You might have heard several myths and misinformation about thyroid physiology. And that's what the first part of today's episode is for.
Here in Medical Insider, together with Dr. Kelly Halderman and Dr. Eric Balcavage, we talk about things people should know about thyroid. We tackle its biggest revelations, its physiology type, the blood work, and its involvement with politics. We also touch on this book called "Thyroid Debacle: Why The Current Medical Model Is Keeping You Sick And Unwell."
If you want to grab a copy, check this Amazon link to order⏩ https://www.amazon.com/Thyroid-Debacle-Dr-Eric-Balcavage/dp/B0B31VDBSV
Stay tuned for more exciting and insightful episodes! Follow and subscribe to our podcast using the links below ⏬⏬⏬
Website: https://themedicalinsider.buzzsprout.com/
Apple Podcast: https://apple.co/3FVK4IU
Spotify: https://spoti.fi/3NkufxH
Youtube: https://bit.ly/3lnlbMo
You might have heard several myths and misinformation about thyroid physiology. And that's what the first part of today's episode is for.
Here in Medical Insider, together with Dr. Kelly Halderman and Dr. Eric Balcavage, we talk about things people should know about thyroid. We tackle its biggest revelations, its physiology type, the blood work, and its involvement with politics. We also touch on this book called "Thyroid Debacle: Why The Current Medical Model Is Keeping You Sick And Unwell."
If you want to grab a copy, check this Amazon link to order⏩ https://www.amazon.com/Thyroid-Debacle-Dr-Eric-Balcavage/dp/B0B31VDBSV
Stay tuned for more exciting and insightful episodes! Follow and subscribe to our podcast using the links below ⏬⏬⏬
Website: https://themedicalinsider.buzzsprout.com/
Apple Podcast: https://apple.co/3FVK4IU
Spotify: https://spoti.fi/3NkufxH
Youtube: https://bit.ly/3lnlbMo
Intro
Welcome to "The Medical Insider" podcast, where we highlight real-life solutions to your health challenges, encorporate new technology and proven solutions from the past with a healthy dose of common sense while resisting the pitfalls of idiopathic classifications and economically-based medical doctrine. This is your host, Dr. Thomas Santucci. Let's get started.
Dr. Thomas Intro
Good morning. Today, I want to talk about a new book that's out by two friends of mine called "The Thyroid Debacle". And this is Dr. Eric Balcavage and Kelly Halderman, who's an MD. And basically, they put together a new, more complex model for thyroid. Thyroid is always getting to be more complex. They're highlighting the historical problems that have always been associated with thyroid misdiagnosis. It's a rather long interview, so we're going to break it into a couple of slots, but stick in there because there's lots of good lifestyle advice. We hit on the issues with Functional Medicine and with Allopathic Medicine and what we're all doing to kind of bridge that gap. So, enjoy.
Dr. Thomas
So today is a special day. This is the first of our interviews. And we're going to start off with thyroid, and we're going to start off with two neurometabolic practitioners. And what that means is people that actually have been the doctors in front of the people that weren't getting well. In all cases, we're talking about complex cases, we're talking about things that don't have a linear ideology. It's not you have a sore throat and it's red and I'm going to give you some kind of an antibiotic. It's much, much more complicated than that. How deep a person goes is an individual design. There are a lot of ways to skin this particular cat. I'm here with Dr. Eric Balcavage. We practiced his name earlier, so I think I've got it now. And Dr. Kelly Halderman. These are two really brilliant people. And they're really brilliant and they actually stayed on the good side of the evil line, so that's even better. So welcome both of you. [inaudible] thing because thyroid was probably the first open debate in the functional medicine frontier. We were getting people who were getting lab ranges and they were basically saying, you know, you're good in this lab range. And one of the things we understood is that we had to rewrite the lab ranges. And this is 25 years ago. I remembered the first time you know, I'm with Jeff Bland and I'm with you know, Mark Percival, and I'm with all the people that started all this. You know, and they're going, oh yeah, we're going to redo the functional levels. And one of the things that we're going to see, and I guess you know, as a highlight of your all's work, is we didn't redo the functional levels. We did the functional levels, but regular people didn't do it. So, you know, you've done a good job or you spend a lot of time basically showing the contrast. But what would you say, the biggest revelations that you all have uncovered in your work, and what are you bringing to the table there?
