Thyroid Supplements: The Nutrients Your Thyroid Actually Needs to Make Energy

All right, and we're live. Welcome everyone. We'll wait for uh people to start rolling in. While we do that, let's just do a quick intro. My name is Cole Sefir, one of the co-founders at MedMatrix. I have a lot of roles here, marketing, patient success, and I'm joined here by the fantastic Dr. Rose. Dr. Rose, thank you for making time after a long day to educate the world on functional medicine. appreciate it. So, today we're going to be talking about a couple exciting things. We're going to be talking about um thyroid issues, Hashimoto's, uh which as we know is pretty commonly um mistreated in conventional medicine. And then we're also going to talk a little bit about uh diabetes. Uh so those are going to be the two segments today. Before jumping in, gotta let you guys know legally that everything we talk about is for educational purposes only. None of this is actually medical advice. So, please be aware. And uh without further ado, let's dive into the first segment, which is going to be thyroid and Hashimoto's. So, uh Dr. Rose, why don't you give a little background on your how long you've been helping patients with thyroid related issues? Uh I've been helping people with thyroid related issues since I started practicing 20 years a 20 years ago. Um super common. Um hypothyroidism meaning like a sluggish or low functioning thyroid is u much more common than hyperthyroidism which is an overactive thyroid. So uh it's very common. I think it's really hard not to have any kind of primary care practice, functional medicine practice and not treat uh thyroid imbalances. Yeah. Gotcha. Um, so let's talk about what low thyroid looks like as far as like conventional medicine versus functional medicine standards. Um, so in terms of lab work, like lab values. Yeah, I guess let me say that differently. How is low thyroid treated in conventional medicine and how is low thyroid treated in functional medicine? So I think the one important place to start is the testing that's done. Um there's a lab uh test called TSH or thyroid stimulating hormone and that is not part of routine um screening. So, a lot of people don't get like screening blood work um unless, you know, unless they're presenting with like really not feeling well until they're, you know, 40s or 50s. Um and even then TSH is not part of a comprehensive metabolic panel, which is what you see um sometimes done on annual blood work when you go to see your your doctor for your annual visit. Um now if a person of any age you know is has unexplained fatigue hopefully their conventional medical provider will order a TSH a thyroid stimulating hormone. Um what we know is that without a full thyroid panel and I'll go into what is included in that you're really only getting a small slice of the picture. Um so [clears throat] um in a panel what we have and that's what we have in our is um automatically included in our initial panel our full our comprehensive um blood work that we do with every person that kind of comes through the doors here at MedMatrix and it's a panel that I will repeat fairly often when I'm helping to support somebody's thyroid health. Um, it includes a TSH, a thyroid stimulating hormone. It includes, um, two types of thyroid hormones. That's the free T3 and the free T4. Uh, T4 is the inactive form of the thyroid hormone. It's produced by the gland itself. there's an enzyme that removes an iodine molecule which um then we get T3 which is the bioactive form of thyroid hormone and that's done throughout the body. We say that's done in the peripheral tissue. So like where the actual receptors are for that thyroid hormone. We also test um two types of thyroid antibodies and we also test something called reverse T3. So, you can let me know, Cole, how in-d depth you want me to go into each of those, but my point is is that we run a comprehensive thyroid panel, and that allows us to see exactly what is going on in the thyroid rather than just this sliver of the TSH, which may come back normal, and I can go into what that normal definition is, but we don't know what the actual levels of thyroid hormone are, and we don't know what the cause of the thyroid imbalance is sometimes about um somewhere of 70 to 80% of the time when somebody has hypothyroidism it has an autoimmune ideology it has an autoimmune cause um people may have heard of Hashimoto's disease that's autoimmune thyroiditis um and because we include the thyroid antibodies thyroperoxidase and thyrolobuline we can tell pretty much instantly ly if that's the root cause of the this person's autoimmune or sorry this person's thyroid hypothyroidism. Um so tell me what your original question was. Did that answer it at all? Yeah, I was just asking for that. I think that did answer it. Just a broad overview of Well, I guess I was asking treated, but I think that was a good explanation of kind of thyroid 101, I guess. Yeah. Le let's talk a little bit how does conventional Let's talk a little bit more about Hashimoto's. How does conventional medicine treat Hashimoto's verse how does how do you treat Hashimoto's with functional medicine? So, the other thing I do like to point out and you other people have probably heard me say this um because I end up saying it a lot when it comes to that TSH uh test specifically. This is like to me the perfect example of normal uh lab values versus optimal. So say the normal range is like 0.5 to five for TSH. Um you go to your doctor, they run a TSH, you could be 4.99 and your doctor is going to say you are totally fine. You know, you're you just within that normal, you're fine. It's not your thyroid. In functional medicine, we have a tighter window of what we consider to be optimal. So yes, it's considered normal, but what is optimal for the thy health of the thyroid gland? And usually I tell people somewhere