Conventional vs. Functional: Who Gets Thyroid Care Right?

For the person who's listening to this that's already on 20 bottles of supplements. There is no magical supplement that's going to fix it either. It's all management strategy. Even when somebody says, well, I'm just deficient in this. Well, if you're deficient in 20 different micronutrients, then you have a dietary problem, a digestion problem or an assimilation problem, or you're in cell danger mode, pick one more supraphysiologic doses of its supplement is is not the answer.

Dr. Eric, thank you so much for joining us. We're thrilled to have you. There's a great need for alternative perspectives on the thyroid and you bring many years of clinical experience or to learn and.

Yeah, well, I appreciate being invited onto the podcast. Thanks so much.

Thank you, Dr. Eric. So we're going to do this a little bit differently this time. You know, we generally have a guest and we ask them questions. But today I was thinking of maybe having more of a roundtable kind of approach, asking both you and our in house conventional medicine model representative, Dr. Canelo.

I'm representing everything.

Maybe not a very good one.

Yeah, exactly.

But what I'm going to do is give you both a common patient scenario, something that I see a lot in my practice and with perhaps a slightly different lab result. And I will ask you both how you approach it. You know, then we could perhaps go on and talk about testing different treatment philosophies based on your respective models. And I love talking about the mitochondria and I know that you speak to it a lot in your book. And of course, immune system, if we have times. All right, so here we go. This is a typical patient that I see. She's about 42 years old. She's gained some weight, maybe about 15 to 20 pounds. She's not able to get rid of it. She's cold all the time, planes of constipation, she's very foggy in the head and she's exhausted. She's utterly exhausted and she's very frustrated. So she walks into either of your practices and two versions of the labs that you run on her. You know, 1, her TSH is technically whatever normal is, maybe 2.8. And the other scenario, her TSH is elevated, maybe 6, 6.5 or maybe more. And in both cases she's very symptomatic. So I'd like to know from both of you, how would you approach a patient or client who comes in like this with these kind of lab results, struggling with symptoms? What would be your approach to this, whoever wants to go first, I'm more.

Than happy to go first. Give me. Just give me the TSH again.

Well, the normal, maybe according to standard ranges, maybe 2. 2.8.

Okay, so the first one's 2.8. And what was the. You gave me another value, about six. So we got two different patients, two different values, and how would we interpret it?

Correct. You know, what would be the first thing you would do if the TSH was normal, but she's still symptomatic? In both cases, the patient is symptomatic just that her TSH is either normal or not normal. So what would be the next thing?

First step for me is I would run a full thyroid panel. A TSH does not do what we think it does. It doesn't give us an idea of the full body status in every tissue of thyroid physiology. It just can't. It just doesn't. TSH can be an indication of the overall thyroid physiology in the body, but on it, it's not a reliable marker. There's too many things that can influence it. So if somebody has hypothyroid signs and symptoms and they have a normal tsh, we have to run a more comprehensive panel, because what we need to determine is, does the person have glandular dysfunction, but they have inflammatory mechanisms that are suppressing the pituitary gland from producing TSH, and the squash TSH is still resulting in reduced T4 production, T3 to some degree, and the patient has peripheral hypothyroidism going on. The other thing that we have to take into consideration is that they may have an appropriate level of thyroid gland production, but that because of cell stress, inflammatory mechanisms going on, there's reduced conversion of T4 to T3, and that's resulting in maybe what somebody might say is a less than optimal level of TSH at 2.8. In my model, we'd have to do a more comprehensive thyroid panel, because if this person has signs and symptoms of hypothyroidism, then we have to ask the question, is the TSH value normal and appropriate? The patient has symptoms, but they don't have a thyroid gland. And the TSH is appropriate given the rest of the context. The rest of the thyroid panel, the rest of a metabolic panel, and the patient's symptoms, is the TSH actually normal but totally inappropriate for the patient because the patient has more cellular tissue hypothyroidism going on, but has a gland that makes enough hormone or they have the inflammatory suppression? So for me, I run a more comprehensive thyroid panel TSH, total T4, total T3 free, T4 free T3 uptake, reverse T3 thyroid antibodies. And I would always run. Initially I'd look at a more comprehensive panel because I want to look at inflammatory markers and I want to see tissue indicators of thyroid status that may correlate with the patient's symptoms. So that's where I would start. So.

