Thyroid with Dr. Balcavage and Dr. Halderman (Part 2)

This is a continuation of our discussion about thyroid physiology. We talk about thyroid when it comes to functional and allopathic medicine. We also speak about its challenges today and try to identify whether or not there is a specific approach to it.

If you want to grab a copy of "Thyroid Debacle: Why The Current Medical Model Is Keeping You Sick And Unwell.", check this Amazon link to order⏩
https://www.amazon.com/Thyroid-Debacle-Dr-Eric-Balcavage/dp/B0B31VDBSV

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Transcript

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
This is Dr. Thomas Santucci. Join us for the second phase of our Thyroid Debacle conversation with Dr. Kelly Halderman and Dr. Eric Balcavage, where we go deeper into the intricacies of whole system remedies for Thyroid. Look forward to seeing you there.

Dr. Thomas
So, Eric, I would charge you with a small task of making this a flow chart and a little simpler. I did that with autoimmune disease, and it's being stolen all over the place where I put the triggers for autoimmune disease. And it's in five books right now. Like, people just took it. They took the cartoon, they couldn't get the concept, but the cartoon they got. And so, now, it's being taught in schools, literally. And I think with your thing if you did an interrelationship kind of a diagram and we're happy to help you with that like I have a MarCom guy who's really good at all that kind of stuff, but where you just say, here's the answer. And I think that it's a little bit like referring a person to another doctor where you've already got the diagnosis. It's really hard for them not to pick up on it. Clearly, you've got the aspects of this thing that would take a person almost having a different mindset. But if you walk in and say, oh, by the way, here's a new way to clear or to address complex thyroid disorders, and by the way, we're not doing that in 50% of the people or whatever the new numbers are, that could really begin to change things. And one of the-- in my more dismal moments, I think that the functional medicine village has become a corporation. That nobody really does anything unless they're being paid for it. You know, if you look at some of this stuff done by the best functional medicine online doctors, they don't do anything that cost more than $800. Do you know why? Because you can't sell anything for more than $800 on the Internet. And, you know, some of our technology costs $50,000. And it's the right answer. You know, it's not an at-home thing. It's a clinical thing. And in some of this, I think that we have an onus to like, this is me being political for a second, but I think we have an onus to like get the message out there. And you have a definite message that I think has real clinical benefit, but I think that the complexity will lose. Like, I don't think that the other side is even listening. You know, I mean, they didn't listen to the simple message. So, like yours, I would hate for it and again, I'm pulling age here. I would hate for it to die with you.

Dr. Eric
Well, look, here, Kelly and I talk about this all the time. And our book started off as an angry version of what we thought about allopathic medicine.

Dr. Thomas
That was in there somewhere. I got a couple of pages in there of that.

Dr. Eric
It was angrier than that before. But the issue came down to is that, you know, we've gotten a little bit older in the process of rewriting this book and maybe a little wiser and a little softer and realized that we need to build a bridge to the community. But we also learn that allopathic medicine is not going to take up this model that we are talking about probably as a primary means of evaluation and treatment because it doesn't serve the bottom line of the sick care industry, which is profit. Okay? So, that does not mean that medical doctors are bad. It just means what medical doctors do is different than what we do in functional medicine. And there's a place for both functional medicine and there's a place for allopathic medicine. And I think allopathic medicine does a really good job at acute crisis care. And for the people that aren't or don't want to put much effort or focus into health management or health improvement, somebody is there to manage their disease processes as they deteriorate. I think that's fine.

Dr. Thomas
Right.

Dr. Eric
I think there's a need for that. But what we want to do with this book and this book is tough, we kind of almost wrote it like the thesis wrote his book, which is we need to write it so the general person can pick it up and get some content.

Dr. Thomas
Right.

Dr. Eric
But we also want to help the functional medicine practitioner or the MD who picks this up and sees there's enough sciency stuff there where they go, okay, I got this to make me look.

Dr. Thomas
Yeah.

Dr. Eric
The thesis book was written really towards the delay person. But tell me a functional medicine practitioner that didn't pick up the thesis book and use that, especially in the beginning, as a guide to go like, oh, okay, now I'm starting to understand what's going on here with thyroid physiology.

