From Sicily with Wellness: A Casual Chat on Health and Lifestyle

Foreign. If this is the first time that you've listened to my podcast, I'm going to apologize because right now, currently I am in Italy, in the middle of Sicily, in a tiny Italian village with no professional microphone. So we're doing this together. You guys have wanted me to, so we're experimenting today. We are going to talk about things that you all have asked me to speak about. This is going to be extremely casual. I apologize in advance if the sound is not great. Please, please do not let today's episode be a representation of what modern thyroid and wellness think of this as us hanging out in Sicily in the middle of a tiny airbnb together. So let's dig in right out of the gate. Since we're in Italy, let's talk about wine. Okay, so I brought this up on a TikTok live a while back and you all have been ravenous for this information since I brought it up. So let me give you a little backstory. I did not think I could tolerate wine whatsoever. I would start to drink a single glass of wine and before I was done with one glass of wine, I felt hungover. So I completely gave up on wine. As the years went on, I would return to Italy. If you guys don't know, I lived in Italy for a year in my 20s. I'm actually fluent in Italian. There's a little known fact for you. And I come back to Italy as often as I can and visit my Italian family, which we'll see in Turin. In a few ways, they are not my blood family. They are my adopted Italian family that I've had for over 20 years now. Love them dearly. My Italian grandfather taught me all the Italian that I know. So I'm going to visit him, hang out with the rest of my family. I just absolutely adore them. They changed my whole life. But as I would return and go hang out with them, I would have wine on occasion and I would notice that it actually didn't make me feel bad. Only with like one particular wine from a region in Piedmont, which is where I lived in Italy, the number one wine producing region in Italy. And I slowly worked my way out from there. So what I've learned and, and this might not work for everyone, but I am the reason I do what I do is because I'm like a canary in the coal mine. I am so sensitive. My physiology is sensitive. If anything is off, I do not feel well. And that's why I'm so invested in finding ways to help you all feel well, because I am actually Just one of you. Over the years, I've tested and tested and tried and tried. I'm going to tell you what has worked for me in Italy. I am fairly open with wines to try. There is one region that I don't really drink wine from and that is Tuscany. Sadly, Americans are familiar with Tuscan wines like Chianti, etc. I find that Tuscany, of all the regions in Italy, tends to be the more mass produced. And it makes me feel bad, y'. All. So I do not drink any wines from Tuscany whatsoever. It's the only region I avoid. My preferred region is the region that I lived in that I'm very familiar with. That really, I think upholds pretty rigorous standard for wine cultivation and production. And again, that's Piedmont or Piemonte. So let's talk reds. My number one favorite red wine in the world, but also in the Piedmont region, is called Barolo B A R O L O. Italians call it the King of Wine because it is the best wine that comes from Italy. It is fairly expensive, though. They often have reasonably priced bottles at Costco, but it's not cheap. So I used to drink Barolo only when I first figured out that I had wine intolerance. But I didn't. I would waste a bottle. Like I would drink a glass and try and keep as much of keep it as long as I could, but it would eventually go bad and I'd have to toss it and start over. So it was a reserve for special occasions. One step down from Barolo that's a lot cheaper. Very readily available is called Barbera B A R B E R A And it can be Barbera d' Asti or Barbera de Alba, either one. It's all from that same region in Italy right next to Barolo. And then the third is Nebbiolo. N E B B I O L O Nebbiolo. All of three of those are extremely easy to get. Clean wine that doesn't make you feel poorly. I tend to buy mid range wine, like 16 to $23. Or if I'm getting a Barolo, I'll spend more for sure. But I don't necessarily go for the cheapest. Some at Trader Joe's that are $5. I've tried them. They actually don't make me feel bad. But I wouldn't start there. If you know you have wine sensitivity, then whites. I generally love whites from Piedmont. Again, my favorite is called Arnaz. It's A R N E I S and it's Arnais from the Ro AO region, not Lange. Can't recommend it enough. It's amazing. The other easy kind of accessible white that I will drink, like it's the most easily accessible white wine, if you're out in a restaurant or something, is Pinot Grigio from northeastern Italy, Via Stay All. There's just several regions that make Pinot Grigio in northern Italy. And I will drink those pretty freely as well. And they don't make me feel bad. There are some from Puglia, which is my second favorite part of Italy. Like Negro Amaro is a great red. And I don't remember the name of the white. And I'm learning about wines from Sicily that do. And don't make me