Sedona Retreat 2024

Thyroid Answers with Dr. Eric Balcavage

Picture of podcast cover art with Christa Biegler and Dr. Eric Balcavage: Episode 290 Thyroid Answers with Dr. Eric Balcavage

Our first episode this week on The Less Stressed Life Podcast, I am joined by Dr. Eric Balcavage.  It’s a GOOD week on the podcast if you are interested in thyroid.  In this episode, we discuss all the things about thyroid physiology. Plus some rapid fire questions at the end from our audience.


  • Allopathic vs functional medicine approaches
  • Vitamin D relationship to thyroid
  • Different stressors & their effect thyroid hormones
  • Multi-system adaptive disorder


Dr. Eric Balcavage is the owner and founder of Rejuvagen, a functional medicine clinic in Chadds Ford, PA. He is a Functional Medicine Practitioner, Board Certified in Integrative Medicine, along with being a licensed Chiropractor in Pennsylvania.
Dr. Balcavage is the co-host of the Thyroid Answers Podcast. The podcast focuses on answering the pressing questions those suffering from chronic hypothyroid symptoms can’t get answered elsewhere. You can find his educational Thyroid Thursday videos on Vimeo and YouTube.
Dr. Balcavage has made it his mission to change the way medicine looks at hypothyroidism. He is the co-author of the book, The Thyroid Debacle, which addresses the problems with current allopathic and functional medicine approaches to hypothyroidism as well as the solutions to restoring thyroid physiology.

Listeners can schedule a free discovery call with Dr. Balcavage at:
Listeners can receive a free ebook at:


Leave a review, submit a questions for the podcast or take one of my quizzes here:


[00:00:00] Dr. Balcavage: Giving something to the person that their body doesn't want, and making the number look good in the blood doesn't necessarily fix the issue. 

[00:00:09] Christa: Stress is the inflammation that robs us of life, energy, and happiness. Our typical solutions for gut health and hormone balance have let a lot of us down we're overmedicated and underserved at the last trusts life.

[00:00:25] Christa: We are a community of health savvy women exploring solutions outside of our traditional Western medicine toolbox and training to raise the bar and change our stories. Each week, our hope is that you leave our sessions inspired to learn, grow, and share these stories to raise the bar in your life and home.

[00:00:53] Christa: All right. Today I have Dr. Eric Balage, who is the owner and founder of Rejuven, a functional medicine clinic in Chads Ford, Pennsylvania. He's the functional medicine practitioner, board certified in Integrated Medicine, along with being Alysis chiropractor in Pennsylvania. He is the co-host of the Thyroid Answers Podcast, which focuses on answering the pressing questions, those suffering with chronic hypothyroid symptoms can't get answered elsewhere.

[00:01:16] Christa: You can find his educational thyroid Thursday videos on Vimeo and YouTube. He recently wrote a book called The Thyroid Debacle. We'll talk a little bit about that today with Dr. Kelly Halderman that addresses the problems with current allopathic and functional medicine approaches to hypothyroidism, as well as solutions to restoring thyroid physiology.

[00:01:31] Christa: And man, what a good topic. We were just talking offline how this interview happened, but he had been on my list for a long time, Dr. EZ, for quite a while to talk about thyroid. And man, I'm gonna ask you, I hope lots of good and hard questions today to serve our audience very well. Welcome aboard. 

[00:01:47] Dr. Balcavage: Thanks for having me on the podcast.

[00:01:49] Christa: Yeah. Well, tell me how you got so interested in thyroid. Where did your passion for thyroid really start? Because you've carved out quite the corner of the world or the internet on it. 

[00:01:58] Dr. Balcavage: Well, I had like no interest at all in thyroid physiology, to be honest. I was a medical technology major, wanted to go to med school, wound up going to chiropractic school instead.

[00:02:07] Dr. Balcavage: And so once I found chiropractic, I really didn't wanna have anything to do with allopathic medicine. I was happy doing that. I had a family member get diagnosed with hypothyroidism, fibroids and iron deficiency, and the solution for her was, uh, hysterectomy thyroid medication and. Iron replacement. And my sibling reached out to me and said, Hey, here's what's going on with his spouse.

[00:02:33] Dr. Balcavage: And I said, why are you, why are you calling me? You know, what do you want me to do about, that's not what I do. He said, because you're gonna figure it out. And so I started getting it back into my blood chemistry roots from my medical technology days and kind of seeing what's going on. Then I found functional medicine.

[00:02:48] Dr. Balcavage: I was like, all right, I'll take some of this stuff, try and learn some of this. I found ATIs Krai, and he'd had a book come out. So I was digging into that and I was like, oh, she's got an immune autoimmune issue. That's what's going on. And so we started, I'm like, here's what I think. Her medical doctors didn't want to hear it, but that started the process of trying to help her through this process so she wouldn't have to, you know, have her, you know, hysterectomy and be, you know, a lifetime of, you know, kind of ignoring the root issues.

[00:03:12] Dr. Balcavage: And so I, I started helping her. As I'm doing that, I'm talking to my chiropractic patients. You know, you are always looking for something to talk to people about while you're on a, working on 'em and start talking to what I'm learning, and I realize that. Man, almost half of my patient base has is on thyroid medication.

[00:03:26] Dr. Balcavage: I never really paid attention to it. And they're not happy and they don't feel good. And so that's, I started to, those clients say, Hey, I'm, I'm doing this functional medicine thing. You know, started taking on some, your chiropractic patients don't really look at you now as the functional medicine specialist, right?

[00:03:42] Dr. Balcavage: They're like, oh no, you're my chiropractor. But that led to me to talking about things. And the more I started digging into the science and literature, the one thing I really hated was reading sciencey. Growing up and now I became this, who started reading all this stuff and then that just kept going. And then I met, uh, a guy named Dr.

[00:03:59] Dr. Balcavage: Ben Lynch when as I was digging into methylation and got in with him, and as we were working on some of his conferences, he's like, man, your opinions are a lot. Different than everybody else. Even in this space, you probably should write a book. And I'm like, I don't even know what I'm doing, writing a book.

[00:04:15] Dr. Balcavage: And he said, well, I think you should go write a book. So go write a book. And so set out to write the book. And it took more time and effort than I was gonna take, but here we are today. 

[00:04:25] Christa: Yeah. And now it's like a podcast and a video series and it's your whole thing. Mm-hmm. So, yep. I guess life happens. So you dug into the blood chem.

[00:04:33] Christa: We'll come back to that. The first thing I wanna know was, and thanks for reminding me, Ben Lynch was on my list of people to contact today because why is all of our stuff out of stock? Because life right now, the last couple of years, right? Yeah. Tell me, what about your opinions were different that were rocking 

[00:04:50] Dr. Balcavage: the boat?

[00:04:50] Dr. Balcavage: Well, there's two kind of approaches when we think about thyroid physiology. One is the allopathic approach that you don't have a thyroid disorder, hypothyroidism, let's say, until your gland is shot. You've lost 90% of the function of your gland. Your tssh is high, your free T4 is low. And that's when we diagnose somebody.

[00:05:10] Dr. Balcavage: As with a thyroid condition, we only look at two lab values in that model. Many times, only one, just a Ts H, but there's no official diagnosis of hypothyroidism and no treatment until you get to that point. And so if you're struggling with hypothyroid signs and symptoms, they're not thyroid and signs, hypothyroid sentence symptoms because you don't have glandular hypothyroidism.

[00:05:30] Dr. Balcavage: So it's like saying you don't have a blood sugar problem because you're not diabetic yet, but everything is a process. So that's the medical model. I understand why they think that way because they don't have any other option. Their treatment is thyroid replacement therapy. So if my only solution is thyroid replacement therapy, why would I diagnose you with something that I can't help you with?

[00:05:51] Dr. Balcavage: So we'll wait until you have something I can diagnose you and treat you with. But now we have this functional medicine model, and in functional medicine model, we would say, Hey, those medical doctors are silly. They don't realize that everybody's got. Hashimotos, this autoimmune condition. And most of the allopathic physicians re fully realize that their clients have an autoimmune condition.

[00:06:11] Dr. Balcavage: But in the allopathic world, an autoimmune condition means we don't know what's causing it. So we either put you on immune suppressants or we wait to the tissue that's being as attacked as damaged enough that we can treat it. So they already know they don't need to run thyroid antibodies. They already know it's an autoimmune condition, but we thought, oh, you silly doctor.

[00:06:27] Dr. Balcavage: So we run more comprehensive panels and we don't just look at ts H and free t4, but we look at the thyroid antibodies and we look at T3 and free t3 and we look at T3 uptake and we look at a fuller panel. And because we're better and we see that T4 isn't converting to t3, cuz we can see it because we're running it and we can see maybe more T4 s being deactivated.

[00:06:50] Dr. Balcavage: We fully realize that the problem is that they have an immune issue. But the other problem that the medical doctor's missing is they're not converting T4 to t3. And so therefore we're gonna give them t3, and that's better. And to me, it still doesn't make sense when you understand the physiology, at least from my perspective, giving something to the person that their body doesn't want and making the number look good in the blood doesn't necessarily.

[00:07:16] Dr. Balcavage: The issue. And so I had a hard time with that. And I also had a hard time with the idea that your immune system's outta control and it's just attacking your thyroid gland. Like you woke up one day and your immune system said that thyroid thing, we don't need it anymore. I don't even understand what it is to do in there.

[00:07:29] Dr. Balcavage: Let's get rid of it and attack it. And so I don't think. What we see is an immune system that's out of order, that's lost control. I think what we see in thyroid physiology is not broken. It's adaptive changes that the cells and tissues and the immune system are making to excessive cell stress, which is a different approach than many in our functional medicine space.

[00:07:52] Dr. Balcavage: Believe. They believe it's just a conversion issue that your immune system, that your body's deactivating it for some unknown reason or profe to. You're deactivated reverse t3, and that verse, T3 is blocking the T3 from working and alls we have to do is get rid of all the T4 and put T3 in and we've solved the problem, but it doesn't work.

[00:08:12] Dr. Balcavage: Okay. At least it doesn't work for a lot of people. I think it's a different issue. I think there's excessive cell stress cells in excessive. Adaptively down-regulate their metabolism. They stiffen their cell membranes. They reduce mitochondrial ATP production. They reduce the amount of fat that's being used as fuel.

[00:08:31] Dr. Balcavage: They increase the amount of glucose that's being used as fuel. They de oxygen transport into the cells and tissues. They increase inflammation. Essentially what cells under perceived stress due is down-regulate the manufacturing process and ramp up the inflammatory process. And one of the tools that's used to do that is a reduction in T3 inside the cell.

