking Omeprazole as a kid. I was maybe 10 or 12 years old. I have never been that person. I never want to take medicine for an extended amount of time. I wouldn’t take it, but my mom is a nurse. My mom was like, “Make sure you take it all the time. Then you won’t have these episodes” of what they thought was acid reflux. I probably had the exact opposite. I would never take it the way I was supposed to. 

I eventually got to where I would only take Pepcid as needed. Even now, it took me almost 30 years to figure out that’s not the best thing to do. 

Now, I’m doing more ACV. I’d like to get back on butane HCl or something like that to see if that helps. Again, I didn’t think those things were abnormal. 

Dr. Eric: 

That’s a big problem a lot of people have. They’re on acid blockers temporarily. A lot of people don’t need to be on them when people are on them for months or years. We need stomach acid, so it’s not fixing the problem. A lot of people have low stomach acid, and they might have symptoms that mimic high stomach acid. They are put on acid blockers. 

In the past, you took butane HCl. Now the ACV, apple cider vinegar. It’s good you know what to do now. You took Rifaximin, but for those who are not familiar with it, it’s supposed to focus on the small intestine. It’s an antibiotic, but it’s not supposed to negatively affect the gut microbiome, like the large intestine, where most of the bacteria are. Even that isn’t as bad as taking a broad-spectrum antibiotic or an acid blocker/PPI. 

Also, we should probably mention that one of your goals is you want to have another successful pregnancy? 

Alexa: 

Yes. That’s partially why I think this last time I fell off some of my dietary changes was I got pregnant then. I was taking the methimazole, which is not the best. They switched me to PTU for part of it. Then I was on a lower dose for the methimazole for the rest of my pregnancy. 

I’m very thankful my baby is amazing. She’s perfect. Ideally, I’d like to have another successful pregnancy. Ideally, not on any type of medication, so I don’t have to worry about that risk. 

Dr. Eric: 

Yeah, I understand. Also, when someone is thinking about conceiving in the future, I talk about detoxification because you don’t want to do that while you’re pregnant. While you were working with a functional medicine practitioner, did they give recommendations to reduce your toxic burden? 

Alexa: 

No. 

Dr. Eric: 

Gut health is very important. That’s arguably even more important. Everything is important. Adrenals, gut health, liver health. You definitely want to focus on gut health. You’ve had a lot of success with that. 

I always have patients do things to reduce their toxic load. A lot of it is environment, trying to do as much as you can through the food you eat; try to eat organic whenever you can; try to eat vegetables, especially cruciferous vegetables, like broccoli; try to support detoxification; try to use natural cleaners and cosmetics in the home as much as you can. 

Alexa: 

I do that. 

Dr. Eric: 

Purified water. Try to avoid tap water and water out of plastic bottles on a regular basis. I do sometimes recommend supplements like NAC, which helps support glutathione production. Sometimes, I’ll give other recommendations. 

Some of it might depend on some of the testing we do. Even if you go all out from a diet perspective, the products you use in your home, which it sounds like you’re aware of that and are trying to use more natural products. 

With gut health, getting back to that. In my book The Hyperthyroid healing Diet, obviously the book focuses on diet. I have a section that goes beyond diet and lifestyle. I do think it might be worth going back on AIP because you mentioned that’s when your antibodies dropped tremendously. Maybe going on it for at least 30 days, if not another two or three months. 

In combination with that, if you should follow another SIBO protocol, I wouldn’t go on Rifaximin again. If you are experiencing any of those symptoms, which it seems like it’s been better recently. If you feel like SIBO might be an issue, you can always do another breath test, and either go back on Rifaximin, if it was positive, or herbal antimicrobials you can take. 

You said you had a comprehensive stool test done also? Did that show anything significant as far as you remember? 

Alexa: 

I remember there was fat in my stool. I can’t remember anything other than that. There were no parasites. I went to the Dominican Republic a couple years prior and got sick. I am trying to go back and trace back to see when did I start having these gut issues? 

Dr. Eric:

I’m sorry to interrupt, but was it food poisoning? 

Alexa: 

Potentially. It was not a parasite linked to that. Since I went on that trip, it felt like I had been having these gut issues. Maybe that was a trigger. Or maybe it was just happenstance. I’m not sure. There was no parasite there. 

Dr. Eric: 

When was this trip? 

Alexa: 

Dr. Eric: 

Okay. A couple of things. First of all, I don’t do stool testing on everybody, but over the years, I have done a good amount of it. it’s not perfect. You could have parasites, even though it’s negative. That’s one thing to keep in mind. 

Also, the reason I asked about food poisoning is because a lot of cases of SIBO, they found out a number of years ago was caused by food poisoning. There is an autoimmune process against the migrating motor complex, which is the cleansing wave of the small intestine. Because you don’t have that cleansing wave, that causes the buildup of bacteria. That is a possibility. 

