Functional Medicine Research with Dr. Nikolas Hedberg, DC: Recent Episodes

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A new study entitled, “The Efficacy of Palmitoylethanolamide (Levagen+) on the Incidence and Symptoms of Upper Respiratory Tract Infection-A Double Blind, Randomised, Placebo-Controlled Trial” aimed to evaluate the effectiveness of a signaling lipid called Palmitoylethanolamide (PEA) in reducing the occurrence, duration, and severity of upper respiratory tract infections(URTIs).

The results showed that participants who took PEA experienced fewer URTI episodes and had reduced symptoms compared to those who took a placebo, suggesting that PEA may be a safe and effective treatment option for URTIs.

Palmitoylethanolamide (PEA) is a lipid compound that belongs to the N-acylethanolamine (NAE) family and has similar properties to endocannabinoids. In the context of cold and flu infections, PEA is suggested to regulate interleukins and inhibit mast cell production, thereby reducing inflammation.

PEA activates NF-κB pathways through peroxisome proliferator-activated receptors (PPAR), particularly PPAR-α, and concentration-dependent mechanisms to decrease NLRP3 and inflammasome activation, ultimately leading to a decrease in the expression of cytokines and alleviation of upper respiratory tract infection symptoms.

It is worth noting that the natural levels of PEA in the body and the use of PEA supplements have been found to be ineffective in producing significant clinical results due to poor absorption, resulting in low levels of PEA in the bloodstream. However, when PEA is combined with dispersion technology, such as Levagen+, the absorption of PEA is greatly improved, leading to higher concentrations in the bloodstream, which may enable a therapeutic effect.

This study was conducted over a period of 12 weeks. It was a double-blind, randomized, placebo-controlled trial, where participants were divided into two groups: an active group receiving 300 mg of Levagen+ PEA twice a day and a placebo group receiving maltodextrin. The purpose of the study was to investigate the efficacy of Levagen+ PEA compared to the placebo in terms of the incidence, severity, and duration of upper respiratory tract infections (URTI).

During the study, 87 participants out of the total enrolled experienced at least one URTI, resulting in a total of 103 URTI episodes. The group receiving Levagen+ PEA reported significantly fewer URTI episodes (39) compared to the placebo group (64), and a lower number of participants who fell sick at least once during the study (32 vs. 55) when compared to the placebo group.

Participants in the Levagen+ PEA group reported a significantly lower severity score for scratchy throat and cough. Overall, compliance with the study was high for both groups in terms of capsule consumption.

The findings of the study indicate that individuals in the Levagen+ PEA group had a significantly lower number of upper respiratory tract infection (URTI) episodes compared to the placebo group.

The study suggests that Levagen+ PEA could be a viable treatment for preventing upper respiratory tract infections (URTIs) and alleviating symptoms of cold and flu. The findings indicate that Levagen+ PEA is safe and effective in reducing the frequency of URTI episodes and relieving scratchy throats and coughing in individuals with URTI symptoms.

I use PEA Luteolin Select from Moss Nutrition, which contains 300 mg of Levagen+ PEA and 50 mg of the flavonoid luteolin per capsule. PEA and luteolin have been shown to work synergistically in COVID-19-related illnesses such as Long COVID.

I have patients take 1 capsule twice a day with meals of PEA Luteolin Select during COVID-19, cold, and flu season for prevention and then increase to 2 capsules three times a day when they feel like they’re coming down with something.

Hedberg Institute Members can download my latest upper respiratory tract infection protocols by logging in.

Click here to learn more about the Hedberg Institute Membership.

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A new paper entitled “Isorhamnetin protects porcine oocytes from zearalenone-induced reproductive toxicity through the PI3K/Akt signaling pathway” investigated the effects of a natural flavonoid called isorhamnetin on the damage caused by a toxin called Zearalenone (ZEA) to pig oocytes (immature egg cells).

Zearalenone (ZEA) is a harmful mycotoxin found in moldy grain like corn, oats, and millet that can cause irreversible damage to the reproductive system of animals and humans. It can cause reproductive disorders by binding to estrogen receptors and has been shown to impair the development of sperm and oocytes in humans and animals.

ZEA can cause oxidative stress that leads to the production of reactive oxygen species (ROS), which can be harmful and contribute to cell death.

ZEA can also disrupt pregnancy, inhibit the meiosis of oocytes, and induce mitochondrial damage and stress in the maturation of oocytes. Since ZEA is heat-stable and cannot be completely eliminated from the food chain, it is important to explore potential compounds that can protect against ZEA-induced damage to oocytes.

In recent years, natural substances called flavonoids, which have antioxidant properties, have gained attention for their ability to support the development of oocytes. For example, quercetin has been found to increase the proportion of porcine oocytes developing into blastocysts, while kaempferol has shown potential in reducing the negative effects of aging on the development of porcine oocytes by improving mitochondrial function and reducing oxidative stress.

Isorhamnetin is a compound found in the herb ginkgo biloba and in foods like pears, onions, and peanuts. It has various pharmacological activities, such as being an antioxidant, anti-inflammatory, and antiviral.

Isorhamnetin acts as an antioxidant by decreasing the production of reactive oxygen species (ROS) and increasing the expression of SOD2 protein, which helps protect against oxidative stress.

This study found that isorhamnetin can protect the oocytes from ZEA-induced damage by improving their development, reducing oxidative stress, preventing mitochondrial dysfunction, and inhibiting apoptosis.

This research provides a potential solution for reproductive toxicity caused by ZEA and treating female infertility.

Mold Toxicity and Ginkgo Biloba Clinical ApplicationsGinkgo biloba is rich in isorhamnetin as well as other powerful flavonoids like quercetin, kaempferol, and luteolin which makes it the perfect herb for patients with mold toxicity.

Ginkgo biloba has many benefits including anti-inflammatory, antioxidant, antiviral, anticoagulant, anti-obesity, hypolipidemic, hypotensive, anti-diabetic, anti-cancer, adaptogenic, and it protects the brain, eye, inner ear, heart, liver, cardiovascular system, reproductive system, lungs, and kidneys.

Patients with mold toxicity tend to have reactivated herpes viruses like EBV, CMV, and HHV-6 and ginkgo biloba is effective against these types of viruses as explained in this article.

I use VascuSelect from Moss Nutrition which contains 120 mg of standardized ginkgo biloba extract along with grape seed extract and mango extract to further support microcirculation. 120 mg of ginkgo biloba twice a day is the usual dose for this versatile herbal medicine.

If you’re a practitioner who sees patients with mold toxicity and/or infertility, then VascuSelect should be considered an important part of your protocol.

Click here to learn more about the Hedberg Institute Membership to take your functional medicine practice to the next level.

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A new paper published in the journal Science entitled, “Persistent complement dysregulation with signs of thromboinflammation in active Long Covid” sheds light on the causes of Long COVID.

The authors begin by pointing out the current hypotheses about the causes of Long COVID, including persistent inflammation, autoimmunity, tissue damage, and viral reservoirs.

In this study, researchers followed 39 healthy individuals and 113 COVID-19 patients for up to a year to identify biomarkers associated with Long COVID. At the 6-month follow-up, 40 patients still experienced Long COVID symptoms. They collected blood samples and measured over 6500 proteins to identify potential biomarkers using computational tools and experimental evaluation.

In patients with Long COVID, there was an increased activation of the complement system, which is a part of the immune system that helps fight pathogens and damaged cells. This activation persists even after the acute phase of the disease. The complement system can cause damage to cell membranes, and in Long COVID patients, there is an imbalance in the formation of a complex called the terminal complement complex (TCC), also known as the membrane attack complex (MAC), which contributes to tissue damage.

Long COVID patients experienced increased markers of tissue injury in their blood, along with a thromboinflammatory signature. This means that there are signs of damage to tissues and an abnormal immune response involving the activation of endothelial cells and the breakdown of red blood cells. These findings suggest that Long COVID is associated with ongoing inflammation and potential blood clotting issues.

In patients with Long COVID, there are lower levels of antithrombin III, a protein that helps regulate blood clotting. This leads to increased cleavage by thrombin, which is a key factor in the formation of terminal complement complexes (TCCs).

Additionally, Long COVID patients show elevated markers of platelet activation and the presence of monocyte-platelet aggregates, particularly in cases where Long COVID symptoms persist for 12 months or more.

These patients also exhibit signs of antibody-mediated activation of the classical complement pathway, which is associated with increased levels of antibodies against cytomegalovirus (CMV) and Epstein-Barr virus (EBV).

In this study, the researchers also used a sensitive test to measure antinuclear antibodies (ANA) in patients with Long COVID. They found that patients with Long COVID had a higher prevalence of positive ANA results compared to those without Long COVID. Positive ANA tests can indicate autoimmunity.

Based on the data presented, it is suggested that Long COVID patients should undergo early cardiovascular assessment due to potential cardiovascular complications. Additionally, antiviral medications targeting SARS-CoV-2 or herpesviruses may help reduce inflammation and blood clotting in Long COVID patients. Therapies that target the terminal complement pathway could also be explored as potential treatment strategies for Long COVID and other post-infection syndromes.

Long COVID Clinical ApplicationsThis paper confirms that inflammation of the blood vessels is common in Long COVID. Supporting microcirculation with herbs like ginkgo biloba, grape seed extract, and mango fruit powder can help reduce this inflammation and repair damaged blood vessels. These three herbs also are effective anti-viral agents against viruses like Epstein-Barr Virus (EBV) and Cytomegalovirus (CMV).

Ginkgo biloba has been shown to help improve the symptoms of Long COVID.

I use VascuSelect from Moss Nutrition which contains standardized forms of ginkgo biloba, grape seed extract, and mango fruit powder.

I also use palmitoylethanolamide (PEA) combined with luteolin to reduce inflammation and fight chronic viruses. Both of these are found in PEA Luteolin Select from Moss Nutrition. PEA and luteolin have been shown to work synergistically to help improve Long COVID symptoms.

Additional supportive compounds to reduce inflammation and balance the immune system in Long COVID patients include black cumin seed oil, curcumin, quercetin, resveratrol, fish oil, and vitamin D to name a few.

Hedberg Institute Members can download my latest Long COVID protocol by logging in.

Click here to learn more about the Hedberg Institute Membership.

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Ginkgo biloba, known for its distinctive fan-shaped leaves, has been used in traditional medicine for centuries, particularly in Asia. Ginkgo biloba is often touted as an herb for brain health, such as improving memory and cognition. This reputation does a great disservice to the most versatile herb in the world.

Ginkgo biloba can be used as a potent antiviral agent for a variety of viruses.

Ginkgo biloba has some key bioactive antiviral components:

Flavonoids and Terpenoids: Ginkgo leaves contain high levels of flavonoids and terpenoids, compounds known for their antioxidant properties. These substances contribute to the antiviral activity of the plant.

Ginkgolides and Bilobalides: These are unique terpene trilactones found in Ginkgo biloba, which have specific antiviral activities.

Ginkgo Biloba’s Mechanisms of Antiviral ActionThe antiviral properties of Ginkgo biloba are multi-faceted, involving multiple mechanisms:

Inhibition of the fusions and synthesis of proteins in the viruses herpes simplex 1 and 2 (HSV-1 and HSV-2).

Inhibition of genome replication in cytomegalovirus (HCMV) and Zika virus (ZIKV).

Inhibition of viral fusion proteins in HIV, Ebola virus (EBOV), influenza A virus (IAV), and Epstein-Barr virus (EBV).

Inhibition of the targeting protein and DNA of coronoviruses (SARS-CoV-2), varicella zoster virus (VZV), and measles virus.

Inhibition of Viral Entry and Replication: Some studies suggest that Ginkgo biloba extracts can interfere with the ability of viruses to enter host cells or replicate. This is a key step in preventing the spread of viral infections.

Immune System Modulation: Ginkgo biloba might enhance the body’s immune response against viral infections. By modulating immune functions, it could help in controlling viral spread and severity.

Anti-inflammatory Effects: The anti-inflammatory properties of Ginkgo biloba can be beneficial in reducing the severity of symptoms associated with viral infections.

Research on Ginkgo Biloba’s Antiviral PropertiesAnti-MERS-CoV and Anti-HCoV-229E Properties: A study focused on the antiviral activities of Ginkgo biloba leaf extracts against Middle East Respiratory Syndrome Coronavirus (MERS-CoV) and Human Coronavirus 229E (HCoV-229E).

Inhibition of Enveloped Viruses: Research published in Scientific Reports discussed how ginkgolic acid, a component of Ginkgo biloba, inhibits the fusion of enveloped viruses.

The study found that ginkgolic acid had a strong inhibitory effect on Human Cytomegalovirus (HCMV) and also tested its effects on Herpes Simplex Virus-1 (HSV-1) and Zika Virus (ZIKV).

Researchers also found broad spectrum inhibition by ginkgolic acid of all three classes of fusion proteins including HIV, Ebola virus (EBOV), influenza A virus (IAV) and Epstein Barr virus (EBV).

In addition, inhibition was found of a non-enveloped adenovirus.

The authors conclude that ginkolic acids may potentially be used to treat acute infections (e.g. Coronavirus, EBOV, ZIKV, IAV and measles), and also topically for the successful treatment of active lesions (e.g. HSV-1, HSV-2 and varicella-zoster virus (VZV)). It was observed that ginkgolic acid could inhibit the entry of these viruses into cells, thereby blocking viral replication.

Another study entitled, “Ginkgolic acids inhibit SARS-CoV-2 and its variants by blocking the spike protein/ACE2 interplay” found that ginkgolic acids from ginkgo biloba inhibited the SARS-CoV-2 virus from binding to the ACE2 receptor and thus could potentially be helpful in acute COVID-19 infections.

I use VascuSelect from Moss Nutrition which contains 120 mg of ginkgo biloba, 100 mg of grape seed extract, and 100 mg of mango fruit powder per capsule for acute and chronic viruses dosed 1 capsule once or twice a day with or without food.

Grape seed extract and mango fruit powder have also been shown to have antiviral properties. This trio of herbs not only has antiviral properties, but they also protect and repair the microcirculation which is damaged by viruses like SARS-CoV-2.

In summary, ginkgo biloba has exhibited diverse antiviral activities spanning multiple different types of viruses, indicating its potential clinical use as a supplemental antiviral agent.

Hedberg Institute Members can download full antiviral protocols by logging in.

Learn more about the Hedberg Institute Membership by clicking here.

References1. Hayder, M, Al-Kuraishy., Ali, I, Al-Gareeb., Ajeet, Kaushik., Małgorzata, Kujawska., Gaber, El-Saber, Batiha. (2022). Ginkgo biloba in the management of the COVID‐19 severity. Archiv Der Pharmazie, doi: 10.1002/ardp.202200188 2. Maimoona, S, Bhutta., Daniel, G, Sausen., Elisa, S., Gallo., Harel, Dahari., Gustavo, F., Doncel., Ronen, Borenstein., Ronen, Borenstein. (2021). Ginkgolic Acid Inhibits Coronavirus Strain 229E Infection of Human Epithelial Lung Cells.. Pharmaceuticals, doi: 10.3390/PH14100980 3. Manal, A., Ibrahim., Hanan, H., Ramadan., Rasha, N., Mohammed. (2021). Evidence that Ginkgo Biloba could use in the influenza and coronavirus COVID-19 infections.. Journal of basic and clinical physiology and pharmacology, doi: 10.1515/JBCPP-2020-0310 4. Marta, Sochocka., Maciej, Sobczyński., Michał, Ochnik., Katarzyna, Zwolińska., Jerzy, Leszek. (2019). Hampering Herpesviruses HHV-1 and HHV-2 Infection by Extract of Ginkgo biloba (EGb) and Its Phytochemical Constituents.. Frontiers in Microbiology, doi: 10.3389/FMICB.2019.02367 5. Ronen, Borenstein., Barbara, A., Hanson., Ruben, M., Markosyan., Elisa, S., Gallo., Srinivas, D., Narasipura., Maimoona, S, Bhutta., Oren, Shechter., Nell, S., Lurain., Fredric, S., Cohen., Lena, Al-Harthi., Daniel, A., Nicholson. (2020). Ginkgolic acid inhibits fusion of enveloped viruses.. Scientific Reports, doi: 10.1038/S41598-020-61700-0 6. Dunja, Šamec., Erna, Karalija., Sabina, Dahija., Sherif, T., S., Hassan. (2022). Biflavonoids: Important Contributions to the Health Benefits of Ginkgo (Ginkgo biloba L.). Plants, doi: 10.3390/plants11101381 7. Wei, Wang., Ke, Ma., Jiangtao, Liu., Feng, Li. (2019). Ginkgo biloba extract may alleviate viral myocarditis by suppression of S100A4 and MMP‐3. Journal of Medical Virology, doi: 10.1002/JMV.25558 8. Jian-Ming, Lü., Shaoyu, Yan., Saha, Jamaluddin., Sarah, M., Weakley., Zhengdong, Liang., Edward, B., Siwak., Qizhi, Yao., Changyi, Chen. (2012). Ginkgolic acid inhibits HIV protease activity and HIV infection in vitro.. Medical Science Monitor, doi: 10.12659/MSM.883261 9. Ezzat, H, Elshazly., Alyaa, Nasr., M., Elnosary., Gamal, Gouda., Hassan, Mohamed., Yuanda, Song. (2023). Identifying the Anti-MERS-CoV and Anti-HcoV-229E Potential Drugs from the Ginkgo biloba Leaves Extract and Its Eco-Friendly Synthesis of Silver Nanoparticles. Molecules, doi: 10.3390/molecules28031375 10. Tian-Tong, Niu., Bo-yao, Yuan., G.-z., Liu. (2022). Ginkgolides and bilobalide for treatment of Alzheimer’s disease and COVID-19: potential mechanisms of action.. European Review for Medical and Pharmacological Sciences, doi: 10.26355/eurrev_202212_30702 11. Dongsheng, Li., G., Yan., Wenwen, Zhou., Shuyi, Si., Xiaoping, Liu., Jing, Shang., Yan, Li., Yunyu, Chen. (2022). Ginkgolic acid and anacardic acid are reversible inhibitors of SARS-CoV-2 3-chymotrypsin-like protease. Cell & Bioscience, doi: 10.1186/s13578-022-00806-6 12. Zinuo, Chen., Qinghua, Cui., Laura, Cooper., Pin, Zhang., Hyun, Lee., Zhaoyu, Chen., Yanyan, Wang., Xiaoyun, Liu., Lijun, Rong., Ruikun, Du. (2021). Ginkgolic acid and anacardic acid are specific covalent inhibitors of SARS-CoV-2 cysteine proteases. Cell & Bioscience, doi: 10.1186/S13578-021-00564-X 13. Maimoona, S, Bhutta., Oren, Shechter., Elisa, S., Gallo., Stephen, D., Martin., Esther, Jones., Gustavo, F., Doncel., Ronen, Borenstein. (2021). Ginkgolic Acid Inhibits Herpes Simplex Virus Type 1 Skin Infection and Prevents Zosteriform Spread in Mice.. Viruses, doi: 10.3390/V13010086 14. Xiang, Y., Zhai, G., Li, Y., Wang, M., Chen, X., Wang, R., Xie, H., Zhang, W., Ge, G., Zhang, Q., Xu, Y., Caflisch, A., Xu, J., Chen, H., & Chen, L. (2023). Ginkgolic acids inhibit SARS-CoV-2 and its variants by blocking the spike protein/ACE2 interplay. International journal of biological macromolecules, 226, 780–792. https://doi.org/10.1016/j.ijbiomac.2022.12.057

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For people with food sensitivities and chronic digestive disorders, the holiday season can be tough. Invitations to indulge in forbidden foods are everywhere—from checkout lines and television ads to office parties and family gatherings. For many, resisting temptation may be an insurmountable challenge.

Sometimes, the visceral presence or memory of how a particular savory dish or sweet treat made one feel in the past is enough to cause one to forget (or simply not care) how that food will make one feel in the present. Which is to say: lousy. Bloated, flatulent, running to the toilet, or in pain. The aftermath of a holiday feast can leave anybody feeling a little sluggish the next day, but those with a medical reason to avoid certain foods might need extra support to recover.

A “3-Day Gut Reset” incorporating a full elemental diet is probably the quickest way to restore digestive function and comfort following such dietary indiscretions. This brief, modified, protein-sparing fast is easy to implement with a product such as Elemental Select™, Moss Nutrition’s tasty, vanilla flavored meal replacement powder.

Elemental Select™ contains all the essential vitamins, minerals, and macronutrients needed for proper physiologic function, in their “elemental” predigested forms. When mixed with water, this complete, easy-to-absorb nutritional shake can be consumed throughout the day without putting any strain on the digestive organs, enabling rapid intestinal healing and repair over the brief course of a three-day period.

Both full and partial elemental diets are recognized as important management strategies for people with digestive disorders. A full elemental diet, for example, was recently shown to prevent surgical recurrence of severe inflammatory bowel disease at a dose of 1200 calories per day. Decreasing intestinal inflammation, reversing leaky gut syndrome and intestinal permeability, rebalancing the microbiome, and improving digestive health are among the clinically researched benefits of elemental diet therapies.

Typically, elemental diets are employed over a period of two to six weeks. But shorter, intensive applications can help with rapid recovery from a relapse, such as may occur when patients with compromised digestion indulge in a holiday spree. A few days of full elemental diet protocol can make a significant difference in helping these folks get back on track and quickly feel their best.

One 30-serving container of Elemental Select™ is sufficient to complete an entire 3-Day Gut Reset. The patient simply consumes ten scoops of the product per day, and nothing else. (Each scoop contains 150 calories of bioavailable nutrition; therefore, ten scoops provide 1500 calories, enough energy for most people to function normally.)

The ten daily scoops may be divided in various ways, depending entirely on individual patient preferences. The most popular method is as follows: In a blender, combine two scoops of Elemental Select™ with 8 to 10 ounces of water. Consume five times per day, at regular intervals.

While two scoops, five times a day is ideal for most people doing a 3-Day Gut Reset, some may prefer to mix a single scoop in 8 ounces of water, and repeat ten times per day, generally on the hour.

Others may opt to divide their daily ten scoops into three or four equal servings, and replicate a “breakfast, lunch, and dinner” routine, with optional snack. (In this latter case, at least 16 ounces of water should be used to blend each “meal,” since several scoops of powder will be taken at once.) All these dosing options are absolutely fine.

Whatever schedule is chosen, it is critical to remember that Elemental Select™ is an extremely nutrient dense formula. Its nutrient density requires that Elemental Select™ must always be sipped slowly, never gulped. Using a straw may be helpful in ensuring this aim is met. If the product is consumed too quickly, stomach upset may occur. A good guideline is to allow 30 minutes for every 8 ounce serving. Using a timer may be helpful.

During the 3-Day Gut Reset, no other food or caloric substances should be consumed. Water and simple herbal teas, such as ginger, hibiscus, or peppermint tea, may be enjoyed liberally. If there is no citrus allergy, lemon juice is acceptable. Coffee should be avoided, but if caffeine withdrawal headaches are a concern, consider green tea, which is gentler on the system.

Along with all the known essential vitamins and minerals, Elemental Select™ features methylated B vitamins to optimize energy production and nervous system function.

Protein precursors are provided as free-form amino acids featuring L-carnitine, L-glutamine, and Reginator®, a proprietary blend of hypoallergenic essential aminos plus gut-friendly L-arginine. Reginator® has been shown to help increase and preserve muscle mass, even without exercise.

Two scoops of Elemental Select™ contain 3.6 grams of Reginator®, providing the muscle protein synthesis equivalent of 15-20 grams of whey or pea protein, to support lean body mass retention and optimization during the 3-Day Gut Reset.

Be sure to discuss the elemental diet and using Elemental Select with your doctor or healthcare provider.

ReferencesShinozaki M, Yokoyama T, et al. Elemental diet therapy plays a significant role in preventing surgical recurrence of Crohn’s disease in the era of biologics. Surg Today. 2021 Feb;51(2):250-257.

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Long COVID, also known as post-acute sequelae of SARS-CoV-2 infection (PASC) or long-haul COVID, refers to a condition where individuals experience persistent symptoms or develop new symptoms after recovering from the acute phase of COVID-19. Long COVID can affect individuals who had mild, moderate, or severe initial COVID-19 infections and can persist for weeks or months after the initial illness.

The specific symptoms and their duration can vary widely between individuals, but common symptoms of long COVID include fatigue, shortness of breath, cough, joint pain, chest pain, muscle weakness, brain fog, difficulty concentrating, memory problems, sleep issues, depression, anxiety, and other neurological or psychiatric symptoms. It can also affect multiple organs in the body, such as the heart, lungs, kidneys, and brain.

How does COVID-19 affect microcirculation?Microcirculation refers to the circulation of blood in the smallest blood vessels, including arterioles, capillaries, and venules. While COVID-19 primarily affects the respiratory system, there is evidence suggesting that it can have systemic effects, including impacts on the cardiovascular system and microcirculation.

Here are some potential ways in which COVID-19 may affect microcirculation:

Endothelial Dysfunction:

COVID-19 has been associated with endothelial dysfunction, which is a condition where the cells lining blood vessels (endothelial cells) do not function properly. Endothelial dysfunction can lead to impaired regulation of blood flow and increased permeability of blood vessels.

In severe cases, viral infection and the resulting immune response may damage endothelial cells, contributing to a pro-inflammatory state and a potential disruption of microcirculation.

Blood Clotting and Thrombosis:

COVID-19 is known to be associated with an increased risk of blood clot formation (thrombosis). The formation of blood clots can potentially affect microcirculation by blocking small blood vessels.

The hypercoagulable state observed in some COVID-19 patients may contribute to microvascular thrombosis, leading to impaired blood flow in affected tissues.

Inflammatory Response:

The body’s inflammatory response to the virus can also impact microcirculation. Inflammation can lead to the release of inflammatory mediators, causing vasodilation (widening of blood vessels) and increased permeability, which may affect blood flow in the microcirculation.

Hypoxia and Tissue Damage:

Severe cases of COVID-19 may lead to respiratory distress and hypoxia (low oxygen levels). Hypoxia can have detrimental effects on tissues and organs, potentially impacting microcirculation.

Tissue damage and inflammation in the lungs may trigger a systemic response that affects microvascular function in other organs.

Impaired Oxygen Delivery:

In severe cases of COVID-19, where acute respiratory distress syndrome (ARDS) develops, oxygen exchange in the lungs becomes compromised. This can lead to inadequate oxygen delivery to tissues and affect microcirculation.

What is grapeseed extract?Grapeseed extract is a dietary supplement derived from the seeds of grapes. It is rich in antioxidants, particularly compounds known as oligomeric proanthocyanidin complexes (OPCs). Additionally, grape seed extract contains flavonoids, another class of polyphenols with antioxidant properties.

These antioxidants help protect the body against damage from harmful free radicals, which can play a role in various chronic diseases. Grapeseed extract is commonly used for its potential health benefits, including improved cardiovascular health, reduced inflammation, enhanced immune function, and anti-aging effects.

How does grapeseed extract improve microcirculation in Long COVID?The proanthocyanidins in grape seed extract help improve blood flow and circulation. By promoting the dilation of blood vessels, the extract supports the cardiovascular system’s ability to efficiently deliver oxygen and nutrients throughout the body.

Antioxidant Properties:

The proanthocyanidins and other antioxidants in grape seed extract have potent free radical-scavenging properties. By neutralizing free radicals, these antioxidants help reduce oxidative stress in the vascular system, including the microcirculation.

Oxidative stress can impair endothelial function and contribute to inflammation, both of which are factors that can negatively affect microcirculation. By mitigating oxidative stress, grape seed extract may support the health of blood vessels and improve microcirculatory function.

Anti-Inflammatory Effects:

Chronic inflammation can compromise microcirculation, leading to impaired blood flow and tissue damage. Some studies suggest that grape seed extract has anti-inflammatory effects, helping to modulate the inflammatory response.

By reducing inflammation, grape seed extract may contribute to maintaining the proper functioning of blood vessels in the microcirculation.

Endothelial Protection:

Endothelial cells line the inner surface of blood vessels, including those in the microcirculation. These cells play a crucial role in regulating blood flow and maintaining vascular health.

Grape seed extract has been studied for its potential to protect endothelial cells from damage. Preserving endothelial function is important for optimizing microcirculatory performance.

Vasodilation:

Some research suggests that grape seed extract has vasodilatory effects, meaning it can promote the relaxation and widening of blood vessels. Vasodilation improves blood flow and enhances the delivery of oxygen and nutrients to tissues, including those in the microcirculation.

The vasodilatory effects of grape seed extract may be attributed to its ability to enhance the production of nitric oxide, a molecule that helps regulate blood vessel tone.

Antithrombotic Properties:

Blood clot formation (thrombosis) can negatively impact microcirculation by blocking small blood vessels. Grape seed extract has been investigated for its potential antithrombotic properties, which may reduce the risk of abnormal blood clot formation.

By inhibiting platelet aggregation and reducing the formation of blood clots, grape seed extract may contribute to maintaining healthy microcirculation.

What does the research show about grapeseed extract and microcirculation?The study “Pleiotropic benefit of monomeric and oligomeric flavanols on vascular health—a randomized controlled clinical pilot study” investigated the effects of monomeric and oligomeric flavanols (MOF) from grape seeds on vascular health. In a double-blind trial, 28 male smokers were given 200 mg/day of grapeseed extract for 8 weeks.

The study found significant reductions in serum cholesterol and LDL in subjects with elevated levels, and an increase in the glutathione to glutathione disulphide ratio in erythrocytes.

Grapeseed extract also exhibited anti-inflammatory effects in blood and reduced expression of inflammatory genes in leukocytes. Overall, the study demonstrated a considerable improvement in vascular health with grapeseed extract supplementation.

What other ways can grapeseed extract help Long COVID?Long COVID is potentially linked to the progression of neurodegenerative diseases. Oxidative stress is implicated in the progression of neurodegenerative diseases such as Alzheimer’s and Parkinson’s. The antioxidants in grape seed extract help protect brain cells from oxidative damage, potentially slowing down the cognitive decline associated with aging.

Long COVID patients have chronic inflammation, which is another factor linked to cognitive decline and neurodegenerative diseases. Grape seed extract has demonstrated anti-inflammatory properties, which may contribute to reducing inflammation in the brain and supporting cognitive function.

What is the best way to take grapeseed extract?My new formulation VascuSelect by Moss Nutrition is designed for microcirculation support including grapeseed extract, mango fruit powder, and ginkgo biloba for a synergistic effect.

One capsule twice a day provides 100 mg of grapeseed extract, 100 mg of mango fruit powder, and 120 mg of ginkgo biloba for optimal effectiveness. I use one capsule twice a day with my patients suffering from Long COVID.

You can read my articles on ginkgo biloba and Long COVID and mango fruit powder and Long COVID to learn more about how these compounds can help heal from Long COVID.

Are there any side effects with grapeseed extract?In general, grape seed extract is well-tolerated by most individuals when taken within the recommended dosage range. However, some people may experience mild side effects, such as headache, dizziness, or digestive discomfort. If these side effects persist or worsen, it’s essential to seek guidance from a healthcare professional.

What about drug interactions?Grape seed extract may interact with certain medications, including blood thinners, anticoagulants, and some antiplatelet drugs. Individuals taking these medications should exercise caution and inform their healthcare provider before starting grape seed extract supplementation.

Grape seed extract, with its array of bioactive compounds and antioxidant-rich profile, holds immense promise as a natural supplement for healing Long COVID. From cardiovascular and microcirculation support to cognitive protection, to its anti-inflammatory properties, the extract’s versatility makes it an excellent supplement for Long COVID symptoms.

Hedberg Institute Members can log in to access the latest Long COVID protocol and webinars on Long COVID.

To learn more about the Hedberg Institute Membership, click here.

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SARS-CoV-2, the virus that causes COVID-19, can severely damage the body’s circulatory vessels, which inhibits oxygen, hormones, and nutrients from getting to vital body tissues.

Patients with Long COVID have been shown to have impaired microcirculation up to 18 months after infection, and possibly even longer if those vessels aren’t repaired.

Damaged microcirculation can lead to many of the symptoms of Long COVID including fatigue, difficulty recovering from exercise, brain fog, sluggish brain function, muscle weakness, depressed mood, loss of smell and taste, to name a few of the most common symptoms.

Mango fruit powder has been shown to improve microcirculation in a couple of excellent studies I will cover below.

Mango (Mangifera indica) has the following properties:· Rich in polyphenols

· Activates Sirt-1 – antioxidant, improves endothelial function, anti-inflammatory, enhances metabolism

· Activates AMPK – improves muscle glucose uptake and fatty acid oxidation, hepatic fatty acid oxidation, lipid homeostasis, balances blood sugar, improves endothelial function

· Improves eNOS – improves endothelial function, increases energy, antioxidant

· Supports mitochondrial neogenesis

The first study entitled “Effects of Mangifera indica (Careless) on Microcirculation and Glucose Metabolism in Healthy Volunteers” was a double-blind, randomized study. The name “Careless” was changed to “Careflow” for good reason because it is more descriptive of the benefits of mango fruit powder.

204 subjects were divided into three groups. One group took 100 mg a day of mango fruit powder. The second group took 300 mg of mango fruit powder. And the third group was the placebo group. Mango fruit powder was taken every day for 4 weeks.

Microcirculation and endothelial function were assessed.

Microcirculatory reactive hyperemia flow increased, especially in the 100 mg group.

300 mg of the mango fruit preparation reduced postprandial glucose levels compared to placebo, accompanied by significantly lower HbA1c values compared to baseline.

300 mg intake significantly improved postprandial endothelial function in individuals with decreased endothelial function after high-dose glucose intake.

Both doses were well tolerated without side effects.

The second study entitled “In Vitro Activation of eNOS by Mangifera indica (Careless™) and Determination of an Effective Dosage in a Randomized, Double-Blind, Human Pilot Study on Microcirculation” showed similar results on microcirculation.

In this study, a dose of 100 mg or 300 mg of mango fruit powder was given to see the effects on microcirculation in a randomized, double-blind, crossover pilot study in ten healthy women.

Both doses improved cutaneous blood flow, indicating improved microcirculation.

Both doses were well tolerated without side effects.

Both of the above studies clearly show the benefits of mango fruit powder on microcirculation which can help patients with Long COVID.

Why not just eat mangos?Careflow, the mango fruit powder used in these studies, is standardized to 0.03% mangiferin which is vital for maximum effectiveness.

Additionally, the mango subspecies used in Careflow is called “Kili-mooku” as opposed to the “Alfonso” mangos found in supermarkets. Mangos are cultivated in the South of India in the Tamil Nadu region as opposed to Brazil and Peru where commercial mangos come from.

Kili-mooku mangos are harvested just at the right time when the beneficial plant ingredients are at their highest levels and manufactured in Germany to the highest standards.

I designed VascuSelect by Moss Nutrition to contain 100 mg of Careflow standardized mango whole fruit powder along with grape seed extract and ginkgo biloba to repair and restore microcirculation.

This makes VascuSelect a perfect formula for those suffering with Long COVID. I use one capsule twice a day with my patients suffering from Long COVID.

If you’d like to read about the beneficial effects of ginkgo biloba on Long COVID, read my article here. And to read my article on grapeseed extract and Long COVID, click here.

Hedberg Institute Members can log into your account and download my latest Long COVID protocol.

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5 case reports were reported in an excellent paper on ginkgo biloba and Long COVID symptoms.

Patients with Long COVID were given 80 mg of ginkgo biloba extract (EGb 761) twice a day.

Patient 1 took ginkgo biloba for 11 weeks, and he had a substantial improvement in cognitive concerns, decreased perception of fatigue and an improvement in olfaction. He completely regained his sense of smell.

Patient 2 took ginkgo biloba for 13 weeks and reported improvement in concentration and fatigue.

Patient 3 took ginkgo biloba for 4 months and reported significant improvement in cognitive deficits.

Patient 4 took ginkgo biloba for 7 weeks and reported improved concentration and fatigue.

Patient 5 took ginkgo biloba for 6 weeks and reported improvement in depression, fatigue, irritability, and hyposmia.

Two of these patients reported complete remission of their cognitive symptoms.

None of the patients had any adverse effects.

SARS-CoV-2, the virus that causes COVID-19, has been shown to damage the microcirculation blood vessels resulting in decreased blood flow to vital tissues such as the heart, kidney, muscle tissue, ear, eyes, liver, brain and nervous system.

Ginkgo biloba has been shown to protect and repair large and small blood vessels, as well as a host of other body tissues. Ginkgo biloba has antioxidant properties, improves circulation, repairs and protects the brain, nervous system, eye, ear, kidney, intestine, heart, and cardiovascular system.

This makes ginkgo biloba a perfect herbal medicine for Long COVID, and the results of these case reports are not surprising.

How best to take ginkgo biloba?Ginkgo biloba is usually dosed 120-240 mg a day in one or two doses with or without food. It can disrupt sleep, so some people may need to take it in the morning and no later than the early afternoon.

The dose used in this study was 80 mg twice a day totaling 160 mg a day. But the author’s point out that a higher dose may have yielded even better results.

I normally use 120 mg twice a day with my patients. Ginkgo biloba side effects such as headache only occur in 2% of people who take it.

It can take up to six weeks to notice the full effects of ginkgo biloba so give it some time to work.

My formula VascuSelect from Moss Nutrition contains 120 mg of ginkgo biloba per capsule with added grape seed extract and mango fruit powder. Grape seed extract and mango also support and repair microcirculation for a synergistic effect with the ginkgo biloba.

Ginkgo biloba should be standardized to 24% flavonol glycosides and 6% terpenes for maximum effectiveness.

Please be sure to consult with your licensed healthcare professional before supplementing with ginkgo biloba due to potential risks of bleeding disorders. Certain medications can increase the risk of bleeding when combined with ginkgo biloba.

Long COVID is having devastating consequences on society and new natural treatments are constantly emerging to help.

Ginkgo biloba is now part of my evidence-based core Long COVID protocol.

To learn more about grapeseed extract and Long COVID, click here to read my article. And to learn how mango fruit powder can help Long COVID, click here.

Hedberg Institute Members can log in and download my latest Long COVID protocol.

To learn more about the Hedberg Institute Membership, click here.

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The endogenous compound PEA (palmitoylethanolamide) is a natural anti-inflammatory agent which works in affiliation with the endocannabinoid system to help modulate pain. PEA was first discovered in the 1950s after being isolated from the lipid fraction of egg yolk. In recent years, PEA research has largely focused on neuropathic pain states and mast cell related disorders. However, earlier research often was directed toward the ability of PEA to support upper respiratory health, a line of inquiry stemming from prior observations regarding the efficacy of egg yolk in preventing rheumatic fever.

PEA for Cold and FluDuring the 1970s, six large placebo-controlled trials were conducted to investigate PEA as a cold and flu therapy. For this research, commercial grade PEA (trade name Impulsin) was used. These early studies, which engaged close to 4,000 subjects in total, yielded remarkable results. Trials conducted during the flu season demonstrated significant efficacy in both prophylaxis and treatment, with no adverse effects reported.

In a study where adult subjects took 600 mg of PEA three times per day or an identical placebo, incidence of disease over a twelve-week period was reduced by up to 40% in the PEA group.

In another trial, subjects with cold or flu who took PEA missed significantly fewer days of work, and experienced significantly less fever, headache, and sore throat than subjects taking placebo. Follow-up studies designed to replicate these findings further showed a significant reduction in acute respiratory infections after administration of PEA. The ability of PEA to downmodulate proinflammatory cytokine activity was proposed as a primary mechanism of action.

In the decades since this early research was performed, enhanced absorption PEA enabling higher efficacy at lower doses has been developed. One such PEA formulation, Levagen+, exhibits up to 75% increased absorption compared to commercial PEA, and has been clinically researched in humans for a variety of uses, including upper respiratory health.

PEA and COVID-19A recent, double-blind, placebo-controlled study gave 600 mg of Levagen+ PEA or placebo twice daily to non-vaccinated outpatients with verified mild to moderate COVID-19 infection. Serum inflammatory biomarkers were evaluated at baseline, and after four weeks of treatment. At the end of the study period, only subjects in the Levagen+ group exhibited significant reductions in inflammatory biomarkers, most notably in levels of P-selectin, a thromboinflammatory marker known to be elevated in cases of severe COVID and other conditions marked by increased inflammation and thrombosis, for example, cardiometabolic disease.

Levagen+ is the form of PEA used in Moss Nutrition PEA Luteolin Select™. The product also contains luteolin, an antioxidant bioflavonoid shown to work synergistically with, and enhance, the benefits of PEA.

Hedberg Institute members can log in to access the COVID-19, Long COVID, cold, and flu protocols.

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References:

Keppel Hesselink JM, de Boer T, et al. Palmitoylethanolamide: A Natural Body-Own Anti-Inflammatory Agent, Effective and Safe against Influenza and Common Cold. Int J Inflam. 2013;2013:151028.

Fessler SN, Liu L, et al. Palmitoylethanolamide Reduces Proinflammatory Markers in Unvaccinated Adults Recently Diagnosed with COVID-19: A Randomized Controlled Trial. J Nutr. 2022 Oct; 152(10): 2218–2226.

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Palmitoylethanolamide (PEA) is a naturally occurring endocannabinoid-like lipid mediator naturally found in many plants. PEA is analgesic, immunomodulatory, neuroprotective, antipyretic, antiepileptic, anti-inflammatory, anticonvulsant, antibacterial and antiviral. PEA also increases endocannabinoids and it down regulates mast cell activation.

PEA can improve immune system function without increasing inflammation. PEA also regulates fatty acid metabolism, reduces oxidation of fats, and inhibits excessive nitric oxide.

PEA may contribute to enhanced muscle recovery and improved cognition, mood and sleep. PEA may be indicated for anti-aging, immunoenhancement, brain health, allergies, and joint health.

These properties make PEA a perfect compound for managing the difficult symptoms of Long COVID.

Studies on PEA and Long COVIDA recent study entitled, “The Use of Palmitoylethanolamide in the Treatment of Long COVID: A Real-Life Retrospective Cohort Study” looked at the potential benefits of PEA for Long COVID symptoms. Some of the most common Long COVID symptoms include fatigue, brain fog, headache, exercise intolerance, trouble breathing, memory lapse, anosmia, dysgeusia, depression, anxiety, psychosis, nervous asthenia, PTSD, insomnia, delirium and anhedonia.

How was the study done?

33 (10 male and 23 female) patients were given 600 mg PEA twice a day for 3 months. All patients were administered the post-COVID-19 Functional Status (PCFS) scale, to assess meaningful function, before (T0) and at the end of the treatment (T1). None of the patients had any side effects from the PEA.

Study results

All the patients experienced improvement in their Long COVID symptoms as measured by the Post-COVID-19 Functional Status scale.

PEA, Luteolin, and Long COVID StudiesThe combination of PEA and Luteolin has been studied extensively, with multiple published papers showing the synergistic benefits of these two compounds. PEA and luteolin have been shown to reduce neuroinflammation by modulating microglia and reducing reactive oxygen species (ROS).

Luteolin is a flavonoid, specifically a flavone, found naturally in fruits, vegetables, and herbs such as celery, parsley, lettuce, spinach, peppers, broccoli, cabbage, carrots, onions (leaves), and apples (skins). Luteolin is similar in structure to quercetin, but luteolin is more potent and is sometimes referred to as a “supercharged” quercetin.

Luteolin has the following properties:

• Anti-inflammatory
• Anti-neurodegenerative (neuroprotective)
• Mast cell stabilizer
• Antioxidant
• Anticancer
• Antiallergy
• Antihypertensive
• Antiviral
• Antidiabetic

Another study entitled, “What Is the Role of Palmitoylethanolamide Co-Ultramicronized with Luteolin on the Symptomatology Reported by Patients Suffering from Long COVID? A Retrospective Analysis Performed by a Group of General Practitioners in a Real-Life Setting” looked at the medical charts of 49 patients with Long COVID who were treated by one of nine doctors in Rome, Italy.

The patients were treated with 700 mg of PEA and 70 mg of luteolin twice a day for 90 days.

No side effects were reported during treatment, nor any drug interactions with their medications.

The authors conclude, “Supplementation with PEALUT (PEA and Luteolin) helped to improve all patient-reported symptoms, especially pain, anxiety and depression, fatigue, brain fog, anosmia and dysgeusia, leading to an overall improvement in patients’ health status.”

PEA and luteolin have been found to be effective for post-COVID loss of smell (anosmia) and memory loss.

The first study entitled, “Ultramicronized Palmitoylethanolamide and Luteolin Supplement Combined with Olfactory Training to Treat Post-COVID-19 Olfactory Impairment: A Multi-Center Double-Blinded Randomized Placebo- Controlled Clinical Trial” was done for 90 days on subjects who took 700 mg of PEA and 70 mg of luteolin once a day combined with olfactory training.

The results of this study found that those supplementing with PEA and luteolin had significant improvements and even resolution of their loss of smell compared to the placebo group who only did olfactory training.

The second study entitled, “Parosmia COVID-19 Related Treated by a Combination of Olfactory Training and Ultramicronized PEA-LUT: A Prospective Randomized Controlled Trial” was virtually identical to the first study. Subjects took 700 mg of PEA and 70 mg of luteolin along with olfactory training for 90 days, and they achieved significant results compared to the control group.

The third study entitled, “Treatment of COVID-19 olfactory dysfunction with olfactory training, palmitoylethanolamide with luteolin, or combined therapy: a blinded controlled multicenter randomized trial” set out to see if doubling the dose of PEA and luteolin to 700 mg of PEA and 70 mg of luteolin taken twice a day was superior to just once a day dosing.

The results were surprising because there was no difference between the single dose or doubling the dose. This is good news for patients because this results in a significant cost-savings.

The fourth study entitled, “Effect of Ultra-Micronized Palmitoylethanolamide and Luteolin on Olfaction and Memory in Patients with Long COVID: Results of a Longitudinal Study” used the same dose as the above studies of 700 mg of PEA and 70 mg of luteolin combined with olfactory training and found significant improvements in olfaction and improved memory/brain fog.

The one common thread among all the above studies was the importance of olfactory training along with the PEA and luteolin supplement.

