Understanding the Cell Danger Response in Thyroid Health | Dr. Eric Balcavage

Speaker A: 00:00:00

Remove one thing, which we often talk about in functional medicine, you have to deal with the root cause. It's bacteria, it's a parasite, it's a this, it's a that. It's usually not a thing.

If you've been doing this for any length of time, you realize they got emotional stress, they got life stress, they're oral, they got bad oral health, their guts a mess. And we give them a gut protocol for 30 days and we're like, okay, yeah, that felt better.

And then 60 days, 90 days later, they call back like, my gut's a mess again. Your protocol didn't work. Sure it did. It worked for the 30 days I. But you weren't in a healing mode.

So all I did was manage your gut dysfunction for 30 days.

And because you still were had all this stress, life stress, work stress that you couldn't manage, your gut got downregulated again and became problematic. Same thing for thyroid physiology.

Speaker B: 00:00:44

Welcome to the Optimized Woman, the podcast for high performing women ready to take back their health. I'm Orshi McNaughton, a board certified holistic health practitioner and functional nutritionist.

Speaker C: 00:00:54

If you're tired of feeling stuck, you.

Speaker B: 00:00:56

Can'T lose the weight. No matter what you do, your energy is in the toilet, your metabolism feels like it's at a standstill, and you lost the spark you once had.

Then you're in the right place. We are here to unleash the unstoppable force you meant to be and give you the tools to fix what's holding you back.

So if you're ready to own it, start thriving again, and live the life you deserve. And let's get to it. So when your body persists, receives a.

Speaker C: 00:01:26

Chronic threat, whether from an infection, toxins, stress or inflammation, it shifts into a protective state.

Speaker B: 00:01:34

This isn't random.

Speaker C: 00:01:35

It's a biological survival mechanism known as the cell danger response.

The body prioritizes defense over growth and repair, slowing metabolism, reducing energy production, and downregulating thyroid function to conserve resources and protect ourselves. Now, this means hyperthyroid symptoms such as fatigue, weight gain, brain fog. They aren't just signs of a malfunctioning thyroid.

They are part of a broader metabolic adaptation. Your body is responding to stressors by slowing down, limiting energy output and shifting resources away from normal thyroid hormone conversion.

Today I'm joined by Dr. Eric Balcovage, a functional medicine expert. Expert who has completely reframed how we understand thyroid dysfunction.

We are unpacking how mitochondrial health, chronic stress, and the cumulative burden of environmental and Internal stressors drive this adoptive response.

How are overall elastic load impacts, thyroid regulation, and what needs to change in your approach if you want to truly restore your thyroid's function? So if you've been chasing thyroid labs without addressing the deeper metabolic curve, you're missing the real problem.

Speaker B: 00:02:47

Let's get into it.

Speaker A: 00:02:48

I had a family member who got diagnosed with hypothyroidism, fibroids and iron deficiency. And they were told they were going to get a. The solution was a hysterectomy, thyroid medication, and iron replacement.

And at the time, I was just doing chiropractic work, but I'm like, that's not what I do. And I was told, hey, but figure it out.

And so I started digging into blood chemistry and then started learning about functional medicine and what was going on at the time. And this is like 25 years ago, but I, it. I had a background in, in college, I was like, on. I planned to go pre med. I was a medical technologist.

So I did all the lab work. So I was very familiar with labs because that was what my job was before I went to chiropractic school.

But I started digging into what was going on, start to learn that, hey, this is immune inflammatory process going on.

You start to learn that, hey, these things are all probably related and here's other alternative strategies versus taking, you know, doing a hysterectomy on a young female. Right. And those are. It's not that those are from a clinician, a medical clinician standpoint.

It's not that those treatments would have been out of line or inappropriate given the training and given how, the bias of what they do. But there, there was something wrong. And that's really what we were trying to accomplish, is figure out what was wrong.

Is there a way to reverse this process or prevent it from contributing to more problems down the line? So I started working with that family member. And then many times as you start to learn something, you start to talk to people around you.

And especially as a chiropractor, like, every day you're talking to people and you're adjusting them, and you start talking about what's going on, and you realize I didn't pay attention to this early on. You know, maybe shame on me, but it wasn't like the focus of what I was doing. I was helping people improve their spinal and neurologic health.

I wasn't thinking necessarily about thyroid physiology and what medications and things that they were on necessarily as a primary. So I started talking to clients, and I realized that, like, a Large percentage of my client base was on thyroid hormone.

And most of them didn't feel and function great. They felt better. They thought that was just the way they were.

They were told that they were, you know, their thyroid physiology was fixed with the medication, but when you really started talking to em, they didn't really feel and function optimal. So that I started trying to understand more and more about what was going on. And that led me to more functional medicine conferences.

I started following the tease Kharazian, who was like one of the early thyroid people that really taught a lot of us and gave us a lot of us the foundation of what was going on from a cellular perspective. And then that just morphed into wanting to learn more, more reading papers, then learning about genetics and epigenetics and polymorphisms.

And that led me to work with and meet Ben lynch and talk to him about what's going on and do lecturing and work at his conferences. And then I was doing all this stuff, and then something didn't seem right. And it was Ben who finally passed me a paper called by Dr.

Robert Navio on something called the Cell Danger Response.

And when I read that paper, I realized that my frustration with what we were doing from a functional medicine standpoint and an allopathic standpoint for patients diagnosed with hypothyroidism or hyperthyroidism and then having their glands destroyed or removed and then put on thyroid medication, like, why did so many of these people not feel well? They felt different on thyroid medication. They didn't feel well. They weren't. They didn't have restored thyroid physiology.

And even though we were doing all these things we were taught in functional medicine, I knew something was missing. But when I read that paper, I was like, oh.