I am thinking probably either parasites, and it was a negative stool test, or potentially SIBO, especially since you were diagnosed with it, and the Rifaximin helped. 

The hope is parasites because the problem with the migrating motor complex, I mentioned that as far as I know, there is no permanent solution once you get that damage. If it’s due to food poisoning, you can’t reverse it. You can treat SIBO. 

There is what’s called prokinetics that someone can take to help with the motility, so the SIBO doesn’t come back. I guess that’s something maybe to look into. It’s ultimately up to you as far as if you want to do another in the future, whether go back to that functional medicine practitioner or go to someone else and do another SIBO test. 

There is a test. It’s not a popular test. You can actually test to see if you’re having antibodies against the migrating motor complex. Dr. Mark Pimentel developed it. I forgot. I can look that up and let you know about that if you were interested in that. 

Like I said, diet and lifestyle. AIP, since you were so successful in helping lower your antibodies with that. It makes sense to go back to that. If SIBO is an issue, and if it came back. It sounds like it’s not really bad as far as the symptoms. It’s one of those things. 

You could always try AIP first and see how you feel gut-wise before spending money on testing. If you feel great with AIP, maybe you don’t need to do testing. If you’re still having some digestive symptoms, then maybe you might want to look into doing another SIBO retest and/or another comprehensive stool test to see what’s going on. If SIBO is an issue, then you do either the Rifaximin or an herbal approach. 

Doing a stool test didn’t show that much other than the fecal fat, fat malabsorption. 

Alexa: 

There may be other things, but I don’t have it. 

Dr. Eric: 

It’s very common to have some dysbiosis, which is an imbalance in the gut flora. You might have some things that were high or low. That’s very common. It depends on what was high or low. It sounds like maybe nothing really significant that was red flagged on that test. Like I said, it’s a challenge because parasites could be negative. 

I did an interview with Dr. Ami Kapadia on the podcast, and she spoke about another company called Parawellness that focuses on parasite testing. I have had a few people do that, where it did pick up parasites, whereas something like the GI Map didn’t. The downside is that is all it looks at. If someone wants an overall look at the large intestine, I usually recommend the GI Map. Like I said, for parasites, sometimes things don’t show up on the GI Map or GI Effects or whatever stool test someone does. 

I would say your next steps would be think about going on the AIP diet again for at least 30-90 days. Maybe just do that, and see how you feel. If you’re still having symptoms, maybe look into some of the testing that you’ve done in the past, especially the SIBO test. 

Alexa: 

Sounds good. 

Dr. Eric: 

Thank you again for doing this health audit. It was great having this conversation. Feel free to keep me posted. Shoot me an email in the future. Let me know how things are going. 

Thanks, everyone for listening. Again, hope you enjoyed this conversation. Look forward to catching everyone in the next episode.

Recently, I interviewed Jim LaValle, who is a clinical pharmacist and author. In this episode he talked about how specific peptides like BPC-157 and KPV can support gut health, reduce inflammation, and potentially accelerate healing in those with autoimmune thyroid conditions. He breaks down the mechanisms in layman’s terms, including how gut permeability and chronic stress can feed into conditions like Hashimoto’s and Graves’. 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 James LaValle. We are going to talk about peptides. James is the author of The Peptide Handbook, second edition. Let’s go ahead and chat about his impressive bio here. 

Jim LaValle is a clinical pharmacist, board certified nutritionist, and author with 40+ years of experience. He specializes in precision and performance health, integrating metabolic-based care. The founder of Metabolic Code Enterprises, he has taught at institutions like University of Cincinnati and George Washington School of Medicine. James LaValle has worked with elite sports teams, military, and first responders, optimizing performance and recovery. He has authored 26 books, including Cracking the Metabolic Code, and over 200 articles. He currently serves as Chief Science Officer at Life Time, leading scientific initiatives toward longevity and performance programs. Welcome, Jim. 

James LaValle: 

Great to be here. How are you doing? 

Dr. Eric: 

Great to have you. I’m doing well. Hope you are. 

James: 

I am. 

Dr. Eric: 

26 books. We recently chatted at a forum. I think you said you’re still working on a couple others. 

James: 

Two coming out this year and two rewrites. I don’t know what it is. I keep getting stuff clustered in my head and got to get it out. That’s very impressive. 

Dr. Eric: 

I don’t know if you have a goal of 50 books in my lifetime. 

James: 

I don’t have a goal. My wife would say, “Get a goal, and get it over with.” Once I establish a goal, then I will hit it, and it will be done. I haven’t done that yet. 

Dr. Eric: 

I’ve only written three books, and I talk about a fourth book. My wife is always like, “What? A fourth book?” I have another 20 in the pipeline, imagine. 

Let’s go ahead and talk about how you also do a lot with metabolic health. We will focus here on peptides. We could talk about anything you want. We could talk about how peptides relate to metabolic health. How did you become interested in peptides? What led you to write specifically the first and second editions of The Peptide Handbook? 