[00:08:51] Dr. Balcavage: So the very thing that we're looking at as the problem, oh, your body forgot how to convert to t4, to t3, your body didn't. It's doing it adaptively. And when that cell stress, cell danger physiology become. Is short term, you get local tissue deactivation habits for a short period of time. You deal with the threat and then your physiology goes back to normal every time you've had a cold, a virus, what?

[00:09:15] Dr. Balcavage: Short term sickness you've had. Cellular tissue, hypothyroidism. But when that cell strep comes chronic and persistent, that. Can lead to the thyroiditis that we see at the gland. So it's not, in my opinion, many times, not an immune system that's lost control, but an immune system that's actually being directed to create the damage at the thyroid gland.

[00:09:36] Dr. Balcavage: I think it's more of an adaptive response, and I think it's a better position to come from because if you tell your patient you have an autoimmune disorder, your immune system's outta control and your body's attacking you, that does not put somebody in a good healing mode. Versus if you tell somebody, Hey, there's excessive cell stress.

[00:09:53] Dr. Balcavage: And what your body is doing is trying to slow the metabolism down to protect you. And one of the things that has to do is reduce the amount of thyroid hormone available. And so if we can address the stressors that are causing your immune system to be upregulated, address them, reduce them, remove them alatum, and support the recovery back in normal physiology with our gland and the conversion could start to recover.

[00:10:15] Dr. Balcavage: So survival 

[00:10:16] Christa: mechanism, body down regulating. To survive, right? I, 

[00:10:20] Dr. Balcavage: yeah, I believe so. And there's been a great paper written, you may have geeked out on this paper called The Cell Danger Response by Dr. Robert Navio, who talks about all seven or eight kind of bigger concepts of what's involved in the cell danger response.

[00:10:33] Dr. Balcavage: And he talks about like these big AIDS steps that happen with that cell danger response. The one thing he does not mention in that paper is thyroid physiology. Hmm. And when I read that paper, I was like, how could he miss the, what's going on with thyroid physiology? Now if you read the works of Dietrich, Dr.

[00:10:49] Dr. Balcavage: Bianco and others, they'll tell you that, hey, this is an adaptive response. Here's the science that shows it's an adaptive response. So you would think the guy who just wrote the paper, the cell danger response, and how cell membranes stiffen and we decrease glucose transport into the cell and we increase, we down-regulate mitochondria would have something, a blurb in there about thyroid physiology.

[00:11:10] Dr. Balcavage: But when I reached out to him, he's. You know what Eric? I don't know much about thyroid physiology. Hmm. So it was just kind of missing from the paper. But that was my aha moment when I read that paper instead of what I learned like, hey, the immune system's outta control and the body just can't convert T4 to t3.

[00:11:25] Dr. Balcavage: Oh, it's not really broken. It's adapting to something. Yeah. And so the analogy I usually use for my clients is if you were, let's say you were having a big party at your house this weekend for the blizzard conditions, right? And you're cooking, you're cleaning, right? You got all four burners on. Do you have any, do you have any kids?

[00:11:44] Dr. Balcavage: Yep. Three. Okay. So let's say your favorite child is sitting on the kitchen island while you're cooking, doing wash, vacuuming, all that stuff, and somebody breaks into your home and starts attacking your child. Are you gonna continue to cook? No. Are you gonna take the time to turn the burners off? Put everything in nice glass.

[00:12:03] Dr. Balcavage: Tupperware? No. Before you go helper. No. Are you gonna try and slide one more? Load of wash in? Nope. You're not gonna try and finish vacuuming. Nope, not at all. You're not gonna try and take a nap? Nope. I didn't do. You're not gonna go have sex? Nope. So if I walked into your home and I saw that the food is burning on the stove, the vacuum cleaner's running washes all over the place, the place a disaster, I could jump to the conclusion that you're a terrible homemaker, spouse, mom, cook cleaner.

[00:12:33] Dr. Balcavage: Right? I could make that conclusion. Mm-hmm. You could. Or I could say, This is unusual. Maybe I need to investigate why this is going on. Mm-hmm. And go maybe look in the basement for you fighting an attacker. Right. But when we look at our physiology and we see cholesterol high or low T4 to T3 conversion, we just make an assumption that it's broken instead as an Hmm.

[00:13:00] Dr. Balcavage: Why would the body do. I like to come from the perspective that the body's pretty smart. We got to this from two cells. Are you kidding me? We were able to create this from two cells, and yet one day your body woke up and doesn't realize, oh, the thyroid gland is my own tissue. Right? I don't really know how to convert T4 to T3 anymore.

[00:13:21] Dr. Balcavage: I don't buy it. I don't buy it at all. And after 30 years of working with clients, what do we see? Well, when we work on the foundational factors that cause excessive stress, their immune reactivity goes down, their inflammation goes down, they convert T4 to T3 at a better without having to manipulate the values with medication.

[00:13:39] Dr. Balcavage: And oh my gosh, the thyroid glance starts to recover and make more thyroid hormone. Isn't that crazy? 

[00:13:46] Christa: This is a conversation about nourishment, it feels like, right? Because we're in survival and our body doesn't have enough resources to do everything it needs to do 

[00:13:54] Dr. Balcavage: well, I think. Yes and no. Some of us are undernourished, I'm not no sure.

[00:13:59] Dr. Balcavage: Nourished is the right word. Overfed over fed. Right. But undernourished, even in that cell stress response, what do we do? We still put stuff in storage. Mm-hmm. And hide stuff from the threat. Right. Think about iron physiology. When we think about iron physiology, an iron deficiency anemia is the biggest cause of anemia in this country.

[00:14:20] Dr. Balcavage: Hmm. I don't buy it. The biggest cause of anemia in this country is anemia of chronic disease or chronic inflammation. Hmm. So what does that mean for the listener? That means iron's like a teenage boy. Okay. It is always chaperoned in the body. If you leave a teenage boy on chaperoned, they're gonna get in trouble.

[00:14:37] Dr. Balcavage: Okay. If you leave iron un chaperone, it's gonna get in trouble. It's gonna react with something. It's gonna be picked up by a bacteria and organism. So we don't like iron to be too, too free. So we absorb it. We bind it to a transport protein, we drive it around the body. We. Unload it to a tissue, a cell so it can do what it needs to do in any excess.

[00:14:59] Dr. Balcavage: We hide inside a storage unit inside cells, the primary one called ferritin. Okay? Mm-hmm. And for the listener, like who's like, well, what's fair? Ferritin's iron? Right? No, ferritin is not iron. Ferritin is the storage container for iron inside your cells. It should not be in your serum at very high concentrations.

[00:15:19] Dr. Balcavage: It should be low in your serum. But when you have a cellular threat, what is the organi? The, the cells want to hide the iron so that the organism can't get at it. It makes you look anemic. Mm-hmm. And you would say, well, I just need to give more iron. No, we have to ask the better question. Why would the body try and hide the iron before we start to consider We should just give it.

[00:15:44] Dr. Balcavage: Mm-hmm. Why? Because it's really hard to be anemic in this world. Unless you're bleeding out on a regular basis. It's almost impossible to be. Iron deficient. Mm-hmm. Real easy to be anemia of inflammation. So are we deficient in the nutrient? Mm. Maybe, maybe not. Right. But maybe the body's sequestering it, and we do this all the time.

[00:16:06] Dr. Balcavage: New client today, 28 bottles of supplements she's taking based on what her functional medicine practitioner recommended for her. And she said, what do we need to do here? What's your opinion? I'm like, we need to be off everything. Mm-hmm. Like, well, I need all these. I'm like, look, here's your lab work.

[00:16:25] Dr. Balcavage: You're taking massive quantities of B vitamins and you're still showing B vitamin deficient. Well, how could I be deficient? Well, maybe you're not absorbing it. Or maybe what you're taking in your cells don't want or can't use. Therefore, it might be in serum, but it's not getting into the cell. So the idea that we can just overload the system with individual micronutrients and that'll solve the problem.

[00:16:51] Dr. Balcavage: Yeah. Dr. Navio does a fantastic job of that in his paper saying, Hey, in health conditions, here's what you do with vitamin D in unhealthy conditions. This is what you do with vitamin D. And it's two different things. 

[00:17:04] Christa: Ooh, I wanna get into the vitamin D controversy and maybe we should just go there now. I was gonna ask you about biggest threats, it's thyroid function that make this essential.

[00:17:11] Christa: Like what is part of the treatment pie of addressing the thyroid stress response essentially. Mm-hmm. But we can do that or we can go straight into vitamin D controversy because you go, where are you gonna go? Let's go Vitamin D controversy cuz you just brought it up. So I have a huge problem with people just supplementing isolated vitamin D cuz we cause other deficiencies.

[00:17:30] Christa: Mm-hmm. And this is how I feel about a, a lot of individual nutrients. So hopefully we're on the same page. I'm sure we are there. Mm-hmm. What you wanna speak to, you tell me about vitamin D in relationship to thyroid and how we're potentially missing. We're not doing the patient justice or we're not using this properly.

[00:17:48] Christa: Yeah. 

[00:17:48] Dr. Balcavage: So first of all, when we think about vitamin D and people measuring vitamin D, they're not measuring vitamin D. Mm-hmm. They're measuring 25 oh h D, which is the circulating storage form of vitamin D. So you either vitamin D is the this vitamin that we make in our skin from cholesterol, or we absorb it from our diet or from our supplements.

[00:18:09] Dr. Balcavage: Vitamin D then must get to the liver to be converted into what we typically see measured 25 oh h d. To get there, it needs transport binding molecules that require something called magnesium to get them there. Okay. Once that vitamin D gets to the liver, it can be converted into 25 oh h D, which again requires.

[00:18:35] Dr. Balcavage: Magnesium, and then that's the circulating storage form. Then where does it go from there? Well, medicine would, and typically anytime somebody's measured that, that's the only thing they're measuring. If it's low, you need more. If it's high, you probably need more, right. So I mean, that's the way it goes. But 25, oh h d is not, what does the work, what does the work is?

[00:18:56] Dr. Balcavage: 1 25 oh h d, which gets activated when there's decreased calcium in the bloodstream or when there's immune inflammatory infection processes. You get an increased conversion of 25 oh h D to 1 25 vitamin D. What does 1 25 vitamin D do? It's like a steroid. It actually calms down immune system. So I get an infection, the immune system ramps up, then I need to calm it back down.