Dr. Eric
Well, I think the biggest thing that I think we're bringing to the table is we're trying to get the focus off the gland-only or gland-centric perspective and what's-- or just what we force into the bloodstream as if what the gland makes is the only thing that's important and what's in the bloodstream because we gave it to somebody is the only thing that's important. And that this kind of whack a mole we do with medications, fixes physiology when in reality, all it does is mask really that there's still an underlying problem and underlying condition. And, you know, we've all been in this game for a while and realized that despite normal TSH levels and despite giving somebody T4, and now we've got a whole group of people that are, hey, we got to load people up on T3 because they don't feel good on T4 only. We've got the whole T3-only crowd. And I think we're still missing the point, which is that its-- the production by the gland and what we put into the bloodstream is only part of the picture. It's about what's happening inside the cells that really determines how we feel and function. And we also need to consider that people show up in one of two primary states. They're either in a state of homeostasis where they make all the energy to do all the things they need, what we call a very low-stress state, or they're in a state of allostasis, which is an excessive stress rate. And the body that works differently and the physiology of the cells works differently whether we're in homeostasis or allostasis. And I think those concepts are virtually ignored to a large degree-- sometimes from an allopathic perspective. But even in the functional medicine perspective, I would argue that that's often ignored or not understood.
Dr. Thomas
Clearly. I would say that that's a key point that you guys have made is dealing with like the cell personality, if you will. You've almost created an analog to insulin resistance or any other kind of signaling molecule resistance. And so it matters not just what those ambient levels are, but what the cell is actually doing. And I think in that it's kind of great and it's kind of awful because now do we have to fix everything in order to fix these people?
Dr. Eric
Well, the answer to that is, is that I think we have to consider is the physiology broken or is the physiology in an adaptive mode.
Dr. Thomas
Right.
Dr. Eric
And early on, I think the physiology is in adaptive mode, right? So if I have excessive cell stress, that cell is going to shift from manufacturing mode, making proteins and peptides and enzymes and cell membranes and burning lots of fat and bringing lots of nutrients in to a cell that's focused on slowing down manufacturing and ramping up the immune inflammatory cell defense mechanisms.
Dr. Thomas
Right.
Dr. Eric
So, you know, we talk about in the book, this is not broken physiology, at least initially. This is adaptive physiology. As real people, we would do the same thing in real life. You know, if Kelly is a better cook. But let's say that I am cooking. I've got a big party tomorrow. I've got four burners on. I'm cooking all this food. I'm trying to vacuum, I'm doing some wash, right? My Kelly's probably going, yeah, that's not happening. But let's just assume all that's going on. And then my daughter is sitting at my kitchen island having lunch and somebody breaks into my home and starts attacking my daughter. Am I going to continue to cook?
Dr. Thomas
Right.
Dr. Eric
No. Am I going to turn the burners off and pack everything up in nice glass tupperware? No.
Dr. Thomas
Right.
Dr. Eric
Am I going to try and slide a load of washing? Just let me vacuum the family room, then I'll come save you, right?
Dr. Thomas
Right.
Dr. Eric
I'm not going to take a nap. I'm not going to go have sex. None of that stuff is important at the moment. And so if you walk into the home and don't realize I'm down in my basement fighting off this attacker, you might walk in and go, man, Eric is a terrible housekeeper and cook. Stuff's burning, vacuum cleaners running washes all over the house, and say, well, Eric is the problem, right? And the solution is I'm going to hire a cook for them and a cleaner. This will all get cleaned up. Life is good, right?
Dr. Thomas
Right.