James: 

The first peptide was synthesized and used 100 years ago. That would be insulin. As a pharmacist, I learned about insulin and realized it was a peptide. It was really this evolution. We work on people in the precision health approach. I had a big institute in Ohio, 300-400 people a week. Same thing as other clinics and institutions, teaching about it.

When peptides came to light for the practitioner, it became another very valuable tool in the toolbox for people to try to move people toward wellness more quickly. The way I best describe that is for example, in my son, 10 years ago, when he got hurt, we used peptides on him. I was working with the orthopedic surgeon. He got over this injury in five months when it’s supposed to take 12-18 months. That was a big aha moment. Ever since then, utilizing them, I see that it moves the needle on restoring homeostasis in someone. 

Just so people understand, all peptides are are signaling compounds that are made in your body that are smaller than proteins and bigger than amino acids. Peptides are made from a small sequence of amino acids. They can only get to so big before they’re considered either biologics as drugs or proteins. 

Peptides are a natural part of our body that we should be using. Either due to injury or age or duress or intoxication of the exposome, somehow, we stop making them. We need to get more of them in order to heal. 

That’s the journey for me. It was self-discovery and realizing that peptides- There are 150 peptides in the funnel right now, in the world of pharmacy and drugs. That’s what we’re using. 

Dr. Eric: 

You said it took your son five months to heal from that injury?  

James: 

Not only was it only five months. He got injured during the second weekend of the California football playoffs. He won the state championship; he was an all-state football player, division 1. He gets hurt, and he wants to do track his senior year. He ends up within five months winning the discus championship for the state of California, which is arguably the hardest in the country to win. He had to spin on that injured foot in order to curl that disc a couple hundred feet. The amount of torque you have to put on that foot is pretty amazing. To have that in five months. 

He had a great surgeon, too. Not going to say the surgery didn’t make a difference. Usually when you get a Lisfranc injury, you got a big old sausage foot. He had no swelling, virtually no discoloration. It was just strange how it healed so fast. 

The next 300-400 people I saw that our clinics utilized them on, I saw an equal type of response, where, whatever the target was, whether it was healing the gut or an injury or a tendon tear or cognitive capacity or reducing anxiety or getting more energy, sleeping better, the peptides seem to help people cross that threshold to wellness way quicker than they normally would have.

Dr. Eric: 

From what I understand, it’s not replacing foundations like diet and lifestyle, but it helps accelerate that process. 

James: 

I don’t think you could ever escape from diet and lifestyle. We are still looking for the miracle pill. The fountain of youth pill. It’s live healthier, understand how to enjoy your life, learn what is the right food for you to eat, and stay within a social context as you’re aging. Chances are you will live a long time one way or the other. If you get injured or develop autoimmunity or have some sort of accelerated aging, peptides will probably help you restore that homeostasis. Another tool in the toolbox, that’s all I try to get across to people. 

Dr. Eric:

Let’s talk about autoimmunity. A lot of the listeners have thyroid conditions. You’re probably aware that most thyroid conditions are autoimmune in nature. What are some of the most helpful peptides for those with Graves’ or Hashimoto’s? 

James: 

In Hashimoto’s, for example, often it’s due to a permeable gut. The gut breaks down. You start creating more lipopolysaccharide because the lipopolysaccharide is released from the bacteria that are no longer surviving. The bacteria die off and release a bunch of lipopolysaccharide. 

Because the gut is leaky, it gets into circulation. It gets into the liver. The intestines should be taking it out, so when you overwhelm it, it can’t. The lymph as well. Then it attaches to the thyroid and triggers that inflammatory response in the thyroid. 

In addition to that, once the gut gets leaky or permeable, you start to react to higher lectin foods, things like gluten and dairy and other food sensitivities. They contribute to Hashimoto’s, food antigen induced thyroiditis. 

The big ones for the gut, one is BPC157, which is allowed as a dietary supplement. BPC157 helps restore the damaged mucosal barrier that allows for gut permeability. That is just one of the main functions. There are other functions to it, but in relationship to autoimmunity, that is the big function.

The other one is a three amino acid peptide called KPV, which acts as something called a TNF alpha inhibitor. 70% of your immune response is in the gut. A lot of TNF alpha gets triggered with a permeable gut. Drugs like Enbrel, which are biologics or other autoimmune conditions, are working to dampen TNF alpha. KPV is a peptide that could help to dampen the inflammation signaling going on in the gut.

The third one, which is very interesting, and has just come to light over the last few years, is one called larazotide. It basically lowers zonulin. What happens, either due to infection or stress or you end up releasing more zonulin. Zonulin makes the tight junctions, so these are the cells of the intestine. Now you’re getting bacteria translocation, bacteria fall through the food. The food isn’t digested all the way. You’re getting reactions to the food. 