Because we're telling these people that their immune system's out of control and their body's broken and it's not. Their thyroid physiology isn't broken. Their immune system isn't out of control. We operate in one of two states.

We either in homeostasis or allostasis. And when we're in allostasis, it's excessive stress state, thyroid conversion and thyroid physiology changes. And that was like the aha moment for me.

And so that was maybe 10, 12 years ago. And when I really had that aha moment, I was like, hmm, we really need to change what we're doing here, because we're not helping people recover.

We're just managing them differently. So that's really been my journey. It's the reason I started my podcast. It's the reason I wrote my book with a friend of mine, Dr.

Kelly Halderman, the Thyroid Debacle.

And it's the reason I continue to do podcasts or summits and things like that to try and just change the message, especially from a functional medicine space, how we help our clients. So we're not just doing greenwashing of medicine with just different hormones and supplements.

Speaker B: 00:07:19

Now you describe hyperthyroidism as an adoptive response, not just a thyroid failure. So what does that mean and how should I, how should it change the way we approach treatment?

Speaker A: 00:07:30

The body operates in essentially two different states.

Homeostasis is this low stress state where given all the stressors on our physiology, physical, chemical, emotional, microbial, we make enough energy to run all the systems under that load and we feel good, we function good, we don't have high blood pressure, we, our thyroid physiology works, our metabolism's great, we're not storing excess weight. That's homeostasis. The other operating state is an excessive cell stress state. We call that allostatic regulation.

So when there's more stress on the system than the physiology has energy for or can manage, our physiology shifts and changes. And so we downregulate the less important systems in the moment and support the more important systems in the moment.

So something's going to get down regulated. The example maybe if I was being chased by a tiger, right?

I'm going to increase energy to my muscles and my brain so I can run and get away and I'm going to downregulate the metabolism to my digestive system, to my sex hormone regulation, to sleep systems, to regeneration systems. I don't need those things. I need fight or flight to be kicked in and I'm going to put all the energy towards that.

That's not broken physiology, that's adaptive.

Now what happens is for too many people, they're in this adaptive physiology and they've got in it slowly and steadily and didn't realize it and that shifted their physiology.

So when they get the signs and symptoms, when we shift that physiology, it is gonna result in signs and symptoms, but it's not because we're broken, but it's because we're in this adaptive state. So we need to make sure that we understand the state of the client because we have to support them appropriately.

And the reason that most people don't feel and funct well on thyroid medication, they may feel a little bit better, but they're not getting their physiology restored because they have chronic signs and symptoms is because the person prescribing the medication either assumes they're in homeostasis or doesn't understand the difference between homeostatic and allostatic regulation of thyroid hormone and cellular function.

So they assume if they put more hormone into a system that either isn't making it or isn't converting it, that they're going to fix the physiology by optimizing the blood. And the blood labs are not the problem, the symptom are not the problem. They are an indication that there's a problem.

And masking and manipulating blood levels changes symptoms temporarily, but it never restores thyroid physiology.

Speaker B: 00:09:54

You mentioned this chronic stress state, and that's where I think most American women, especially in their 40s and 50s, live in this chronically stressed out state. And now how is that actually lead to sort of a cell danger response and what exactly cdr. Can you explain that a little bit to our listeners?

And how does that lead to thyroid function? Metabolic dysfunction?

Speaker A: 00:10:18

So the cell danger response is something that's been written up in the literature and there's lots of different like hypotheses for what goes on. But it was kind of all brought together by a guy named Robert Navio in a paper titled the Cell Danger Response.

And in, in that paper he helped lay out that the cells of the body are essentially working in this nice community.

And when the cell perceives danger or a threat, a bacteria, a virus, a toxin, an organism, some inflammatory process, something that triggers a danger physiology, the cell shifts from its normal mode, which is bringing lots of food and fuel and energy into and micronutrients into the cell and making hormones and enzymes and energy and burning lots of fat, to saying, oh, there's a threat.

I'm going to stiffen my cell membranes, I'm going to slow down the production of these resources and I'm going to increase inflammation and free radicals to fight, find and kill the threat. So it's a protective response. And everybody's experienced this acutely.

Like if you've ever had a virus or an infection, when the body senses it, you stiffen cell membranes, you can't make much energy, so you're tired, you're fatigued, you're a little depressed, you don't feel like doing anything, your bowels don't work right, like nothing works really well.

You get fever and chills and we think we're ill, but really that's the body's adaptive response, the cell danger response kicking in to find the bacteria, the virus, kill the threat and then what happens? Seven to 10 days, maybe two to three days later, we're back to normal. We were from homeostasis to threat cell danger.

Find a problem, find it, kill it, and then we go back to normal function. And that works really well in an acute model. Okay.

And part of that cell danger response to stiffen the cell membrane, to slow down the energy production, to do this whole cell danger response. And there' ten steps that Navio outlines. And thyroid hormone plays a direct or indirect role in every step of the cell danger response.

So what does a cell do? Is the cell to engage all these processes of the cell danger response or activate them?

The cell decreases the conversion of T4 to T3, providing a lower T3 state inside the cell. That slows down metabolism. That means there's less energy for and fuel for a bacteria or a virus.

It decreases the lower T3 causes, helps produce stiffening of the cell membrane.

Glucose can't come into the cell for the organism to use, so iron can't come into the cell for the organism to use, so other micronutrients can't be used. It prevents the production of amino acids in tides which could be used by the organism for its own benefit.

The downregulation of T4 to T3 happens under the cell stress response. It's not broken physiology. It doesn't make us feel good. But that is part of the inappropriate response. It's designed to be short term and acute.

But for too many people, at some point, they've entered into they' stress for a long period of time and then all of a sudden they've exceeded their capacity and now they're operating in this different mode we call allostatic regulation. They can still get through the day, they can still do a lot of the stuff that they need to do. There's a price to pay.

