What can you do when you feel unwell, but all of your medical tests come back normal? According to Dr. Efrat LaMandre (known as Dr. E), if you are healthy from a conventional medicine perspective – great. However, your feeling of unwellness still means something and needs to be addressed.
Dr. E is a Family Nurse Practitioner (FNP) with a Ph.D. in Integrative Medicine who helps people optimize their health, prevent illness, reduce medication, and feel great. Dr. E joins me on the show this week to talk about finding your personal path to wellness whether you are dealing with gut issues, joint pain, fatigue and more.
Some of the topics we explore include:
- The difference between functional medicine and conventional medicine (13:24)
- It is important to dig deeper and find the root cause (17:29)
- Why Dr. E says, “Fibromyalgia is not an acceptable diagnosis.” (22:37)
- Lactose intolerance: what is it, and do you have it or not? (26:21)
- Why people get worked up over hormonal replacement therapy? (39:23)
One last thing, the updated and revised edition of my book How to Stop Feeling Like Shit comes out on December 27th month! 🎉 Don’t miss out on some of the amazing bonuses and giveaways available. Head over HERE to pre-order and grab those!
You know how I love a good personal development book, right? I’ve compiled a list of book recommendations, as mentioned in past episodes. Check out these amazing book recommendations here. Happy reading!
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Dr. Efrat LaMandre owns and operates her own Medical practice, EG Healthcare, which provides pediatric, adult, and geriatric care to over 20K patients. In addition to her primary care practice, she has taken conventional medicine to the next level with her signature process The Knew Method.
The Knew Method helps patients take control of their health destiny using a Functional Medicine Approach that empowers them to finally realize that their symptoms are not in their heads. As a result, she helps people optimize their health, prevent illness, reduce medication, and feel great.
Dr. E is co-chair of the Staten Island Hospital Board Of Trustees. She also serves as the President of the Nurse Practitioner Association State Board. In addition, she is Clinical Faculty at Wagner College. She is also the Primary Care Provider for the City University New York, College of Staten Island Athletic Department.
Efrat owns a Medical Scribe company, HawkScribes, that allows providers to focus on their patients instead of charting.
Dr. E is also a public speaker and offers consultancy services to other nurse practitioners who are opening up their own practices.
Dr. E 00:00
But for those you listening who don't have a thyroid issue, that feeling of unwellness still means something. It means something. It could mean another hormonal balance, it can mean insulin resistance, it could be adrenal fatigue, it could be an autoimmune issue cooking, but it's definitely not in your head. I wrote a book called Not In Your Head, and it definitely needs to be looked at to primary care will not find it for you.
You're listening to Make Some Noise Podcast episode number 496 with guest, Dr. E.
Welcome to Make Some Noise Podcast. your guide for strategies, tools and insight to empower yourself. I'm your host, Andrea Owen, global speaker, entrepreneur, life coach since 2007, and author of three books that have been translated into 18 languages and are available in 22 countries. Each week, I'll bring you a guest or a lesson that will help you maximize unshakable confidence, master resilience and make some noise in your life. Are you ready? Let's go.
Everybody, welcome back to another episode of the podcast, I am so glad that you are here. As usual.v We are still on the women's health theme that we're doing this year as we close out 2022 and head into the new year. And then coming up in the new year. We're gonna have a few more episodes of these. And then we are going to do we're moving into the recovery thing, which I'm really excited about. Hey, let me know. If you like these themes, send me a DM on Instagram. And if we don't, if we're not already friends over there, it may take me a little bit to get back to you because I kind of check my other messages every couple of weeks or so. But let me know how you're liking these themes. And if there's a particular theme that you wish that I would get some experts on. And in the new year we're also going to be sending out a survey. I like to get your feedback every once in a while like to do it every year or so. So keep your eyes out for that.
And next week I'm excited because we're broadcasting our asked me anything call. It's coming out as a podcast episode so stay tuned for that. And last but not least announcement you have probably heard me talking about it, How To Stop Feeling Like Shit is being rereleased. It's going to ship on the 27th of December which is coming up here just a few days 2022, depending on what year you're listening to this in, and it is the updated version of How To Stop Feeling Like Shit that came out several years ago. We have a bunch of bonuses that are happening right now. You can get a book plate which is essentially a sticker branded How To Stop Feeling Like Shit sticker with personalized and I'll sign it, personalize it send it to you snail mail style. We have a secret podcast series. It's four episodes long that coincides with the book, there's a free workbook for you to download. There is all kinds of fun things. We're doing a giveaway in a couple of weeks. A drawing, if you share about the book, lots of fun stuff. So head on over to AndreaOwen.com/HTSFLS. All the details are there.
And today's episode, again on women's health is someone that I found on social media, talking about particular symptoms that I was having in my life and I thought I need to have this person on the show because I think she's going to be so helpful to many of my listeners. So for those of you that don't know her, let me tell you a little bit about our guest today. Eve Ratlam Andre, also known as Dr. E owns and operates her own medical practice EG Healthcare, which provides pediatric adult and geriatric care to over 20,000 patients. In addition to her primary care practice, she has taken conventional medicine to the next level with her signature process, The New Method, the new method helps patients take control of their health destiny, using a functional medicine approach that empowers them to finally realize that their symptoms are not in their head. As a result, she helps people optimize their health, prevent illness, reduce medication, and feel great. So without further ado, here is Dr. E.