How best to take PEA and Luteolin?PEA is not well absorbed, so it must be delivered in a specific form called Levagen+. Levagen+ PEA uses LipiSperse technology to enhance the absorption of PEA.

Most of the studies on Levagen+ PEA used 300 mg twice a day with excellent results. For more complex cases, 600 mg twice a day of Levagen+ PEA may provide better results.

The therapeutic dose of luteolin is 100-200 mg a day, since it is a potent flavonoid.

Moss Nutrition’s product PEA Luteolin Select contains 300 mg of Levagen+ PEA and 50 mg of luteolin per capsule. I use one capsule twice a day with meals for most patients, and two capsules twice a day for more complex cases.

Long COVID patients are experiencing more and more viable supplement options, and the combination of PEA and luteolin is now part of my core Long COVID protocol.

Hedberg Institute members can download my Long COVID protocol in the Practice Tools section of your membership area. Hedberg Institute members also get access to all my course material on how to treat Long COVID.

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A new study entitled, “Coenzyme Q10 + alpha lipoic acid for chronic COVID syndrome” has been published in the journal Clinical and Experimental Medicine which found that supplementation with Coenzyme Q10 (CoQ10) and alpha lipoic acid (ALA) may be helpful in Long COVID.

COVID-19 can deplete CoQ10 levels and damage the mitochondria which are important for energy production and immune system function. CoQ10 and alpha lipoic acid can both be helpful in protecting and supporting mitochondrial function by reducing oxidative stress.

CoQ10 deficiency can lead to decreased energy production resulting in fatigue and increased free radical production. Fatigue is by far the most common symptom reported in Long COVID so CoQ10 is at the top of the list of supplements to try with this condition.

Alpha lipoic acid is a powerful antioxidant, and it is involved in mitochondrial energy production. ALA also has immunomodulatory properties and may actually be an anti-viral as well. The properties of both nutrients in theory make them a promising combination in the treatment of Long COVID.

How was the study done?

174 patients (51% male and 49% female) aged 18-81 (mean of 51) who had COVID-19 previously and met the 2015 National Academy of Medicine diagnostic criteria of myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS).

52% had comorbidities including chronic lung disease (16%, 28/174), diabetes mellitus (13%,23/174), psychiatric diseases (7.5%, 13/174), and rheumatic diseases (9.8%, 17/174).

17.8% (31) of patients had been previously hospitalized for severe respiratory SARS-CoV-2 pneumonia.

82.2% had mild/moderate symptoms during the acute phase.

The mean duration of Long COVID symptoms was 5.9 months.

The most common symptoms were fatigue (80%), impaired concentration (68%), sleep disorders (85%) disturbed smell and/or taste (60%), memory loss (45%), dyspnea (21%) and arthromyalgias (64%).

Patients were divided into two groups. The first one (116 patients) received coenzyme Q10 (ubiquinone form) and alpha lipoic acid taken every day for two months at a dose of 100 mg of CoQ10 and 100 mg of alpha lipoic acid twice a day. The control group of 58 patients did not take either supplement.

The characteristics of the patients in the two groups were similar at baseline. Patients in both groups also received a variety of medications including paracetamol, codeine, NSAIDS, antidepressants (duloxetine), anticonvulsants and analgesics (pregabalin and gabapentin). They also undertook psychological and psychiatric counseling, physio-kinesiotherapy, yoga, and Pilates.

What were the results?

“The primary end-point was to evaluate the effectiveness of the association of coenzyme Q10 and alpha lipoic acid in reducing fatigue, expressed as a reduction in Fatigue Severity Scale (FSS), at the second month (T1), of at least 50% (complete response) from the baseline (T0) or at least 20% (partial response) from the baseline (T0). A reduction in FSS < 20% from baseline at T1 was considered as a non-response.

A complete FSS response was reached most frequently in the treatment group compared to the control group. An FSS complete response was reached in 62 (53.5%) patients in the treatment group and in two (3.5%) patients in the control group. A reduction in FSS score < 20% from baseline at T1 (non-response) was observed in 11 patients in the treatment group (9.5%) and in 15 patients in the control group (25.9%) (p < 0.0001).”

Author's Conclusion

“Despite the short follow-up period, we demonstrated a clinical benefit, suggesting the rapid effect of this therapy. On the other hand, because of the short follow-up duration, we do not know if this clinical benefit persists over time. Our results, all based on subjective indices, were definitely in favor of the treatment group.”

Dr. Hedberg’s Comments on Long COVID, CoQ10, and Alpha Lipoic Acid

This study shows promising results in the use of coenzyme Q10 and...

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The elemental diet dates back to 1932 and is one of the most utilized tools by functional medicine practitioners. It is useful for a variety of gut-related conditions and even conditions outside the gut. The elemental diet is a liquid diet that reduces inflammation in the gut, heals the gut barrier, and has an antibacterial effect.The elemental diet is done with Elemental Select powder from Moss Nutrition. A full elemental diet can be done with 100% of daily calories coming from Elemental Select or a partial elemental diet with 25-75% of calories coming from Elemental Select and the rest from whole food sources. Elemental Select is mixed with water or in a blender with ice and consumed by slowly sipping the mixture over the entire day in divided doses.

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The elemental diet may be helpful for the following conditions:

IBS-C and IBS-D

SIBO

Crohn’s disease

Ulcerative colitis

Diversion colitis

Eosinophilic gastroenteritis and esophagitis

GERD

Gastritis

Multiple food sensitivities

Leaky Gut

Constipation and diarrhea

Short bowel syndrome

High ileostomy output

Ileal fistulas

Pancreatitis

Pancreatic insufficiency

Pancreatic fistulas

Bile-acid-induced diarrhea

Refractory Celiac disease (gluten-free diet fails to resolve issues)

Malabsorption

Rheumatoid arthritis

Eczema

Psoriasis

Stroke recovery

Critical illness recovery

COVID-19 and other viral illnesses

MCAS

Histamine intolerance

Anemia

Asthma

Dermatitis herpetiformis

Chronic kidney disease

Cystic fibrosis

HIV

Cerebral palsy

How does an elemental diet work?

The elemental diet is purely vitamins, minerals, amino acids, medium chain triglycerides for fat, and simple carbohydrates. This means that digestion is not required so almost everything gets absorbed regardless of gut function.

It is also void of any food-based compounds such as whey, pea, hemp, rice, soy, gluten, dairy, eggs, nuts etc. which makes it entirely hypoallergenic. There is virtually nothing in the elemental diet that the immune system can react to.

This is a game-changer for those with food sensitivities and gut problems. There is also no fiber in the elemental diet, so it won’t exacerbate SIBO or IBS.

The elemental diet also allows your digestive organs to rest. The stomach doesn’t have to pump out as much hydrochloric acid, the pancreas doesn’t have to make so many enzymes, and the gall bladder can rest as well.

The elemental diet contains all the right amino acids for healing the gut barrier. For those with leaky gut syndrome or malabsorption, it can rapidly heal the gut.

The elemental diet reduces pathogenic bacteria in the gut and can also improve healthy bacteria diversity. This helps reduce inflammation in the gut so the microbiome can become more balanced. This is why the elemental diet is so effective for SIBO, IBS, and IBD.

How to follow an elemental diet?

Elemental Select from Moss Nutrition contains 150 calories per scoop, and total daily calories should be determined by a healthcare professional. 

The first option is a Full Elemental Diet with 100% of daily calories consumed from Elemental Select.

Sample 1,500 calorie/day protocol:

10 total scoops/day = 1,500 calories

4 scoops in the AM divided into 4 separate 8-ounce glasses of water. Mix 1 scoop with 8 ounces of water and sip slowly over a 20-60 minute period. Repeat for the next 3 scoops. Alternatively, all 4 scoops can be mixed with 32 ounces of water and sipped slowly over a 1-4 hour period.

3 scoops around lunch time. Same consumption guidelines as noted above sipped slowly over a 1-3 hour period.

3 scoops around dinner time. Same consumption guidelines as noted above sipped slowly over a 1-3 hour period.

Alternatively, all 10 scoops in 10 glasses of water can be sipped slowly over the entire day without breaks.

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Zinc Functions

Zinc is an essential trace element required by almost every biological process in the human body including growth and development, immune function, wound healing, protein and DNA synthesis, and cell division. It is used in over 300 enzymatic reactions, serves as an anti-inflammatory and an antioxidant, and is important for sight, hearing, and taste.

The system-wide ubiquity of zinc increases the clinical importance of detecting and supporting a deficiency when present. Unfortunately, it is frequently underutilized in clinical practice. Gaining a deeper understanding of the many roles zinc plays in human health, learning the appropriate methods for assessing deficiency, reviewing which conditions may benefit from supplementation with zinc, along with supplementation guidelines and recommendations will increase the clinician’s confidence in the appropriate use of zinc with patients.

Zinc Select

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Causes of Zinc Deficiency

The most common reasons for a zinc deficiency are increased losses of zinc, increased requirements for zinc, inadequate dietary intake, or reduced bioavailability/absorption of zinc. Increased losses can come from gastrointestinal diseases, surgery, trauma, oral contraceptives, and zinc lost in ejaculate with excessive sex. The requirement for zinc increases during periods of rapid growth, pregnancy, and lactation. Common examples of inadequate dietary intake include teenagers and college students as well as individuals following plant-based diets. Diets high in fiber are also rich in phytates which inhibit absorption.

Dietary factors, such as the consumption of alcohol or following a vegetarian/vegan diet, can impair zinc absorption. Decreased absorption increases the risk for deficiency. Plant-based diets and diets high in seeds, legumes, and unprocessed whole grains contain phytates that bind with zinc, inhibiting its absorption. Soaking, sprouting, and/or fermenting can reduce the phytic acid content of these foods, increasing the bioavailability of zinc. It has been shown that the process of sour leavening to make sourdough bread reduced the phytate content by ~ 25% and increased the rate of zinc absorption by 30-50%.

Other dietary factors that reduce the absorption rate include coffee, calcium in dairy products, increased fiber intake from fruits and vegetables, and a high fat diet (> 100g/day) in those with fat malabsorption issues. Deficiency can also be present in those with gastrointestinal issues that impair absorption such as Celiac disease, Crohn’s disease, or bypass surgery, and in those with hypochlorhydria (commonly seen with aging).

Assessment of Zinc Status

Laboratory Assessment

A zinc deficiency is not always easy to recognize. It can manifest as a variety of symptoms and routine laboratory testing does not provide a reliable indicator of zinc status. Low plasma stores of zinc (~0.1%) cause the standard blood test for plasma zinc concentrations to lack sensitivity and specificity, making it unreliable as a marker of deficiency. Therefore, an assessment of zinc status and a diagnosis of deficiency is largely based on clinical findings.

Clinical Zinc Assessment

Zinc homeostasis is primarily regulated by the amount of zinc in the diet. Clinical evaluation should include a detailed review of the patient’s dietary eating patterns to determine if a deficiency is likely. The physical examination may reveal white spots on their fingernails and/or patches of dry skin. The patient history should be reviewed for associated conditions or medications known to cause impaired zinc absorption and a therapeutic trial of zinc may be recommended in those instances.

A Zinc Taste Test provides a quick and inexpensive evaluation of zinc levels that can be conducted during the office visit. This test is not completely reliable due to the dependence on individual variances in self...

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Berberine is an isoquinolone alkaloid that is bitter and bright golden yellow in color. It is derived mainly from the roots, stems and rhizomes of plants such as Coptis chinensis (Chinese golden thread), Hydrastis canadensis (goldenseal), Berberis aquifolium (Oregon grape), and Berberis vulgaris (barberry). It has been used for thousands of years in traditional Chinese and Ayurvedic medicine and is generally considered safe, though it should be avoided during pregnancy and lactation.

Berberine

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Gastrointestinal side effects may occur due to berberine's impact on bowel motility. These include abdominal pain, distention, nausea, vomiting, and constipation. Side effects appear to be dose dependent, with increased symptoms such as low blood pressure, dyspnea, and flu-like symptoms at higher doses.

Berberine is commonly used as an antibacterial, antiviral, antimicrobial, antifungal, and antihyperlipidemic agent. The many therapeutic applications of berberine are due to its antioxidant and anti-inflammatory properties, making it one of the top supplements of choice in clinical practice.

It has traditionally been used for gastrointestinal related issues as well as issues involving liver dysfunction, digestive complaints, blood sugar regulation, inflammation, and infectious diseases.

While berberine has exhibited a bioavailability of <1%, the metabolites of berberine have demonstrated increased absorption in the system. These metabolites contribute to the widespread impact observed from the use of berberine on liver, kidney, muscle, lung and brain.

Gastrointestinal Support

Chen at el (2015) conducted a randomized clinical trial that demonstrated the usefulness of using berberine in treating patients with IBS-D. Berberine (400 mg delivered twice daily) reduced the frequency of diarrhea, abdominal pain, and the urgency of defecation after 8 weeks. They concluded that berberine was well tolerated and was beneficial in treating IBS-D. They also noted that those in the berberine group showed improvements in their depression and anxiety scores and in their IBS quality of life scores.

Berberine has been shown to induce structural and compositional changes in the gastrointestinal microbiota. These changes affect the metabolites dependent on the microbes such as trimethylamine N-oxide (TMAO), short chain fatty acids (SCFAs), bile acids (BAs), branched-chain amino acids (BCAAs), and aromatic amino acids (AAAs).

Yao et al confirmed berberine's gut modulatory ability in their 2020 study using rats. They showed that berberine caused changes in the GI microbiota that included increased beneficial microbes in the phylum Bacteroidetes and the family Lactobacillaceae. An increase in Lactobacillaceae was also observed to be negatively associated with the risk of Type 2 Diabetes (T2D). A decrease in potentially pathogenic microbes in the phylum Proteobacteria and Verrucomicrobia was noted along with a decrease in aromatic amino acids (AAAs).

The authors concluded that berberine was able to modulate the gut microbiota of the rats in the study. This led to improved glucose tolerance and the alleviation of symptoms associated with T2D, such as abnormal glucose and lipid levels. They recommended the use of berberine in the treatment of T2D in rats.

Glucose and Lipid Regulation

Berberine is useful in conditions associated with metabolic diseases and atherosclerosis due to its ability to decrease inflammation, improve glucose and lipid metabolism, and improve energy homeostasis, making it beneficial as a treatment option for those with T2D. The hypoglycemic effects of berberine have been shown comparable to Metformin.

An important mechanism of action that occurs with the use of berberine is the activation of AMPK. Drugs such as Metformin work by stimulating this AMPK pathway. Turner et al (2008) concluded, in their study on IR mice,

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Background Information—Form and Function of B12

Vitamin B12 Form

Cyanocobalamin has no known biochemical function. It must be converted to become active. It gets converted for use into hydroxocobalamin, methylcobalamin, or adenosylcobalamin. These three forms are equal in bioavailability.An exception to this is for the use of adenosylcobalamin in infants with a rare inborn error of synthesis.Methylcobalamin and adenosylcobalamin are coenzyme forms of B12.Hydroxocobalamin can be converted into the above two forms.

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Vitamin B12

Function

Vitamin B12 is used for DNA synthesis, homocysteine metabolism, S-adenosylmethionine, red blood cell formation, nervous system and immune system function.Vitamin B 12 is necessary for folate to be metabolized properly into Methionine and Succinyl-CoA. Low levels of B12 and increased levels of folate are associated with higher concentrations of methylmalonic acid (MMA) and total plasma homocysteine (HCY).

Vitamin B12 Sources

The average American diet contains adequate amounts of vitamins B12, ranging from 5-15 mcg/day. Meat, poultry, fish, eggs, and dairy, constitute the primary food sources. It is not found in most non-animal food sources. Individuals consuming a plant-based diet are at an increased risk of deficiency. Non-meat food sources such as chlorella, spirulina, nori, and fermented soy contain mostly B12 analogues which have no activity in humans. Fifty-one percent of those following a macrobiotic diet were found to be deficient.Vegan Diets 0.3-0.4 mcg/dayLacto-vegetarians 1.4 mcg/day

Recommended Dietary Allowances (RDA)Males >14 years: 2.4 mcg/dayFemales >14 years: 2.4 mcg/dayPregnancy: 2.6 mcgLactation: 2.8 mcg

Absorption of B12

Pepsin and hydrochloric acid (HCL) are necessary for cleaving B12 from protein in stomach.Individuals with low levels are at a greater risk of deficiency due to decreased break down for absorption.B12 supplements (crystalline B12) do not require HCL or pepsin to bind to intrinsic factor (IF).B12 supplements are absorbed normally in hypochlorhydria.Intrinsic factor (IF) is made in the stomach and necessary for carrying B12 from the stomach to intestines for absorption.Individuals with genetic SNPs impairing intrinsic factor (IF) production are also at a greater risk of deficiency and must rely on B12 injections, bypassing the need for IF.IF becomes fully saturated at 2 mcg of B12.Large doses can be absorbed through passive diffusion which doesn’t require IF. This accounts for 1-2% of absorption.1000 mcg/day can overcome loss of IF due to pernicious anemia.Pernicious anemia is an autoimmune disease characterized by the destruction of parietal cells which produce IF.

Possible Causes of Vitamin B12 Deficiency

Pernicious anemia—Auto antibodies against parietal cells and IFGastric disease or surgeryChronic atrophic gastritis—parietal cell death/autoimmuneUse of gastric acid inhibitors (antacids, histamine receptor 2 antagonists, proton pump inhibitors)Pancreatic disease or pancreatectomyOther intestinal diseases: parasitic infections, bacterial overgrowth, ileal resection, impaired B12/IF absorption.Medications, such as cholestyramine and metformin, that impair B12 absorption or metabolism.Limited/poor food sources/choices that result in general malnutrition. Examples include vegan or vegetarian diet.Chronic alcoholismInherited disorders involved in B12 trafficking and metabolismMiscellaneous: including HIV and nitrous oxide anesthesiaConditions that result in chronic diarrhea or malabsorption states, such as celiac disease and Crohn’s disease.Helicobacter pylori infection results in hypochlorhydria. Eradicating H Pylori can improve B12 levels.Long term psyllium supplementation (> 1 year)Genetic factors can affect absorption and transport. Individuals with genetically higher methylmalonic acid levels will require higher-than-normal B12 dose...

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Many factors in our modern society increase the risk of magnesium deficiency, placing a vast number of individuals at risk of suboptimal levels. An individual’s magnesium level can become depleted from issues such as medication usage, chronic diseases, poor magnesium content in crops and soil, and the increased consumption of refined and processed foods.

Magtein Magnesium L-Threonate

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Magnesium L-threonate offers a cost effective, safe for long term use, and well tolerated form of magnesium that provides optimum levels. It has been shown to be the only form of magnesium capable of increasing magnesium levels in the brain and cerebrospinal fluid (CSF).

This ability to cross the blood brain barrier (BBB) increases its efficacy for use in many chronic disease states, especially those associated with central nervous system (CNS) dysfunction.

Conditions that respond to magnesium l-threonateMagnesium L-Threonate and PainMagnesium is useful for treating chronic pain and inflammation that occurs due to the activation of the NMDA receptor during trauma. The NMDA receptor, which is normally not activated, becomes activated during traumatic physical or emotional events. During periods of excitotoxicity, calcium shuttles through the NMDA receptor and causes increased immune system responses (release of substance P, mast cells, immune cells, oxidative stress). Magnesium works to inhibit calcium influx through the NMDA receptor thereby decreasing oxidative stress as well as decreasing inflammation by blocking substance P. Blocking the NMDA receptor also serves to inhibit cortical spreading depression (CSD).3

Magnesium L-Threonate and MigraineMagnesium is also useful in treating migraine due to its ability to inhibit platelet activation. Platelet activation stimulates the release of serotonin which triggers spasming of blood vessels in the central nervous system (CNS) resulting in migraine. Magnesium inhibits calcitonin gene related peptide (CGRP) mediated vasodilation, another driver of migraine.3 Magnesium threonate is especially useful for the treatment of migraine as it is capable of crossing the blood brain barrier (BBB) and providing Mg2+ directly to the affected area.

Magnesium L-Threonate and the EarMagnesium helps protect against hearing loss from noise as well as drug ototoxicity by decreasing the oxidative stress created by these stressors. Magnesium is also protective in sudden sensorineural hearing loss due to issues such as viral infections, vascular impairment, CNS disorders, inner ear abnormalities, or immune related mechanisms. Magnesium provides protection from hearing loss due to its ability to function as a Ca2+ antagonist, vasodilator, antioxidant, and a non-competitive NMDA antagonist.3 Magnesium threonate, with the ability to enter the CNS, is particularly useful in working with individuals with tinnitus.

Protecting and Repairing the Hippocampus: Learning, Memory, and EmotionAlzheimer’s diseaseAlzheimer’s disease (AD) is associated with a magnesium deficiency in the serum or brain.7 Yu, Guan, Gu (2015) found that magnesium L-threonate enhanced the clearance of amyloid beta, the plaquing seen in AD. They demonstrated that magnesium L-threonate was able to slow the progression of AD.7 Magnesium threonate treatment was even effective at preventing synapse loss and memory decline when used in mice with end-stage AD.8 It has also demonstrated the ability to be neuroprotective against oxidative stress and hippocampal neuronal apoptosis.9

Chemotherapy-induced memory/emotional deficitsMagnesium L-threonate prevented oxaliplatin(OXA)-induced behavioral and synaptic changes in a 2020 study conducted using rats. This study showed that magnesium L-threonate prevented the OXA-induced upregulation of inflammatory cytokines such as tumor necrosis factor alpha (TNF-α) and nuclear factor-kappaB (NF-кB).

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The combination of hydrochloric acid, lipase, and pepsin combine to create the acidic gastric juices found in the stomach. These healthy stomach acid levels serve as a first line of defense for the gastrointestinal system, preventing infectious agents from reaching the intestines. A normal gastric pH is considered to be present with pH values >3, with values below 4 capable of killing bacterial invaders within 15 minutes. Gastric juices with a pH >3 mark the beginning stages of hypochlorhydria. As the pH increases above 4, there is an increased prevalence of bacterial overgrowth. Achlorhydria is defined as a pH >7.

Betaine HCL

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There are two main categories of hypochlorhydria: iatrogenic and acquired. Iatrogenic hypochlorhydria is the most common, resulting from the use of medications to reduce gastric acid secretions. Proton pump inhibitors (PPIs) are one of the top ten most prescribed drugs in the world, contributing to the rise in iatrogenic hypochlorhydria. Malnutrition is the leading cause of acquired hypochlorhydria.

Individuals taking PPIs generally have a pH between 5-7. Individuals with hypochlorhydria are at an increased risk for infection and disease due to a loss of this protective barrier. Research conducted by Martinsen, Fossmark, and Waldum (2019) demonstrated that individuals with hypochlorhydria were at an increased risk of a variety of infections including bacterial, fungal, and parasitic infections. One study they reviewed reported a significant decrease in Shannon’s diversity of the GI microbiome and changes in 20% of the bacterial taxa in PPI users versus non-users.

The increased use of PPIs makes it necessary to review current medications, both prescribed and over the counter, at each patient encounter. Nutritional status should also be evaluated utilizing blood labs, anthropometrics, diet diaries, food allergies/sensitivities, etc. Other useful factors in screening a patient for gastric hypoacidity include assessing gender, age, stress levels/eating behaviors, geographic origin/nationality, testing of stomach acid levels, and labs to rule out concurrent diseases such as Helicobacter pylori, chronic gastritis, parietal cell autoantibodies, hypothyroidism, etc. Keep in mind that there can be discrepancies between different testing methods and cutoff values depending on the labs used.

Malnutrition can be the cause of or the result of hypochlorhydria. Malnutrition that leads to a deficiency in the nutrients needed to make HCL can cause hypochlorhydria. These include chloride, sodium, potassium, zinc, and iodine. Malnutrition can also develop as a result of hypochlorhydria. Decreased gastric acidity impairs nutrient absorption resulting in possible nutrient deficiencies for most of the essential vitamins and minerals including protein, iron, calcium, magnesium, zinc, vitamins A and E, copper, and all of the B vitamins. The presence of both malnutrition and hypochlorhydria increases the risk of enteric infections. There is also an increased prevalence of food allergies in individuals with reduced gastric acidity as they lose the ability to sufficiently denature proteins. With hypochlorhydria, larger protein peptides remain which can trigger an immune system response, resulting in allergic symptoms. Therefore, screening for hypochlorhydria should be conducted in individuals that suffer from malnutrition and/or food sensitivities/allergies.

There is also an increased prevalence of food allergies in individuals with reduced gastric acidity as they lose the ability to sufficiently denature proteins. With hypochlorhydria, larger protein peptides remain which can trigger an immune system response, resulting in allergic symptoms. Therefore, screening for hypochlorhydria should be conducted in individuals that suffer from malnutrition and/or food sensitivities/allergies.

Stress management is also important in regulating gastric...

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A new paper entitled, “Impaired Vagal Activity in Long-COVID-19 Patients” sheds light on the vagus nerve’s involvement in Long-COVID-19.

COVID-19 is divided into three phases of infection:

1. “Acute COVID-19” (signs and symptoms of COVID-19 infection up to 4 weeks).

2. “Ongoing symptomatic COVID-19” (from 4 weeks up to 12 weeks).

3. “Post-COVID-19 syndrome” (signs and symptoms persist beyond 12 weeks).

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Study Methods

30 Long-COVID-19 patients were compared to 20 control subjects who never had COVID-19.

21 patients were classified based on their experience while having COVID-19 as mild/moderate and 9 as severe/critical.

7 patients had no/negligible functional limitations, 6 had slight functional limitations, and 17 had moderate/severe functional limitations.

No significant differences were found among study subjects and controls regarding gender, demographics, medical history, drug use, and vital signs. However, previous studies have shown that females are more affected by Long-COVID-19.

Heart rate variability was measured through ECG. Heart rate variability parameters are controlled by the parasympathetic nervous system.

The sympathetic nervous system promotes inflammation through catecholamines and beta-adrenergic stimulation in contrast to the parasympathetic nervous system which is anti-inflammatory. COVID-19 causes an imbalance between these two systems, thus driving inflammation and a procoagulative state.

Study Findings

Heart rate variability was found to be lower in the Long-COVID-19 patients.

Left ventricular ejection fraction was lower in Long-COVID-19 patients.

When SARS-CoV-2 comes into contact with the eye, it may reach the central nervous system via the trigeminal nerve. And when the virus contacts the nasal mucosa, it may reach the brain through the olfactory nerve. It may also travel to the central nervous system via the vagus nerve from the respiratory system, the heart, the digestive system, the kidneys, bladder, uterus, and testicles. This occurs through neuronal retrograde transport to the axonal terminal.

SARS-CoV-2 has been detected in the vagus nerve, thus persistent damage to this nerve could explain impairment of the parasympathetic nervous system in Long-COVID-19 patients.

SARS-CoV-2 can also invade the brain through a dysfunctional blood-brain barrier, which has been damaged by cytokine storm.

SARS-CoV-2 binds to the ACE2 receptor found in the respiratory airway, lung, vascular endothelia, kidney cells, and small intestine. ACE2 receptors are also found in neurons and glia in the brainstem regions responsible for cardiovascular function and regulation.

SARS-CoV-2 neuronal invasion drives epinephrine and norepinephrine from the adrenal gland known as the “catecholamine surge” which causes cardiovascular, lung, and brain injury.

NT-proBNP levels were found to be increased in Long-COVID-19 patients, which reflects myocardial strain due to increased vascular pressure. This persistent myocardial strain may drive the dysautonomia, or it could be due to increased ischemia and inflammation.

D-dimer can have prolonged elevation in Long-COVID-19 patients, which can lead to increased thromboembolic complications.

Dysautonomia, neurotropsim, inflammation, and the persistence of a procoagulative state with an elevated myocardial strain may explain vagus nerve impairment in these patients. However, the authors state, “...it remains unclear whether dysautonomia associated with Long COVID-19 directly results from post-infectious immune-mediated processes or from the autonomic-virus pathway.”

The authors call for research on evaluation of cholinergic nerve fiber damage in Long-COVID-19 patients to confirm impaired vagal activity.

How to improve vagus nerve function?

I have patients do a variety of exercises throughout the day such as singing, humming, gargling with water,

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Histamine is often overlooked as a cause of chronic health problems yet the fix for this issue can be quite straightforward. In this article, I cover the details of histamine and how to follow a low histamine diet. Histamine intolerance (HIT) affects approximately 1% of the population. Approximately 80% of those affected are middle-aged.1 Histamine intolerance occurs when an individual has more histamine in their system than they can breakdown. Excess systemic concentrations of histamine can result from overproduction, overconsumption, and/or having a reduced ability to clear out histamine from the body. For those with HIT, eating a diet that results in increased histamine can contribute to chronic inflammation due to the ongoing exposure to histamine. This excess histamine often accumulates as a result of decreased diamine oxidase (DAO) activity.2, 3 The resulting excess histamine contributes to the physical symptoms associated with HIT. Following a low-histamine diet along with supplemental DAO is often recommended to decrease the symptoms associated with HIT. Eating a low-histamine diet involves more than simply eliminating foods that are high in histamine. This article will help to explain the challenges with following a low histamine diet and will highlight the many ways excess histamine can occur in food and in the body.

Histamine Synthesis and Degradation Excess histamine concentrations may be exogenously released from food or endogenously produced. Histamine is synthesized by a variety of cells in the body including mast cells, basophils, platelets, histaminergic neurons, and enterochromaffin cells. Endogenous histamine is released in response to a variety of immune and inflammatory related stimuli as well as certain foods, alcohol, or drugs which can activate release.1 Endogenous histamine supplies are also controlled by genes that code for the enzymes that synthesize and degrade histamine. Genetic polymorphisms in histamine receptors and DAO can decrease the rate of DAO activity, reducing the rate of clearance and increasing systemic histamine concentrations.3 Exogenous sources of histamine mainly comes from ingested foods. Several factors in food processing and storage can increase the histamine content of certain foods as well. Histamine is normally metabolized by amine oxidases in healthy individuals. These amine oxidases include monoamine oxidase (MAO), DAO, and histamine N-methyltransferase (HNMT), with DAO being the primary enzymes for metabolism of histamine.5 It is thought that low gastrointestinal levels of DAO contributes to an individual being unable to break down histamine in the intestines, resulting in the increased sensitivity to histamine found in common foods. As excess levels accumulate, intolerance symptoms develop.1, 2, 6, 7

Symptoms Associated with Histamine Intolerance There is great heterogeneity in the presentation of symptoms in those with HIT, making it difficult to define a clear clinical picture. Histamine intolerance is generally suspected when symptoms appear after the ingestion of histamine containing food.3 Symptoms may develop immediately or can be delayed as much as three hours following ingestion.5 Histamine receptors are found ubiquitously throughout the body, making different organ systems susceptible to adverse reactions due to excess histamine concentrations. This results in a wide variety of symptoms that may be exhibited by an individual, contributing to the difficulty in diagnosis. These symptoms include gastrointestinal issues such as abdominal pain, bloating, diarrhea, and constipation. Extraintestinal complaints may affect neurological, respiratory, dermatological, and/or hemodynamic systems.2 Histamine has vasoactive properties that may result in flushing, headaches, and/or hypertension.5 Other common symptoms related to HIT include brain fog, fatigue, dizziness, itching, and difficulty swallowing, low blood pressure, nasal congestion, sneezing,

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The National Institutes of Health (NIH) states that five out of every 100 Americans over the age of 12 have hypothyroidism. The prevalence of this disease increases with age.(1) This makes hypothyroidism the most common disease arising from a hormonal insufficiency.(2) Gender is an influencing factor, as women are three to seven times more likely to develop hypothyroidism than men.(1) Known risk factors that increase the likelihood of developing this disease include having a family history of hypothyroidism and pregnancy.(1) Recent research by the British Medical Journal (2021) suggests that taking birth control pills, or oral contraceptives (OCs), may also increase the odds of developing hypothyroidism.(3)

Birth Control Pills Statistics Oral contraceptives are a widely used form of birth control by women. Many individuals turn to these medications for reasons other than birth control such as relief from symptoms such as abnormal uterine bleeding, endometriosis, hormonal and menstrual irregularities, etc.(3)Approximately 6 million women in the US, aged 15-49, take oral contraceptives (OCs) each year.(4) The National Survey of Family Growth (2015-2017) reported that OCs are the second most common method of contraception used by women between the ages of 15-49.(4) The use of OCs is higher among younger populations and decreases with age. Approximately 90% of women taking birth control pills are < 40 years old and 54% are under the age of 20.(1)Therefore, an association between the use of OCs and the risk of hypothyroidism could potentially affect a significant number of individuals. These individuals, when presented with other options for contraception and/or better monitoring of thyroid function, may be able to avoid the increased risk of morbidity and mortality associated with hypothyroidism. Birth Control Pills and Risk of Hypothyroidism The British Medical Journey (2021) recently stated that women with a history of taking OCs for more than 10 years have greater odds of developing hypothyroidism (OR, 3.837; 95% CI 1.402-10.500; p=0.0090). Their finding was the result of a retrospective, cross-sectional study derived from information gathered in the National Health and Nutrition Examination Survey (NHANES) 2007-2012. This large epidemiological survey included a total of 30,442 participants. Of this number, 5116 females met the inclusion criteria for participation in the study. These individuals were divided into two groups: those with a history of OC usage (n=3034) and those that had never used OCs (n=2082).

Approximately 16% (830) of the combined individuals were identified as hypothyroid. Hypothyroidism was more frequently diagnosed in those with a history of taking OCs (17.7% vs 14.1%). The state of being hypothyroid was defined as either those taking levothyroxine, regardless of thyroid stimulating hormone (TSH) or those with a TSH >5.6 mIU/L.(3) Women should therefore consider the long-term health effects of OCs and the increased odds of developing hypothyroidism associated with their use.

This study had several strengths, including the large population surveyed, and the strict criteria used to control for confounders. Limitations were also inherent in this type of study. One of the main limitations is the lack of data to differentiate between the types of OCs used, including their chemical composition. Knowing the types of contraceptives used, i.e.: combined contraceptives containing estrogen and progestin versus progestin only contraceptives, may have provided different outcomes. Other limitations included possible recall bias due to the use of self-reported data from individuals, which can often be incorrect. These factors may have skewed the results obtained. It is also important to recognize a cross-sectional, retrospective analysis can only demonstrate an association between the OCs and hypothyroidism and cannot establish causation.(3)

According to the National Institute for Health (NIH),

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In this episode of Functional Medicine Research, I interview Palmer Kippola on how to beat autoimmune disease and her new book "Beat Autoimmune: The 6 Keys to Reverse Your Condition and Reclaim Your Health". We had a great talk walking through her F.I.G.H.T.S. protocol which includes food, infections, gut health, hormones, toxins, and stress.

Our focus in this interview was on practical strategies for those with autoimmune disease to implement right away into their lives. Palmer has dealt with autoimmune disease herself, so she offers a unique perspective.

Full Transcript on How to Beat Autoimmune Disease with Palmer Kippola

Dr. Hedberg: Greetings everyone, and welcome to "Functional Medicine Research." I'm Dr. Hedberg, and I'm looking forward to my conversation today with Palmer Kippola. She's a best-selling author, speaker, and functional medicine certified health coach who specializes in helping people reverse and prevent autoimmune conditions. She developed a framework called F.I.G.H.T.S, which stands for food, infections, gut health, hormone balance, toxins, and stress to help others beat autoimmune conditions based on her two-decade battle to overcome multiple sclerosis. Her book is "Beat Autoimmune: The 6 Keys to Reverse Your Condition and Reclaim Your Health," with a foreword by Mark Hyman. And as she shares the science stories and strategies to help people heal and thrive, today she provides total health transformation programs for people who seek to heal from any autoimmune condition by addressing the root causes head-on with functional lab testing and comprehensive mind-body strategies. She also serves a growing community of people in a guided online membership program called Beat Autoimmune Academy. Palmer, welcome to the show.

Palmer: Thank you so much, Dr. Hedberg. It's such a pleasure to be here.

Dr. Hedberg: Right. So, as I mentioned in the bio, you dealt with multiple sclerosis. So, I'm sure there's a story there. So, why don't you walk us through your healing journey, what that was like, and that whole process?

Palmer: Sure, sure. I do need to take you back in time a little bit because I was diagnosed at 19. Let me tell you the story. I was a happy, healthy, well-adjusted 19-year-old, by all accounts. I was home for summer after my freshman year of college, and I was working as a hostess in a restaurant. And one day I woke up and the soles of my feet were tingling, like that feeling you have when you've slept on a limb too long, when the blood flows back, it gets all tingling. But this particular morning, the blood wasn't flowing back. But I thought it'll just go away, so I went off to work. And the tingling just continued to creep up my legs like a vine. It got to my knees and by that time, I knew something was really wrong. So, I called my parents who called the family doctor who said, "Get her over to the neurologist at UCLA today." And we did. That's where we were that afternoon. And this particular neurologist had me do really simple heel-toe walking across her floor and tapped my reflexes. And after about five or six minutes, pronounced that she was 99% certain that I had MS, multiple sclerosis. And if she was right, there was nothing I could do except take medication. And we were absolutely shocked. Remember, this was in the mid-80s, so there was no guidebook, there was nothing. We had never heard of MS.

And we just left that office completely confused, devastated, and with very little hope. But I was sent home and that night, my mom lay in bed with me and she was holding me and I was crying and she was crying and it turned out that all of the parts of my body that had been tingling, which by the time I got to the neurologist's office, it had reached right under my collarbone, so all the way up, full body. And then by the time we got into bed that night, all my body went completely numb from the neck down and I would stay numb for a full six weeks. So,

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Functional medicine practitioners often take a “Foods First” approach, recommending dietary modifications to improve health. However, for those with low stomach acid, diet alone may not be enough to ensure adequate nutrition. Low stomach acid can impair digestive ability, causing nutritional deficiencies even in those individuals consuming an optimal diet.

This article will focus on the main digestive chemical associated with the stomach, hydrochloric acid. The causes of low stomach acid and the associated symptoms will be covered. In addition, natural treatment options for low stomach acid, such as betaine HCL and herbal bitters will be discussed.

What is Digestion? Digestion is the process of breaking food down into particles small enough so that the nutrients in the food can be absorbed and then transported throughout the body. Digestion begins in the mouth with the mechanical process of chewing along with salivary enzymes that begin the digestive process. This process is continued as the food passes into the stomach, activating the release of hydrochloric acid. The bolus of food then passes to the small intestines where the majority of digestion takes place. The useful nutrients are digested and absorbed and the waste products are sent through the large intestines for evacuation as feces. Why Does the Stomach Contain Hydrochloric Acid? The stomach is a naturally acidic environment, especially following a meal, with a normal pH value of <3. Low stomach acid (hypochlorhydria) is observed with a rise in pH >3 and an absence of stomach acid (achlorhydria) is obtained with a pH > 7.1 This acidity comes from the hydrochloric acid that is secreted by the parietal cells in the lining of the stomach.

Healthy stomach acid levels serve as an immune system barrier, providing a first line of defense against unwanted bacterial or microbial invaders that enter the stomach. Hydrochloric acid is also necessary for the digestion of proteins. Proteins are a conglomeration of amino acids folded together into different shapes.

Stomach acid serves to denature (unfold) the proteins and expose the bonds that hold the amino acids together. These bonds can then be cleaved by pepsin, which breaks the protein down into smaller, easier to digest, amino acids. The formation of pepsin from pepsinogen is dependent on sufficient stomach acid levels as well.

Hydrochloric acid is also responsible for deactivating the enzymes of salivary amylase as it enters the stomach and for stimulating the release of cholecystokinin in the small intestines. Both processes are essential for healthy digestive function. Certain vitamins and minerals depend on hydrochloric acid to liberate them from their carriers, such as vitamin B12 and calcium. Having low stomach acid levels can impair all of these functions. What causes low stomach acid levels? Factors that contribute to low stomach acid include: Chronic stress Aging Poor diet Infections Medication use

Stress—Stress impairs digestion. Chronic stress may decrease the production of hydrochloric acid in the stomach due to associated nutrient deficiencies.2 Stress also causes the vagus nerve to lose its proper tone. The vagus nerve is a major part of the parasympathetic nervous system, and it is deeply involved in stomach acid production. With chronic stress it loses its ability to fire properly which disrupts normal stomach acid production.

Aging—Low levels of stomach acid following a meal are more common with aging. Studies that compared stomach acid levels in young individuals (mean age 25) versus older individuals (mean age 75) found that older individuals experienced low levels of stomach acid following a meal for a greater length of time than their younger counterparts. It took 89 minutes for the elderly participants versus 42 minutes for the younger participants to regain normal stomach acid levels (pH 3.0) following a “standard meal”.1, 3,

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In this episode of Functional Medicine Research, I interview Sally Norton in a discussion about how oxalates affect your thyroid and your health. We covered what oxalates are and how they can damage the body. We also discussed how oxalates affect gut health, liver health, thyroid health as well as all the symptoms and associated conditions connected to oxalates.

If you're really struggling to get well, but your diet appears to be healthy, oxalates may be the missing link.

Full Transcript on Oxalates and Thyroid Health

Dr. Hedberg: Well, welcome everyone to "Functional Medicine Research." I'm Dr. Hedberg, and I'm really looking forward to my conversation today with Sally Norton. Sally is a consultant writer, educator, and speaker with over 30 years in the health promotion and wellness field. Sally specializes in helping people improve their health with an oxalate-avoiding diet. Sally holds a nutrition degree from Cornell University and a Master's of Public Health degree from the University of North Carolina at Chapel Hill. She worked in the field of medical education at UNC Medical Schools Program on Integrative Medicine and as a research grant writer and research administrator at the Virginia Commonwealth University School of Medicine. Despite a healthy lifestyle, she struggled for over 30 years with seemingly unanswerable health challenges, including chronic pain and fatigue. When she finally discovered the cause and turned her health around, she committed to teaching and reaching out to others stuck in similar frustrating situations. Sally, welcome to the show.

Sally: Thank you. It's great to be here.

Dr. Hedberg: Yeah, I'm looking forward to this and we were kind of discussing this early on. Oxalates is something that I've always kept my eye on for the last 17 years and I was really looking forward to this conversation. So why don't we lay a little bit of bedrock for the listeners? And if you could just talk about what are oxalates, and do we know why plants actually have oxalates?

Sally: Yes. Plants are a major producer of oxalate and obviously, it's also ubiquitous in nature itself. Soil is loaded with it. Even apparently sea spray produces some oxalate and polluted air produces oxalates, so, in really heavily polluted cities, the air has got oxalate in it too. So oxalate is this really minuscule molecule that its parent compound is called oxalic acid. And acids ionize and become charged particles because they drop off the acidic protein and so they become these negatively charged ions that attract positively charged things and oxalates can have a one negative or two negative. It is a tiny, tiny little compound. It has four oxygens, which is a heavy load of oxygen on just two little carbon molecules. So it's very oxygen-heavy, which is probably partly why it's such a pro-oxidant molecule, you know. Oxidation is very bad for tissues, membranes, mitochondria, and it is a great mitochondrial poison, membrane destroyer, and troublemaker. And it's not just the oxygen, though. It's much more about this reactivity that the charge creates where it bonds with minerals and becomes salts. And so, salt is a chemical term for things that can dissolve, but when it...because it can have two negative charges, it will also hook up with minerals that won't dissolve well. So calcium, for example, is a two positive charge mineral. With that double-positive and double-negative marriage between the two, you create an insoluble oxalate, which is the backbone of oxalate you see in nature because calcium is everywhere in soils and in nature, and plants are having to manage their calcium. And one of the ways they do that...because too much calcium can be toxic to the plant. So one of the ways they do that is they make oxalic acid. Often they make vitamin C first, very similar compounds, and vitamin C naturally degrades just hanging around into oxalic acid and oxalates.

So plants will create vitamin C and they'll cre...

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In this episode of Functional Medicine Research, I interview Dr. Theodore Belfor in a discussion on cranial facial development and airway resistance. If you have read James Nestor's new book "Breath" then you are aware of Dr. Belfor's work.

We talked about the causes of abnormal cranial development and how this causes airway resistance and a number of health problems including sleep apnea, insomnia, IBS, bruxism, and more.

Our cranial bones don't form properly when we aren't breastfed and eat a modern diet of processed foods. Dr. Belfor's oral appliances help to correct these abnormal developments to restore proper facial bone structure and improve the airway.

Full Transcript with Dr. Theodore Belfor

Dr. Hedberg: Well, welcome everyone to "Functional Medicine Research." I'm Dr. Hedberg, very, very excited today to have Dr. Theodore Belfor on the podcast. I first heard about Dr. Belfor in James Nestor's new book called "Breath." And we're gonna be talking about all of that today on the show.

And Dr. Belfor, he's a graduate of New York University College of Dentistry, and a senior certified instructor for the International Association for orthodontics. In the 1960s, Dr. Belfor was sent to Vietnam to work as the sole brigade dentist for 4000 soldiers of the 196 Light Infantry from the jungles of Vietnam to Park Avenue in Manhattan. Upon his return, he opened his own private dental office in New York City, and has been in private practice for more than 40 years. And Dr. Belfor specializes in the treatment of the cranial facial system, and that's what we're going to be diving into today. So, Dr. Belfor, welcome to the show.

Dr. Belfor: Well, thank you for having me. It's my pleasure.

Dr. Hedberg: Excellent. So, why don't we start by talking about how this all began, and go back to, you know, what happened that changed the cranial bones, the cranial structure, our skulls, that led to this epidemic of airway issues, breathing issues, and all of the health issues that come with that?

Dr. Belfor: Well, how we develop, how we grow and develop is based on how we breathe, how we swallow, and how we chew. So, just looking at how we chew, according to the U.S. Department of Agriculture today, in the U.S., 63% of our diet is processed and refined foods. So, without the proper stimulation to the body, we are not fully expressing our genes, we're not developing to our full potential. Because of that, particularly when our jaws do not grow forward enough, the retrusion of those jaws helps to push the tongue backwards into the airway and down the throat, so now we have compromised sleep and breathing.