feel bad, but I don't want to share those with you because I'm not confident in my knowledge base yet. But, guys, it doesn't matter if I drink a $30 bottle or a $300 bottle of wine from Napa. It's making me feel bad immediately. Without ever even feeling a tinge of a buzz. I'm hungover before I finish my glass of wine. I go to Napa, and I will not consume a single glass of wine. There has been tests done on Napa wines that are organic, and they all have glyphosate in them. They're just heavily mass produced. They're not held to the same standard as Italian wine. I do not drink Napa wine at all, full stop. The last type of wine that I will drink is French rose. So I will absolutely do that pretty freely. I don't worry so much about that. I aim for a lighter glass of French rose, light pink, not darker red, not syrupy kind of thing. And really, it has low sugar. It doesn't make me feel bad. So if you want to start it with wine and you're like, hey, where do I start? There's some good tips and tricks. Now, studies have come out that say no alcohol level or no amount of alcohol consumption is beneficial to your health. I agree. Like, I'm not drinking red wine thinking that I it's going to make me live longer. I'm drinking a glass of red wine because I enjoy it. And for me, it's worth it on occasion. So to each his own, for sure. Let's pivot topics. The other form of alcohol that I actually will drink is tequila. I'll drink tequila with soda and lime, and that's it. And the way that I gauge good tequila from not good tequila is my husband uses an app called Tequila Matchmaker, and it grades it on additives, anything they put in the tequila outside of the agave, what tequila is made of. If they add quite a bit of that, the score goes down. On Tequila Matchmaker, we use that app to differentiate clean versus unclean tequila. It's like shopping organic to try to get the cleanest version of what you are consuming. I hope that helps. I asked you all questions on my Instagram of like, hey, I'm just going to do a basically a question answer session on my podcast what do you want to know about? And you all had some great questions. So let's talk about GLPs and metformin. Someone asked, what about Metformin? Can you take it with or without a glp? Metformin is classically used as a diabetes medication. It is meant to lower circulating blood sugar. It actually has a lot of longevity benefits. It can reduce cancer risk. It can help protect your metabolic kind of function, your metabolic flexibility, your insulin sensitivity as we age, which in turn helps with heart disease. So I love Metformin. I think it's a great tool of longevity. I use it commonly in my patients before they go on a GLP to see if it will work for them to aid in weight loss or improved metabolic function. And then I very commonly use it when people are tapering off of a glp. We slowly take them off and I'll add them on Metformin to help maintain the metabolic improvement they've created so far with the glp. I also hear reports that people just say, hey, it helps me with inflammation, it helps me be less reactive. I agree myself, Metformin is easily available through if your doctor is like, why would I prescribe you Metformin if you're not a diabetic? I very much recommend that people use Ageless Rx, which is an online sort of telemedicine platform that's happy to prescribe. Someone also asked about GLPs postpartum leading up to pregnancy. I did a whole deep dive on fertility a couple weeks ago on the podcast. If you haven't listened to that one, please do. The formal recommendation for GLPs leading up to pregnancy or when you're actively pregnancy planning is ideally you want to stop them two months before you're actively pregnancy planning. The thing about GLPs is they improve fertility in so many ways that are independent to weight loss. They actually improve egg quantity, quality, function, timing, all sorts of things reduce pcos. So people are taking them thinking they can't get pregnant and then they end up getting pregnant. There are no formal studies on pregnant or breastfeeding women on GLPs. And so because of that, medicine says we don't want to do that. Interesting fact is, with men, men should actually be off GLPs 90 days before actively trying to get their partner pregnant, as compared to women who are only 60 days, which is pretty fascinating. I presume that's because it takes 90 days for sperm to completely turn over. Now, after someone has discontinued breastfeeding when they are postpartum, I think GLPs can be a great tool to help women rehabilitate their metabolic function, especially if they are in a really bad thyroid place, which is very, very common postpartum. And I would have no issues starting GLPs in a postpartum woman who is not nursing about GLP. So can you effectively treat SIBO and H. Pylori on a glp? I wish I could answer with my own clinical expertise, but I rarely treat SIBO people in general. I'll get them started on a very basic plan of Xifax. And SIBO is small intestinal bacterial overgrowth. I do not treat people for H. Pylori. That is really a question for a GI doc. Another GLP question. How long do you have patients stay on a glp? We have a