between 75 and two. Now this has to be matched with clinical symptoms, right? If somebody is feeling um like they have great energy, they're not having trouble losing weight, their um their skin is not dry, they're not constipated, their temperature, you know, they don't have they're not unusually cold. Um they're not really exhibiting really they're not really exhibiting any signs of a sluggish thyroid. and their TSH is 2.75. You know, I don't think anything necessarily needs to happen, but um it's just a I just can't tell you how many times people have come in and they have been told that their thyroid is fine and their again their TSH is at that that really high normal level. To me, it's like pretty clear that that thyroid is struggling. Um, so your question is how does how does how do I or how does functional medicine treat Hashimoto's specifically versus conventional medicine? Correct. Yeah. So, um, I usually will do a number of things. Um, I do want to get to the root cause of the autoimmunity and so sometimes that means that we're circling to gut health. Um, and we're talking about leaky gut, um, which can cause inflammation oftent times, um, triggering that autoimmune process in the th you know, towards the thyroid gland. Uh, so that's a whole another conversation of like what's involved in that. But just takeaway is leaky gut, gut support um, and overall inflammation. looking at, you know, um inflammatory markers, other signs of inflammation, ways that we can kind of systemically reduce inflammation. Um there's even, you know, with Hashimoto's, it's pretty well accepted at this point that if somebody um eliminates gluten from their diet, that that can really help. Um, an interesting little factoid is that gleadin, which is the protein in gluten, is molecularly similar to part of the thyroid gland, thyrolobuline. And the body sometimes gets confused. If it had if it has if it's reacting to gluten, it will often also react to thyrolylobulin. And that's when we see those thyrolobuline antibbody levels elevated. So often times eliminating um or greatly reducing gluten in the diet is actually a way to benefit the thyroid. Um can you explain the relationship between TSH, T4, T3 and reverse T3? Yep. So um T so so it's basically this feedback loop. Um so um uh TSH is coming from the pituitary. It is telling the thyroid to produce thyroid antibbody spec or sorry thyroid hormone T4. So T4 is produced in the gland. Again, you need this enzyme um 5Dase to convert the inactive form T4 to T3. That happens at the level of the receptors and the tissues kind of away from the thyroid gland. Um and the kind of halflife of T3 is short. The half relative halflife of T4 is long. So the body is very intelligent. it produces larger amounts of T4, the inactive, which can kind of circulate and then when necessary be converted to T3, the bioactive form. Um, there is another uh hormone called reverse T3, which is kind of an inert version of T3. It locks into the same receptors that T3 locks into. we included in the panel because if somebody has abnormally elevated levels of reverse T3, those are going to uh bump out they're going to kind of uh take out some of those spots on the receptors so that T3 has a harder time locking into the it's a competitor so it basically kind of takes up spots. Um so if we see that usually what that means is we want to again support the thyroid in producing its own um hormone and or if we are doing hormone replacement kind of get an optimal level of that hormone replacement um so that reverse T3 isn't as can't kind of take up those spots as easily. Uh yeah, I think that I think that answers most of those those are the things that are on the on the panel. Mhm. Okay. So, it's really about the the key is the conversion of T4 to T3 and that's that again there's four um iodine molecules on T4 thus T4. This enzyme is required to remove one iodine molecule to get T3. There are co-actors that are required in that conversion. Things that you um are our our viewers, our listeners may have heard of um that are important for the thyroid. Iodine um you know sometimes we will recommend kelp um whether cooking with kelp or just taking it kind of on its own obviously really high in iodine or there's just straight iodine supplements that can be helpful. um and you know fish other things that are kind of rich in in um iodine. Selenium is a um very important co-actor for this conversion found in ridiculously high quantity um amounts in Brazil nuts. Who knew? Um you know eat five Brazil nuts a day supports the thyroid. Um then like your vitamins A, C, E, D, those are all a lot of the B vitamins. You need all of these for for optimal conversion. H okay. So why is T3 important? Like they test TSH. It's really all they look at. But what's important from my understanding is T3. So what does T3 actually do in the body? That is so important. It's the bioactive form. It's the one that's actually like um in charge of your metabolism, right? It's the one locking into the receptors in the peripheral tissue. It's um it's I mean there's receptors everywhere. It's really important for again everything from gut health to um uh optimal immune health, everything. The thyroid really touches everything. Um it's it's also you know it's it's one of our it's part of the endocrine system. It's part of the hormonal system. Um so when another common thing that we see on the blood work is that T3 is normal but what I would argue is not optimal. So we like to see T3 being you know at least at three usually like a 3 to 3.5. Um and uh clinically that's often when we see people's energy improving is when we can do that. So yeah, so that can kind of tweak how we are supporting them because their T4 could be normal, maybe even optimal, their TSH is is optimal or around optimal, but their T3 is lagging. There's something happening with that conversion. That's