Dr. Eric
But it's not. And so, cells are the same way. If they're still perceiving a threat or danger, they're not going to operate like we want them to, right? We're saying, hey, let's just put more thyroid hormones into the system and that will increase metabolism. No. The cell is saying, hey, I'm down-regulating metabolism because I'm perceiving a threat. And so we have to take that into consideration. Now, the longer somebody's in that allostatic regulatory mode and I've turned down the energy to hormone production and cell membrane physiology, then I am going to start to see pathology start to develop. I'm going to see not just symptoms, but dysfunction and disease start. But that's not the beginning of the problem. That's longer down the line. We're trying to help people understand this from a very early perspective. When you start to have signs and symptoms, regardless of what your TSH is in your Free T4, if you've got signs and symptoms of hypothyroidism, you've got lab values indicating a down-regulation of the metabolism, it's time to act. And it's time to act now.
Dr. Thomas
Right. So this is very much like the concept of fight or flight, that if we're talking about, you know, central vascularization going away and going to the periphery, it's not that nothing's happening. It's that a specialized, almost protective mechanism is going in and the body is actually doing what it should be doing. So, therefore, the intelligence, if you will, is in that whole system. And you probably have to look at more things than just that cascade. Now, I personally was very proud of myself when I could go, you know, body to the hypothalamus, to the pituitary, to the thyroid, to the individual conversion organs, to the thyroid binding globulin, to the receptor sites in each cell. So you sort of blew that to hell. What do you tell a practitioner that has to kind of understand this because you did just add a dimension by putting the cortisol part in it. And, you know, we all know those three systems are linked and it's wet chemistry and you've got to deal with everything. But how do a regular person who is in a hyper genius and neuroendocrine stuff deal with all this? What's there for a person to pick up on, to actually do on a practical level?
Dr. Kelly
Well, I think I'm a really good case in point is that I was trained as a medical doctor. And so I knew, just like Eric's analogy, I knew something wasn't quite right. The way we were approaching thyroid physiology, something is not right here, but no other tools existed in the toolkit here.
Dr. Thomas
Right.
Dr. Kelly
So I don't fault medical doctors. I don't fault functional medicine practitioners who just don't understand. But I think that's where when I came in to write part one about why your doctor treats you the way he or she treats you, in our book, "The Thyroid Debacle", it's because I wanted people to understand that they're not taught the allostatic load. They're not taught about homeostasis. They're just taught numbers are okay, you're okay. Numbers are not okay. We're going to put in some additional thyroid hormones to make those numbers look good. So, I myself actually have Hashimoto's Thyroiditis, and that's why I gravitated toward everything, Eric. I was Eric's number one biggest fan.
Dr. Thomas
Nice.
Dr. Kelly
I still am, but absolutely read every blog post because I'm like, this guy is on to something huge. This is the paradigm that I knew that I didn't know existed, but I knew that this is the way we're going to get out of all these people suffering, including myself. So, Eric, you can kind of swoop in and then answer that side of how do we get people to understand that.
Dr. Eric
Well, I think the key is-- and, you know, I got my early training much probably like you, Tom, you know, the T's was like the foundational to a lot of our understanding of thyroid physiology and the depths of it.
Dr. Thomas
Right.
Dr. Eric
But there was a piece that was missing and that was kind of handed to me by my friend Ben Lynch, who gave me Dr. Robert Naviaux's paper on the "Cell Danger Response". And when I read that paper, I was like, oh, okay, this is not in a thyroid gland that woke up one day and decided it didn't work. This wasn't an immune system that totally lost control and just started destroying the thyroid gland for no apparent reason. This is more of a potential calculated, adaptable response to some type of excessive stress. So that changed everything. So then you go, okay, well, all that stuff I learned, right, does it still have value? And I think a lot of that stuff still has value because at the end of the day, how do we help somebody? We don't help them necessarily by giving them more drugs or giving them more supplements and keeping them on the thyroid protocol. We help them by reducing or eliminating what's creating the excessive cell stress. So the things we learn foundationally as functional medicine practitioners improve somebody's dietary fitness, improve somebody's physical fitness, and work to improve their respiratory fitness, which nobody cares to work on. And there's probably one of the biggest problems we have in this country.