So that's with someone with a normal TSH. Yeah, but who's still symptomatic. Dr. Canelo, how about you? Can you chime in and tell me what happens in your system and your model?

Yeah, and I mean, I will obviously be speaking as myself, but I think pretty close to what a lot of conventional will do. So for the woman with the TSH of 6, you bet that's going to deserve a recheck for sure. Especially since it's leaning as a hypothyroid picture. I would usually just start with TSH free T4, thyroid peroxidase antibody, thyroglobulin antibody, and I might wait six weeks. If there was something funky going on. I'll let some time pass before we get another shot at it. And that's probably where I'd go. First step for the patient with the normal tsh, thyroid disease would drop down my list, but not off my list. But it would, in all honesty, drop pretty low at that point. And I would be thinking probably mostly of iron deficiency, feeling cold, low energy, a woman, maybe heavy periods. And there's a rise in colon cancer. So if you think if there's an iron deficiency, that can cause bowel habit changes. So I'd be paying close attention to a cbc, iron panel. I disagree with a lot of the cutoffs on the ferritin, as a lot of experts will use 30. That's the number I use. So you always want to be aware of the ferritin of 16. That never gets flagged. In my world, it's all about, yes, you do want to help and make the right diagnosis, but you really can't miss diagnoses like colon cancer is. It's just really high on the mind. And then, of course, if I strike out, then you know other things.

So can I put some input in there? So for the patient who's got the elevated tsh, I would run the same labs. Okay. And in my comprehensive metabolic panel, we'd be looking at iron physiology, cbc, everything else as well, because we want to see the bigger picture. But my job is different from your job document. Cause your job is to determine if the patient has a glandular hypothyroid condition where they can't produce enough thyroid hormone. That's not necessarily my primary job. My primary job is decide, does the patient have a conversion, a thyroid gland production problem, that the gland's dysfunctional, and then if that is, why is the gland dysfunctional? Is it due to some type of cell stress mechanism, immune issue, or does the patient have a conversion issue which is resulting in their signs and symptoms? It's a different job. So you might say the patient. The idea that they have a thyroid disease goes way down. They may not have a thyroid disease, but they may have what we call thyroid allostatic regulation going on due to some type of cell stress response. The other things I would look at, for sure, it would be interesting to maybe even discuss the difference in, from an iron physiology standpoint, what the medical standard is for an iron panel and determination of iron deficiency versus maybe what in functional medicine, or what I would consider it from a functional medicine standard. The bigger issue here, because I think in general, iron deficiency kind of gets misdiagnosed a lot. The bigger issue, in my opinion, in 30 years of practice, is not true iron deficiency. It's anemia of inflammation and not true iron deficiency. But the standards of what you're looking for, disease and what I'm looking for may be totally different.

The perspective actually really starts with this dual goal as which 50% of primary care doctors will be sued and no one likes to miss a cancer. And that is just super high on mind. I mean, anemia of chronic disease is a great example. When you see an anemia of chronic disease, we start at the big things to rule out, you know, we're sending people for expensive scans through insurance, like, you know, you don't want to miss something like that. And then what ends up happening is there often is a. Assuming they stay in the practice, there is a delay. Right. So like I go through all these different things, can't misdiagnoses, even if they're less common, once you check those off, you know, it might be three, four visits later, five. Then that's where in my practice, the more alternative functional side will come in. So there is this delay, but hopefully their visits are being paid for by insurance, which I think is a big difference. Right?

Yeah. So, Dr. Canelo, in the meantime, the patient is still complaining. You know, I have this problem, I have a fatigue. And is this very common in all conventional medicine models? To look for antibiotics, to think about autoimmunity, to think about, about hashi or something like that? And then if it is true and if the antibodies do reflect that, what happens in a functional model versus a conventional model, because I have seen many models just ignore the antibody rise.

Ignore is a reasonable way. There's a lot of watchful waiting.

Yeah, I don't know what else to call it because, I mean, if someone's on Synthroid and if they do have that increased antibody presence, I don't see what the next step is. And I'd love to get your take and Dr. Eric's take on that. You know, what would you do in your respective models for autoimmunity, which is such a big problem today?