Dr. Thomas
Right.

Dr. Eric
So, I think what we've come to realize through writing this book is, look, we just need to let people know that there is something else going on here. Your allopathic physicians are not trained on this, their peers are not going to be driving this. The insurance-based industry is not going to be necessarily supportive of this role. This is something that you're going to need a different physician if you really want to improve your health and your vitality. It's just that's where functional medicines place is if we do it right and then let's leave allopathic medicine do what they do and this gives us a place in a home. And now we can all kumbaya, we can come together and we can say, hey, look, you do your crisis management job, let me take those chronic patients that want an alternative to drugs and surgery and let me work with them. They're the biggest pain in the ass patients you have anyway.

Dr. Thomas
Right.

Dr. Eric
So let me take care of them, right?

Dr. Thomas
Sure.

Dr. Eric
Because they're the ones you can't get better. And what you wind up doing is putting them on another med and another med and another med is that all you're doing is managing them as they're getting worse. Why not let somebody take that load off of you, send them to the functional medicine practitioner, we can work with them and coach them through the things and the steps that they need to get healthy and get better. If they don't want it, great. Stay with the drugs and surgery. If you do want something other than drugs and surgery or that's not even working for you, then this is a different approach.

Dr. Thomas
Nice.

Dr. Eric
So, I totally understand what you say, but we fully realize that this book for a practitioner is a starting point, much like the thesis book was a starting point for that functional medicine practitioner to say, oh, there's more depth here, and I got to get that. We couldn't do all of that. And I think Kelly, I had to pull back on even some of the sciency stuff that I had in there because it was just too heavy.

Dr. Thomas
Yeah, you did a lot. I mean, in the last six or eight chapters, you are kind of molded in almost everything a person consider. There's room here for style. There's definitely room for individual approaches. I like the whole idea of, you know, kind of outfitting people with the tools, like the thesis work. It was the end you go, okay, Th1, Th2, I'm going to do cell-mediated immunity versus, you know, autonomic immunity, so, and we all kind of got that. And, you know, what are those triggers? I think in your work, though, I think that the really important point is the details around what is a holistic approach really means. What is an integrated approach really mean? And you didn't leave out any subsystems, which was really brave. It reminded me of, you know, in the early days of functional medicine, we had antecedents, triggers, and modulators. Well, now it looks like a tree with every single substantially like stuck in the whole thing. I'm still doing antecedents, triggers, and modulators because I'm a simple person, but, you know, I look at what you've done and kind of go, no, you have to look at the whole system and you have part and parcel. You have to look at the patient. And then to me, I think there's an invitation here for a level of integration because I think that it's being pushed by the public. I think that you know, groups like Medicare are saying, you know, what's the efficacy? And so, you know, if we go, oh, by the way, we've been measuring the wrong thing in thyroid, I just think that would be so cool. You know, like and if you don't do antibodies in reverse T3, you don't know what you're talking about. You know, it's like something more.

Dr. Eric
I'm hoping we get more of a bridge as a younger generation comes up and they start learning maybe some different things. And we've got a younger generation of people who are maybe more inquisitive buck the status quo a little bit, and maybe we get more people-- I think we're starting to see more physicians even getting frustrated with the allopathic model, much like maybe Kelly did, and say, hey, there's got to be something else. But what's interesting is I have a patient who's a cardiovascular surgeon, and he came to ask me for help. I asked him on the phone call, like, do you know what I do? He's like, well, no, I just heard you on a podcast, and I've got diabetes, and I've got-- I'm overweight, and I'm on insulin, and I'm on this, and I'm on blood pressure med. I'm like, dude, you're a cardiovascular surgeon. He's like, yeah, and he's a really good cardiovascular surgeon, and he's doing everything that he is telling his clients and people to do. And when over the six months that we were like working together and he got, you know, from his weight down to his high school wrestling weight and all is off his medications, and he's like, the new person. I had him on my podcast, and he's like, you know, he said, I got to be honest. Before I met you, I didn't even know there was this parallel universe called functional medicine.

Dr. Thomas
Right.

Dr. Eric
I mean, he's not even aware of it.

Dr. Thomas
Yeah.

Dr. Eric
They're not really talking about it in most circles. And one of the things we talked about was, hey, you could use these principles in your practice.