They're tired a lot because they don't make enough cell energy, they're fatigued, their sex hormones don't regulate appropriately, their adrenal physiology doesn't work appropriately. Their blood glucose doesn't transport into cells and get used appropriately. They can't burn fat efficiently.

And that all starts to cause them to have more dysfunction. And somebody say, you're broken. They're not broken. They're just stuck in this adaptive response because of excessive stress.

So we get the downregulation of T4 to T3, conversion the active pro hormone to the active hormone. We see these signs and symptoms occur.

And then in time, the longer that danger response is going on, it can start to trigger the thyroiditis, which is the damage to the gland. And so now the gland in time starts to not work appropriately and make enough thyroid hormone.

And then somebody comes in and assumes that the gland just broke down and that they don't consider the fact that there's some inflammatory cell stress response going on. So they just provide thyroid hormone as if it's going to work and it provides a temporary boost in symptoms maybe, but long term it won't work. Why?

Because the body's not in this homeostatic regulation to convert T4 to T3 optimally, it's deactivating T4 at a greater rate to called reverse T3 and decreasing the conversion of P4 to T3 resulting in those symptoms. That's not broken physiology, that's adaptive.

And so that's the issue that we have is that too many people are being assumed that they're in homeostatic regulation. If we just give them T4 or we give them T4 and T3 or just T3, it's going to work to restore their health. And it typically doesn't.

It provides a temporary benefit, but it doesn't provide a long term solution or thyroid recovery.

Speaker B: 00:15:09

So a lot of us get stuck in this adoptive state because of chronic stress. Multiple stress buckets are overflowing and we don't know how to get out of it.

So if the body intentionally slows down metabolism as a protective mechanism, what actually tells it that it's safe to turn the thyroid back on?

Speaker A: 00:15:28

Yeah, that's a great question. And there's a innate intelligence within the body.

I don't know that we fully understand it, but as the indicators of cell stress go down, then the body adaptively starts to reduce the the whole cell stress response. We have decrease of the inflammatory system, we have downregulation of the upright of the immune system that may be creating some of the damage.

And the body adaptively starts shifting or tries to shift back to a more homeostatic state. What's the actual mechanism? I don't know if we actually know the full mechanism, but like the chemical mechanism of action that does it.

And we can get into NRF2 and NF Kappa B and how all that stuff does, but I think that's beyond what we covered today in that conversation.

But the cool thing about the body is the immune system, the inflammatory system can sense and the mitochondria sense that there's less of a danger response that triggers the return to more homeostatic regulation. It's not by just dumping more thyroid.

Speaker B: 00:16:28

Medication in what's happening inside the mitochondria or women with hyperthyroidism hypo or hyper hypo.

Speaker A: 00:16:36

Okay, so when there's a cell stress response, there is a change in mitochondrial function. Okay, so cell stress response. So for the listeners, what is the mitochondria?

First of all, the mitochondria is the engine inside your cells that convert food energy into cellular energy we call ATP.

We all learned some of this stuff in seventh grade science class, and nobody wanted to remember it, but you learned it for the test and then you forgot it. But for some of us geeks, we need to know this stuff, especially when it comes to thyroid physiology.

So when there's a cell stress response, you have. Your cells have lots of mitochondria in them. And what the.

One of the first things that a cell does as part of that cell stress response is it decreases the number of mitochondria, so we make less. Why would we do that? Because we're bringing less resources into the cell, because we've stiffened the cell membrane, so we're bringing less in.

And the other reason is to manage what we call the oxidative stress inside the cell. So the mitochondria converts food energy into cell energy.

When we're in homeostatic state, which makes us feel good, function good, we have plenty of energy. And when we have healthy mitochondrial function, we can push excessive levels of food energy through the mitochondria.

And the mitochondria is able to dissipate excess food energy as heat energy. Now, under stress situations, the body's decreasing the number of mitochondria. Why would it do that?

Because in the conversion of food energy to cell energy through the mitochondria does make energy, but it also makes it exhaust. And we call those free radicals. And those are things that can damage the cell. That doesn't sound good. Right?

But your car, in an effort to run, creates exhaust. But inside the cell, while the mitochondria is making these free radicals, the cell also makes what we call antioxidants.

These are things that counterbalance the amount of free radicals that the mitochondria makes. So we make some toxins from the mitochondria, but we make some things to deal with those toxins.

In a healthy cell, when there's a cell stress response going on, part of that cell stress response is to increase free radicals inside the cell to find and kill the threat.

So if we make free radicals as part of the cell stress response, and we still have all the mitochondria running at full tilt, we'd have an excessive level of oxidative Free radicals being generated, and it would be less than we, the cell would be able to manage with the antioxidants it's able to make. Because, remember, we stiffen the cell membrane. It's harder to bring micronutrients into the cell.

And so if we let the mitochondria run at full tilt, we'd have too much oxidative free radicals. We destroy the cell, and the cell does not want to destroy itself. So the mitochondria is generally downregulated.

So is the mitochondria dysfunctional? The answer is no, not really. Short run, it definitely isn't. Long term, could it become problematic? Dysfunctional? Sure.

If I'm in that cell stress response for an extended period of time and I can't get micronutrients in there, or I inappropriately give somebody too much thyroid medication and increase mitochondrial density, yeah, I could create some mitochondrial dysfunction. But in general, the downregulation of mitochondrial numbers and making the mitochondria more efficient means that I can't as much cell energy.

And I may be more tired and more fatigued and not feel quite as good. But the mitochondria in general is not technically broken under that state, at least early on. It's just being downregulated. Does that make sense?

I'm not sure if I answered your question.