High zonulin is real problematic and associated with a lot of different health conditions, including autoimmunity. Larazotide lowers zonulin and allows the gut tight junctions to come back and be aligned. 

That of course is in light with what you said earlier. Do you have adequate glutamine? Do you have adequate zinc? Do you have the nutrients? Do you have enough fiber to make butyrate to repair the epithelial cell? All of that plays together. Those are three really big peptides related to gut and autoimmunity. 

Of course, one of the ones that got taken out with the FDA’s actions is thymosin alpha 1. It helped with immunomodulation. That can be really important because obviously, what we are trying to do is balance our immune response. Turns out when the gut gets permeable, you start creating more histamine response, more inflammation, more antigen antibody response. You’re wanting to throw a big bucket of water on that fire. 

That’s where peptides accelerate the ability to do that. When you used to have to struggle for eight months to help get people’s guts aligned, now it’s happening in a few months, and they’re feeling the difference. 

That was a pretty short answer for all that. 

Dr. Eric: 

To summarize, BPC157 to help with the mucosal barrier. KPV, which is a TNF alpha inhibitor. Larazotide, which helps lower zonulin, and can assist with the gut healing process. Then thymosin alpha 1 is no longer available, but there are other peptides that could- 

James: 

TA11 will be out shortly. It’s compliant. I think TA1 is going to come back in the short run. I think we’re going to see it change its status on TA1 over the next 60 days. Visited Washington on the compounding issue a couple times. I was in front of the FDA. I think TA1 probably has a really good shot. 

I think some other ones will come back as well related to longevity, like epitalon or delta sleep inducing peptide will probably get a shot. I think there will be some positive moves related to that. The GLP1s, pharma will say we need to have that space. We’ll see what happens. 

Dr. Eric: 

Taking those three peptides alone that you mentioned can have a dramatic impact on pretty much any autoimmune condition. All autoimmune conditions are associated with that increase in intestinal permeability. 

James: 

Without a doubt. Where it gets powerful is when you combine nutrition. Hey, what will I do to kill the bad bugs? Put some beneficial flora back in. Add fiber, so the microbiome can make butyrate. Do something like Moducare, which is really good for immunomodulation. There are some great human studies on Moducare. It creates a good basis. 

When you layer those peptides on the nutrition and dietary changes that you make in autoimmunity, because of course you will make changes on diet with autoimmunity, right? It just makes them stick quicker. People get better faster. No aching. Not noticing the visual disturbances. I’m not as puffy. Gee, my belly isn’t bloated. It really is I think one of the most significant things to come out over the last 25 years: the more random acceptance and awareness of peptides. 

Dr. Eric:

I know everybody is different. On average, how long do people take these peptides for when dealing with an autoimmune condition? 

James:

At least a good 12 weeks. You may be on them for quite a while. It may take six months. It depends on the individual as to how they’re feeling. They could always take a break. I tend to want to keep people on them until I feel really comfortable, and my staff or a dietician feel really comfortable. You’re in a good place now; let’s start to reverse titrate you out of this. See if it sticks.

The beauty of it is if they need a peptide, the side effect profile is way less, especially if you’re not injecting them. One of the big issues that the FDA brought up was the immunogenicity. If you inject it, the immune system gets after it and attacks it because of the injection into the tissue. 

Other than the secretagogues, the sermorelin helps release the growth hormone, which is also important because it helps retain circadian rhythm for your body. You start making the hormones and sync them when you use things like sermorelin at bedtime. The secretagogues are probably the only ones that might- You might get injection redness or irritation depending on what it is. The secretagogues are the only ones I have seen over the last decade where it could potentially lead to getting a welt or wheel or rash, in which case they have to discontinue it. Start back really slow after a couple months, a tiny amount, almost as if they were doing an allergy vaccine. Build back up to it, and tolerate it.

On a secretagogue, you would only do it five days out of seven because of the immunogenicity risks. Five days on, two days off. 

Dr. Eric: 

With BPC157, I know you could take that orally. Are those other two only injections, or can you take those orally, too? 

James: 

Larazotide is great orally, as is KPV. Full disclosure: we have played with patent pending process of a solid-state liposome that had patent pending for all drugs, all nutrients. It was initially made to deliver oncology drugs and opioids in the European market. It’s particularly good at delivering small molecules. 

Peptides are really small. You can wrap them in this solid-state liposome chewable. We have seen dramatic results partnered with compounding pharmacies to experiment on these things. Obviously, the BPC and KPV actually qualify as dietary supplements in their natural state. We are seeing really great results with them orally.

In the end in certain instances, injection is going to be favored. If you want to build collagen in your skin, copper peptide is best. If you can inject GHKCU, it’s great. Now of course, for working around that through microneedling or driving the medicant through the skin, so they can do that way, too. 

I do think new technologies are around that will allow us to deliver these things in a more elegant and easier way. Some people get injection fatigue. I’m getting tired of sticking myself. 