proprietary method of when we begin to pull patients off of the glp, but we want them to reach their goal weight. GLP so effectively influence inflammation that it's very common. People will gain water weight back when they stop them because that inflammatory response does not stay gone. If it's genetics, et cetera, just because it was improved on a glp, if you stop that glp, that inflammatory response tends to come back. They'll gain water weight. Inflammation is often associated with puffiness, water weight, kind of like if you get stung by a bee, it swells. Same thing with systemic inflammation. So we have people drop a little bit below that and then we look for very particular lab markers that show this person metabolically is good, their metabolism is sensitive, they should be able to appropriately maintain their weight or continue to lose weight with reasonable amounts of effort. I do not publicly release what those numbers are yet because they are proprietary. We have arrived at them over analyzing a lot of data of our patients at Modern Thyroid Clinic and soon to launch Modern weight loss. Those are the numbers that we are looking for on labs. It is not simply about someone getting to their goal weight. A lot of times people get to their goal weight before, metabolically speaking, their labs have shown that they're in a safe zone. When that happens, I cannot be confident that you are not going to have to over restrict or gain weight back or over exercise. The goal for us is always the end goal in our programs. Modern weight loss and modern thyroid clinic. I want your the effort that you put in to losing weight, maintaining weight to be appropriate for the outcome. Because what I don't think so many people understand is especially people who are metabolically disadvantaged. For example, people with thyroid dysfunction, they can work out four, five, six, seven days a week. They can eat a low inflammatory diet, high in protein, calorically restricted and they cannot lose weight. They can do everything perfect. They can see five nutritionists and do everything to a T. The outcome does not yield the appropriate outcome. So our goal in our programs is always we want the effort that you put in to yield the appropriate outcome. And that is what we are looking for in the end, for sure. Another question, Is it feasible for someone with IBD to take a GLP? GLPs come with gastric issues. Research shows over and over GLPs improve gut function full stop. Do they cause constipation? Sure. Like if you're over medicated, it can cause constipation that is easily solvable 98% of the time. If you're seeing someone who's able to to tailor their dosing specifically for you and adjust it according to side effects and struggles like constipation, it should not be an issue. Research shows GLPs improve good bacteria. They reduce negative bacteria, they lower gut inflammation. One of the most common pieces of feedback that we get from patients in our program is their gut function is better. They have less bloating, they have less reactivity to foods, they have less gut pain, they have improved gut function. So what's so sad to me is you guys are like it's beaten into your heads that these meds are just going to completely shut down your GI tract. Meanwhile, we have a practice full of people with improved gut function day in and day out. It's absolutely life changing. So 100% it's possible. And in fact, I couldn't count on two hands how many people with IBS and IBD, their symptoms completely were eradicated by taking a GLP. I did forget to mention metformin. With GLPs, people can take both of those medications at the same time. You need to be monitored closely by your clinician, but people in general can use metformin alongside a glp. In fact, that's one of our methods of allowing people to break through a plateau in weight loss by layering in metformin. The last topic I want to talk about is ldn. So I got a lot of questions whenever I asked you all. And if you don't follow me on Instagram, y', all, please do. I poll who you guys want me to interview on Instagram, what you want me to ask them, what you want to know from me. I source so much and cultivate so much of my information from Instagram. So please, please, please follow me there. McCall McPherson, Pennsylvania. So let's talk about LDN. LDN dosing. I get this question a lot. The dose of LDN or low dose naltrexone, which let's back up and say exactly what that is. It is a microscopic dose of a medication called naltrexone. Naltrexone is an opioid blocker. It is a pain medicine blocker. So in cases of addiction, overdose, people can take it and it will block opioids when it's compounded into microscopic doses. Normal dosing starts at 50 milligrams. Compounded can be any dose you want it to be. It does something unique at a microdose. It blocks a small amount of our natural endogenous opioids that we produce ourselves, and that communicates to our body that we don't have enough opioids. So what ends up happening, happening is our body gets this signal that we need more. So we upregulate opioid production, and that actually has us walking around with a little extra. When you're walking around with a little