[00:19:21] Dr. Balcavage: I used 1 25 vitamin D to calm it back down, and we want to assess somebody. Vitamin D physiology. We need to look at a couple different things. We need to look at what's my magnesium level, whether you measure serum, magnesium, R b, C, magnesium, whether you wanna go get a muscle biopsy, that's up to you, but you'll probably do it once you 25 oh h d, which is what everybody measures.

[00:19:44] Dr. Balcavage: But we also need to measure 1 25 vitamin D, which is the activated form. Now, medicine typically, and people who don't measure it, say, well, it's too small to measure. We don't, it can't, we can't measure it accurately. It's the same excuse we gave for why we don't look at the active form of thyroid hormone t3.

[00:20:01] Dr. Balcavage: It's too small. We can't measure it accurately. But if you have an immune inflammatory process going on, we know you're going to cur 25 to 1 25 vitamin D most likely. And when you have high 1 25 vitamin D, what does it do? It suppresses the liver's conversion of vitamin D to 25 vitamin D, so it actively down regulates it.

[00:20:21] Dr. Balcavage: The other thing, we're not considering. Is under certain immune inflammatory processes. We can also deactivate vitamin D to what's called 24 25 oh H D, which requires magnesium. Or we can deactivate the 1 25 vitamin D to 1 24 to 25 vitamin D, which also requires magnesium. So we're not really even looking at the whole picture of what happened with vitamin D, and so we need to consider that we're only looking at this small little picture, not the big picture as to what's going on.

[00:20:52] Dr. Balcavage: If you think you need vitamin D, we also have to consider, hey, my 25 oh H d is low. Well, Are you deactivating it? Do you have not have enough magnesium to make it? Are you over converting it to 1 25? So the body says, Hey, don't do more. Well, you don't know. And we don't measure the inactivated forms at this point.

[00:21:10] Dr. Balcavage: The other thing we have to consider is as you gain weight, more vitamin D goes into your fat cells and people will say, well, it's because it just gets stored there. No it doesn't. It actually makes more room and more space for you to store more stuff. Why does it do that? Well, because if you start crowding your adipose sites with more stuff, that creates more tension, more inflammation, and we don't want to do, that's what just make 'em bigger.

[00:21:36] Dr. Balcavage: Now you got more space. Interesting study. It's a rat study cuz you can't do these studies in humans. But when they got rid of the vitamin D receptors in rats, so the vitamin D couldn't work, they could not get fat. Interesting. Right. But here's the bigger issue. Most people think that they need high vitamin D, so they don't have.

[00:21:57] Dr. Balcavage: Osteopenia or osteoporosis? Well, let's think about what activated vitamin D does. It pulls calcium from your GI tract, so that could increase the calcium in the in the bloodstream. It also pulls calcium from your bone. Mm-hmm. To restore the serum level of calcium, not the bone level of calcium, the serum level of calcium.

[00:22:19] Dr. Balcavage: So then you have to consider, okay, if I'm taking a whole bunch of vitamin D and my serum calcium is still low or it's normal and I'm blasting my myself with it, where's the calcium going? Is it laying down my arteries and causing calcifications of my arteries, my joints, my tissues? Or is it because 1 25 vitamin D combined to CEP vitamin D V D R receptors on cells and increase calcium absorption?

[00:22:47] Dr. Balcavage: Into cells. And most people would say, what is that good or bad? I don't know. Well, some calcium inside the cell, not too bad. A lot of calcium in the cell causes more what? Oxidative stress. Probably the very reason you're trying to take vitamin D in the first place is to suppress the immune inflammatory response.

[00:23:05] Dr. Balcavage: So I don't think it's a great idea. The other reason I don't think it's a good idea is vitamin D and vitamin A have to be in sort of a ratio inside the body. Like it's a four to one vitamin A to vitamin D ratio in the body. And so if you're taking a lot of vitamin D. You typically reduce the amount of vitamin A you absorb and therefore you reduce the amount of vitamin A that's there to do a lot of reactions inside the body.

[00:23:30] Dr. Balcavage: And there's a lot of receptors inside the nucleus in the cells rxr, r a r receptors. These are retinoic acid receptors that help with signaling. So if you're depleting the body of vitamin A, you could negatively be impacting signaling, including thyroid signaling. So is that a great. I don't think so.

[00:23:52] Dr. Balcavage: Right. So I think there's lots of problems with it. And anytime we just think an unlimited amount of something is good, because to me that's a problem. It's, I have the same argument with Omega fatty acids. Everybody needs to be taking omega fatty acids. Well, there's controversy there that we're not paying attention to.

[00:24:09] Dr. Balcavage: No. Everybody says it's good. Is it? Well, we don't make much d h a from in our bodies naturally. Okay. Well, is that a flaw worldwide or is that an adaptive response? Maybe we don't need as much d h A at high concentrations from omega-3. Well, the, you know, cold water fish have it. I don't swim in cold water.

[00:24:29] Dr. Balcavage: Why would I need to have that fatty acid? And what the, we don't often realize is D H a, which everybody thinks is awesome. It's a, again, another steroid, which is great short term. What the science has shown is, is you start to increase the amount of this stuff that you take and do it for a prolonged period of time.

[00:24:46] Dr. Balcavage: It replaces something called cardiolipin in the mitochondrial. D H A is six double bonds. Cardiolipin is four double bonds. Which one's more reactive? Now you're replacing a less reactive fat with a more reactive fat. Right. In the mitochondria where you make all the free radicals. Good idea, fat idea. I think it's probably a bad idea.

[00:25:07] Dr. Balcavage: Mm-hmm. 

[00:25:07] Christa: My issue when people take vitamin D is similar to yours. It's that there we're depressing vitamin A. I'm just underlining some things that you mentioned. Mm-hmm. Mm-hmm. And we are screwing with our calcium stores, which is also what you des described. Mm-hmm. And I that impairs thyroid function. So is there a time where vitamin D taken exogenously or via orally is warranted?

[00:25:29] Dr. Balcavage: Well, I think if you are truly deficient, Sure. Yeah, I think you'd take it. I'd tell most people, if you're gonna take vitamin D, take it in a ra, take it with vitamin A and good ratio. If you want a simple way to do it, Cod liver oil's got a great four to one ratio, why not do it that way? Mm-hmm. But I see reasons to take it.

[00:25:45] Dr. Balcavage: But you have to take a look at multiple factors. Now some people say, well, you need to take it to suppress your thyroid antibodies. Well, it all depends. If you believe that thyroid antibodies are like little pacmen eating away your thyroid gland then and suppressing the TH two side of the immune system, then maybe you're right.

[00:26:03] Dr. Balcavage: But they don't. The thyroid antibodies don't act like little pacman eating away the thyroid gland. Then that's been shown in the literature, even though we learn that in functional medicine. So if I suppress that side of the immune system, am I improving it or am. Suppressing it. Yeah. You're just making the labs look good.

[00:26:19] Dr. Balcavage: Right. So I don't wanna do that. I actually wanna see who you are and I wanna make sure that things we're doing that aren't suppressing things. But if I look at somebody's vitamin D levels and they're 25 vitamin Ds low, they're 1 25 vitamins, D low, their calcium is low, then maybe they need some vitamin D.

[00:26:33] Dr. Balcavage: Mm-hmm. If they get their labs and they have poor fat absorption in their GI tract and they have poor bio function, yeah. Maybe I need to support biophysiology. Right. But I also wanna ask the question, if their vitamin D is low, why is it low? Mm-hmm. Is because they don't get sun exposure? Is it because they don't have cholesterol in their system to convert from sun?

[00:26:55] Dr. Balcavage: Is it because they have poor absorption of fats and fat soluble vitamins in their diet? I don't want to jump to. Replacement. Is it, they're, they're 

[00:27:02] Christa: stressed and deficient 

[00:27:02] Dr. Balcavage: in magnesium. Could be. Right? Right. Another whole thing. And if you look at somebody's, say what you want about magnesium testing, but a lot of people wind up being looking deficient.

[00:27:12] Dr. Balcavage: Mm-hmm. Let's 

[00:27:13] Christa: talk about, now let's make a list of things that you see stressing out these cell membranes that causes this multi-system adaptive disorder or essentially serv, uh, thyroid survival mechanism. What's excessively stressing out these cells and these maybe receptor sites, 

[00:27:30] Dr. Balcavage: et cetera. So easy things would be like, okay, organisms, obviously, right?

[00:27:35] Dr. Balcavage: So if you have an organism in a cell and it's stealing energy from a cell, that can trigger that cell danger response. So, you know, whether, is it bacteria, is it Lyme co-infection, a virus? It doesn't matter. Any of the organisms could potentially do if it's excessive. But the things that people don't pay attention to is like hypoxia, right?

[00:27:52] Dr. Balcavage: A reduced amount of oxygen getting into the cell. That will trigger a cell stress response. And most people are like, well, how could that be me? Well, if you look at somebody's blood chemistry panel and they have a low carbon dioxide on their blood draw, could that be pack their ability to get oxygen to the tissues?

[00:28:11] Dr. Balcavage: I'll give you the answer. The answer is yes. Okay, so what does that mean? When you breathe in oxygen that binds to your red blood cells. That oxygen then hasn't done its job. That oxygen's only doing its job when it gets off the red blood cell and gets into the tissue where it can then get inside the cell, stimulate energy, what we call aerobic metabolism, where we take one glucose molecule or some fat molecules and turn it into a whole bunch of cellular energy.

[00:28:38] Dr. Balcavage: But if you have low carbon dioxide in your blood, that red blood cell's probably not gonna want to give up that oxygen. You could have 99% oxygen saturation, but the red blood cell's like, I like this oxygen. I'm not giving it up. If it sees a lot of carbon dioxide, it's like, uh uh. If I can get two of those for one of these, yeah, I'll give up the oxygen.

[00:28:59] Dr. Balcavage: But if you have low carbon dioxide, that could be creating some cellular hypoxia. So why would you have low carbon dioxide? Well, option A is you have. Too much acidosis in the body. One of the places you'd get too much acidosis is a GI tract. So in, in the GI tract you make, you break foods down with a bunch of acids and then you've got to neutralize it with some stuff called bicarbonate.

[00:29:20] Dr. Balcavage: But if you have lots of acid in the body and then you need to steal carbon dioxide from the bloodstream to use as a buffer for all this acidity, now your carbon dioxide is lower. Now you have a harder time giving up oxygen to the tissues. Mm-hmm. The other way that can happen is you're a mouth breather.