I would say it depends on the symptoms. If you really believe they're thyroid. Depends on the age, because the TSH will go up with time and depends on the trends. So if you have TSH trends where it's like moving in the wrong direction, you might be more likely to act. And then the patient preference for medication, polypharmacy being a big concern, potential for side effects. So if they're on 10 medications already, if the numbers are not in a clear trend in a bad way, they're older, this is the first time they've ever had an antibody done. I'm much more likely to be watchful waiting, or I guess that's been rebranded as active surveillance. But if it becomes clear, especially if you try some other things, that your treatments for their other symptoms aren't working. Yes, I've definitely had patients in those similar scenarios where we eventually try usually a little T4 as a bit of a test, actually, just to see are we getting anywhere close to what's causing the problems. Yeah, I'd love to Hear your. Yeah.

Dr. Eric, how about you?

Sure.

It's different. Yeah, that's just how I do it. Yeah.

I think, again, the model's different. Right. So you're saying I would only look at TSH free T4 and thyroid antibodies, so we can start there. I think it's because of the training and the guidelines. But the patient who is symptomatic is not symptomatic because of the T4 that's in the bloodstream. Necessarily, they're symptomatic because of a reduced level of either circulating or tissue levels of T3. And so if you don't look at T3 and free T3, you might miss it and not see it. Just because those are low doesn't mean we should give them T3. That is what some people in functional and integrative medicine believe. And I don't believe that in most cases. I think that's the reduced conversion of T4 to T3 helps explain why the patient feels hypothyroid signs and symptoms. And the rest of a lab panel may help us understand what tissues are experiencing that hypothyroid condition in that hypothyroid state. But I think the fuller panel is helpful as far as the antibodies. And if the patient had high antibodies and they had a TSH within the normal range or the high tsh, what should we do about the antibodies and should we diagnose them with Hashimoto's? I think there's a misunderstanding regarding antibodies that a patient doesn't have potential thyroiditis going on if they don't have positive antibodies. And that is not true, at least from my research that I've done and I've done a lot. But based on the current scientific literature, it appears that most of the damage that occurs at the thyroid gland is cell mediated directed. It's not antibody directed. Thyroglobulin antibodies aren't thought to cause any damage. TPO antibodies are thought to cause maybe minimal amount of damage, but most of it's driven by TH1 cells, TH17 cells, and CD8 cytotoxic, CD8 cells. Those are the primary cells that are really driving the inflammatory cascade. And we can get into a discussion as about why that might be. But I've run lots of immune panels and the vast majority of people who are diagnosed with hypothyroidism that I see in clinical practice are TH1, TH17 dominant and or CD8 cytotoxic, CD8 dominant. And they don't have high TH2 cells to really drive a high antibody response. And so they may have low antibodies or they may have no antibody when they're in their chronic health state. And somebody says, well, you don't have thyroiditis or you don't have Hashimoto's going on because the antibodies are negative. It's just not the case. It's not true. In a lot of cases they may very well have thyroiditis and stuff going on in the medical model. I don't think you guys have a strategy in that situation to say we're going to start chasing down what might be driving this immune inflammatory response. And correct me if I'm wrong, I think the general thought process is that there is a thyroiditis going on. There's not much we're going to do to address it. At some point there's going to be enough destruction of the gland. This person's going to need thyroid Hormone, and we'll provide it. And the general guidelines are you provided T4 and the T4 should convert to T3.

Yeah.

And that conversion, T4 to T3, I mean, do you start looking into gut health, microbiome, mitochondrial health? Do you bring that into the conversation with the patient? And again, Dr. Canelo, it's just zooming out a little bit to look at it. A lot of that conversion is happening in the gut. How do you approach someone with maybe no antibodies, but they're definitely symptomatic, they're continuing to complain with the same symptoms, what is your next step in the terrain? How do you handle the stress? How do you deal with the constipation, all of those other things? And that is what a person or a patient wants. They want freedom from these symptoms. So I'm wondering, what would you be your next step in that, even just from that perspective?

Oh, to me, both of you, you.

Know, both of you, as far as.

Yeah, let him answer.

No, Dr. Eric. Yeah, I'm curious about both of you. You know, how would you respond? Because the patient really cares about getting better. They don't care about the model. They just want to know what should I do to have more energy? Because they are exhausted. They don't know what's happening behind the scenes, but they know that they don't have answers. So how would you respond to your patient?