Dr. E, thank you so much for being here.
Dr. E 04:29
My pleasure and honor.
Oh, I'm so excited. Okay, so there's a lot to cover. And you and I were chatting before I started recording and we decided to kind of start with…and everybody listening I'm not being selfish just to like have Dr. E come on here and talk about all my ailments. That would be a boring podcast episode. But I think I was briefly telling her my synopsis over the last couple of years and she was like let's use that as an example because…just trust the process everybody All right.
So for those that don't know, pretty much around the onset of the pandemic, I think it was just a handful of months after that, I started to have physical symptoms. And by the way, at that point I was 46 years old. I was having joint pain, mostly my lower extremities. I was having some sleep issues. My biggest symptoms is that I was exhausted. Exhausted, but I was getting enough sleep. And just a huge lack of motivation. I got put on an antidepressant. And what else did they do to treat me? So it was the antidepressant, and I think that was it temporarily. Oh, and then I did get a vitamin D supplement, because my vitamin D was super, super low, and a B 12 supplement and that was it. And then they sent me on my way. And I started to feel a little bit better in terms of just not wanting to eat. I mean, my depression, it was bad. I will say that it got a little bit better. I told my doctor, I said, I feel about 30% better. And they were kind of like, well, that's amazing. And I'm like, I still need to work. Like I still need to make a living and I don't feel like doing anything. And I was just so tired. So the months and months and months went by my labs were mostly normal. But my I ended up pulling out, I mean, it was over a year of testing. I printed out all of my labs over the last like five years and I looked for patterns. And I saw that my thyroid was…my TSH was consistently climbing up until about I think it was 4.47. And they were like, but it's normal because it's below what we you know, four and a half is you know, still normal. So it was actually a woman, Dr. Margaret Romero was on my show and years ago and I DM’d her and I'm like, hey, what do you think about this? And she's like, if you were patient, I would be treating you for? Yeah, that's what she called a subclinical hypothyroidism. And so that that's what made me go back to my doctor and say, I need more tests I need you to help me like is this perimenopause? Is this…and I hadn't had COVID yet. And so finally, I saw and not a functional medicine doctor an endo…
Dr. E 07:14
Thank you. Brain fog is another one. Endocrinologist. I almost said endometriosis. No, I did not see an endometriosis. And he diagnosed me with Hashimotos. And I cried when I went out into the parking lot, because I'm like, oh my gosh, oh, and I had gained 20 pounds quickly. That was another big symptom. And my regular doctor was like, well, you know, you're getting older. It's the pandemic. Everybody paid 20 pounds over the pandemic. That's what she said. And I was like, but it came on super quick. And it's very unusual for me. I don't fluctuate with my weight. And so I just felt like, and I cried in her office, too. And I said, I feel like my body is trying to tell me something, and I don't know what it is. And then that's when she looked me in the face and was like, sometimes this is just getting older.
Dr. E 08:02
Oh my God. I’m actually nauseous from this whole story.
So I ended up going on Facebook and finding a great, what did I found, oh, I just in my like, local mom's Facebook group. I was like, please help somebody help me hear my symptoms. And then people said, you need to see an endocrinologist. And that's what I got my diagnosis.
Dr. E 08:24
So I just, I'm so happy you started with this. And this is why I said to start with your experience, because your experience is just about every woman's experience when they go to their primary care. Now, let me just say this. And, you know, I'm not against primary care. I'm not against commercial medicine. I practice it every Monday, I still practice in conventional medicine. I used to do it full time. But like quick recap, I switched gears years ago when my wife wasn't well, and conventional medicine wasn't helping us. And that's how we got into it get into that later. But so but the point is, I am not against conventional medicine at all. I'm not against prescribing medications, when I am not against any of that. If you're sick, it's the right place to be because you will get a diagnosis, but it is designed to find a pathology, a sickness. If you don't have a pathology, there is nothing wrong with you in air quotes. But you don't feel well, there is no space for you, and primary care does not deal with unwellness. It deals with sickness. So if you're sick. Great. You have pneumonia. Great. You need antibiotics, right? God forbid you have cancer, you know you're going to need certain treatments. But if you're just not well, don't actually don't get frustrated by PCP because they don't have the answer for unwellness.
So it's kind of it's not really their fault. It's like just their education kind of stops at a certain point.
Dr. E 09:45
There's no malice these are good people. We're not paid by Pharma. There's no big conspiracy. We went to school to find a diagnosis and I used to do the same thing. So and I from the first years of my practice, I was guilty of same thing, but you're fine, gonna lose some weight. You know, maybe you're depressed, maybe anxious, and there's no malice. It's just there's nothing there. Right and so and so you send the patients on their way. So I encourage you, when you go to your PCP, if they say there's nothing wrong with you, don't get frustrated. Be happy that there's nothing wrong with you, but then find a different type of provider, because you can't ask electrician to do plumbing. So and so what happens is, you know, and then there's anger, and justifiably so. But I'm just trying to, like, tell people like, it doesn't matter how many times you go, they still are going to use the same tools. So let's talk about what you describe, then I'll go specifically to thyroid, but many of your listeners, I'm sure are resonating like yes, yes, yes, my joints hurt, I have brain fog, I'm gaining weight, and I don’t feel good. But I went to my annual everything's fine. I got my pap smear. I did a mammogram. I did everything they told me to do, and they can't find anything. And that's because they're doing, they're gonna say the wrong test for wellness.