[00:29:38] Dr. Balcavage: That was my first thought. And so if. Yeah, so if you're a mouth breather, you're blowing off too much carbon dioxide and nobody's a mouth breathers when I ask them, but when are you most often a mouth breather when you're sleeping at night when you're sleeping and you don't realize that your mouth is open and breathing through your mouth.

[00:29:56] Dr. Balcavage: And so when people are like, well, how could that be a problem? I'm, I'm breathing in locks of oxygen. Doesn't matter if it comes through my nose or my mouth, but it does. And so when we mouth breathe, we blow off too much carbon dioxide, then we're not, we've got all this oxygen but it can't be released. And cells, when we have cells that have reduced oxygen, That's an emergency signal to the cell.

[00:30:18] Dr. Balcavage: Like, whoa, we don't have enough oxygen. We need to shut down the mitochondria. We need to shift from aerobic oxygen using respiration to anaerobic non oxygen using respiration. And how do I do that? I turn down the amount of T3 inside the cell. So when a cell perceives low oxygen, it activates an enzyme called hydroxy inducible factor alpha one, which then increases dase three, which is the enzyme that converts T4 and T3 into their inactive forms.

[00:30:46] Dr. Balcavage: That's just take your mouth shot at night. Paper, your mouth shut, paper your nose open, right? Mm-hmm. So that's like a huge thing nobody wants to pay attention to, right? Mm-hmm. Other things are emotional stress. Trauma, like what goes on between the six inches of your ears, right? Mm-hmm. And sometimes that's hard for people to realize that that triggers this, a stress response and the tissues.

[00:31:06] Dr. Balcavage: But do you, what I usually tell people is when they say, I don't think that really is changing my physiology, really. Okay. So do you like speaking in front of a large group? No. Okay. So we're gonna go speak for four hours in front of this large group starting now, right? And they're. Some people get like physically upset, like when you're just making it up and they go, they do one of the, you know, big five piece.

[00:31:28] Dr. Balcavage: Like, I'm gonna pass out, I'm gonna puke, I'm gonna poop, I'm gonna pee, I'm gonna perspire. Right? Any one of those that is a thought changing your physiology and, and we've all experienced that where we're like, well, we're nervous, right? A perception of things. Something's not even happened yet and it changes our physiology.

[00:31:48] Dr. Balcavage: What do you think happens day in, day out when either consciously or subconsciously you're in a worry stage? You steps change your physiology, right? 

[00:31:57] Christa: You're exercising that fight or flight all day long and atrophying your rest and digest. Before you know it, you can't digest or get any nutrients. Yeah. So it's challenging topic for a, for us who are, you know, we start with science and we're like, oh, I don't know.

[00:32:10] Christa: I was gonna be talking about emotions and trauma so 

[00:32:12] Dr. Balcavage: much. Right? And so I think we throw the word trauma around. Mm-hmm. To yeah, easily. Everybody's traumatized. You didn't hold the door open for me. Oh my gosh, I'm traumatized. No you're not. No you're not. Okay. But every bad stuff happens, right? I called emotional fitness.

[00:32:27] Dr. Balcavage: How quickly can you take a bad experience, a negative experience, and turn it into a win? A positive? Not that it's great, right? If somebody died, it's not. But how can I take that really bad experience and turn it into something that's gonna be beneficial? Right? I call that emotional fitness. If you're not good at that and then that's, you're carrying that burden every day that's adding to that stress load.

[00:32:49] Dr. Balcavage: And you only have a certain amount of tolerance before you're into danger. Physiology. Totally. And so what we want to do is not have this big load of stuff day in, day out. Disrupted sleep patterns will cause excessive stress response on your physiology. How many people go to bed too late, have altered sleep patterns?

[00:33:07] Dr. Balcavage: Wake poorly recovered? I mean, large percentage of the population, right? How about people that either don't do any physical activity that's stress on, on the tissues, or like what I was doing when I found out I had Hashimotos was four hours of sleep. Triathlon training, work coach, parent study. You know nerd doubt, right?

[00:33:28] Dr. Balcavage: I ate good, I exercised, but I was over training. And under recovering, and you do that, you know, 20 guess what happened. You find out you have Hashimotos and insulin resistance in your forties. So physical stress strain, chemicals in our environment, I mean, we're inundated. We're not gonna escape them, but it's really, to me, it's more the load than typically one thing.

[00:33:48] Dr. Balcavage: I think sometimes we look for the Dexy thing. Is it Epstein Bar? I have Epstein Bar, and that's what it is. Yeah. It's probably a combination of relationship stress, reduced sleep, poor breathing, that's triggering this inflammatory response. So it's making breathing and respiration harder. You're making bad food choices.

[00:34:04] Dr. Balcavage: That's just changing your gut biome. The changing gut biome is triggering inflammation and it's just a cascade of things. And so I look at the load versus the thing, but it's a lot of the things we do haven't, lifestyle-wise, it creates problem. 

[00:34:17] Christa: Yeah, totally. You know, a good analogy that I heard about emotional stress or how the, the brain can't really discern between imaginary stress and real stress.

[00:34:27] Christa: And one example is if you've ever woken up from a, a nightmare and you like in a jolt, cuz it was a horrible dream and your heart is racing, et cetera, that was imaginary. But your brain saw it the same way. And I heard that recently and I thought, that's a good one. You know, if you don't really believe that this perceived versus real stress is an issue anyway.

[00:34:45] Christa: But we use that 

[00:34:45] Dr. Balcavage: all the time in sports. Mm. Right. We visualize. The shot. And there's studies been done where they had people just with free flows, free throws, right? Shooting basketball, one group free throws, another group didn't shoot free throws for 60 days. And then the third group never shot a free throw.

[00:35:02] Dr. Balcavage: They just envisioned shooting free throws. The group that didn't shoot any didn't get any better. The group that shot 'em got better. The group that envisioned shooting them, but never actually took a shot J just as good as the group that shot the actual free throws. I love research like that. So you see this in sports and right, and so why do you see people before they go do their downhill run or their gymnastics move, or their movements that they're gonna do?

[00:35:26] Dr. Balcavage: They practice those things in their minds so many times that when you get out there, when you gotta do it, it's like second nature. 

[00:35:32] Christa: Mm. Love it. Okay, so we talked about reasons that we have. The cell danger response or, or maybe more. So you have a multi-system adaptive disorder. It's a mouthful. 

[00:35:44] Dr. Balcavage: Well call that multi-system adaptive disorder.

[00:35:47] Dr. Balcavage: What happens as a consequence of that cell danger response? Right. So what happened? I would have patients come in and say, I have adrenal fatigue, I have leaky gut, I have this, I have that. I have this. And thinking it's a whole bunch of separate conditions. And what I was trying to tell them, you don't have a whole bunch of.

[00:36:04] Dr. Balcavage: Non-connected conditions, you have one real big issue, excessive cell stress, and it's resulting in a whole bunch of systems having to adapt because when we have excessive cell stress, the body shifts energy away from normal physiologic processes to defense. And so I don't have as much energy to make more proteins and peptides.

[00:36:24] Dr. Balcavage: I don't have as much energy to make for sex hormones. So that's gonna go to get down regulated. So when you think you've got an adrenal fatigue, a gut issue, what you have is a multiple multi-system adaptive disorder, which means if we address what's causing the stress, then guess what? Those systems were adapting to the stress.

[00:36:42] Dr. Balcavage: So if we reduce the stressors, then we can go back to more normal physiology. Mm-hmm. So, but I had to come up with some name. 

[00:36:49] Christa: Yeah, no, it's reasonable. Let's come up with like a nice, what do we call that? A mnemonic device now? 

[00:36:54] Dr. Balcavage: Yeah. Well people wanted to know, but what do I have? Right, exactly. That's why I said, okay, so you have a multisystem adaptive disorder.

[00:36:59] Dr. Balcavage: Right. There you 

[00:37:00] Christa: go. There you go. Okay, so before we get into rapid fire audience questions, I think one area we didn't cover very much was a little bit around, we touched on this just a little bit around medication, and you started the conversation with this. Once you are having essentially tissue damage and it shows up in blood.

[00:37:19] Christa: Mm-hmm. Then we get medicated and that's kind of where we're at. And this is why when you're medicated, you don't respond as fast, in my opinion, to interventions or I think it takes, it takes more effort than if you're subclinical. But you also bring up, there's two main causes of hyperthyroidism with autoimmune and Hashimotos thyroiditis being a primary cause.

[00:37:36] Christa: And you talk a little bit about iodine and you talk about autoimmune versus primary hyperthyroidism. What do you wanna say about primary hyperthyroidism versus Hashimotos thyroiditis? And iodine. So 

[00:37:48] Dr. Balcavage: there's two camps with, with from iodine perspective, the one camp is everybody's over iodinated and nobody should be having iodine.

[00:37:56] Dr. Balcavage: And there's another camp that everybody is UN who has hypothyroidism is under iodinated and everybody needs lots of iodine. I don't really think that iodine is the primary issue in this country. And really we don't have a great way of assessing it. We have urinary tests, we have people doing the rub, the iodine on your arm test.

[00:38:14] Dr. Balcavage: But really to test if somebody's got iodine deficiency, you have to do multiple tests over multiple days to really get a feel of what's going on from an iodine standpoint. So I just don't think it's a major, the major issue is too much iodine. So I think some people, small amount of iodine that we need, I think if you're taking that amount, it's probably not a problem.

[00:38:33] Dr. Balcavage: I don't think it's the major trigger for why people have high TPO o antibodies, cuz they have just too much iodine. So I don't buy into that camp either. I think. Immune driven thyroiditis is the primary cause of primary hypothyroidism. Some people would say, well, does that Hashimoto's thyroiditis or is it just thyroiditis?

[00:38:50] Dr. Balcavage: What is it? It's all the same thing. In my opinion. Whether you have a TPO O or thyroglobulin antibodies does not necessarily distinguish whether you have thyroiditis, but is it Hashimotos? Well, we call it Hashimotos when we see the antibodies. News flash when you start to look at the immune panels of people who have thyroiditis, most Hashimotos thyroiditis is th one dominant, at least at the onset.

[00:39:14] Dr. Balcavage: Mm-hmm. And the literature seems to point that out, that some people are th one dominant. Some people are two H two dominant, and a lot of people fluctuate from th one at the start into th two later on. And I've seen this in my practice, people who have, you know, have thyroiditis. You look at a lymphocyte panel, they're th one dominant, they're not making antibodies.