Dr. Hedberg: So, it's a combination of things. I know Dr. Nestor talks about it in his...or James Nestor talks about in his book, the changes in diet, soft food, not enough hard foods, not breastfeeding. Can you talk a little bit more about these changes in our society and some of these predisposing factors that can cause an abnormal airway?

Dr. Belfor: Well, for me, the enlightenment came, when almost 20 years ago, I was treating performing artists who couldn't wear braces and they wanted straighter teeth, and I used an appliance and had a unilateral bite block, which basically, in essence replaces the missing hard food in our diet. And guess what? The actors, performers were coming in, and their makeup artist was telling them that their faces are changing, and the singers were coming in and saying they were reaching higher notes. So, that's what set me on the path.

You see, the concept in dentistry is to balance the bite all the time. And it's kind of an anathema to have, when you bite down, to hit on one side. However, if I give you a stick of gum to chew, nobody on the planet is going to chew on both sides at the same time. We chew on one side then we chew on the other. And apparently from the research, many articles that have been written, the latest one in August 2018,

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In this episode of Functional Medicine Research, I interview Dr. Ron Parks in a discussion about COVID-19 and the mental health crises. Dr. Parks has written a new book "COVID-19 and Mental Health Crises" which we discuss as well as a variety of other topics that can help those afflicted by this pandemic.

The mental health aspects of COVID-19 are often overlooked with more of a focus on the physical aspects of the illness, medications, vaccines etc. As usual in the United States, mental health is pushed to the back of the bus with little to no dialogue or support for those who need psychological support. Dr. Parks provides a voice for those in need with his excellent new book.

Full Transcript on COVID-19 Mental Health Crises Dr. Hedberg: Well, welcome, everyone, to Functional Medicine Research. I'm Dr. Hedberg. Very excited today to have my good friend and colleague, Dr. Ron Parks, on the show. And we're gonna be talking about his new book. And Dr. Parks is a respected physician, teacher, book author, writer, and mentor, with an integrative and holistic perspective. He especially trained in internal medicine, nutrition, preventive medicine, and board-certified in psychiatry. Currently, Dr. Parks is the medical director and psychiatrist for The Center for Spiritual Emergence and Katharos Sanctuary in Asheville, North Carolina. He has an MD from the University of Maryland and a master's degree in public health and health service research from the University of California at Los Angeles. He has completed specialty training and internal medicine at George Washington University, preventive medicine at UCLA, and psychiatry at the University of Maryland. Dr. Parks is a former assistant professor at the Albany and University of Miami Medical School, chief of internal medicine at the Homestead Air Force Base Hospital in Florida, former director of the Center for Preventive and Nutritional Healthcare in Baltimore, Maryland, and founder of the MacroHealth Medicine, a comprehensive and holistic consultative and treatment service, formerly in Asheville, North Carolina. Dr. Parks, welcome to the show.

Dr. Parks: Well, thank you, Nik. Thank you for having me.

Dr. Hedberg: Yeah. I'm looking forward to this. So, you've written a new book, it's called "COVID-19 and Mental Health Crises." So, we're gonna dig into that. But before we do that, can you just talk a little bit about how you got into integrative functional medicine and psychiatry?

Dr. Parks: Well, that's a good question. Actually, it started when I was very young. I think I write a little bit about this in the book. I came down one summer as a kid with polio. And it was very upsetting, of course. And I compared it to the current COVID crisis. Back then there was no treatment and everybody had been waiting 10 years, 8 to 10 years for a vaccine. But here I was, a young, healthy, athletic kid that suddenly was running high fevers and a stiff neck. So, I ended up in the hospital at a children's ward. And back then the only treatment they had was more of a natural treatment called the Sister Kenny treatment. It was like a heat treatment. They wrap you in warm towels. And so that was my first exposure to, you know, what I would call functional medicine or holistic medicine. Though I had a sweat through it, but luckily, I didn't end up with the paralytic form of it, but sometimes I do think I have some of the long...they're talking about with a new virus, the long hauler syndrome. But with polio, there were some aftermaths there, and I think maybe some of the weakness I had some time in the legs and things like that might be from that.

But anyway, that got me started on the path of interest in broader treatment programs. But a lot of it came, though, from my being formally, formally trained in internal medicine, where everything was about labels and diagnosis. And I remember in training, I got yelled at by the pathology teacher because I looked at a slide and ...

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In this episode of Functional Medicine Research, I interview Tom Fabian, PhD in a detailed discussion about the GI-MAP stool test interpretation. We covered virtually every aspect of the GI-MAP stool test including what the test results mean and how to use them in clinical practice.

Dr. Fabian has tremendous knowledge of the gut microbiome and the intricacies of the GI-MAP stool test markers. This is a vital interivew to listen to if you're utilizing the GI-MAP stool test in your practice.

Full transcript of the GI-MAP Stool Test Interpretation interview with Dr. Tom Fabian:

Dr. Hedberg: Well, welcome, everyone to Functional Medicine Research. I'm Dr. Hedberg, and I'm looking forward today to my conversation with Dr. Thomas Fabian. He is a PhD., and he's a clinical laboratory consultant, translational science expert, functional nutrition practitioner, educator, and speaker. He is a former biomedical research scientist and deep expertise in the role of the human microbiome and health, chronic disease and aging. As a leading expert in translational applications of microbiome research and functional medicine and integrative health settings, Tom's primary focus is on providing educational resources and consulting services for practitioners and scientific advisory and consulting services for clinical testing laboratories. Dr. Fabian, welcome to the show.

Dr. Fabian: Thanks so much, Nik. It's great to be here today, and I'm looking forward to the conversation.

Dr. Hedberg: Excellent. So, we're gonna be talking about the diagnostic solutions, lab, GI-MAP test, and we're gonna cover interpretation, you know, what these markers mean. And so, for all the practitioners listening, they'll have a strong idea of how to approach this test and how to use these things clinically. So, why don't we start with...take it from the top in the pathogen section? And I wanted to ask you specifically about C-diff. There's toxin A and toxin B Clostridium difficile markers on this test. And what is your interpretation of this if it's positive and the patient is symptomatic, and then you treat them, and then they're no longer symptomatic, but the toxin still shows up on the stool test? Can you elaborate a little bit on that type of presentation?

Dr. Fabian: Sure. No, I haven't personally seen that particular scenario but, in general, it's important to keep in mind a lot of people can be carriers of C-diff. So, the majority of the time that we see it detected positive, whether it's low levels or high levels, typically, patients don't have the classic symptoms. So, that suggests that they're probably just a carrier. And there's, sort of, kind of, a gray area in between where there still may be some effects of C-diff. Of course, that's one of the purposes of looking at the markers on GI-MAP like calprotectin, zonulin, etc. to see if there seems to be any evidence that may be have an impact, even if there aren't symptoms. So, we're also learning a lot more from research about factors that can control or influence the ability of various pathogens to thrive and also whether or not they can cause infection or if they have their, you know, typical pathogenic effects. So, that's essentially factors that influence virulence.

So, one of the first things I want to mention is all the microbial markers on GI-MAP are assessed based on detection of DNA. So, when you're looking at DNA, you're looking at detection of the organisms or the genes but not necessarily whether the genes are being expressed. And that's definitely true for toxins. So, lots of research has been coming out in research years in terms of, again, as I mentioned, things that regulate toxins, and it's very specific. So, pathogens tend to only express those toxins under very specific conditions when conditions are favorable for them. So, for example, if you've detected C-diff and it really syncs up with what's going on with the patient, symptomatically,

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In this episode of Functional Medicine Research, I interview Robb Wolf about his new book and documentary Sacred Cow. We had a great conversation dispelling some of the myths about meat and saturated fat as well as climate change, plant-based diets, sustainable agriculture, veganism, cattle and methane, and the ethics of eating animals.

This was a well-rounded interview packed with information that should help people make better decisions about what they eat but also become educated about the facts around meat. I highly recommend watching the Sacred Cow documentary and reading the book which goes into tremendous detail on these issues.

Full Transcript of Sacred Cow with Robb Wolf Interview

Dr. Hedberg: Well, welcome, everyone, to "Functional Medicine Research." I'm Dr. Hedberg. And I'm really looking forward to my conversation today with Robb Wolf. And Robb is a former research biochemist, and he's a two-times "New York Times," "Wall Street Journal" bestselling author of two books, "The Paleo Solution" and "Wired to Eat." And he coauthored a book with Diana Rodgers, which we'll be talking about today, called "The Sacred Cow," and that explains why well raised meat is good for us and good for the planet. Robb has transformed the lives of hundreds of thousands of people around the world via his top ranked iTunes podcast, books and seminars. He's known for his direct approach and ability to distill and synthesize information to make the complicated stuff easier to understand. Robb, welcome to the show.

Robb: Doc, a huge honor to be here. Thank you.

Dr. Hedberg: Great. Yeah, I had Diana on last year. And we talked a little bit about plant-based diets and meat and things like that. And then since then, we've had the "New Sacred Cow" book that you co-authored, and the documentary, which is excellent. And so, why don't we begin by...I'd really like to focus on helping the listeners understand some of, you know, the misunderstandings and the truths and the myths about eating meat versus plants and things like that. And so why don't we start with a discussion about why meat has become a scapegoat. And I think, and you can expand on this, of course, but I think part of this probably goes to Ancel Keys' work in the 20th century, his promotion of misinformation on saturated fat. Can you take us from that point up to where we are now, and why you think meat has been getting such bad press?

Robb: Yeah, you know, it's interesting and worth noting the book covers the health, environmental, and ethical considerations of a meat or animal product-inclusive food system. You know, so the raising and the selling and the slaughter and the whole deal. And all of those points are important, and all of those points have some really interesting, historical antecedents, I guess, kind of describing why in different cultures meat would become vilified to varying degrees.

And like, food is an interesting cultural tool for defining self from non-self. Like, if we look within the Abrahamic religions, there are some very specific delineations of what is and is not allowed within, say, Judaism versus Christianity versus Islam. And we see similar things within different Buddhist traditions and whatnot, so I mean it...Or even just within Christianity itself, you have like the Seventh Day Adventists versus, you know, certain rules and followings within Catholicism, you know. And so, it's interesting that food is a powerful tool for defining self from non-self. And not infrequently it is the beginning point of creating out of accepted groups of people. Like, there's some pretty ugly historical examples of where the different food practices of one religion or one type of people start being used as a means of, kind of, ostracizing and, kind of, walling those folks off.

But we have these three different pieces that if we're really gonna do diligence on this topic that we have to address. And, you know,

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In this episode of Functional Medicine Research, I interview Ashok Gupta about his limbic system retraining program. Trauma of any kind can change the brain and nervous system in a way that prevents one from getting well. Many people never get well because they don't address the underlying trauma that has triggered or contributed to their health challenges.

If you've tried eating right, exercising, sleeping well, taken the best supplements, and managed your stress, but you still aren't feeling well, your brain and nervous system may be out of balance. The Gupta Program is designed to change the neuroplasticity of your brain and nervous system so you can heal and feel well again.

We discuss a new and exciting published paper that validates this method of limbic system retraining.

Full Transcript on Limbic System Retraining Interview

Dr. Hedberg: Well, welcome everyone to "Functional Medicine Research." I'm Dr. Hedberg, and I'm very excited today to talk to Ashok Gupta about limbic system retraining. And Ashok is an internationally renowned speaker, filmmaker, and health practitioner who has dedicated his life to supporting people through chronic illness and achieving their potential. Ashok suffered from myalgic encephalomyelitis or chronic fatigue syndrome about 25 years ago when he was studying at Cambridge University, and through neurological research that he conducted, he managed to get himself 100% better. He then set up a clinic to treat others and then published the well-known recovery program known as "The Gupta Program" in 2007. He's published several medical papers and he's continually researching these conditions. You can find out more information at guptaprogram.com. Ashok, thanks for coming on the program.

Ashok: Thank you so much for inviting me. Very excited to be here.

Dr. Hedberg: Yeah. So, the limbic system is something that I've been interested in since I started practicing 17 years ago, and you know, I have a variety of recommendations that I give to patients for that. You know, things like meditation, mindfulness training, therapy, or just a number of things, but your particular limbic system-intensive program, I heard about it recently and became very interested in it. And why don't we begin by talking about just the limbic system itself? Can you give people kind of an overview of what the limbic system does and why it's important?

Ashok: Yes. So, there are many different ways of describing the limbic system. I think primarily if we start with this idea of it being a defensive system to ensure survival, right? So, most people would associate the limbic system with our emotional responses and medicine often separates the kind of psychology and the emotional responses from defense responses as if they're something different, you know, physiological defense responses versus emotional defense responses. But I see the limbic system as the automatic survival systems that we've inherited over generations of different animals and whatever that actually create responses that ensure survival. And so, a fight or flight response, a fear response, an anger response, a memory of a previous experience, all of these things are designed to ensure survival. So, that is for me the primary motive or motivation of that limbic system. And within that limbic system, there are different structures that play specific roles. And a lot of our research focuses on the amygdala, which are two almond-shaped structures that sit behind our eyes that essentially are taking all the incoming information from the outer world and the inner world, process it according to the previous experiences we've had in life, our memories, and then creates a coordinated response across the brain to ensure survival, yeah? And one way to look at this Dr. Hedberg, which I find fascinating is to ask the biggest question of all, you know, why are we here? And we can answer that question from a philosophical perspective,

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In this episode of Functional Medicine Research, I interview Dr. Deb Matthew about her new book on male sexual health "Why Can't I Keep Up Anymore?: A Guide to Regaining Energy, Focus, and Peak Physical & Sexual Performance for Men Over 40". We discussed the causes of male sexual dysfunction, lab testing, causes of low testosterone, stress and cortisol levels, sex hormone binding globulin, testosterone replacement methods, how sleep affects hormones and much more.

This book isn't just for men. If your male partner is showing signs of low testosterone then this book is a must-read with resources on how to find the right kind of doctor to get well.

Male Sexual Performance with Dr. Deb Matthew Interview Transcript

Dr. Hedberg: Well, welcome, everyone, to "Functional Medicine Research." I'm Dr. Hedberg, and I'm really excited today to have Dr. Deb Matthew on the show. Dr. Matthew is a medical doctor, and she's also known as the happy hormones doctor. She's a best-selling author, international speaker, educator, wife, and mother of four. And after suffering for years with fatigue and irritability, her quest to resolve her personal health led her to change everything about her practice of medicine. She has been featured on national podcasts, radio, and broadcast shows, including NBC, ABC, CBS, and Fox. Dr. Matthew, welcome to the show.

Dr. Matthew: Thank you so much. It's great to be here.

Dr. Hedberg: So, we're going to be talking about your new book, "Why Can't I Keep Up Anymore?: A Guide to Regaining Energy, Focus, and Peak Physical & Sexual Performance for Men Over 40," which I read recently. It's an excellent book. Wanted to have you on and talk about something that is...well, I would say most male issues are overlooked, but testosterone is really a big one and so is sexual performance and male hormones. So, why don't we begin by talking about why testosterone is so important for men?

Dr. Matthew: Yeah. You know, hormones, in general, play a big role in how we feel on the inside, how we relate to the world around us, how we react to other people. And so, testosterone drives a lot of how men feel and even behavior, and it really plays a role in men feeling like a man. So, it's important for drive and for motivation so that when you wake up in the morning and your boots hit the floor, you're ready to take on the world. And when testosterone levels are not quite right, men just don't quite feel right. And for women, when we go through our hormonal changes, it's pretty obvious. We either get menstrual problems or, you know, we get hot flashes. And so, there's some pretty obvious things that happen at some pretty obvious times in our life in order to notify us that our hormones may be changing. But for men, it's much more subtle.

So, it is something that often happens gradually over time. And so, what I hear men say a lot is, you know, "I just don't quite feel like myself anymore. I'm just not quite keeping up the same way that I used to. But you know, maybe it's just my age." I hear that all the time, "It must just be my age. I'm not 18 anymore." And so, you know, maybe it's not fair to compare to an 18-year-old, but if you're 40 or 50, like let's not blame it on age. If you're 95, okay, fine. We'll blame it on your age. But when you're younger, even though things change, they don't have to feel that way. And so, one of the things that could be contributing to not quite feeling like yourself anymore is low testosterone.

Dr. Hedberg: One of the things I see in practice is men who, you know, they're diagnosed with low testosterone or they have the symptoms and they see their conventional medical physician and they try a testosterone, but it doesn't work at all. Sometimes they get a little bit worse. Sometimes there's really no change. What do you think the conventional medical approach is missing when something like that happens to a man?

Dr. Matthew: Oh,

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In this episode of Functional Medicine Research, I interview my friend and colleague Cass Nelson-Dooley, M.S. in a discussion on how to heal your oral microbiome. Cass recently published the book "Heal Your Oral Microbiome" and we discussed many important topics about this often overlooked health issue. We discussed what conditions may be connected to a dysbiotic oral microbiome, how oral microbiome dysbiosis affects your health, health sweeteners, strategies to heal the oral microbiome, testing, dental products and more. If you're struggling with healing your gut or have a health issue that won't resolve, your oral microbiome may be the missing link.

Full Transcript on How to Heal Your Oral Microbiome Dr. Hedberg: Well, welcome, everyone, to "Functional Medicine Research." I'm Dr. Hedberg. And I'm very excited today to have my friend and colleague, Cass Nelson-Dooley, on the show. And Cass studied medicinal plants in the rainforests of Panama in 2003 as a Fulbright Scholar and then launched a career in science and natural medicine. She researched the pharmacology of medicinal plants at the University of Georgia and AptoTec, and then joined the innovators at MetaMetrics clinical laboratory and Genova. She enjoys teaching, presenting, writing, and researching how to address the underlying causes of disease, not just the symptoms.

She has over a decade of experience teaching doctors about integrative and functional laboratory results. In 2013, she started Health First Consulting, a medical communications company with a mission to improve human health using the written word. She created innovative videos and patient education handouts to improve practice efficiency and motivate patients. Miss Nelson-Dooley is the author of the book "Heal Your Oral Microbiome," which we'll be focusing on today. And has published case studies, book chapters, journal articles about natural medicine, nutrition, and laboratory testing. Her website is healthfirstconsulting.com. Cass, welcome to the show.

Cass: Thank you, Nick. So happy to be here.

Dr. Hedberg: Yes. It's been a while. We were just kind of reminiscing about the days at MetaMetrics and I read your new book, "Heal Your Oral Microbiome." So, I was excited to have you on about that because no one's really talking about it. So, why don't we talk about, kind of, the foundation of what we're talking about here, which is periodontal disease? And so can you just talk a little bit about what that is?

Cass: Sure. Sure. So, yeah, it's great talking with you after all these years and in the starting out, getting to know you in the functional lab industry. But, yeah. So, this book was a really fun book to write, especially from the jumping-off point of gut health, right, which is kind of a central tenet in functional medicine. And that's some of the testing that we used to talk about years ago. So, so much of what we know about the gut really just perfectly translates to the mouth. And periodontal disease, you know, I kind of like to just simply say that it is a dysbiosis. It's an oral dysbiosis that...and an aberrant or an over-reactive immune response to that dysbiosis.

So, one of the fascinating things, when I was writing this book, was realizing that so many of the things that plague our mouths are really just dysbiosis, you know, which we talk about all the time in regards to the gut. So, periodontal disease is an imbalance of oral bacteria that triggers an immune response that attacks and destroys bone and teeth. Cavities are a bacterial dysbiosis in the mouth. Root canal infections are bacterial imbalance in the pulp of the tooth. And then you can get cavities on the root of a tooth, which is, again, dysbiosis. So, it was pretty fun to realize, wow, all of these problems just go back to the oral microbiome and we just need to try to rein in that oral microbiome and make it healthier in order to prevent these diseases.

Dr. Hedberg: Yeah.

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In this episode of Functional Medicine Research, I interview dietician Tracey Long in a deep discussion about how to overcome mold and biotoxin illness. Tracey has firsthand experience with mold and biotoxin illness so she brings a unique and valuable perspective to this topic. We discussed Tracey's personal journey with mold and biotoxin illness, how to test your home for mold, lab testing, associated conditions, symptoms, and management strategies to get well.

Full transcript on How to Overcome Mold and Biotoxin Illness Dr. Hedberg: Well, welcome, everyone, to "Functional Medicine Research." I'm Dr. Hedberg. Really excited today to have my good friend and colleague, Tracey Long, on the show. Tracey is a registered dietician, with specialty certification training in Integrative and Functional Medical Nutrition Therapy and The Bredesen Protocol to End Alzheimer's. She owns a private practice, Big Picture Health in Hendersonville, North Carolina, where she sees clients via video consultations. She specializes in working with clients with neurodegenerative conditions, biotoxin illnesses, gastrointestinal conditions, and nutrigenomics. She is a published author and teaches health coaches for Chris Kresser's Health Coach Training Program. Tracey's education includes a master of public health, an emphasis on nutrition and exercise physiology from the Colorado School of Public Health, where she studied under Dr. Loren Cordain who many of you may know as the author of "The Paleo Diet." And she's also a registered yoga teacher and certified exercise physiologist. Her personal interest include hiking with her husband and dog, urban farming, teaching yoga, foraging for mushrooms in the mountains of Western North Carolina, growing medicinal herbs and produce, paddleboarding, and visiting her three grown daughters in Colorado. Tracey, welcome to the show.

Tracey: Thank you so much, Nik. I'm so happy to be here with you today. Really appreciate the opportunity.

Dr. Hedberg: Yes. Yeah. It's gonna be fun. So why don't we begin by talking about your personal journey with mold? And that's gonna be the topic of today, mold and biotoxin illness. So why don't you share your personal journey?

Tracey: You bet I'd love to. And really, my personal journey, Nik, really started with a professional journey in that I became very interested in neurodegenerative conditions and I completed Dr. Bredesen's training, as you mentioned, The Bredesen Protocol to End Alzheimer's. And Dr. Bredesen has sub-categorized underlying causes of Alzheimer's, and one of those underlying causes he refers to as type three Alzheimer's that's really related to toxins. And he's identified three categories of primary toxins. The first one is heavy metals and the second one is biotoxins. And in that category, biotoxins, certainly, mold is included and also tick-borne illnesses. And now even recently we've added COVID-19, especially from the standpoint of, you know, people who have had COVID-19 and they haven't recovered. You know, we're referring to them as long haulers. And I bring that up. I'll tie that all in in just a minute. The third type of toxin Dr. Bredesen addresses are organic compounds. So there are things like herbicides and pesticides, things that we can be highly exposed to in the environment. It was interesting in that journey that I had that training and I started working with clients with all the subtypes of Alzheimer's, little did I know that I would end up having my own personal experience. So I was assisting clients who had been exposed to mold, certainly, and then we ended up moving to North Carolina. It's in the South. It's very moist here, as you know, I know you live here too. So, you know, we've had a year of record rainfall here.

So I moved from Colorado, which was very hot and dry to the Southeast, which is living like in the tropics, really. We're living in a rental house. And when we found the house,

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The Paleo Diet is a popular diet that can work well for many chronic diseases, especially autoimmune diseases like Hashimoto’s disease. However, the Paleo Diet can be somewhat restrictive which can result in deficiencies if the dieter doesn’t carefully review their food and micronutrient intake. Iodine is one important micronutrient that may become depleted on a Paleo Diet. The Autoimmune Paleo Diet is an even more restrictive diet so the same deficiency may happen.

Let’s review what the research shows about the Paleo Diet and iodine deficiency.

A paper published in the European Journal of Clinical Nutrition entitled, “A Paleolithic-type diet results in iodine deficiency: a 2-year randomized trial in postmenopausal obese women” sheds some light on this question. Introduction to this study on the Paleo Diet and iodine deficiency This study was done in Sweden and the authors begin by stating >50% of iodine intake comes from iodized table salt followed by dairy and seafood. The Paleo Diet is void of dairy, grains, legumes, refined sugar, processed oils, and salt thus removing two important sources of iodine. 150 micrograms of iodine per day is recommended by the Nordic Nutrition Recommendations (NNR) but the thyroid can function at 70 micrograms of iodine per day.

Urinary iodine concentration (UIC) by spot urine is recommended for determining iodine status. Adequate iodine intake is a UIC of 100-199 ug/l. Mild iodine deficiency is a UIC of 50-99 ug/l. Moderate iodine deficiency is 20-49 ug/l. Severe iodine deficiency is <20 ug/l.

However, the authors do state that the best way to measure iodine status is a 24-hour urinary iodine excretion over multiple days.

The authors point out that those at greatest risk for iodine deficiency include pregnant or lactating women and vegans. How was this study done on the Paleo Diet and iodine deficiency? This was a randomized controlled trial consisting of one group following the Paleo Diet and the other following an NNR-based diet for two years. Urine and blood samples were collected at baseline, 6-months, and 24-months. Testing included 24-hour urinary iodine concentration and excretion as well as thyroid hormones.

24-hour urine was collected on three separate days. TSH, Free T4, and Free T3 were the thyroid hormones tested.

70 post-menopausal women were included of which 74% were obese and the rest overweight. 49 subjects completed the study of which 22 followed the NNR diet and 27 followed the Paleo Diet. What were the study results? Women following the Paleo Diet totaled a weight loss of 10.7% compared to 7.7% in the NNR group.

The Paleo Diet group developed iodine deficiency but the NNR group maintained normal iodine status.

TSH, Free T4, and Free T3 levels did not differ between the groups at any time except for Free T3 levels declined after 6 months in the Paleo Diet group.

The author’s conclude that pregnant women should avoid the Paleo Diet because iodine deficiency can cause impaired brain development of the fetus.

The weakness of this study is the 30% drop out rate but the authors state that they don’t believe this affected the results because those most likely to adhere to the diets remained. Dr. Hedberg’s Comments This study was done well but a larger group would have provided stronger results. 24 months is an adequate time to assess micronutrient deficiencies from dietary interventions.

The Paleo Diet group did lose more weight but when you look at the NNR recommendations you’ll see a much higher carbohydrate intake of 60% compared to the Paleo Diet group who only consumed 30% carbohydrates. These women were obese or overweight, so they were insulin resistant which means that they won’t do well on higher carbohydrate intake. The Paleo Diet group also consumed 30% protein compared to just 15% in the NNR group.

The decline in Free T3 on the Paleo Diet is due to the lower carbohydrate intake which isn’t necessarily a bad thin...

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I would like to report on the new product GI Meal Select from Moss Nutrition. With the increasing prevalence of gut disorders, we need more strategies to help patients get well quickly and effectively. GI Meal Select has been carefully formulated to address many aspects of gut healing in an affordable and effective product.

GI Meal Select is designed to provide optimal nutrient sustenance so it can act as a stand-alone meal replacement. It is easy to digest, pleasant tasting, and reasonably priced. One of the issues with many meal replacement products is the carbohydrate and fat content which can cause gut issues like gas and bloating so this product has almost completely eliminated both.

It also contains no protein powder such as whey and pea which most people with gut issues can no longer tolerate. Instead, it uses the Reginator amino acid blend to maintain muscle mass and promote tissue repair.

Resting the digestive organs can be paramount in helping to enable proper gut healing and repair, provided there is an ongoing presence of protein building blocks (essential amino acids) to prevent tissue breakdown, and sufficient micronutrient cofactors to enable enzyme function and structural support. GI Meal Select provides these requisites along with two targeted gut health nutrients: a potent 2 grams of immunoglobulin rich IgY Max plus 1.75 grams of pure L-Glutamine, the primary fuel of enterocytes (cells lining the digestive tract).

All the nutrient components in GI Meal Select are provided in their basic, predigested or “elemental” forms, taking a great burden off the digestive organs. In this sense, GI Meal Select offers restorative and reparative benefits similar to those of elemental formulas. However, GI Meal Select is very low in calories and free from added carbohydrates and fats, macronutrients which may trigger symptoms in GI patients. Individuals who do tolerate fats may be advised to add one teaspoon of a liquid omega-3 supplement such as EPA/DHA HP Select (high potency fish oil), Icelandic Cod Liver Oil (also a good source of vitamins A & D3) or flaxseed oil to their GI Meal Select shake.

While not appropriate for extended use as the sole source of daily nutrition, GI Meal Select can be taken one or more times per day, as directed, in place of a regular meal or between meals. By allowing the digestive organs to temporarily rest, removing dietary components that feed gut microbes, supplying the body with elemental nutrition and directly nourishing the gastrointestinal tract with immunoglobulins and amino acids, GI Meal Select may help to promote repair of the intestinal lining, decrease the severity of inflammatory GI conditions, diminish the incidence of small intestine bacterial overgrowth (SIBO) and help to reset overall gut health, structure and function.

A COMPREHENSIVE MULTIPLE VITAMIN/MINERAL Each serving of GI Meal Select contains a complete array of vitamins and minerals. Fat soluble vitamins A, D3, E and K2 help to heal mucous membranes and support healthy immune function, bone and vascular health. B-complex vitamins in bioactive forms, featuring methylated folate and B12, and vitamin B6 as P-5-P, promote healthy energy production, detoxification and nerve cell transmission. Buffered vitamin C is gentle on the stomach. Full spectrum minerals, essential for countless physiological mechanisms, are provided in natural, carrier-free forms to minimize the potential for irritation in hypersensitive gut patients. Moderate rather than therapeutic V/M dosing allows GI Meal Select to be taken more than once daily if needed.

FREE-FORM ESSENTIAL AMINO ACIDS (EAA) represent the microscopic building blocks for all the proteins in the body—from skeletal and smooth muscle tissue to enzymes and antibodies. In contrast to food-bound proteins and protein powders such as whey, rice or pea protein, free-form EAAs are already broken down or “predigested” hence they require no effort to process,

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“Adrenal Fatigue” is a term used for many years by alternative medicine practitioners but does it exist? This is certainly a term that I have used for some time but not in the way that most practitioners use it. I will use terms at times that are widely searched for on the internet so that I can spread the science behind these terms but it doesn’t necessarily mean that I endorse the term or subscribe to the existence of a condition.

There are a few published papers that tackle this very issue that I’ll cover in this article on “adrenal fatigue”.

What does the research show about "adrenal fatigue"? The first paper I’d like to mention is entitled, “We are tired of ‘adrenal fatigue’” by Ross et al. The title of this paper quickly gives you the underlying frustration of the authors about this term. This paper is a position statement and not a clinical trial, review, or analysis of any kind. The authors begin by outlining the adrenal fatigue theory and that is doesn’t exist as a defined medical condition.

The authors do point out a valid adrenal disorder called adrenal insufficiency which is characterized by insufficient cortisol production after an adrenocorticotropic (ACTH) hormone stimulation test. They also mention Addison’s disease which is true adrenal failure.

Interestingly, those who suffer from fatigue actually showed a greater rise in cortisol with an ACTH stimulation test which indicates excessive cortisol production not insufficient cortisol production in those with adrenal insufficiency.

And another study actually found no difference in salivary cortisol levels taken throughout the day in two-thirds of healthy subjects compared to those who suffered from fatigue.

Dehydroepiandrosterone sulphate (DHEA-S) has also been used as a marker for adrenal fatigue but research has shown this to be unreliable.

The most recent systematic review of adrenal fatigue is entitled, “Adrenal fatigue does not exist: a systematic review” by Cadegiani and Kater. The authors searched 3,470 published papers but only 58 of them fulfilled proper criteria for evaluation. Of the 58 studies, only 10 actually used the term “adrenal fatigue” but none of them did any kind of testing to validate this false condition. Some studies tried to use the term “burnout” instead of “adrenal fatigue” but no scientific evidence was presented in these papers.

None of the studies in the above review were able to validate any of the functional tests used to assess adrenal hormone production including cortisol and DHEA. Additionally, no valid information was found in these tests to assess HPA axis dysfunction which is one of the hallmarks of “adrenal fatigue”.

The authors rightly point out that anytime there is a suspected issue of HPA axis dysfunction, the following must be ruled out as a cause of this dysfunction:

1. Sleep apnea

2. Adrenal insufficiency

3. Mental illness

4. Overwork

5. Night-shift workers

6. Other hormonal imbalances

7. Liver and kidney dysfunction

8. Heart conditions

9. Lung disease

10. Autoimmune disease

Some alternative practitioners are not adequately assessing each patient for the above list of potential issues and jumping into treatment of “adrenal fatigue”.

The authors conclude that there is no demonstrated evidence that “adrenal fatigue” is a real condition. Their two final statements are:

1. “The results of previous studies were contradictory using all the methods for assessing fatigue and the HPA axis.”

2. “The most appropriate methods to assess the HPA axis were not used to evaluate fatigue.”

It is clear from reviewing the above paper that the methodology in all the studies reviewed was very poor and did not provide any valid scientific support of “adrenal fatigue”. What about corticosteroids? Many integrative practitioners are prescribing oral corticosteroids to treat adrenal fatigue which can have many negative consequences.

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In this episode of Functional Medicine Research, I interview naturopathic physician Dr. Ilana Gurevich on overcoming inflammatory bowel disease.  We had a deep discussion about testing and treatment options for inflammatory bowel diseases including Crohn's disease and ulcerative colitis.  We covered diagnostic testing, the pros and cons of stool test markers, probiotics, fiber, digestive enzymes and hydrochloric acid, gut healing nutrients, diets like the Specific Carbohydrate Diet, helminths, and much more.  It was a pleasure to have Dr. Gurevich's expertise on inflammatory bowel disease.

Below is a transcript on How to Overcome Inflammatory Bowel Disease with Dr. Ilana Gurevich

Dr. Hedberg: Well, welcome everyone to "Functional Medicine Research" I'm Dr. Hedberg, really looking forward to my conversation today with Dr. Ilana Gurevich. She is a naturopathic physician and acupuncturist. She graduated from the National University of Natural Medicine in 2007, with her doctorate in naturopathic medicine, and in 2008, with her masters of Oriental medicine. She is currently co-owner of two large integrated medical clinics, one in Northwest Portland and one in Northeast Portland.

She runs a very busy practice specializing in treating inflammatory bowel disease, which we'll be talking about today, as well as IBS, SIBO and other functional GI disorders. She lectures extensively and teaches about both conventional and natural treatments for gastrointestinal conditions, including inflammatory bowel disease, SIBO, and IBS. She's one of the foremost experts on the intersection of IBD and IBS and how treating one resolves the other. Dr. Gurevich also acts as a mentor in the naturopathic community, educating and consulting with physicians about GI disorders. She supervises residents and consults with doctors about their most difficult GI cases. She was nominated as one of Portland's top docs by the Portland Monthly in 2014, 2016 and 2020. So Dr. Gurevich, thanks for coming on the show.

Dr. Gurevich: Thank you so much for having me.

Dr. Hedberg: Yeah. So this is gonna be really interesting. I've heard you talk before and I wanted to have you on because you're extremely a research-based, you know, scientifically sound. And of course, you have tremendous experience in inflammatory bowel and SIBO and IBS. So why don't we just lay some groundwork? And if you could just talk a little bit about what have you found to be the real causes, the triggers of inflammatory bowel in your patients?

Dr. Gurevich: You know, it is such a multifactorial disease. So with inflammatory bowel disease, there are these two peaks of when people generally get diagnosed. The first is, you know, adolescence, right around puberty to like the mid-30s or 40s. And then the second is menopause, andropause in your 60s, 70s, 80s. And those patients tend to get found a lot just on their basic screening colonoscopy.

And so, you know, because there are these bi-modal peaks of diagnosis, it really makes me think that one of the issues is hormonal changes that happen. And, you know, we're learning more and more recently about how hormones affect the GI, mainly using the estrobolome as an example, and then how the estrobolome affects how you conjugate or process your hormones. And so there's definitely a hormonal component.

Research is also exceptionally clear that diet is a huge component. You know, in parts of the world where they don't really see inflammatory bowel disease like Africa, like Asia, when people from those countries move to a Western civilization, they start getting diagnosed with inflammatory bowel disease equal to people of the West, which means that the way that we're eating is definitively changing our microbiome, which is then causing onset of inflammatory bowel disease.

What's interesting is the opposite now is also happening as we introduce the Western diet into more diverse countries that in the past were, you know,

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In this episode of Functional Medicine Research, I interview Dr. Liz Lipski in a discussion about how to choose the best therapeutic diet for gut health.  We discussed the low FODMAP diet, comprehensive elimination diet, Simple Carbohydrate Diet (SCD), GAPS diet, Paleo diet, histamine, pancreatic elastase and low HCL levels.  Liz discussed why we would choose each one of these diets for an individual and what each diet entails.  I use all of these diets in my practice so it was nice to have an overview of each diet from one of the top experts in gut health.

Dr. Hedberg: Well, welcome everyone to "Functional Medicine Research." I'm Dr. Hedberg. And I'm really looking forward to my conversation today with Dr. Liz Lipski. And Dr. Lipski, she's a Professor and the Director of Academic Development for the Nutrition Programs at Maryland University of Integrative Health. She has a PhD in Clinical Nutrition, two board certifications in nutrition, one in functional medicine, and she's a fellow of the American College of Nutrition. She's the author of the fantastic book "Digestive Wellness" which I highly recommend. And she's the founder of the Innovative Healing Academy. She's on faculty for the Institute for Functional Medicine and the Metabolic Medicine Fellowship in Integrative Medicine. She's been a pioneer in the field of functional nutrition for four decades. Liz, welcome to the program.

Dr. Lipski: Thanks, Nick. It's so nice to be with you today.

Dr. Hedberg: Yeah. This is gonna be a great talk. We're gonna be talking about how to choose the best diet for gut therapy. And why don't we start by just a general question about, you know, what is the best overall diet for GI health? Do we really know, based on the research at this point, what the vast majority of the population should follow? Do we have any insights on that?

Dr. Lipski: I do. I think a lot about what's different between people who are healthy and wanna work on tweaking their health or preventive health, and then people who are already in a deep hole where already their health is compromised. And hands down, when we look at research, it looks like a whole foods diet based on a Mediterranean-type diet is the very best diet. When we look at it, cancer rates go down and diabetes rates go down and cardiovascular disease rates go down, but we also have some research on GI.

And one of the main issues in the way that we're eating... And I know you see this in your practice, Nick. What we see is, when you ask people, "Well, how do you eat?" And what do they tell us? They say, "I eat pretty well." Right? Don't you hear that all the time?

Dr. Hedberg: Yeah. Yeah.

Dr. Lipski: And then you look at somebody's food diary and maybe they do, but usually they don't. And so for me, steering somebody at first to a whole foods diet is the most important thing because what we know is that according to a recent study based on kind of looking at every food that has a barcode and it represented, you know, any food company that had more than, you know, a tiny share of the market, they looked and they said 70.9% of the foods that we Americans are eating are ultra-processed. Ultra-processed.

And so we now have other studies that say, "Well, if you have more than two servings a day of these ultra-processed foods, we have a 62... For each 10% increase in ultra-processed foods, we increase our risk of cardiovascular disease by 12%, and heart disease by 13%, and strokes by 11%."

So, we also have some research on cancers as well. And so, you know, it's not that we can have a treat. It was just my son's birthday and I made a cake and we all had cake. It's not like, you can't have some treats, but at least I made the cake. I knew every ingredient that was in it. And most of us are just eating, the majority of our food is fast, easy, cheap, and filled with all kinds of additives and highly-processed foods. And so the first step is moving towards a whole foods d...

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I’d like to share with you all the things I’ve been doing since the COVID-19 pandemic started to better myself and stay as healthy as possible. I like the quote, “Whenever one door closes, another door opens.” Of course, I miss doing many of the things I normally do to have fun and interact with other people but this has been a time to take advantage of the many opportunities available. No matter what kind of health issues you’re dealing with, some of these ideas can have significant impact on your overall health.

Birding Birding or birdwatching has been a growing passion of mine for the last few years but quarantine has given me more time to dedicate to this fascinating hobby.

Recent research by Cox and Graston found that people living in neighborhoods with more birds are less likely to suffer from anxiety, depression, and stress. The study participants had lower levels of depression, anxiety, and stress simply by looking at birds, trees, and shrubs. The more birds the participants could see, the better their mental health. The study participants who spent less time outdoors had higher levels of anxiety and depression.

Dr Daniel Cox, who led the study, stated: "This study starts to unpick the role that some key components of nature play for our mental well-being." Birds around the home, and nature in general, show great promise in preventative health care, making cities healthier, happier places to live."

Here are my tips to get into birding so you can avoid any of the mistakes I made:

1. Only buy Squirrel Buster feeders from Brome. These will save you a lot of time and money if a squirrel finds your feeder. Squirrels will eat all the food and sometimes destroy a feeder, but they have no chance of getting the food in a Squirrel Buster feeder. “Fiery Hot” squirrel food blends that are supposed to burn the squirrel’s mouth with hot pepper oil just don’t work well so save your money.

2. Avoid bird mix blends that are filled with millet, milo, and wheat. These are cheap fillers that most birds won’t eat so it may seem like you’re saving money by buying cheap bird food but most of it will just be thrown to the ground by the birds. Start out with just black oil sunflower seeds which will attract the most amount of birds.

3. A water feature is just as important as a bird feeder to attract birds to your property.

4. When you put up a new feeder, sprinkle some seed below the feeder on the ground to attract birds.

5. 120 million birds die every year flying into windows. Put up some stained-glass features or buy anti-bird stickers to put on your windows near the feeder so no one ends of dying.

Whenever I’m stressed I like to sit outside on my porch and watch the birds come to my feeders. It always puts a smile on my face no matter how stressed I may be. Astronomy I’ve been into astronomy for many years but it had fallen by the wayside the last few years. You don’t necessarily need a telescope to get started as you can use binoculars in the beginning. The stars and the planets are always there for you to enjoy. I just saw the moons of Jupiter and the rings of Saturn the other night and I’m still in awe of how amazing it was.

You can install an astronomy application called Stellarium on your computer or cell phone which tracks the entire night sky. It makes it easy to find any planet, the moon, or stars with a built-in compass so you can find anything quickly by whatever direction you’re facing.

Astronomy makes you realize how vast the universe really is and the great astrophysicist Carl Sagan really puts things in perspective with his Pale Blue Dot narrative:

Coding Learning how to code is very easy these days due to the sheer number of free resources. I am currently learning HTML, CSS, and JavaScript, so I can build my own websites and web applications.

The key to learning to code is to have a passion project that you can begin working on right away.

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We have known since the early 1970s that infections can trigger autoimmune diseases and now we have an interesting hypothesis on the potential triggering of Hashimoto’s disease by COVID-19 infection.

A recent case study out of Singapore published in the Singapore Medical Journal entitled, “COVID-19 complicated by Hashimoto’s thyroiditis” presents an individual who developed Hashimoto’s thyroiditis after contracting COVID-19.

COVID-19 can cause a hyperinflammatory state in the body which is a potential recipe for developing autoimmune disease. The authors begin by pointing out the most current literature on COVID-19 connections to the autoimmune diseases antiphospholipid syndrome, autoimmune thrombocytopenia, autoimmune hemolytic anemia, and Guillain-Barre syndrome.

This patient was a 45-year-old Chinese man who developed a non-productive cough and rhinorrhea for one day after exposure to COVID-19 in his dormitory. On the second day of his symptoms he was diagnosed with confirmed COVID-19 infection.

His symptoms went away after 7 days, but he reported new onset of severe generalized fatigue and muscle weakness. Before these symptoms happened, he was in good health, not taking any medications or supplements, working productively, and no history of smoking. He had no family history of autoimmune disease.

His physical examination was unremarkable and his thyroid was normal without goitre. However, his TSH level was high at 6.49 and his free T4 was low at 9.19 which is a classic presentation for hypothyroidism. His thyroid peroxidase antibody was extremely high at >2,000 confirming Hashimoto’s disease. His inflammatory markers were normal as well as electrolytes and other metabolic tests. Chest x-ray was completely normal.

He was prescribed 25mcg of levothyroxine once a day and five weeks later he reported increased energy, and he had started running again. His TSH was 6.59 and free T4 was 10.91 so those markers did not improve despite the medication and his energy improving.

The authors state that the onset of his symptoms from the time he first developed COVID-19 to the time he developed Hashimoto’s disease was similar to the onset of the other 4 autoimmune disease connections noted above in previous studies.

The authors conclude that the hyperinflammatory state triggered by COVID-19 also known as a “cytokine storm” can predispose patients to developing autoimmune diseases such as Hashimoto’s thyroiditis.

Dr. Hedberg’s Comments

Some patients will develop Hashimoto’s disease after getting the flu or other infections such as Epstein-Barr virus, H. pylori, Yersinia enterocolitica, Blastocystis hominis, Parvovirus-B19, Hepatitis C, and Herpes 6 to name some of the most common triggers.

Infections can cause abnormal shifts in the immune system thus triggering autoimmunity in predisposed individuals. Normally, it takes three important factors to trigger autoimmune disease:

1. A genetic predisposition.

2. A gut problem such as leaky gut or intestinal dysbiosis.

3. A triggering event such as infection, physical or emotional trauma, giving birth, mold exposure, medications, radiation exposure, excessive iodine exposure, or toxin exposure such as mercury.

What is interesting about this case is that he did not have a genetic predispostion at least not that we knew of or was stated in this paper. We also don’t know if he had any gut problems.

The cytokine storm caused by COVID-19 can be quite intense compared to other infections so perhaps any predisposing factors were overriden by the storm. This is just speculation on my part but with only a single study subject and not more data about this individual, there isn’t much more to go on other than what we know about how the immune system responds to infections and how autoimmune diseases are triggered.

Additional speculation on my part would be that if you have an autoimmune disease like Hashimoto’s disease,

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It this episode of Functional Medicine Research, I interview Dr. Lucy Mailing in a discussion about the best diet for your gut microbiome.  We had a fascinating discussion focused on all of the different diets out there and how they affect the gut microbiome including the ketogenic diet, plant-based diets, high-fat, low FODMAP, and the autoimmune paleo diet.

We also talked about fiber, protein, hydrogen sulfide, resistant starch, butyrate, gluten, lectins, stool testing, and whether or not you should take probiotics after taking antibiotics.  I think you'll find this conversation quite eye-opening about a number of exciting topics related to the gut micobiome.