So let's talk about thyroid and then I'll give you other examples. So in your case, every time you went to the doctor, the office, they did a test called TSH, thyroid stimulating hormone. That is the test we're taught in school to run. If it is, okay, the patient is okay. Again, no mouse.
Or at least their thyroid is okay.
Yes, their thyroid is okay. Which means the patient is okay. Remember, in this world, it's all about diagnosis, right? The thyroid is okay, the patient is okay. So, you're okay, go on your way, you're depressed, here's an antidepressant, you're stressed, maybe you have a lot of kids, maybe take care of your parents maybe have a high stress career, but it's always gonna go back to, you know, suck it up. That's gonna be the question. I mean, yes, really encourage people to power through which resiliency is important. But it's okay to also not feel well and figure that out, like, and it's, you know, and it's not weakness to not feel well. It's something like you said you by telling you something, right. So, thyroid, you do TSH. If the patient is TSH is fine, no further testing should be done. According to guidelines. Not laziness, guidelines. You went to an endocrinologist. But also, if you would have been to me like a functional medicine provider, we know that the antibodies will cook for years, 10 years, 20 years before the TSH will shift. So we will run an antibody test, I run antibody tests on all my patients, because I will have a lot of patients. It's like the check engine light check engine light is on but the engine is functioning fine, but they will have the symptoms, the waking the cold fatigue. You can intervene medically, like with medication at a certain point, but we can start with certain supplements that are really targeted for a thyroid. Really understand. You know, before I even get to, first of all, like you said, you cried in the parking lot. First of all, to empower the patient, that you're not crazy. And that what you're feeling is real, and it's not because you're weak and not powering through, and it's not because you're lazy, and it's not because you eat too much apple pie. It's because you have a thing. And that in itself is so empowering. And then we could talk about achievement. So what you experience constantly happens, the two in various diagnosis, thyroid’s an easy one, because we have this antibody testing that if we would just run it, yeah, we'd have the answer.
Took about a year. And they ran it and then didn't say anything. I'm the one when I told her like I printed out all of my labs. I looked at it and then I was Googling like, what are all these acronyms like? I don't know what any of this is. And then I saw that it was the antibody thing and I'm like, is this related to thyroid? So it's like I was the one that was doing all the research and but it was never flagged by my general practitioner.
Dr. E 13:43
It’s not flagged because there's nothing to do for it. Again, not because he's a bad doctor, or she's bad doctor. There was nothing to do for antibodies and conventional medicine. Again, you're asking, what is he going to do? He's going to tell you, you have antibodies, and there's no medication to give you. Now, the other doctor you spoke to on the podcast, I forgot her name, but there is a word. So in primary care, the parameter of like thyroid is roughly one to four. So as long as you know, and of course four point something, as long as you're not over the four point something, we don't medicate.
But in functional medicine, we will start medicating if you're like close to three. And the reason is, because this is what I learned this years ago, like blown away. So how are these parameters made? Like, how is it me? 124123 who decided that was normal? Well, they take an average of all the humans that they test kind of in the world, and then it could this, you know, I'm simplifying it but then they create averages. But those averages include the sickest people in the ICUs. So the average over the years if you were to check the normal average 20 years ago, it was very different. It keeps creeping to the right. And so what's considered a normal thyroid…so anytime you want to talk to Someone who's like if you're trying to get pregnant, they're going to really close to forget about for fertility, like there are so many times where they realize that that four is really not my so that's why this other doctor told you, hey, I wouldn't medicate you already as you were creeping up into four, because we're falling a little bit of a different guidelines is a bit more awareness. But for those you listening who don't have a thyroid issue, that feeling of unwellness still means something. It means something, it could mean, another hormonal balance, it can mean insulin resistance to be adrenal fatigue, it could be an autoimmune issue cooking, but it's definitely not in your head. I wrote a book called Not In Your Head. And it definitely needs to be looked at which to primary care will not find it for you.
After one of those appointments with my primary care doctor, I started questioning I was like gaslighting myself. I'm like, am I making all this up? I really dug deep and was like, am I? Well, I know I've gained weight because I can see those numbers on the scale. But like, am I tired? Am I just lazy? Like, am I just lazy? I went through that whole thing. Or is this how a woman is supposed to feel at this age? Like I felt like… And then I remember thinking also, if this is how I'm supposed to feel, I don't want it like how am I going to feel when I'm 67 or 87? This sucks.
Dr. E 16:18
That's a good point, too because you will turn people will turn to their peers and say, wow, I'm freaking exhausted. Um, you know, and, and they're like, yeah, me too. Yeah, me too. So now it's normalized, right? Well, we all feel crappy. Well, this must be what it's like to be 40 or 50 or 60 because all your peers feel crappy. Because there's this general acceptance again, that if you're not sick, then the rest is just a mindset issue. You're just lazy. You just, you know, get off the couch, go work harder, you know, exercise more. And so you do gaslight yourself because well, alright, I'm on I feel well, but my sisters in the field, well, my best friend in the field, I guess this is 40. I should just, and this authority figure in the primary care setting is telling me I'm fine. You know, maybe I am just anxious about my health. So it's very easy to go down that road and question yourself.