[00:39:33] Dr. Balcavage: And then as they get better, thyroid glands starting to produce more hormone on its own, they need less medication, they're conversions better, they're feeling and functioning better. All of a sudden they're antibodies pop up. Ah, am I worse? Yeah. Nope. You're just now making some antibodies that are out there now cleaning up some of the debris that was there from before, and you're just balancing it.

[00:39:54] Dr. Balcavage: So I don't really, I used to kind of be like, oh, is it Hashimo or is it like that was the defining, I don't look at it that way anymore. I think most of the cases are Hashi or thyroiditis, call it Hashimotos, not cause it a hashimo. It doesn't really change what, how we're gonna help 'em. Lab testing 

[00:40:08] Christa: is lovely and it could also shoot you in the foot that way, right?

[00:40:11] Christa: In a way, when you're looking at it from a black and white, is it going up, going down. So on that note, this is what people are gonna ask. They're gonna say, this is great Dr. Eric. But if either, and this I think is two different cases. I think every case is different, but let's say subclinical thyroid case walks into your office or a medicated thyroid case walks into your office.

[00:40:30] Christa: I think that's probably, maybe even a more common one. Medicated and feels like crap. Is there some initial steps or workup that you're gonna look at first? First 

[00:40:38] Dr. Balcavage: thing I do is it look at their health history, health timeline, their signs and symptoms, and a comprehensive blood chemistry panel. I never look at a thyroid panel all by itself.

[00:40:46] Dr. Balcavage: Okay, so for, if you're a person who's got hypothyroidism and you went to a GP or an ologist, you're gonna get, tssh would reflex the t4 and they're gonna look at it in that limited context. You can't assess thyroid physiology in the body with the tssh in a free t4. You just cannot. Why do medical doctors and only then run those two tests?

[00:41:04] Dr. Balcavage: Because their treatment is to provide enough T4 medication to suppress your tssh back into range. Okay. So I look at a full thyroid panel and we wanted, there's four, and then I look at the full thyroid panel in contacts with a comprehensive metabolic panel. What does that mean? My comprehensive metabolic panel is 65 testing, or now it has about seven or eight inflammatory markers, full lipid panel, full iron panel blood sugar markers.

[00:41:29] Dr. Balcavage: So it's pretty comprehensive because I wanna. What's going on with thyroid physiology, and I need to know, especially for that patient who is on t4, one of the things that happens to people that get put on T4 only is they realize when they look at T3 and free T3 is the more T4 they get and the lower they drive their Ts h, the worse their T3 gets and the worse they feel.

[00:41:50] Dr. Balcavage: And medical doctors, I don't think realize that or they do realize it, and therefore do not want to run T3 and free t3. Okay, now why does that happen? If you wanna know that. You want me to say why? Yeah, please. Okay, so you have this thing pituitary gland. Okay. And it's the gland in your brain above, that's your hypothalamus.

[00:42:09] Dr. Balcavage: So the hypothalamus. Pituitary monitoring. How much T4 and T3 are in the bloodstream? When your thyroid gland makes hormone? Most of it is t4. Small percentage, maybe five micrograms per day is t3. Okay. They get dumped out into the bloodstream. Most of what circulates in your bloodstream is t4. It's a less active hormone.

[00:42:28] Dr. Balcavage: It when somebody says it's inactive, it's technically not inactive. It does things, which concerns me about people taking too much t4. That T4 gets to a cell or tissue that needs thyroid hormone. It. T4, that becomes free t4 and then that can get into a cell. And then at the cell, each tissue type gets to decide what it does with that thyroid hormone.

[00:42:51] Dr. Balcavage: Do I want to increase my metabolism? I'll cur convert that, bring that T4 in, convert it to T3 and turn on the machinery in the manufacturing process. Do I not wanna increase my metabolism? I'll deactivate the T4 to reverse T3 and send it on its way. The cells can also bring in some t3, and it's usually a split in the cell.

[00:43:12] Dr. Balcavage: Some of the T3 inside the cell is what the, IS direct from the bloodstream, and some of it's converted from T4 from the bloodstream, but if the cell doesn't want to increase its metabolism. Same thing with the t3. Do I bring the T3 in and use it, increase metabolism, or I deactivate it to T2 and off it goes to get metabolized by the body.

[00:43:32] Dr. Balcavage: So we need to know what's going on. And so. When the, when there's a lot of T4 in the bloodstream, the hypothalamus is monitoring that, and as soon as the hypothalamus is saturated with t4, it decreases the production of something called T R H Thyrotropin Releasing Hormone, which then goes to the thyroid gland and says, Hey, don't make as much T S H.

[00:43:51] Dr. Balcavage: I'm good. We got enough T4 in the system, the pituitary gland. It. It's got another job. So it's listening to the hypothalamus monitoring how much T4 is coming in, but it's also monitoring how much T3 is in circulation. And most of the T3 in the body is made by the peripheral cells bringing T4 in, converting a t3, and then putting it back out into the bloodstream so it can be used again by another cell.

[00:44:13] Dr. Balcavage: And it gets used a couple times before it gets metabolized outta the body. So the pary Glen is like, alright. T4 is good. How's my t3? Ooh. T3 is still low, and so because T3 is still low, it realizes that the peripheral tissues aren't doing such a great job of converting that T4 to t3, that it keeps tssh elevated to tell the thyroid gland to make more thyroid hormone.

[00:44:38] Dr. Balcavage: But instead of a 10 to one ratio of t3, that ratio can go down to five to one. Okay? So when you go to your dock and the ts H is still elevated, right? But you feel pretty good, that's because your body's trying to help you. It's trying to get that thyroid gland to make more T3 to compensate for what the peripheral tissues aren't doing.

[00:44:58] Dr. Balcavage: What's interesting is, It's tssh. So somehow that thyroid signal, that tssh signal is different based on whether we need more T4 or we need more T S H. It'd be like saying yo or yo, right? It's the same word just said differently. So tssh, the signal changes the thyroid glass. So the thyroid typically can only makes about five to 10 micrograms tops.

[00:45:23] Dr. Balcavage: But if it needs to help, it'll make more if the peripheral conversion, if it's not up to par. So when you flood the system with too much t4, it can suppress the ability for the pituitary gland to override it. And so what happens now is that you push so much T4 into the system that ts H gets plummets. Now you're under one.

[00:45:44] Dr. Balcavage: And what happens? Well, I lose the ability of my thyroid gland to try and help compensate with t3 and the excessive T4 in the cyst in the bloodstream deactivates an enzyme inside your cells called dase two, which is the enzyme that converts T4 to t3. So now I just made the problem. I had worse. I already had a problem converting T4 to T3 in the cells.

[00:46:09] Dr. Balcavage: I over flood the cells, the bloodstream with t4. Now my cells are going, whoa, there's so much T4 out there. We must be hyperthyroid, deactivate. Don't make any more t3. So too much T4 medication. Suppresses T4 to T3 conversion, so we shouldn't be trying to drive T S H sometimes down to two under one. We should be monitoring and giving enough T4 that it supports the physiology, but not so much that it's suppressing T S H production and conversion.

[00:46:42] Christa: Right. Okay. Okay. Let me jump into these rapid fair questions. This one is gonna kind of be on the tails of what you were just describing, so these are all Got it submitted from the audience. This person says, I've done all the labs. I'm taking the thyroid meds. I tried armor first, now I'm on levothyroxine.

[00:46:56] Christa: I don't see any improvements in thyroid numbers or symptoms, and the endocrinologist has only increased. Dose of T4 to decrease ts H, which is what you were just talking about. Mm-hmm. What can I do? What are my next steps in healing my thyroid and approving symptoms of fatigue, brain fog, hair 

[00:47:11] Dr. Balcavage: loss, et cetera.

[00:47:12] Dr. Balcavage: Yeah. So this is classic, right? I tried t4, it doesn't seem to work. I tried t4, t3. It doesn't seem to work, and sometimes when you get t3, initially you get like a boost and you're like, oh, that's good. And then plateaus. Why? Because I'm a cell, do I increase my metabol or do I not want to increase my ta?

[00:47:28] Dr. Balcavage: Metabolism doesn't matter if you give t4, t3. You're gonna have a boost and then it's gonna plateau, right? So what do you gotta do? This is not sexy, but what you have to do is look at your health, your life, what I call the fitness factors and say what is creating the biggest stressors in my physiology?

[00:47:45] Dr. Balcavage: And start improving 'em. You don't even have to hire a functional medicine practitioner yet. What's my diet look like? I eat a lot of processed food. Stop doing that. Eat more whole healthy food. I don't care about what food, religion you wanna believe in. I really don't care. Eat more whole food. Keep it that simple.

[00:47:59] Dr. Balcavage: If you got that under control, am I under exercising? Over exercising? Am I getting to bed before 10 o'clock? Am I getting up like after six, eight hours? Like 8, 7, 8 hours would be good. No, I'm not doing that. Stay up late. I don't go to bed till 12, one o'clock. I, you know, get up at five cuz I gotta go. Stop doing that, right?

[00:48:15] Dr. Balcavage: Start having better habits first. Fix your habits, improve your behavior. Fluid intake, cut out the things that are toxic, clean up your environment. Do those things first, and if you struggle there, then find a functional medi. Yeah. Then work with the functional medicine practitioner to start digging in and give you a better idea what's going on, but gotta identify what's creating that excessive stressors.

[00:48:35] Christa: All right. The next one is cruciferous vegetables. Do these really harm thyroid production, or do you have any issues with these? No. Yeah, same. Are you seeing a spike in Hashimoto's or thyroid antibodies 

[00:48:46] Dr. Balcavage: post covid? All I see all day is patients that have some level of thyroid issues. So has, have I seen a difference or change in my practice since covid?

[00:48:57] Dr. Balcavage: I don't know that I've seen a difference is does the literature show. Potential immune issues, thyroiditis, hashimo stuff since Covid. Yes. Yeah. Makes sense. Right? I think that immune, I think, I think the literature shows it. The whole conversation, Hey, you gotta, you got a virus? Yeah. The whole, you got a virus, what should the body do?

[00:49:13] Dr. Balcavage: Slow down it. Right? Right. It's slow down tablets. Okay. 

[00:49:16] Christa: This is a good one. This is actually where I first wrote you down on my notes. Someone has sent me a message and said, if I have a thyroidectomy, does anything in my care. I don't know how she phrased the word, but I'm gonna just fill it in. How does care change?

[00:49:27] Christa: And I was like, you know, I know the guy for this. 