Speaker B: 00:20:52

My question is obviously it's. It can be probably brought back to. But. But that is my question.

If somebody is completely burned out, exhausted, metabolically stuck, what is the process of restoring mitochondrial function or just the body's energy production, how restore that function?

Speaker A: 00:21:13

You have to identify what's creating the excessive stress cell stress response. Here's the issue is that most people would say I need to provide more thyroid hormone, right?

If you're tired and fatigued, let me just give you more thyroid hormone. But more thyroid hormone may increase the mitochondrial density.

It means there might be more mitochondria, but more mitochondria that don't have the resources to work appropriately creates excessive oxidative stress. It's probably going to be more problematic if you give somebody too much thyroid hormone. So that's not necessarily the best strategy.

The best strategy, and what I've been employing for decades, is we want to make sure that they have enough thyroid hormone to replace potentially what a gland would have made, but not more than that if we're trying to help them to recover their physiology.

So if a thyroid gland makes T4, a hundred micrograms of T4 and five to ten micrograms of T3 they shouldn't need more than that to replace what the gland would have made. If they still don't convert T4 to T3, well, it's because they have this inflammatory cell stress mechanism going on.

And more thyroid hormone into that system is not going to make those mitochondria work effectively or restore normal operating physiology.

So what we need to do is say, do I have enough thyroid hormone here, especially T4 to support basic functions, the ability for, do I have enough T4 to be able to convert to T3 inside the cells and tissues? And if I do, then how we help these people heal and recover their thyroid physiology is to let them know that you're not in homeostasis.

That's why the medication's not working right. Instead of gaslighting them, that you're optimized or you're normalized with medication.

There's no level of medication that's going to restore your physiology if you're in this state. So stop thinking you're broken. That changes their mindset a little bit.

And then say, now we need to get busy figuring out what's contributing to the successive stress load. Is it dietary stressors, life stressors, relationship stressors, financial stressors? Like what is contributing to an excessive load.

And if we reduce or eliminate that load and raise their level of health and their, their social well being and their financial well being and we improve their diet, that's how they're going to recover in time. It's not about 40 bottles of supplements. It's not about the magical dose of T4 and T3. Those are all management strategies.

Something an excessive cell stress load created it for your clients or for the people listening to this, they may like, well, everybody's got stress. I agree, we all do. But not everybody under the same stress has the same response.

It's about our adaptability to the stress load and it's our perception of those stress, those different stressors. Right.

So the analogy I typically use is if I have two cinder blocks and I put a board across the cinder blocks and we think about our ability to adapt to the stress in our life, like the ability of that two by four to adapt to the stress I put on it. And every. My work stress is a 5 or a 10 pound weight and my rel.

My stress with my wife is a five or ten pound weight and my kids a five or ten pound weight, and my financial issues a five or ten pound weight and my poor nutrition and the alcohol and I start loading those things on, I'm going to get Close to the capacity of the board.

So if I'm at 95 pounds of stress of weight on that 2 by 4 and the capacity is 100 pounds, it probably is only going to take a little bit more weight, five pounds and I break that board. So now my dog passes away, I'm emotionally distressed. There's, that's another 10 pound weight I add to that board. The board breaks.

From a physiology standpoint, now I'm in fight or flight. I can't adapt to this level of stress.

So my body has to start down, regulating metabolism, increasing inflammation, this big level stress, I managed it before fine. I was healthy, I didn't have high blood pressure, I didn't. My thyroid physiology was working fine, I was maintaining my weight.

But now since that trigger, it can't recover. I'm chronically inflamed, I'm gaining weight, my thyroid physiology is not working well. My, I'm over the dog, I got a new dog, why can't I recover?

Because the body is still operating as if you're in danger. So think about that board.

If the board was at £95 and managing £95 just fine, but I put 10 more pounds on and the board broke and I take the 10, the last £10 back off that board. Is the board fixed? Still broken. It still won't hold weight. So what do I have to do?

Can I just pick up the two pieces of wood and screw them back together?

I could, but what I have to do first is I have to pull almost all 95 pounds of weight that's on top of those two broken pieces of board off so that now I free up the board and now I can repair the board. So for our physiology, once we enter that danger physiology, maybe it was that last virus that did it.

It the last argument with my spouse that did it, getting fired that did it. If you got a new job but you're stuck in the operating mode, how do you recover?

You've got to look at all the other stressors that you were managing before and really reduce them so that the cells can start to perceive there's less danger threats. And now the cell can start to say, okay, danger's going away. Now I can start to shift back to normal physiology.

So we have to not just remove one thing, which we often talk about in functional medicine. You have to deal with the root cause. It's, it's bacteria, it's a parasite, it's a this, it's a that, it's usually not a thing.

If you've been Doing this for any length of time, you realize they got emotional stress, they got life stress, they're oral, they got bad oral health, their guts a mess. And we give them a gut protocol for 30 days, and we're like, okay, yeah, that felt better.

And then 60 days, 90 days later, they call back like, my gut's a mess again. Your protocol didn't work. Sure it did. It worked for the 30 days, but you weren't in a healing mode.

So all I did was manage your gut dysfunction for 30 days.

And because you still were had all this stress, life stress, work stress that you couldn't manage, your gut got down regulated again and became problematic. Same thing for thyroid physiology. Thyroid physiology is being down regulated because they're in that cell stress response.

We give them a little bit of T4 medication or T3 medication, and they get that hit where they feel better. Then the body's like, whoa, we're trying to slow down the medication. And within a short period of time, it starts deactivating that T4 and T3.

And now I don't feel good again. So what do you do? You go back to your thyroid doctor and they give you. Let me give you a little bit more. Okay, I got a.

Okay, that's a little bit better. And then it doesn't work after a while, and they start riding this roller coaster ride of which medication increase it. Now I'm. Now it's too much.