extra opioids, couple things happen. One, it lowers inflammation of any kind, which in turn can impact autoimmune disease greatly. Two, it can improve immune function. So whether that's helping you resist getting sick or pruning off circulating weak cancer cells, it has a lot of benefits. I personally have seen a patient's TPO antibodies, their Hashimoto's antibodies, drop 500 points in three months without changing anything else in their lifestyle. That's a big deal. That's a lot of antibodies for three months. So it's very well tolerated. Most people, if they experience anything, they experience vivid dreams. Not bad, but kind of strange, bizarre. Just you're on an adventure. I have put thousands of people on ldn. I've had one person stop it for vivid dreams. I've had less than 10 people ever stop it. So it's very well tolerated. It's generally taken at nighttime before bed, which it peaks about four to five hours after you take it. Most people sleep through that, so they don't really feel it. Occasionally, maybe 10% of people, when they wake up in the morning after they first start taking it, they feel a little bit groggy. That almost always resolves. The research is done at 4.5 milligrams. Remember, standard dose of LDN starts at 50. So we're talking about a tiny bit. Generally, I start people on 1.5 milligrams and I increase them twice up to 4.5 milligrams. So they go from 1.5 milligrams. They stay there for about a week. If they have side effects or they're having trouble adapting, then I increase them to 3mg for at least a week. Again, if they're having trouble adapting, then again at 4.5. There are some people who recommend that because there is often an adjustment of dosing, like you feel a little groggy when you wake up, you might feel a little bit different every time you increase. That happens. So what some people do is reduce the dose and put people on, let's say 0.5 milligram increments and increase from there as opposed to 1.5. I generally do not recommend that. What happens is every time that person increases their dose and I increase them twice up to 4.5 milligrams. So they go from 1.5 milligrams. They stay there for about a week. If they have side effects or they're having trouble adapting, then I increase them to 3mg for at least a week. Again, if they're having trouble adapting, then again at 4.5. There are some people who recommend that because there is. They have to go through that adaptation period again, and that might last for a week, let's say two weeks. What happens if you're putting them on milligram increases as opposed to 1.5, now you're increasing them in dose increments for often an adjustment of dosing, like you feel a little groggy when you wake up, you might feel a little different. Every time you increase, that happens. So what some people do is reduce the dose and put people on, let's say 0.5 milligram increments and increase from there as opposed to 1.5. I generally do not recommend that. What happens is every time that person increases their dose three times as many times. So instead of increasing them twice, now you have to increase them from 0.5 to 1, from 1 to 1.5, from 1.5 to 2. And what I find is every time they increase, they have a week or two of feeling a little groggy. Right? So now instead of it being three weeks of waking up feeling groggy in the morning, it's like nine weeks. So I don't recommend people do that. That's just me. It's very personalized. So you need to talk with your clinician about the best plan. But that is what I found over the last 10 years of Prescrib LDN. Lastly, there is a subset of people that get stimulated from ldn, meaning they take it at nighttime and they feel they have to go through that adaptation period again. And that might last for a week, let's say two weeks. What happens if you're putting them on 5 milligram increases as opposed to 1.5 now you're increasing them in dose increments for like it's disrupting their sleep. Most people report improved sleep on ldn, but this subset of people is like, oh my gosh, I feel so energetic. I wake up bright and bushy tailed. After I take it, I switched three times as many times. So instead of increasing them twice, now you have to increase them from point to take it in the morning. And honestly I find those people are generally some of the best responders. They have this very quick effect of LDN and it's usually associated with really positive things. 