Dr. Thomas
Sure.

Dr. Eric
And that was kind of like, whoa, if I start doing these things, that may affect who refers people to me, like, hey, I may not get people referring because I can't-- you know, it sounds bad, but this is a business, right?

Dr. Thomas
Yeah.

Dr. Eric
And so, you know, I think Kelly talked about that earlier. Like, we need to keep people coming back to the machine.

Dr. Thomas
Yes. And I think that that's the challenge here because we all want the right thing to happen in the big picture. But we also-- my little brother is a surgeon and does the same kind of thing. You know, I was like, we were doing a complex case, and I was getting a referral from him, and we were talking about you know which nerves actually innervated the part of the body that was dysfunctional. And so I was like, oh, it's this, this, and this. And he goes, did you research that? And I said, no, I know the nervous system of the human body. And he goes, how do you still know that? I mean, he learned it in school. And I was like because I do it every day. And, you know, he was like, wow, you know, like that's amazing. And truly, and he's a great surgeon, you know. And I'm like, oh, my God, you guys over-specialized to the point where you're missing basic diagnostics, and then you don't know the answer of what to do to this without, you know, the fast answers. And I think that-- my personal opinion is we put way too much stock in specialists, and we've really just done it. We've gone too far down that road. And, you know, in medical school, they know that they make a third more money, and everybody wants to go that route. But if you then ask them to do kind of like the interrelationships that you're talking about, they would be lost in the woods so quick, it's not funny. So, one of the things that-- I'm starting a new book, and that is rewriting the scope of practice of regular medicine. I mean, I have two medical corporations now, so I'm in that world and I look at it and I just go, oh, my God. You know, the nurse practitioners are trained to do one or two things. They're really not cross-the-board people, and yet they're running medicine right now. Nurse practitioners do 90% of the procedures in medicine, and then I look at, you know, what a holistic-- and I don't care where they come from. The thing I always liked about functional medicine is one of the best guys in our functional medicine study group was this Indian shaman guy. He was the best biochemist in the group. You know, he was super spiritual, and he knew energy, but that guy knew every pathway on the face of the Earth. You know, and he really brought it all together, and I was kind of like, this is what we need to do. We need to kind of celebrate the differences, but not settle on the backward answer and certainly not the stuff we did half a century ago. You know, I mean, it's like, come on, the body of knowledge is doubling every three years. And, you know, like what I find when we do innovation, at the headwind on this thing is enormous. You know, we're doing stem cells now. Even if I do complex acute to take over of somebody's case, it's always seen as an individual doing, like, Eric. You know, like Eric is this amazing doctor, Kelly is this amazing doctor. These guys, personally, are these amazing doctors, which is true. But you're also part of a type of medicine that is very good at fixing this kind of problem. And I don't think that that's really known. Just like your surgeon guy didn't know, what my surgeon guy didn't know, what Kelly didn't know it. And, you know, I think we need way better PR. You know, people were like, why are you doing this podcast? You know because I don't sell anything, I don't make any money out-- I don't do whatever. And I was like because this needs better press. You know, this needs as much as our knee pain or, you know, endocrine disruption ads or anything else that we talk to people about. Our type of medicine needs to be featured if you will. And that's one of the things that I'm seeing, is there's kind of a lack of coordination. You know, this whole presumption that doctor groups get together and fix people, that's not true at all. You know, it's not true on their side of medicine. It's not true on our side of medicine. But we certainly don't cooperate for like the bigger picture kind of thing. And, you know, we know on the other side, you know, the pharmaceutical companies and insurance companies are very organized. You know like they are more lawyers than we have people sometimes. So, you know, one of the things that I am sort of advocating, even in my staunch individualistic, stoic type personality, is the kumbaya saying. You know, like I'm really saying that's the only answer. You know, until we all kind of get together and say, you know, here's the best of our world. Therefore, the scope of practice, meaning the scope of practice is what you guys wrote in your book, not you know, you've got TSH within this huge range. And so I'm going to give you this one drug and everybody's fine. And that hasn't been a great answer for forever. But I went to a training the other day on bioidentical hormones and in that group there's a bunch of senior doctors, they put me in there because I'm the old white guy thing, you know, I got the hair, you know, whatever. They handed around one-grain thyroid tablets and every single person in the room ate one other than me. And I was kind of like, my thyroid is fine. Why would I do that? You know, and I would probably use neurofeedback and intranasal stem cells before I would put a drug into my hypothalamus, but, you know, thanks, but no thanks.