Below is a transcript on the best diet for your gut micobiome:

Dr. Hedberg: Well, welcome, everyone to "Functional Medicine Research". I'm Dr. Hedberg and I'm really looking forward to my conversation today with Dr. Lucy Mailing, PhD. She is a microbiome researcher, educator and passionate scholar of integrative, evidence-based gut health. Lucy received her bachelors in biology from Kalamazoo College and her PhD in nutritional sciences from the University of Illinois where her graduate research focused on the impact of diet and exercise on the gut microbiota. She has authored numerous peer reviewed journal articles, regularly presents at national, international conferences and was named an emerging leader in nutritional sciences by the American Society for Nutrition in 2017. Lucy is the founder and sole author of lucymailing.com, a website dedicated to integrative, evidence-based articles about the gut microbiome, health and nutrition science.

Dr. Mailing, welcome to the show.

Dr. Mailing: Thanks so much for having me.

Dr. Hedberg: Great. So you've done some great writing and research on some topics that a lot of people are interested in. That's why I wanted to have you on. So why don't we begin by really focusing on diet and the gut microbiota and what the research is really showing at this point? So why don't we start with one of the very popular diets out there which is the ketogenic diet and we can kind of lump in just the high-fat diet in general with that. So what can you tell us about high-fat diets, ketogenic diets and how it affects the gut microbiota?

Dr. Mailing: Sure, yeah. That's a great place to start. I think one of the key things to keep in mind here is that we're still in the infancy of microbiome research and especially in our understanding of what constitutes a healthy microbiome. And we have certainly done a number of studies looking at how diet can impact the microbiome. A lot of this has been done in animal models where we can essentially really control the diet of the animals and determine what effects that has on their microbiome. So a lot of the studies with the high-fat diet in the literature are kind of misleading because they're labeled as a high-fat diet but they're really more accurately a diet that is very high in refined fats and also high in refined sugar and low in fiber. So we can't really take that and compare it to the equivalent of a very healthy, like a health-conscious ketogenic diet that's got lots of non-starchy vegetables, healthy fats. There's just really not much comparison we can make there.

And the other thing is that the gut microbiome has really evolved with us, often in the context of periodic ketosis. So if we think about human evolution, we've been coevolving with our gut microbiome for thousands of generations. And the environment we evolved in required regular adaptation to changing conditions. When there was nutrient scarcity or even just carbohydrate scarcity, our metabolism would shift to reflect what was available in our environment to consume.

And so we have that metabolic flexibility in our host genome, right. As humans, we have the ability to metabolize carbs or metabolize fats in periods of carbohydrate scarcity. So the real question is why would our bodies not have this....

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In this episode of Functional Medicine Research, I speak with therapist Martina Barnes about how EMDR can help people overcome trauma.  I have personally used EMDR with great success in overcoming trauma and I routinely refer for EMDR to help patients get well.  One of the most important aspects of practicing functional medicine is understanding how much trauma can be connected to chronic illness.  Many patients won't get well until they address their past and how it is affecting their current health issues.  All the healthy diets, supplements, exercise, sleep, exposure to nature, community etc. won't be enough if there is underlying trauma history wearing you down.

Mental health professionals are severely underutilized yet they should be the first line of therapy for the majority of patients with chronic illness.  Unfortunately, they usually end up being the last.  This interview should help shed some light on the benefits of EMDR and how it can help you heal and get well for lasting health and well-being.

Below is a transcript on overcoming trauma with EMDR

Dr. Hedberg: Well, welcome everyone to "Functional Medicine Research." I'm Dr. Hedberg and really excited today to have Martina Barnes on the show. Martina has a Master's Degree in Counseling Psychology from Western Carolina University and that was completed in the year 2000. So, many, many years of experience and Martina's theoretical underpinnings are informed by attachment theories of human development which determine our interpersonal basis for relationships. And when working with individuals together, we seek to understand the attachment wounds developed in childhood and how your style impacts your relationship with yourself and others.

And Martina says you can transform your life by transforming the way your brain and nervous system are wired. She utilizes a range of evidence-based yet cutting-edge holistic modalities such as Trauma Resilience Model, EMDR, which is what we're gonna be talking about today in detail, Internal Family Systems, Neuro-Linguistic Programming, and mindfulness, and Martina has been a speaker and educator at trauma recovery conferences and seminars for victims of murder, suicide, and even sudden death. So, Martina, welcome to the show.

Martina: Thanks, Nick, and great to be here. I'm excited to share what I know about EMDR.

Dr. Hedberg: Yeah. I'm excited as well. This is something that I've been wanting someone on the show for a long time to talk about EMDR. This is something that I've used myself and recommended to many patients. So, why don't we just talk about some of the basics and why don't you give us an idea of what exactly is EMDR and what does it stand for?

Martina: Yeah. Great. So, EMDR stands for Eye Movement Desensitization Reprocessing. And it's a modality that originally only used eye movements to help give the brain bilateral stimulation to help clear trauma. It's gone to incorporate other types of bilateral stimulation. Maybe hand taps or also bilateral auditory tones can be incorporated as well. And it's one of the most powerful trauma recovery modalities that I've ever utilized. It was discovered in 1988. So, it's been around quite a long time.

Dr. Hedberg: And who invented EMDR?

Martina: Francine Shapiro who was a psychologist invented EMDR quite by accident. She loved to take long walks and when she was walking, she would notice if she was thinking about something that's setting or something disturbing that her eyes would dart back and forth, back and forth, and then they would stop darting, and she would notice that she had cleared that disturbing thought. So, it occurred to her that she might be able to develop some kind of protocol that would involve the eye movements to help clear disturbing thoughts. And she first decided to try this on veterans who had PTSD.

Dr. Hedberg: Fascinating. And so, this modality, so, like you said,

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In this episode of Functional Medicine Research, I interview Dr. Tommy Wood on the question of whether commercial genetic testing for SNPs is helpful or harmful.  This is a topic I have wanted to cover in detail for a long time so when I read Dr. Wood's paper and listened to him speak, I knew his expertise would be invaluable to this conversation.  It is important that practitioners and patients know the truth about the current state of genetic testing and whether or not it is scientifically valid or invalid.

Dr. Wood has done the necessary research to outline all of the reasons why genetic testing is not a valuable tool in practice and he presents compelling data that it can be more harmful than helpful.  As stated in the interview, this is an area that I have never bought into because the science simply doesn't support genetic testing or interventions to address SNPs in clincial practice.  I think you'll find this interiew invaluable to your understanding of genetic testing.

If you have any published papers to refute any of this information, myself and Dr. Wood would love to read these papers.

Below is a transcript of the interview if genetic testing is helpful or harmful:

Dr. Hedberg: Well, welcome, everyone, to "Functional Medicine Research." I'm Dr. Hedberg and very excited today to have Dr. Tommy Wood on the show. We're gonna be talking about genetics and genetic testing. And Dr. Wood is a research assistant professor of pediatrics in the University of Washington, Division of Neonatology. Most of his academic work is focused on developing therapies for brain injury in newborn infants but also includes adult neurodegenerative and metabolic diseases, as well as nutritional approaches to sports performance. Tommy received an undergraduate degree in biochemistry from the University of Cambridge before obtaining his medical degree from the University of Oxford. After working as a doctor in central London, he moved to Norway for his PhD, and then to the University of Washington as a postdoc.

So, in addition to his academic training, he's coached athletes and dozens of sports, weekend warriors to Olympians and world champions. He's the outgoing President of the Physicians for Ancestral Health Society, a Director of the British Society of Lifestyle Medicine, and sits on the Scientific Advisory Board of Hinson performance, which includes researching performance optimization strategies for Formula One drivers. Tommy's current research interests include the physiological and metabolic responses to brain injury and their long-term effects on brain health, as well as developing easily accessible methods with which to track human health performance and longevity. So, Dr. Wood, welcome to the show.

Dr. Wood: Thanks so much for having me. I'm excited to be here.

Dr. Hedberg: Great. So, before we got on, we were just talking about a lot of the big issues in functional medicine include, unscientific and unvalidated testing and therapies and things like that. And so that's why I was really looking forward to this because genetics is something that I've never really got on board with as far as testing and treating patients. So, why don't we lay some bedrock for the listeners? And if you could just let us know, what is the current academic position by scientists on commercial genetic testing for SNPs and the interventions that some practitioners are using?

Dr. Wood: That's a great question. And having spent a lot of time sort of straddling both traditional allopathic medicine, traditional academic research, and then also functional medicine, particularly with athletes, but also with various clients with chronic health conditions, there's this real tension between the two in terms of, you know, what's done and the evidence that supports it. And I think that's where some of these genetics stuff comes into play. And when I started really looking into this, you see very rapidly that academic geneticists who h...

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Adrenal adaptogens are one of the most commonly prescribed supplements by functional medicine practitioners due to the impact of chronic stress on the majority of sick patients. Stress breaks your body down in every way imaginable so mitigating the negative effects of stress is priority number one in most patients.

I’ve been using adrenal adaptogens in my practice for over 15 years now and I’d like to share my favorite adrenal adaptogens that may help you feel better. Adrenal adaptogens can cause negative reactions in some patients so do not take any of these without proper evaluation from a healthcare practitioner to avoid side effects.

What is an adrenal adaptogen? An adaptogen has “non-specific” activity and acts by increasing resistance of the organism to a broad spectrum of adverse biological, chemical, and physical factors. Adaptogens act by regulating and normalizing organ and system function in the body.  Adaptogens work primarily by affecting the Hypothalamic-Pituitary-Adrenal (HPA) axis and the autonomic nervous system. Thus, adaptogens modulate our response to stress (physical, environmental, or emotional) and help regulate the interconnected endocrine, immune, and nervous systems.

Your adrenal glands produce cortisol and adrenaline which make you more susceptible to infections and weaken the immune system. Adaptogens can help with infections through immune-building properties over time. Adrenal adaptogen myths Adrenal adaptogens do not increase cortisol levels above that of normal physiologic levels. Adrenal adaptogens do not lower cortisol levels below that of normal physiologic levels. Adrenal adaptogens will only help to normalize levels that may be too high or too low.

“Adrenal fatigue” does not exist based on the most recent scientific evidence. There is no doubt that adrenal gland and HPA-axis dysfunction exists but not in the way that adrenal fatigue has be traditionally described. I still use the term on this website since it is searched for online so I want people to be educated when they come to this website. Rhodiola Rosea Rhodiola rosea is a flowering perennial native to sub-Arctic regions around the globe, notably Scandinavia and Russia, where it has been studied extensively since the 1960’s. Traditionally used in Russia and Mongolia for the treatment of long-term illness and weakness caused by infection, Rhodiola root has been studied for its favorable effect on central nervous system activity and neurotransmitter levels (e.g. dopamine, monoamines and beta-endorphins).

Widely regarded as an effective natural antidepressant, rhodiola is distinguished by its lack of side effects. In addition to mood health, rhodiola has been shown to help improve sleep quality, memory and learning, to help reduce binge eating and to help increase stress tolerance in astronauts. Rhodiola is rich in potent antioxidants including vitamin C, catechins, organic acids, proanthocyanidins and the active compounds salidroside and rosavin.

Rhodiola has the following positive effects on the body:

Enhances utilization of glucose Increases serotonin levels in the brain Improves energy and stamina Balances norepinephrine (adrenaline) Improves dopamine levels Reduces anxiety Enhances memory and brain function Antioxidant properties Stimulates healing Increases work productivity High altitude sickness Improves Depression Antimicrobial Cardio-protective Neuroprotective Immunomodulatory Improves female fertility

Although low in potential side effects, Rhodiola can be over-stimulating for some patients and can actually cause insomnia.

Recommended dose is 200-600mg a day in divided doses in the morning and around noon with the above caution in mind. Don’t take Rhodiola anytime after the lunch hour. Ashwagandha Ashwagandha (Withania somnifera) is a well-researched, multipatented herbal extract, standardized to contain uniquely high levels of withanoli...

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There have never been any studies on leaky gut and Hashimoto’s disease but now we have a new study on this connection. Leaky gut was something rejected by conventional medicine despite the fact that papers on leaky gut date back to the 1970s. For many years functional medicine practitioners have been testing for it and treating it which has helped many patients overcome their chronic illnesses. There are currently over 500 published scientific papers on leaky gut so there is no doubt it exists.

Before we get to the new paper, there was an interesting paper published in 2004 which looked at the gut barriers of patients with Hashimoto’s disease. The paper is entitled “Ultrastructural changes in enterocytes in subjects with Hashimoto’s thyroiditis” by Sasso et al. The authors biopsied the small intestine of patients with Hashimoto’s disease and compared the microvilli to healthy controls.

The results showed that patients with Hashimoto’s disease did in fact have structural changes in their microvilli which are the finger-like structures that line the gut barrier. Healthy microvilli are required for proper absorption of nutrients as well as preventing unwanted particles from entering the blood stream. These patients with Hashimoto’s disease had abnormal looking microvilli under the microscope compared to normal looking microvilli of the healthy controls.

The authors also performed a lactulose/mannitol test which is used to assess gut permeability. The results showed that the patients with Hashimoto’s disease had abnormal lactulose/mannitol test results indicating abnormal intestinal permeability.

Now let’s cover the new paper on leaky gut and Hashimoto’s disease entitled “Children With Hashimoto’s Thyroiditis Have Increased Intestinal Permeability: Results of a Pilot Study”.

The authors begin by discussing the connection between increased intestinal permeability (IIP) and autoimmune diseases. Zonulin is a compound that controls the tight junctions in the gut barrier which are involved in movement of nutrients in and out of the gut. The higher the zonulin levels, the more severe the increased intestinal permeability. Higher zonulin levels have also been found in patients with autoimmune disease and in those leading up to the onset of autoimmune disease. How was the study done on Leaky Gut and Hashimoto's Disease? 30 children and adolescents with Hashimoto’s disease and 30 age, gender, and BMI matched patients with congenital hypothyroidism.

Blood tests included zonulin, TSH, free T4, anti-TPO antibodies, and anti-TG levels. What were the study results? Serum zonulin levels were significantly higher in the subjects with Hashimoto’s disease compared to the control group. Free T4 levels were higher in the control group but differences in TSH levels were not statistically significant. Anti-TPO and anti-TG antibody levels were higher in those with Hashimoto’s disease as we would expect.

Higher zonulin levels correlated with higher thyroid medication dose (levothyroxine). Zonulin levels did not correlate however with anti-TPO or anti-TG antibody levels. Author Discussion and Conclusion Increased intestinal permeability is a key component of autoimmune diseases. The tight junctions in the gut are key regulators of not only nutrient absorption but also the immune system. Increased zonulin levels are linked to aging and obesity so with our population continuing to become more obese, this may be one of the key factors in the increased incidences of autoimmune diseases.

Patients with Hashimoto’s disease need more thyroid medication based on their zonulin levels which may indicate the severity of the disease. The authors do point out that this pilot study is limited due to the small sample size and because the control group wasn’t healthy.

The authors conclude, “Higher zonulin levels in children and adolescents with Hashimoto’s thyroiditis suggested increased intestinal permeability in these patients...

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There is a new exciting paper on the connection between eradicating the intestinal parasite Blasctocystis hominis and improving Hashimoto’s disease. I previously reported this infection connection in a case study which revealed an individual with Hashimoto’s disease getting better after eradicating Blastocystis hominis. Case studies aren’t the strongest scientific proof of a particular therapy but now we have an excellent paper with three research groups including a much-needed control group.

This paper is entitled, “Improving Hashimoto’s thyroiditis by eradicating Blastocystis hominis: Relation to IL-17” published in the journal Therapeutic Advances in Endocrinology and Metabolism by El-Zawawy et al.

The author’s begin by pointing out a very important fact that Hashimoto’s thyroiditis was once thought to be a TH1-mediated disease but once TH17 cells were discovered it became clear that it is a TH17-mediated disease. TH17 cells drive autoimmunity through production of the cytokine IL-17.

Blastocystis hominis is the most common intestinal parasite in humans and most individuals never get any symptoms. This parasite is opportunistic however so if your gut or immune system becomes compromised, it can multiply and cause gut symptoms such as constipation and diarrhea, joint pain, drive autoimmunity and a host of other health problems.

Blastocystis hominis has a prevalence of 1.6% to 16% in developed countries and up to 60% in developing countries. You can get this parasite from contaminated food or water. How was this study done on Hashimoto's Thyroiditis and Blastocystis hominis? 60 patients aged 19-57 with 19 females and 1 male in each group.

Group 1: 20 patients recently diagnosed with Hashimoto’s thyroiditis without Blastocystis hominis infection.

Group 2: 20 patients recently diagnosed with Hashimoto’s thyroiditis with confirmed Blastocystis hominis infection.

Group 3: 20 healthy subjects without Hashimoto’s thyroiditis and not infected with Blastocystis hominis infection.

All subjects in group 1 and 2 had a history of fatigue. 9 patients in group 1 and 7 patients in group 2 had a history of constipation. 6 patients in group 2 had a history of diarrhea.

Interestingly, all subjects in group 2 who were infected with Blastocystis hominis had significantly higher blood pressure than the other 2 non-infected groups.

The following tests were done on all subjects:

Free T4 Free T3 TSH Anti TPO antibodies IL-17 Stool analysis CBC (complete blood count) ALT and AST (liver enzymes) Albumin Bilirubin Cholesterol Triglycerides BUN (blood urea nitrogen) Creatinine

Group 2 which was infected with Blastocystis hominis was treated with the medication Nanazoxid for 3 days to eradicate the parasite and then retested 6 weeks later. What were the study results? TSH levels were higher in groups 1 and 2 compared to the healthy group 3 as expected.

Free T4 was lower in group 1 compared to group 3 however group 2 did not have lower levels than group 3.

Free T3 was significantly lower in group 2 compared to group 3. Free T3 levels in group 1 were not significantly different than the control group.

TPO antibodies were the same between group 1 and group 2.

Group 1 and group 2 had significantly higher levels of IL-17 compared to the healthy control group. However, group 2 had significantly higher levels of IL-17 compared to group 1 because group 2 was infected with Blastocystis hominis.

They also found that high levels of IL-17 correlated with higher levels of anti-TPO antibodies and lower levels of Free T3. What happened to the patients treated for Blastocysis hominis? 10 patients in group 2 reported improvement in fatigue and 5 patients had improved constipation. Diarrhea completely resolved in all 6 patients.

Blood pressure in group 2 which was significantly higher before treatment did not change after treatment.

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I was very excited to interview therapist Samantha Osborne in a discussion about anxiety, irritable bowel syndrome (IBS), insomnia and cognitive behavioral therapy (CBT).  I had been wanting to interview someone for a long time on CBT because it is so effective for conditions like anxiety, insomnia, and IBS.  We discussed why we develop the thoughts that we do as well as beliefs and emotions and the many triggers of these conditions.  We also covered some excellent CBT strategies to overcoming these conditions that you can do on your own.

Below is a transcript on Anxiety, IBS, Insomnia and Cognitive Behavioral Therapy Dr. Hedberg: Well, welcome everyone to "Functional Medicine Research." I'm Dr. Hedberg. And I'm really looking forward to my conversation today with Samantha Osborne. And Samantha is an Asheville based therapist and she serves busy professionals with anxiety and irritable bowel syndrome. She's certified in cognitive behavioral therapy and integrated mental health techniques. Samantha uses a variety of approaches to help clients move from feeling burned out and overwhelmed by their to do's to engaged and excited by their work and life.

She earned her master's degree at the University of North Carolina at Greensboro and has been a featured speaker in several publications including "The Funk'tional Nutrition Podcast" and "Abundant Practice Podcast." And when she's not serving clients, you'll find her taking long walks with her poodle and listening to her favorite podcast. So welcome to the show, Samantha.

Samantha: Thank you so much.

Dr. Hedberg: So I've been wanting to have someone on for a long time to talk about cognitive behavioral therapy. So this was really serendipitous. And why don't we begin by just laying some bedrock information about, you know, what is the cognitive behavioral model and how does it explain where our thoughts, emotions, and our behaviors come from?

Samantha: So CBT is basically a model of therapy that says that circumstances are really neutral. So no matter what happens in the world, that's not really what's determining our thoughts, emotions, and behaviors, it's just information, is an invitation to that. And then we have thoughts about those circumstances that lead to our emotions that lead to behavior that ultimately determine our results. And so CBT says that our thoughts really originate from, you know, different circumstances that we've had in our lives, you know, all kinds of home media, cultural expectations. Essentially they're formed really early, these core beliefs are, and then they're sort of hardened and solidified over time with different input that we're getting from the environment.

Dr. Hedberg: And kind of that behavioral therapy is based on the ancient philosophy of stoicism, is that correct?

Samantha: I believe so.

Dr. Hedberg: Some of my patients know I'm a big fan of stoicism, stoic philosophy, which, you know, it's my understanding that CBT comes from that particular philosophy. And, I know that, you know, from what I know about CBT, it's very effective for anxiety and other mood disorders and insomnia and also IBS, which we'll be talking about today. So if our thoughts don't come from circumstances, where do they really originate from?

Samantha: So our thoughts really come from core beliefs about ourselves and the environment. So you know, when we are kids we have different kinds of experiences that teach us about who we are and what the world is like fundamentally. And then those beliefs about ourselves and the world are then solidified over time with different experiences.

So for instance, you know, if you grow up in an environment that's really unsafe and abusive then you think that the world is a really unsafe place and then you might have other experiences that reinforce that over time. So then when you're met with circumstances like, you know, someone approaching you at night, you're sort of primed to think, oh no,

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Human herpesvirus 6 or HHV-6, is a herpes virus just like Epstein-Barr Virus, Cytomegalovirus, Chicken pox (varicella zoster), HHV-7, HHV-8 and Herpes simplex 1 and 2.  There are two types of this virus including HHV-6A and HHV-6B. 100% of human beings get infected with HHV-6B by the age of three which results in fever, diarrhea and a rash called roseola. In rare cases it can cause seizures and encephalitis.  There are many infection connections to autoimmune diseases like Hashimoto's disease and in this article I'll cover the connection between HHV-6 and Hashimoto's disease.

Less is known about HHV-6A which was found in a small study in 50% of adults.  HHV-6A is said to be the most problematic of the two types and it is the type found inside the thyroid glands of some people with Hashimoto’s thyroiditis.

Just like other herpes viruses, HHV-6 can reactivate (occurs in the thyroid gland, GI tract, brain, heart, kidneys, uterus, and lungs) later in life when the immune system is compromised resulting in a variety of conditions including:

Hashimoto’s thyroiditis Sjogren's syndrome Lupus Rheumatoid arthritis Sarcoidosis Guillan-Barre Multiple Sclerosis Infertility Chronic fatigue syndrome Fibromyalgia HIV progression to AIDS Epilepsy Seizures Immune suppression Certain types of cancer Kidney, liver, lung disease Heart disease Encephalitis Colitis Transplant recipient issues Bone marrow suppression Autoimmune hepatitis What is the link between HHV-6 and Hashimoto’s disease? Here are some studies supporting the connection between HHV-6 and Hashimoto's disease:

Rizzo et al. in 2016 found a direct connection among natural killer cell activation, thyroid antibodies, and HHV-6 in patients with Hashimoto's disease.  This study found that the HHV-6 virus causes an increase in natural killer cells against the virus which causes an ongoing inflammatory process in the thyroid gland that correlates with thyroid peroxidase and anti-thyroglobulin antibodies.  This means that an active HHV-6 infection in the thyroid gland drives the elevation of thyroid antibodies and increases inflammation in the gland resulting in increased damage to thyroid tissue.

A study published in 2012 entitled "Virologic and Immunologic Evidence Supporting an Association between HHV-6 and Hashimoto's Thyroiditis" by Caselli et al. found that a high percentage of patients in the study with Hashimoto’s disease have active HHV-6A infections inside the thyroid gland.  This increases inflammation in the thyroid gland since the immune system is concerned about Human herpesvirus 6 and due to antibodies against the thyroid gland.

A follow-up study by Caselli et al. in 2017 entitled "HHV-6A in vitro infection of thyrocytes and T cells alters the expression of miRNA associated to autoimmune thyroiditis" also found a connection between HHV-6 and Hashimoto's disease.

Sultanova et al. in their 2017 paper entitled "Association of active human herpesvirus-6 (HHV-6) infection with autoimmune thyroid gland diseases" found a statistically significant higher level of persistent HHV-6 infection in those with Hashimoto's disease compared to the control group.  They also biopsied thyroid tissue of patients with Hashimoto's disease compared to a control group without Hashimoto's disease, and they found a statistically significant higher level of HHV-6 in those with Hashimoto's disease compared to the control group (18/44 (41%) vs. 1/17 (6%)).

Seyyedi et al. in their 2019 paper entitled "Human herpesvirus 6A active infection in patients with autoimmune Hashimoto's thyroiditis" consisting of 242 patients found 57 out of 151 (38%) of patients with Hashimoto's disease had active HHV-6A infections.  5 out of 59 (8%) patients with non-autoimmune thyroid disorders had active HHV-6A infections.  And 0 out of 32 (0%) patients with normal thyroid function had active HHV-6A infections. Why does it reactivate in some people?

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There are many digestive enzyme supplements out there but which ones are the best and what is the best way to use them? In this article, I’ll be covering my 3 favorite digestive enzyme supplements and the way I use them in my practice. I’ll also dispel some of the myths and misconceptions about digestive enzyme supplements.

Digestive enzymes are an important part of my practice because most of my patients have gut issues that are connected to their thyroid and autoimmune problems. I have found them to be a vital part of my gut healing protocols. Let’s jump in and cover the details of each product I recommend.

Betaine HCL Supplemental betaine HCl helps to optimize hydrochloric acid levels in people with low stomach acid and can help to improve digestive function and comfort in patients of all ages. Many symptoms of digestive distress such as acid reflux, heartburn, gas, bloating or nausea after eating may be due to abnormally low or non-existent gastric acid secretion (hypochlorhydria and achlorhydria, respectively.) Endogenous HCl production naturally decreases with age but other factors such as illness, highly processed and acidic diets, overuse of antacids and high stress physiology in general may impair the body’s ability to generate healthy HCl levels. In addition to impaired digestion, hypochlorhydria has been associated with bacterial overgrowth, enteric infection, low vitamin B12 levels and an increased risk of gastric neoplasms.

Hydrochloric acid is secreted by parietal cells in response to the presence of food in the stomach. HCl activates the conversion of pepsinogen to pepsin, an enzyme required for the digestion of proteins. Gastric HCl also works directly on protein molecules to assist in their breakdown and helps to separate nutrients from their carrier compounds (e.g. releasing vitamin B12 from protein molecules, and cleaving calcium from carbonate.) By helping to support efficient breakdown of proteins, betaine hydrochloride can help to prevent large peptide molecules from entering the intestines where they may contribute to inflammation and leaky gut pathologies.

Adequate HCl levels in the stomach also help to minimize food sensitivities. In one study, 25% of patients taking acid-lowering drugs for dyspeptic disorders exhibited increased IgE formation towards commonly ingested foods. The same study suggested that food allergenicity could be reduced up to 10,000-fold by enhanced gastric digestion.

Gastric hydrochloric acid plays a role in immune defense by destroying foodborne pathogens and microbes such as Helicobacter pylori, implicated in the pathogenesis of stomach ulcers. Although stomach ulcers are typically associated with excess acid production and treated with acid-blocking drugs, insufficient gastric HCl may, in fact, be a predisposing factor in ulcerative pathology. H. pylori is, of course, only one biological organism that multiplies in the absence of sufficient gastric HCL levels. Many species of bacteria and fungi overpopulate in the high gastric pH environment caused by low hydrochloric acid production, contributing in turn to a variety of metabolic and dysbiotic symptoms both within and beyond the digestive tract.

Based on molecular weight, Betaine HCl is composed of 76.26% betaine and only 23.74% HCl. Hence we propose that the betaine component of the supplement may play a key role in its functionality. Nutritionally, betaine (also known as trimethylglycine) is obtained from beets and other sources—either as betaine directly or as synthesized endogenously from choline-containing foods. By serving as a methyl donor, betaine helps to support proper liver function, cellular replication and liver detoxification. Betaine also serves as a critical cofactor in the conversion of homocysteine to methionine. Betaine is well known to help reduce high homocysteine, associated with increased risk of Alzheimers and cardiovascular disease.

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The connection between iodine and Hashimoto’s disease has been one of the most requested topics that I cover, so I’d like to present the research on this topic, so we can set the record straight. Please be aware that none of this is my opinion but rather a detailed analysis of what the scientific literature currently presents.

Your body has about 15 to 20 mg of iodine and 70 to 80% of it resides in the thyroid gland. Iodine is transported into the thyroid gland through the sodium-iodine symporter or NIS. The thyroid peroxidase enzyme oxidizes iodine which is then integrated into thyroglobulin resulting in the production of thyroxine (T4) and triiodothyronine (T3). Thyroid stimulating hormone (TSH) regulates this process.

Your thyroid only needs 150 to 250 micrograms a day of iodine to function properly. Once iodine intake exceeds this range, hypothyroidism and autoimmune thyroid disease may occur in some individuals.

How Much Iodine do the Japanese Consume? The first issue I want to briefly clear up is the false idea that the Japanese consume 13.8 mg of iodine per day from their diet. This is actually a mischaracterization of a single study by Nagataki et al that I will clarify. Here is what the literature shows:

Aceves et al state that, “This element (iodine) has been associated with the low incidence of benign and malignant breast disease in Japanese women (iodine average consumption in the Japanese population is 5,280 μg/day versus 166-209 μg/day in the UK and USA, respectively).” 5,280 ug/day equals 5.28 mg/day.

Cann et al agree in their paper stating, “Japan has a comparatively high iodine intake with an average urinary iodine concentration of 3400 μg/L (approximately 5,280 μg/day) as determined in a recent study of 4138 men and women in Sapporo, Japan.”

Tajiri et al state that, “...the average daily iodine intake was 1-5 mg in the remaining 10 patients, equivalent to the ordinary intake of normal Japanese.”

Kapil et al state, “Iodine Intake in Japan: Average daily intake of iodine in Japan has been reported to be 3000 micrograms, which is 20 times more than the RDA value of 150 mcg in India.”

According to a report on iodine from the FAO/WHO Expert Consultation on Human Vitamin and Mineral Requirements, the following is stated about the daily iodine intake in Japan: “The amount of iodine intake by the Japanese is in the range of 2-3 mg/day.”

And finally, let’s clarify the Nagataki study. Nagataki states, “...the dry weight of such food as ‘tangle’(Laminaria) contains 0.3% iodine...” “...the average daily intake of seaweed was 4.6 g (wet weight).”  The well-known doctors who make this claim of 13.8 mg made a major mathematical error. 0.3% of 4.6 g does in fact equal 13.8 mg, but they confused dry weight and wet weight. The issue is that the paper is referring to dry weight in the above quote but the second quote refers to wet weight.

A follow-up paper in 2008 by Nagataki further clarifies the question of how much iodine is ingested by the Japanese on a daily basis. In this paper, Nagataki states, “The average of dietary iodine intake due to the ingestion of seaweeds is 1.2 mg/day in Japan.”

Alan Gaby, MD, also picked up on this in an editorial from The Townsend Letter for Doctors and Patients entitled “Iodine: A lot to swallow,” states the following: “The idea that Japanese people consume 13.8 mg of iodine per day appears to have arisen from a misinterpretation of a 1967 paper. In that paper, the average intake of seaweed in Japan was listed as 4.6 g (4,600 mg) per day, and seaweed was said to contained 0.3% iodine. The figure of 13.8 mg comes from multiplying 4,600 mg by 0.003. However, the 4.6 g of seaweed consumed per day was expressed as wet weight, whereas the 0.3%-iodine figure was based on dry weight. Since many vegetables contain at least 90% water, 13.8 mg per day is a significant overestimate of iodine intake.” Does Iodine Cause Hashimoto’s Disease or Make it Worse?

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In this episode of the Functional Medicine Research podcast, I interview Dr. Nirala Jacobi in a discussion about the Bi-Phasic SIBO Diet.  I have successfully used the Bi-Phasic SIBO Diet with many of my patients so I was excited to cover this topic with Dr. Jacobi.  We discussed the specifics of the diet including the various phases, oxalates, salicylates, FODMAPs, vegetarian options, candida, histamine, fermented foods, MCAS (Mast Cell Activation Syndrome), SIFO (Small Intestinal Fungal Overgrowth), DAO, hydrogen sulfide, hypnotherapy, DNRS and much more.  If you have SIBO or are a practitioner working with SIBO patients, this is one interview you don't want to miss.

Dr. Hedberg: Well, welcome everyone to Functional Medicine Research. I'm Dr. Hedberg. And I'm really excited today to have Dr. Nirala Jacobi on the show. Dr. Jacobi is a board-certified naturopathic physician. She graduated from Bastyr in 1998 and practiced primary care in Montana for seven years before arriving in Australia. She's one of Australia's leading experts in the treatment of SIBO, which we're gonna be talking about today. And she's also the medical director for SIBOtest. And that's an online testing service for practitioners. She's very passionate about educating practitioners so much so that she founded The SIBO Doctor. This is an online professional education platform for functional digestive disorders. She lectures nationally and internationally about the assessment and treatment of SIBO. And she's the host of the popular podcast which I listened to, it's called The SIBO Doctor podcast. And she's the medical director and senior naturopathic physician at The Biome Clinic. It's center for functional digestive disorders in New South Wales. She's one of the co-founders of the Australian Naturopathic Summit. This is a biennial event that aims to promote and showcase the art and science of naturopathic medicine in Australia. She's also a member of the Gastroenterology Association of Naturopathic Physicians and the Natural Path and Herbalist Association of Australia. So, Dr. Jacobi, thanks for coming on.

Dr. Jacobi: Thanks for having me.

Dr. Hedberg: Great. So, we're gonna be focusing a lot today on treatment and approaches to SIBO and let's go ahead and begin with your bi-phasic SIBO diet. This is something that I've used in practice for years now and it's very, very effective. So why don't you walk us through the bi-phasic diet and why you created this for people at SIBO?

Dr. Jacobi: Well, first of all, thanks for that introduction and to let me know that it's working so well for you because it's always wonderful for me to hear from successful practitioners like yourself that it is indeed a really useful tool that I've created. So, that's really good for me to hear. So, the bi-phasic diet came about, because ultimately, I needed a little bit more... As a practitioner, I wanted to give more structure to a dietary approach rather than just this sort of spectrum of foods, some of which you should avoid and some of which you shouldn't avoid, which is of course, the FODMAP diet. And also what I found is that many people that were on FODMAPs, the Monash FODMAP diet, still had symptoms of SIBO. So, what I wanted to do was structure it and I used the SIBO-specific food guide, which is from Dr. Allison C. Becker, which is based on the FODMAP diet as well as the SIBO-specific... Sorry, the SCD, the Specific Carbohydrate Diet. And so what I wanted to do is take all of that information and put it in a format that allows practitioners to structure their treatment approach.

And so basically, phase one is about six weeks long. It depends on the practitioner, how long they want to extend that diet, but typically four to six weeks. And really, it's about reducing pretty much any fermentable food which includes grains and potatoes and all of the vegetables that we know that are fermentable. And the idea was,

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In this episode of Functional Medicine Research, I interview Dr. Robert Hedaya about overcoming PTSD.  Post-traumatic stress disorder is an extremely difficult condition to manage but Dr. Hedaya and I discuss multiple approaches that can help patients with PTSD get well.  We discussed how PTSD is defined, how it changes the brain, QEEG guided laser, neurofeedback, loneliness, social isolation, social media and much more.  I always love having these kinds of conversations with psychiatrists and other mental health professionals because I believe it is the most overlooked aspect of functional medicine today.

Below is a transcript of the interview on overcoming PTSD: Dr. Hedberg: Well, welcome, everyone to "Functional Medicine Research." I'm Dr. Hedberg and really looking forward to today's conversation with Dr. Robert Hedaya. I first heard him speak at the Institute for Functional Medicine last year on PTSD and so I wanted to have him on the show to talk about that. He is a medical doctor. He's been on the cutting edge of medical practice, psychiatry, and psychopharmacology since 1979. With the publication of his first book, understanding biological psychiatry, in 1996, he pioneered the use of functional medicine in the psychiatric field and he is now pioneering the use of G-guided laser treatment of neuropsychiatric disorders.

Dr. Hedaya is a clinical professor of psychiatry at Georgetown University Medical Center where he's been awarded the teacher of the year on three occasions while teaching courses on affective disorders, cognitive therapy, and one of my favorite topics, psycho-neuro-immuno-endocrinology. Since 1983, he's on faculty at the Institute for Functional Medicine, the author of two additional books, "The Antidepressant Survival Guide," and "Depression: Advancing the Treatment Paradigm," and he's the founder of the Center for Whole Psychiatry and Brain Recovery. Dr. Hedaya is an editorial volunteer for Advances in Mind-Body Medicine and Alternative Therapies in Health and Medicine. He's been featured in local and national media on things like "20/20", "60 minutes," "Vogue," "The New York Times," and "The Washington Post" on many occasions. And he's a frequent nationally and internationally recognized speaker. His website is wholepsychiatry.com. Dr. Hedaya, welcome to the show.

Dr. Hedaya: Thank you very much for having me.

Dr. Hedberg: Excellent. So, like I said, I heard you speak at IFM last year and was really interested in your research and studies on PTSD. Why don't we start by you just talking about how your career evolved from traditional psychiatry into functional medicine and now using some cutting-edge treatments for treatment-resistant depression, dementia, PTSD, chronic fatigue, and technologies like laser?

Dr. Hedaya: Okay. Well, it's been a long arc and I would say that the main thing is that I always try to follow where the science guides me, what's the truth that as far as I can best make it out to be. So, rather than being afraid of stepping outside of the box, you know, I just feel it's my responsibility, as a clinician, helping people to always try to do the right thing, and the right thing for me means doing what the science dictates, and sometimes it's benched to bedside science. Sometimes, you know, like translational medicine, sometimes you have the studies, but following the principles of biology and physiology and sometimes you have to take a leap because you can't wait until the studies are there.

So, the way it started for me was, 1983 about, I was treating a woman with panic disorder and she was not really recovering. And panic disorder is pretty easy to treat. Whether you use cognitive behavioral therapy, which I was using, or medications or combination of the two. So, it was about a year and she wasn't getting better and she paged me, I had a beeper back in those days, on a Saturday night, I was at a wedding and dancing and my beeper went off and looked and...

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In this episode of the Functional Medicine Research podcast, I interview Dr. Scott Antoine in a discussion about overcoming PANDAS.  Dr. Antoine shares a personal story about PANDAS and his daughter which sparked a deep interest in this disorder that is misunderstood by conventional medicine.  We discuss PANDAS, PANS, IVIG, OCD, and Dr. Antoine's Fully Functional practice model.  You'll also learn how to find a practitioner who is well-versed in PANDAS and the associated disorders discussed in this interview.

Below is a full transcript on Overcoming PANDAS with Dr. Scott Antoine

Dr. Hedberg: Well, welcome everyone to "Functional Medicine Research". I'm Dr. Hedberg and I'm really looking forward to my conversation today with Dr. Scott Antoine. We're gonna be talking about PANDAS today. And Dr. Antoine is an osteopathic physician and after medical school, he completed an emergency medicine residency and emergency medical services fellowship at Albert Einstein Medical Center in Philadelphia. He also has completed a fellowship in metabolic, nutritional and functional medicine through the Metabolic Medical Institute. And he was 1 of only 121 physicians nationwide to achieve board certification in integrative medicine through the newly formed American Board of Integrative Medicine. And he also holds a certification in functional medicine through the Institute for Functional Medicine.

He and his wife currently run a busy functional and integrative medicine practice in Carmel, Indiana where they focus on helping patients who are hopeless and overwhelmed, find the root causes of illness and recover their lives and vitality.

Dr. Antoine, welcome to the show.

Dr. Antoine: Thank you very much. I'm glad to be here.

Dr. Hedberg: Great. So this is a topic I haven't covered previously and you have a particular interest in also not just PANDAS but also mycotoxin illnesses and mold exposure and you have a personal story about that with your daughter who had developed PANDAS in 2013. And it sounds like that's what kind of propelled you into functional medicine. Do you wanna talk a little bit more about that background?

Dr. Antoine: Sure. That's certainly true. So I have a daughter. Her name is Emma. She's 18 now. But five or six years ago, she came to my wife and I one day and said, "I don't think God is happy with me. I think I'm a bad person." And she was having some intrusive thoughts. Shortly thereafter she developed some compulsive handwashing. She had issues with terrible insomnia and bladder control. And we weren't really sure what was going on. At the time, we were both physicians. My wife and I had been physicians for years and so we hit the books to try and figure this out. And one night at about 10 p.m. my wife Ellen came to me and she said, "I think I know what's wrong with Emma. I think she has PANDAS."

I wasn't really sure what that was but I hit the books and said, "Sure enough. That sounds exactly like what she's got going on." PANDAS is pediatric autoimmune neuropsychiatric disorder associated with strep infection. So these kids get a run of the mill infection, maybe a sore throat or a cold, something that involves the strep bacteria, and the antibodies they make to fight it which is what your body's supposed to do, cross the blood-brain barrier and then cause inflammation in the brain and produce all of these characteristic symptoms. These kids become very defiant. They can develop facial tics which my daughter had as well.

So once we figured that out, I figured now we have a direction to go in. So I called the infectious disease...head of infectious disease at our local children's hospital and he got on the phone with me and said, "Well, PANDAS doesn't exist. There's nothing to do here." And it was very frustrating. And I ended up...we went back, tried to figure this out. And my wife and I had remembered hearing a lecture by a guy from New York named Dr.

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In this episode of Functional Medicine Research I interview Dr. Kara Fitzgerald about her book, "The Methylation Diet" and a preview of her upcoming study on The Methylation Diet.  We had a great discussion about topics like methylation and diet, MTHFR, COMT, SAMe, methylated folate and B12, homocysteine, epigenetics and much more.

The Methylation Diet with Dr. Kara Fitzgerald Interview Transcript

Dr. Hedberg: Well, welcome everyone to "Functional Medicine Research." I'm Dr. Hedberg, and I'm really looking forward today to my conversation with Dr. Kara Fitzgerald. She's a naturopathic physician and a real thought leader in the functional medicine arena. She got her doctorate in naturopathic medicine from National College of Natural Medicine. And she did postdoctoral training with the Metametrix Laboratory, which is now in Genova. And she's also certified through the Institute for Functional Medicine, and she's on faculty at the Institute for Functional Medicine. So, she's been published in a lot of papers and she's been involved in various publications and peer review journals that she's written. She's contributed to functional medicine textbooks, and she recently wrote a chapter for the new "Integrative Gastroenterology" book. And that's Dr. Gerry Mullin's book on gastroenterology. And she's also co-authored an e-book, it's called the "Methylation Diet and Lifestyle." And we'll be talking about methylation today. So, Kara, welcome to the show.

Dr. Fitzgerald: Thanks, Nick. It's nice to reconnect with you. I was just dialoguing with you. I'll tell your audience that we knew each other way back when I was doing my post doc. I think you were one of our early folks to really become an expert in the specialty testing we were offering. So, anyway, it's nice to reconnect.

Dr. Hedberg: Yes, yes, it's great. So, some really interesting things to talk about today. And, as I mentioned, we're going to talk about methylation. And so, why don't we just start with some bedrock information for our laypeople and practitioners about, you know, what is methylation, and if you could just give us a basic overview of what it is and how it works.

Dr. Fitzgerald: Yeah, sure. Listen, if you've got any serious sort of biochemistry history geeks, it was actually...our ability to methylate compounds, to detoxify them was first discovered in 1887, if anybody needs a cocktail party factoid. But it was long after that before the methylation cycle was actually characterized and S-Adenosyl methionine was discovered. You know, it was in the 20th century when all of that was teased out. So, methylation is really quite simply, as you know, either we're putting a methyl group, which is a carbon and three hydrogens, either we're adding it to a compound, or we are removing it from a compound, or we are producing S-Adenosyl methionine, which is the co-factor that carries that methyl group that can be put on compounds.

So that's what methylation is. And it's everywhere. You know, an internet lord [SP] says, those folks talking a lot about methylation say it's happening in every cell all of the time. And I would argue that it's probably pretty close to that. I mean, it's interesting to me that we use this addition of a methyl group or the methylation cycle which interfaces, as you know, intimately with the folate-vitamer cycle and sulfuration. But, you know, it's interesting that we use these in such important fundamental processes, you know, body-wide.

Just to give you a couple of ideas, Nick, of its importance, you know, three of the four DNA bases require a functioning folate/methylation cycle for production. Three of the four bases. And that fourth base, which is cytosine, is the base that in DNA methylation gets methylated. So, for gene expression, fundamentally for gene expression, we have to have good methylation. And for DNA repair, we need good methylation. So just think about it. To make DNA, to regulate DNA expression,

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In this episode of Functional Medicine Research, I interview Dr. Bruce Hoffman, who’s a board certified physician and he has a fellowship in Anti-Aging as well as a Master’s degree in Clinical Nutrition. He is also a certified functional medicine practitioner. Speaking with Dr. Hoffman was extremely educational, we spoke about mast cell activation syndrome and how exactly the condition is diagnosed. Dr. Hoffman covers how he first got interested in the disease and the progress that he’s made working with several other doctors working to understand the implications of mast cell activation syndrome. Dr. Hoffman explains how some conditions overlap and indicate mast cell activation syndrome; such as fatigue, brain fog, and even GERD.  You should come away from this interview with a much better understanding of mast cell activation syndrome, how it’s diagnosed and what lab tests are beneficial in assisting in this diagnosis.

Below is a transcript of the interview on Mast Cell Activation Syndrome: Dr. Hedberg: Well, welcome everyone to "Functional Medicine Research." I'm Dr. Hedberg. And I'm really looking forward to today's conversation with Dr. Bruce Hoffman. He's a board certified physician, and he has a Fellowship in Anti-Aging, as well as a Master's Degree in Clinical Nutrition. He's a certified functional medicine practitioner. And one of the really interesting things about him is that, in addition to his clinical training, he studied with many of the leading mind-body and spiritual healers of our time. So people like Deepak Chopra, Paul Lowe, Osho, Ramesh Balsekar, and one of my favorites, Jon Kabat-Zinn.