not That's not optimal. Okay. So, what do how do you help patients like I like Well, I guess I'll ask you this first because we hear all the time from patients, hey, I have low energy. I just feel tired all the time. How often is it thyroid related when you hear this from patients? Um there's so it's fatigue is so multiffactorial. Um I mean I think how often is and and I would say this that it's rarely like one thing but how often is thyroid a part of the picture? Um probably at least 50% of the time. And how do you help patients optimize their thyroid? Is the answer always bio identical thyroid replacement therapy or uh I know you mentioned kelp like how do you how do you help patients fix their thyroid? There's like there's a lot of things that that that I do. Yes, there's that nutritional piece. So, making sure that the micronutrients are optimal. Um maybe something like kelp or taking an iodine supplement. There's great neutrutical supplements that are kind of combination products where you can get your selenium, your iodine, your some of your vitamins. They're specifically formulated to support the thyroid gland. Um, clinically, I haven't seen so they they're great. Clinically, I don't see that if you just do that that you move the needle a whole lot. It's usually I'm usually recommending a neutrautical supplement as kind of part of a bigger um a little more of a comprehensive or holistic thyroid plan. But that is that is important. Um again, is it is it autoimmune? Is it Hashimoto's or is it not? That helps determine how much do we need to really target inflammation and just auto you know gut health, autoimmunity in general. Um, another thing to think about like diet food wise is um there's a a category of vegetables called the grogens. This includes broccoli, cauliflower, kale, Brussels sprouts. These are great. Everyone knows those are like great vegetables. Those are like healthy vegetables. And I don't disagree. they have um a certain chemical constituent that's actually that actually inhibits that 5Dase enzyme. So it kind of inhibits that conversion. What I will tell a patient is um when you eat these vegetables try to avoid eating them in their raw form and when you eat them cooked try to not eat them on a daily basis. So, I'm not telling somebody never eat broccoli again, but there are people who that's their vegetable. Like, every night at dinner, they're having maybe even raw broccoli, you know, or they go to the salad bar every day at lunch and it's some raw cauliflower and raw broccoli. Um, so it's just one kind of additional handicap on the thyroid that we can experiment with taking away and seeing if that kind of helps the thyroid thrive a little bit better. Um, so that's kind of a nutrient and food a few nutrient and food um, ways to approach it. Again, if it's autoimmune, if it's Hashimoto's, there's diet, there's the autoimmune um, the AIP protocol, autoimmune protocol, and it's basically a way to eat in an anti-inflammatory way, specifically when you have an autoimmune condition that can be helpful and educational to people. Um there and then um yes we are also looking at kind of the overall hormone and endocrine picture. Is this person in pmenopause? You know is the the fluctuating changes in estradiol, estrogen and progesterone contributing to a thyroid imbalance? Um another common time for hypothyroidism to to um start is postpartum. You know in the months after a woman has given birth. it's not an unusual time for um the thyroid to become sluggish and for her to get that diagnosis of hypothyroidism. Um so just looking again it's a very c it's a very personalized medicine and so everyone's different and depending on what's going on with this person it the treatment plan will may vary or will vary. Um I am a fan of thyroid replacement. Um there's different options. There's the synthetic ones that most people have heard of like levothyroxine. The brand name, one brand name is synthroidid. Um that is just T4. Um and that uh will lower somebody's TSH and people will often feel better on it. um it does require the body to do that conversion itself and to have like you know optimal levels of co-actors of micronutrients to make that conversion. Um I will sometimes if somebody is on T4, they have felt fine on T4 on levothyoxin, I will add in T3 which is uh the generic is leothyronine to give that body a little bit of support, a little bit of less of the burden of doing of [clears throat] making that conversion themselves. Um so that's one, you know, very common plan that I will start somebody on. And then there's natural thyroid replacement products. Um there's a couple versions. There's armor thyroid, there's NP thyroid, there's naturid. These are basically desiccated porcene uh thyroid glandulars. So what this is is both T4 and T3. One reason why if I if it's not obvious already is that this takes some of the burden off of the body from having to do that conversion. Um the other thing that I like about it is that physiologically are the ratio is of T4 to T3 is 3.5 to 1. So in our bodies ideally we have 3.5 units of T4 to every one unit of T3. That's exactly what you get with these natural um thyroid replacements. Um and they're natural. There's less there's like very few ingredients compared to a synthetic levothyroxine or synthroidid. So sometimes even in levothyroxine you're going to get gluten. I just talked about why gluten can be inhibitory to the thyroid. um especially if it's an autoimmune version and it's there's just a lot of other kind of inactive ingredients. Um and some people are more or less sensitive to those and or just want to go as natural as possible. So those are just some examples of thyroid treatment plans. Gotcha. Okay. Thank you. Uh just want to take a quick moment thank the people who are live right now. We appreciate you guys taking time to come live. uh for the handful