For me, I view essentially what goes on for most people through a lens of what we call the cell danger response. And we're either in homeostasis or in more allostatic regulation. And so if somebody has hypothyroid signs and symptoms, but their gland appears to be making sufficient thyroid hormone regardless of what TSH is, then my focus is not to try and manipulate T4, T3 or TSH. My focus is what's creating the excessive stress load that's causing their physiology to adapt the way it is. I don't think the physiology is broken. I think the symptoms are the result of this adaptive physiology. So I would look at diet, I would look at habits, I would look behaviors, I would look at sleep, I would look at relationships, mindset, emotions, what's work, what's contributing to their excessive stress load, and work to reduce that stress load. Because if we have an excessive level of stress, we know that our body adaptively goes into an adaptive response. Danger physiology, increased blood pressure, downregulate sex hormone, gut physiology, and all of these things. So in my model, identify what's contributing to the excessive stress load and work with that patient over time to reduce and eliminate those stressors. And then we might use supplemental strategies to kind of help potentially manage some symptomatology, but ultimately to help speed the recovery from this allostatic regulation and any dysfunction that occurred while they were in that allostatic regulatory state back to a homeostatic state. And I think in the medical model, and I'll let you know, answer that, it's just a different job, you know, And I think that's where with the controversy is, Somebody would come into my office and Dr. Canelo's office and expect us to have the same treatment strategy, the same medication ideas, the same supplemental ideas. I've got more time with my clients probably than you do. And it's a different model. It's not okay. What's broken that I need to manage the model for me is what's contributing to the excessive stress load, how do I reduce it, eliminate and help the patient get to homeostasis so they need less of whatever their medication is and potentially not eat it at all in time.

Yeah. And I think you both are right. And there's a gap in the system and the poor patients find themselves in that gap and they don't know how to address the problem. And Dr. Nick, for you that could be very frustrating, right? Being in a model where you have to go through all of these parameters, you know, really just to be sure that you don't get sued because you miss the big questions. But at the same time, you want to care for the patient, you want to be sure that their questions are answered. Where do you see functional medicine and the conventional medicine kind of make that.

You know, I think that the secret ingredient is time, which I'm so glad you brought up, like how much time you have with patients, because I was just going to say it sounds like we end up doing the same thing. Now, I might put thyroid down the list, not go through the lens of thyroid. But in terms of treating all the various stressors on the system, it's 100% what you do in a comprehensive primary care practice. And I will say comprehensive primary care practice, because that is where I differ from a lot of other primary care. I actually have 30 minute visits as a standard, which is pretty, pretty rare.

It's eight minutes is the average.

Yeah, yeah. You know, we get there in a lot of ways, but the lens may be different. And then the other part of it is I think the open mindedness is really important. I have patients who are really still concerned about thyroid problems. And my answer is usually maybe I'M familiar with a lot of what you're talking about. And I'll say, like, on the next panel, let's throw some more tests in. Keeping in mind this is related to previous is people often see me with the expectation that they're going to get insurance coverage for the testing I order. That is like huge. And those complaints when it doesn't work out, I even get pushback on tests that should have been covered. And I have to change the codes. If I mean, the pain of this is terrible. That's where you get a lot of like stepwise workup, like, oh, let's include a T4 and a couple antibodies. So like you move a little slower but keeping cost. And you're balancing all of these other competing things that you have to do because you have this comprehensive, can't miss approach.

Dude, to be fair, I was this way too because I came from a medical background, came to functional medicine from traditional medicine, and I was angry with traditional medicine and like, why wouldn't they do more of this stuff early on? Because I was just like, you know, when you start learning things differently, like, obviously this is what should be done, right? But then as you get older and you get a little bit maybe wiser, we some might argue is you start to see both sides and you say, look, there is a different set of guidelines here. The insurance piece is a huge issue, right? You could run a test, you could even get verification from somebody at the insurance company that, yes, we pay for it with that code. And then the patient gets a $400 bill in the mail for a homocysteine test. And you're like, we verified it with two separate people and the insurance company might say it's not covered. Well, that was a recording of the call where you verified it. Why don't we listen to the recording? Well, that's for training purposes only. We don't listen to this. Right, but now the patient's mad at you.

I was called and asked if I could record and they said, no, it's a different model.