Well, I might be jumping ahead a little bit here. But I am seeing a functional medicine doctor now. I do jitsu and it's a new relationship. She's here locally, where I live. What is the difference? Like how does functional medicine work and how is it different than just like a general practitioner?
Dr. E 17:29
Okay, great question. So functional medicine really believes that you have to get to the root cause. Let's give a classic example. Right? If I say to you, you have diabetes. The root cause is obviously doing too much sugar. Right? It's pretty obvious one. But if you didn't know, like, oh, man, I have diabetes, I need this medication. Wow, there was something wrong on my body. No, there isn't. You're eating too much pizza, right? So if we can eliminate the pizza and the carbs your diabetes will get better. Right? That's a clear one to see. But that's true for just about every disease. We just don't have that kind of clear spectrum.
So for example, back to your thyroid issue. Oh, my God, I have a thyroid issue, I need medication. Which by the way, once you do need medication, the thyroid, unless it's very early, you probably are going to need it forever. But what is the root cause? Why did I get Hashimoto’s? Why did I get it is never a question that's asked in primary care. So the root cause for most people who hash models is probably leaky gut and a gluten sensitivity. And until we discover that piece, and get that person off the gluten and repair the leaky gut, that person's thyroid is going to continuously get worse and need more and more medication. The goal with thyroid treatment for functional medicine, by the way, for those listening, is that is to stabilize your thyroid not necessarily to come off the meds, but for it to not to continue to need more. So that it's a root cause conversation. I just have this whole, you know, I was just telling you this whole debate on TikTok, because I did this this TikTok about fibromyalgia and I said, it's not an acceptable diagnosis. It didn't say it wasn't real. But…
That was on my list of things to ask you about.
Okay, cool. Because like there's a whole big thing happening and it's like, it's a big debate. I got excited because someone tweeted me so I guess I mean, in life, so what I said and I doubled down because I did a second video on it. Power management is real. I didn't say it's not real. There's a ICD 10 code for it. There's criteria on how to diagnose it. There's even a test supposedly that test for what I said was, it's not acceptable because what's the root cause? Okay, so to walk around, say I have fibromyalgia, it literally just means my fibers hurt. That's all it means. And the test just shows inflammatory markers, that's all. So I have pain. I have inflammatory markers. Awesome. Thanks for the name. It's real, but what's the root cause? So it's about find out the root cause. And each person is different for some people would be as easy as fixing their nutrition. For some people, they're exposed to mold, or some people are exposed to pesticides, for some people, it's hormonal. So it's about the cause, as opposed to just putting the label. So that's a functional medicine. But what's happening? Why are you here in my office? How can we how can we get you to no longer need me? That's, I guess that's it.
Okay. So it's accepting that it's not just random magic that you have pain in your body and then get the fibromyalgia. That something is actually causing it.
Dr. E 20:33
Yes. And that's true, but it's not. And putting Fibromyalgia aside, back to the aches and pains. Not, I'm 50 my knees supposed to hurt. It's not I'm 60 I'm supposed to be tired. It's 60, and for the past 60 years, I've probably been eating and living a certain way which has accumulated and has caused me these pains but if I can hopefully reverse them in time. So that it's really all about requests as a function Madison's about.
The show is sponsored by BetterHelp. So you guys might know that I have two teenagers right now. They are 15 and 13 and there have been a few moments where I've thought to myself since they've been teens, it would be so amazing. If these babies had been born with owner's manual, you know, like a User's Manual like cars have? So we just like know everything and like what to do, but that's not how life works. And although that's frustrating therapy can be I feel like just as helpful. Some of the things I've learned in therapy are better coping skills, self-empowerment, communication, dealing with trauma, seeing my own blind spots. That's just a few things off the top of my head that I remember learning from therapy. And the world's largest therapy service is BetterHelp. They have matched 3 million people with professionally licensed and vetted therapists that are available 100% online. Plus, it's affordable. All you do is fill out a brief questionnaire to match with a therapist and if things aren't clicking, you can easily switch to a new therapist anytime. It could not be simpler. There are no waiting rooms, no traffic, no endless searching for the right therapist. Learn more and save 10% off your first month at BetterHelp.com/kickass that's BetterHelp H-E-L-P.com/kickass.
Fibromyalgia and irritable bowel syndrome and maybe even adrenal fatigue kind of fall under that same umbrella of kind of like diagnosis that gets thrown at people and then they're like, well now what do I do with that? It just… And IBS seems to be one of those things because my daughter was diagnosed with IBS
Dr. E 22:37
Is different. But IBS fibromyalgia. I would put in the same group. And like I'm saying this I know some people are gonna go bananas.
Like good bananas or like rotten bananas?
Dr. E 22:47
I mean, it depends. I have some people who actually are so excited that I'm calling out fibromyalgia for what it is. And then I have those people who are like, how dare you say this about fibromyalgia? I'm like, I'm on your side, bro. I'm not actually saying that you don't have pain. Okay, so fibromyalgia we discussed. IBS is like a fibromyalgia in that, again, what they have in common fibromyalgia and IBS is that the doctor did all the tests, and they are all negative. So the criteria for fibromyalgia and IBS is after you know, I'm simplifying, but after running all the tests, no other diagnosis has been found, the patient still has the symptoms. So you give it this name, irritable bowel syndrome, which is different than IBD, irritable bowel disease, inflammatory bowel disease, which is a significant disease. So it's not that. IBS, irritable bowel syndrome, it means your bowels are irritating. Why are they irritated? And in that constellation, some people have diarrhea, some people have constipation. So what the heck?