Dr. Thomas
Sure.
Dr. Eric
Work on their emotional fitness, improve their sleep fitness, like, work in improving these foundational factors, improve their microbial fitness, right? Their habitual fitness, you know, their genetic fitness, their environmental fitness. So work on those things. Those are all still foundational. Nothing changes.
Dr. Thomas
Right.
Dr. Eric
But what helps--and we'll wind up doing some training on this-- training course on this, too. Okay, how do we interpret labs maybe differently now than maybe before? And now, the way I look at it is it really opens up that blood chemistry panel and a real important reason. Take a look at a more comprehensive panel when we look at it, so we're not just looking at a thyroid panel all by itself. Whether it's a TSH and a Free T4 or just a more complete thyroid panel, I often see people say, I'm better because I run a more complete thyroid panel. Okay, but that's all you ran. So what we really want people to do is say, okay, do I have a glandular problem? Do I have a cellular or tissue hypothyroidism? I'm having a lack of conversion of T4 to T3. And if I see that pattern and I have a patient with signs and symptoms that there's tissue hypothyroidism going on, and I look at my comprehensive lab panel and see indicators that I've got enough regulation of inflammatory mechanisms that would drive that, well, if you don't run inflammatory markers, you might not see it. But if you see those elevations of inflammatory markers, instead of just saying, hey, I got to suppress inflammation, let's ask better questions. But if we see the inflammatory markers and I typically run about seven or eight inflammatory or oxidative stress markers on my blood panel, I go, okay, we've got inflammatory cell stress mechanisms. We got up-regulation of the inflammatory mechanisms that is going to cause a change in T4 to T3 conversions. So instead of saying, oh, they're not doing well on T4 only, and they're T3, though, I'm just going to give them T3, that can have a Band-Aid approach. Instead, we want you to think a little bit differently and say, well, if they're not converting T4 to T3, it's probably an adaptable response because I got this inflammatory mechanism going on. And part of what a cell in danger wants to do is downregulate cell metabolism. So instead of saying, hey, this is flood, let's just put a different gasoline in the car. Instead, let's ask a better question. And then when we look for the physician, now, once you've said, hey, I've got tissue hypothyroidism going on, I may also have glandular because of the thyroiditis that was created by the cell danger mechanism. I've got inflammatory markers, where's the inflammation potentially being generated from? That may help me go find out where I need to go and then look at the rest of the lab panel for what systems are being impacted by the cell danger physiology and down-regulation of cell metabolism or tissue hypothyroidism. So, we can go and look at somebody's blood sugar markers, right?
Dr. Thomas
Sure.
Dr. Eric
If glucose is high or glucose is normal, but insulin is high, right? We know we've got an insulin-resistant state. Well, what does that have to do with tissue hypothyroidism or the cell danger response? Well, the cell in danger is not bringing more glucose into the cell.
Dr. Thomas
Right.
Dr. Eric
Why would that cell bring more glucose? And that's just going to feed the threat. So it stiffens the cell membrane, reduces transport, and what do you need to get glucose into a cell? You need these glucose transporters to escort the glucose in. Well, the glucose transporters all need T3 to be functional. So whether they're insulin-dependent, insulin transporter, or non-insulin-dependent transporter, you need T3. And so when we see insulin resistance, you know, we have all this noise about too much carbs, too little carbs, too much, you know, not enough exercise, whatever. But at the end of the day, it's a cell that's perceiving stress or danger. Right?
Dr. Thomas
Sure.