of people on Instagram and YouTube. If you have um any questions about thyroid, feel free to put them in the comments and we'll uh try to answer them on the live. Um if you're watching the recording and you want to witness one of these live, I we go live every Tuesday and Thursday, I believe, around uh 4:30 or 5. So, and then if you're interested in becoming a patient, uh you can go over to medmatrixusa.com and click get started or you can even click pricing and you can create a customized uh treatment plan based on your budget and your goals. Um you can see what it would be like to work with us. So, anyways, back to the show with um with thyroid function. How is because we have so many like I know a lot of patients who come to us with thyroid issues and then we kind of fix them. Why is like conventional medicine failing patients when it comes to their thyroid? I mean to be fair, I don't think they're failing every patient. Um but partly it's to go back to the testing, right? The testing is kind of I think insufficient. Um a lot of people come in, they were given a hypo a diagnosis of hypothyroidism years ago, but they have no idea if it's Hashimoto's or not. Um, and that means that, you know, that root root cause medicine has not been practiced. And there's just these, as I've been saying, there's all these other things that we can do to support the thyroid. And that hasn't happened. They've basically been given a, you know, a prescription for levothyroxine and that was it. And that was, you know, 20 years ago. Um, so I think it's just kind of incomplete testing and very I mean I'm a little bit of a broken record around this, but I just feel like conventional medicine is just really uh has a very limited toolbox and there's one option and there's no no education around nutrition. There's no education around kind of what the thyroid what the thyroid function how the thyroid functions in other with other in relation to other systems in the body. There's just it's just very there's one there's one prescription and that's kind of it. Um and people come in and they're still really fatigued, right? And they're like, "My doctor said, my doctor says the labs are normal." And it's like, "Well, what does normal mean?" And what are the labs that have been done? And this and they don't even know that there's all these different options on the menu of how to support the thyroid, whether that's the various types of thyroid replacement, whether that's the lifestyle pieces. Um, so just I guess in a nutshell, it's just limited. Uh, and I think I think that's where they've that's where they've failed. Yeah. And what is limiting them from testing like a full because it seems pretty common sense to just do a full thyroid panel, especially since T3 is so important. Why do you think so many doctors refuse to do I know some doctors do uh but I know probably majority of them refuse to. The majority do not. Yeah. I mean, sometimes it may be insurance that the person that the insurance won't pay for more than a TSH. Um, sometimes I think it's lack of training and education on the on the physician's part. They don't really know a lot more about the thyroid than then, you know, get the get the lab level right. Um, what else? um time seven minute visits make it kind of tough to get into everything I just got I just went into for example um and it's it's it's just the model the model is not um personalized. It's not figuring out like in this person with this person's physiology, you know, kind of what's going on and how can we um support it. It's just your your TSH is high. Here's a here's a medication. You'll be on it for the rest of your life. Gotcha. Okay. Can um can thyroid dysfunction be reversed or are you also putting patients on things like armthroidid for the rest of their life? It's a good question. Um no, it's not necessarily for the rest of this person's life. I do think like in all transparency um people will often always have a tendency at least for a sluggish thyroid. Now again if it's like a woman going through pmenopause and we are able to support her overall hormonal picture um she might not you know that thyroid imbalance might go away. um if it's Hashimoto's and the you know overall kind of um tendency towards autoimmunity and inflammation if that's really high and we can balance that out the thyroid can kind of I self-regulate I don't know if that's the right word but find balance and we don't need you know we don't need to keep them on armor or another replacement um realistically a lot of people with a tendency um for hypothyroidism, they are usually going to feel better on at least a very low dose. Now, it's all multiffactorial, right? Things might change. They might lose a lot of weight. They overall other things might change and they don't need it. But realistically, people often just um feel better on that that even a small metabolic boost. Okay, gotcha. Can you um share maybe a patient case study, like give an actual example of someone you helped with their thyroid issues and kind of Yeah. what the results were? Yeah. Um, [sighs] the first person that comes to mind, um, she is, I want to say, early 40s, um, and was given a diagnosis of hypothyroidism probably 15 years ago. um and had been basically on levothyroxine for that amount of time. [sighs] She it was one of those um stories when I got her health history that um when she was first diagnosed, she was like pretty sick. like she had been she was like really fatigued was were was just having like her hair was falling out was just having all sorts of pretty intense symptoms and signs and um they caught it and diagnosed her as um having I think it was not this one was not Hashimoto's I believe this was just um hypothyroidism uh so she'd basic she felt a lot better 15 years ago when she was initially put on levothyroxine Um but things had kind of like fluctuated through