IBD or IBS-D or IBS-C. See, right, and I'm like, what was happening here? So IBS again, why IBS is so important is first of all, why. Why are you having these cramping and diarrhea and because we if it is irritating your belly, here's what's important. It's also irritating the rest of your system. So if you have psoriasis is gonna make you psoriasis worse. If you have brain fog is gonna make your brain fog worse. If you have asthma to make asthma worse. So it's not just about fixing your IBS, it’s about fixing it so your system calms now. So IBS, fibromyalgia, both of them, docs did everything, there's nothing there have a nice day. Adrenal Fatigue is on the other side. Conventional medicine doesn't believe in adrenal fatigue. Yeah
My doctor actually, all she did was tested my cortisol. Which back normal.
Dr. E 24:41
Of course it did. She tested on a blood test in the middle of the day. Right. So that's gonna give you some information. So conventional medicine, when it comes to your adrenals, they're either two on which you're in the ICU for or two off and you're in the ICU and everything off the middle is fine. Literally. Literally. there is no such thing as renal fatigue, you're either on, or they're all like too much too little. Both of them are life threatening, and nothing in the middle. So if you try talking about doing fatigue, if you go to endocrinologist, he or she will roll their eyes. And that's okay.
That's your answer that you need to get a different doctor?
Dr. E 25:18
Adrenal fatigue is tested in certain labs, not Quest, not LabCorp. It's a saliva test. And it's four points throughout the day. Because what the heck is it going to tell me if your cortisol levels are at 10am? I need to know the whole day. How are you doing? It's at least for some of them do six. How were you when you first wake up? How are you at lunch? How are you between lunch and dinner? How are you…
It shows that comparison.
Dr. E 25:45
And you will be amazed, right? It's supposed to be like this, like high in the morning and then low, then I have some people that shoot up at night. Well those people can't fall asleep. Have some people who are flatline, they've nothing all day, these are the people that say I cannot exercise I'm too exhausted. Go tell this person exercising, they can't, right. So Adrenal fatigue is so real. And it's measurable. It's quantifiable, it's treatable. It's just not accepted by conventional medicine. That's why it's kind of on the other side of it. And this is one of those things, if you have a patient, any listener who's not feeling well, you should be tested for adrenal fatigue. The primary care will not do it.
Can we talk about lactose intolerance, because I watched one of your videos and I always thought lactose intolerance it's like, either you have it or you don't. But what was interesting that I found is that I've always been able to tolerate dairy and then I got pregnant with my second child, first child was no totally no big deal. Second child, I could not tolerate it at all, none of it. And then after she was born, when I would nurse her, she would get fussy when I would have dairy. And then this is the same child that got diagnosed with IBS. Who loves yogurt. When she was six, or seven. And so I thought, well, it can't be because I've always been able to tolerate dairy. So tell us because according to your video, like it can be kind of like a fair-weather friend.
Dr. E 27:11
It's a spectrum. It's a spectrum. So just like gluten is a spectrum. Just like everything you know, think about Let's go. Let's go easy. Let's go like alcohol. Because some people can have one drink and they're completely wiped out. And some people can have one drink and they're fine, two drinks they’re fine, by the time you're on the fifth, you're like not speaking, right? So it’s the same thing as like those. I just made up those two connections. I don't know why just came to my head because I tried to…
I think that's a good correlation.
Dr. E 27:39
Yeah, so the same thing. So now some people have true true true lactose intolerance almost like an allergy. And they have it almost from birth. Soon as they have it, these are the kids that are projectile vomiting, when they have it, they're sick, and they have it. And then for the rest of us, it's shades of tolerance. Because it's all about how much of the enzyme lactase do we have in our body worn with non you cannot handle any lactose. If you're born with some you can handle some lactose. As we age, we make less of this enzyme. So in your 20s, you could have the ice cream sundae. In your 30s, it starts to hurt you and you feel dizzy. Like I can only have one bite, because you're making less of the enzyme, which is why it's really important when you are testing to see if you're tolerant. You have to test it like with a lot because like I could have cream in my coffee and be fine. But I should not conclude that I'm not lactose intolerant. Because if I had had my coffee and a cheese cake, it'd be a wreck. So if you're going to test it, don't just have a teaspoon full, obviously for teaspoonful does if you don't continue to test that makes sure you truly test it. And this is really important because…so you don't want like people say I need to test you don't need to test you drink the milk or stomach hurts. That's your test move on. Okay? You don’t need the test. But you don't want to bypass this because if your belly is angry again, everything is going to be ending. I cannot tell you how many children I see this is especially true for children whose eczema is so related to dairy. I take these kids off from dairy, that eczema goes away. Of course, when I bring this up in the middle of a conference, I'm actually laughed out the door because there's no studies on it. Because who's going to fund the study? Not the milk company, not a steroid company. No one's gonna fund the study. But anecdotally I treat over 20,000 patients 50% of them are pediatrics. They're my primary care practice. A seven-year-old kid comes in like there are a mess here. Let me just try three days out there. What do you have to lose? So side effects to try and from wrong the wrong? Invariably the parents come back and say, oh my god, the eczema’s gone. And then you know, when this ice cream truck comes again in summer, it gets worse. They will so they're able to kind of find the sweet spot for their kids. But it's really important that you manage it.