Dr. Eric
So we look at that, we can look at the liver. How's the liver doing? Well, we've got elevated cholesterol, and that elevated cholesterol and LDL may be a great sign. I don't have enough T3 to deliver for the cholesterol to get into the liver and get pushed out through the bile. We can look at triglycerides. Can I even burn the fats that I may be liberating? Well, it doesn't look that way because triglycerides are elevated, and VLDL is elevated. We can look at the renal system, sees the kidney being struggling, we can look at mitochondrial markers on a blood work. So it gives us the ability to start looking at that blood work more completely and get more value out of it because what we can see is that we've got not a thyroid issue, but we've got a thyroid condition that's associated with a whole bunch of other conditions. And that's where we coined that term multi-system adaptive disorder because almost every system is going to start to be compromised when you're in that cell stress or cell danger response for an extended period of time.
Dr. Thomas
Beautiful. I think it's so important because we're looking at complex systems. We like those linear relationships. They're clean, but they're not true. And it's hard for a regular person and it's hard for doctors to say, your liver dysfunction, malfunction, under function is actually the cause of your "thyroid problem". And I think we've underplayed cortisol so bad. You know, like, we used to do adrenal stress tests on everybody, and now we're like, you're in the Silicon Valley, you're breathing, you're under stress. Until we tested people that were one stage from dead, and then all of a sudden we went, no, we better pay attention to that because it's bleeding into everything else. And then the thing that I think everyone should do is everyone should have to take the blood chemistry results and put them on an Excel spreadsheet by organ systems and then interrelate that because there are two groups of people that amaze me. People that can hold on to an X-ray or MRI and say, yes, looks good. I've never seen one in my life that looks good. You know, I can always find something wrong. And then blood work, the same thing. And I was just like, wow, because there are about ten dimensions on, you know, like, a 40 panel SMAC. No one can analyze that, and yet we analyze those in less than ten seconds, and we're looking for HS and Ls, you know. It's absurd. And so in your kind of work, how much work are you doing to actually analyze the blood? Are you transcribing the results to a functional indices report, or how are you actually looking at the blood work?
Dr. Eric
So when I look at blood work and we talk about this in the book like you can't interpret blood work in a vacuum. You have to interpret blood work with the patient's health history, patient's health-- their signs and symptoms, the medications they're taking, and the supplementation they're taking. Two, there are lab reference ranges and functional ranges, and everybody thinks that, okay, that's the range something needs to be in. No. Lab ranges are adaptable, right? So when I look at lab work, when Kelly looks at lab work, we consider that lab values could be normal, whether it's functional or lab reference range, whichever, it could be normal and totally appropriate. Right?
Dr. Thomas
Right.
Dr. Eric
A lab value could be totally normal and inappropriate, right? And so, TSH is a great example of that, especially early on in the thyroid condition, TSH could look normal or actually be low, and yet somebody might say, well, you're not hypothyroid because TSH is normal, or your TSH is low. You don't have a thyroid-- you're more hyperthyroid than hypothyroid. But if they just look at their patient and saw their hair is falling out, they're overweight, they're obese and listen to their story, they go, okay, that value is normal, but it's totally inappropriate for my client. Right?
Dr. Thomas
Right.
Dr. Eric
And so, you know, there are so many things that can influence TSH, and one of the biggest problems we have in this country is chronic low-grade inflammation. And guess what chronic low-grade inflammation does in the early stage of hypothyroidism? It actually suppresses TSH, cause inflammation increases the hypothalamic conversion of T4 to T3, but reduces the peripheral conversion of T4 to T3.
Dr. Thomas
Right.
Dr. Eric
So, if a doctor doesn't know that or isn't interpreting the labs based on more, they miss it.
Dr. Thomas
Right.
Dr. Eric
But a lab value could be abnormal and totally appropriate given the patient's situation, right? So you have to interpret it like, okay, this TSH is elevated. I got a low T3. I got a patient here who looks like they're hypothyroid. This confirms it's abnormal but totally appropriate. And then the fourth component is, it could be abnormal and totally inappropriate, right? Like, hey, I'm perfectly healthy. Look fit, look great, and you get the CRP back, and it's 45.