Now I can't sleep and I'm anxious. Okay, let me decrease it.

But the thing that the doctor's missing, the thing that the patient's missing, is you're never going to optimize your thyroid physiology.

If you're in an allostatic state, you can manipulate the blood levels to make somebody feel good about what they're doing or make you think that you're fixed, but you'll never be fixed. In that model, you have to address the stressors that created the problem to begin with.

Speaker B: 00:28:02

So you need to remove a lot of this allostatic load that you mentioned on the board with your analogy.

I'm assuming then we have to work on our nervous system regulation because we have to give safety signals to our body that it's okay to turn things back on to get out of this adoptive state. So what does that actually look like in practice for someone who's deep in metabolic burnout?

Speaker A: 00:28:30

In my practice, what does it look like?

Speaker B: 00:28:32

Sure.

Speaker A: 00:28:33

So when somebody comes to me for help, one of the first things I want to know from them is, what are you trying to accomplish? And somebody says, hey, I just want to feel good. Okay, all right, well, do you want to just manage the condition?

You just want a, a type of medication that's going to manage. You just want to know what medication is going to make you feel good? Yeah, that's a management strategy. What the dose should be, I have no idea.

Because the dose today is going to be different than the dose next week, next month, next year. Because depending on the stress load on your physiology, it's going to change. That's not what I do.

If you want to try and recover your thyroid physiology, I can help you with that. But you got to be willing to identify what the stressors are and actually make some life changes.

If we don't change something about your habits, your behaviors, your life and what's going on in your environment, why would you change?

And so once they understand that they're not broken, they're in this holistatic state, that's why the medication hasn't restored their health and they're willing to make some changes, then we use questionnaires, health history surveys say, to look at. Currently I look at about 17 different areas of their physiology, areas of stress in their life, life.

And we scale those things and say, okay, where's the weakest points at? And those are the things we're going to start with. Maybe it's somebody who's got like, I hate my job.

Okay, if that's the elephant in the room and you hate your job every day and you're telling yourself you hate your job every day, you're triggering stress behavior on your nervous system and your physiology. So you're, you're training your brain to be in this stress state. What's going to happen? Gut's going to be downregulated.

Sex hormones are going to be downregulated. You're going have a chronic inflammatory state. So we have to address it. What can we do? I can't change my job.

If you can't change your job, then we need to change your perception of your job. Why do you hate it? What do we need to do? Start working on that process. And what's the next system that's really struggling.

I rate my relationship stat. Health like a two out of three out of ten. Ten's good. Zero is bad. Okay, we're gonna have to address it.

Because if we don't address the things that they had the least, the lowest level of health in, there's no way you're going to restore their physiology. There's no way you're Going to restore their gut physiology, their sleep, their respiration, all these key systems.

So we got to look at what's the weakest areas and start to improve them. And that it's not sexy. I know that people prefer, like, what's the magic supplement? Like, what can I take to just make my thyroid work?

Well, there's not enough drugs in the world.

If you hate your spouse every day and you live with them and you lay down with them at night and you're telling yourself you hate them, you hate them, you hate them, there's not enough supplements or drugs in the world that are going to make you normal. You have to either change the situation or change your interpretation of the situation.

And this is where people say, like, you like I should be stress free. No, stress is good. Stress is what makes us stronger. It's why I work out every morning, because I'm stressing my muscles.

But if I stress the muscles give them a chance to recover. My muscles are bigger and stronger tomorrow than they were today.

Stress in our life is good and we perceive it appropriately, we chat, it challenges our system. And then if we were right in the right mind frame and we're not in an allostatic state, then we can be more resilient later.

There's too many people don't realize they're already in an allostatic state. They just think this is normal health. They've been, but they've slowly declined into this state. They don't realize what healthy is.

And so we have to get them to understand that these things that are going on in your world, in your sphere, in your environment, are either what make you stronger or are continuing your decline. We've got to change some of them. Even the strategies that we think are help helpful.

Like there's a lot of people who are in this cell stress inflammatory state and somebody is telling them, you need to work out harder. Oh, okay, so I'm unhealthy already. I'm in chronic inflammation. I got down regulated mitochondrial function and you want me to exercise harder.

Does that make sense? Right?

Like I'm gonna break my muscle tissue down with an aggressive workout and then not have healthy enough mitochondrial function to actually recover from it. And that's somehow gonna help me get healthier? No, it's not. So it's a.

The idea is good and exercise is, is critically important, but we gotta consider the load. I'm gonna do sauna five days a week to restore my health, because sauna stimulates the heat shock proteins and that's gonna help My immune system?

Well, you're already excessively stressed. Now you're gonna shock and stress your immune system even more or cold plunge or whatever. They're good things to do in homeostasis or recovering.

But if you're already overloaded, more stress to the system isn't necessarily gonna make somebody healthier.

Speaker B: 00:33:17

I would love to just reiterate this message because a lot of women in the, especially in the biohacking community, people that are like that top 5%, you know, they can tolerate sauna and cold plunge and fasting and exercise and doing a lot of hard hitting workouts.

But people that are in a broken state and fatigued and already sort of don't have enough gas in the tank to even get through the day, they have to be very careful with these hermetic stressors because you may do a hard hitting workout in the morning, but then the rest of the day you have to take a nap because you just don't have enough energy in the system. So how do you get.

It's a little bit of a chicken and an egg situation, because in order to get us back on track, we do need to improve our stress resilience. But how do we start with that process? And you mentioned, okay, we need to start removing allostatic clothes.

So what would be the order of business of addressing that elastic load without adding more stress to the system?

Speaker A: 00:34:27

Yeah, and this is the art, right, of functional medicine practitioners. We love protocols.