So my functional medicine doctor… Well even before I saw her, you know I'm in these Facebook groups is now, these Hashimotos groups and everyone's talking about how they cut out gluten and I'm learning about, you know, like how the relation to your thyroid and autoimmune. And I did it for two months. And I was really great about it, I did not cheat, and I felt no different at all. And so I was like, okay, then I'm not going, it's fine. But my functional medicine doctor said, she's like that might, she's like, my guess is it's still a problem for you. But you're not just seeing these like big sweeping changes in like your bloating or the way that you feel. She's suspicious that it might be corn for me. Corn’s in everything.
Dr. E 30:37
So here's…it's two different conversations. One conversation is the healthy thyroid and the other conversation is how do I feel, and you put them together. You put them together that you know, since I didn't feel a difference in one must not be making a difference and that is not one hundred percent accurate. So Hashimotos almost always reacts to. You may not feel that, because what happens is that antibodies are building up, building up, building up, building up, pounding, pounding, pounding. And the reason that happens, by the way, is because there's something called molecular mimicry. So the same antibodies that are coming to gluten are also attacking parts of the thyroid. So every time we have a sandwich, it's attacking the thyroid, and you feel fine. This is kind of like my patients who have high blood pressure, but I feel fine. Yeah, but it's still pounding on the kidneys. So you feel fine until you don't. Until the TSH gets to seven, eight. And now you need to up your meds. Remember I said managing thyroid is about not having to up your medication. So you're gonna feel fine. So that is like a prevention. That's like saying, you know, I don't need a pap smear. I don't feel anything, right. Yes. Okay. So that's that.
How you feel, may or may not be a good issue, because now you're talking about a GI sensitivity. Right? This is a thyroid sensitivity. But your GI may not react to gluten, but clearly something else is reacting to, and you're measuring how well you're doing, but how your belly’s feeling, which is good, but that's not necessarily the thyroid connection. So removing the other problem people will say I'm going gluten free is the now switch to gluten free garbage. Gluten free oreos, chips, gluten free pancakes. All of it is made up of corn. Corn was like the other devil. And so now you're just eating crap. But gluten free. So of course, you're not going to feel well, because you're still eating gluten free nonsense, right? Not you like you know, whoever.
Yeah, well, ya it’s me. So yeah, it's okay. Yes.
Dr. E 32:48
So it's gluten free stuff is still gonna where it’s at. And it probably is more than just corn. The problem with corn is that it's probably causing insulin resistance in your body, which has caused the aches and pains. So corn is really problematic. The corn of this industrialized agriculture is really problematic and I can go off on that tangent. So yeah, so you want to in addition to gluten, you're going to want to eliminate the things that are angering your belly. It's not that gluten isn't where it's at, it’s like gluten wasn't enough to remove you need to remove more.
That's what I I'm afraid, is the answer. I'm still, to be honest with you. Like it's just, and I think it's worth mentioning. You know, so many people are gluten free, and for whatever reasons. But I think that, like no one's talking about when you have to cut out something from your diet that's been a staple your whole life, there can be an emotional component to that. That's like this grieving process. And like, I'm almost embarrassed to say it out loud. Like, oh, how sad for you that you can't have like crescent rolls anymore. But it's a thing. It's like God dammit, like it just, it's life changing.
Dr. E 34:00
Food is the hardest thing to give up. It's everywhere you go, every celebration, every memory, you have everything. You know, let's have a party, let's get married, it's a birthday. Everything's around food. What are we eating? Where are we going? You want to go out? Like it is. It's everywhere. It is not easy. And this is why like when I work with my patients, I'm like, Okay, here's the ideal scenario. I would love for you to be on this and some people are great, let's do it. No problem. I love everything. And some people come back two weeks later, I'm like, are you freaking kidding me? And then I'm like, okay, okay. Okay, where can we meet? And this is where this is why I work my patients no less than one year. Like if you cannot commit to a year, I'm not your girl. It's not a 30,,60 90 bootcamp situation. It's at least a year because we're going to have to find the path that works for you. And some people might be great for the first 30 days and then they're like, forget it and they go off completely. And we never see them again. So I always tell my patients just show up. I mean, I have patients that we have to accommodate for drinking, because that's kind of their life. And that's a different addiction that we have to do with. I have patients that accommodate for, for the fact that they're in different time zones. And so intermittent fasting becomes an issue. I have patients like, all different levels. So there is like an ideal. Like, I wish everybody could be honest. But if you have to recognize what people are bringing with them. Their packages and bring them to this, and you have to help them get to, like a place that works for you.
Well, another variable in my whole journey, my this health journey is that I'm at the age where you know, perimenopause could be a thing, and I had my hormones checked and everything looks normal. So they were like, no, you're not in perimenopause, or close to menopause. I'm assuming that for women, and so your practice is you mostly only work with women?
Dr. E 35:55
I work with everyone it happens to be the mostly women constantly because they tend to be the most dismissed.