[00:49:29] Dr. Balcavage: So I, yeah. And I get this all the time, but I had a thyroidectomy. Listen, if you've had thyroidectomy. Glands out. You should need some T4 medication and possibly about five micrograms of t3, because that's what the body would typically make. So how much T4 do you need?

[00:49:47] Dr. Balcavage: Well, let's look at your body weight and all those things. If you've done that and you still don't feel well, then guess what? You have that excessive cell stress, which probably was there. You had the thyroidectomy, which was maybe one of the reasons why you had some problems with your thyroid physiology to begin with.

[00:50:06] Dr. Balcavage: So I get a lot of people like this. Yeah. But it's different for me cuz I have a thyroid. No it's not. If your downstream physiology from the gland is working and I give you the appropriate level of T4 and maybe a little bit of T3 should work. Right. But if you have that excessive cell stress going on, it doesn't matter if you have a thyroid glen, no thyroid, Glen on meds, not meds, the thyroid hormone is gonna work differently at the cell level.

[00:50:28] Christa: Mm-hmm. Okay. These couple are medication ish related. So one of them is, mm-hmm. Is Hashimoto's reversible and the other one is, I'm just trying to group 'em together. Do we need medication? If. Thyroglobulin is high before pregnancy and Ts h T three T4 are within reference range. Actually, there's a few medication questions.

[00:50:51] Christa: I'm gonna stop there and let you answer that one. Let's get the first one. So people are wondering if they're trying to remove medication. Like, can I reverse this? Can I remove 

[00:50:58] Dr. Balcavage: medication? That's a big question. Okay, so have I seen Hashimoto's? Resolve? The answer is yes. Okay, me included. So I see people, thyroid antibodies go down to nothing.

[00:51:10] Dr. Balcavage: Their thyroid physiology con, their T4 to T3 converts and they need less and less medication. And many of my patients wind up not needing medication over time. Now it does take time for a thyroid gland to regenerate, recover. So it's not like necessarily a today or tomorrow thing, but I think there's a lot of people that are on medication that have really no business being on it in the first place.

[00:51:30] Dr. Balcavage: Cool. 

[00:51:31] Christa: So maybe this answers the next one about do I need to take medication if my thyroglobulin antibodies are high before pregnancy, but my T s H T three T4 are in 

[00:51:40] Dr. Balcavage: reference range? No. With the thyroglobulin antibodies probably indicate is there might be some level of thyroiditis going on, but you may not need, you may still be producing plenty of thyroid hormone, you may still be converting T4 to t3.

[00:51:51] Dr. Balcavage: What you might wanna do is if you're not, if you're not pregnant, is to start to look at. Some of those factors that may be contributing to it. If you are pregnant, you can start to look for some of those lifestyle factors that you can in all that you can change. But a lot of times when somebody's pregnant, at least in my world, I don't like people taking a whole bunch of other supplements while they're pregnant.

[00:52:08] Dr. Balcavage: We kind of keep it super simple. Good diet, good nutrition, good lifestyle, and a prenatal. Mm-hmm. Cool. 

[00:52:14] Christa: There's a couple more. You go. I, 

[00:52:16] Dr. Balcavage: I got time. You 

[00:52:17] Christa: go for it. All right, cool. Do you think that gluten must be removed with elevated thyroid antibodies or do you see that this is not always an issue in Hashimotos or 

[00:52:26] Dr. Balcavage: thyroid?

[00:52:27] Dr. Balcavage: I don't think it's always an issue. Same. Cool. I think it's an easy answer and I don't, and I've gotten a problem that it is gluten really the issue. I don't know if gluten's really the issue. I think there's other factors that come into play. What do we spray a lot of the crops with? With Roundup?

[00:52:42] Dr. Balcavage: Roundups and antibiotic? The antibiotic disrupts the gut. Flus. Dysbiosis. We fortify a lot of things with excessive iron. I think the combination of those things, plus we've modified the wheat to some degree. Maybe we're starting to make it look like something we didn't recognize, but I think if you're reactive to it, remove it.

[00:53:00] Dr. Balcavage: But I don't think it has to become the thing that has to be removed for every person. Mm-hmm. Any advice for hair loss? It bald is beautiful. No, I know you can't say As I'm sitting here with life. Yeah. I don't have much hair. So what to do? I think when, when we think about hair, You know, people jump to thyroid, but it's not necessarily always thyroid.

[00:53:20] Dr. Balcavage: It could be mineral deficiencies, right? It could be vitamin mineral deficiencies. Could it be too much thyroid hormone? Could it be too little thyroid hormone? Could it be too much or too little androgens going on in the system? So what do you do for it? Have somebody do a really good look at your physiologies to try and help you undercover.

[00:53:35] Dr. Balcavage: What's the underlying mechanism? And if you're a woman who's overweight, insulin resistant, P C O S start to consider like, Hey, maybe my thyroid's a part of it, but maybe my androgens are really a part of this, of that too. Okay, I'm 

[00:53:50] Christa: gonna try to group two more questions together. This one is another classic.

[00:53:55] Christa: What can I do when you have all the symptoms, but your doctor says your tests are normal, and or where do I start if I suspect thyroid 

[00:54:02] Dr. Balcavage: issues? Okay, so first place to start. If you want somebody to really assess kind of root cause issues, you're not getting that from an allopathic physician. It's not because they're bad people, it's just not in their wheelhouse, right?

[00:54:16] Dr. Balcavage: I don't ask my plumber to run my electric in my house. I ask my plumber to do that. So allopathic physicians are awesome at what they do, diagnosing diseases and managing illnesses. But when it comes to, Hey, I think I'm hypothyroid, but I don't have a disease identified yet, you need a functional medicine practitioner because those are the people that should be looking for root cause issues so that you never actually get to the full-blown disease model.

[00:54:40] Dr. Balcavage: Mm-hmm. You're an allopathic physician. So find a functional medicine practitioner, and I will tell you, because I get this question all the time, how do I pick a good one? There's lots of different opinions just like picking an orthopedic surgeon or a cardiovascular surgeon. But when we're talking thyroid physiology, if you're seeing a functional medicine practitioner whose first thought process is, I need give you, I just need to give you T3 to optimize your thyroid physiology, that's a red flag for me.

[00:55:03] Dr. Balcavage: Mm-hmm. They don't understand what's going on. Just because somebody puts T3 into your system doesn't mean they fixed your thyroid physiology. They have not optimized your thyroid physiology, optimal thyroid physi. You don't need extra T3 cuz your body makes it the way it should. So that's a red flag for me.

[00:55:20] Dr. Balcavage: If you're seeing somebody who's just a ex specialist in functional medicine, that's probably not the, what you're looking for because functional medicine isn't about being a specialist in one thing and ignoring all the other systems. A good functional medicine practitioner, my opinion is good at hormone physiology, gut physiology, cuz you gotta know all of it because it's all tied together.

[00:55:41] Dr. Balcavage: And you may disagree with me, but I 

[00:55:43] Christa: don't, I don't, I think I would just say, have a conversation with them and make sure that they like thyroid physiology and or if this is subclinical, let's say you did go to the doctor in the labs were normal and we're experiencing maybe, maybe not subclinical thyroid issues.

[00:55:57] Christa: Maybe ask them if they're comfortable with that because I don't think everyone is 

[00:56:01] Dr. Balcavage: probably Yeah. Or they. What we have happening in functional medicine. And I kind of wrote like a head talk on guarding the gate because in functional medicine what we're seeing, and it's great, we're seeing a lot of allopathic physicians or a lot of allopathic mindsets coming to functional medicine and my opinion screwing it up.

[00:56:21] Dr. Balcavage: The thought process is drugs are bad, so I'm gonna give you 10 supplements to fix what that drug would've done. So to replace it. And if you're showing up in my office, taking 28 supplements from a functional medicine practitioner, I'm sorry, they are not practicing functional medicine. They're greenwashing, allopathic medicine.

[00:56:37] Dr. Balcavage: Am I antis supplement? No, I am not. But if you need 28 supplements to feel awful, you don't need any of 'em because you're trying to treat deficiencies instead of trying to treat the cause of the deficiency. Mm-hmm. Which is what functional medicine should be all about. Mm-hmm. 

[00:56:53] Christa: I would agree with that.

[00:56:54] Christa: That's a touchy subject, but I sometimes I ask them like, oh, did you see a, what kind of practitioner was it? Cuz sometimes they still kind of. Bring the same thought processes over. Mm-hmm. Like we're just gonna be able to give this thing and it's gonna solve it. And that does not work that way. On the note of supplements, that is the next question.

[00:57:09] Christa: Mm-hmm. Mm-hmm. This person asked, what are three top supplements? I love these kinds of questions like, um, what are three top supplements you should be taking if you have hyperthyroidism, hyper thyroid, hyper, hyper. This person, this person, wrote hyperthyroidism, don't know who they are. So that's a little different, I feel like, but 

[00:57:25] Dr. Balcavage: a lot different.

[00:57:26] Dr. Balcavage: Yeah. So at the end of the day, and I almost hate to to say cuz I don't know what's going on, but there are some supplements that you can use that can help somebody with hyperthyroidism and elk carnitine is one of those things that can be very beneficial to help kind of reduce the excessive thyroid physiology.

[00:57:47] Dr. Balcavage: I don't like giving out general supplement recommendations cuz then people just like, I'm gonna buy it. Mm-hmm. But in general, across the board, Right. There's a couple things I think we could generically recommend to a lot of people. If they're not doing well, one of them is not seeing anybody. One of the best things I think you could do before you grab for a multivitamin is a really good quality digestive enzyme or some between HCL l because as soon as you're in that stress response, your digestive capacity goes down.

[00:58:16] Dr. Balcavage: If you have gas, you got bloating and pressure. A good digestive enzyme helps you break down your food better. Less likelihood from food reactivity, you're gonna probably extract more micronutrients from your food. So if you got digestive issues, I think starting with a digestive enzyme could be a, a great place to start.

[00:58:32] Dr. Balcavage: Okay. If you are chronically fatigued, one of my go-to things that I think, especially for somebody, you've probably had these people that are like, I am so tired at three o'clock in the afternoon, I can barely keep my eyes open, right? And I wanna drink coffee. In those patients, especially patients with thyroid issues, hyper or hypo, they have probably high levels of circulating adenosine by three o'clock in the afternoon.

[00:58:54] Dr. Balcavage: I think one of great tool is something called creatine. Hmm, yes. Creatine the same stuff to the bros at the gym we're using, and let me tell you why. When you have excessive cell stress or you have hyperthyroidism, you are not making, let's say, let's do it from a low mitochondrial standpoint. First, you eat food.