Dr. Eric: 

Since you’re a clinical pharmacist, I wanted to ask you about potential interactions, especially those taking- Pretty safe when it comes to thyroid hormone replacement. I don’t know of any interactions. But people with hyperthyroidism who are taking antithyroid meds like methimazole or beta blockers. Are there any known interactions with at least any of those medications? 

James:

If you’re on beta blockers, and you give a GLP1, it’s a little bit of concern as your heart rate will go up. Honestly, the other benefits are so big, it doesn’t matter. There is a known interaction with methimazole. I’ve seen no issues with thyroid. 

The only thing I’ll say is people who are taking thyroid hormone, you start to correct their chemistry, and their cortisol is coming down. Thyroid hormone receptors come back to life, and you will have to adjust that dose down most likely. 

Same thing if your cortisol is elevated, and you’re wanting to use kisspeptin for stimulating gonadal release of hormones. Once cortisol is under control, cortisol competes with testosterone and estrogen receptors. You get your cortisol under control, and your hormones are starting to work better. It’s giving that full thought of understanding. All of these hormones are in sync. All these peptides are part of that cascade or symphony, where you’re creating a harmonic signal for “I’m healthy.”

As a practitioner, you want to watch and go, “Okay, they’re still doing well. Maybe I can lower something or even get off of it.” 

Dr. Eric: 

Makes sense. Let’s talk about some other peptides. Weight loss is a hot topic. I know you said GLP1s might not be available, it sounds like, in the near future. Feel free to talk about them. I don’t know if there are other peptides that also can help with weight loss. 

James: 

There will be other GLP1s available through compounding pharmacies. They will be there. Phase 2 or 3a. Researched peptides. I don’t have a crystal ball to look into the middle of that, and it’s way above my pay grade from the legal side. When you think of the magnitude of the companies that are making GLP1s, Nova and Lily. I can’t gaze into the crystal ball.

I think GLP1s are super important. They are one of the most significant drugs to be developed for the U.S. in particular, or what I would say morbidly obese countries because Canada is following us fairly closely. 

There is a big controversy, “Oh, it’s cheating to use a GLP1.” Then there was, “You only lose lean mass; you don’t lose fat,” which is absolutely a lie. It’s not a fact. GLP1s actually stimulate muscle synthesis. When people undereat, they are going to get catabolic and lose muscle and lose fat pads on their face. 

Given that you use a GLP1 correctly, and I am big on teaching at least at the American Academy of Anti-Aging Medicine, and what we are implementing at Life Time, is titration to where you are losing weight, about two pounds a week. Keep at that lower dose. When you go to get off it, your body isn’t so dependent on it. Hopefully, at the same time, you’re implementing lifestyle changes, like exercise, diet, stress reduction, better sleep. Those are four biggies. How do I manage those four things? 

In that criticism, I laugh because people who are trying to say GLP1s are cheating is like saying taking insulin is cheating. Nobody would deny anyone insulin because they die really quick. The only difference is when you’re not getting a GLP1, you die a slow, miserable death. You get pulmonary hypertension. You get ventricle failure. You get cardiac remodeling. You get fatty liver. All the complexes of insulin resistance and type two diabetes come crashing down on a person. 

The challenge is if we’re using it as a miracle again. Societally, we’re not doing enough to teach people, “If you want to use this to lose weight, you need to use it as the bridge to adopting a healthier lifestyle,” which I don’t think that message gets out too much or nearly enough. 

Dr. Eric: 

Very true. That’s good to know. I’m glad you mentioned how GLP1s actually stimulate muscle synthesis. Also, it’s a slow process. Like you said, two pounds a week, which is losing weight at a healthy rate. You don’t want to lose 10 pounds a week.

James: 

The protein targets 1.6g/kg. That’s the one that says you’re not going to lose lean mass. Yes, exercise. Exercise to stimulate lean mass as well. Those are the things people should be doing if they’re trying to lose weight. 

I have been around this business for 40 years, like you said in my introduction. 40 years, I have seen the HCG diet. Everybody jumped on that. “Oh my god, it’s a miracle. Look how much weight I lost.” They abused it. They didn’t change their lifestyle. Three times a year, they are going back to use HCG, and by the third year, it’s not working anymore. They have just lost a bunch of lean mass, which is the currency of your health, aging process, and metabolism. 

If you just take a GLP1, and you don’t do anything else, a third of your weight will be lean mass, not weight loss. If you lose 20 pounds, about seven of it, 6.75 of it, is going to end up lean mass and not fat mass versus doing it a little slower, eating enough protein, and burning off the fat. 

We’re talking about this at Life Time. People need to lose 20-30 pounds of weight, and nothing has worked to get it off. It’s because they’re insulin resistant. They’re under stress. They’re probably eating too many carbs and sugars. Who knows what their exposome burden is? What their glyphosate is at, which messes with insulin receptors. Is your gut permeable? When your gut is permeable, and you’re releasing all these inflammatory cytokines, that turns off your insulin receptors. 