Dr. Eric
Right.

Dr. Thomas
And they were kind of like, oh, you're going to do it the complicated way? And I was like, yeah, I am. And, you know, it was-- it really took me home because I was kind of like, wow, there isn't like a deep level of respect for prescription medicines. It's not like it's like that. It's the fast answer to get through your afternoon. I mean, I would drink a cappuccino. You know, and literally, they were doing thyroid, you know-- now, it was a bioidentical T4, T3 you know, in their defense, but it was still popped like it was a chicklet. And I look at that and I just say, okay, so we are really coming from very different places on this thing and it almost is like, we've got to change the whole mentality, which I thought the Internet was going to do. It looks like you know, that's slowing and you know. I love the idea of actually having the better answer because it has this way of emerging. You know like I love the idea of saying, you know, you said something in your book. You said two or three things that I have cliches for. It was really fun reading it. If you want the wrong answer to a complex question, just make it simple. You'll get the wrong answer. Really quickly as a matter of fact.

Dr. Eric
Oh, you have an answer.

Dr. Thomas
Yeah. A lot of people will be shaking their heads, yes, and, you know, you'll all be in that big agreement. You know, schoolhouse democracy with the wrong answer. So, what I hope is people are tired of having the wrong answer, you know in some of the bigger picture things, our outcomes are just not that good in regular medicine. You know, we haven't made any progress. So in the thyroid thing, we still get Kelly's story. We still get, you know, there's something wrong with the way you're telling the story because your thyroid levels are okay because I said you know .5 to 5.5 is normal. Well, that story is 50 years old. You know it's like God, and yet we got it last week. You know, we got, you know, the patient with intractable pain being told it was all in their head. You know, and I was kind of like, yes, except for the arsenic poisoning. You know, I mean, it was ridiculous. You know, and so, now, you know, I sort of get-- we view people that find us as being very good at searching for things. Like we're the secret. And what I think is really necessary at this point is to really be out there, you know, like what you're doing with your book, what you're doing with podcasts, what you're doing with being the dean of a school, with, you know, being visible. I think it's incumbent upon our group to kind of put themselves out there, and it's one of my criticisms of the Functional Medicine Institute. You know it's like they have a lot to say, but they're not political. And I think if you don't put your message out there, we're whispering in a well, a lot of the time. I think it's really great that you wrote it all in a book. You know, I think you have to write it in a cartoon now so people actually understand the next level. But it's really a great thing.

Dr. Eric
Well, thanks. I mean, the tough part is, is that we've got more people in our industry who are looking at this, and I can't blame them as a business as well, right?

Dr. Thomas
Sure. Yeah.

Dr. Eric
And so, if you're going to be in this, you're trying to make a living, you're trying to do stuff, so we start seeing, unfortunately, infighting within our own community as to my thing is better than your thing, which is better than this thing, and in reality, we should be kind of all working together, as you said, to say, okay, everybody's got a unique approach to looking at stuff and doing stuff. So let's pull all those approaches together, find the best way or ways to assess physiology, the best ways to measure, best metrics, and then let's get really good at that. And that way we can build a nice, consistent bridge. And unfortunately, just like you know, the diet industry, instead of circling the wagons and shooting out and saying, hey, processed food is bad, processed oils are bad, they've circled the wagons and shot in and saying, paleo is bad, vegan is bad, carnivore is awesome. Right? The same thing in functional medicine, we sometimes get too much infighting on whose method or protocol is better versus saying, hey, we just need whatever mechanisms we can whatever process or pathways makes sense scientifically, we can kind of back them up a little bit. How do we identify, what's creating this excessive cell stress, this change in physiology, and what's the most efficient way and most, yeah, cost-effective way to help our clients go from poor health to average health to more optimal health?