the years. She had a child in the interim, you know, hadn't felt so great right afterwards. They had upped the dose of the leothyroxine and now her child is uh I believe 8 years old and um in the last year those some of those very initial signs and symptoms were coming coming back. And she I mean it it was it had been so intense. So she had this like visceral memory of what that felt like. And so she kind of knew it was thyroid um and not other not other causes. Went to her doctor. Doctor tested just TSH. Uh patient was told you're fine. You're normal. You know you're on the right dose. Um you know maybe you're depressed. Here's some here's an anti-depressant. Patient didn't want to take that. Didn't feel like that was the issue. um and kind of dealt with it for months and then reached out to us and we saw on her initial panel we saw that her um in my opinion TSH was yes normal but certainly not optimal um I don't have it right in front of me but you know it was um it was over four was her her TSH again normal reference is 0.5 to five at least on our labs. So certainly not optimal and her T3 was really low. She really wasn't converting that T4 to T3. Um so we I did a lot of the things that that I already mentioned like making sure that she had those micronutrients, you know, we made sure that her vitamin D levels were optimal, all of all the things. Um, and I switched her from I'm trying to think if I switched her. Uh, yeah, I switched her off of the levothyroxine to Npathy, which is one of those natural thyroid replacements. Um, and we have a conversion. So, I know I know if you're on this amount of levothyroxine and we want you to get on somewhat of the equivalent on the natural, I know exactly how much to prescribe. But I bumped it up because she hadn't been quite getting quite enough even of the levothyroxin. So, I bumped up the NP thyroid and um in I saw her three no not even three months. I think I had I think I retested in eight weeks, saw her in like 10 weeks and it was amazing. I mean, her lab values were much better now within optimal. But more importantly, like she was like that was she was just she just felt so great. Like her energy was back, her hair wasn't falling out anymore. She it just it happened pretty quickly, I guess. Um, so that was a relatively straightforward case. She, you know, she had this history. She knew her body really well. Um, and it was kind of a tweaking of the thyroid medication, but that's not an uncommon scenario. Wow. I mean, what's scary to think is like that if she just accepted that, oh, this is how it is and took an anti-depressant, she got probably would have had a pretty low quality of life as far as like just getting by when the reality was was a thyroid issue. So, that's scary. Yeah. But but really great work. Thanks for sharing. Um what is the relationship between thyroid and menopause? Like is it an issue when women are going to you know hormone replacement therapy clinic or they're getting taking synthetic thyroid medications from their you know OB or they're getting it from online and they're not checking out their thyroid like what's the relationship? So when they're getting your question is when they're getting like um hormone replacement therapy but thyroid isn't part of the conversation. Is that the question? [clears throat] Correct. Yeah. So yeah, it's um I know you've heard me say this, but there's just that intimate relationship between kind of the the ovaries which are making estrogen and progesterone and the thyroid gland and then the adrenal and the adrenal. the adrenal puts out several hormones including cortisol. That's the most well-known um hormone. And so they're all interrelated. They all affect each other. It's all one big hormone bath. Basically, all the hormones are in the blood. They all circulate together. Um, one thing that we will often see in pmenopause is that when estrogen starts to drop and progesterone um starts to drop, the body is more sensitive to cortisol, your your stress hormone. And so more sensitive to I would say high levels of cortisol, but even just fluctuations in cortisol and cortisol. So that so that is going to affect everything. Um you're you're going to basically you're going to feel more stressed, you're going to feel more irritable. Um and then directly in relation to thyroid cortisol inhibits again that conversion. It inhibits the um the work of that enzyme that 5Dase which converts T4 to T3. So you're overall more sensitive to cortisol relative to these other hormones. You kind of have higher levels of cortisol. Um, and then you kind of have this inhibitory effect on the thyroid. So, super common for somebody who either already was hypothyroid for it to kind of get worse or somebody who never exhibited or never had it before for it to kind of suddenly um develop. Um, and then with, you know, with cortisol as well, it's kind of a vicious cycle. So, you start, you know, you're more sensitive to cortisol, you start, you're conf why am I feeling this way? then your adrenals start making more cortisol and um that's just kind of a very common I guess aspect of pmenopause. Okay. All right. All right. Um so that is time for the thyroid segment. I think thyroid goes it's very interesting. I actually personally have Hashimoto's and remember um before I saw a functional medicine provider at Matrix to get help with it. Uh, I was really struggling so much I would even fall asleep at dinner with friends or my family. I would just be so fatigued. It was this unreal low energy I had. Something that I hear a lot of patients come in to the office with. Um, and something that, you know, my normal doctor said everything looked normal. Um, so, you know, if you're a patient who's dealing with low energy, chronic fatigue, your doctor won't run a full thyroid panel. Um, what should that patient do? Dr. If your patient if your your doctor is