That’s the GLP1s. I think they’re really important because people have themselves backed into a corner. 

Dr. Eric: 

I definitely agree. If someone is 50, 75, 100 pounds overweight, even 25 pounds overweight, time and place for that. How long can someone safely take them? If someone is 50 pounds overweight, and they’re losing an average of two pounds per week, and they are incorporating the foundations, eating enough protein, doing strength training, is it safe for them to be on it for 25 weeks to achieve their goal of 50 pounds?  

James: 

Look, there are diabetics who have been on them for years. It’s safe for people to stay on them until they hit their target weight. There are people who may need to be on them on a microdose. It’s showing up a lot. Even in the literature, there is starting to be this rumbling of microdosing.

In my opinion, I come by weight loss honestly. I have run weight loss clinics. I had a contract research organization on weight loss clinics. My brother was 476 pounds. My mother was obese. My father was a type 2 diabetic that was obese. My aunts and uncles, all a bunch of little Italians who tended to be overweight. 

If you had to stay on it for the rest of your life on a small dose in order to keep the weight off, I don’t have a problem with that. That excess weight will kill you really quickly. If you’re a diabetic by age 30, you will lose 13 years of your life. That study just published. 

I am a big fan of trying to get people to titrate off when they hit goal and see if their diet and lifestyle holds them. If it does, awesome. The older you are, the harder that probably is because you have trained your body in a certain metabolic signaling pathway that may be hard to reset, but you don’t know until you try. 

Dr. Eric: 

Very true. Hair loss is very common in those with thyroid conditions. You want to address the cause of the problem. If the thyroid hormone imbalance is the cause, you want to address that. Still, sometimes, they will address the cause of the problem, and the hair won’t grow back, or not as quickly as they want. I know there are peptides that can help with hair regrowth. 

James: 

The big one is copper peptide, GHKCU. The other two, BPC and TB4. TB4 is another one that is probably going to come back. Topically, there’s peptides for topical use for the hair that are accepted because they’re more cosmeceuticals. When you start to combine thymic peptides with copper peptide, which helps with collagen synthesis and gene regulation. When you think about your hair bulb, you get a lot of inflammation there, and that changes gene transcription in the hair bulb. The GHKCU helps modulate that. 

Then there are a couple of things that work with it as well. Melatonin and caffeine are interesting topicals to go with peptides. Using PRP, platelets are spun down and getting the plasma and injecting that with the peptides, that’s been a stable process for a lot of folks that I know. It’s involved at the American Academy of Anti-Aging Medicine on hair restoration.

Once again, topical BPC. Thymic peptides. Copper peptides. Actually, an interesting compound that is used is a senolytic called rapamycin. They are finding a lot of success with rapamycin topically. It’s a powerful drug. 

I tend to say to start with the topical melatonin, topical caffeine. Usually, people will see benefit, especially if they are including red light therapy with it, to get the good red light therapy helmets. It can do really well. I have had a lot of success with it with COVID long-haulers who lost their hair, especially women who lost 50% of their hair. Same issue, immune system got fired up, and hair came out. 

Dr. Eric: 

I’m sure it’s something that takes a while, where they are using the peptides for a few months rather than a few weeks to get some significant hair regrowth. In combination with that red light therapy helmet, correct? 

James: 

Correct. I tell people all the time that it takes six months. Once again, great teachers are your family members. My spouse had COVID, and she had long haul signs. She lost a lot of hair. She had a lot of hair, but she lost a lot of hair. It was very concerning for her. 

It was interesting because yesterday, we were doing QEEG assessments. The guy said, “My god, I can’t get this helmet on your head because your hair is so thick.” That’s what we did with her. We used the peptides. Her hair came back really beautifully. It took about six months, but it grew back to its original luster. You can’t ask for more than that. 

Dr. Eric: 

Definitely agree. Have you had any success with alopecia areata, like autoimmunity? If so, would it make sense to incorporate some of the gut healing peptides that you mentioned earlier, like BPC157 and the others? 

James: 

I think there are a couple things you want to talk about there. A lot of times, alopecia areata, you have high cortisol levels. If you wanted to use intranasal sprays of Selank or Semax, which help dampen someone’s anxiety, that could be fantastic.

Yes, you would want to work on their gut. Yes, you would want to do something topical. It’s a little more layered in complexity because you have multiple systems that are interplaying there. Most of my alopecia cases are stress-induced. 

Dr. Eric: 

That’s interesting. Stress is a big factor with a lot of conditions. You won’t get rid of the stress, but trying to do things to manage stress, improve stress handling. Definitely could make a big difference. 