Like, you do this first on everybody, then you do this next on everybody, and then you do this next on everybody, and then they're fixed. And that's great.

When we're a new practitioner and we don't know anything, but once you've been in this for a period of time and you've worked, you're like, protocol's not working. Like I was taught at the seminar, if I do this, then this, then this, everybody will get better.

And you realize this person's already had six gut protocols done through six different practitioners, and it keeps coming back. So, yes, their gut is dysfunctional. I need to figure out why they're in this persistent dysfunctional state in their GI tract.

They have an excessive level of stress, their nervous system's wound up. Many times we'll look at, okay, what's the diet? We want to make sure we're at least putting healthy fuel into the system.

We want to make sure there's appropriate calories for what their burn rate is and what their metabolism is is doing. Many times for me, it means eliminating their supplement load.

That they're coming to me with it means making sure they're not over medicated for somebody who's trying to recover and then the next thing and to do is based on my process, what are the biggest stressors that are impacting this person? Because if I can influence the biggest stressor in this person's environment, that's going to move the needle the fastest. Does that make sense?

So if I have somebody whose biggest stress is their spouse, I need to address that almost right away.

I want them to be eating that healthier food because when they're upset and mad at their spouse and they hate their spouse, they're probably going to eat and drink more, maybe eat more crappy food and drink more alcohol. So I need to address that. Right.

They may be taking excessive thyroid medication or other medications, manage the symptoms of that are triggered by that. So we want to make sure they're on an appropriate dose.

But then I, and I may still, if their gut's inflamed and they've got multiple malabsorption and micronutrient deficiencies going on, yeah, I may have to manage their gut. What? But I got to address the elephant in the room which is the biggest stressor.

So if that's the big stressor then I need to start talking to him about what can we do to change this or improve this. There's nothing we can do. I just have to ride it out until my kids are graduate high school.

Okay, well then we're going to be managing you for a while and then if we're going to get you from allostasis to homeostasis then and we know that that issue with your relate that your spouse is like a 60 pound weight on that board, then we've gotta all the other things that aren't very big stressors in your life, the way you work out, the limited sleep, some of the bad influences, bad habits that you have, they're all gonna have to be cleaned up to be able to manage this elephant in the room appropriately without it keeping the danger response.

Speaker B: 00:37:24

I would love to switch over to talking about a little bit of hormone replacement therapy because I know you have some strong opinions on that.

And a lot of women, especially in the perimenopause menopause age group, you know, we know that estrogen and progesterone play a direct role in mitochondrial function, metabolic regulation. What's your take on hormone replacement therapy especially for women that are sort of tail end of perimenopause or in a post menopausal state?

Speaker A: 00:37:54

So if somebody wants to take bioidentical hormones or any kind of hormone therapy and they feel good and they function good and they're happy with it, great. Doesn't bother me at all. But if you ask me, do I think every woman needs hormone replacement therapy because estrogen level goes down with age?

No, I don't. I would love to have this debate with anybody because there are people who are big providers of it.

If that's what you do and that's what you want to do, and that's what your patient wants, you should be doing what your patient wants. Sense.

But to tell women, all women, that the innate intelligence of the body decided it was going to screw women over once they hit middle age and not provide enough hormone for them to survive and function appropriately, that's nonsense. Or every woman would have that issue.

So my opinion on why women have bigger challenges as they go into menopause is because as they shift into menopause, they already have inflammatory issues going on. They already have reduced adrenal function, they already have reduced T4 to T3 conversion.

And when the ovaries are not making sufficient amount of estrogen anymore, and now you're totally relying on the adrenal physiology to produce androgens so those androgens can go make estrogens. If that process isn't working, you're going to feel like crap. And you're correct.

Estrogen does drive mitochondrial function, and progesterone is a steroid that helps manage some of the immune inflammatory processes and makes us feel good.

But I just don't believe that the divine intelligence that created human beings decided that, hey, we're going to, we're going to shaft women once they turn 50, their physiology is going to break. If that was the case, then every woman would have the same experience. And it's not. Not every woman needs it. Some women feel fine.

But what happens is when you have this chronic cell stress inflammatory process going on and you have a dramatic drop in estrogen, on top of having inflammation and on top of having reduced T4 to T3 conversion, you're not going to produce sex hormones at a level that's going to be able to support your physiology. And so people are like, well, the ovaries aren't there there. It's not making enough estrogen.

Well, in the second phase of life, where does it come from? From it's coming from your adrenal tissues. How do you make it in your adrenals?

You have cholesterol from your bloodstream bound to HDL docks to your adrenal gland with the help of T3. Because T3 helps regulate that HDL receptor on the adrenal gland, the cholesterol is now transported into the adrenal gland.

Now, the adrenal gland has some ability to make its own cholesterol on its own. But most of the adrenal hormone production comes from cholesterol coming into the body with the help of T3 and HDL.

Then that cholesterol needs to go to the mitochondria and be converted into pregnenolone and down the other downstream hormones. Okay.

If you have decreased conversion of T4 to T3 in the cell because it's, there's inflammation going on, if you have reduced circulating T3 to come into the cell or there's reduced T3 inside the cell, mitochondria is downregulated. We already said that there's less mitochondria under the cell stress response to be able to convert the cholesterol into those precursor hormones.

So there's less DHEA and androcentadione produced. There's less DHEA and andcrocentidione to go out to the tissues to be converted into estrogens.

So what we should be doing when we say that, hey, this woman needs estrogen, if we look and their cholesterol levels are elevated and their T4 to T3 conversion is down, the reason they can't make the estrogen is because the physiology is not working appropriately. And if the person wants a management, hey, just give me some hormones so I feel better, great, I think that's fine.

Just make sure they have the ability to detoxify those things appropriately out of the system. But if they're saying, hey, why is my sex hormone physiology not working appropriately?