Dr. Thomas
Right.
Dr. Eric
Right? You go, something's wrong here. Right? So we have to interpret that way. We also have to understand that the lab value is not the problem, in most cases. The lab value is the indication that there's a change in physiology. And our job as a functional practitioner is to try to figure out why is the TSH elevated, right, in this given patient. Or why is there cholesterol elevated? Not just say, oh, we don't want to give them a statin. Let's give them, you know, a--
Dr. Kelly
Red yeast rice.
Dr. Eric
Red yeast rice, and that's going to be good. No. That's greenwashing of medicine, right?
Dr. Thomas
Right.
Dr. Eric
I'm just going to take away a drug, and give them a supplement, it's going to do the same thing, but not really address the underlying issue. So, I think for practitioners, what we really need to do is we-- early on, we all do the same thing. We go to a seminar, we learn the basics, we get the protocol, and we do the protocol. As we get into this more, what we have to do is become more astute on the pathways and the mechanisms that things work and realize the body is trying to tell us stuff through the blood work. And if we're good physicians, good generalists, you know, versus I'm a specialist, right? You have to be a fantastic generalist, in my opinion, because I need to understand how gut physiology is tied to thyroid physiology, how respiration is tied to my thyroid physiology, right?
Dr. Thomas
Sure.
Dr. Eric
How all of these things are tied in. If I only understand thyroid lab values, I don't know that I'm going to wind up doing a better job for my client than telepathic physicians going to do.
Dr. Thomas
Beautiful. So, one of-- I almost called myself an informed generalist when people said, you know, what are you? And I was like, a person that understands neurology, biochemistry, you know, regenerative medicine and everything your doctor knows. And, you know, people go, but you're a chiropractor. And I said, but all those chiropractors didn't stop going to school and learning and plus, this isn't owned by anybody. One of the things that I think is true at this point, and I'm a little older than you guys, so it's a different viewpoint of life. I actually think politics is a huge part of the answer going forward, and I want to touch on that. So, some of the things that you're bringing up are wider, deeper, interrelating organs and then really looking at etiology. So what caused this, you know? And that's really-- I think we should be detectives, not doctors. So I think it's a big, big part of the thing, but why the hell hasn't this been fixed? I mean, we could have had this conversation with less sophistication, but pretty much the same 25 years ago. And then if you're an endocrinologist, why didn't they pick up on they should be doing reverse T3 and thyroid antibodies and look at what the person's lifestyle is? Like, why are we aliens at this point? Why isn't this normal? And we just all moved on to think about the meaning of life or something? Why are we still doing basic biochemistry?
Dr. Kelly
I would say, from my perspective, being trained in this allopathic model is that what comes to mind is when you address root causes, you go after and fix a person's physiology, and there's no longer a need for medication. So that may be a reason. However, the training, it is what it is. It's archaic. It hasn't changed. That is political. Nobody really knows why it hasn't changed. The literature is robust and that's what's so brilliant about this book.
Dr. Thomas
Exactly.
Dr. Kelly
Dr. Eric, there are no opinions here. This is all published data.
Dr. Thomas
I love your book that way. It was really well formatted and footnoted. And if there's an opinion, you footnoted it. Yeah, it was good.
Dr. Kelly
So, here comes the substance for the revolution. Or changing, you know, that's a big word, but yet it really wasn't here before. We knew something was wrong, we knew we weren't-- we were sniffing that out. An Allopathic, maybe some physicians aren't really comfortable, maybe some endocrinologists aren't-- but where's the path? Where's the [inaudible]? Here it is.
Dr. Thomas
Right.
Dr. Kelly
Here's the book.
Outro
Thanks for listening to "The Medical Insider" podcast. If you enjoyed today's episode, make sure you visit "themedicalinsider.com". Go ahead and sign up for these episodes. Get them sent directly to your inbox. Do us a favor and give us a "Like".