unwilling to kind of dig deeper, I'm getting that they should come to see Medatrix. Yes, they should. Thought that was an obvious answer. Yeah, if you tell your patient coordinator you're coming from one of the live streams or podcast, uh you'll get a $200 credit as a new patient that can go towards some of this advanced testing that we would do for you. Uh but yeah, we could we would love to help you. Uh with that said, that is it for today's episode. If you want to work with us as a patient, go to the website, click get started. Um and yeah, with that said, we're going to move into uh diabetes. All right. Um talk about the difference and how conventional medicine versus functional medicine treats diabetes. Uh maybe go through some patient case studies. Um so on and so forth. If you're just joining us, uh you should know that everything we're talking about is for educational purposes only. None of this is medical advice. My name is Cole Seer, one of the co-founders of Meden Matrix in charge of all sorts of things like patient education and marketing um and patient success. And then I'm joined here with the amazing Dr. Rose. Dr. Rose, thank you so much for uh continuing to join us. [laughter] Happy to be here. Thank you. So yeah, let's uh start off with kind of what's your background and knowledge around diabetes. Yeah, I mean it's part of it's um type two diabetes is just so common. It's, you know, we learn a lot about it in medical school. Um, uh, it's, I'll just give a personal anecdote, which is that when I was in medical school, I got some routine blood work done and my, surprisingly to everybody, my blood sugar was really high on the labs. We retested and my insulin was really low. And so that's when I found out that I have um an autoimmune like an adult autoimmune form of diabetes. Um so I ended up doing my basically my thesis my dissertation on um it's not a dissertation, it's basically like a thesis on autoimmune diabetes of the adult. So I I went pretty deep into kind of the differences between type one and type two and um all of it kind of how elevated blood sugar affects the whole body. Um, so that was really eye openening and it does I think because of my personal history like when I have somebody come in and their blood work, their blood sugar is really um elevated, their insulin is really low, they don't kind of fit the classic type two picture which is um the t the stereotypical is like kind of overweight um you know and that person and this person is over the age of 25. I'm always just making sure that it's not an autoimmune form. Um the classic kind of difference is that type one we always thought was um juvenile, right? So like a child who gets diabetes that is it is statistically more common for that to be an autoimmune form. And then um so let's sorry let's restart. So for those who don't know what is the difference between type one diabetes and type two? Yep. So, type one is when the pancreas kind of starts to um not function as well and is no longer outputting insulin as well. Type two is [clears throat] where the pancreas is doing fine, but the cells um become insulin resistant. So, the pancreas is putting out insulin, which lowers your blood sugar, but the cells are no longer as receptive to the insulin. And so the pancreas then thinks, "Oh, I need to put out more insulin and more insulin. Why is the blood sugar still high?" [clears throat] Um, and so it's not necess it's not kind of a an issue directly with the pancreas. Type two is thought of as more of a bit of a lifestyle, you know, that somebody um the diet hasn't been optimal. there's been like you know eating a lot of sugar, processed carbs for a long time and lack of physical activity. Um again like thyroid can contribute. So if there's like slow metabolism that can also kind of give you you make you a little bit more prone. Um other metabolic what we call comorbidities can make you more at risk for type 2 diabetes. Um, but fundamentally type one is an autoimmune process within the pancreas where you're not making enough insulin. It's not so much of a lifestyle um cause whereas and classically type two is. So that means that type somebody with type one is usually going to be insulin dependent um for probably for the rest of their life. Whereas type two they can usually um rever either reverse it or manage it really well with diet and lifestyle. Okay. How okay let's say you were just diagnosed with type 2 diabetes. How would you go about reversing it? Well, the first thing is, you know, whether you are working with a nutritionist or um a provider who is really well educated in nutrition, working on, you know, exactly what you're what your what's the glycemic load, right? So, what's what are you eating, how much are you eating? Um, and kind of finetuning that. And almost as important is how how much are you moving your body? What what level of activity um do you have on a daily basis? Everybody's different. Some people come in and they are, you know, used to doing some exercise, but it's just not enough. Other people are kind of debilitated to the point where they um for various reasons are not able to get off the couch. Okay. Gotcha. Um what is your like what is the your functional medicine approach to diabetes? Um I guess or how different is it from type one versus type two when you're treating a patient? Um it's pretty different. I have I mean I type two is so much more common. So, I obviously have more patients who have type two diabetes, but I actually do have um like right now I can think of like five patients on my panel right now who are adults with type 1 diabetes. Um it for them they had it since they were children. So, um I mean the goal with either really is to keep your blood sugar down, right? So, we use a test called a hemoglobin A1C which is a it gives us the average blood sugar over the previous three months. um it's the