And I give you kudos for wanting to do more of this stuff. But I think this is where, from a functional and integrative medicine standpoint, at some point we have to all realize that we all have the patient's best interest at heart. As a traditional medical physician working through an insurance based model, there's restrictions, there's things that can be done, there's things that can't be done, and there's things that really can and should be done in that model, especially when there's advanced testing, cancer testing, more advanced testing, that needs to be done, especially looking at potential pathology. But when we're looking for dysfunction, this may fit better in a functional medicine model. And we need to realize that a lot of these functional medicine tasks, while very good, aren't going to fit in an allopathic model of medical necessity because of the definition of medical necessity. And that's where instead of functional medicine kind of beating up allopathic medicine and allopathic medicine beating up functional medicine, we just need to realize that we have two big picture. We have two different jobs in helping patients heal and recover. And if we can clear the nonsense between the two professions and just say, hey, we're going to work together, here's what we need to do to manage crisis, manage condition, what can we realistically bill and get covered? And then what we can't, we're going to put it over on this functional medicine model. That would be the best in going forward. And I'm hoping those are the changes we'll see.

So that would be that team reconciled.

I think we are, I think we've come a long way.

Requires communication, as you say.

I think within the conventional model, it's so hard for like say family medicine to have a conversation with a cardiologist or the endocrinologist and have all be on the same page, on the team patient page. So really from jumping from that to functional medicine, I mean, would be wonderful to have like a team kind of outlook towards the patient because the patient is finally well served. When everybody is on their team. Do you see this happening? Do you see change?

The big issue is that doctors, clinicians, practitioners have egos. They often think they're right and other people are wrong. And that is an issue that is not going to be easily fixed. What can be fixed is the willingness to engage or the patients to actually play a role in that. I have patients who, they'll say they're seeing a functional, but they say it like, are you going to yell at me? Are you okay with me seeing that is like really common. I would say that is much more fixable than doctor's egos. And I'm always like, I'm absolutely fine with that. I love a lot of what that is. What are you taking? They're like, you really want my supplement lists? Like, they're like shocked I care about a supplement list. I mean, that's like such a basic thing, you know. And I do see patients who are, you know, not upfront that they're doing both and that's where people get hurt. There's not that cross communication. Ideally, the communication's actually happening on the back end. Unfortunately, we're still using fax machines, and it'd be lovely to get into the 21st century on that one. But the communication on our end is nil. I'll be requesting records. You know, they're never sent to me. I mean, I'm the primary, but it doesn't seem to mean that much sometimes. And the patients themselves, like, hey, I brought this report and these supplements. Like, I want these to be in your records. Not even, what do you think? Like, do you have it? And then these models can at least start to intermix, where I'll say, you know what, There's a bunch of testing for the thyroid you may need, but it's not going to be cost effective with me. I have a great person down the street I Trust. I've read 10 of their notes for 10 of my patients. They're awesome. That's not happening.

Yeah.

So I think that's really the biggest.

Yeah. And I encourage, because I don't prescribe, I just give recommendations. So I'm like, okay, here's what my recommendations would be from a thyroid medication perspective. Here's my justification. I type all that stuff out in my notes. Here's the justification for doing it. Please share this information with your prescribing physician. Let them know what we're doing, what the recommendation would be, they need to make the medication change. And, oh, by the way, let them know that we're going to recheck their lab values in somewhere in 30 to 60 days to make sure that the changes that were made between them and I are appropriate and had the appropriate response. And my clients get all of the notes and a recording of the call. And I always say, hey, you should share this with your physician. If they have any questions, send them to me. I'm more than happy. If they have any question on any supplementation, let me know what the questions are, the concerns, and I'm more than happy to answer them. And in my world, I would say, and I don't know, it's just because I've been doing this for so long that I get less pushback and issue. But I would say in the beginning there was a lot more angst, and now it just doesn't seem to be so.

Yeah. And I think the conventional model is recognizing the need for this. And I see as a functional health coach, a lot of doctors reaching out to me and saying, do this part Because I don't know how to get this, you know, because I don't have the time to handle this part of it that is happening, that is changing. But you're right, there's this disconnect between functional and conventional. And I see that the more cohesive and more conversations we have, it's much better for the patient. So thank you both for this, because this was really on my mind for so long. And, Dr. Eric, thank you so much for agreeing to do that. And I know, Dr. Nick, you had some questions that you were really fascinated about and wanted Dr. Eric's perspective on it. And so let's move on.