Adds a whole layer of additional symptoms that have to be looked at because of the way that our hormones work and then we go through this quote, unquote, change of life at a certain age. Or women who are struggling with their fertility if they're, you know, under a certain age. So does that add a whole additional…
Dr. E 36:20
Yes. So I just did actually, just before I got on this podcast, I just did an episode on hormones. So first of all, I'm sorry, how old are you, if I may?
Dr. E 36:34
Okay, you're in perimenopause. It doesn't matter what the bloodwork says, okay? You're perimenopause. You're in perimenopause, pretty much from 40 on until your menopause and menopause just means this is again, one of the things that really confused me menopause means you stopped a period for 12 months in a row. So like until then, so what am I perimenopause. Oh, the entire time before? There was no test. There was no test. What they're testing is FSH to let you know, if you're in menopause. Your follicle stimulating hormone will go up. But there is no test for primary because it's your symptoms. It’s your symptoms. You know, I'm fatigued, I might have hot flashes sometimes. And one month might be great and one month might not be great because your hormones are fluctuating and there really is no way to test for perimenopause because of that fluctuation. So we have to go based on the symptoms. Generally speaking, we try not to do hormone replacement therapy for people in perimenopause because it's fluctuate so much. Sometimes we do, mostly postmenopausal.
Okay, so that being said, if you're feeling unwell, it's top bars have to always, always fix your adrenals adrenal cortisol is a hormone. So when we say hormonal imbalance, everyone thinks progesterone, estrogen, testosterone. Yeah, it's not that. That's the bottom, gonna fix your cortisol. Insulin is a hormone, you have to fix your insulin level. If your diet is off, if your nutritional house is not tidy, the rest your hormones gonna be a mess. For women, it will elevate testosterone for men, that will elevate their estrogen. So like we got to top down or we have to fix cortisol hormone, we have to make insulin hormone. Gotta make sure your thyroid is on point. I read stimulating hormone, it's a hormone. That's a hormone we have to… Then and only then we can start talking about your sex hormones. Because a lot of times the perimenopausal stage, when you're still producing hormones, a lot of times just fixing those, takes away all the symptoms. Normalizes your home, your sex hormones and postmenopausal it's a little different because they're not producing their hormones, we have to sometimes replace them. So we have to do that. Then we talk about the other hormones, which is estrogen, progesterone and testosterone. So top down usually normalizes most of it. And then when we get to that postmenopausal stage, we could talk about hormone replacement therapy, bioidentical, by the way, not regular hormone replacement therapy. If you walk away with one thing, please remember that. And for me, personally, I will not address hormone replacement therapy with my patients unless they do the other work.
Did I hear somewhere that vitamin D is actually a hormone?
It is. Yeah, it is.
No wonder I felt like shit.
Dr. E 39:05
It is a hormone. It is part of like enzymatic processes all over your body. It's not teeth and bones. That's like just like one of the things on the list. Like teeth and bones and my teeth. No, no, it's like everywhere. Vitamin D is a coenzyme and it's like it's everywhere
What is the controversy, why do people get so all up in their feelings about hormone replacement therapy? I mean, I haven't even opened up that door to research yet because I'm not postmenopausal. But I've heard people like, people are out like this fighting over this. What's the deal?
Dr. E 39:38
The controversy is that HRT, hormone replacement therapy, that exists in conventional medicine is very problematic. The bioidentical hormone therapy that exists in functional medicine you can find functional gynecologist, functional endocrinologist, is not problematic and people are getting them confused. So if you go to end, and they're also going to confuse from things that happened in the 50s, when we didn't know what the heck we were doing. So you go to your GYN say, Hey, I'm having hot flashes, this is a postmenopausal woman. Your GYN will likely give you something called Premarin. There's really only two products out in the conventional Premarin and Premarin Pro, both made from horse urine. Both have very high…
I’m sorry did you just say horse urine?
Dr. E 40:25
Yes, ma'am. Yes, ma'am. I did.
They take the estrogen from horse urine, cuz somehow horses and that humans, whatever. And they're both high doses, they don't really address the issue. For postmenopausal women, the issue is actually not that your estrogen drops, it does drop, but the issue is that because your progesterone dropped as well, you're actually estrogen dominant. So now you're giving them more estrogen that they don't really need. So now you have a lot of…
So it's the ratio that's the problem, not necessarily just one of the hormones. Okay, got it.
Dr. E 40:58
So they slap you with this, like either like gel or a patch or pills of estrogen, which you probably don't need anyway, because that wasn't the issue. Now you have increased risk of cancer, increase risk of blood clots in like, all what I've heard with it, yes. That HRT by identical hormone therapy, it's not natural hormones, it's still manmade, I don't want… My wife was pointing out yesterday, because I was read my talk to her first, too. So now, it's still manmade, but it is designed to molecularly mimic human estrogen already, and it is compounded specifically, you can't just get at CVS, you have to use a compounding pharmacy. Specifically, your provider needs to know what they're doing. Specifically for you. Not a one size fits all. Based on results. I like to do saliva testing. Based on results, tailored to some people just need it. Some people just need e three, some people need e three e to progesterone and testosterone, everyone's different. Each, each one of my patients here has a couple of different creams and the other. Some people need a gel, some people just need it on their skin. So it is a completely different world of hormone replacement therapy, which is not just for symptoms, it's actually to prevent issues. Like it is the first thing I'm doing once I'm 50. But I'm not, I'm not menopausal yet. Soon as I am, is the first thing I'm doing because of its benefits. It is cancer protective, bone protective, heart protective. Because it's giving you it's actually replacing what you're missing, as opposed to overdosing you just. And so I encourage anyone who's researching this, when you read the studies online, make sure you ask, your finding what kind of hormones were given? Was this HRT was this high dose? Or was a BHRT? Because you will notice that all the studies that say it's not so good, is HRT high dose usually oral.