[00:59:14] Dr. Balcavage: You convert food energy into cellular energy called a T p, adenosine Tri phosphate. That means there's three phosphate groups attached to this molecule called adenosine. Adenosine, not melatonin is your sleep hormone. It's what keeps you asleep. So let's make up a mystical number of a hundred attp. You start the day with a hundred full-blown attp.

[00:59:37] Dr. Balcavage: As you go through the day and you're using up energy, you're pulling those phosphate groups off. And what's happened by evening time is you've got a lot of naked adenosine running rolling around the bloodstream and those naked adenosine can bind to the adenosine receptor. And that's how what helps you get deep, good quality sleep.

[00:59:58] Dr. Balcavage: Okay. That's why the person says, I can't sleep. I can't sleep, man, I slept like a dream last night. What'd you do yesterday? Oh, I was outside all day in the cold, working all day. Slept like a, I never slept that good before, right? Because you exhausted your adenosine levels and you had a great night's sleep.

[01:00:13] Dr. Balcavage: But if you've got excessive cell stress, you've got hypothyroidism, you've got too much thyroid hormone, you're burning out and you're chewing through those adenosine, those ATPs too quickly, or you're chewing through them because you don't make a lot of at t p efficiently, let's say instead of having a hundred at TP to start today, you start with 50 at P and 50 adenosine, and now you're going through the day and now you're pulling those phosphate groups off.

[01:00:40] Dr. Balcavage: Two, three o'clock in the afternoon, you have the same level of Aden, naked adenosine that you usually would have at 10 o'clock at night. So guess what happens at two or three o'clock in the afternoon? You are 10. You're tired. So what do you wanna do? You wanna reach for your cup of caffeine. What does caffeine do?

[01:00:56] Dr. Balcavage: Caffeine blocks the adenosine from binding to the adenosine receptor. So now your brain. Sleepy, which is why people say, well, I could drink a cup of coffee and go to bed, right? Because getting to sleep or your brain getting the single to go to sleep is melatonin, get up is melatonin, but to keep you asleep is adenosine.

[01:01:13] Dr. Balcavage: So yes, you can still get to sleep if you drink your cup of coffee, but you will not get a good deep quality sleep. If you don't, then you're not filling up those ATP molecules. By morning time, you're waking up a little bit more tired, more cranky, more craggy, and then by two or three o'clock in the afternoon you're crashing.

[01:01:28] Dr. Balcavage: Again. People think it's adrenal fatigue. It's not adrenal fatigue. In most cases, it's too much adenosine. Why might that be important? We have this process in the body called methylation detoxification process. My Good Bed buddy Ben Lynch, worked with them on those, and one of the things we learned is that it takes a lot of methylation to make creatine in the body.

[01:01:46] Dr. Balcavage: I think like 70% of methylation goes to that process. And so if you already. Have some cell stress issues and you're not making a lot of, and you're consuming a lot of energy to try and make up for these phosphate donors. Why not just give the body the creatine? There's really not a side effect to it.

[01:02:05] Dr. Balcavage: Now you have adenosine that your body can use for phosphate groups. You can now have. Methylation resources to use for other things that are really important. And what you see is people are like, man, I'm not as tired, I'm not as fatigued. I got a little bit more energy. So a simple strategy and while we used to think about it for just the bros in the gym now, the longevity science is really saying, Hey, this is stuff that could be really beneficial for health and longevity.

[01:02:28] Dr. Balcavage: Because as we get older, we have more oxidative stress to deal with. This will allow us not have to use as much energy to make creatine cuz we've given what somebody needs to make. So I think it's a really easy, good, simple strategy, especially for those that are people are chronically fatigued or exercising or working out and have some type of condition.

[01:02:48] Dr. Balcavage: So that would be number two. The third thing, I'm a big fan of electrolytes. We almost, you could 

[01:02:53] Christa: get creatine inside the electrolytes, especially if you drink Ben Lynch's electrolytes. 

[01:02:57] Dr. Balcavage: You can, you could get those in in there. I drink. So I think the numbers. In Ben's, I think it's 500 milligrams in Ben's think so.

[01:03:05] Dr. Balcavage: Optimal electrolyte. So you would, yeah, that'd get you some. Mm-hmm. On average, for female it's about 2.5 grams. For male it's about five grams. So it'd be a little light, but that's a great way to start and say, hey, hmm, maybe I do a little bit better. Mm-hmm. Yeah. 

[01:03:18] Christa: From, uh, I liked how you went into the physiology there, so you actually brought up El Carine.

[01:03:23] Christa: When you talk about El Carine, I like to think about muscle. On the signs of really low L carnitine being like, man, my legs like hurt walking up the stairs when it's like super deficient. And so that's where my brain goes with L Carnitine. But what are the other mechanisms of L carnitine? And we see a lot of like leg heaviness in thyroid issues, right?

[01:03:41] Christa: So this is where my brain is like connecting those things. But you probably have like a whole different rabbit hole for this. So what is the mechanism of action for EL carnitine or the research? Rhino, carnitine and thyroid. 

[01:03:53] Dr. Balcavage: So we can use it as a tool for kind of blocking the excessive action of the thyroid hormone.

[01:03:59] Dr. Balcavage: So when somebody has hyperthyroidism, it can really have an impact there. I think it, there's a, a component where we can actually, it actually has an impact on reducing the excessive production. The one interesting thing about carnitine, you'll see I want to give it to increased. Metabolism. Mm-hmm. And when you look at the science, there is some science that says carnitine decreases the amount of T3 inside the cell.

[01:04:28] Dr. Balcavage: Hmm. So then you go, Hmm, wait a second. How does that all tie together? So if it reduces the hyperthyroid effects, so if you had somebody hypothyroid, would it be beneficial to give them carnitine L carnitine? Carnitine? Probably for them. Okay. Because it's gonna decrease some of that thyroid hormone signaling.

[01:04:46] Dr. Balcavage: But when we think about is it, Hey, I wanna burn fat, I'm gonna give carnitine to help with fat transport into the tissue. If it's reducing T3 inside the cell, does it really do what it's supposed to do? Mm-hmm. And then I don't know if it always does what we want it to do. Sure. But if you give it to somebody and, and then they see benefit from it, that's awesome.

[01:05:08] Dr. Balcavage: I've used. For a while I was, Hey, I want to increase fat metabolism too. But I didn't see quite the benefit from doing it with a lot of patients. I actually saw the opposite was patients weren't doing well with it. Now what's interesting, you could look at it this way. If I give El carnitine and I'm increasing fat, maybe they don't need as most T3 inside the cell.

[01:05:29] Dr. Balcavage: Mm-hmm. 

[01:05:30] Christa: Maybe. Or if you're extra special. I'm used to people, I have seen EL carnitine used in people who are doing more heavy fitness. I don't have an opinion about it. If I'm using carnitine, it's usually in a product that is supporting overall mitochondria. So like I might pick out some that, you know, that's how I like to use it.

[01:05:45] Christa: But we all have different ways cuz I'm always trying to reduce the amount of supplements. Of course. Right. You know? Yeah. So it just kinda depends. They pick the. 

[01:05:52] Dr. Balcavage: So I think the, the link is, cuz it kind of goes with fasting, right? Mm-hmm. Because people will say you shouldn't fast if you're hypothyroid.

[01:05:59] Dr. Balcavage: You've heard that? Yeah, I have. What's your 

[01:06:01] Christa: thought about this? I actually feel like I gave myself subclinical hypothyroidism with. Lazy fasting. It's almost like when you change your diet and you're like, oh, that goes fine at first. And then before you know it, you're just like under nourishing and living on coffee in the morning.

[01:06:15] Christa: Right. That's what fasting can become for people when not done properly. And I was working for a fasting program, so it was just, you know, life happens. It's like, oh, I'm doing really good and then mm-hmm I'm just drinking coffee for breakfast and not getting enough nutrients. And so that is where that can go wrong, in my opinion.

[01:06:31] Dr. Balcavage: Yeah, I agree with that. What happens for most people is they're really strictly, they're under categorizing, right? Yes. And then they're going, Hey, I'm fasting. Yeah. You're taking 800 calories a day. Mm-hmm. For a couple days. Yeah. Maybe not a bad thing. Big deal, right? Yeah. Right. You do that for a month or two.

[01:06:49] Dr. Balcavage: Yeah. You're gonna restart to reset your metabolism a bit. But when I hear people say you can't do intermittent fasting cuz it's gonna slow your metabolism down, it decreases T3 to a degree. It does. But understand why when we're burning glucose for energy, we get what, four calories outta that, right?

[01:07:06] Dr. Balcavage: Mm-hmm. When I'm burning fat as energy, I'm getting how many calories? Nine. So I get more net energy from fat than I do glucose, so I need more thyroid hormone to run glucose through the system than I need when I'm running fat through the system. Yeah. Good argument is that, so when I see somebody, they're like, Hey, I'm fasting and they're doing well, and they're getting enough calories, and their T3 s a little bit lower.

[01:07:34] Dr. Balcavage: You feel 'em function good? Yep. Great. But my T3 s not in the optimal range. Well, given the fact that you're fasting, you're not eating, watching the way a carbohydrates and you're burning this big fat log versus a whole bunch of newspaper carbohydrate, that thing burns longer. You get more energy out. You won't need to rev the system up as much because you're getting more energy for the alternative source.

[01:07:57] Dr. Balcavage: And so if you look at some of the literature on that, it comes down to, that's probably makes the most sense for why you see a little bit lower T3 in somebody who's doing some fa intermittent fasting. So I don't see it as a problem as long as. You're getting sufficient quality calories. Right? Right. Yeah.

[01:08:14] Dr. Balcavage: If you're fasting and you feel awful, don't do that. Maybe you shouldn't be doing it. Right. But I don't think we have to have this global thing like, Hey, if you're hypothyroid, you can't do any type of intermittent fasting. Yeah. I, I don't think that's, that's 

[01:08:24] Christa: a tricky, that's a tricky thing with any global policy, right.

[01:08:27] Christa: Health policy is like, well, my bottom line would be do it sustainable. Be open to experiments. You can do experiments. I think intermittent fasting is a good experimental thing to do sometimes for most people, right? Mm-hmm. If you, if you really wanna do it and, and do it perfectly and you're gonna do a good job, great, but just human behavior falls off a wagon usually.

[01:08:47] Christa: I'm sure a while. 