So, Dr. Hoffman, you shared the stage with Dr. Deepak Chopra, Dr. John Demartini. And he continues to spread his inspiring vision of healing and wellness with audiences and patients around the world. So Dr. Hoffman, welcome to the show.

Dr. Hoffman: Thanks very much, Nikolas. I'm glad to be here. Thank you.

Dr. Hedberg: Great. So I'm really looking forward to this discussion on mast cell activation syndrome. It's something I haven't seen a lot of in my practice. I have heard a number of lectures on this and read quite a bit about it. And it seems to be an area of your expertise. So why don't we jump right in and just talk about what mast cell activation is, and how is this condition diagnosed?

Dr. Hoffman: Sure. I first got interested in mast cell activation syndrome when I started to work with a cancer patient advocate by the name of Dr. Mark Renneker out of San Francisco. And he alerted me to the connection between cancer and mast cell activation syndrome, particularly in gynecological cancers. And then put me in touch with Dr. Lawrence Afrin, who leads one of the major sort of advocacy groups for mast cell activation syndrome as opposed to systemic mastocytosis, which I'll explain in a bit.

And so I've been for the last three to four years working with Dr. Lawrence Afrin's group and learning to understand the implications of mast cell activation syndrome in most of the patients that we see. Which are chronic multisystem, multisymptom patients who, as you know, have been everywhere and remain frustrated with the one disease, one drug paradigm that we learned at medical school. So, what I learned over time was how to separate between two specific conditions, one called systemic mastocytosis and the other called mast cell activation syndrome.

But before I begin with that, I'd like to say that mast cells are part of a...they're produced in our bone marrow, and they're part of our immune system. And they make up a very small percentage of it. And they act as defense structures against incoming invading pathogens. So anything that comes into our environment or into our biome, mast cells are often at the first line of defense. And they were actually discovered a long time ago, 1878, I believe, by Paul Ehrlich. And he called them mast cells because they were fat and puffy.

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“All disease begins in the gut.” --Hippocrates Was Hippocrates right over 2,000 years ago? I would have to agree with him a majority of the time when it comes to chronic diseases. A healthy digestive system begins with excellent digestion so let’s go over some tips to help you improve your digestion naturally. Firstly, I’d like to briefly cover the reason why your digestion may be out of balance. What causes bad digestion? Eating very quickly while on the run and not completely focusing on your meal will result in poor digestion. You must be in a parasympathetic dominant state which is your “rest and digest” branch of your nervous system. Many people are sympathetic dominant when they eat which is the “fight or flight” branch of your nervous system.

Stress is a major cause of bad digestion which puts you in a sympathetic dominant state. When your sympathetic nervous is revved up, your body produces adrenaline which takes blood away from your stomach and lowers stomach acid so you won’t digest food very well. Sympathetic dominance also shuts down the gall bladder and the pancreas further impairing good digestion. Watching television, reading, texting, checking Facebook etc. while you’re eating will draw you out of your rest and digest state resulting in poor digestion.

Antibiotics are major cause of bad digestion and the more antibiotics you have taken in your life, the more likely you are to have digestive problems. Each time you take an antibiotic the bacteria in your gut change their genes to become resistant to antibiotics. Additionally, the bacteria will behave differently and will actually be out of balance for appoximately 13 months after a single round of antibiotics.

Birth control pills have been linked to Inflammatory Bowel Diseases (IBD) including Crohn’s disease and ulcerative colitis. Birth control pills deplete the body of many vital vitamins and minerals including folic acid, magnesium, and zinc that are important for gut health. The longer you have taken oral contraceptives, the more likely you are to develop gut problems.

Dental infections can cause bad digestion if you are constantly swallowing bad bacteria from the mouth. Proper oral hygeine is vital to improve your digestive health. Sinus infections can also be connected to bad digestion as these bacteria make their way down the back of the throat and are swallowed into the gut.

Antacid medications lower your natural production of stomach acid which will impair digestion. This leads to poorly digested food entering the small intestine which can increase inflammation, cause dysbiosis, and irritate the gall bladder and pancreas. Those who take antacids are at risk for developing many nutrient deficiences as well as infections in the gut. Stomach acid is absolutely vital for a healthy digestive tract so suppressing it can only cause problems in the long run. If you have heartburn the key is to figure out what is causing it rather than just suppressing acid levels. Are there any conditions that cause bad digestion? Helicobacter pylori is a bacteria in your stomach that overgrows when someone is under chronic stress resulting in low stomach acid, heartburn and poor digestion. This bacteria causes ulcers and it can wreak havoc on your digestion.

Small intestinal bacterial overgrowth or SIBO, is a condition where too many bacteria are in your upper intestine causing dysbiosis which results in the signs and symptoms of irritable bowel syndrome (IBS). Dysbiosis mainly means that the bacterial colonies in your gut are out of balance. If you have taken a lot of antibiotics throughout your life or have eaten a lot of sugar and refined carbohydrates then you may have SIBO or dysbiosis. Symptoms of SIBO include:

Gas Bloating Abdominal pain & discomfort Abdominal cramps Fatigue Weight gain with difficulty losing weight Feeling like you don’t completely empty your bowel when you have a movement

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Fiber is an important part of a healthy diet but like anything we consume, too much or too little may be problematic.  Fiber has been touted as an extremely important nutrient but is it really as beneficial as it is purported to be? When used at the right time in the right individual, fiber can be a game changer for healing the gut and improving overall health.  Let’s discuss the health benefits of fiber and the best fiber supplements if supplementation is necessary.

What is Fiber? Fiber is a compound found in food categorized as soluble and insoluble as well as fermentability.  Fermentability is how well your gut bacteria can eat the fiber. Soluble fiber dissolves well in water and insoluble fiber does not.  This means insoluble fiber is much harder for your gut bacteria to eat and to ferment than soluble fiber so we usually start with soluble fiber supplements.  

Soluble fiber has higher fermentability than insoluble fiber so it feeds your gut bugs much better but this can lead to more gas and bloating.  Insoluble fiber has a greater chance of irritating your intestines so we usually don’t start with this type of fiber. However, insoluble fiber has low fermentability so it usually causes less bloating and gas than soluble fiber.  Most studies show that soluble fiber works better than insoluble fiber for most conditions. What Conditions can Fiber Help Treat or Prevent? Fiber research is difficult to properly perform because there are many variables in each person’s life that can affect their disease risk.  And since everyone has a different gut microbiota we have to take some findings with a grain of salt. Many factors have to be taken into account when studying fiber and disease such as:

Exercise Stress levels Sleep Other dietary factors such as sugar intake, alcohol, processed foods etc. Fruit and vegetable intake Medications Smoker? Genetics Antibiotic history

Here are some quick facts based on the latest research on fiber and various conditions:

Fiber reduces the risk of type 2 diabetes with fiber from fruits and vegetables being more protective than cereal fibers.  Cereal fibers work well just not as well as fruits and vegetables. Fiber supplements lower fasting glucose and hemoglobin A1c. Paleo diets and low-carb diets work better than low-fat/high fiber diets for heart health and weight loss.  Interestingly, Paleo and low-carb diets are low in fiber indicating that balancing blood sugar and reducing inflammation are more important than eating a lot of fiber. Fiber supplements decrease blood pressure and cholesterol but it doesn’t mean this reduces the risk of cardiovascular disease. Fiber supplements help with weight loss. Some research shows fiber protects against colorectal cancer and some research shows fiber has no protective effect from colorectal cancer. Fiber reduces the risk of Inflammatory Bowel Diseases (IBD) like Chron’s disease and Ulcerative colitis but once you have IBD it is best to eat a low fiber diet until you are in remission and then slowly increase to a tolerable amount. Fiber may make Irritable Bowel Syndrome (IBS) worse or it may help.  If you have diarrhea dominant IBS then avoiding fiber is probably a good idea as it can make some people worse.  However, if you have constipation dominant IBS, fiber may help. Like with IBD, it’s best to start with low fiber intake and slowly increase to a tolerable dose.  If your IBS is due to Small Intestinal Bacterial Overgrowth (SIBO), it is best to avoid fiber supplements until the SIBO is under control.  Fiber supplements do not appear to help much with bloating and pain in IBS but they do help with quality of life, stool consistency, and frequency.  Soluble fiber appears to work better than insoluble fiber.

When should you use a fiber supplement? If you currently have a digestive issue such as SIBO, IBS, IBD, GERD or any of the common symptoms of gut dysfunction such as gas,

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Inflammation is at the core of most chronic illnesses including hypothyroidism and Hashimoto’s disease. But how exactly does inflammation cause hypothyroidism? Nonthyroidal illness syndrome (NTIS) is the state in which inflammation causes negative changes to thyroid hormone including low T3 and increased reverse T3 (rT3). T3 is the most active form of thyroid hormone and rT3 actually blocks T3 receptors so inflammation can really knock out thyroid function. TSH levels however stay relatively “normal” in NTIS thus leaving many patients with the symptoms of hypothyroidism but no diagnosis since no one is checking their T3 or rT3 levels.

In this article I’ll be referencing a paper entitled, “IL-6 promotes nonthyroidal illness syndrome by blocking thyroxine activation while promoting thyroid hormone inactivation in human cells.”

T4 is normally converted into the more active T3 under normal conditions but when you’re chronically inflammed, the enzymes that perform this conversion may not be functioning properly. The “4” in T4 indicates that it has 4 iodine molecules and the “3” in T3 indicates that it has 3 iodine molecules. There are three enzymes called deiodinases involved in this process:

D1 converts T4 into T3 by removal of one iodine from T4 to make T3. D2 does the same thing as D1. D3 inactivates both T4 and T3 but also increases rT3.

80% of the T3 in your body comes from D1 and D2 converting T4 into T3. Inhibition of D1 and D2 due to inflammation is the most common cause of low T3 but D3 is also a contributing factor to low T3 and increased rT3. What is inflammation? Inflammation is basically an overactive immune response that is acute or chronic. This overactive immune response can result in tissue damage if it is localized to a specific area in the body or it can be present throughout the entire body resulting in various symptoms such as fatigue, brain fog, joint pain, digestive problems and much more. There really aren’t any symptoms I could list that aren’t related to inflammation.

If you have elevated C-reactive protein levels on your blood tests then this can indicate inflammation. I test all of my patients for this marker to see their level of inflammation. Cytokines are chemical messengers in your body that communicate with your immune system in response to any kind of stress. Interleukin 6, or IL-6, is a well-studied cytokine that is elevated when there is inflammation and it has been specifically studied in relation to thyroid hormone. Increased levels of IL-6 have been shown to lower T3 levels and increase reverse T3 levels. What causes inflammation? Many things can cause inflammation and some of these tend to be overlooked. Here is a list to think about if you have hypothyroidism or Hashimoto’s disease:

Stress-both physical and emotional Infections of all types ie. viruses, bacteria, parasites, yeast Food sensitivities ie. gluten, dairy etc. Loneliness Social isolation Lack of meaningful purpose in life Lack of sleep Lack of exercise or excessive exercise Relationship conflicts Gut dysbiosis Dental infections Autoimmunity Lack of physical affection Environmental toxins

Some of the above may surprise you but all of these need to be seriously confronted if they are present. What did the above study find on inflammation and hypothyroidism? When the authors subjected cells to the inflammatory cytokine IL-6, both D1 and D2 activity decreased thus resulting in low T3 and increased rT3 levels. Additionally, D3 activity increased thus lowering T3 levels even more and increasing rT3. It was clear that inflammation significantly disrupts thyroid hormone in the peripheral tissues of the body. This means that your thyroid may be producing healthy levels of thyroid hormone but once it leaves the thyroid and is supposed to be activated in other organs such as the gut, liver, kidneys etc., it may not do so optimally.

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TSH is the current gold standard for diagnosis of hypothyroidism but are the current TSH levels optimal and how do they relate to Hashimoto’s disease? An excellent paper out of China entitled, “Using Hashimoto thyroiditis as gold standard to determine the upper limit value of thyroid stimulating hormone in a Chinese cohort” has shed some light on this important question which looked at the upper limit of TSH levels in relation to Hashimoto’s disease and hypothyroidism.

The authors begin by stating that subclinical hypothyroidism is characterized by “normal” T4, T3, Free T4, and Free T3 with an elevated TSH. And these patients have an increased risk of cholesterol abnormalities, heart disease, mental illness, and pregnancy complications even though their symptoms are relatively mild.

The current upper limit for “normal” TSH is 4.0-5.0 mU/L but some authors have stated that it should be 2.5-3.0 mU/L. The National Academy of Clinical Biochemists (NACB) guidelines have stated that 95% of normal individuals have a TSH below 2.5 mU/L which tends to be the upper limit value used by functional medicine practitioners. How was the study done? A hefty study group of 2,856 individuals aged 20-60 were examined and tested for the study.

Blood tests included:

Free T3 Free T4 TSH Thyroid peroxidase antibodies Thyroglobulin antibody Total cholesterol Triglycerides LDL cholesterol Fasting glucose Uric acid ALT (liver enzyme) Creatinine Carbon dioxide combining power

Participants were diagnosed with Hashimoto’s disease based on the presence of thyroid antibodies and abnormalities on a thyroid ultrasound.

They excluded individuals who were taking thyroid medication, pregnant, history of thyroid operations, or a history of autoimmune disease. The average age was 36 with 75% being women and 25% men. What were the study results? 7% of the subjects were diagnosed with Hashimoto’s disease with 14 men and 173 females which syncs with previous data that Hashimoto’s disease is more prevalent in women.

Those diagnosed with Hashimoto’s disease did not show any differences in age, body mass index, waist to hip ratio, blood pressure, liver tests, blood glucose, or cholesterol. Creatinine and uric acid levels were lower in the Hashimoto’s disease group but his is due to the higher prevalence of women in this group who tend to have lower levels of these markers compared to men.

The proportion of participants with Hashimoto’s disease was 4% when the TSH was below 2.6 compared to 14% when the TSH was above 2.6. They grouped the participants into three categories of 2.6, 2.9 and 4.5 TSH cutoff values and found some interesting results.

TSH values of 2.6 and 2.9 cutoff values were able to detect more people with abnormal triglycerides and LDL cholesterol. The authors did find that a TSH value of 4.2 to the be the upper limit of normal in their analysis.

However, the authors used a “prevalence of Hashimoto’s thyroiditis” factor to determine the upper limit of TSH and found a range of 2.6-2.9 to be more appropriate. They state that this correlates with the National Academy of Clinical Biochemists findings of a 2.5 upper limit for TSH levels.

The authors reference multiple studies linking TSH levels in the upper limit to high blood pressure, high cholesterol, and a higher Framingham score which is a marker for cardiovascular disease risk. These include:

Age- and Race-Based Serum Thyrotropin Reference Limits

Associations of TSH levels within the reference range with future blood pressure and lipid concentrations: 11-year follow-up of the HUNT study

Serum TSH related to measures of body mass: longitudinal data from the HUNT Study, Norway

Thyroid-Stimulating Hormone Levels within the Reference Range Are Associated with Serum Lipid Profiles Independent of Thyroid Hormones Author conclusions “This study shows a high prevalence of Hashimoto’s thyroiditis occurred among indiv...

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Would you like to learn how to boost your immune system and stay healthy this cold and flu season? Read on to find out what simple diet and supplement strategies you can follow to beat these viruses in their tracks.

Your immune system is constantly protecting you from invading organisms at a level of complexity most of us cannot comprehend. Modern medicine focuses mainly on the invading organisms as the source of disease without an appreciation for the beauty of your immune system’s ability to protect you from harm. Two people can be exposed to the same organism but only one person may actually manifest symptoms. Why would one person get sick but not the other?

Why do people get sick? Many factors can answer this question such as the current state of the individual's unique biochemistry, genetics, environment, toxic load, stress levels, nutritional status, state of mind etc. Every day your body accumulates a specific amount of wear and tear. It is up to your immune system to repair the daily wear and tear you experience. It is only when your immune system can no longer keep up that your body begins to break down and cannot fight off an infection. If your body is functioning at a level that puts you in the best possible position to defeat an organism then you will most likely not get sick. There are exceptions to this such as the HIV virus, but in most cases, you can win the battle.

There are many dietary strategies, supplements, and herbs that will help support your immune system. The first thing to look at is your dietary protein intake. The immune system requires high energy levels and amino acids from protein sources to mount an immune assault on an invading organism. A condition known as "PEM" or protein-energy malnutrition can lead to immune system suppression and make you more susceptible to infection. In addition to high-quality lean protein sources, a good quality whey, pea, or hemp protein powder or free-form amino acid powder can provide your body with an extra boost of amino acids.

Processed carbohydrates and sugar can lead to immune system suppression. A study published in the American Journal of Clinical Nutrition found that white blood cell activity was reduced by 50% for 5 hours after ingestion of 100 grams of sugar. Stay away from sugar! What are the best supplements for immune health? Essential fatty acids from fish oil such as EPA and DHA help to balance the immune system as well as act as precursors for vital immune system chemicals. Dietary fiber directly supports the immune system by stimulating the lymphoid tissue in the gut where 70% of the immune system resides. Fiber also helps to eliminate toxins and increases the number of healthy gut bacteria. Increase fiber intake from fruits, vegetables, beans, and lentils.

Vitamin D is not actually a vitamin but a prohormone that is intricately involved in a healthy immune system. You must attain 20-30 minutes of sunshine every day on your entire body in order to produce enough vitamin D, so supplementation is usually required. Vitamin D supplementation has been shown to reduce the rate of upper respiratory infections. Vitamin D can be taken at a dose of 800-2,,000IU/day safely and effectively depending on your age and current health. Higher doses are used in our patients with autoimmune diseases and for genetic reasons.

Vitamin A deficiency is the most common vitamin deficiency in the world. Vitamin A is vital for healthy mucosal barriers such as the intestine, lung, and sinuses which account for your first line of defense against invading microbes. Vitamin A is required for white blood cell division, natural killer cell activity, lactoferrin secretion and improved immune system communication and antibody responses.

We can’t talk about immune system function without discussing the mighty vitamin C. Not actually a vitamin, ascorbic acid is highly concentrated in your immune cells and it is not well known that by the time you have ...

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I’m excited to announce the new release of a protein supplement that I’ve been waiting for for a long time. When I first started practicing functional medicine 15 years ago, most patients could easily tolerate whey protein which was the best quality protein powder at that time. As the years went by more and more patients were reporting sensitivity to whey so I had to try and use alternate solutions like rice, hemp, and pea protein.

But after a few years of using these alternate protein sources I started to get more and more reports of sensitivities to these forms of protein just as I had with whey. All of my colleagues practicing functional medicine were confirming the same issues with protein powders leaving us with little to nothing to choose from.

This brings us to today and the excitement around the new AminoMeal Select by Moss Nutrition which isn’t based on any foods for it’s protein content but rather being a purely amino acid based formula. I’ll get into the specifics of this product shortly but first let’s answer a few questions about why a product like this is necessary.

Why are so many people sensitive to whey, pea, rice, hemp protein etc.? Our immune systems haven’t changed in just 15 years but what has changed is our environment, microbiota, and our stress levels. Stress drives immune intolerance to foods and we couldn’t be more stressed in today’s modern world. I’ll lay out a few of the main causes of this shift in how our body’s are responding to foods.

1. Blue light exposure

Blue light from cell phones, tablets, and computers is zapping our melatonin levels thus diminishing the quality of our sleep. The loss of quality sleep is the quickest way to stress the body and drive immune system intolerance. I have a “no screens after 6pm” policy so I never look at a device after six. If I’m watching TV then I wear blue light filtering glasses to minimize exposure. I’ve also changed all the light bulbs in my house to blue light filtering bulbs.

1. Social Media

Social media has been shown to cause anxiety, depression, and depressed mood after using it. Additionally, many of the conversations are heated debates about various political and religious issues that create stress. Social media also has lead to more social isolation since everyone already knows what their friends are up to. What is there to talk about or catch up on when you put your entire life on the internet?

1. Social Isolation

This ties into the issue with social media as social isolation is a major stress to the body. Feeling isolated or lonely increases inflammation and stress hormones in the body. This is a recipe for gut problems and immune intolerance. Our society is becoming more isolated with a diminishing sense of community.

1. Gut Microbiota

Our gut bacteria are changing as the use of antibiotics, cleaning products, sanitizers, medications, pesticides, herbicides, and stress all negatively affect our microbiota. When your microbiota is out of balance you become more sensitive to foods.

1. Low HCL

Stress really knocks out stomach acid production which means that the food you eat doesn’t enter the small intestine properly digested. This puts more strain on the pancreas, gall bladder, and the upper GI leading to abnormal immune responses to food. Low HCL also leads to dysbiosis and SIBO which can increase immune intolerance as well.

People are eating way to fast and stressed while they eat due to watching the news, texting, checking social media etc. This keeps you in a sympathetic dominant state of mind which lowers stomach acid production. I always try to get patients to eat in a quiet and comfortable place so they can enjoy their food, chew slowly and thoroughly, and without distractions.

1. Alternative Medicine

This one may surprise you since I am an “alternative medicine” practitioner but many practitioners are doing more harm than good by recommending long-term restrictive diets to patient...

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IgY Max is a new compound designed to improve gut function with some decent research behind it which I’ll cover in this article. Thousands of studies are coming out every month on the gut microbiome and millions of people worldwide are suffering with gut issues like irritable bowel syndrome (IBS), inflammatory bowel syndrome (IBD), and small intestinal bacterial overgrowth (SIBO). We need all the tools we can get when it comes to gut health so I was excited to see the research on IgY Max and the introduction of GI Globulin Select by Moss Nutrition which contains IgY Max.

Many people have gut problems because they have dysbiosis which basically means that the bacteria in the gut are out of balance. This means that there are too many harmful bacteria and not enough beneficial bacteria. IgY Max actually targets 26 of these bad bugs and helps your body suppress their growth.

What is IgY Max? It is a compound made from specifically immunized chicken eggs. IgY is in the immunoglobulin family which basically means a protein that is important for immune function. Our bodies have the immunoglobulins IgG, IgA, IgE, IgM, and IgD all of which have important immune properties and functions.

IgG makes up the bulk of the human immunoglobulin system which is used in products like colostrum or specific IgG products all designed for gut healing and immune health. IgY however has some advantages over IgG:

IgY is 3 to 5 times stronger than IgG due to increased efficiency of the immune response IgY does not stimulate inflammation IgY has a more rapid and specific local response such as targeting specific bacteria Eggs have 20 times more immunoglobulins than IgG so it is more economical

IgY Max does the following:

Heals the gut lining making it ideal for leaky gut Ensures the right bugs stick to the gut lining and the wrong ones don’t stick Reduces harmful bacteria Supports overall immune system health Helps the body fight infections Reduces inflammation

The gut barrier protection that this compound provides supports any probiotics or prebiotics that you may be taking. The “bad” bacteria are inhibited from multiplying and sticking to your gut lining so the good bacteria can remain intact. What does the research show on IgY Max? The first is a pilot study done by the company itself which can be a bad thing but not necessarily if the study is well done. Six subjects with mild to moderate gut complaints were given two 500mg capsules twice a day of IgY Max for 8 weeks and had gut assessments of zonulin, histamine, Diamine oxidase (DAO) for gut integrity at the beginning and the end of the study.

Zonulin is a decent test for gut barrier integrity, histamine is a good marker for inflammation and gut barrier integrity, and DAO is the enzyme that breaks down histamine so low levels are connected with chronic inflammation and autoimmune diseases.

Three of the six subjects did a comprehensive digestive stool analysis to assess their gut bacteria as well as testing yeast. What were the results? None of the subjects had any adverse reactions to the supplement. The subjects did report improvements such less gas and bloating as well as feeling more energy at 8 weeks. Zonulin improved, DAO improved, and histamine improved in all six subjects. There was also an improvement in beneficial flora in all 3 subjects as noted on the repeat stool analysis. Lactobacillus was the specific strain in the gut that improved.

Another clinical trial to mention is an unpublished study by Rehnini Ambekar, MD entitled, “Effect of a nutritious drink fortified with immune egg in improving the weight and enhancing the well-being of subjects.” In this study 14 patients with AIDS were given a drink that contained IgY egg powder for 8 weeks. Most of the patients reported significant improvements in all aspects of quality of life including energy levels, mood, and physical health.

Dr.

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Your gut microbiota has an intimate connection with your thyroid including connections with hypothyroidism, Hashimoto’s disease and Graves’ disease. In this research review I’d like to cover a recent paper entitled, “Microbiota and Thyroid Interaction in Health and Disease” published in the journal Trends in Endocrinology and Metabolism by Eleonare Frohlich and Richard Wahl.

The authors begin by stating that the gut microbiota can act on thyroid function due to the region of where someones lives, their diet including iodine intake, obesity, age, sex hormones, and how autoimmunity can impact the microbiota. I was impressed to see them state that the gut microbiota is linked to autoimmune disease, estrogen, iodine, and obesity. Estrogen can be a key factor in Hashimoto’s disease and a healthy gut is required for optimal estrogen metabolism and excretion through the feces.

They also mention the connection between the gut and the liver in relation to thyroid hormone metabolism in both these organ systems. Your gut is key to properly absorbing and utilizing the thyroid medication that you’re taking and they mention this as well.

Your Gut Microbiota and Hashimoto’s Disease Thyroid hormone is a vital part of a healthy gut barrier and a healthy gut barrier is vital for Hashimoto’s disease. When the gut microbiota become out of balance, the chances of developing Hashimoto’s disease increases.

The author’s make a very important point that the severity of Hashimoto’s disease is not correlated with the levels of thyroid antibodies such thyroid peroxidase and anti-thyroglobulin. I’ve written about this before that it is unwise to chase antibody levels and get them as low as possible because there is no evidence that lower levels improve Hashimoto’s disease.

The microbiota of patients with Hashimoto’s disease tends to be more diverse and the authors state that this is probably due to slower transit time due to hypothyroidism. I have written about this previously in my Hashimoto’s and SIBO connection article. It’s important to understand that increased diversity of the gut microbiota may be are harmful or beneficial depending on the individual so it isn’t always a good thing to increase diversity.

Interestingly, the authors also state that supplementation with Lactobacillus reuterii improved thyroid function in mice by increasing T4 levels. And when chickens were given lactic acid producing bacteria they had higher T3 levels. We are uncertain if this would also happen in humans however.

As women enter perimenopause, their progesterone levels drop more than estrogen leading to estrogen dominance. Estrogen dominance will have a negative effect on the microbiota but an imbalance microbiota will negatively affect estrogen metabolism and clearance. One of the reasons why some women go through menopause much more smoothly than others is due to the fact that they enter this process with a healthier gut. Increasing estrogen levels can drive autoimmunity so one of the main key factors in Hashimoto’s disease is to focus on a healthy gut so estrogen is in proper balance.

Thyroid medications like levothyroxine may not be absorbed well if there is dysbiosis or small intestinal bacterial overgrowth. Hypothyroidism leads to lower stomach acid levels which can decrease absorption of the medication as well as begin to cause overgrowth and dysbiosis in the the small bowel. Helicobacter pylori infection in the stomach can lower hydrochloric acid levels thus impairing absorption of medication as well. And we know that there is a connection between H. pylori and Hashimoto’s disease. What about iodine? Iodine is absorbed in the stomach and upper small bowel but it can be inhibited by inflammation in these areas due to H. pylori, food sensitivities like gluten, and dysbiosis. Fluoride will interfere with absorption of iodine in these areas so be sure you’re filtering your water if it contains fluoride. Selenium, Iron,

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Ashwagandha is one of my favorite supplements for Hashimoto’s disease and hypothyroidism and we have some excellent studies to support using it for these conditions.

The main study I’ll cover in this research review is entitled, “Efficacy and Safety of Ashwagandha Root Extract in Subclinical Hypothyroid Patients: A Double-Blind, Randomized Placebo-Controlled Trial” published in The Journal of Alternative and Complementary Medicine. We’re already off to a good start just by reading the title which indicates that it is a double-blind, randomized placebo-controlled study so we know it is of the highest standard.

The authors begin by discussing subclinical hypothyroidism which is usually caused by Hashimoto’s thyroiditis. Subclinical hypothyroidism is characterized by a TSH of 4.5-10 with or without the symptoms of hypothyroidism as well as positive thyroid peroxidase (TPO) and antithyroglobulin antibodies. Subclinical hypothyroidism is connected to type 2 diabetes, abnormal cholesterol, atherosclerosis, aortic calcification, impaired vascular function, as well as abnormal heart, muscle, and nerve function.

Interestingly, a full review was done which found that treating patients with prescription thyroid hormone who have a TSH between 4.5 and 10 did not yield any improvements in any of the above risks. What is Ashwagandha? Ashwagandha or Withania somnifera is an adaptogen which stabilizes biochemical processes in the body. Scientific studies have found Ashwagandha beneficial for adrenal stress, fatigue, depression, anxiety, inflammation, and it helps to regulate the immune system, improve low blood pressure, and it works as an antioxidant. It has been shown in previous studies to improve T4 and T3 levels in animals. And in a human study on those with bipolar disorder, Ashwagandha improved TSH, T4, and T3 levels. Ashwagandha was even able to reverse hypothyroidism caused by the drug Metformin. How was this study done on Ashwagandha and Subclinical Hypothyroidism? This was an 8-week study including 25 subjects taking Ashwagandha at 300mg twice a day and 25 taking the placebo pill. They all had an elevated TSH between 4.5 and 10 but T4 and T3 levels were within the normal range. TSH, T4, and T3 levels were tested at the beginning of the study, at 4 weeks, and at 8 weeks. What were the study results? 2 subjects from each group dropped out of the study so we finished with 23 people in each group.

T3 levels increased by 18.6% at 4 weeks and 41.5% at 8 weeks. T4 levels increased by 9.3% at 4 weeks and 19.6% at 8 weeks. TSH levels decreased (which means they improved) by -12.5% at 4 weeks and -17.4% at 8 weeks.

Only 1 person in the Ashwagandha group experienced side-effects including fever, cough, headache, and weakness but these were reported as mild and temporary. Author conclusions: The author’s do state that Ashwagandha normalized thyroid function in subclinical hypothyroid subjects to a significant degree and treatment was safe and tolerable. They do point out the limitations of this study including small sample size and the low duration of the study of only 8 weeks. A better study would include hundreds of subjects monitored for a much longer period of time. Dr. Hedberg’s Comments I was impressed to see a discussion in the paper on how stress inhibits thyroid function. When the hypothalamic-pituitary-adrenal axis, or HPA axis, is upregulated, it suppresses the hypothalamic-pituitary-thyroid axis, or HPT axis which inhibits thyroid function. We also know that cortisol inhibits T4 and T3 production so Ashwagandha can help lower excess cortisol levels which will allow thyroid hormone levels to improve. Inflammation will also upregulate the HPA axis and Ashwagandha is an excellent anti-inflammatory agent.

Since this was a double-blind, randomized placebo controlled trial, I don’t have much criticism for the study other than what the author’s already pointed out including the small sample si...

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We finally have a study specifically looking at the efficacy of the Autoimmune Protocol Diet, also known as the Autoimmune Paleo Diet or AIP, and Hashimoto’s disease. The exact title of the paper is, “Efficacy of the Autoimmune Protocol Diet as Part of a Multi-disciplinary, Supported Lifestyle Intervention for Hashimoto’s Thyroiditis” by Abbott et al. Published in April of 2019 in the journal Cureus.  I break down the study details below so you can better understand if this diet actually works for Hashimoto's disease.

I have written before about the Autoimmune Paleo Diet but this was on a paper looking at inflammatory bowel disease which did show some promising results.

The authors begin the study by stating some of the potential causes of Hashimoto’s thyroiditis including genetic and environmental factors, pregnancy, drugs, nutritional intake, vitamin D receptor defects and infections. They also state something very important which is the fact that individuals with Hashimoto’s disease who are treated with thyroid medication tend to continue to have a reduced quality of life and chronic symptoms like fatigue, nervousness, dry skin, hair loss, and irritability even though their thyroid numbers look fine.

I also liked the fact that they stated there isn’t enough evidence that goitrogens consumed in moderation negatively impact thyroid function. How was this study done? 17 subjects between the ages of 20-45 with Hashimoto’s disease began the study but only 16 finished due to one of them getting pregnant. They couldn’t have been following the AIP diet within 30 days of starting the trial and it was ok for them to be taking thyroid medication. Subjects did a 2-week washout period and filled out symptom and food questionnaires.

The following blood tests were done:

TSH Total and Free T4 Total and Free T3 Reverse T3 Thyroid peroxidase antibodies (TPO) Anti-thyroglobulin antibodies (TGA) Complete blood count (CBC) Complete metabolic profile (CMP) Vitamin D Highly-sensitive C-reactive protein (hs-CRP)

And surprisingly they did an organic acids test and a stool analysis. A stool analysis is vital for those with Hashimoto’s disease to identify infections like H. pylori, Blastocystis hominis, and Yersinia enterocolitica. Organic acids gives a detailed view of overall metabolism so we know how well someone is making energy from fat, protein, and carbohydrates as well as detoxification, gut health markers, neurotransmitters, and certain amino acids, vitamins and minerals.

After the two week washout period, the subjects started a 10-week process including:

-Six weeks of food elimination which included gluten, all grains including gluten-free grains, dairy, nuts, legumes, nightshades, eggs, coffee, alcohol, seeds, refined sugars, oils, and food additives.

-More nutrient-dense foods including bone broth, fermented foods, seafood, organ meats, and more mono and polyunsaturated fats.

-Lifestyle modifications including sleep hygiene, support systems, stress management, movement, and more time outdoors.

-A four-week maintenance phase with no food reintroductions.

All participants had the support of health coaches and NTP’s who helped them with menu planning, grocery shopping, recipes, cooking, and lifestyle modification suggestions. Unfortunately, the participants engaged in a private Facebook group despite the fact the Facebook has been shown to cause anxiety and depression.

Once the 10 week intervention was over the subjects repeated all of their lab tests and questionnaires to see how they responded. Did the Autoimmune Paleo Diet yield good results for Hashimoto’s thyroiditis? All of the symptoms measured in the questionnaires improved and the symptom burden decreased significantly. None of the thyroid blood tests changed with any significance including TSH, total and free T4, total and free T3, and the thyroid antibodies did not change either.

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Is there a connection among Hashimoto’s disease, hypothyroidism, and small intestinal bacterial overgrowth also known as SIBO? Does Hashimoto’s disease cause SIBO or does SIBO cause Hashimoto’s? I’ll answer these questions in my latest research review below.

There isn’t a lot of research, only two papers actually, on the specific connection between Hashimoto’s disease and SIBO which I’ll cover in this article. There are more papers on the connection between hypothyroidism and SIBO without mention of Hashimoto’s and the basic conclusion of those papers is that hypothyroidism is connected to SIBO because gastric motility is decreased in hypothyroidism. Decreased gastric motility basically means the food you eat is moving through the bowels to slowly so bacteria can build-up in the small intestine.

The first paper is entitled, “Association between Hypothyroidism and Small Intestinal Bacterial Overgrowth” published in the Journal of Clinical Endocrinology and Metabolism.

The authors begin by giving an overview of SIBO which is basically an overgrowth of bacteria in the small intestine which damages the gut wall leading to malabsorption of nutrients. The main signs and symptoms of SIBO are bloating, abdominal pain, cramping, gas, weight loss, and diarrhea or constipation or actually a mix of the two.

The main causes of SIBO are hypothyroidism, proton pump inhibitors and antacids, Helicobacter pylori, autoimmune disease, malnutrition, and immune dysfunction. Anything that can decrease gut motility may lead to SIBO such as gut surgeries, inflammation, metabolic issues, endocrine diseases, and muscle and nerve illnesses.

We know that thyroid hormones, especially T3, are involved with proper movement of food through the intestines known as peristalsis. Those with hyperthyroidism tend to have diarrhea and those with hypothyroidism tend to be constipated due to too much or too little thyroid hormone.

The authors wanted to answer three questions:

1. Is hypothyroidism associated with the development of SIBO?

2. How does treatment of SIBO affect those with hypothyroidism?

3. Does SIBO affect thyroid hormone levels? How was this study on Hashimoto's Disease and SIBO done? 50 patients with hypothyroidism due to Hashimoto’s disease were enrolled. TSH, Free T4, Free T3, thyroid peroxidase (TPO), and antithyroglobulin antibody were tested. Hypothyroidism was considered a TSH above 2.8 and low Free T4 and Free T3 which was quite promising because most studies use a higher cut-off point for TSH. Thyroid antibody levels were elevated and thyroid ultrasounds were done showing tissue changes in the thyroid gland which is a normal sign in Hashimoto’s disease.

These patients were supplemented with synthetic T4 which normalized their thyroid function in 2-6 months before beginning the study. The good news is that we did have a control group of 40 healthy volunteers which strengthens the validity of the study.

A glucose breath test was done on everyone to measure hydrogen levels which is a gas produced by bacteria in the gut. Every patient who tested positive for SIBO was then treated with the antibiotic Rifaximin for 7 days. A glucose breath test was then repeated one month after the antibiotic treatment to see if the SIBO was eradicated.

Thyroid hormone levels were tested prior to beginning the study and one month after antibiotic treatment and then one month after the initial evaluation in those who didn’t have SIBO.

Patients were asked to fill out a symptom questionnaire before and after treatment including abdominal pain, bloating, gas, constipation, or diarrhea. What were the study results? 27 patients or 54% of the study group tested positive for SIBO compared to only two in the control group which was statistically significant.

No significant association was found between the presence of SIBO and age of hypothyroidism diagnosis, time from diagnosis, or average T4 daily dose.

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

Full Transcript of the Interview:

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

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

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

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

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

And so if we look at the average weight of our population, it's way higher than that. And so the 0.8 grams per kilogram of body weight is at, you know, where people think that we only need about 45 grams of protein for women, and about 54 for men are based on way thinner people than the average population. So in my clinical practice, I always start people at about 100 grams of protein, and nobody is eating that much protein. And it's really hard to get your protein from a plant-based diet for a few reasons. One is it's really hard to get it from plants, just because they're lacking in certain amino acids.

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

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

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

Background on Blastocystis Hominis

Blastocystis hominis is the most common protozoan parasite in humans with incidence between 5-75% depending on the country's level of development.  In the past, it had been considered as a non-pathogenic parasite. However, studies by the research teams of Katsarou-Katsari, et al. (2008), Valsecchi et al. (2004) and Vogelberg et al. (2010) showed that Blastocystis hominis infection is associated with chronic urticaria. What is urticaria? In general, urticaria is a very common skin disorder that can have immune, non-immune or idiopathic causes.  It appears as swollen, pale red bumps or plaques.

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

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

Existing research has revealed that chronic urticaria and the presence of anti-thyroid antibodies, or autoimmune thyroid disease, have some kind of association with reported prevalence from 12-29%. How does the parasite Blastocystis Hominis trigger Hashimoto's disease? A study conducted in 2004 by Pasqui et al. and a clinical review published in 2008 by Tan discussed how Blastocystis hominis activates specific Th2 immune cells that produce interleukins which are proteins that are important in the immune response.

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

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

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

That did not resolve the urticaria. What Lab Tests Were Done? The patient then endured quite a battery of tests.  Those included:

Blood count Differential blood count Glucose Urea Creatinine Minerals C-reactive protein

…and over 25 other tests.

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

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

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

IgE (immune system antibodies) TSH FT3 FT4 Anti-thyroglobulin (Anti-TG) Anti-thyroperoxidase (Anti-TPO)

What Did the Thyroid Lab Tests Reveal?

Total IgE was slightly elevated

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

An interesting study was published in the Journal of Alternative and Complementary Medicine entitled “Thiamine and Hashimoto’s Thyroiditis: A Report of Three Cases” which looked at thiamine deficiency and Hashimoto’s disease. The authors begin by stating that levothyroxine is the treatment of choice for hypothyroidism however some patients still complain of fatigue after taking this medication and their lab tests look normal. How was this study done on thiamine and Hashimoto's disease-related fatigue? The sample size was quite small at only 3 women with a diagnosis of Hashimoto’s disease and hypothyroidism. All of them were taking the prescription thyroid hormone levothyroxine. These women reported the following symptoms: fatigue, sleep disorders, depression, anxiety, chronic nervousness, memory loss, focus and attention disorders, cold intolerance, and dry skin.

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

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

Two of the patients took 600mg/day of thiamine orally and one patient received 100mg injections of thiamine every 4 days. This was done for 20 days and then the patients reported their results. What were the results of this study? All three patients reported improvement in their fatigue levels. Patients 1 and 2 reported 100% elimination of their fatigue and patient 3 reported moderate improvement. Looking more closely at the numbers, patient 3 had the highest levels of TPO antibodies at 1,725 compared to patient 1 at 322 and patient 2 at 526. Patient 3 may not have gotten the same improvement as the other two patients due to her antibodies being so high. Elevated antibodies do correlate with symptom severity in Hashimoto’s disease so this is a possible explanation.

The authors do state that ongoing intake of thiamine should be accompanied by all of the B-vitamins in a B-complex form. This is because all of the B-vitamins work together and taking high doses of one without the other could cause problems over time. Author discussion Why would we see improvement in fatigue if none of the patients were deficient in thiamine to begin with? The authors explain that there could be issues with the transport of thiamine in the cell into the mitochondria where energy is produced. Or, there could be an enzyme defect in the utilization of thiamine. In either scenario, large amounts of thiamine would be required to make energy. So the issue could be genetics in these individuals who have difficulty utilizing thiamine thus requiring higher doses of the vitamin.

This is similar to those who have a vitamin D receptor defect and thus require more vitamin D. Author conclusions “Our case experience with these 3 patients supports the hypothesis that the chronic fatigue and related disorders accompanying Hashimoto’s thyroiditis are manifestations of a mild thiamine deficiency that may be due to either a dysfunction of the active transport from the blood to the mitochondria or to structural ...

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

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

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

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

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

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

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

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

And that's why I created the three tiers to epigenetic mastery. I saw it as a way to teach into honoring the individuality of each patient. So the three tiers are, tier one, what I call the non-negotiables. Tier two, deficiency to sufficiency. And tier three, dismantling the dysfunction. And what I see in functional medicine is that we often go to the tier three approach. We often want to skip to the sexy infection or the thing that's happening in the body that may...

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

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

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

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

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

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

So those lawsuits led to, you know, these big powerful corporations hired lawyers,

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

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

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

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

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

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

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

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

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

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

Dr. Wentz: Sure. So Hashimoto's is probably the top autoimmune condition, the most common autoimmune condition worldwide. For those that don't know what it is, it's actually the immune system starts to recognize the thyroid gland as a foreign invader and begins to launch an attack against the thyroid gland, and this eventually leads to the thyroid gland not being able to produce enough thyroid hormone. And it really goes along with a lot of different symptoms. So people will have problems with brain fog,

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

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

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

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

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

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

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

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

Now, the summer of '07, I'm so weak I cannot sit up anymore. I have a zero gravity chair, where my knees are higher than my nose. A staff, resident clinic's there. I work in the Institutional Review Board reviewing research protocols that way. And I have another chair at home.

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

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

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

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

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

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

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

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

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

I had the engineering background, I was looking for ways to get the medical, clinical background.

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

1. How avoiding dairy helps Hashimoto’s disease

2. How dairy affects the absorption of thyroid medication

Background

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

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

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

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

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

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

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

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

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

How was the study done?

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

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

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

Raloxifene Bile-binding acids Cholestyramine Orlistat Colestipol Proton pump inhibitors Any preparations including iron, aluminum or calcium

Additionally, patients with the following conditions were excluded:

Pregnancy Diabetes Celiac disease and/or other related alimentary tract disorders such as occult or overt inflammatory bowel disease Previous bowel resection surgery

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

The remaining 20 patients had no lactose intolerance.

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

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

What lab tests were measured?

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

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In this episode of The Dr. Hedberg Show, I interview Niki Gratrix in a discussion about adverse childhood experiences, overcoming trauma, PTSD, EMDR, somatic experiencing, relational trauma, anxiety, depression, emotional freedom technique, ADHD, chronic fatigue, and psychedelics.  Niki speaks with great passion about her work which is why I wanted to interview her.

Dr. Hedberg: Well, welcome everyone to the Dr. Hedberg show, this is Dr. Hedberg. I'm very excited today to have Niki Gratrix on the show. I heard her on the 15-Minute Matrix with Andrea Nakayama and just really enjoyed that interview. So, I wanted to have her around today. So, Niki, she's actually an award-winning nutritional therapist, bioenergetic practitioner, and transformational coach. She helps people to optimize energy. And in 2005, she co-founded one of the largest mind-body clinics in integrative medicine in the UK. The results with patients at the clinic were published as a preliminary study in 2012 in the British Medical Journal open. In August 2015, she hosted the largest ever online health summit on overcoming fatigue, interviewing 29 world leading experts on optimizing energy with over 30,000 attendees. So, Niki, welcome to the show.

Niki: Thank you so much for having me. It's awesome to be here.

Dr. Hedberg: Great. So a lot of my listeners are familiar with the material I've been putting out on average childhood experiences, but why don't we just lay some bedrock for that? Can you give us just an overview of what adverse childhood experiences are?

Niki: Yes. So, it's very interesting. It's based on a lot of data that's been done actually. It's been a lot of mainstream research that should get more attention in my view. So there were some big studies done by the CDC and Kaiser Permanente, looking at what they were calling adverse childhood events, and they called them ACEs. And they were looking at if you had a high level of ACEs, the sort of correlation with illness in adulthood. The sort of things they were looking at were sort of parents separating, divorce, that would count as an ACE, things like physical, sexual, or emotional abuse, physical or emotional neglect, domestic violence, mental illness in the family, substance abuse, or things like incarceration of a family member. So those were the particular categories that were chosen by the researchers that were working on this. It's about the mid 1990s, they started that work. And it's important work because it really... I'm sure you've covered some of the data, it never does any harm just to mention, you know, if you had a high level of ACEs, you have an increased risk of 7 out of the top 10 causes of death, 67% of all the people in these studies. And it was a huge study, they were like...it was almost seventeen and a half thousand people in the study. Sixty seven percent had said, "Look, we had exposure to some degree of this." And that was probably an underestimate, which we can talk more about why that is. I got into this topic because things like chronic fatigue, you have a six-fold increased risk of chronic fatigue in adulthood if you had ACE's in childhood. So I called fatigue and the kind of fibromyalgia and those kinds of related illnesses, I like the poster children for adversity and childhood. You know, and if you have six ACEs, you have a 20-year reduction in lifespan. So you that gives people a bit of an idea about why we're talking about it and the types of things we're talking about.