amount of glycosillation or sugar that attaches to the red blood cells. It doesn't really have to do with red blood cells. It's just a really great way to track the sugar in your blood. Um and that hemoglobin A1C is a much better test than a a fasting blood sugar. Um because a fasting blood sugar is like a snapshot. You could have a totally you could not be diabetic, not be pre-diabetic, but you happen to eat a pint of ice cream the night before, then you fasted for 12 hours, but your sugar is still high when you come in to get your blood draw blood draw at 8 in the morning and it's high. Um, so the hemoglobin A1C is just the best marker. We do run that on people ideally about um someone who's dealing with blood sugar issues every 3 months. Mhm. So, um, the goal with type one or type two is to kind of keep that hemoglobin A1C sort of as low as possible. Now, it's going to be, you know, more realistic. Um, if somebody's type one, we're kind of trying to get it ideally under, I would say 6.5. Um, the classic, the conventional idea is under seven. Um, how do we address that? Again, type one you really the body does is not making its own insulin. The pancreas is not making its own insulin. So, you really do need to give insulin. Now, you can also work on you can also make sure that the diet isn't so high in sugar because the higher the diet sugar, the more insulin the person's going to need to inject. Um, and we want to kind of, you know, keep that to as low of a amount as possible. Gotcha. Yeah. Okay. Yeah. um how do you treat as a functional medicine doctor diabetes differently than say a conventional doctor would? Um again I think it's kind of that holistic piece. So a lot of people with type 2 diabetes um there they come in to us they have there really has been very minimal conversation about nutrition about exercise. um they were basically put on maybe a medication like metformin which um keeps the liver from making another reason that blood that um blood glucose or sugar can go up is the liver produces um glucose. So metformin kind of like suppresses that. Um and maybe that maybe if they're lucky they were like you know sent to a nutritionist um who depending on the you know the skill of the nutritionist kind of helped them or not but it's very I guess again here's a for the most part like here's a medication and they were basically told you know you need to exercise and I guess I would say that we just really get into the weeds with people like what is the obstacle for this person, why do they is it lack of education? They don't really know how to eat a diet that's not high in processed foods, high in sugar. So, like really figuring like educating them on what does that mean and what are the barriers to this person to actually eating real food, low glycemic food, um giving them the tools that they need to kind of become empowered themselves. And same with exercise, right? So, I'm not going to tell somebody to go exercise. That means so many that means different things to each person. person who's been on the couch for three years needs different advice than somebody who actually does go to the gym. They're just not doing the right things at the gym or they're not going enough. Um so very personalized. And then we have, you know, we have neutrautical supplements that can help um regulate blood sugar. Things like chromium, things like venadium, which is a botanical, um bourberine, which is another botanical. These are all um natural like evidence-based tools that can lower your blood sugar. Um again, this is I'm specifically talking about type two in this situation. Um what else? um you know and then sometimes we will talk to people about using like a GLP-1 medication which you know those are the medications that we now think of them as for weight loss but they were originally designed as diabetic drugs and they have some amazing benefits metabolically. They will help lower your blood sugar. They'll help lower your triglycerides and your cholesterol. They'll help you lose weight. [clears throat and cough] They help with fatty liver. So, I I really appreciate them because I do think of them as being somewhat holistic and we often see that when somebody is able to lose weight, when some of that food noise goes away, their blood sugar goes down. Um, yeah. So, that's a I guess some some idea of how we might approach somebody with type two diabetes. Okay. What's the relationship between diabetes and cholesterol? Um what I see is that people come in and they say um you know, oh my cholesterol is high. I need to stop eating eggs or I need to start getting um lowfat dairy. And that's not really that's kind of a myth I think that's stuck around for few few decades too long. Um really what we see is when you're eating processed carbs, high sugar, which is going to in you know increase your risk for diabetes, pre-diabetes and diabetes, it's also going to raise your cholesterol, your LDL, which is your bad cholesterol. So, um, I would say fundamentally that's an important relationship between diabetes and cholesterol is that it's like the way that we want you to eat is going to help both your cholesterol and your blood sugar. Okay, gotcha. Have how So, if a patient comes in and they're like either they've discovered I know we have a lot of not a lot but a handful of patients who've seen us and they discovered they had type two diabetes from the initial lab work they do with us. Let's say patient comes in, they understand they have type two diabetes. Um, if they're super motivated, they're willing to make all the lifestyle changes, get in the gym, how confident are you that they could reverse the type two diabetes? I'm fairly confident. Yeah. I mean, if they again, if they really are consistent um uh I I don't know what what my percentage would be, but um 85 95 90% of the time probably those thing, you know, Mhm. those are going