Dr. Kelly
I think a case in point of that is Dr. Ben Lynch wrote our Forward, and he has the "Dirty Genes" book and his approach, but yet he's very much an advocate for "The Thyroid Debacle" and what we're doing, and it melds really well. Or do our protocol, don't do this protocol. It's a very nice amalgamation of the approaches. And you said that Doctor Tom, you said in the beginning that it leaves the door open for many artforms, of many artforms of how one goes about decreasing the allostatic load, decreasing the cellular stress. And I would say that part three, it depends on where you are in your health journey, how sick you are, and how well you are. But, you know, I'm having my 16-year-old daughter read part three because these are all just very much granular approaches to keeping oneself healthy. And it's not just for the person who has hypothyroidism. It's not just for the person who has Hashimoto's or, you know, it's really just the approach of how we're dealing with the world we're living in right now.

Dr. Thomas
Right.

Dr. Eric
It's interesting, I had a client who I've been working with. Her spouse has been fireside the whole time, and, you know, I had an appointment with them last week or a couple of weeks ago, and he said that you know, I haven't taken any supplements, but I've lost 65 pounds through the process of you working with my wife over the last six months. And so what if they've done-- like what has happened for him to do that, right?

Dr. Thomas
Right.

Dr. Eric
To clean up her diet, and she-- you know, they eat together, so they're eating a whole food, anti-inflammatory diet. We've worked on breathing exercises. We've worked on improving sleep habits and sleep quality. We've worked on emotional stressors and the things that can impact, we call it emotional fitness, right?

Dr. Thomas
Sure.

Dr. Eric
We work on, you know, physical fitness and, you know, getting a level activity, how to do cardiovascular exercise so that you're not taxing your system. You're actually increasing your ability to burn fat as a fuel. And just those working on those foundations of what we call the fitness factors in the book, in that part three. Here's a guy, who didn't take one supplement yet. Now, he's not where he wants to be quite yet. He's like, hey, there are some things that I still need some help with.

Dr. Thomas
Sure.

Dr. Eric
But hey, this is what we talk about in the book. If you do those other things, that metabolic fitness, right? That's where-- if you do allow the other things before you come to the functional practitioner, you're already way ahead of the game.

Dr. Thomas
Right.

Dr. Eric
And now we can really hone in on what we're trying to do and really get nuanced as to okay, how do we get this tissue to that next level? And I think that's one of the mistakes sometimes we make in functional medicine, is we're trying to fix something, and then we get frustrated because it doesn't work. Our protocol doesn't work. And I had a conversation with a physician the other day. They're like, hey, I'm working on this case. I keep treating their gut. It's chronic. I can't get it. What do you think is going on? I'm like, did you look at their respiration? Did you look at their sleep quality? Did you do these other things? They're like, well, no. I'm like, well, why don't you work on those things? And he's like, well, why would that be? I'm like, this is a person who's in danger physiology, they're not in repair and regeneration physiology. You're giving them antimicrobials, assuming and some things to repair the GI tract, but you're assuming that they're in a repair mode. They're not in a repair mode, they're not in a regenerative mode. They're in self-defense. They're still in-- you know, we know from Naviaux's work and others that when cells are in that cell danger response, they lose the cell-to-cell communication. That goes down.

Dr. Thomas
Right.

Dr. Eric
And so, we need to-- the reason those fitness factors are so important in that to talk about, and we talk about a lot in functional medicine is because if we don't build somebody's level of fitness in those categories, we're not going to get them out of danger physiology and they're not going to-- the protocol will work for the 30 days or 40 days that they're taking a boatload of supplements, but as soon as they go away, they're right back to chronic illness. And that's where they get frustrated. The physician gets frustrated. And then sometimes I think we get a little bit of a black eye, like, hey, I spent a lot of money there and I didn't get better and, hey, we jumped over dollar bills to pick up pennies. Do you know what I mean?