Dr. Hedberg: Yeah, it's a big issue. And in my 15 years of functional medicine practice, I do admit that it's something that I overlooked, you know, early on for many years, just no one was really familiar with it or talking about it. So one thing I wanted to ask, you had mentioned... So one of the questions on the ACE questionnaire I'm having difficulty getting a good answer on this, so maybe, you know, but, how come an ACE is if your parents get a divorce,

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In this post I'll cover everything you need to know about ferritin and hypothyroidism.  The ferritin test is a simple blood test and it is one of the most important tests you should have if you have Hashimoto’s disease, Graves’ disease, and hypothyroidism. Ferritin is a storage form of iron and the ferritin level test can tell you if your iron stores are low and need to be increased. The ferritin test is rarely ordered by conventional doctors so many patients are left with the signs and symptoms of hypothyroidism when it is actually their low ferritin levels that are causing their health problems.  The first issue with iron is that iron deficiency may be quite severe but blood markers such as hemoglobin and the red blood cell count may be normal. This leaves many patients, especially women, misdiagnosed as not having anemia.

What are the symptoms of low ferritin?

Weakness Fatigue Difficulty concentrating Poor work productivity Cold hands and feet Poor short-term memory Difficulty remembering names Dizziness Pounding in the ears Shortness of breath Brittle nails Headaches Restless legs

The above symptoms overlap with Hashimoto’s disease and hypothyroidism so it can be difficult to ascertain what is causing the symptoms. What causes iron deficiency and low ferritin? A lifelong history of blood loss due to heavy menstrual bleeding, blood donations, pregnancies, surgeries, accidents, atrophic gastritis, antacid medications, and celiac disease. If you have gut problems that are causing malabsorption of nutrients then your ferritin levels may be low. Additionally, if someone is a high-level athlete or vegan/vegetarian, they are also at risk for low iron. These lead to excessive loss of iron or poor absorption of iron leading to low ferritin levels. What are optimal ferritin levels for thyroid health? Once ferritin gets below 30, this is considered iron deficiency despite the fact that the lower end of the laboratory cut-off range is usually 10-20. However, even the ferritin level can be normal, around 50-100, and the patient may still actually be iron deficient. This makes the diagnosis somewhat tricky in certain cases.

According to Dr. Esa Soppi of the Eira Hospital in Helsinki, Finland, optimal ferritin levels for hypothyroidism are >100 and iron therapy should be continued until symptoms have resolved. He also recommends that the ferritin level should be checked regularly to be sure the levels stay normal.

He also states that if someone has restless leg syndrome and their ferritin is <75, then they should be considered iron deficient.

This is interesting because I have noticed that many patients with Hashimoto’s disease and hypothyroidism, start to feel worse when their ferritin drops below 80 and usually there is hair loss when it drops below 50.

According to Dr. Soppi, 10-20% of menstruating females are iron deficient. If we think about the reasons why this could be prominent in those with Hashimoto’s disease and hypothyroidism, we can see what a big problem this may be.

Hashimoto’s disease is very common in those who have celiac disease and celiac disease often leads to iron deficiency due to malabsorption in the intestine from the damage that gluten has inflicted on the intestinal barrier. Not only that, but hypothyroidism can lead to low stomach acid which would also impair absorption of iron. Thyroid hormone is also very important for the utilization of iron so you can see what a vicious cycle this could be for someone with Hashimoto’s disease and hypothyroidism.

“Hypothyroidism based on symptoms is indistinguishable from iron deficiency,” stated Soppi.

Dr. Soppi has a special interest in thyroid disease and hematology and he points out that many patients come in with the following symptoms:

Fatigue Brain fog Muscle and joint pain Weight gain Headache Difficulty breathing Heart palpitations and arrhythmias

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One of the main priorities in my practice is to stay on top of the latest cutting-edge research in Hashimoto’s disease and thyroid disorders. My latest round of research reviews involved six clinical studies that examined inositol and selenium and how they conferred major benefits in those with Hashimoto’s disease and subclinical hypothyroidism. The highlights of each study are summarized in a table at the end of this article for ease of reference.

What are Inositol and Selenium? Before we get started, let’s do a quick review on the supplements inositol and selenium.

Inositol is referred to as Vitamin B8 but is not actually a vitamin but a sugar. It naturally occurs in foods such as fruits (especially citrus), beans, grains and nuts. It helps provide structure to your cells and also affects the hormone insulin and how chemical messengers work in your brain.

Some of you may wonder if myo-inositol and inositol are the same thing and the answer is yes. So if you buy a product that is just called “inositol”, this is the myo-inositol form.

D-chiro-inositol is another form that works equally as well as myo-inositol, but the d-chiro-inositol has a slight edge in reducing excessive androgen levels in PCOS whereas the myo form is better with insulin resistance.

I have mainly used inositol over the years with excellent results for the following:

Polycystic ovarian syndrome (PCOS)

Insomnia

Anxiety

Insulin resistance

PMS

Depression

Fibrocystic breast disease

Uterine fibroids

Selenium is a trace element that is essential to well-being. It plays a role in the immune response, cell growth and viral defense as discussed in previous research including the studies of Huang et al. and Brownand and Arthur. Selenium also plays a huge part in the synthesis and function of thyroid hormones. It has antioxidant and anti-inflammatory properties and has been shown in previous investigations including those headed by Gartner et al., Landucci et al. and van Zuuren et al. to reduce an inflammatory condition in patients with Hashimoto’s thyroiditis. The first study I’d like to cover on inositol, selenium, and Hashimoto's disease came out of Italy in 2017 by Nordio and Basciani. That study was published in the European Review for Medical and Pharmacological Sciences entitled “Myo-inositol plus selenium supplementation restores euthyroid state in Hashimoto's patients with subclinical hypothyroidism.”

In that study, 168 patients ages 22 to 62 years had a TSH level between 3-6 mIU/L, elevated thyroid peroxidase antibody (TPO) and/or thyroglobulin antibodies (TgAb) and normal free T4 and T3 levels. They were randomized into two groups and were given either 83 mcg of selenium or a combination of 600 mg of myo-inositol and 83 mcg of selenium for six months.

After six months of taking these supplements, all participants taking myo-inositol and selenium showed improvements in their TSH, free T4, thyroid peroxidase antibody (TPO) and thyroglobulin antibody (TgAb). The group taking only selenium had a decrease in TPO levels which we have known for a while now based on previous research. Thyroglobulin levels, however, decreased only in the inositol+selenium group.

Additionally, subjects filled out a symptom questionnaire before and after which showed significant improvement in their thyroid-related symptoms.

In 2013, the research team of Nordio and Pajalich examined the effects of supplementation with myo-inositol and selenomethionine on patients with subclinical hypothyroidism. Their article was published in Journal of Thyroid Research and was entitled, “Combined Treatment with Myo-Inositol and Selenium Ensures Euthyroidism in Subclinical Hypothyroidism Patients with Autoimmune Thyroiditis.”

This study recruited 48 women with autoimmune thyroiditis with blood levels of thyroglobulin (Tg) and thyroid peroxidase (TPO) antibodies above 350 IU/L and TSH levels that were elevated between 4.01 mIU/L and 9.

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In this episode of The Dr. Hedberg Show, I interview Chris Kresser about his new book "Unconventional Medicine" as well as "The Paleo Cure."  We discussed many topics including how to reform our healthcare system, functional medicine, gut health, SIBO, social isolation, diet, psychoneuroimmunolgy, social media, ancestral diets, and eating seasonally.  I think you'll find many excellent takeaways from this interview whether you're a healthcare practitioner or someone interested in health.

Dr. Hedberg: Well, welcome, everyone, to the "Dr. Hedberg Show." This is Dr. Hedberg, and I'm really excited today to have Chris Kresser on the show, been following his work for a long time. And Chris is the CEO of the Kresser Institute, he is a licensed acupuncturist and he's also the co-director of the California Center for Functional Medicine. And chriskresser.com most of you who do any kind of reading on the internet have most assuredly come across Chris's website for some excellent health information there. And he recently published a book called "Unconventional Medicine" as well as "The Paleo Cure" and this was a New York Times best-selling book. And Chris was also named one of the 100 Most Influential people in Health and Fitness by greatist.com. So Chris, welcome to the show.

Dr. Kresser: Thanks, Nick. It's a pleasure to be here.

Dr. Hedberg: Great. So why don't we jump in and just talk a little bit about conventional health care because obviously there are some big issues there with conventional medicine. And so what are the areas that you see in conventional medicine that really need to really be changed and really worked on to get people in this country you know, much healthier.

Dr. Kresser: Yeah, I think the biggest issue with our current system is that it's not set up to address chronic disease. It was...the conventional medical system really came out of a time and a place where acute challenges were the biggest issues that we face. So if you look at the turn of the 20th century top three causes of death were all acute infectious diseases: typhoid, pneumonia, and tuberculosis.

And you know, conventional medicine today is remarkably effective for those kinds of problems. If you...I always say if I get hit by a bus, I definitely wanna be taken to the hospital. You know, we have pretty amazing medical technologies and interventions that allow us to even reattach severed limbs. You know, we're starting to maybe be able to restore sight to the blind. And you know, if I get an infection, I'm grateful that I can, if necessary, take antibiotics that might save my life. So there have been some incredible developments in conventional medicine that have extended our lifespan and, you know, basically eliminated certain causes of death that were the scourge of humanity for many years.

Unfortunately, that's not the biggest problem today. Today we are suffering from an epidemic of chronic disease, in fact, seven of 10 deaths are caused by chronic diseases. Things like cardiovascular disease and lung disease and cancer and now Alzheimer's and dementia at a growing rate. And our conventional medical system was really never set out to deal with those conditions because they weren't as big of an issue at the time when the medical system developed. So now we have this huge burden of chronic disease and the conventional health care system really, its main approach is to prescribe medication. And these medications though they might be somewhat helpful in addressing the symptoms of these diseases, they almost never address the underlying causes of chronic disease. And that's why we see the rates of these conditions just continue to rise each year.

Dr. Hedberg: Yeah, we had a major overhaul to our health care system, but it was just sort of a different way to pay for the same model.

Dr. Kresser: Exactly.

Dr. Hedberg: So that aspect is disturbing, you know, we can find a lot of different ways to pay for h...

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In this episode of The Dr. Hedberg Show I interview Dr. Carrie Jones of Precision Analytical on hormone balancing and testing.  We cover a lot of detail about reproductive and adrenal hormones including testosterone, estrogen, progesterone, cortisol, DHEA and more.  Dr. Jones explains the causes of elevated and decreased hormone levels and some strategies on balancing these issues.  We also discuss the best way to test hormones including the DUTCH test which is my favorite hormone test offered by Precision Analytical.

Dr. Carrie Jones, ND, MPH is an internationally recognized speaker, consultant, and educator on the topic of women’s health and hormones. She graduated from the National University of Natural Medicine (NUNM), School of Naturopathic Medicine in Portland, Oregon where she also completed her 2-year residency in women’s health, hormones and endocrinology. Later she graduated from Grand Canyon University’s Master of Public Health program with a goal of doing more international education. She was adjunct faculty for many years teaching gynecology and advanced endocrinology/fertility and has been the Medical Director for 2 large integrative clinics in Portland. She is the Medical Director for Precision Analytical, Inc, creators of the DUTCH hormone test.

Dr. Hedberg: Well, welcome everyone to the Dr. Hedberg Show. This is Dr. Hedberg, and I'm excited today to have Dr. Carrie Jones, on the show. I've been listening to her and reading her material for some time now. And I've also heard her speak in person. So Dr. Jones, is a naturopath and she's definitely an expert on hormones, we'll be talking about all the different hormones today. So Dr. Jones welcome to the show.

Dr. Jones: Thank you Dr. Hedberg, I appreciate you having me on, hormones is my favorite subject.

Dr. Hedberg: Great. So, why don't you just fill everyone in on what you're working on these days and your area of expertise.

Dr. Jones: Yeah, so like you said hormones is it. So I went to school and did my residency in all things women's health, hormones and gynecology. And expanded a little bit into men's health and hormones, just by default as women would bring the men in in their life, and they would say, "He has a hormone problem too." So I always joke and my ongoing joke is that if something's wrong with your child, don't ask me. And if you hurt yourself, like you hurt your knee, don't ask me that either. But if you're a hormonal mess I can help you with that, that's what I'm good at.

Dr. Hedberg: Right. So you work for Precision Analytical which is the lab that I use for hormone testing and they do the Dutch test. So why don't we jump in and excuse me. Why don't we jump into the first hormone which is, I always like to start with start with progesterone. So why don't we start with cycling females. So when you talk a little bit about what may be some of the reasons why we would either see high or low progesterone, in a cycling female?

Dr. Jones: Yeah, and actually will start with a level because I think that's well, a lot more common. So there are two reasons that a cycling female will be low. One is she does not ovulate. So when a woman releases an egg she has two sets of cells around her follicles, and they convert into a third set of cells called the lutein cells. And that's what makes progesterone. So if she doesn't release the eggs, then she's not gonna get that little conversion and she's not going to make progesterone. Now the other reason the second big reason is she may ovulate. She might release an egg, she feels it, she notices it, her mucus changes what have you. She does the you know, ovulation predictor kit from the grocery stores, it's positive. And still her progesterone might be pretty low, pretty weak. And then the reason for that is that those cells that are supposed to make progesterone, they themselves are weak. And so we have to do something to pump up the cells.

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In this episode of The Dr. Hedberg Show, I interview Sara Lewis in a discussion about the health benefits of yoga. If you struggle with pain, fatigue, depression, anxiety, insomnia, gut issues, or have adverse childhood experiences, this is one episode you should really listen to.

Sara spent 25 years providing program management expertise to international public health projects in South America, Eastern Europe, Africa and South Asia.  The work included directing, managing and planning projects in maternal, newborn, child health and nutrition.  After her career in public health, Sara began a second career as a Holistic Health Coach and Yoga Instructor.  As a Health Coach, she helps clients discover the benefits of using food as medicine and making small lifestyle changes that have big impacts.  She has been practicing yoga for over 15 years and teaching since 2014.  Her passion for cooking and food led her to yoga when she began studying the connection between mindfulness and stress eating.  Sara teaches both vinyasa flow and yin/restorative classes.  Her yin classes include pranayama (breath work) and deep relaxation.  When she's not on the mat or working with clients, Sara can be found in the kitchen fermenting foods, experimenting with locally sourced ingredients from the farmers market or out exploring the hills of Western NC on a bicycle.

Dr. Hedberg: Well, welcome everyone to "The Dr. Hedberg Show." This is Dr. Hedberg and I'm excited today to have my good friend and colleague Sara Lewis on and we're gonna be talking about yoga. So I've known Sara for quite a while and she's actually my yoga teacher and she's also a health coach. So Sara, welcome to the show.

Sara: Thank you Dr. Hedberg, great to be here.

Dr. Hedberg: So why don't we just start off by you filling everyone in on your background and what you do and what you've been working on lately?

Sara: Sure. So I had a career in international public health for about 25 years and I traveled all over the world. I was in Latin America, South Asia, Eastern Europe, and Africa. And I worked mostly in maternal/child healthcare and nutrition and it was a very gratifying career, but at the same time, it was very stressful with all that travel. And so I looked for support from the health coach and I got so much from my health coach that I decided to become one myself. And one of the healing modes that my health coach suggested was to increase my yoga practice and that led me to become a yoga instructor in addition to the health coaching.

So now I have a business called Simply Sara Wellness and Yoga, and I teach about six classes a week at the Waynesville, North Carolina Yoga Center and I provide health coaching to individuals and group clients. So sometimes people will say to me, "Well, what is health coaching?" Health coaching is similar to a personal trainer, but I focus on food and nutrition and lifestyle. So if you came to me and you said, "Sara, I need help with insomnia or my IBS, or I want to prevent type two diabetes because it runs in my family," then I would work with you to create short-term and long-term goals and I would support you and I would challenge you. I'd probably gave you some homework. I'd wanna know about your life's ambitions and your fears. I'd probably ask you what you had to eat today. But health coaching is much bigger than food and nutrition. It's about finding balance in your life and feeling your best.

Dr. Hedberg: Excellent. So I've been doing yoga for many years. It's been very beneficial. Some of our listeners are probably already doing yoga or have done it so far. And even those who have been doing it, they might not really know the background of it. So for those who have never done it before and don't really know about it, can you just kind of break down the basics of yoga and where it comes from?

Sara: Sure. So the word "yoga" is an ancient Sanskrit language word and it means "yoke" or "union.

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The Therapeutic Effect of Cordyceps on Hashimomoto's Disease and Graves' Disease

In 2016, a clinical trial was conducted in China that aimed to investigate the therapeutic effect of cordyceps on Hashimoto's disease and Graves' disease.

The research paper was entitled, “Dual-Directional Effects of Corbrin Capsule on Autoimmune Thyroid Diseases” and was published in the journal Evidence-Based Complementary and Alternative Medicine.

Let's find out what this research paper showed if cordyceps could help Hashimoto's disease and Graves' disease.

What is Cordyceps? Cordyceps, also known as Cordyceps sinensis Sacc., is a fungus closely related to the mushroom. While it is not officially classified as a mushroom taxonomically speaking, it has been described as an exotic medicinal mushroom used in traditional Chinese and Tibetan medicine for over 2,000 years.  This fungus has active components that have been determined to have highly positive effects on human health including these roles:

Increased oxygen utilization of ATP production Stabilization of blood sugar metabolism Regulation of the immune system by exerting anti-tumor effects, modulating the immune system in organ transplantation and the prevention of kidney, liver and heart disease.

In recent years, studies have revealed that cordyceps has immune-mediating effects on autoimmune inflammatory diseases including lupus, chronic hepatitis, chronic kidney disease and diabetes.

The active constituents in Cordyceps include: cordycepin, polysaccharide, cordycepic acid, nucleosides, ergosterol, aminophenol, and trace elements. Background Information on Autoimmune Thyroid Diseases Autoimmune thyroid diseases come in a few forms. They include:

Graves’ disease

Hashimoto’s thyroiditis

Idiopathic hypothyroidism (atrophic Hashimoto’s)

Graves’ ophthalmopathy (GO)

Post-partum thyroid dysfunction

A main characteristic of autoimmune thyroid disease is an elevated level of auto-antibodies and hyperactive T and B lymphocytes that are reactive to thyroid auto-antibodies.

The researchers in this study identified a unique opportunity to investigate the effect of cordyceps on autoimmune thyroid disease because despite the administration of anti-thyroid drugs and thyroid hormone replacement to control symptoms of autoimmune thyroid disease, a means to actually target thyroid autoimmunity has been lacking in scientific research.

The study authors pointed out that if the immunoinflammatory process in autoimmune thyroid disease cannot be intervened, what will consequently occur is that the disease will just end up progressing and become full-blown in afflicted individuals.  Likewise, those who had success managing their autoimmune thyroid disease at earlier stages could inevitably experience a higher recurrence rate if the immunoinflammatory process is not curtailed.

In 2013, there was one study conducted in China that demonstrated that cordyceps could significantly reduce blood levels of thyroid antibodies in both Graves’ disease and Hashimoto’s thyroiditis and that it could play a helpful role in cell-mediated immunity in animal models in many diseases.  The authors of the current study then wanted to build upon existing research by seeking to investigate the effect of cordyceps on the hyperactive lymphocytes seen in autoimmune thyroid disease since after all, it is not only antibodies that play a role in autoimmunity.  Lymphocyte dysregulation also is a factor in autoimmune diseases. Yanaba et al., Norman and Hickey and dozens of other research teams have confirmed this fact. How Was the Study Done on Cordyceps and Hashimoto's Disease? A random selection of subjects with “newly definitely diagnosed” Graves’ disease and Hashimoto’s thyroiditis were recruited.

Study participants with the following conditions were excluded:

Unclear diagnosis of autoimmune thyroid disease

Any clues of other autoimmune disorders

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Can Genistein Help Heal Hashimoto’s Disease and Hypothyroidism? In the fall of 2016, a study was conducted in China and published in the medical journal Immunobiology. The researchers looked at the compound genistein and Hashimoto's disease to see if it affected thyroid function in patients with Hashimoto’s thyroiditis.  The research paper was entitled, “Genistein improves thyroid function in Hashimoto’s thyroiditis patients through regulating Th1 cytokines.”  To clarify, “Th1 cytokines” refer to a type of thyroid-helper cells that indicate how much inflammation there might be in the thyroid gland.  In other words, they are markers of inflammation.

The results of this study were very exciting so you might want to pay close attention.

What is genistein? Genistein is an isoflavone which is a plant-derived compound with estrogenic activity.  It falls in the class of phytoestrogens and is found in soybeans.  Clinical studies in the past have demonstrated that this compound has immune-regulating properties by exerting anti-inflammatory effects in certain health conditions including encephalomyelitis (inflammation of the brain and spinal cord), cardiac inflammation resulting from diabetes, coronary obstructive pulmonary disease (COPD) and other serious diseases.

In this study, Zhang and four of his colleagues began by pointing out that Hashimoto’s thyroiditis is now considered the most common autoimmune disease in the world.  It is believed that excessively stimulated thyroid-helper cells play the main role in giving rise to the autoimmune condition in Hashimoto’s thyroiditis patients.  While conventional treatment has typically addressed only the symptoms of the illness via oral administration of a thyroid hormone replacement, the fact remains that there is still an autoimmune condition in Hashimoto’s thyroiditis which can be a concern. Why is it problematic for an autoimmune condition to persist in an individual with Hashimoto’s disease? Previous studies have demonstrated that in those with fully or partially functional thyroid glands but not “fully hypothyroid Hashimoto’s patients”, long-term Hashimoto’s thyroiditis closely correlated with the prevalence of thyroid cancer.

Chronic inflammation is never beneficial for the body so if someone is invested in his or her health, mitigating any autoimmune condition would be prudent.  In this investigation, the researchers wanted to evaluate any beneficial anti-inflammatory properties of genistein for those with Hashimoto’s thyroiditis and examine what impact it might have on the chronic inflammatory condition associated with Hashimoto’s disease. How was the study done? Two-hundred eighteen female subjects between the ages of 20 and 80 were recruited, all with Hashimoto’s thyroiditis.

These requirements had to be met in the subjects:

1. Normal levels of free T3 and free T4 with or without thyroid replacement therapy
2. Normal TSH levels or slightly elevated TSH levels below 20 mU/L
3. Increased blood levels of thyroid antibody (thyroid peroxidase) greater than 100 U/mL

Subjects with any of the following conditions were excluded:

1. Prior use of immunoregulators
2. Presence of infection
3. Presence of thyroid nodules
4. Thyroid hypoplasia
5. Prior treatment with radioiodine
6. Pregnancy
7. Presence of serious illnesses such as cancer, kidney or liver failure.

The 278 females with Hashimoto’s were split into two groups with 143 in the placebo group and 135 in the genistein group.  Patients in the genistein group were given 600 mg per day of genistein as a purified soy extract taken orally for thirty days. What lab work was required? To measure thyroid function: 1. TSH 2. T3 3. T4  (total T4) 4. fT4 (free T4)

To measure thyroid antibody levels:

1. Thyroid peroxidase - TPOAb
2. Thyroglobulin – TgAb

To measure inflammation: Thyroid-helper cell bodies (Th1 and Th2) which we will refer to henceforth as inflammatory markers.

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Is There a Connection Between Vitamin D and Hashimoto's Disease?  Does Vitamin D Supplementation Help Heal Hashimoto's Disease? Vitamin D has long been established in literature as a highly essential nutrient with benefit to the musculoskeletal system and bone density. It also functions in the body as an immunomodulator, facilitating normal immune system function and improving resistance against certain diseases.

Given this background, one has to wonder if a deficiency in vitamin D would be prevalent among individuals with Hashimoto’s thyroiditis and if so, would supplementation with vitamin D help patients manage the disease or perhaps even prevent it?

PART ONE – Vitamin D Deficiency and Hashimoto’s Disease Research goes back to 2009 on the first question:  is there a connection between vitamin D deficiency and Hashimoto’s disease?  The earlier studies either indicated that indeed there was a connection while other studies concluded that there was none at all.  How is one to draw a final answer when the outcomes are 180 degrees apart?

Kmiec and Sworczak (2015) reviewed twelve studies published between 2009 and 2014 whereby seven of those studies concluded that there was a connection between lower vitamin D levels and Hashimoto’s thyroiditis while two other studies showed no association and three others were inconclusive.

Among the studies that established a connection included the ones by Bozkurt et al. (2013), Camurdan et al. (2012) and Mansournia et al. (2014).

Goswami et al. (2009)  showed no association between vitamin D levels and thyroid peroxidase antibody (TPO-Ab) positivity.

What was the takeaway message from the Kmiec and Sworczak article?

The authors concluded that no final word on a correlation could be made.  It was neither an absolute ‘yes’ nor a definitive ‘no’. They reported:

“…in many points accumulated data are inconclusive, many unresolved questions remain, therefore, it remains necessary to perform further studies that would affect clinical approaches to thyroid disease.”

They went on to state that the idea of vitamin D supplementation being able to influence the levels of antibodies in Hashimoto’s was also inconclusive:

“Moreover, vitamin D supplementation has not affected disease occurrence in intervention studies, as summarized in 2 recent reviews. The associations between vitamin D deficiency and disease may indicate that 25(OH)D is only a marker of ill health ([Theodoratou et al. 2014]; [Autier et al. 2014]).”

Fast forward a few years, and what does the research reveal on whether there is a connection between vitamin D and Hashimoto’s thyroiditis?

Anaraki, et al. (2017) found no association between vitamin D levels and Hashimoto's thyroiditis.

Boyuk et al. (2016) also reached the same conclusion of no correlation between vitamin D and Hashimoto's thyroiditis.

In 2018, Botelho, et al. reviewed several studies conducted around the world between 2012 and 2016 that basically led to the findings that an association between vitamin D and Hashimoto’s Thyroiditis “…remain unresolved in literature”.

Some of these included:

D' Aurizzio, et al. (2015) No differences in vitamin D deficiency in Hashimoto's thyroiditis patients and healthy controls

Yasmeh et al. (2016) No association of vitamin D deficiency and Hashimoto’s relative to controls

On the contrary,

Sun et al. (2017) revealed Vitamin D levels were inversely correlated with positive TPO-ab and higher D levels were linked to lower TSH in males.

Ma et al. (2015) found that there were lower levels of D in Hashimoto's thyroiditis patients relative to controls.

Wang et al's.  (2015) meta-analysis of twenty studies and the Mazokopakis et al. review (2014) also corroborated with Ma’s conclusion that there is an association.

Bozkurt et al.  (2013) found a direct relationship between vitamin D and Hashimoto's thyroiditis.  He and his colleagues looked at 180 Hashimoto's thyroiditis patients...

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We have never had any good studies looking at how food allergies, or more specifically food intolerances, affect Hashimoto’s disease. A recent paper, however, did show that people following a gluten-free diet can help heal Hashimoto’s disease.  In this article, Dr. Hedberg answers the question if food intolerances affect Hashimoto's disease?

I was excited to find a new paper just published last month that looked specifically at food intolerances and Hashimoto’s disease. The paper was published in the Journal of the American College of Nutrition and it was entitled, “Evaluation of Correlations Between Food-Specific Antibodies and Clinical Aspects of Hashimoto’s Thyroiditis.”

Let’s break down the study and see what food intolerances may be connected to Hashimoto’s disease. The authors do point out a previous study that showed TSH levels improved in people with Hashimoto’s disease who were lactose intolerant when they avoided consuming lactose.

The aim of this study was to evaluate whether testing IgG antibodies for specific foods show differences in people with Hashimoto’s disease compared to those without Hashimoto’s disease. The authors wanted to find out if there were any specific foods connected to Hashimoto’s disease so that those individuals would know what to avoid to help their condition. How was the study done? 74 patients, 91.9% being female, with Hashimoto’s disease had blood testing done for 125 IgG food antibodies. Some of them were taking thyroid medication and some were not (28.17%). They also performed a thyroid ultrasound and tested them for thyroid-stimulating hormone (TSH), thyroxine (T4), free thyroxine (fT4), triiodothyronine (T3), thyroid peroxidase antibodies (TPOAb), and anti-thyroglobulin antibodies (TgAb). Additional markers included body mass index (BMI), height, weight, blood pressure, and asked them how many symptoms they had.

I was pleased to see a control group of 245 subject of which 54.7% were women. The control group was also tested for the same 125 IgG food antigens.

To test the food antibodies they used enzyme-linked immunosorbent assay or ELISA which is a very popular technique for testing food intolerances. They broke the food intolerances down into these categories:

Milk products Eggs Grains Legumes Nuts Fruits Vegetables Fish Seafood Meat Coffee and Tea

They also took into account all the differences of the above blood markers, biomarkers, medication, and symptoms to see if they could find any correlations. They even looked at how frequently the subjects were eating specific food groups. What were the results? They found increased IgG antibody responses in 12 foods that were significant but these were elevated in both groups. Of the 12, only plum was significantly elevated in the Hashimoto’s group with egg white and barley showing borderline significance. Interestingly, almond was actually significantly less reactive in the group with Hashimoto’s disease compared to controls.

Looking at the proportion of positive results however, only plum and barley were higher in those with Hashimoto’s disease but no significant difference with egg whites.

Anti-gliadin IgG antibodies which are specific for gluten were tested but they did not find any differences between the two groups.

The authors did not find any correlation with IgG food antibodies and symptoms of Hashimoto’s disease and hypothyroidism.

The magnitude of reactivity from strongest to lowest in both groups was:

Milk products and eggs > Grains > Nuts > Legumes > Fruits > Vegetables > Fish > Seafood > Meat > Coffee and Tea. Author Discussion The authors conclude that only plum was significant between the two groups with barley and egg white to a lesser extent. They did however find significant connections with thyroid volume and almond-specific IgG levels as well as for nuts, meat, and fish in those taking thyroid medication.

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If you’re reading this then you’ve probably taken the ACE Survey but if you haven’t then you can download it here. If you even just scored a 1 on the ACE Survey then this article is definitely for you. The higher your ACE score the more likely you are to have health problems as an adult due to what you went through as a child. Additionally, if you feel like you’ve been doing everything right with your diet, exercise, sleep, managing stress levels etc. but you just can’t get well, then you probably haven’t addressed your ACE’s.  This article will give you the tools you need and cover how to heal adverse childhood experiences.

In a previous article I discussed the connection between ACE’s and autoimmune disease, more specifically Hashimoto’s disease where I cover some of the best research on ACE’s. This article will focus on all the things you can do to overcome your ACE’s and start feeling the best you’ve ever felt. Let’s jump right in and cover all the different therapies you can do.

A large portion of the recommendations and quotes below come from the book, “Childhood Disrupted: How Your Biography Becomes Your Biology, and How You Can Heal” by Donna Jackson Nakazawa. I highly recommend you read this book if you have an ACE score of 1 or more. Somatic Experiencing Somatic Experiencing was started by Dr. Peter Levine to help people overcome trauma. According to Dr. Levine, humans have difficulty recovering from trauma compared to animals because our traumas are stored in the brain and nervous system. Animals can easily shake off their trauma but humans get stuck in a trauma loop and dissociated for their bodies.

Somatic Experiencing helps you slowly reintegrate with your body without having to relive your trauma. Specific exercises are recommended by skilled therapists to get in touch with your body again which eventually lets the trauma go.

I have personally done Somatic Experiencing for my own trauma and it has been extremely useful in my healing journey. I’m more in touch now with my feelings and my body and things that used to bother me don’t get to me anymore. Somatic Experiencing is one of the most common therapies I recommend to my patients who are trying to get well.

You can find a practitioner on Dr. Levine’s website the Somatic Experiencing Trauma Institute at https://traumahealing.org/. EMDR EMDR, or Eye Movement Desensitization and Reprocessing helps you overcome trauma by thinking about negative memories while rapidly moving your eyes back and forth similar to REM sleep. This is done staring at a device with lights that rapidly move back and forth while holding a device in each hand that vibrates.

Research has found that doing this will result in the dissipation of emotions and stress reactions that are associated with these memories. I have done EMDR before and I found it very useful and helpful for overcoming trauma. As with any therapy, the key is finding a skilled therapist in EMDR.

Just like meditation, EMDR has been shown to decrease the firing of the amygdala and increase the size of the hippocampus. EMDR is one of my top choices for healing childhood trauma. Psychotherapy Traditional psychotherapy is always a great place to start when you’re trying to heal. There is nothing better than a third-party objective view of your life and your feelings. Many people make the mistake of using a priest, friend or family member as the person they talk to. There is no substitute for a mental health professional trained in psychotherapy who can give you the best treatment.

Unfortunately, our society still views seeing a therapist as a weakness and it certainly isn’t given the funding or attention it deserves. I hope that in the future, everyone works with a mental health professional even when they are feeling well. Your mental health is the bedrock of everything about you and how you feel so it must be the number one priority for everyone.

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Recently I have been researching the fascinating field of childhood trauma and uncovered an interesting link between adverse childhood experiences and Hashimoto’s disease.

One of the studies I discovered came out of a large, important public health study, The ACE Study, but it focused specifically on cumulative childhood stress and autoimmune disease in adults. What are adverse childhood experiences? Adverse childhood experiences, or ACEs, are experiences that expose individuals under the age of 18 to childhood traumatic stress. These experiences include physical, emotional or sexual abuse; witnessing domestic violence; growing up with household substance abuse, mental illness, parental divorce, and/or the incarceration of a household member.

Who was studied? A group of 15,357 adult Kaiser Permanente health maintenance organization members available for follow-up through 2005 was involved in this study. They were selected from the ACE Study, which was performed from 1995 to 1997.

These individuals are interesting because while many studies have looked at inner-city poor people of color, this study’s participants were mostly white, middle and upper-middle class college-educated San Diegans with good jobs and great health care.

This highly educated population was made up of 40 percent college graduates. Of the remaining individuals, 36% had some college education, 17% were high school graduates (i.e., they had 12 years of education). Only 7% had not completed high school. What did they measure? The study authors looked at the data from the ACE Study and created an ACE Score that included eight types of interrelated and co-occurring exposure to childhood adversity to measure cumulative childhood traumatic stress. So, the greater the number of adverse experiences, the higher the score.

The ACE Study Questionnaire is very simple and includes the following 10 questions.

“While you were growing up, during your first 18 years of life:

1) Did a parent or other adult in the household often …

Swear at you, insult you, put you down, or humiliate you?

or

Act in a way that made you afraid that you might be physically hurt?

2) Did a parent or other adult in the household often …

Push, grab, slap, or throw something at you?

or

Ever hit you so hard that you had marks or were injured?

3) Did an adult or person at least 5 years older than you ever…

Touch or fondle you or have you touch their body in a sexual way?

or

Try to or actually have oral, anal, or vaginal sex with you?

4) Did you often feel that …

No one in your family loved you or thought you were important or special? or

Your family didn’t look out for each other, feel close to each other, or support each other?

5) Did you often feel that …

You didn’t have enough to eat, had to wear dirty clothes, and had no one to protect you?

or

Your parents were too drunk or high to take care of you or take you to the doctor if you needed it?

6) Were your parents ever separated or divorced?

7) Was your mother or stepmother:

Often pushed, grabbed, slapped, or had something thrown at her?

or

Sometimes or often kicked, bitten, hit with a fist, or hit with something hard?

or

Ever repeatedly hit over at least a few minutes or threatened with a gun or knife?

8) Did you live with anyone who was a problem drinker or alcoholic or who used street drugs?

9) Was a household member depressed or mentally ill or did a household member attempt suicide?

10) Did a household member go to prison?”

If the answer was yes to any of these questions, the respondents were allocated one point.

Next, the authors looked at those scores and compared them with the risk of 21 different autoimmune diseases that resulted in hospitalization. These illnesses included Graves’ disease, diabetes, irritable bowel syndrome,

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In this episode of The Dr. Hedberg Show, I interviewed Dr. Shannon South to discuss healing trauma and finding joy in our lives.   Dr. Shannon D. South, aka the “Joy Doctor”, is an award-winning therapist, an Amazon best-selling author, and a professional speaker. As an expert in the field of spirituality and healing trauma for over 20 years, she knows how to assist people in finding wholeness and joy naturally. In 1994, during graduate school, Shannon had a spiritual experience during meditation that healed her debilitating anxiety and depression permanently. Since this transformative experience, she has helped thousands of clients connect to their most loving and joy-filled selves. Shannon also leads workshops and retreats for counselors, chaplains and coaches on how to integrate Spirit and Soul into their practice. Her most upcoming book, Ignite! Turn off the Chaos and Turn on the Joy is a roadmap to this unique, healing process. Shannon loves dancing, being in nature, teaching spiritual psychology and enjoying the beautiful mountains of NC where she resides with her family and friends. She can be found at www.whatsyourjoyiq.com or www.drshannonsouth.com

We answered the following questions in the transcript below: 1) Why did you start working with trauma and studying integrative approaches to counseling? (i can share a blip of my personal story in healing from anxiety, depression, and PTSD)

2) What are some of the best approaches you see/use in healing trauma?

3)Why is it important to heal unresolved trauma for health? (mind-body healing, connection to how we relate to something vs. what the something is, etc.)

4) How do clients learn to get out of stress reactivity and into the relaxation response?

5) How does unresolved trauma impact health?

6) Tell us more about Mindfulness-Based Stress Reduction and the research on it for healing.

7) You also use spiritual psychology in your work with clients. How is this different than traditional therapy?

8) Does healing old trauma patterns create more creativity, joy, and peace?

9 Does unresolved trauma hurt relationships? If so, how?

10) Thoughts on anxiety, depression, compulsive behavior and PTSD and healing from these…. Ex. what is the mind really meant to be used for? (instead of obsession and over thinking)

11) What are some attitudes that are important in healing from trauma from a mindfulness perspective? Podcast Transcript: Dr. Hedberg: Well, welcome everyone to the Dr. Hedberg Show. This is Dr. Hedberg. And I'm excited today to have Dr. Shannon South on the show. We've known each other for quite a while now here in Asheville. And Dr. South, she's also known as the Joy Doctor and has a tremendous amount of information and expertise on trauma, healing trauma, and really overcoming things like anxiety and depression, and things like that. So, I want to really dig in today, and you should learn a lot from her. And we'll talk about things that if you're a patient of mine, you know, we talk a lot about. But, of course, these are things that are outside of my area of expertise and that's why I want to have around today so that we could really dig into that. So, Dr. South, welcome to the show.

Dr. South: Thank you. I'm honored to be here. I've been following your work for some time and watching your amazing healing and supporting of other people, so I'm thrilled to be a part of that.

Dr. Hedberg: Great. Before we jump in, why don't you just tell us a little bit about yourself and what you're focusing on these days?

Dr. South: Absolutely. I am a licensed professional counselor and an author, and I do trainings for therapists on bringing more soul and spirit into their practice. But I also have been working with trauma and spiritual psychology for over 20 years. And I, of course as you know, we get into the field sometimes because of our own personal journeys. And when I was in my 20s, I was diagnosed with an anxiety disorder,

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A fair number of the patients I see are already eating a healthy diet but they’re still not feeling well. Once we delve deep into their history and their lives, it becomes very clear that stress is at the bedrock of their illness. It’s extremely frustrating to be eating well all the time but still experiencing symptoms.

We know that stress shuts down digestion including suppression of stomach acid, bile flow, and pancreatic function. All of these are necessary for healthy digestion but if we’re stressed while we are eating, that healthy food we’re putting into our bodies won’t get digested properly and it may have some more interesting effects on the body.

Stress also immediately changes the behavior of your gut bacteria which also influences how your food is digested and absorbed.

I decided to look deeper into this connection and I found a very interesting paper entitled, “Depression, Daily Stressors, and Inflammatory Responses to High-Fat Meals: When Stress Overrides Healthier Food Choices.” The paper was published in the journal Molecular Psychiatry in March of 2017.

Let’s dig in and break down what the researchers found. 58 healthy women with a mean age of 53 received either a high saturated fat meal or a high oleic sunflower oil meal. An inventory of stressful events was assessed prior to consuming the meal.

The researchers found as expected that women without any prior day stressors showed increased signs of inflammation after the high saturated fat meal but no increase in inflammation after the sunflower oil meal.

This is expected because too much saturated fat increases inflammation and monounsaturated oils that are high in oleic acid such as sunflower oil or olive oil do not increase inflammation when eaten in excess. In fact, olive oil has been shown in studies not to increase inflammation when eaten in excess and also it has been shown to decrease inflammation.

However, any of the women who had prior day stressors showed an increase in inflammation after eating the high saturated fat meal as well as the high sunflower oil meal. The results looked identical after eating both types of fat. This clearly showed that if you have been under stress, eating fats that don’t increase inflammation such as sunflower or olive oil will still increase inflammation.

They also found that the more daily stressors the subjects had leading up to the meals, the greater the levels of inflammation after the sunflower oil meal but not the saturated fat meal. So saturated fat had a cut-off effect when more stressors were accumulated.

Additionally, any of the women who had a history of major depressive disorder showed an abnormal increase in blood pressure after the high-fat meal of both types. The authors go on to discuss how this increase in inflammation promotes plaquing of the arteries and can lead to diabetes by increasing insulin resistance.

The authors also discuss the connection between a history of depression and how people respond to stressors. Those with any history of depression or PTSD show an amplified response to stressors compared to those without such history.

Previous studies have also shown that marital stress can lead to higher insulin and triglyceride levels post-meal. What did they eat? The subjects at eggs, turkey sausage, biscuits, and gravy which contained 60 grams of fat, 59 grams of carbohydrates, and 36 grams of protein. The authors point out that these types of numbers are similar to that of a Burger King Double Whopper with cheese or a Big Mac cheeseburger and medium French fries. How was inflammation measured? Blood testing included CRP(c-reactive protein), serum amyloid A, sICAM-1, and sVCAM-1. SICAM-1 and sVCAM-1 are specific indicators of increased damage to arteries thus potentially leading to atherosclerosis. Dr. Hedberg’s Comments It is interesting that more daily stressors did not increased inflammation above a certain point in those who ate the high satu...

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In this episode of The Dr. Hedberg Show, I interview Dr. Michael Ruscio and we discuss non-celiac gluten sensitivity, prebiotics, probiotics, the microbiome, SIBO, FODMAPs and much more.  You can read the transcript below.

Michael Ruscio is a doctor, clinical researcher and best-selling author whose practical ideas on healing chronic illness have made him an influential voice in functional and alternative medicine. His work has been published in peer-reviewed medical journals and he speaks at integrative medical conferences across the globe. Dr. Ruscio also runs an influential website and podcast at DrRuscio.com, in addition to his clinical practice located in northern California.

Dr. Hedberg: Okay. Well, welcome, everyone, to "The Dr. Hedberg Show." This is Dr. Hedberg. And I'm excited today to have a good friend and colleague on Dr. Michael Ruscio. We've known each other for quite a long time I think since I launched "The Infection Connection" back in around 2012, and Dr. Ruscio has a lot of expertise in the gut and the thyroid and autoimmune disease, so we'll be talking about some of that today. So, Dr. Ruscio, welcome to the show.

Dr. Ruscio: Hey, thanks, for having me on.

Dr. Hedberg: Great. Well, you and I have a lot in common in that most of what we do is driven by the literature and so why don't we jump in and talk about some of the latest work on non-celiac gluten sensitivity. Because gluten is really one of those... it's a big topic right now. A lot of people are avoiding gluten maybe unnecessarily. But why don't you talk a little bit about the latest research on non-celiac gluten sensitivity?

Dr. Ruscio: Sure. And you're actually right. It's an important issue because I'm sure that if... whether you're a clinician listening to this or a patient or just a healthcare consumer you've likely heard of gluten-free dieting. You've probably known someone who's gone gluten-free and reported that they felt better eating gluten-free. It's certainly something that can help people. I think where we have to be careful is when we try to tell everyone that they have to eat like they have celiac disease. And it's kind of this mistake of falling into extreme ways of thinking or dichotomous ways of thinking where it's either all or none, 100% avoidance or total, you know, unrestricted gluten in the diet. And for some people, that's absolutely true, for some people they have to be very diligent with gluten avoidance.

But, and I guess one could ask the question, "Well, if it's a potential problem, if gluten in the diet is a potential inflammatory or detrimental food then why not just avoid it?" Well, because that poses some psychological and psychosocial stressors on people. It can be difficult and I certainly see patients who come in afraid of food and it's causing an impairment of their social life because of it. And so these are serious things that do have documented influences on your health. Fear, stress and social connectivity or lack thereof have been documented to have truly profound impacts on various measures of health. So this is important to have a nuanced idea of what we should be recommending for gluten avoidance.

And there was a multicenter study performed in Italy, and a group of different physicians and gastroenterologists, essentially comprised a 60-point assessment for identifying and tracking those who had non-celiac gluten sensitivity and also correlating what other symptoms and conditions non-celiac gluten sensitivity was associated with. And just for the audience, you have celiac and then if you're not diagnosable as celiac but you still seem to have a negative reaction to gluten then you can be labeled non-celiac gluten sensitivity. And what they found was very interesting. They found that 0.3% of the population that was studied and rigorously evaluated trying to identify non-celiac gluten sensitivity, looking at symptoms, physical exam, lab testing.

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I was pleasantly surprised to learn about some recent research on the positive effects of black cumin seed oil and Hashimoto’s disease. I’m always searching for compounds that can help my patients with Hashimoto’s disease and black cumin seed oil looks like a real winner.  In this article I break down two promising studies on black cumin seed oil and how it can help autoimmune thyroiditis.