James: 

Nervous system in a modern world. It’s very difficult. Getting people to get to sleep at night, that’s where the growth hormone secretagogues, like sermorelin. When you’re stressed, you lose your secretagogue action on growth hormone. That’s pretty important for resetting your master sleep clock. The superchiasmatic nucleus that is responsible for all the mini clocks in all your organs. When people do sermorelin, they typically report they are sleeping so much deeper. 

Another big area. When you’re under stress, by default, you shut down your gonadotropin releasing hormone. You shut down your growth hormone releasing hormone. You want to reset those. I think it’s critical for people, but they work at that. Great peptides for sleep that I think will be back on the market. You can do things like bioregulators, which are natural approaches to doing a peptide. 

Epithalamin, which is basically Epitalon. Epitalon is a peptide that has to do with signaling of longevity in getting all your circadian clocks to align. That’s a pretty interesting compound as well. Epithalamin or Epitalon. 

Dr. Eric: 

The question everybody wants to ask, but it’s different with everybody. When taking these peptides or bioregulators to help with sleep, could they get results in a few days or a week or two? Is that something where it’s also a few months before they really notice a difference? 

James: 

Great question actually. People start noticing sleep a little bit quicker. You have to realize that sleep is a disorder of hyperarousal. Your brain gets jacked up and gets hyperaroused. It thinks a white tiger is chasing it at bedtime. In fact, it was just one too many texts or emails. You’re staring at your phone before you go to bed. You’re telling your body, “It’s a white tiger.” You have to work on correcting that one way or the other. 

What I find on peptides, the older you are, the more you probably would stay on a peptide. As you age, sleeping and the regulation of your circadian timing becomes more difficult. If you’re on beta blockers, that depletes melatonin, so that becomes more difficult. Now you don’t have melatonin on board. Therefore, you are always taking melatonin if you are on a beta blocker probably.

Once I get people to understand calming their stress during the day, peptides like Selank or Semax help calm stress during the day. Eventually, you may not need anything to sleep at night because you have appropriately reset that circadian timing of your hormones. Then you kick back in your melatonin production like you should versus when you’re under a lot of stress, you don’t make melatonin. Delta sleep inducing peptide, you don’t make much of that, so you stay awake. Or you go to sleep and wake up at 3am, making a list.

Dr. Eric: 

Just to confirm, it is safe to be on these long term, for good if you need to? I know everything is risks versus benefits, just like you said with weight loss. If you have to be on a low dose GLP1 rather than gain the weight back. Similar with the sleep. Sleep is essential, so maybe there is a time and place for weaning off. If you need to take the peptide in order to get quality sleep, then the benefits outweigh the risks. 

James: 

Right. I am a big believer on a lot of these peptides, like the mitochondrial peptides. People have heard of MOTS-c or SS-31. There are things that should be seasonally applied. Just like the Epitalon I talked about that resets the circadian rhythm, every six months, you do it for 10-14 days. You don’t do that all the time. There are certain families of peptides where you have a seasonality to them. 

There are other ones where as you’re getting older, or if your immune system is really off, and it’s really helping you, why get off? like I mentioned, the sermorelin, you should be taking two days off out of the week. Some peptides, you do every three days. In the book, it details how to dose those things. 

Dr. Eric: 

Okay. Thymic peptides are every three days? 

James: 

Right. 

Dr. Eric: 

Okay. Can I put you on the spot and ask you what peptides you take? I don’t know if there are regular supplements for you, where you take a dozen or more. What are at least a few of the main ones that you take? 

James: 

I take a small molecule called OS-01, which is not a peptide but a tiny little molecule. That regulates AMPK and induces autophagy. It’s great for lean mass retention.

I’ll periodically use a GLP1 because of my family history. I don’t have to dose it all the time, but I’m one of those people who does better if I do a little bit of it.

I’ll do sermorelin because of my age. I turned 65, and I want to keep producing some growth hormone.

I utilize BPC and KPV pretty regularly in a chewable tablet because I grew up living on antibiotics as a child. I had severe candida. I had allergies and did have obstructed breathing; it wasn’t officially asthma. I had rashes. All of that stuff led to a leaky and permeable gut. Because I still work out fairly hard, I like being on a little bit of KPV and BPC just to protect the gut, decrease inflammation signaling. 

I don’t inject all day every day. I am not doing six peptides four times a day. I am very selective. I will have periods of time where I go off the sermorelin. I have periods of time where I may not take KPV. I went weeks, months without taking Ser peptide. I try to be selective and ask what my body needs.

I certainly take a fair amount of nutrients, and I watch my diet. That’s the core. I exercise. Those are probably the most important aspects of my health journey. I think peptides augment it and put a cherry on top of the journey. 

Dr. Eric: 

Very informative. That first one you mentioned that you took, for the lean muscle mass retention, is it OS-01? 

James: 

Yes. 100mg, daily, six days, six weeks on, four weeks off. Really interesting small molecule. I have seen a lot of results with that. Losing fat mass, gaining lean mass without having to knock yourself out. It’s an interesting one. Because of its mechanisms of action, it burns fat and retains lean muscle and signals building of lean muscle. When you combine that, say for example with a GLP1, it’s an interesting combination.  