So when you say the studies that say it's not so good, the studies that say that it points to increased risk of breast cancer. Okay.
Dr. E 43:05
Yes, yes. Yeah. So always look at what they're not equal. Look at what was the hormone replacement given? And especially oral estrogen is like, it's so problematic, as opposed to transdermal. So there's just, there's controversy, because of the lack of understanding of the different types that are available. So both sides are right, right. So the HRT does have adverse effects. But the BHRT has a much better… I can never say that has no side effects. Everything has the potential side for side effects, I can’t say zero, but has such a good safety profile, and is protective.
I think that that's the part where the like, I'm like, oh, my God, I'm not ready to open that door. Because it's, it's overwhelming, because then you have people who are like, pro estrogen, and then the other people who are like, no pro, like the, and it's just like, oh, my God, my head's gonna explode. And it's, it's like walking into a football game, where there's two different teams that are just fierce, rooting for their team, and you're like, you're like, I don't even know how to play this game.
Dr. E 44:08
So same thing with the gluten, right before. It's like did you not live at a time or at some point in your life? And you're like, Okay, gluten sensitive, get over yourself. Right? Definitely. I know, I lived that life for a while and you're like, Okay, you're not celiac. Let it go. Everybody's gluten sensitive all of a sudden, and now you're like on this side, you're like, oh sugar, I am gluten sensitive, right? So those teams exist. And honestly and until it affects you or someone that you love, you stay on one side. And then when you when you go through it, you're like oh man, and the blinders come off, and you come to the other side.
The reason that my doctor thinks that it might be corn for me is because I've been bloated, like as long as I can remember. Forever and I didn't even really know I was bloated until my daughter got her IBS diagnosis and the pediatric gastroenterologist said, you know, just kind of offhandedly that she has bloating and I'm like, show me where this small child has bloating. So she was on her back. And he's like, her stomach right here should look like this. And he's like, see, there's this little lump. But I'm like, my stomach looks like that and it always has. And he's like, you're bloated. And so I did a whole 30 and 2015, I did a whole 30 in 2015. For the first time ever in my life, my stomach was completely flat. And then again, when I cut gluten out, I'm still bloated. When I cut dairy out, I'm still bloated. So that's why my doctor is like, it might very well be the corn.
Dr. E 45:27
Corn, legumes, grains. It's a lot of stuff. Oh, yeah.
Vegetables is another one. So raw vegetables give me gas, and not just like farts, but like that stomach churning just hurts. Some people but cooked vegetables are fine.
Dr. E 45:49
Exactly. And that's I'm saying it could be more, we more than just that. And that there's going to be reason for your joint pain and all that stuff. Until you fix that the rest is not going away.
So for people listening, who maybe are feeling unwell, and they're not really getting anywhere with their regular doctor, can they can they do a concert with you? Like what is the advice that you have for them to take that next step to feel start to feel better?
Dr. E 46:17
Absolutely. So first thing you do always, always, always go to your PCP first. Never ever self-diagnose, go to PCP, let them send it to every specialist, they want the GI, the rheumatologist, whatever, do it. Do it, do it, do it because you want to make sure that there is nothing…
Rule certain things out.
Dr. E 46:35
You want to rule everything out. And then when they say everything's fine, perfect, you're in the right place. Either you can come work with me or another functional medicine provider. So with me, my company is called The Knew Method and Knew is spelled with a K. Because you always knew there was a better way my patients always know.
So clever. I didn't know that. I didn't… I knew it was called The Knew Method. But I didn't know that that was the connection.
Dr. E 46:54
Yeah, they always know the comment, like I knew it. Oh my God, when we have this moment. They do they always know. And just about any platform except for Twitter, because I talk too much. There's a way to message 144 characters. And then TheKnewMethod.com. And you go into console, the first console is free, you talk to my team, and my team tells you what the next steps are like to do saliva test. And there's some questions when asked, and they'll walk you through that piece. And that's when you set up your schedule with me. Some people are not willing to do their work, and that's okay. But just know that their first call for you is for you to figure it out. And if it's for you, then they set up a time to meet with me. You and I have a 45-minute session, we go over everything. And then I connect the dots for you. And then you decide some people like hey, great, thank you so much. And some people are like, okay, now how to fix it. And then we could talk about how to work me for a year. So that's it. The Knew Method.
I asked around in like one of those Facebook groups, and there was a couple of functional medicine doctors in my area. I had a couple calls. That's what I did. And I'm like, okay, this is the one that I feel the best about. And so that link will be in the show notes. Is there anything that you want to circle back to to say before we close up so you can feel complete? Or are you good.
Dr. E 48:05
I just want to tell everybody, it's not in your head.
I could have used that a year ago because I was starting to tell myself is in my head. Thank you listeners so much for being here. I'm so grateful that you choose to spend your time with me and my guests. And remember, it's our life's journey to make ourselves better humans and our life's responsibility to make the world a better place by for now.
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