What is Black Cumin Seed? Black cumin seed is also known as Nigella sativa which is a medicinal plant and the seeds have been used in traditional and folk medicine in the Middle East for centuries. Black cumin seeds are used mainly in Iranian, Pakistani and Northern Indian cuisines. Black cumin seeds contain compounds that have the following properties:

Anti-inflammatory Antioxidant Immune balancing Enhanced blood sugar metabolism thus improving insulin resistance Anti-cancer Kidney protective Decreases pain (Analgesic) Liver protective Bronchodilator Antihistamine Antimicrobial against bacteria, viruses, parasites, and fungi Breaks down biofilms and prevents biofilm formation Gastroprotective Cholesterol-lowering Cardioprotective Hypoglycemic Hypotensive Improves memory Supports a healthy microbiome Reduces lung inflammation

Specific chronic diseases that black cumin seed has been shown to improve include:

Hashimoto’s thyroiditis Type 1 and Type 2 Diabetes High cholesterol Coronary artery disease High blood pressure Gastritis Obesity Polycystic ovarian syndrome Urinary tract disorders Asthma Encephalomyelitis Neurodegenerative disorders Hair loss (alopecia) Eczema Bronchitis Rheumatism Rheumatoid arthritis Indigestion Loss of appetite Diarrhea Male infertility Pain Convulsions Depression Allergies What did the latest research show on Hashimoto’s disease? 40 patients were split into two groups of 20 receiving black cumin seed and 20 receiving a placebo. 2 grams a day of black cumin seed powder was taken for 8 weeks.

What improved at the end of the 8 week study period in those who took black cumin seed?

Body Mass Index (BMI) improved Waist circumference improved Hip circumference improved TSH decreased indicating improved thyroid function T3 increased which is the most active form of thyroid hormone Thyroid Peroxidase Antibodies (TPO) decreased

None of the above measurements improved in the placebo group who just took a starch pill. This clearly indicates the black cumin seed had a profound effect on weight loss, metabolism, thyroid function and improvement in the Hashimoto’s antibody thyroid peroxidase (TPO). What is it that resulted in such excellent improvements? Black cumin seeds contain a compound called thymoquinone that has all of these beneficial properties. Thymoquinone has been heavily studied and one of its mechanisms is suppression of the COX-2 enzyme resulting in reduced inflammation. COX-2 inhibitors like Celebrex are popular drugs for inflammatory conditions but black cumin seed has similar benefits without the side effects.

Thymoquinone also has also been shown in previous research to improve thyroid function. Not only has it been shown to increase T3 but it actually can repair thyroid tissue that has been damaged by your immune system.

Black cumin seeds also contain thymohydroquinone and thymol which also have many of the same benefits. Is there more research on black cumin seed oil and Hashimoto's disease?

Another exciting paper was just published which looked specifically at black cumin seeds and their effect on lipids, glucose metabolism, and anthropometric variables including body weight and body mass index (BMI).

The authors start by discussing the connection between hypothyroidism and lipids such as cholesterol, triglycerides, and LDL. High cholesterol levels are a hallmark sign of hypothyroidism which is interesting because some patients are prescribed cholesterol-lowering medication without a proper thyroid evaluation.

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Hashimoto’s disease can have many triggers including iodine, low birth weight, pregnancy, smoking, mercury, drugs, stress, leaky gut, environmental toxins, and of course infections.  This article will focus on the connection between infections and Hashimoto’s disease.

The infection connection and Hashimoto’s disease is something I have been investigating since 2005 when I first learned about the connection between Yersinia enterocolitica and Hashimoto’s disease.  Since then, I’ve been researching the infection connection to Hashimoto’s disease and science continues to shed more light on this area.

The vast majority of my patients with Hashimoto’s disease do have some kind of active infection that has been shown to be connected to Hashimoto’s disease.  Let’s go ahead and jump right into what the latest scientific literature has to say about this fascinating area of research. Why do infections trigger Hashimoto’s disease? Molecular mimicry is one explanation for bacterial trigger of the disease.  This basically means that the infection looks similar to your own thyroid tissue so your immune system launches an immune attack on the microbe and your thyroid.  Yersinia enterocolitica is a classic example of this connection.

Other explanations are complex immunologic mechanisms that I won’t go into detail here because of the technical nature of the material.  To put one mechanism simply, viruses can reside inside the thyroid gland which triggers immune activation against the virus and the thyroid.  Epstein-Barr Virus and Human Herpes Virus 6 are examples of this mechanism.

For those of you with a scientific background who would like to read more about the technical immunologic mechanisms, you can search for the phrases used in this quote, “Possible mechanisms by which infections may trigger thyroiditis include release of sequestered antigens by cell destruction or apoptosis, exposure of cryptic epitopes, molecular mimicry, or via a bystander mechanism resulting in activation of resident T- cells.” This quote is taken from this paper freely available for you to research. Lyme disease and Hashimoto’s disease Borrelia burgdorferi is the spirochete that causes Lyme disease and there is some evidence that this bacteria is connected to Hashimoto’s disease.  The data is limited at this point but with Lyme disease, there can be many other indirect factors and co-infections that could potentially be involved in triggering Hashimoto’s disease.

Patients with Lyme disease also tend to have some of the predisposing factors to autoimmune diseases such as a compromised digestive tract, inflammation, and tremendous oxidative stress. Yersinia enterocolitica and Hashimoto’s disease I have written about and recorded a podcast previously about the connection between Yersinia enterocolitica and Hashimoto’s disease.  There is good evidence of this connection so it is important to get tested if you have Hashimoto’s disease.  This can be done with a stool test and/or blood test. Helicobacter pylori and Hashimoto’s disease I cover this connection in detail in this article and podcast. Viruses and Hashimoto’s disease The following viruses have been shown to potentially trigger Hashimoto’s disease:

Coxsackievirus B

Rubella

Enteroviruses

Epstein-Barr Virus

Human Herpes Simplex Virus 6 (HHV-6)

Mumps

Parvovirus B-19

Hepatitis B

Hepatitis C

The Hepatitis C virus actually has the strongest infection connection to Hashimoto’s disease.  In fact, studies have shown that this virus can actually reside outside of the liver inside the thyroid gland thus triggering autoimmunity. Can we be certain that the virus triggered the autoimmunity? This can be difficult to make a definitive conclusion about the direct connection due to the interaction between the virus and the patient’s immune system.  Some viruses like the Epstein-Barr Virus and Herpes 6 can be activated inside the thyroid gland but there is no im...

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Aloe vera is one of the oldest medicinal plants we know of that was used by the ancient Egyptians who called it “the plant of immortality.” And 200 years ago Greek scientists considered Aloe vera a “universal panacea.” Aloe vera is technically named Aloe barbadensis and you most likely have heard of using Aloe topically for burns or internally for soothing an inflamed gut.

I’ve used Aloe vera over the years as one of the compounds in a gut-healing supplement I use for leaky gut, inflammatory bowel, SIBO, constipation, and irritable bowel syndrome. It works extremely well at reducing inflammation and repairing inflamed and damaged mucus membranes in the gut and the urinary tract. I have also used it quite successfully with the bladder pain caused by interstitial cystitis.

Aloe vera is rich in 200 nutritional substances most notably the following: Minerals: Iron

Chromium

Zinc

Selenium

Copper

Manganese

Magnesium

Sodium

Potassium

Calcium Vitamins: A

B1,B2,B3,B5,B6,B12

C

E

Folic acid Enzymes: Alkaline phosphatase

Amylase

Bradykinase

Carboxypeptidase

Catalase

Lipase

Peroxidase Additional compounds: Choline

Anthraquinones

Sterols

Lignins

Saponins

Salicylic acid

The above compounds explain its anti-oxidant, analgesic, antiseptic, anti-viral, and anti-inflammatory properties. Aloe vera has been scientifically shown to be beneficial for the following: Genital herpes

Psoriasis

Seborrheic dermatitis

Burns

Wound healing

Mucositis

Radiation dermatitis

Frostbite

Acne

Lichen planus

Apthous stomatitis

Type 2 diabetes

HIV

Cancer prevention

Constipation

Ulcerative colitis

Pressure ulcers

Traditional uses not scientifically supported yet include:

Parasites

Chronic leg wounds

Lupus

Arthritis

Alopecia

Bacterial and fungal skin infections

Tic douloureux Promising study results on Aloe vera and Hashimoto's Disease New research indicates that Aloe vera may be extremely beneficial for Hashimoto’s thyroiditis in patients with subclinical hypothyroidism. The study was inspired by an individual with Hashimoto’s thyroiditis who drank 50ml of Aloe Barbadensis Miller juice as a laxative and to soothe her skin. She noticed that after drinking this juice for 3 and 6 months, her TSH, Free T4, Free T3, and thyroid peroxidase antibodies (TPOAb) all improved.

Her TSH went from 5.14 to 1.83. Free T4 improved from 8.3 to 11.44. Free T3 went from 5.22 to 4.78 which indicates improved efficiency. And TPOAb decreased from 1,875 to 246.

These were quite profound changes with no other interventions and no thyroid medication.

Based on these results the authors recruited 30 women aged 20-55 with Hashimoto’s thyroiditis and subclinical hypothyroidism which was defined as having a TSH >4.0 and high TPOAb levels. These women had never been treated with thyroid medication before or taken any supplements for their thyroid issues.

All 30 subjects drank 50ml of Aloe Vera Miller Juice (ABMJ) manufactured by ZUCCARI (Trento, Italy) every morning on an empty stomach for 9 months.

TSH, Free T4, Free T3, and TPOAb levels were measured at baseline, 3 months, and 9 months.

The control group consisted of data on 15 women from a university hospital who had Hashimoto’s thyroiditis and subclinical hypothyroidism. What did the results reveal? The control group did not show any statistically significant changes in any of their thyroid test numbers.

At three months the study group showed statistically significant improvements in all four thyroid tests. TSH, Free T4, and TPOAb levels all improved again at the nine month mark. Free T3 levels declined at three months but then did not significantly change from three months to nine months. Here are the basic averages during the study: TSH Baseline: 5.19

TSH 3 Months: 3.12

TSH 9 Months: 2.01

Free T4 Baseline: 9.63

Free T4 3 Months: 10.67

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The ketogenic diet is currently sweeping the internet and the diet book world as the best thing since sliced bread for everything under the sun. Unfortunately, you can’t eat bread on the ketogenic diet and it really can be difficult to follow for some people.

Since I work with many patients who have Hashimoto’s disease and hypothyroidism, I wanted to investigate whether the ketogenic diet can cause hypothyroidism or decrease thyroid function. Let’s jump into the research and see what it has to say.

First let’s look at a study done on epileptic kids who followed a ketogenic diet since epilepsy was the first condition to be thoroughly studied and treated with a ketogenic diet. The first thing the authors point out is that we already know calorie restriction lowers T4 and T3 levels. The ketogenic diet mimics fasting so it makes sense that it could lower these thyroid hormone levels. They point out that the ketogenic diet is anti-inflammatory, anti-oxidative, and it balances neurotransmitters.

The authors state that the ketogenic has been documented to be helpful for the following conditions:

Polycystic ovarian syndrome (PCOS)

Migraine headaches

Autism

Depression

Diabetes mellitus type 2

Amyotrophic lateral sclerosis (ALS)

Alzheimer’s disease

Parkinson’s disease

Obesity

Glucose transporter protein-1 (GLUT-1) deficiency

Pyruvate dehydrogenase deficiency

In this study, 120 patients (63 male and 57 female) aged 4-10 were treated with a ketogenic diet for one year and their TSH, Free T4, and Free T3 levels were checked at 1, 3, 6, and 12 months. 20 patients (16.7%) in total developed hypothyroidism within the first 6 months which required thyroid medication. 70% of the 20 patients who developed hypothyroidism were girls as expected. Hypothyroidism was defined as a TSH level greater than 5.0 uIU/L with normal Free T4 levels.

TSH levels actually increased in everyone during the first month but dropped overall at 12 months follow-up. Free T3 levels however dropped significantly overall at 1, 3, 6, and 12 months.

The interesting thing is that the authors state that none of the kids who were diagnosed with hypothyroidism based on the TSH test developed any hypothyroid signs or symptoms. It’s also interesting to note that any kid who had been taking fish oil 6 months prior was excluded from the study since we know that fish oil improves thyroid function.

The authors point out the limitations of this study including lack of total T4 and total T3 levels as well as no testing for Hashimoto’s thyroiditis antibodies such as anti-thyroid peroxidase (TPO) and anti-thyroglobulin (TG) levels. Additionally, some of the kids were on anti-epiletic drugs which are known to disrupt thyroid function.

I don’t see how this study found anything conclusive if none of the kids developed any symptoms and hypothyroidism was based on a TSH >5.0 in growing children.

We already know that low-carbohydrate diets can work very well for fat loss such is the Volek study which had patients eat 8% carbs, 61% fat (calories from fat were 25% saturated fat, 25% monounsaturated fat, and 11% polyunsaturated fat), and 30% protein. Volek measured T4 levels which remained normal but didn’t look at T3 levels however but the subjects did extremely well with their weight loss. If thyroid function had decreased then it would have been difficult to lose weight.

We know that cutting calories and losing weight will decrease T3 levels. Not only that, we know that fasting increases reverse T3 which knocks out T3 receptors. The ketogenic diet suppresses appetite quite effectively so many people just aren’t eating enough calories on the diet which will affect thyroid hormone levels. Why would T3 levels drop on a ketogenic diet? Eating carbohydrates increases T3 levels because that extra T3 is required to burn glucose produced from the carbohydrates. This is why you feel warmer after eating a meal with a lot of carb...

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Did you know that the thyroid gland has the highest concentration of selenium compared to any organ in your body? Selenium is a powerful and essential trace mineral actually first discovered by the Swedish chemist Berzelius in 1817. Selenium mainly acts as an antioxidant, anti-inflammatory, and it is involved in the production and activation of thyroid hormone. Selenium protects the thyroid from oxidative damage but a deficiency can lead to an increase in the weight of your thyroid which can be compounded by an iodine deficiency. When you’re deficient in selenium, you actually lose iodine more quickly so these two substances must work in perfect balance.

This is an interesting adaptation your body has developed because your thyroid has the potential to be damaged when you are deficient in selenium but you have normal iodine levels. Iodine ensures normal thyroid hormone production but the protective effects of selenium may not be there to clean up free radicals produced during hormone synthesis. It has been found that supplementing with selenium if you are deficient in iodine can actually suppress thyroid function. This is why it may be important to have your iodine status checked before supplementing with selenium so we can figure out the best plan forward. The catch is that supplementing with iodine can increase damage to the thyroid gland in patients with Hashimoto’s disease. This is why you should work with an experienced healthcare practitioner to help figure out the right balance for you. Selenium acts as a “thyroid antioxidant” and is vital for the production of thyroid hormone and it is involved in the conversion of T4 (least active thyroid hormone) to T3 (most active form). One clear pattern on you thyroid labs that can indicate selenium deficiency is a high or high/normal Free T4 but low or low/normal Free T3 with a normal TSH. This indicates that your T4 isn’t converting well to T3 possibly due to a selenium deficiency. Selenium protects the thyroid gland from the damaging effects of thyroid peroxidase (TPO-Ab) and anti-thyroglobulin (Tg-Ab) antibodies. Selenium also can protect the thyroid by binding to mercury and making it completely inert. Mercury is a major thyroid disrupting chemical but not as significant when selenium is present. Selenium and iodine are intricately intertwined in the thyroid gland. They are both necessary for thyroid hormone production, but when iodine-deficient subjects were given selenium alone, it made their hypothyroidism much worse. Since iodine deficiency is very rare in industrialized nations, this is usually not something to be concerned about.

Can selenium help Hashimoto’s disease? Three separate studies have shown that selenium supplementation suppress TPO-Ab and Tg-Ab levels. A recent study by Wichman et al. Showed that selenium supplementation reduces TPO-Ab levels at 3, 6, and 12 months and Tg-Ab levels at 12 months. This was only in those treated with levothyroxine (T4), not in those who did not take thyroid hormone. This study also found that antibody levels only decreased in those taking selenomethionine but not in those taking sodium selenite. This is because selenomethionine is absorbed much better than sodium selenite. Selenium has been found to be highly effective in patients with Hashimoto's thyroid disease. Multiple studies have shown that selenium supplementation significantly reduced thyroid antibodies which are an indicator of thyroid autoimmunity. In fact, the higher the antibody levels were at the beginning of the studies, the greater the positive effects from selenium. It was also found that selenium improved the overall sense of well-being in these individuals. One study out of Greece found that supplementing with selenium for 12 months lowered TPO-Ab levels but once the patients stoppped taking the selenium, their antibody levels rose 4.8% after 6 months. Another study out of Italy found the same positive TPO-Ab lowering effects after pati...

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One of the most common questions I get is, “What are optimal Hashimoto’s thyroiditis antibody levels?” For years, many patients and clinicians have been chasing thyroid peroxidase (TPO) and anti-thyroglobulin (TG) antibody levels in an attempt to get them as low as possible or even undectable as a measure of success.  This can leave many people frustrated and stressed about their condition.  Some individuals feel that these levels should become undetectable in order to consider the condition in complete remission.  But is this entirely true or necessary?

A recent study out of Germany has helped us get a clearer picture of how we should be looking at thyroid antibody levels.  The study is entitled, “Anti-thyroperoxidase antibody levels >500 IU/ml indicate a moderately increased risk of developing hypothyroidism in autoimmune thyroiditis” published in the journal Hormone Metabolism Research.

The authors were specifically looking at thyroid peroxidase and anti-thyroglobulin antibody levels and if they are associated with developing hypothyroidism.  Here is a breakdown of what the authors found:

Patients with TPO antibody levels >500 did show an increased risk of developing hypothyroidism.

Patients with TPO antibody levels <500 did not show an increased risk of developing hypothyroidism.

Patients with anti-thyroglobulin and thyroid peroxidase antibody levels <500 did not show an increased risk of developing hypothyroidism.

Anti-thyroglobulin antibody levels at any level did not show an increased risk of developing hypothyroidism.

Even those who did have elevated TSH after years of follow-up were still considered euthyroid which means they had normal functioning thyroid glands.

They did follow the patients for an average of 6 years which is a fair amount of time to make a good conclusion about how antibody levels potentially cause hypothyroidism.  Hypothyroidism was defined as a TSH >4.6. Free T4 levels weren’t statistically important in any group because they didn’t vary enough to be of concern.

Over the last 15 years, I have found that these study results hold true and that patients are usually feeling great once their antibody levels are below 500.  Some will remain in the 50-400 range no matter how well the patient eats, manages stress, improves gut function, and no matter how targeted their supplement plan is put together.

I have always followed the advice of “Treat the patient, not the labs” so when a patient is feeling great I have always discontinued focusing on these numbers.  Everyone is so unique after all that we can’t completely go by numbers and ranges on laboratory tests.  I do love testing because it almost always reveals deficiencies and imbalances that can be difficult to identify simply by talking to someone.  However, once we get deep into treatment and a patient gets well, these numbers become less and less important. What is the takeaway? One potential flaw in the study is the fact that hypothyroidism was defined as a TSH >4.6.  There are some clinicians who believe that the range for TSH is far to broad and that TSH should be within a tighter window such as 1.5, 2.0, or 2.5 as the upper cut-off point.  There is little evidence to support this claim for every single human being who has Hashimoto’s or hypothyroidism.

Sure, some people just feel better with a TSH that is in these lower ranges but some people also feel great with higher TSH levels.  As with everything in functional medicine, this is an individualized question which shouldn’t be set in stone.

Additionally, as pointed out above, the patients who did have TSH levels above 4.6 after the 6 year follow-up had normal thyroid function despite the higher TSH levels.

Once we’ve dealt with the most significant causes of Hashimoto’s thyroiditis including gut health, infections such as Epstein-Barr Virus, food sensitivities like gluten, vitamin D deficiency, selenium deficiency, stress,

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In this episode of The Dr. Hedberg Show, I interview Gary Stapleton of Aerodiagnostics Laboratory answering the question, "What is the best SIBO test?"  We covered a lot of ground about the ins and outs of SIBO breath testing including the best methodology, glucose vs. lactulose, how to properly perform the test, proper test interpretation, hydrogen sulfide, when to retest and much more.

Gary is the founder of Aerodiagnostics Laboratory which I personally use in my practice and highly recommend to everyone who wants the most accurate SIBO test on the market today.  Combine that with the best customer service and support and it's a no-brainer to use them for your SIBO testing. Below is a transcript of the entire interview with important links at the end: Dr. Hedberg: Okay. Well, welcome, everyone. This is Dr. Hedberg and welcome to "The Dr. Hedberg Show." I'm excited today to be talking to Gary Stapleton. And Gary is the founder of Aerodiagnostics Laboratory. And this is the laboratory that I use for small intestinal bacterial overgrowth testing. Their lab offers non-invasive hydrogen and methane breath testing. It's the lab I've been using to test for SIBO because the quality is really unparalleled in the SIBO world and I've been very, very pleased with the quality of the results I've been getting and the customer service. So we're going to be talking about some really interesting items today about SIBO and SIBO testing. So, Gary, welcome to the program.

Gary: Oh, thank you, Dr. Hedberg. I really appreciate joining today and I look forward to discussing SIBO and breath testing, hydrogen and methane breath testing with the audience.

Dr. Hedberg: Excellent. Yeah, it's good to have an expert like you here because this is really a hot topic. I mean, the prevalence of SIBO is continuing to grow and we're seeing it more and more. And then, of course, our IBS population really struggles with SIBO, for the most part. So why don't you start by just talking to us about hydrogen and methane breath testing and how it works in the diagnosis of SIBO?

Gary: Yes, so thank you. And please feel free to interject if there's something that I've said or am in the process of saying that might be beneficial as well. So hydrogen and methane gas, for those listening that aren't aware, are not produced by the body. Hydrogen and methane gases are produced by bacteria that is fermenting. So the way that the test works and why it's so incredibly important to prepare correctly, to use the right devices correctly and to administer and ensure that your devices are operating correctly, to ensure that we're measuring hydrogen and methane gas appropriately, it all begins with the preparation. And then, if you prepare correctly, which means you're moving food from the GI tract, there...even if there's bacteria, there's no gas being produced because the bacteria, if it's there, needs to be fed to ferment and to produce this gas.

So if you have bacteria in your small intestine and you're not supposed to have bacteria in your small intestine, I believe it should be less than 103 colony-forming units in the small intestine. If there's bacteria there and you've prepped, which means you've removed all food, your baseline breath sample should be relatively low to no gas because, again, the bacteria's there, it's not being fed.

Now, after that baseline sample, you ingest either glucose or lactulose as a substrate that has been validated to ensure appropriate measurement of gas levels inhalation of small intestinal bacterial overgrowth. When you ingest either that glucose or lactulose, that is a food source. And that food source will now feed bacteria, if it is there. That bacteria will ferment or rot and the gas that's produced, either hydrogen or methane, will diffuse through the blood and exit via the lung air.

I'll deflect for just a moment and say everyone is aware that there's a third gas. It's called hydrogen sulfite gas.

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Sometimes very simple tests provide a significant amount of valuable information when it comes to Hashimoto’s thyroiditis. One simple blood test is the red blood cell distribution width or RDW test which is included in the complete blood count (CBC). A recent study found that patients with Hashimoto’s thyroiditis have higher levels of RDW.

What is RDW? RDW is basically a measure of the variability in size of your red blood cells. The greater the variability in size, the higher the RDW test results. Anemia is usually the cause of elevations in RDW but chronic inflammation can also cause it to elevate. Disorders such as rheumatoid arthritis, inflammatory bowel disease, high blood pressure, and Hashimoto’s thyroiditis can increase RDW. So we can confidently use RDW as a sign of inflammation along with other helpful inflammatory blood markers such as c-reactive protein, fibrinogen, erythrocyte sedimentation rate, D-dimer, and homocysteine. What did the study show? 165 patients were included in the study with 102 of them having confirmed Hashimoto’s thyroiditis and 63 were in the healthy control group. The mean age of the participants was not statistically significant. 85 of the 102 patients with Hashimoto’s thyroiditis were women and 55 of the 63 participants in the healthy control group were women. This is no surprise since women have much higher rates of Hashimoto’s thyroiditis than men.

The complete blood count (CBC) markers were not significantly different between the groups.

Free T4 levels were significantly lower in the Hashimoto’s thyroiditis group compared to the control group. TSH levels were higher in the study group compared to the control group. We expect this since TSH levels increase in Hashimoto’s disease and Free T4 levels usually decrease.

Previous studies have shown a direct connection between lower T4 levels and increased RDW such as in this paper by Brenner et al.

Interestingly, Free T3 levels were not significantly different between the groups.

RDW levels were significantly increased in the study group compared to the healthy control group.

The main conclusion of the study was that RDW levels are increased in those with Hashimoto’s thyroiditis compared to healthy controls.

The authors point out some interesting additional findings that connect RDW to thyroid disorders. A previous paper found that elevated TSH levels are connected to elevated RDW levels entitled, “The red blood cell distribution width is associated with serum levels of thyroid stimulating hormone in the general population.”

And an additional paper found that RDW levels are higher in those with hypothyroidism. Why does RDW increase in Hashimoto’s thyroiditis? Since Hashimoto’s thyroiditis is a chronic inflammatory process, based on this paper and previous research, RDW increases in conditions that result in inflammation. RDW should also be assessed along with other inflammatory markers when dealing with Hashimoto’s thyroiditis.

We also know that thyroid hormone has direct effects on RDW such as in this paper it was found that RDW levels increase in hypothyroidism and hyperthyroidism. What about Selenium? We can actually use the RDW test to decide if we want to use selenium supplementation or not in Hashimoto’s thyroiditis. This study showed the RDW can be intimately tied to selenium status so it could be a good indicator to supplement with selenium. We already know that selenium can be very beneficial in those with Hashimoto’s thyroiditis.

I always test every patient’s blood and we look at the complete blood count which includes the RDW so we can make the best decision about what direction to go. I recommend combining it with other inflammatory markers as noted above for the best clinical picture.

Don’t forget to have a CBC done periodically if you have Hashimoto’s thyroiditis to see how your RDW is doing because it may be a key indicator of your thyroid health.

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In this episode of The Dr. Hedberg Show, I interviewed Dr. David Brady about the new GI-MAP stool test by Diagnostic Solutions Laboratory.  We discussed many topics including autoimmune disease, stool testing, stealth infections, gut infections, the gut microbiome and much more.  This is the stool test I use in my practice to identify bacterial dysbiosis, viruses, parasites, yeast, and overall digestive health.

Nikolas: Well, welcome everyone. This is Dr. Hedberg. And welcome to The Dr. Hedberg Show. I'm excited today to have a long-time friend and colleague on the show, Dr. David Brady. We're gonna be talking about the GI-MAP stool test and autoimmunity. And for those of you who don't know Dr. Brady, he has 26 years of experience as an Integrative Medicine Practitioner and over 22 years in Health Sciences academia. He's a Licensed Naturopath in the State of Connecticut and also Vermont. He's board-certified in Functional Medicine and Clinical Nutrition. And he completed his initial clinical training as a Doctor of Chiropractic in 1991. He's currently the Vice President for Health Sciences, Director of the Human Nutrition Institute, and Associate Professor of Clinical Sciences at the University of Bridgeport in Connecticut.

He has a private practice called Whole Body Medicine in Fairfield, Connecticut. Dr. Brady is also an expert consultant to the professional nutraceutical and nutritional supplement and clinical medical laboratory industries. He serves as the Chief Medical Officer for Designs for Health and Diagnostic Solutions Labs. He's also an internationally sought-after presenter on nutritional, functional, and integrative medicine. He's appeared on the speaking panel of some of the largest and most prestigious conferences, this includes IFM, ACAM, A4M, IHS, AANP, and many more. And we're gonna talk about some of his papers today. So welcome to the show, Dr. Brady.

David Brady: Hey, thanks, Dr. Hedberg, great to be on your show. We go back a long way in this journey together in functional medicine and we have amazingly similar paths, although you're fortunate enough to have gone through it a little later than me which means, you're younger.

Nikolas: Right, right. Younger but...

David: Younger but we're pretty similar, so.

Nikolas: Younger but not smarter. So that's why I have you on the show.

David: Oh, I don't know about that.

Nikolas: So let's jump into autoimmunity and you've emphasized this topic a lot in some of your papers, and in a lot of your lectures, and you also work with a lot of autoimmune patients in your practice. So what do you think it was that developed your interest in autoimmunity?

David: Oh, I don't know sheer desperation, probably like yourself, you know? Just seeing so much of this stuff come in on practices over the years, and it's just grown, and grown. And, you know, even in my couple of decades in practice, I certainly see it as being so much more prevalent as a presenting concern with patients than I did back in the beginning. And what we've seen emerging in the literature in parallel to that has really made autoimmunity one of these...well not a disorder but sort of a constellation of disorders that have a similar underlying etiology.

It's really a group of disorders that is really just innately attached to the functional medicine approach, right? Because of the emphasis in functional medicine on the importance of the health of the gastrointestinal system, gut ecology. And now, we would talk about it in more detail is the microbiota and the microbiome, and certainly an appreciation of the role of toxins and things like that, just make it a natural that patients would turn to providers like us if they had an option.

And they become aware of other types of approaches and certainly with the internet coming, you know, blowing up during that same amount of time, people have access to information now including so much good information,

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In this episode of The Dr. Hedberg Show, I interview DUTCH test founder Mark Newman.  We covered a lot of detailed information about hormone testing and why the DUTCH test is superior in many ways to other forms of hormone testing.

Here is a transcript of my interview with Mark Newman on the DUTCH Test Dr. Hedberg: Okay, well, welcome, everyone. This is Dr. Hedberg and welcome to "The Dr. Hedberg Show." I'm excited today to have Mark Newman on the show, and Mark is the founder of Precision Analytical. This is a lab that I've been using, I think, pretty much since the beginning, but Mark is a recognized expert and international speaker in the field of hormone testing. He has assisted many labs in developing novel tests to create world-class laboratory testing. He's also educated thousands of providers about hormone monitoring best practices. Welcome to the show, Mark, thanks for coming on.

Mark: Yeah, glad to be here. It's good to chat with you.

Dr. Hedberg: Why don't we start with you just filling everybody in on what you've been doing and what you've been working on with your testing?

Mark: Sure. The tests that we do and most people know it by its acronym, which is DUTCH, so it's a Dried Urine Test for Comprehensive Hormones. It's kind of a culmination of everything I've done career-wise vocationally in this world of hormone testing, starting off developing and working on 24-hour urine testing and kind of taking a good look at that in terms of the pros and cons. And then moving on to blood testing and saliva testing and governed over about a million of those tests over a five or six-year period. And what we've been doing the last five or six years is trying to piece together a little bit of a better model for people to get more information when it comes to reproductive and adrenal hormones.

You know, saliva testing has its advantages and blood testing has its advantages, and we've tried to combine all of that into one model that people can use to get a lot of information. So, we've got a uniquely comprehensive look at your adrenal hormones and your reproductive hormones and that's what we did and launched in about 2000, early 2013. I think you were kind of one of the first to jump on with us, which we've, of course, appreciated. And since then, we've been looking at this puzzle and saying "Okay, what else can we add to this to add into the picture?" So, we added a melatonin marker, we added 8-Hydroxydeoxyguanosine for an oxidative stress marker.

And then we've recently added a handful of organic acids so that we can see B12 deficiency, B6 deficiency, glutathione deficiency, a window into the neurotransmitter world. Because those all have a lot of crossover with the hormones and our goal and my goal is really just to give people the best most cost-effective tool they can for when you're dealing with functional medicine, integrative medicine and just some of these tough cases where you've got multiple things going on and we're trying to figure out as much as we can about those patients so that we can treat them well.

Dr. Hedberg: Yeah, I was really looking forward to this interview so we can really delve deep into some of these areas. So, like you said, I think I was one of the first to start using the DUTCH Test and like a lot of practitioners out there, I started with saliva and blood. And then I had done some 24-hour urine, but that always was a little bit difficult to get the patient to do all 24 hours of collection. And then with that, we didn't have the cortisol rhythm that we have with the DUTCH Test. So there were a few disadvantages there, but why don't you give us a general breakdown of the advantages of urine compared to saliva and blood testing?

Mark: Sure. Yeah, I mean, I think historically, if you're trying to use something for its biggest advantage, then you're really better off, if saliva and blood are your options, you're really better off going to saliva to look at cortisol.

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In this episode of The Dr. Hedberg Show, I interviewed writer and thyroid advocate Rachel Hill of The Invisible Hypothyroidism.  We discussed Hashimoto's disease, hypothyroidism, and many connections to these illnesses.

Rachel suffers from thyroid issues herself so we can learn a lot from her about her personal experiences.  I urge everyone to listen or read and connect with her through her website and social media which I have linked to at the end of the transcript.

Here is a transcript of the recording with Rachel Hill for those who prefer to read rather than listen: Dr. Hedberg: Okay. Well, welcome, everyone. This is Dr. Hedberg and today, I'm gonna be talking to Rachel Hill. And Rachel Hill is the founder of Invisible Thyroid and just some background on Rachel. She was diagnosed with hypothyroidism, Hashimoto's disease, as well as chronic fatigue syndrome, as well as having adrenal fatigue, and experience with depression and anxiety disorder. Rachel created The Invisible Hyperthyroidism. This is an award-winning patient advocacy blog that focuses on helping others by advocating for better thyroid disease diagnosis and treatment. So, I'm excited to have you on. Welcome to the show, Rachel.

Rachel: Thank you for having me. I'm excited to talk to you today.

Dr. Hedberg: Excellent. Why don't we start with you talking about The Invisible Hypothyroidism, exactly what that is and why you started it?

Rachel: Yes. So, The Invisible Hypothyroidism is the name of my thyroid patient advocacy blogging website that you've just touched on. Under that name, I also get involved in other things such as doing interviews, podcasts like this, fundraising for thyroid charities, and I run a couple of forums in Facebook groups as well to reach for the thyroid patients and other halves, to provide some support and advice, really. The Invisible Hypothyroidism encapsulates what it means to advocate for yourself and your own health, which I think is incredibly important and something that I've learned along my thyroid journey.

Before my blog went live, back when I used to write about my experience as a coping mechanism, like a diary or journal if you will, for myself to read back on. I wrote a poem called, The Invisible, which I really wrote to try and encapture all the sides of living with thyroid disease, which is an invisible illness, and all the signs a lot of people don't understand or see. So, when I decided to start writing on a private blog space, I used the title of this poem, The Invisible, but felt that The Invisible Hypothyroidism described what I was writing about and wanting to convey much better.

And I just wanted to just, kind of, get out all of the sides of hyperthyroidism that people often don't see, and all the various sides that I was struggling with. And then eventually, I turned my little private corner on the web where I was blogging my personal experiences to a public setting, and my blog went public and I haven't looked back since. It's been really popular, and a lot of people seem to resonate with my experiences across the globe actually. And despite being based in the UK, about 60% of my traffic is from the U.S., which is quite interesting.

Dr. Hedberg: Excellent. So, of course, you've gone through this yourself. You've been diagnosed with hypothyroidism, Hashimoto's, chronic fatigue. So, that was obviously a motivation, but can you give us some more insights into what motivated you to become an advocate for thyroid patients, and also create The Invisible Hypothyroidism?

Rachel: Yeah. So, essentially, I'd had signs and symptoms of hypothyroidism and Hashimoto's for years. And I was frustrated that it took so long for doctors to find it and then get to the point where I was eventually diagnosed and then began treatment. I was just flabbergasted, if you will, that it had been missed for so long, and even worse, that there are still people out there who don't know that they have it,

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In this podcast, I discuss the gut-brain axis with Dr. Jeff Moss.  This was a fascinating conversation about the latest research on the connection between gut microflora and it's intimate connection to the brain and nervous system.  We talk about this connection with neurotransmitter imbalances, autonomic nervous system dysfunction, Alzheimer's disease, Autism, gut healing strategies and much more.

Here is the transcript of my conversation with Dr. Jeff Moss on the Gut-Brain Axis: Dr. Hedberg: Okay, well, welcome, everyone. This is Dr. Hedberg, and thanks for tuning into "The Dr. Hedberg Show." I've got a very special guest today, Dr. Jeff Moss. And Dr. Moss is a graduate of the University of Michigan Dental School 1974. He practiced dentistry in Grand Rapids, Michigan until 1985. And he employed clinical nutrition in that practice, and he decided to use that experience and enter the professional supplement industry.

So, for the last 24 years, Dr. Moss has operated Moss Nutrition, which supplies the Moss Nutrition professional line of supplements to practitioners. And, since 2000, he has served as adjunct faculty at the University of Bridgeport Nutrition Institute, starting with the vitamins and minerals class and most recently adding the assessment in nutrition class to his teaching responsibilities.

He's co-authored the textbook, the "Textbook of Nutritional Medicine" by Dr. Melvyn Werbach, and Dr. Moss was president of the International and American Associations of Clinical Nutritionists from August 2000 to June 2001.

Moss Nutrition's website is mossnutrition.com, and those of you who are patients of mine know that I'm a big fan of Moss Nutrition products because of the quality and because of all the research behind their products, and just fantastic customer service, and just a great company to work with across the board. So Dr. Moss has definitely been a mentor of mine. He's one of the only doctors out there in the functional medicine world who I listen to and respect, so I'm really excited to have him on. Jeff, thanks for joining me.

Dr. Moss: Well, thanks so much for having me.

Dr. Hedberg: So today we're gonna be talking about the gut-brain axis. This is a topic that is kind of sweeping the functional medicine landscape with good reason. We've been addressing this issue for a long time, but we're learning more and more about how the gut flora affect extraintestinal aspects of the body, and the brain, and the rest of the body system. So why don't we jump in, and can you just talk a little bit about how the gut microbiota actually interact with our nervous system?

Dr. Moss: Sure, there are really several different ways that it does it, and before I get into all of the ways, I guess the big picture here is that why this is so interesting and why it is important and so exciting is, because of the way we've traditionally viewed any type of central nervous system issue, either behavioral or neurodegenerative, we've kind of viewed as the central nervous system kind of hanging out there in space. We view the blood-brain barrier as basically impermeable to a lot of different things, and because of that the way we viewed it and the way we intervene was basically looking at it directly. There really wasn't connected to anything else in the body.

And I remember I got this very early on as a dentist. You know, the head is just kind of detached from everything else from a physiologic and mostly in terms of a diagnostic and clinical interventional therapeutic standpoint, and so I think that's the big picture here before we get into the complexities even if some of it's a bit difficult to understand. The big picture here is that the brain is incredibly influenced by what else is going on in the body, and particularly what's going on in the gut. So, with that in mind, there are really several different ways.

Number one is what is classically known...we have neuroanatomical pathways,

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Approximately 90 million Americans now suffer from some type of sleep disturbance.  Rejuvenating sleep is an extremely important and fundamental part of feeling great and healthy. Unfortunately, too many of us are plagued with insomnia and miss out on sleep's wonderful healing properties.  You'll become more inflamed and more insulin resistant simply by getting 6 hours of sleep or less.  Your immune system will also suffer significantly if you don't get enough sleep making you more prone to colds and the flu.  This article will explain what you can do (and what you should avoid) to naturally cure insomnia at home.

Get Into the Rhythm Getting good sleep is all about balancing your circadian rhythm.  The best thing to do to kickstart a healthy circadian rhythm is to expose yourself to sunlight before 8:30 am.  When you get up in the morning it is time to tell your brain that the sun is out and it is time to get your body and your hormones going.  Step outside and soak up some early morning sunrays or do a brisk walk first thing to get you going.

If your work schedule doesn't allow this, just try to set up your workspace near a window or get outside as much as you can during the day when you're on break or during lunch. What About Exercise? Exercise can significantly improve your sleep quality. The earlier in the day the better if you are going to exercise, but some exercise is better than none so do it late if you have to.  Moderate and intense exercise raises cortisol so if you are going to exercise late in the day be sure it is something light and gentle such as Tai Chi, light stretching, gentle flow yoga, or a walk around the neighborhood. Stay Away From Drama Avoid watching television before you go to bed as this can disrupt your sleep.  Watching the news can trigger negative emotions such as fear, anger, and frustration which will raise cortisol and adrenaline.  Avoid intense movies or reading material as this can stimulate your adrenals which will keep you awake.  Read some light fiction or learn something that is easy to understand and pleasurable.

Social media is the perfect way to upset your mind and your rhythm.  Social media increases the sleep-disrupting brain chemical dopamine with all the notifications, flashes, arrows, videos, ads, links, and inflammatory posts by your "friends."  Even if you don't have sleep issues I recommend avoiding social media outlets such as Facebook as I mention in this article on how Facebook could be making you sick. Stay Consistent Try and follow a regular sleep schedule. Go to bed and wake up at the same times every day.  Make going to sleep a ritual and stick with your plan even on the weekends.  Don't stay up late on the weekend and then try to sleep in.  This disrupts your consistency and throws off your rhythm.  If you really want to change your life and feel better then commit to a consistent schedule.

The hours you sleep from 10 pm to 2 am are the most restorative so get to sleep early enough so you're out by 10.  I go to bed at 9 pm and read very light material such as fiction and then turn out the lights around 9:30-9:45.  You'll notice a big difference in how you feel if you've become a night owl by training your body to go to bed earlier.  Don't try and make a big shift right away.  Start with 15-minute increments each night until you are falling asleep before 10.

Also wake up consistently at the same time every morning and shoot for about 7-8 hours of sleep each night.  Sleeping longer than that may make you feel groggy for the early part of the day so be consistent when you go to bed and when you wake up. Can Meditation Help? Begin a regular meditation practice. Meditation can calm the mind, reduce stress, anxiety and help you get clear on what is important so your mind is not racing. I highly recommend www.calm.com to teach you how to meditate. Just 5 minutes a day to start will begin to work and you can meditate up to 20-25 minutes a day ...

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What is the MTHFR test? The MTHFR test or methylenetetrahydrofolate reductase test has become extremely popular due to a number of alternative medicine practitioners promoting it as the source of many chronic illnesses.  But is it something you should worry about?

This test is basically looking for two types of genetic mutations known as C677T and A1298C that affect the MTHFR enzyme involved in folate metabolism in your body.

Proper MTHFR enzyme function ensures that homocysteine is properly metabolized to the amino acid methionine which then makes SAMe. SAMe is known as the “universal methyl donor” which is extremely important for serotonin, melatonin and your DNA.

Folate is a B-vitamin and is important because it is at the heart of metabolism and the production of all your cells. Without it, nothing really works well so our list of symptoms and health problems would be extensive.

The National Library of Medicine Genetics Reference states that MTHFR:

"The MTHFR gene provides instructions for making an enzyme called methylenetetrahydrofolate reductase. This enzyme plays a role in processing amino acids, the building blocks of proteins. Methylenetetrahydrofolate reductase is important for a chemical reaction involving forms of the vitamin folate (also called vitamin B9). Specifically, this enzyme converts a molecule called 5,10-methylenetetrahydrofolate to a molecule called 5-methyltetrahydrofolate. This reaction is required for the multistep process that converts the amino acid homocysteine to another amino acid, methionine. The body uses methionine to make proteins and other important compounds." How common is it? Approximately 5-14% of the US population has two copies of the MTHFR mutation.  It is the most common in those of Mediterranean descent and lowest in those of African ancestry.  In America, about 25% of people who are Hispanic, and 10-15% of people who are Caucasian have two copies of C677T.

Should you worry about Homocysteine and MTHFR? Although controversial in its connection with cardiovascular disease, elevated homocysteine levels may damage blood vessel walls leading to plaque (atherosclerosis) development and thus the potential for a heart attack, stroke or blood clot.

Homocysteine requires healthy levels of folate, vitamin B12, and vitamin B6 to be metabolized properly.  Recent data, however, shows that supplementation with these vitamins to lower homocysteine levels does not produce any benefit regarding cardiovascular risk reduction.  This is most likely due to the complexity of cardiovascular disease which doesn't have a single cause such as elevated homocysteine.

Elevated homocysteine levels, however, are rarely connected to a single genetic variant.  Patients with elevated homocysteine should be thoroughly evaluated for the causes of elevated homocysteine such as:

Hypothyroidism Obesity Diabetes Insulin resistance Inflammation High cholesterol High blood pressure Lack of physical activity Aging Smoking Medications (atorvastatin, fenofibrate, methotrexate, and nicotinic acid)

Are there any disease connections to MTHFR? The only conditions with significant scientific support connected to MTHFR are the following:

Spinda bifida Homocystinuria Age-related hearing loss Anencephaly (neural tube defect) Blood clots

There are many claims on the internet that MTHFR is linked to cardiovascular disease, high blood pressure, stroke, glaucoma, certain cancers, and some psychiatric disorders.  All of the studies related to these conditions with MTHFR have mixed results with some studies finding no association.  So at this point, there is no clear scientific evidence that MTHFR alone has any connection to these disorders.

This is a classic example of cherry picking by alternative practitioners extracting the information from the mixed studies that support their own agenda and ignoring the opposing evidence.

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In this interview on The Dr. Hedberg Show, I had a great time talking to Shannon Garrett about Hashimoto's disease.

We started by talking about Shannon's personal journey with Hashimoto’s disease.  And then we got into how stress triggers Hashimoto's disease as well as emotions and early adverse life events in childhood and how they connect to autoimmune disease as an adult.

Shannon's book Hashimoto’s: Finding Joy in the Journey.

The many shades and stages of grief and Hashimoto's disease.

Shannon's eCourse and the FLT triangle of Hashimoto's disease.

We talked about LDN (low-dose Naltrexone) and if it is suitable for everyone with Hashimoto's disease.

Shannon's nutrition approach to Hashimoto's disease and why she doesn't always start with the autoimmune paleo diet.

Additionally, Shannon went through her process of gently helping women change their diets without creating additional stress or anxiety on the patient.

Shannon's Thyroid Fatigue Special Report which includes the de-stress the holidays eGuide and free 7-Day Fatigue Makeover Challenge.

Shannon's new book will be out in the 3rd quarter of 2018 called Hashimoto's R&R. About Shannon Garrett Shannon Garrett, BS, RN, CNN is an Autoimmune Thyroid Wellness Nurse Expert & Certified Functional Nurse-Nutritionist. Shannon is a Hashimoto’s patient, advocate, and educator who has dedicated her career to helping women diagnosed with Hashimoto’s live their best life.