And we just tell them, because your body is broken and it can't make it anymore, I think we're doing a disservice to women. It that's the part that I get upset about people. I am not anti hormone replacement therapy. I am pro woman.

And I want women to feel well and feel fantastic. But we also need to tell them that the answer is that you're a slave to your somebody giving you bioidentical hormones for the rest of your life.

That's not recovering their normal physiology. That is managing their physiology.

And then we have another consideration that we have to consider, which is, is if I start loading them with these hormones, how does the adding those additional hormones to a system that at this age didn't necessarily need them because the physiology downregulated those systems. Now we're putting more hormones into a system that may not be able to regulate them well. And what problems does that create?

Does the extra estrogen now contribute to more sex hormone binding globulins? And now there's less breath hormone available, especially thyroid hormone. Is that contributing to a greater thyroid problem? It creates an issue.

So I'm not opposed to it, and I know people think I am, but I'm not. I'm pro. If you said to me I want to be on hormone replacement therapy, great. I have patients that are on it.

And I'm like, do you want to address why you can't make it? No, I just want to take it and feel better. Right. Let's just make sure all those detoxification pathways work.

I don't prescribe, but go ahead and get it. Let's manage it. What's the level your doctor wants to keep you at that. They don't have a level. They just want me to feel good. Okay. Okay.

So we don't have a. We're just doing it to how you feel. That is not functional medicine approach. In my opinion. That's a management approach.

That's an allopathic approach. So what's the level that's appropriate for somebody if we're going to use it? And can they use it appropriately?

And can we metabolize that extra hormone we're putting into the system? Those are the things that are concerns for me, but I'm not opposed to it.

And I think some women definitely can benefit from hormone replacement therapy. But I don't think it should be like everyone at 50, you got to check in at the gas station and get your hormone replacement therapy because you're.

You just can't do it anymore. I don't believe that. You may and other people do. And I. I know I've gotten some comments from people that are upset. Like, I feel so good on it. Great.

I'm. I'm not opposed to you taking it, but I'm. My point of view is that that. Shouldn't we ask why?

If you're a person that believes that the body can't do it, it's broken, it can't make sufficient hormone after a certain age, then yeah, you're going to manage. That's why. That's what allopathic physicians think about thyroid. They think that the thyroid gland is dysfunctional, it can't come back.

Therefore, we have to give T4. We're doing the same thing when it comes to hormone replacement.

It's my opinion, in my experience, that if we address the root issues as to why they can't make it, they can make enough for their age to feel and function optimally in most cases.

Speaker B: 00:44:50

I definitely agree with a much more nuanced approach with hormone replacement therapy.

And I, if I understand your position, you basically just saying that the underlying issues still need to be addressed because I do see a lot of women that are already on hormone replacement therapy and either.

And not on the right dose, or are they still dealing with a lot of other symptoms such as fatigue and things that could be related to hypothyroidism as well.

So clearly the hormone replacement therapy for them, it may help a little bit, just eliminating some symptoms, but clearly they still haven't addressed a lot of those. The elastic load that you mentioned. So do I understand that correctly?

Speaker A: 00:45:33

Yeah, absolutely. So if you had high blood pressure and I give you a blood pressure medication, did I improve your blood pressure?

Speaker B: 00:45:40

No. I mean, on paper, yes.

Speaker A: 00:45:44

Did I fix the physiology that created it? No. Could that blood pressure medication, the longer I take it, lose its effectiveness or create a problem? Sure.

Same thing with thyroid hormone medication, same thing with hormone replacement therapy. We put these things into the system, assuming that they're going to work as if the person's in homeostasis. They are not.

So if we're going to put something into the system, it may work for a while at a lower dose and make us feel a little bit better, but it's not going to probably last. And we're going to have to be tinkering with the dose to maintain it. Right.

People get their first hit of a drug and they're like, whoa, that was awesome. The next hit doesn't have the same effect. So they got to do more. And they got to do more. They got to do more.

And this is where we get people, especially in the thyroid world, that, like, I just had one this week come in. Who's taking, I think, 140 micrograms of T3. I think they're taking, I don't know, 20 or 30 or 40 micrograms of T4.

And their doctor said they're optimized. All you have to do is look at them. They're not optimized. Optimizing the blood doesn't restore physiology and the body will continue to adapt.

That person started on 5 micrograms of T3 and with some T4, and now they're at 130, 140 micrograms of T3. Does that sound like optimization? If we're giving them four times the amount of T3 that the body would make in any given day. That's optimization?

I don't think so.

Speaker B: 00:47:09

So just to wrap, wrap up the conversation, I'm, I'm curious, what is full thyroid recovery actually looks like? When you work with your patients, do you look at any lab markers? What symptoms or metabolic signals tell you that someone is fully recovery learned?

Speaker A: 00:47:26

Recovery to me for some people means they no longer need any thyroid medication.

Their thyroid labs are normal, they feel good, their function good, their blood sugar's in a normal place, their liver markers are normal, the inflammatory markers are normal. All the tissue indicators of tissue hypothyroidism are non existent.

They're at an optimal body weight, they feel good, they function good, they're not on thyroid medication. For some people, that's what that recovery means. For some people, it means that they're on some level of thyroid medication.

That thyroid medication they take converts appropriately to T3. And it's not more than a thyroid gland would make. And oftentimes it's less than a thyroid gland would make.

And not only does it normalize their thyroid labs, but it improves their glucose and insulin resistance. It's restored their cholesterol levels to a normal level. It's improved their sex hormone production.

It's improved their GFR and their renal function and adrenal function. And so we see the tissue markers of hypothyroidism, they're still on it.