I'm kind of fascinated by, we'll call them health trends. And I'd love to get your perspective. You know, something I've been thinking about a lot, it's seeing things come and go. A lot of hype, and then they leave. Given how long you've been practicing, I'd love to hear your perspective when something new comes along. How do you look at it? Whether it's promising, overhyped. Are there things that you started doing and then pulled back on? Or maybe the opposite? Because this is a big, big issue for, you know, some people are early adopters, late adopters. It's often case by case. And then, interestingly, some things just. I always love when something is old and great. A little extra virgin olive oil, blueberries. It's not sexy anymore, but, you know, they kind of stand the test of time. And over time, what ends up like that is always super interesting to me. Whatever's any more on your algorithm, I.

Guess I would say for when I was younger in practice, and I've been in practice 30 years at this point. So when I was younger in practice and in functional medicine, something came out. I was like, oh, let's do that. Because that, you know, everybody's on it, right? Let's do it. And even in early parts of functional medicine, somebody said something and I believed them. And I was like, oh, okay. And then somewhere along the way, I was like, it doesn't seem to work this way. What people are telling me, it doesn't make sense to me. And so I started doing a lot of my own research. I've, you know, got probably, I don't know, thousands of PubMed articles and journals and papers at this point and have to do my own research and try and figure things out. Is this really accurate? And now I'm way more skeptical of everything that comes out. And I don't think there's any sexy miracle Thing in general that's going to come out. I am a in the non sexy camp that a healthy diet, healthy lifestyle, good relationships, good mindset, good quality sleep and respiration is the medicine that's going to make us better or allow the body to make the medicine that makes it better. It's problems in those areas that contribute to issues. Sure. Are there organisms that may be problematic? Yeah. I would make the argument usually that in many cases a weakened physiology is the reason those things take hold and become chronic infections versus acute infections in many cases. But I'm not a huge advocate of what's the flavor of the day. It's why I speak up many times when people talk about iron, everybody's iron deficient. I don't believe that based on the literature and the science, some of the iron scientists, I don't believe the whole world is vitamin D deficient. I think we evaluate, interpret it wrong. And I think there's more to this story. In the world of thyroid physiology, T4 was going to be the big thing and then it didn't pan out for everybody. So then adding T3 was going to be the savior and people started seeing a change and then it was like, okay, well then this must be the secret. We'll give more and try and force the physiology. And that didn't work out. And then people said, well then we're going to do T3 only. That's going to be the saving grace and that'll work. And now the T2 supplementation is the hot thing and that's going to fix everybody. None of this stuff really works long term. Even the fish oil industry is a massive, massive industry. And I think that's bogus to some degree as well. So I hate to say I'm Julian Skeptic.

Yeah.

Which brings me to your thyroid blueprint. Talk to us about that. You know you have a blueprint that you.

So I wrote a book called the Thyroid Debacle with my friend Dr. Kelly Halderman. And just to give a different model, an adaptive model of thyroid physiology, which instead of broken physiology, when we see changes in thyroid physiology, it tends to be an adaptive response. Based on 30 years of practice, all the clinical research I've done, cell danger theory and a bunch of other these things that are out there, even papers today talking about how hypothyroidism is protective against cancer. And so we're seeing these things now and we could get into damps and pamps and mitochondrial physiology and we can do all that if we want, but this is the Model and the lens of physiology I look through. I'm not necessarily saying that everybody needs thyroid treatment. I'm just saying the downregulation metabolism and the change in thyroid physiology is an indicator that something is going on in the physiology, that we have to take a closer look. And instead of people jumping to, I need to manipulate my TSH into an optimal range that you hear in functional medicine. Well, it's got to be between 1 and 2. That's BS that TSH fluctuates all the time. It's age dependent. Depending on the time of year you get it done, the TSH will be different. Time of day, time of year, age. All these things come into play. So there is no, like, absolute number. Like, this lab range is too wide. This narrow range is healthier. That's B.S. you know, we like to look at that, but we have to interpret labs, not read them. But to get people away from the idea that the focus should be on manipulating a blood value into range, whether it's TSH, T4 free T4, T3 free T3, reverse T3, thyroid antibodies. That is wasted time, in my opinion. From the patient's perspective, their job should be what is contributing to my excessive stress load, that I can start changing my habits and behaviors and start to see improvement in my health. So when we wrote the book, the thyroid debacle, I had 10 of what I call fitness factors. These areas of health. Sleep fitness, respiratory fitness, emotional fitness, dietary fitness, physical fitness. Like these different areas that they could self assess and score themselves and say, okay, I don't do any physical activity exercise. Okay, well then if you're like a 3 out of 10 for your physical fitness, instead of worrying about your T3, how about we start working on improving our physical fitness? And so since then, I've expanded that to 18 different fitness factors. And that's what the blueprint's about. You don't need me technically to assess your relationship fitness with your spouse. Right. Or your family. You can do the self assessment and then you can say, okay, these are areas where I'm weak. And oh, yeah, by the way, here's the support protocols that go with fixing potentially each of those questions that you didn't score well on. That's what they should spend most of the time on. Not looking for the magical dose of T4 or T3 that's gonna, you know, magically fix their physiology. I'm here to tell you it doesn't exist. And for the person who's listening to this, that's already on 20 bottles of supplements. There is no magical supplement that's going to fix it either. It's all management strategy. Even when somebody says, well, I'm just deficient in this. Well, if you're deficient in 20 different micronutrients, then you have a dietary problem, a digestion problem, or an assimilation problem, or you're in cell danger mode. Pick one more. Supraphysiologic doses of its supplement is not the answer.