5 to 1, from 1 to 1.5, from 1.5 to 2. And what I find is every time they increase, they have a week or two of feeling a little groggy, right? So now instead of it being three weeks of waking up feeling groggy in the morning, it's like nine weeks. So I don't recommend people do that. That's. I did get a couple questions about LDN2. I want to make sure I covered the questions that people sent. Someone said LDN dosing is really low doses beneficial, like under 1 mil. Just me. It's very personalized. So you need to talk with your clinician about the best plan. But that is what I gram long term. I do find that there is some variance in dosing for ldn. I think if people simply cannot tolerate the dose that research is done at of 4.5, but they can tolerate a 1mg dose. Why not try it? We could check antibodies before you start, check them three months later, see if we're getting some objective bound over the last 10 years of prescribing LDN. Lastly, there is a subset of people that get stimulated from ldn, meaning they take it at nighttime and they feel like it's disrupting their sleep. Most people report improved Sleep on ldn. But the markers that say, hey, this is worth it, right? On the flip side, some subset of people is like, oh my gosh, I feel so energetic. I wake up bright and bushy tailed. After I take it, I switched. People need more. Sometimes that's for antibodies to reduce. Sometimes it's they felt improvement initially to take it in the morning. And honestly I find those people are generally some of the best responders. They have this very quick effect of LDN and it's usually associated with really positive things. I did get a couple questions about LDN2. I want to make sure I covered the questions that people sent in. Someone said LDN dosing is really low doses beneficial, like under 1 milligram long term. I do find that there is some variance in dosing for ldn. I think if people simply cannot tolerate the dose that research is done at of 4.5, but they can tolerate a 1mg dose. Why not try it? We could check in, for example, joint pain and then their joint pain returned. Some people increase from 4.5. I usually go up to 6 milligrams. I have patients on as much as 9 milligrams. Very commonly I see that with Graves. I don't know if it's simply that people with graves are metabolizing everything out more quickly because of their heightened basal metabolic rate essentially. But I find that to be the most common subset of people that need more ldn. Someone else said, what is a reasonable dose for LDN is 3.5 milligrams in the morning and PM. Okay, so it's interesting. LDN is antibodies. Before you start, check them three months later, see if we're getting some objective. Half of the weight loss medication called contrave. The other half is Wellbutrin. With contrave, people take it multiple times a day. I personally markers that say, hey, this is worth it, right? On the flip side, some people need more. Sometimes that's for antibodies to reduce. Sometimes it's they felt improvement initially in for example, joint pain and then their joint pain returned. Some people increase from 4.5. I usually go up to 6 milligrams. I have patients on as much as 9 milligrams. And clinically for my patients do not really recommend people take LDN during the day because again, what it does is it suppresses your opioids and it does that the most about four hours after you take it. So if you take in the morning, generally people are going to feel a little flat, a little apathetic. They're not Going to feel great during the day. And then if you take it twice a day, very commonly, I see that with graves. I don't know if it's simply that people with GRAVES are metabolizing everything out more quickly because of their heightened basal metabolic rate, essentially, but I find that to be the most common subset of people that need more ldn. It's even more of that feeling. Unless people are really good responders, meaning unless they get energy from LDN, which is very much less than 5% of people, I have them take it at nighttime before bed. In those 5% of people, sure, they can take in the morning. But generally someone else said what is a reasonable dose for LDN is 3.5. I dose it all at once before bed, not in the morning. So I hope that helps. All right, I think that covers the topics. I appreciate y' all tuning 5 milligrams in the morning and PM. Okay, so it's interesting. LDN is again, for those of you who did tune in, I. I'm hoping this audio is not atrocious. Thanks for joining me on my little Italian vacation. I can't wait to get back. I have some really, really half of the weight loss medication called contrave. The other half is Wellbutrin. With contrave, people take it multiple times a day. I personally exciting interviews coming up. I appreciate you all tuning in. And. And clinically for my patients, do not really recommend people take LDN during the day because I can't wait for the next episode. I'll see you there. Again. What it does is it suppresses your opioids and it does that the most about four hours after you take it. So if you take in the morning, generally people are going to feel a little flat, a little apathetic. They're not going to feel great during the day. And then if you take it twice a day, it's even more of that feeling. Unless people are really good responders, meaning unless they get energy from LDN, which is very much less than 5% of people, I have them take it at nighttime before bed. In those 5% of people, sure, they can take in the morning. But generally I dose it all at once before bed, not in the morning. So I hope that helps. All right, I think that covers the topics. I appreciate y' all tuning in. For those of you who did tune in, I'm hoping this audio is not atrocious. Thanks for joining me on my little Italian vacation. I can't wait to get back. I have some really, really exciting interviews coming up. I appreciate you all tuning in and? And I can't wait for the next episode. I'll see you there.