They may have had atrophy of the gland because they've been over medicated or they've had too much damage to the gland, but they still need some. But it actually restores health. Okay, if you've had your thyroid gland removed, you will need thyroid hormone for the rest of your life.

But we want to make sure if you need more than a thyroid gland would have made, then there's something else going on. One that's preventing the conversion of T4 to T3. I need like way more than my thyroid glands should be for my size and my weight.

Well, then you have, maybe you have a gut issue, maybe you have a malabsorption issue. Maybe there's an inflammatory issue, an infection issue, an oral infection that's reducing T4 to T3 conversion.

If we're going to help you recover, we got to deal with the infection. So now that T4 to T3 conversion occurs and you don't need more than a gland would have made.

So it doesn't mean that you don't need medication, but the medication restores signs and Symptoms and restores chemistry.

Speaker B: 00:50:04

So what is for, for like 130 pound female, what is like a physiological dose of thyroid medication? Whether it's a combination of T3 and T4 or can you give me an example of what that.

Speaker A: 00:50:16

Let's just say on average somebody about that size, right, their thyroid gland was cut out, removed, maybe an appropriate dose, maybe somewhere between 88 and 100 micrograms of T4 and 5 to 10 micrograms of T3.

And then, you know, we would look at, at their chemistry to see if you had a 150 pound person, they might need a little bit more T4, maybe not 5 micrograms, but maybe 10 micrograms of T3 to replace. But it would depend on how much damage was done to the gland. How do we know how far is the TSH being suppressed? Right.

If we're giving so much thyroid hormone that TSH is being suppressed too much, that might be too much. So we look at the reverse T3 and look at some of those other markers. Look at the free T3 to free T4 ratio. We can see how well they're converting it.

But, but we can't assess thyroid physiology by just looking at a thyroid panel. We have to assess thyroid physiology by looking at the thyroid panel and the rest of a metabolic panel.

We have to look at inflammatory markers, we have to look at tissue markers of thyroid status. We gotta look at the patient and listen to the patient's signs and symptoms and not gaslight them.

The other thing that's really important is so many people are told that their labs are normal. So they're normal. Anybody, anybody can read a lab report and look for an HRL in a lab report.

If you've passed second grade, you know what an L looks like and you know what an H looks like. People who just read labs are managers. That's different than what some of us do, which is interpretation of labs.

And so when I look at a lab report, I need to determine is that lab value normal or what some people would say optimal and is it appropriate. So if you came in and said, I have.

Have hypothyroid signs and symptoms, you look like you have them, you feel like you have them, and your TSH is 1.0. Yeah, it's normal, but it's inappropriate for you. I can see that you have signs and symptoms of hypothyroidism.

I'm not going to gaslight you and tell you, yes, that's normal. So you don't have a thyroid condition. I would look at that TSH and say, wait a second. What's the T4 level? What's the T3 level?

What's the reverse T3 level? If TSH is. This is 1.0, do I have enough T4, T3 in the bloodstream?

If there isn't enough T4 and T3 and you could have normal TSH and low T4 and T3, then I've got to go look at the rest of the labs and say, is there inflammation in here that's causing the TSH to be suppressed, resulting in low T4 to T3 conversion and causing the person to have the symptoms? So we have to interpret the labs. So we interpret the labs. Is the lab normal and appropriate for the patient and sitting in front of me?

Is the lab value normal and inappropriate for the person sitting in front of me? Is the lab value abnormal but totally appropriate? If you had.

If you're sitting in front of me with signs and symptoms of Hypothyroidism and your TSH is 7, you may say, oh, my gosh, that's terrible. No, it's. That's awesome. Your TSH is elevated. Now let's take a look. Yes. You're not making enough T4.

Your labs are abnormal, but they match your signs and symptoms. We know you've got some conversion issues and production issues. Now we can start to identify why.

If we don't interpret it appropriately, then we can't help our patients. But too many people just get.

We manipulate their blood levels into an arrange an optimal or a normal range, and we assume we fix them and then we gaslight them to tell them you're optimal. We've fixed you, your T3 is normal, therefore your thyroid's optimized and it's not. So we have to interpret labs.

The other thing I like for me when I'm looking at labs, even if the full thyroid panel was normal, do they have inflammation? Yes. Is their glucose transport reduced? Yes, they have glucose resistance. Is their GFR depleted? Yeah, it's down at 70.

Well, then they don't have enough T3 to run the GF, potentially run their kidneys. What's going on with their cholesterol? It's elevated. Okay. They don't have enough T3 to either get it out of the.

Into the liver and get rid of it or get it into the tissues and get used.

So I not only look at the labs and interpret the thyroid panel, but you also have to look at the labs or patterns of inflammation, cell danger response, and tissue hypothyroidism it's way more complex than just saying, oh, what's your T3 value? Or what's your TSH? That's what managers do, and I apologize to any of my colleagues who they like to do that. I'm not saying you're wrong.

If that's what your goal is with a client and that's what the client wants, that's what you should do. But if the client wants recovery and you're trying to optimize them as if they're in homeostasis, you're never going to achieve recovery with them.

Speaker B: 00:54:49

Well, thank you so much for this conversation, Dr. Eric where can our listeners find you? How can they find your book? If you could just repeat the name of your book, Tell us everything.

Speaker A: 00:55:00

Sure. I have a podcast called Thyroid Answers, so wherever you listen to podcasts, you can listen to that.

I have a book that I wrote with my friend and colleague Dr. Kelly Halderman called the Thyroid Debacle, and I'm on Instagram, Dr. Eric Walcavage.

That's where usually my team puts most of my content out, and my office website is rejuvencenter.com the views expressed on this podcast are solely those of the speakers and do not reflect the host's opinions. The content is for informational purposes only and is not a substitute for medical or nutritional advice.

Always consult a licensed healthcare provider.