Yeah, you're saying the patient or the client needs to tap into your own inner wisdom. Really kind of start taking stock of what's happening in their body and then making the right decision in the system. That's probably the weakest link and that's getting harder and harder. Dr. Eric. Because we are so bombarded by influencers or people saying this or that and we start self doubting. Nobody knows what's going on in my body better than me. No doctor or no functional or. I mean, that's respect for that inner wisdom. I think today we are just kind of losing that because of the bombardment of outer voices.

Yeah. The psychology piece is so fascinating. You know, people, when there's red on a lab page, it is hard to convince a patient that is not a true abnormality and vice versa. If it's not red, it is hard to convince them that it should be red.

Oh, it's borderline and yeah, yeah, that's.

One piece of the psychology. And then of course, you know, our brains are all being hacked by our phones and I'll tell a patient something and then one year later they decided to do it because it was on the phone. And I'm like, I'm a little hurt. I'll be honest.

I was just saying this for a long time now.

Yeah, I think we've become so connected to technology and everything else and we've become so disconnected from ourselves so many times. We'll have patients. I'm sure you do. Both of you as well. Somebody says I'm doing everything right and yet I have these problems. Okay, the starting point is you think you're doing everything right. You very well may be, but there must be something you're not aware of. And psychologically there may be problems, especially things going on in your brain, in your mind, subconsciously, that you don't even realize are contributing to the stress response. Like I'll give you an example. I got a patient who every time I meet with her, she tells me how stressful her job is, how much of a problem it is, how this is the biggest stressor in her Life. I'm like, look, there's no way we're going to fix your conversion of thyroid hormone. There's no way we're going to reduce the glucose resistance issue. There's no way we're going to restore gut physiology unless you deal with the elephant in the room. We can deal with, hey, roofing, diet, all those things, we should work on all those other things. But if the elephant in the room is the conscious or subconscious thoughts of you're going on in your mind about how much you hate work, how stressful it is, how unhappy it makes you, that is creating fear physiology in your brain, it's winding up your limbic system, it's winding up the sympathetic nervous system. It's not downregulating all your parasympathetics. Well, I can't sleep at night. Of course you can't because you're winding it up. I have no libido, my sex hormones are just. Of course they are. Your body's not putting a time and attention there. I get gas and bloating when I eat. Why? Because you don't have the appropriate terrain to produce stomach acid and pancreatic enzymes and digestive enzyme, and you're triggering dysbiosis and inflammatory mechanisms that are infecting both gut and brain and exacerbating this whole cascade. There's no way you're going to fix that with a supplement. You have to deal with the biggest stressors and many times people are just not willing to even go there early on. And it takes visits, right, sometimes to get them to the point where they finally go, you know what? I think it's the relationship with my spouse. Yeah, how about that? You and I may have known that on visit one, but they were not willing to discuss that or admit to that on visit one. Yeah, right.

So well said. I don't know if we should even ask you the rapid fire round right now.

There's one question I just.

Let's go for it.

If you're familiar with it, I just heard about this very recently, the desiccated thyroid. Abbvie is doing a randomized control trial on desiccated thyroid. It's not going to be apparently done for a few years. I don't know if you'd heard about this or your thoughts.