[01:08:48] Dr. Balcavage: I think when we talk about, like, people are like, well, did you have to do this every day? No. Like early man and woman did not walk around going, I know there's a deer right there, but I'm not eating that because it's the morning time. Right. We weren't walking around like that. We were, I'm hungry.

[01:09:03] Dr. Balcavage: I eat something. I'm not hungry. I don't Right. So we make up a whole bunch of crap about how things work. But if you wake up tomorrow morning and you're like, you know what, I'm really not hungry. Great. Don't eat right. Mm-hmm. But if you're really, truly hungry, eat. But make sure simply that, you know, over the course of the week you're getting a sufficient amount of calories.

[01:09:23] Dr. Balcavage: You can have a little bit of days where you have a little bit less calories, but other days where you compensate a little bit, but for your size, your, your ideal size and your activity level, make sure you're getting sufficient amount of calories. But if you fast it's, it's not gonna set you back as long as you are have good, healthy physiology and you are getting sufficient calories.

[01:09:41] Dr. Balcavage: Totally. 

[01:09:41] Christa: So I wanna ask you about the strategic thyroid solution, but I thought of one more question, which is, you talked about the fried cell membrane, which I no one talked about. Thank you for talking about that. I think a lot about cell membrane support so you can get nutrients in and outta the cell.

[01:09:56] Christa: What do you like for cell membrane support? 

[01:09:59] Dr. Balcavage: As a starting point, I think if we're going to provide fats, I think we focus on parental fats, which means parental omega-3, parental omega six and fat rich foods, quality, fat rich foods that we get in. And then our body's gonna use those things to help make healthy cell membranes.

[01:10:18] Dr. Balcavage: Now, there's other things out there, choline from eggs and a whole bunch of other things that are gonna be beneficial. But I'd like to start with the parent. I'm not a big derivative. Take Omega-3, take or take epa. D h a. Mm-hmm. I'd say eat the whole sources, the parent oils and let your body do the best to convert them over.

[01:10:36] Dr. Balcavage: So 

[01:10:36] Christa: therefore you must always make sure that your bile is being produced while support the liver support bile function so you can digest the fats and use them for possible 

[01:10:45] Dr. Balcavage: lipid memories. Absolutely. Yep. So how did, right, so that's huge. Dr. Kelly and I did a three day course on Biophysiology a couple years ago where we got into the nitty gritty of all aspects Biophysiology.

[01:10:58] Dr. Balcavage: So if anybody's bored, you know, that's out, out there somewhere in. But how do you know if you have a gallbladder issue? How do you know if you have a bile issue? Several 

[01:11:05] Christa: things. If you are nauseous, it's like a giant red flag. If you have loose stool with you, you increase that. All of those are like huge ones, but I look for any other signs of liver and gallbladder stress as well.

[01:11:15] Christa: It 

[01:11:15] Dr. Balcavage: could be tough, right? Upper back pain, right? If you're the person, if you're going to your chiropractor or your physical therapist with right upper shoulder pain or back pain, it doesn't go away. Think gallbladder. If you have. Palpable tenderness underneath the rib line on the right side. You stick your fingers up there and it's tender and sort there.

[01:11:30] Dr. Balcavage: Good idea. If you have loose stools, especially when you eat fatty food or you have greasy stools, meaning, and everybody says gross, but when you flush the toilet, kind of slimes the side of the bowl. Probably too much fat in your stool. If you've been told you have an oxalate problem, probably a good idea that you might have some fat mal absorption.

[01:11:49] Dr. Balcavage: You can look on your blood chemistry panels. If your bilirubin's over 0.8, good indication, you might have some gallbladder issues. You could look at your A S T, your A L T or G G T. If you have elevated cholesterol, you probably have some issues with. Biophysiology. If you're dehydrated, you don't drink a lot of water, you might have some problems with Biophysiology cuz bile is 90% water, right?

[01:12:14] Christa: And there's a connection between your cholesterol being out of range and your thyroid being outta range, 

[01:12:19] Dr. Balcavage: right? Ab Absolutely to get cholesterol. So when you eat food, you turn that glucose into something called acetyl that goes into something called your your cell on your mitochondria. It goes into something called your kreb cycle.

[01:12:33] Dr. Balcavage: You learned about in seventh grade science class, if you've got a low T3 state or you don't need to make energy, that acetyl-COA comes out of that kreb cycle instead of going to make a t p. And we've converted into cholesterol cuz body goes, Hey, my mitochondria doesn't need to make any more energy. I'm gonna use that food energy to make some neurotransmitters.

[01:12:51] Dr. Balcavage: I'm gonna use it to make some hormones. I'm gonna use to make some cortisone, some D H E a, some estrogen, right? So the cholesterol comes out into the bloodstream and then it needs to go places. But to get cholesterol out of the bloodstream and. Into your liver to make bile, you need optimal levels of T3 to get it in there.

[01:13:10] Dr. Balcavage: To get cholesterol out of the bloodstream and into your adrenal gland to make cortisol and D H E A and progesterone and pregnant alone and all kinds of other good stuff, guess what you need? You need T3 for those L D and HDL D doc and dump off your cholesterol. So if you see cholesterol building up in your bloodstream, there's a good chance you have some bile issues going on and there's a good chance you've got tissue or gland tissue hypothyroidism going on before you jump to, oh, I have adrenal fatigue.

[01:13:39] Dr. Balcavage: You do not probably have adrenal fatigue cuz adrenal gland ate doesn't fatigue. But if your cortisols low, your d h e is low, your estrogen, your testosterone's low, your adrenal gland is probably not broken. Look for your, look at your T3 levels and look at your cholesterol levels. If cholesterol's hanging out in the bloodstream and you have low t3, That's probably why your adrenal gland's not making D H E A and cortisol.

[01:14:02] Dr. Balcavage: Hmm. 

[01:14:02] Christa: So many things. So the thyroid debacle is the name of the book. Mm-hmm. And you have this strategic thyroid solution that you discuss in there. What are some of the parts of the strategic, tell us about it. Tell us a little bit about 

[01:14:13] Dr. Balcavage: that in the book. So the focus of the solution is to, from the person to understand, okay, how do I attack this thing?

[01:14:19] Dr. Balcavage: Well, we talk about all what we call the fitness factors, physical fitness, emotional fitness, di nutritional fitness, sleep, fitness, respiratory fitness. So these are all the categories that you wanna start to take a look at as to why my thyroid physiology might be downregulated. Each chapter in that part of the book is dedicated to, in each one of those fitness factors, each chapter could have been a book itself, like on breathing.

[01:14:43] Dr. Balcavage: I mean, there's full books written on it, but we just give you a TA how to test some of it and how to assess some of it. But those are things to work on. So we want people, before they jump the supplements, we want them to look at their habits and their, and their behaviors for the clinician. And I, as we are talking, Mitch, my guy Mitch, just put our, we did a, a course on the book for clinicians and that course will be out here probably in the next month.

[01:15:10] Dr. Balcavage: So Mitch just said, Hey, it's almost ready to go. But we want the clinicians to also look at those same things and work their way through the process before you jump to just throwing somebody on a bunch of thyroid medication, let's walk through these steps and we also walk them through some, how somebody can look at their blood chemistry panel to say, okay, what's going on with my thyroid panel?

[01:15:31] Dr. Balcavage: Do I have inflammation? And then do I have. What tissues are being impacted by that hypothyroid state? Do you have an adrenal pattern? Do you have a renal pattern? Do you have a blood sugar pattern? Do you have a liver pattern? Do you have a lipid pattern? And we kind of walk through that process. So the strategic thyroid solution is to really look at the physiology and go, okay, thyroid physiology is adapting to something.

[01:15:53] Dr. Balcavage: This is where we start, how we go through the process to start looking at what is causing that excessive cell stress response. And how do I start reducing the load or eliminating the load so you can shift the body back to homeostatic regulation. Perfect. 

[01:16:08] Christa: And it's out, it's been out since last summer, last fall.

[01:16:11] Christa: So you can go get it now. Thyroid debacle. 

[01:16:13] Dr. Balcavage: You can get it, you can get it, yep. You can get it on Amazon, wherever you buy your books. But it's, you know, Amazon's probably the, the big beast in the room these days. Yeah. And 

[01:16:22] Christa: if clinicians are interested in your programming, where can they find out more or where can people find you online in 

[01:16:28] Dr. Balcavage: general?

[01:16:29] Dr. Balcavage: So rejuven is, My primary website and we'll have a link to the thyroid debacle course on there. I have a podcast called Thyroid Answers Podcast. And by all means, if you want to come join us on the podcast, you can come on and we'll chat on the podcast. And then I have on Instagram, I'm not a huge social media person.

[01:16:48] Dr. Balcavage: I'm not doing any like TikTok type videos or I'm dancing or anything. Most of my stuff is more kind of educational. So if you're looking for the three secret tips to fix your thyroid physiology tomorrow, Don't come to my channel. If you wanna learn about, okay, why do I have blood sugar issues if I have a thyroid issue?

[01:17:04] Dr. Balcavage: I'll teach you that. Okay, so Instagram on, it's Dr. Eric Ball cabbage on Instagram and got a YouTube. I think it's rejuven my, some of my team's starting to put all the stuff that I've done on those sites, cuz I'm not a huge social media guy. But we're getting it 

[01:17:19] Christa: there. I can't see you dancing, but I could see you shooting hoops possibly with, they put words on the top maybe.

[01:17:26] Christa: I'm not sure it's possibility. 

[01:17:28] Dr. Balcavage: Possibly. Possibly. Did they? Possibly, yeah. Just now. I also don't, I probably don't, I don't have any, any moves either, so that, that's another reason why it's not gonna happen. 

[01:17:37] Christa: All right. Thank you so much for coming on today. I was absolutely so fun to listen to you geek out about different mechanisms.

[01:17:44] Christa: I'm sure there will be lots of people that love that. And worst case scenario, I think it's such a good service. I mean, there's a large percentage of people with diagnosed thyroid issues. There's a much larger percentage of people with undiagnosed thyroid issues that are just walking around suffering with these symptoms.

[01:18:02] Christa: So I think that there was plenty of lip service for both of those audiences in this episode today. So thanks for coming on. 

[01:18:08] Dr. Balcavage: You got it. Thanks for having me. 

[01:18:11] Christa: Sharing and reviewing this podcast is the best way to help us succeed with our mission. To help integrate the best of East and West and empower you to raise the bar on your health story, just go to review this stressed life.

[01:18:26] Christa: That's review this stressed life, and you'll be taken directly to a page where you can insert your review and hit post.

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