Dr. Thomas
Understand. This has been so great. I really appreciate your guy's effort, your enthusiasm, and your science. The times that you agreed with me, that was really good. But now, it's fun because some of the people that are doing the best work in this are also infectiously enthusiastic. So that is a great thing to see. And, you know, we hear more and more and more that, you know, as we do it, you know, it is frustrating some moments and I think we all have to be cheerleaders for each other. So, I appreciate you both. I'm going to hold it there. They'll probably break this into two or three little podcasts and we'll send you the things and we'll feature your book. And so I want to talk about that again. So, it's called "The Thyroid Debacle" and it's on Amazon and you can get your copy. And it's really a book that's much more than thyroid. It's really a book that really talks about lifestyle contributions to general health, but specifically organ health, and how you can set up these preconditions that Dr. Eric was talking about to really put yourself in a position to live a more full life. And, you know, we're defining that as living longer years, but also being more fit, physically, you know, emotionally, sexually, every single way a human being can be fit. And one of the things that we're looking at when we're kind of looking at the competition is they're not saying any of those things. They're just saying you know if you get sick that they'll head it off at the past in some very limited way and even with not great results. So, this is a more complex answer. It takes more commitment. It definitely takes patient involvement and awareness and it takes the practitioner you know, constantly being a student. All these people are students you know, as they go, even though they could all teach courses. And so, one of the things that we invite the public to do here is to have higher standards, is to sort of say, how is my practitioner helping me live a happier, longer, vibrant, you know, full life? And those are obtainable things. I think in both Kelly's and Eric's cases, they're doing it themselves. You can look at them and see that's what's going on. They're living a purposeful existence. And I think especially these days where there's so much anomic you know, lack of support and kind of just general lack of cohesion in our own personal identities, that this kind of thing can go a long way toward you know, building that personal health. So thank you, both of you. I really appreciate your time.

Dr. Kelly
Well, let me take a minute to share with the audience my thoughts about you, Dr. Tom. So, I have known you for quite some time as we trained in functional neurology together, and you and I would be in the back of the classroom chit-chatting about the function of locus coeruleus. So we were really into it. We really enjoyed that. But I've always thought of you as such a brilliant mind in this field. When you started your podcast, I was so excited because the message that you bring is so clear. It's so well articulated and so well researched, and so it was an honor to be on your podcast, Dr. Tom.

Dr. Eric
I'll second all those comments that Kelly just articulated very well.

Dr. Thomas
Wonderful. You know, it's like in this where we're I have the proud distinction of having amazing friends and pretty serious enemies. So, when I tolerize people, it's gone, you know.

Dr. Kelly
Maybe that's my problem. I'm polarizing. I don't know, life is very interesting. Fun, right?

Dr. Thomas
It does. My wife is like, we go to these MD cocktail parties, and she's like, could we just stay long enough to get a drink and an order before you make half this room mad at you? And I was like I said, everybody deserves individual attention. I didn't, you know, say I was for Al Qaeda, you know. It got a backlash that was serious enough that we left. But, yeah, I think that we're all kind of-- you know, we're detectives, but we're also gladiators, and you have to be able to walk into the strong wind, and you have to have your convictions. In some of this, I think that we're not really getting very good support from the "system". So we have to kind of do it for each other and ourselves. And so, I want to be a voice for that. Like I want to be a voice that says, you know, these people are doing it well. And I'm the first one to criticize the people that are on the Internet you know, that they've done amazing things, but it's so clear they don't do anything unless they can sell you something. Well, that's not okay. It has to be that we share information because we share information. And then, you know, like going very, you know, back to, you know, Georgetown University philosophy class, you know, there is a reason to do things because it's the right thing to do. And I think you guys are doing that. I don't think you can do work on your level and not be that person. And I think at times we all have these frustrations as a result of dealing with this work in this community and really this environment. And, you know, every once in a while I go, I'm going to St. Thomas, I'm setting up a little clinic there. I'm going to fix everybody. I'll do stem cells for free, you know, like, whatever. And you just know that you can make these big changes. So, instead, I'm staying in the Silicon Valley at 8,000 sqft. You know, with all the pressures of nurse practitioners in this kind of a world, you guys are both smarter in your lifestyle decisions than I am. You know, it's complicated being this kind of doctor. And I think that, honestly, the functional medicine doctors are the heroes. I think they're the great hope medicine right now. So, again, thank you for all you do. I really appreciate you guys being on.

Dr. Eric
Thanks, Tom. We appreciate you having us on and we appreciate all the hard work you're doing as well to share the message.

Dr. Thomas
You guys take care. Thank you.

Outro
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