Dr. Eric: 

That’s orally? 

James: 

Yeah. It’s an oral capsule, 100mg. 

Dr. Eric: 

The GLP1, you say you take occasionally because of your family history. Do you take it for a month or two at a time, and then you take a break for six months? 

James: 

Because of what I do, I’m around- I dose fairly intuitively, so I would say probably every other week is the way I do it. I’m pretty solid at every other week, 2.5mg. That isn’t a microdose; it’s within the range of dosing on it. Every couple weeks, it tends to keep me where I want to be. 

Dr. Eric: 

Wonderful. Thanks for sharing that. There are plenty more peptides in your book, so I don’t want to steal the thunder. We’d have to spend a few more hours, maybe the whole rest of the evening, talking about them all. Any others that you really wanted to talk about? Did we hit the major ones during this conversation? 

James: 

I think we hit the big ones. I mentioned Epitalon. That is incredibly important. Epitalon and Vilon are the big longevity peptides that as people continue to want to reach for being healthier as they age, to maintain their vitality, those are biggies. I know I mentioned Epitalon a little bit. Those are really big. 

My gosh, there is Cerebrolysin or thymosin beta 4. Obviously, the MOTS-c I mentioned. There is a lot to go into that. How do you repair your mitochondria as you’re aging? They get damaged as you age, so you’re not making energy like you should. That’s a topic for another interview. Maybe you could have me back, and we could talk more about peptides. 

Dr. Eric: 

Yeah. Or your future books or past books. I’m sure we’ll have plenty to talk about with future interviews. 

The final question related to the contraindications. I know we spoke about some of the medications. For example, pregnancy, breastfeeding, children. What contraindications? 

James: 

When women are pregnant and breastfeeding, all things are off, other than what the OB-GYN says. I don’t play there. It’s just too many unknowns in terms of peptides.

With children, it depends on what you’re trying to accomplish. You’re not trying to create growth hormone on a normal child. Maybe they need some gut help because they have eosinophilic esophagitis, and you are trying to quiet that mucosal barrier. 

There isn’t a lot of evidence around peds in the use of peptides. You have to rely on the individual wisdom of the practitioner to think through what they might consider doing. 

Obviously, the GLP1s, endocrine, type 2 tumors, and certain thyroid cancers, can’t do it with. Those things are well known. If you have a history of cancer, you don’t want to do a growth hormone secretagogue because it’s in the literature that it could stimulate it. That’s pretty much it.

Once again, read up. If somebody is really interested in starting on peptides, I’d encourage them, if they don’t buy my book, to get somebody else’s book. Read what they do, and we list what the cautions are on each of the peptides, so you can get an understanding of, “Is this a candidate for me to try?” Once again, people spend more time picking at their refrigerator than picking out what they need to do for their health. They need to spend more time understanding their health. I’d invite them to do that.

Don’t just listen to a podcast off some bro science situation. We discuss this responsibly. You asked me about contraindications. Are there any interactions? Those are a part of the conversation that should be taking place, not just take this for that. I really appreciate that we get to have that kind of conversation. 

Dr. Eric: 

Same here. Definitely appreciate you being up front about the contraindications. There is mostly good with the peptides. It’s not even bad; it’s just that not a lot of research with pregnancy and breastfeeding, just with anything else. People ask me about certain herbs during pregnancy. The truth is, there is not much with certain herbs. We don’t know, and we don’t want to take the chance, to say there’s no problem. 

James: 

“Yeah, just take it.” No. 

Dr. Eric: 

Great. Jim, this was an amazing conversation. Where can people get not only your new book, The Peptide Handbook, second edition, but your other books? Your future books? I assume Amazon. If there are any other places. 

James: 

Amazon is a great spot. They can go to the @TheRealJimLavalle on Instagram. I have a lot of information. They can always look up what we’re doing at Life Time with our longevity centers as well. I’m real passionate about all of it. 

Dr. Eric: 

Wonderful. TheMetabolicCode.com is another website of yours. 

James: 

Metabolic Code is our cloud-based infomatics platform. It targets where the person is metabolically broken. I teach a lot of that at the American Academy of Anti-Aging Medicine, where I am the co-chair. We have meetings there. My biggest regret is I am always on stage, so I don’t get to network and meet people. 21 hours, I was teaching at the West Palm event. It was crazy. 

Dr. Eric: 

Wow. I didn’t know that. You were there that Thursday. 

James: 

Conference event, yeah. 

Dr. Eric: 

That’s awesome. I enjoyed your presentation. Grateful for everything you do. Thanks for sharing your knowledge about peptides. Definitely look forward to having you back in the future. 

James: 

Great, thanks for having me. Real pleasure. 

Dr. Eric: 

All right, thanks again, Jim.