Shannon received her degree in nursing (magna cum laude) from the prestigious Aquinas College School of Nursing, and her degree in human development & psychology from Amridge University. She has achieved multiple certifications specific for practicing holistic nurses in nutrition, environmental toxins, cardiology, and holistic stress & anxiety management.

She is also the author of The Hashi’s Sister’s Guide to LDN, Hashimoto’s: Finding Joy in the Journey and the soon to be released book (2018) Hashimoto’s R&R. Shannon is a member of the Institute of Functional Medicine, the American Holistic Nurses Association, and the National Nurses Business Association. She serves on the advisory board of HeyHashi.org and is a volunteer advocate for the use of low-dose naltrexone in autoimmune thyroid disease. She is most well known as an LDN nurse educator and is a featured expert on LDN Research Trust.org website.

Shannon Garrett is committed to raising awareness on how to reverse the symptoms of Hashimoto’s through her blog, online programs, educational events and consulting services.

Please visit Shannon's website for more information.

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"The dose makes the poison." ~Paracelsus Are artificial sweeteners bad for you?  I recently received an email from another alternative medicine practitioner stating that “he couldn’t believe I recommended artificial sweeteners on my website!”  My response was, “So let me get this straight if one of your patients asked you if she could have a Diet Coke once a month you would say no?”

So many things in our world have become so black and white that people have forgotten about moderation as a sensible way of life.

Artificial sweeteners have been taking a beating since saccharin was lynched in 1977 supposedly being linked to cancer despite no real sensible data on humans to support it. The amount of saccharin you would have to consume to potentially have negative effects would be 4 cans of Tab every single day (Who still drinks Tab?).  Saccharin doesn’t really even exist anymore other than in Tab and a tiny amount in Sweet’N Low.

The main three artificial sweeteners in commercial use today are:

Aspartame Sucralose Acesulfame-potassium Alitame Cyclamate Neotame

I’ll cut right to the chase, there is absolutely no evidence that long-term consumption of diet sodas consumed in a reasonable amount have any negative health effects.  What causes negative health effects related to diet sodas is simply too many calories and people who drink diet sodas tend to already eat too much food.  People who already eat a healthy diet and exercise tend not to gravitate towards diet sodas but if they want to enjoy them in moderation there are absolutely no health consequences in doing so. What created the mass hysteria about artificial sweeteners? A few studies on rodents showed that aspartame increased certain types of cancers but they were fed quantities of aspartame that no human could actually consume in a day. Imagine a pick-up truck with a big mountain of aspartame in the back and you would actually have to eat that mountain every day to possibly get cancer.  Then imagine a single granule of that mountain as a single diet soda consumed in moderation.

Additionally, rodents do not metabolize aspartame the same way humans do so we can’t even effectively make similar conclusions from these studies. What about sucralose? A safe amount of sucralose is 5mg/kg bodyweight but most people don’t even come close to this averaging about 1.6mg/kg bodyweight.  No studies have shown any detrimental effects from sucralose in these ranges.  You would have to consume 11,450 packets of sucralose every day to have any detrimental effects. But don't artificial sweeteners spike insulin? No, at least not to any significant level that would be detrimental to health.  There is no solid evidence to support that diet sodas spike insulin to an unhealthy level.  In fact, when aspartame was consumed with or without carbohydrates it did not spike insulin levels.  Even diabetics who consumed artificial sweeteners did not experience an insulin spike.

The only study to show it spiked insulin was done on rat pancreatic cells in a test tube when combined with sugar. What about weight gain? The CHOICE study actually found that eating a healthy diet and changing from regular soda to diet soda was effective for losing weight.

The PREMIER TRIAL found that if you reduce diet soda consumption you will not improve your weight loss numbers at all.

The NHANES study showed that if you increase your consumption of diet soda you will not eat more calories and gain weight.

The key points that researchers make about artificial sweeteners in regards to weight gain are that many people are eating poorly in the first place and then they change to diet soda to “do less damage” which clearly will not make much of an impact.  Those people who are eating a healthy diet in the first place and consume artificial sweeteners in moderation will have absolutely no negative effects.

If you’re eating a crappy diet in the first place then consumin...

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Meditation for anxiety and depression is something I highly recommend for everyone suffering from these symptoms.  Sometimes some of the most powerful tools to improve your health are built right into your own body and are absolutely free.  Most of you are probably in a state of information overload with your mind racing at night, feeling stressed, out of control and you just can’t seem to calm down your mind to a state of happiness, clarity, and well-being.  I've been meditating almost every day for the last 14 years with many benefits.

Meditation is one of the most powerful tools you can use to reduce anxiety and depression, sleep better, manage stress, eliminate pain, and get clear on what you love to do on a daily basis.  And it doesn’t require any fancy or expensive tools to learn how.

Many studies have shown meditation to be helpful for the following:

Anxiety Depression Pain Mental focus Cardiovascular health Improving empathy and concern towards others Severe speech and physical impairments Improve well-being

Meditation has even been used in cancer care to help individuals deal with the stresses of their disease.

The research on meditation is exploding with over 4,500 published papers indexed on PubMed which is the main hub for peer-reviewed scientific papers that doctors and scientists read to keep up with the latest literature.  Some newer studies are showing that meditation actually rewires your brain. What type of meditation is best? There really isn't a "best" form of meditation as there are so many types of meditation out there including:

Open Heart Transcendental Meditation Zazen (Zen Buddhist) Qi Gong Kundalini Vipassana (Mindfulness) Loving Kindness

There are many more types out there but the most important thing is to avoid any teacher who says that their way is the only way.  Many meditation practices and teachers use words like "energy" or "becoming one" with everything.

Energy is a very specifically defined term in physics yet it is used loosely in new age circles to describe people or places such as, "She has good energy", or, "This place has good energy."  Some people will also say that they can feel "energy" moving through their bodies.

It is fine to go along with these terms if they make you feel good with the understanding that they are incompatible with science.  The reason why we feel good about other people is because of the way they look, their facial expression, posture, smell, hormone levels (pheromones), and body language.  The same goes for places that we visit which feel good because of how things are laid out, the smell etc.

One of the reasons why people feel a subtle sense of euphoria that feels like "energy" is due to the fact that they are finally taking in plenty of oxygen through deep belly breathing.

My personal favorite is vipassana (mindfulness) meditation because there aren't any religious mantras and it is simply about focusing on your breath and everything that you experience.  Vipassana can be used in a secular way so anyone with any belief or non-belief system can use it.  After you have been focusing on your breath for a while you begin to become aware of sounds around you, thoughts, sensations etc. and you just go with what you are feeling.  If you find your mind thinking about other things like work, then you recognize that thought but let it go like clouds passing in the sky. Are there any meditation apps? Meditation is pretty simple to learn how to do on your own.  My absolute favorite is the Waking Up meditation app by neuroscientist Sam Harris.  The Waking Up app takes you through an entire course on mindfulness meditation guided by Dr. Harris himself.

Another one of my favorite free apps is called Calm at www.calm.com.  You can use it in any web browser such as Google Chrome or Firefox and it’s available on all Android devices and the iPhone or iPad.

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The autoimmune paleo diet (AIP) also known as the autoimmune protocol diet is an extremely popular diet these days for autoimmune disease but there has never been any studies done to evaluate if it actually works.  Although testimonials should be taken into account, and there are many all over the internet,  the ultimate test for validity is a clinical trial.

As of August 29th, 2017, we now have a study that looked at this diet and how effective it was for autoimmune disease.  The paper is entitled, “Efficacy of the Autoimmune Protocol Diet for Inflammatory Bowel Disease.”  Dr. Konijeti is the lead author and it was published in the journal Inflammatory Bowel Disease.

Let’s dig into the study and see what they came up with.  The study included 18 adults but three of them withdrew because they couldn’t commit to the diet so there were only 15 participants.  9 of them had Crohn’s disease and 6 had ulcerative colitis.  Crohn’s disease and ulcerative colitis are autoimmune inflammatory bowel diseases.

What causes these diseases?  The authors note that Crohn’s disease and ulcerative colitis are due to genetic factors, gut dysbiosis, dietary factors, environmental exposures, and immune system dysregulation.  This is mostly true for all types of autoimmune diseases but I would also include infections in this list such as viruses and bacteria.

To be more specific regarding dietary factors that increase the risk of inflammatory bowel disease, it is noted that a typical Western diet high in refined carbohydrates, omega-6 fatty acids, saturated fat, low in fiber, vitamins, and nutrient-dense foods are part of the problem. What is the autoimmune paleo diet (AIP)? The autoimmune protocol diet is also known as the autoimmune paleo diet since it is an offshoot of the classic paleo diet.  The following foods are eliminated from this diet:

Gluten-containing grains Gluten-free grains Dairy Eggs Nuts Seeds Refined carbohydrates and sugar Legumes Nightshades Oils Food additives Coffee Alcohol

Why are these particular items avoided in the autoimmune paleo diet? The goal is to remove any foods that tend to be inflammatory in nature and can lead to dysbiosis.  Approximately 70% of the immune system is in the gut and the microbiota have key connections with the immune system so it makes sense to reduce inflammatory stress in this area as much as possible.

The autoimmune paleo diet consists of the following:

Fruit Vegetables Lean meats Fish Healthy Fats Coconut Sweet potatoes

A few additional items that are emphasized are fermented foods to help maintain a healthy microbiota and bone broth for intestinal healing and nutrient density. How did the subjects eat in this study? All subjects followed a 6-week elimination phase and then a 5-week maintenance phase where no foods could be reintroduced.  The participants had a lot of support including a private Facebook page where they could interact with each other and share recipes and ideas.

Additionally, they worked with a health coach and a registered dietician.  The subjects were educated on proper sleep hygiene, stress management, exercise instruction, grocery shopping and food preparation including how to make bone broth and the benefits of fermented foods.  Education against the use of NSAIDs was also provided since these lead to bowel inflammation and contribute to dysbiosis.

They were also given two books:  “The Paleo Approach:  Reverse Autoimmune Disease and Heal Your Body” by Ballantyne and “The Autoimmune Paleo Cookbook:  An Allergen-Free Approach to Managing Chronic Illness” by Trescott.  These are two excellent books on the autoimmune paleo diet.

C-reactive protein and fecal calprotectin were measured before and after the diet.  If you are a patient of mine you know that we always run c-reactive protein levels because it is an excellent marker of inflammation.

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GMOs, or genetically modified organisms, are one of the most contentious topics in the world today.  We should however, consider the following questions:  What do we really know about them? Are these concerns justified?  People are so passionate about this issue that some misguided individuals have actually rioted and vandalized crops in Oregon, Australia, the United Kingdom and the Philippines.  This mob behavior is similar to the burning of women at the stake for committing imaginary crimes like witchcraft.

Unfortunately, public opinion oftentimes has absolutely nothing to do with scientific fact.  A Gallup poll showed that 48% of respondents actually believe that foods produced using biotechnology pose a serious health hazard, compared to 36% who think that they do not.

GMO labeling is a hot issue.  Currently, laws are being passed around the country requiring labels on all GMOs with Vermont being the first state to enact such a law.

What is a GMO? Basically, scientists extract DNA from an organism, modify the DNA, and then incorporate it into the genome of the same species or a different one.  This transfer of modified DNA can be accomplished by using a “gene gun” to inject DNA-coated metal pellets into the plant cells, or by just using bacteria for delivery.

Another type of GMO is created by turning off a gene that is normally expressed without introducing a new gene.

Cisgenic GMOs are achieved by introducing genes from closely related species, and transgenic GMOs are the result of genes from distant species crossing over to other kingdoms of life.  For example, taking a gene from a bacteria and inserting it into a plant will produce a transgenic GMO.

Both of these types of genetic modifications actually occur in nature on a regular basis, so they are nothing new and completely “natural."

GMOs are truly one of science's greatest achievements that have yielded many benefits to humans other than food.  Two very important achievements include insulin that diabetics inject themselves with to regulate blood sugar to keep them alive and growth hormone that is used for kids with rare genetic disorders that prevent them from growing normally.  Both of these hormones are produced from GM bacteria. How long have GMOs been around? Did you know that genetically modified foods have been around for the last 10,000 years and that most of the foods you have eaten throughout your life are genetically modified?  The food you eat today bears little resemblance to what our ancestors ate thousands of years ago.

Apples are a perfect example of genetic modification through breeding practices for millennia.  Have you ever wondered why there are so many different types of apples such as Granny Smith, Golden Delicious, Macintosh, etc?  These are all genetically modified for various reasons such as taste, size, and resilience to climate change.

All bananas used to have seeds until they were bred out, and carrots used to be yellow and purple until the Dutch bred them to be orange in the 17th century.

Genetically engineered plants became a commercial product in 1994, but they have been around for the last thirty years.  Since these plants were developed, more than 1,700 scientific studies have been conducted to determine whether they are safe for human health and the environment.  The overall conclusion of these studies is that GMOs are completely safe for human health and the environment. Why are people so afraid of GMOs? The paranoia surrounding GMOs actually comes from the false idea that things that are “natural” are more wholesome and safe than those that are man-made or artificial.  This is known as a “logical fallacy,” because it is not based on valid information.  Farmers throughout history have always tried to create the best possible crop yield by breeding and “unnatural” cultivation methods.

If you were a farmer, you would pick seeds from the healthiest and most robust crops and cast aside those tha...

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What is Hepatitis C? The Hepatitis C Virus infects the liver and it can spread to other body tissues such as the thyroid gland. Once inside the thyroid gland, it multiplies and may cause Hashimoto’s disease. Hepatitis C has also been found to trigger arthritis, diabetes, autoimmunity to the liver, Sjogren’s syndrome, and autoimmunity to the kidney. Chronic infection of the liver causes liver cirrhosis and even liver cancer.

What are the symptoms of Hepatitis C? This can be the tricky part because some people don’t have any symptoms. The virus could be silent for many years before you get symptoms. You could have Hepatitis C along with Hashimoto’s disease and not know it. The main symptoms include:

Abdominal pain Yellowing of your skin and eyes (jaundice) Fatigue Fever Loss of appetite Swollen blood vessels that look like a web Nausea Rectal bleeding Bloating Fluid in your abdomen Confusion Drowsiness Slurred speech Weight loss Swelling in your legs Itchy skin Bruising and bleeding easily Dark-colored urine Muscle aches How do you get Hepatitis C and how is it tested? This virus is transmitted by sexual intercourse, blood transfusion, or sharing drug needles with someone who is infected. Antibody tests to Hepatitis C are readily available through most commercial labs such as Labcorp.

One of the things I will see on blood testing is elevated liver enzymes including AST and ALT in Hepatitis C infection. I’ll also look at a CBC (complete blood count) which usually reveals elevated lymphocytes indicating viral infection. Inflammatory markers such as c-reactive protein and erythrocyte sedimentation rate may also be elevated. The ANA (anti-nuclear antibody test) has been shown to be positive in up to 33% of cases. How does Hepatitis C trigger Hashimoto’s disease? At the time of this writing, the exact cause is unknown but there are a few different theories. These include triggering the immune system to attack thyroid cells when the Hepatitis C virus is actively infecting the thyroid gland. The immune system may be tricked into attacking thyroid cells instead of the virus.

We do know that the Hepatitis C Virus can leave the liver via the bloodstream and infect the thyroid gland. It can remain there in a chronic state resulting in autoimmunity and inflammation in the thyroid gland. How is Hepatitis C treated? Interferon is the standard treatment but using interferon can actually trigger Hashimoto’s disease. It is recommended that patients with Hepatitis C be tested for thyroid antibodies prior to interferon treatment. Elevations in thyroid antibodies prior to interferon treatment are a big risk factor for developing Hashimoto’s disease.

There are a number of natural agents that may work well for the Hepatitis C Virus.  These include:

Elderberry Isatis Shisandra berry Licorice root Garlic Silver St. John's Wort Lactoferrin Zinc

Another important factor is to focus on improving glutathione levels in the liver with the following:

Whey protein NAC Milk thistle Selenomethionine Glycine

Glutathione itself can be taken as a supplement in the liposomal or reduced form, but make sure it is a quality brand with good absorption.

The other important factor is to help with “liver congestion” due to all the inflammation and damage the Hepatitis C virus does to the liver. These compounds can help:

Dandelion Methionine Choline Inositol Artichoke Taurine Ox Bile Curcumin Beet root powder Black radish B-vitamins Magnesium

In addition to fighting the Hepatitis C virus and supporting the liver, we must also use our normal protocols for viral infections inside the thyroid gland in patients who have Hashimoto’s disease as well. The focus is reducing inflammation inside the thyroid gland, reducing viral activity, and balancing the immune system. These protocols are unique to each patient so I won’t get into them here. Your functional medicine practitioner will ident...

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In this exciting interview on The Dr. Hedberg Show, I interviewed Dr. Izabella Wentz about everything Hashimoto's disease.  We had a great conversation and covered some very practical information that everyone can use right away.

Here are the topics we covered in the interview: How did you become interested in the thyroid?

What are some of the common root causes of Hashimoto’s?

You’ve now worked with over a thousand people with Hashimoto’s and figured out that you can accelerate healing and symptom reduction within one to two weeks, even for people who have been suffering for years. How do you do that?

Is there a particular diet that you recommend that is better for people with Hashimoto’s?

How big of an effect do you feel that food sensitivities play in not only developing Hashimoto’s, but also in hindering remission?

Stress can negatively affect your adrenals. What are some coping mechanisms that people can use so that stress doesn’t compromise their health?

Can you talk about the gut and thyroid connection?

Are there supplements that would benefit most people with Hashimoto’s?

What role does trauma and stress play in Hashimoto’s?

Is it possible to get Hashimoto’s into remission?

Can thyroid tissue regenerate after it’s been damaged by the immune system?

Where can people get more information on your work? For those of you new to Dr. Izabella Wentz, here is her story: Izabella Wentz, PharmD, FASCP is an internationally acclaimed thyroid specialist and licensed pharmacist who has dedicated her career to addressing the root causes of autoimmune thyroid disease after being diagnosed with Hashimoto’s thyroiditis in 2009.

Dr. Wentz is the author of the New York Times best-selling patient guide Hashimoto’s Thyroiditis: Lifestyle Interventions for Finding and Treating the Root Cause and the recently released protocol-based book Hashimoto’s Protocol: A 90-Day Plan for Reversing Thyroid Symptoms and Getting Your Life Back.

As a patient advocate, researcher, clinician, and educator, Dr. Wentz is committed to raising awareness on how to overcome autoimmune thyroid disease through The Thyroid Secret Documentary Series, the Hashimoto’s Institute Practitioner Training, and her international consulting and speaking services offered to both patients and healthcare professionals.

You can visit her website for more information:

www.thyroidpharmacist.com

Download a free 2-week recipe plan to begin healing your Hashimoto's here:

===> 2-Week Recipe Plan

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Epstein-Barr Virus or EBV is a herpes virus (Herpes 4) that is significantly connected to Hashimoto’s disease and many other autoimmune diseases.  It is the most common infection I see in my patients with Hashimoto’s thyroiditis.  Testing for Epstein-barr virus is fairly straightforward but treatment can take a long time.

https://www.youtube.com/watch?v=WR96Gt9hWLQ How do you get infected? Epstein-Barr Virus is transmitted by saliva resulting in mononucleosis (“mono”) also known as “the kissing disease.”  EBV can also be transmitted via semen during sexual intercourse, by blood or blood transfusion. Most people get infected when they are young after their first kiss or if they exposed to another infected person’s saliva on a shared drinking glass.

What are the symptoms of mono due to acute Epstein-Barr Virus infection?

Fatigue Swollen lymph nodes in the neck Sore throat Fever Rash Enlarged liver and spleen

The above symptoms are the usual result of the initial infection which lasts about 2-4 weeks but sometimes they can go on for months.  Once your immune system fights off the virus, it becomes inactive for life.  Epstein-Barr Virus however can reactivate later in life resulting in autoimmune disease such as Hashimoto’s thyroiditis, fatigue and many more illnesses.  This is similar to the Chicken Pox virus that stays in your body for life but it can reactivate resulting in painful shingles.

Key point: Just because you never had mono, this doesn’t mean you can’t have the virus.  Some people get infected with EBV and never develop symptoms.

You can infect another person no matter how old you are if the virus is reactivated in your body.

***Some people will have a “mono-like” illness and EBV antibodies are negative. This is due to another active infection including cytomegalovirus, toxoplasmosis, herpes 6, herpes 7, HIV or hepatitis B.

What health problems can Epstein-Barr Virus cause? Many autoimmune diseases such as Hashimoto’s disease, Lupus, Rheumatoid arthritis etc. Weakened immune system making it more difficult to fight other infections Facial nerve palsy (Bell’s palsy) Guillan-Barre Syndrome Sleep problems Chronic fatigue syndrome Viral meningitis Transverse myelitis Optic neuritis Encephalitis Cerebellar ataxia Paralysis on one side of the body Pneumonia Pancreatitis (swelling of the pancreas) Myocarditis (swelling of the heart)

Epstein-Barr Virus is also associated with a number of cancers including Hodgkin’s lymphoma, Non-Hodgkin’s lymphoma, nasopharyngeal carcinoma, and Burkitt’s lymphoma. What is the best test for Epstein-Barr Virus? Blood testing through all commercial labs such as Labcorp are readily available for testing.

Let’s break down each test component:

EBV Viral Capsid Antigen (VCA) IgM: Indicates an active infection and stays positive for 4-6 weeks. VCA IgM antibodies can cross-react with cytomegalovirus, toxoplasmosis, herpes simplex or rheumatoid factors. This must be taken into account due the potential of a false positive. VCA IgM antibodies have been shown to rise in those over 60 years of age.

EBV Viral Capsid Antigen (VCA) IgG: Positive in the early stages of infection peaking at 2-4 weeks, then it begins to drop and stays positive for life.

EBV Nuclear Antigen (EBNA) IgG: Not positive in the acute phase but starts to elevate 2-4 months after infection.  IgG stays positive for life.

EBV Early Antigen (EA) IgG: Positive in the acute phase of infection and then begins to drop for 3-6 months after infection.  A positive test indicates active infection.

The early antigen is usually left out of many EBV tests I review which unfortunately means we can’t make an accurate diagnosis of reactivation without it.  Since the VCA and EBNA IgG tests are positive for life, it is best to use the Early Antigen IgG to monitor successful treatment of the infection.  The VCA IgM is beneficial to have only if you want to see if it is an...

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Discovered in 1982 in those with gastritis and ulcers, Helicobacter pylori or “H. pylori” is one of the most common infections connected to Hashimoto’s disease and also Graves’ disease for that matter. Like Yersinia enterocolitica and Epstein-Barr Virus infections, Hashimoto’s thyroiditis can be triggered by H. pylori through a process called molecular mimicry which basically means that the infection looks similar to your thyroid tissue so the immune system attacks the infection and the thyroid gland.

http://youtu.be/AdTUrEn_xnw What is Helicobacter pylori? H. pylori is a bacteria (gram-negative) usually found in the stomach of 50% of the world’s population. It tends to found in those with gastritis, GERD(heartburn), gastric ulcers and stomach cancer. It burrows into the stomach lining resulting in inflammation and damage.

H. pylori is capable of forming biofilms which protect it from the immune system and antibiotics.

H. pylori doesn’t like the acid in your stomach so it will infect areas of low acid production. Low stomach acid also known as hypochlorhydria, can set you up for H. pylori infection.

Hypothyroidism leads to low stomach acid production which makes you more susceptible to H. pylori infection. Also, if you are taking antacids for a long time then you are more prone to infection.

Stress(cortisol and adrenaline), Zinc deficiency, adrenal imbalances, intestinal dysbiosis and b-vitamin deficiencies also contribute to low stomach acid production.

Is it contagious? We actually don’t really know for sure how it is transmitted but it can be contagious. It is most likely transferred from mouth to mouth or oral to fecal routes. We do know that H. pylori is found in contaminated food and water as well as dental plaque, saliva, vomit and feces of those who are infected. This would indicate a simple kiss may result in infection or sharing of a drink. What are the symptoms of H. pylori infection? Up to 85% of those with H. pylori are asymptomatic! Symptoms can include:

Stomach pain, burning or ache (worse when your stomach is empty) Heartburn Nausea Black stool Belching Bloating Vomiting Loss of appetite Weight loss Is H. pylori actually beneficial? Some strains of H. pylori can actually help with the following:

Normalizing stomach acid production GERD(heartburn) Dermatitis Asthma Rhinitis Inflammatory bowel Esophageal cancer prevention Barrett’s esophagus Appetite normalization

Your stomach makes a hormone called ghrelin which makes you hungry. H. pylori can potentially suppress ghrelin levels so you aren’t hungry all the time. Sometimes after H. pylori is treated, people will say that they always feel hungry, even after they eat. This is because ghrelin levels are no longer suppressed by the H. pylori.

We also know that people gain weight after being treated for H. pylori so we must use caution in someone who is obese or has type 2 diabetes. What are the best tests for H. pylori? There are five ways to test for H. pylori:

Urea breath test Blood test Stool test Stomach biopsy Urine test

The urea breath test and the stool test are the most accurate for active infection. The blood test can show past infection and active infection, however, it can remain positive for years after the infection is gone. The blood test is adequate if you have never been treated for H. pylori before. The blood test has advantages because it can show an infection that has gone systemic meaning it has left the stomach and is now present in arterial plaques for example.

After a review of many research publications on testing, they all report different results as to what the best test is for H. pylori. A biopsy is very invasive but highly accurate so we have to choose between stool, blood and urea breath test. Blood testing is 76-85% sensitive, the urea breath test is >93% sensitive and specific, and the stool test is 93-98% sensitive and 88-96% specific.

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Yersinia enterocolitica is one of the most common infections I see in my patients who have Hashimoto’s disease.  Let us explore some basic information about Yersinia so you can understand it better and how it relates to Hashimoto’s thyroiditis.

http://youtu.be/50IUuPMSPp0 What is Yersinia enterocolitica? Yersinia enterocolitica is a gram-negative bacteria that causes yersiniosis usually caused by drinking contaminated milk or water or eating raw or undercooked meat, usually pork (chitlins).  Human-to-human infection is possible if the carrier doesn’t thoroughly wash his or her hands before preparing food. You can also get yersiniosis from a blood transfusion.

Approximately 117,000 people every year in the US get yersiniosis and it mostly affects children in the winter.  Additional carriers of Yersinia enterocolitica include cats, dogs, birds, deer, rodents, rabbits, sheep, cattle and horses.

What are the symptoms of Yersinia enterocolitica infection? This bacteria infects the intestines causing diarrhea (usually watery or bloody), vomiting, abdominal pain, and fever which lasts about 4-7 days but can last up to three weeks.  Many people think they just have some food poisoning which eventually goes away unless medical attention is required.

Yersinia can cause right-sided abdominal pain which may be confused for appendicitis.  A skin rash called erythema nodosum (red or purple lesions) is sometimes present 2-20 days after infection mainly on the legs and torso in women but it usually goes away within one month.

Joint pain can develop called reactive arthritis which can last for 1 to 6 months.  Yersiniosis can become life-threatening when it spreads into the liver, spleen and bloodstream due to a compromised immune system.

Yersinia enterocolitica loves iron so infection could be problematic in someone with low ferritin levels when we are trying to improve iron stores in a patient’s body. What is the best test for Yersinia enterocolitica? This infection can be detected in a stool analysis or blood test.  Stool testing is best for an acute infection but it can miss many infections when the infection is chronic.  It can take up to two weeks for the stool test to be positive after infection.

Blood testing checks for IgG, IgA and IgM antibodies.  A positive IgG test indicates a past infection.  If IgG and IgM are positive then we know the infection has been present for 1-3 months.  If IgG and IgA are positive but IgM is negative, then we know the infection has been ongoing for greater than three months in the intestinal barrier.  IgM is not entirely necessary if you aren’t concerned about knowing if it is recent or not, so IgG and IgA will usually suffice.  If IgG, IgA and IgM are all present then you know it is an active infection in the last 3 months.

Always check for Yersinia in stool and blood for the best chance of identifying the infection.

It is possible that the Yersinia enterocolitica blood test may cross-react with a virus or the bacteria Borrelia burgdorferi which causes Lyme disease.  If you use an effective treatment for Yersinia and then retest the blood and it is still showing active infection, this may mean that the positive test was actually for a virus or Lyme disease. How is Yersinia enterocolitica treated? Yersinia usually goes away on its own but if not, then it is treated with antibiotics.  If Yersinia comes back positive in a stool analysis, then the lab will run a sensitivity to identify herbal medicines that will eradicate the bacteria.  Berberine, black walnut, caprylic acid, oil of oregano, uva ursi, grapefruit seed extract and silver can all eradicate this bacteria.  The sensitivity will tell you which one of these will work best.

If we only have a positive in blood, then I’ll use a combination of these herbal medicines for about 4 weeks with excellent results.  It is important to get retested after treatment to be sure the infection is gone.

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In this episode of The Dr. Hedberg Show I interview Stacey Robbins!  This was a very unique interview because we didn’t focus on biochemistry, but rather how Hashimoto’s can affect your life and your relationships.

Stacey Robbins (Certified Health Coach and Certified Yoga Instructor RYT200) is an award-winning Author, Speaker, and Integrated Wellness Coach.

She is honored to work with senior executives in global organizations and is a trusted advisor to influential thought leaders, film producers, authors and creators who make a major impact in the world through their work.

Stacey took a diagnosis with an autoimmune condition, Hashimoto’s – where the body attacks the thyroid -- and turned it into an opportunity to look behind the scenes at where she was at war with herself.  Traveling around the country for years to study and attend conferences, Stacey learned more about the mind, body, spirit connection, which allowed her to dive into the thoughts, patterns, and beliefs that were undermining her health.

Her book, ‘You’re Not Crazy and You’re Not Alone: Losing the Victim, Finding Your Sense of Humor and Learning to Love Yourself through Hashimoto’s’(with a foreword by Dr. Izabella Wentz) is Stacey’s funny, honest, and soulful journey, to not only heal from the physical part of Hashimoto’s, but to address the inner work and healing that is available to every woman with Hashimoto’s.

Giving back to the community is a core value as Stacey serves on the Board of Directors for Hashimoto’s Awareness, an organization that educates and empowers the Hashimoto’s community in the areas of testing, self-care, and healing.  At Hashimoto’s Awareness, she works alongside esteemed experts in the field of Thyroid health:  Dr. Izabella Wentz, Mickey Trescott, and Dana Trentini (a.k.a. Hypothyroid Mom).

Stacey inspires women to live their happiest, healthiest life with Hashimoto’s and to use it as a teacher and guide to discovery as they learn to love themselves. As she says, “Hashimoto’s isn’t the end of your health, it’s the beginning of your healing.” We discussed the following topics in detail during the interview: -How Stacey got connected to Hashimoto's.

-The top three messages women should know from reading Stacey’s book.

-How relationships are affected with your spouse or partner, when you have an autoimmune condition.

-Helpful tips for both of you to have when dealing with Hashimoto’s.

-How Hashimoto’s affects being a parent.

-How Stacey’s life and lifestyle changed by having Hashimoto's. I urge everyone to connect with Stacey at the following resources: You can find her at ⇒  http://www.staceyrobbins.com

Her Facebook group the “Girlfriends’ Guide to Hashimoto’s” ⇒ https://www.facebook.com/groups/girlfriendsguidetohashimotos/

Stacey’s book on Amazon ⇒ You’re Not Crazy and You’re Not Alone

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In this podcast episode I interview Dana Trentini, the founder of the well-known Hypothyroid Mom blog.  I really enjoyed our talk, in particular discussing thyroid issues with someone who is so passionate about thyroid health.

Dana Trentini created the thyroid advocacy blog Hypothyroid Mom. Dana launched her blog on October 1st, 2012, in memory of the unborn baby she lost due to hypothyroidism. She set out on a mission to learn all she could about hypothyroidism and to share her discoveries with people around the globe. Dana has since been featured in The Wall Street Journal and The Atlantic.

In our new podcast interview, we covered the following topics in order:

What motivated you to become a thyroid patient advocate and create your blog?

What are the signs and symptoms of hypothyroidism?

What is the prevalence of thyroid disease? Why do you think there are so many undiagnosed thyroid sufferers in the world? Which lab tests do you recommend for hypothyroidism? The number one prescribed medication for hypothyroidism is Synthroid. Why are so many hypothyroid patients still struggling despite taking levothyroxine medications like Synthroid? You write at Hypothyroid Mom that treating thyroid disease is really like putting together a big puzzle. What are the main pieces of the puzzle that should be considered? What resources are available to help patients find open-minded thyroid doctors? You wrote a book with Mary Shomon, Your Healthy Pregnancy with Thyroid Disease: A Guide to Fertility, Pregnancy, and Postpartum Wellness. Tell us about it.

Dana has a true passion for Hashimoto's and Hypothyroidism advocacy so I urge everyone to connect with her online to learn more.  Her blog is filled with many excellent articles and resources to help you wade through all the thyroid information that is available on the internet.

Connect with Dana online:

Visit the Hypothyroid Mom blog here ⇒  Hypothyroid Mom

Facebook Page ⇒ https://www.facebook.com/HypothyroidMom/

Twitter ⇒ https://twitter.com/HypothyroidMom

Pinterest ⇒ https://www.pinterest.com/hypothyroidmom/

Google+ ⇒ https://plus.google.com/+Hypothyroidmomblog

Instagram ⇒ https://www.instagram.com/hypothyroidmom/

Dana’s favorite thyroid books ⇒ http://hypothyroidmom.com/hypothyroid-moms-favorite-books/

Dana’s top thyroid resources ⇒ http://hypothyroidmom.com/hypothyroid-mom-top-resources/

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The thyroid is a small gland that lies in the neck about the level of the Adam’s apple and weighs approximately one ounce.  It produces thyroid hormone and calcitonin.  The parathyroid glands are very small and lie on the outside portion of the thyroid gland and secrete parathyroid hormone.  Thyroid hormone ignites your metabolism so you can burn fat and produce energy.  We will be focusing on thyroid hormone.

The thyroid gland is stimulated to make thyroid hormone by thyroid-stimulating hormone (TSH) which is produced in the pituitary gland located in the brain.  The pituitary is controlled by the hypothalamus in the brain which monitors the amount of circulating thyroid hormone.  Iodine must enter the thyroid gland through a transport system that is repaired with the intake of vitamin C.  There is usually about 20-30 mg of iodine in the body and 75 percent of it is stored in the thyroid.  In addition to iodine, iron, tyrosine, selenium, vitamin E, vitamin C, vitamin D, magnesium, zinc, copper, and vitamins B2, B3, and B6 are required for thyroid hormone production.

The thyroid gland produces two thyroid hormones: T4 (thyroxine) and T3 (triiodothyronine).  Eighty percent of thyroid hormone produced is T4 and twenty percent is T3.  T3 is ten times more biologically active than T4 and it is produced as a result of one iodine being cleaved from T4.  T4 is inactive so the majority of thyroid hormone produced is actually inactive.  The numbers “3” and “4” indicate the number of iodines.  This is key in understanding optimal thyroid function.  Both T4 and T3 are bound to proteins in the blood until they reach your cells and become unbound to work their magic on metabolism.

Most of the T4 is converted into T3 in the liver.  Approximately sixty percent of the T4 is converted into T3, twenty percent is converted into an inactive form of thyroid hormone known as reverse T3 (irreversible), and the remaining twenty percent is converted into T3S (T3 sulfate) and T3AC (triiodothyroacetic acid).

Reverse T3 can be problematic; even though it is inactive, it will still bind to T3 receptors and block T3 from binding and working its magic on metabolism.  Too much or too little cortisol that is produced by the adrenal glands will increase circulating levels of reverse T3.  This mechanism is due to suppressed liver detoxification and clearance of reverse T3 from excess cortisol production.  Stress can not only cause signs of hypothyroidism but it will also impair the liver’s ability to detoxify.  Cortisol will also suppress TSH production resulting in low thyroid function.  Immune system activation, high adrenaline, excess free radicals, aging, fasting, stress, prolonged illness, and diabetes will also drive the inactivation of T3 to reverse T3.

T3 and reverse T3 can also be inactivated by conversion into a hormone known as T2.  Elevated insulin levels due to a diet high in refined carbohydrates will also increase reverse T3 levels.  Toxic metals including mercury, cadmium and lead will also increase reverse T3 production.  T3S and T3AC are inactive until they are catalyzed by an enzyme in the GI tract known as sulfatase.  This enzyme is dependent on healthy gut bacteria.

Thyroid hormone’s main role is to control metabolism (energy production) inside the cell.  Our cells contain tiny factories called mitochondria that produce energy from fat, sugar and protein.  Thyroid hormone controls the function of the mitochondria which determines how much energy is produced.  Symptoms of low thyroid function are related to a decrease in energy production including:

Fatigue Weight gain/inability to lose weight Constipation Dry/itchy skin Dry brittle hair and nails Depression Headaches Overly sensitive to cold Cold/numb hands and feet Muscle cramps Depressed immune system–can’t recover from infections Slow wound healing Unrefreshing sleep Digestive problems due to low stomach acid

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The gut-thyroid connection is one of the most important and overlooked aspects of healthy thyroid function.  Did you know that many diseases can be traced to a breakdown in the gastrointestinal tract?  70 percent of your immune system resides in this area - your gut, and the GI tract has many important functions for your health including digestion, nutrient absorption, elimination, detoxification, hormone metabolism and energy production.  99% of the neurotransmitters in your body are actually created in the intestine (part of your GI tract), and every brain chemical known as a neurotransmitter is found there. This means the GI tract, or gut, plays a very important role in achieving optimal thyroid health.

For proper thyroid function, your body must convert T4 into the more active T3 and 20% of this happens in your intestines. In order for this conversion to happen, healthy colonies of beneficial bacteria must be present in the GI tract.  An imbalance in the bacteria ratio (of good vs. bad) in the GI tract (dysbiosis) can lead to low thyroid function.  This explains why so many patients with thyroid hormone imbalance also have digestive problems but normal thyroid blood chemistry panels. Why do people get Gut Problems? One of the most important things to look at is how many rounds of antibiotics you have taken in your life. The more antibiotics you have taken, the more likely you are to have abnormal gut bacteria as well as yeast overgrowth and parasites.  Antibiotics can cause an imbalance in your gut bacteria for up to 13 months after just a single round of antibiotics.  Additionally, antibiotics change the DNA of your bacteria which makes some of them more resistant to antibiotics.

Stress also causes gut problems because it decreases stomach acid production, bile flow and pancreatic enzyme production.  This will significantly impair your ability to digest and absorb your vitamins and minerals as well as protein, healthy fats and right carbohydrates.  This will even decrease your absorption of prescription thyroid hormone.

Poor dietary choices and food sensitivities are another big factor both of which create inflammation that damages your GI tract.  Sugar and processed carbohydrates are like fast food to your gut bacteria which causes them to grow out of balance.  Food sensitivities such as gluten, dairy, eggs, soy and peanuts to name the top five, create inflammation and will also spike your blood sugar too much.

Additional problems can be created by antacid medications called proton pump inhibitors.  They shut down your acid production which is extremely vital for a healthy gut.  Birth control pills also cause gut problems because they deplete your body of important nutrients for the gut such as folic acid.

Eating to fast or "eating on the run" is common in our society today which is an additional stress to your gut.  You should be in a relaxed state focused only on your meal and refrain from reading, texting, watching TV etc.  Alcohol and caffeine in excess further stress the GI tract. How to Determine if You Have a Digestive Problem If you are having digestive problems, there is a good chance that it is affecting your thyroid function. Bloating after meals, gas, cramping, loose stools, constipation, burping, heartburn, and inconsistent stool formation can all be signs of a digestive problem.  You can begin to see if you have digestive problems by doing an easy test at home.  This is known as the transit time test. Performing the Transit Time Test Food should pass through your intestines in 18-24 hours.  If it takes longer than twenty-four hours, there is something wrong with your digestive tract.  This easy to do test can be done at home to measure food transit time.

Purchase a product called “activated charcoal” which is an inert substance that will turn your stool black or dark gray. Swallow four capsules with a meal and write down the day and time that you take the capsules.

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The ferritin test may be the most important blood test you ever get, especially if you have a thyroid problem. When I began my training in the diagnosis and management of internal disorders immediately after graduation, one of the first things we studied heavily was blood chemistry analysis.  My teachers always stressed the importance of taking a careful look at iron levels in the blood and a rare test known as the ferritin test. What is ferritin? Ferritin is an iron-containing protein and is the primary form of iron stored inside your cells.  Even though there is a small amount of ferritin released into your bloodstream, it is an accurate marker of how much iron is actually stored in your body.  Iron is primarily stored in your liver, muscles, spleen and bone marrow but if you have too much it can accumulate in your organs and the brain.

You either have too much iron, too little or just the right balance in your body and the ferritin test can give us an excellent picture of how much iron is actually stored in your body.  Iron is found in your red blood cells but it also accumulates in your organs and tissues.

Iron is important for healthy oxygen transport throughout your body so you can see how vital it really is for your health.  Too little iron will result in anemia which basically means that your red blood cells cannot carry enough oxygen to your cells and you start to develop signs of oxygen deficiency.  Signs of anemia include:

Weakness Dizziness Headaches Pale skin Fatigue Low body temperature Memory loss Hair loss Poor brain function Hypothyroidism Adrenal fatigue Spoon-shaped finger and toenails Smooth tongue Burning sensation in the tongue Sores at the corners of the mouth Dry skin Shortness of breath Ringing in the ears (tinnitus) Leg pains Chest pain Pica (cravings for specific substances, such as licorice, chalk, dirt, or clay)

Too much iron can have the opposite effect because iron creates a lot of oxidative stress which is basically too many free radicals that create inflammation.  These free radicals eat up your antioxidants like vitamin C and E creating deficiencies.

Menstruating females lose a small amount of iron every month during their cycle so they tend not to build up too much iron in their bodies.  However, iron levels can get too low when your diet is deficient in iron and you have absorption issues due to things like gluten and gut infections.  I tend to see low ferritin levels quite a bit in chronically-ill women who are still cycling but it is also common in postmenopausal women who never restored their iron levels before entering menopause.

Since men do not have a menstrual cycle, we are the most at risk for accumulating iron.  As iron builds-up in a man’s body he may develop the following symptoms as it accumulates in the brain and other body tissues (most of these also apply to women):

Brain fog Fatigue Low sex drive and erectile dysfunction (iron accumulates in the testicles) Mood swings, especially anger Digestive problems as iron builds-up in the gut Anxiety Depression Fatigue after meals (insulin resistance) Memory loss Joint pain Weight loss Abdominal pain Hair loss Congestive heart failure

Iron is extremely “heavy” in the bloodstream so it forces the heart to work harder as it pumps this heavy metal through your blood vessels resulting in blood pressure changes and more inflammation in your arteries.

This is where the ferritin test is so important because it can tell us if there is too much or too little iron in your body.  It’s a simple blood test but rarely ordered during general check-ups and standard blood panels however I believe it is one of the most important and overlooked tests in medicine today.  This is why I include it in every patient’s blood panel even if it was normal within the last year.

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Understanding the importance of gluten and Hashimoto's disease may be the key factor in healing your thyroid. The Link Between Gluten and Hashimoto's Disease Has your doctor talked to you about the link between gluten and Hashimoto's Disease? Hashimoto's Disease is an autoimmune condition that causes 90% of all cases of hypothyroidism. Gluten is a combination of proteins found in grains such as wheat, rye, barley, spelt and many others. Ongoing scientific research indicates that there is a dangerous link between eating foods that contain gluten and Hashimoto's disease.

The hard truth is that gluten and Hashimoto's Disease are a destructive combination. If you have been diagnosed with Hashimoto's disease, also known as Hashimoto’s thyroiditis, you need to completely avoid gluten to avoid triggering autoimmune attacks on your thyroid gland.  However, you may not have to avoid gluten forever but this depend on a number of factors.

What decides if someone must be gluten-free forever? Once my patient's antibody levels are in a healthy range, their thyroid and blood tests look great, and they are feeling great, then we can try a gluten challenge.  I always make sure they are eating small quantities from high quality sources such as sourdough bread.  Sourdough has much lower concentrations of gluten than normal bread because the leavening process breaks down a lot of the gluten.

I'll have a patient eat some high quality sourdough bread a few times a week and see how they feel. Sometimes they will know right away that they must completely avoid gluten.  In other cases, they will feel fine and when we test their thyroid antibodies and thyroid numbers, they actually look great and have not changed.  These individuals can have gluten in moderation.

So as you can see, the answer is not black and white as it is very patient-specific.  It would be a tragedy for someone to have to avoid gluten for their entire life unnecessarily.  Most people will have to avoid gluten for life but there are always exceptions to this statement. Why should gluten be avoided if you have Hashimoto's Disease? Gluten has been shown in multiple studies to be a contributing factor to not just Hashimoto's disease, but many autoimmune diseases.  Gluten can break down the intestinal barrier leading to “Leaky Gut Syndrome” which can lead to autoimmune disease.  Gluten can also be an irritant to Hashimoto's disease by creating inflammation in the thyroid gland.  The process is known as “molecular mimicry” which basically means that your body’s immune system is attacking the gluten, infection or environmental toxin but also attacking it’s own tissue. Get the Facts on Gluten and Hashimoto's Disease Many physicians do not discuss the connection between gluten and Hashimoto's disease with their patients but instead put them on a regimen of thyroid medications. But medications do not deal with the autoimmune response that damages the thyroid. A functional medicine perspective is that a practitioner must find out what triggers the immune system to attack the thyroid, and work with the patient to develop strategies to avoid those triggers.

To get a comprehensive overview of the connection between gluten and Hashimoto's disease, as well as other triggers of autoimmune attacks that lead to hypothyroidism, read The Complete Thyroid Health and Diet Guide by functional medicine practitioner Dr. Nikolas R. Hedberg. The Functional Medicine Approach to Gluten and Hashimoto's Disease A functional medicine practitioner like Dr. Hedberg will discuss gluten and Hashimoto's Disease with you because the functional medicine approach thoroughly investigates underlying causes of dysfunction and targets the unique causes of low thyroid in each person. That means each patient undergoes a comprehensive examination, including health history, environment, diet and nutrition, exercise level, psychological and emotional state, social interactions, hormone levels,