Yeah, I think people think desiccated thyroid is better because it has T4, T3 and maybe some T1 or T2, and that's going to make all the difference. Look, my problem with desiccated thyroid is that it's in the wrong ratio for what we typically take as a human being. There's arguments as what the T4 to T3 ratio is. You know, some people say 8 to 1, 10 to 1, up to 18 or 20 to 1. The reality is it can go down to 5 to 1 under stress conditions. Based on the reading literature, I'm not sure we know why and how. Same TSH can tell the thyroid gland, I need more T3 out of you than T4. But the thyroid gland can generate more T3 if the conversion is downregulated. But the general thought process is we need to give more T3. But if we give more glandular product, desiccated product, it's at like a 4 to 1 ratio, which is not what we need. Now, as you try to raise the dose to get a lab value into normal range, you start having more T3 in circulation than T4. What happens? You early suppress TSH. That. Then if the gland is making thyroid hormone, starts to suppress the gland, and then time, it's like, okay, now I'm hypothyroid, I feel hypothyroid again. Right, because you're adding more T3. Most of the T3 in the body does not come from the thyroid gland. It comes from perotonic peripheral conversion. So if there's a conversion issue, we need to fix what's causing the conversion issue. If the person had a complete thyroidectomy, their complete atrophy of the gland, then they. A healthy gland makes somewhere between 5 and, let's say, 10, maybe 15 micrograms of T3 in a given day. Why are we giving 30? Like, that is not the issue. So if we're going to replace the T4 that a gland would have made, let's say it's 100 micrograms and we need to give some T3, then it should be 5 to 10. Well, that's not a 4 to 1 ratio. So doing a desiccated, in my opinion, is going to create problems. And I think they'll see this way out in time because initially patients at a lower dose are going to say, wow, I got a little bit of T3. My body wasn't converting it. And that feels good for a while. And then as they ratchet up the dose, they're going to be like, now I'm getting some hyperthyroid symptoms. Now I'm getting hypothyroid symptoms. It's not going to pair out the way that I think they think it will.

Yeah, well, in three years, we can always come back to the study and see how it works out. Dr. Eric, it's been great. I just loved hearing your perspective and how we're very aligned. Anu, thank you for moderating, if you will.

Thank you.

We want to be respectful of your time, get you to your next meeting. Thanks for joining us. I don't know, Anu, you have any parting words, but that was awesome.

I did have one question to finish off. I know people always ask you this. Is there one supplement or one thing that you wish the conventional model would look at? Something that you feel like this is you. My parting thing. I wish this would happen in a conventional model.

No, I don't, because I think they do a different job than I do. So to ask somebody, a medical physician, traditional allopathic physician, who doesn't typically have a strategy in place to deal with low T3 or low free T3, to ask them to run a more comprehensive panel that they don't have tools in place to actually deal with based on insurance guidelines and other factors I don't think is fair to the clinician because it puts them in a situation where they're running a test, they're now responsible for the results of that test, and they are opening themselves up to liability then. So, no, I think they do their job. They do the best job in the world from a crisis care perspective, from a management perspective. But if somebody truly wants a health or a recovery perspective, then, hey, let's manage it. And let's get you to somebody who's really spends a lot of time in the recovery process, and that's my friend over here, the functional medicine practitioner. And I'll be part of the team. They're part of the team. But now the strategy changes. If somebody came to me and said, listen, I've got high blood pressure, what supplement would you give me? I'm like, well, first of all, if you got high blood pressure, we got to make sure you're not in crisis situation. So let's address that first. Let's get that under control. And then two, do you want to change diet, lifestyle, habits, behaviors that cause this high blood pressure to begin with? No. Great. Then keep seeing your medical doctor in the prescription and we'll deal with the other problems you have later when you're ready to make change. If they say, yeah, I don't want to be on medication, are you willing to make changes? Yes. Great. Let's talk about root cause. I wouldn't start them with a magnesium supplement or any other stuff until I know if magnesium deficiency is the issue. Right. So I think we just have to do what's best for the individual client. And I think we need to fully understand the different role the traditional allopathic physician and traditional allopathic endocrinologist and gastroenter, what role they play and the difference between functional medicine. And instead of trying to monopolize it or they're terrible, we're better, we just say, look, this is my job. This is their job. Let's try and work together to get you better.

So well said. Thank you so much.

Again, thank you for joining us.

I appreciate it. Thanks so much.