to do that's going to do it. Now, with anything chronic, the longer that somebody has had a condition, including diabetes, the longer it's going to take to reverse usually. So, it's not going to happen in a week or a month. The body is like used to basically living with this level of of blood sugar. Um but you know over months once probably weight is lost and um you know all of those kind of metabolic changes happen um the lifestyle habits are kind of you know those are are solidified that's like the new normal for the person we will start to see that hemoglobin A1C first go from the diabetic range to the pre-diabetic range and then ideally even lower than that. Okay, great. Can you provide a uh patient case study and kind of like the treatment plan and the results of uh someone who had type two diabetes and reversed it? Um [sighs and gasps] let's see. Yeah. Um, so this is a man who is in his um early 60s and he I think he had just been he he came in he knew he was diabetic. he but it was a relatively recent diagnosis for him like um I don't know maybe it would have been done in the last few months he over the p you know the last five years maybe it was partly the COVID pandemic like he you know had a sedentary job everything kind of became more stagnant and sedentary for him compared to his life before that so he really wasn't moving his body as much he had gained probably about 40 pounds over that time. Um, again, we can blame he can blame the pandemic or not, but like, you know, eating wasn't great. A lot of processed food, a lot of just sitting on the couch kind of eating whatever. Um, eating late at night and um so he had been diagnosed by his primary care provider. They had recommended metformin. Um, he didn't he really wasn't a medication guy. he really didn't want to take it. Found us. Um and we saw yes blood sugar was elevated um over the hemoglobin A1C was over seven. We also I also guessed based on his blood work some of the liver enzymes that he had fatty liver. um [clears throat] the inbody scan that kind of shows us like the body metrics also indicated um elevated visceral fat. So all of these things kind of go together, right? Um what else on our it was it wasn't just type 2 diabetes. His triglycerides were high, his cholesterol was high. And um he came to us and he had already kind of like he had joined a gym for the first time in five years, right? he was trying to not buy ice cream as much. So, he was going in the right direction and he kind of needed education. Um, and he needed accountability and um and so that's largely what what it was. It was like education about like, well, what do I, you know, he's a single guy, like what do I make for dinner and what can I do so that I'm not eating my way through a couple bags of potato chips and ice cream on the couch. So, it's really like a again getting to the root of like what's let's let's give you some new habits. Um, we figured that out. Um, he met with um a trainer that we work with to kind of really customize get a really specific workout plan. Um, and um I think we did do some neutrauticals for him. Um, it was it was faster than I thought. his weight loss, his again, we tested his hemoglobin A1C. 3 months later, it had gone, if I'm recalling correctly, from a seven to 6.2. So that's like within the pre-diabetic window. Um, and was losing weight at a pretty healthy pace, not too fast, but enough that he, you know, he had to go buy new pants. and um that initial difficulty and like kind of inertia at the gym, he was kind of getting through that. Still didn't love it, but was committed and he went and then 6 months after that initial visit, um his hemoglobin A like you wouldn't have known that he was diabetic. He was like his his hemoglobin A1C I think was 5.5% which is not even pre-diabetic. All the other biomarkers had improved as well. lower triglycerides, lower cholesterol, better liver enzymes. Um, you know, visceral fat had gone down. So, most likely that, you know, I don't have an ultrasound machine here, but most likely that fatty liver was gone. Um, needless to say, he felt better, right? Mood was better, energy was better. So, there wasn't anything magical. There wasn't like this magic medication. There are, again, there's medications like the GLP1s that can be great. in this situation. It was really I think it came down to um education and time and just him feeling like he had a partner along the way and wasn't just hadn't just been handed a script. Great story. Appreciate it. Uh real quick in 30 seconds or less because we're at time. Why? Like I understand some medications are bad, some aren't, some are worse than others. What's the deal with metformin? Um, [sighs and gasps] it's I mean there are definitely time a time there's definitely a time and a place for metformin. Um, I don't like it because I think it's a band-aid approach. Um, some people have GI side effects and you're just not getting to the root cause. Band-aid approach. Sorry, what is you're just basically like, oh, your blood sugar is high. Take this. Like there's not it's the opposite of root cause medicine. Okay. Sorry, continue. I just wanted to Okay. Yeah. It's basically like here's your here's a symptom, take this as opposed to why do you have this symptom. Um so to me it's kind of again it's not some people need it and it there's a time and a place but um I guess I get frustrated when that's the only thing that's offered. Okay, well that's time for um the diabetes segment. Maybe uh we'll do another one. Um Dr. Dr. Rose, really appreciate your time after a busy day. Uh, if you are listening to this live or you're listening to the recording and you want to work with us as a patient, you can get a $200 credit towards some initial advanced testing if you tell your patient coordinator you came from the live or webinar. Um, all you got to do just go to the website medmatrixusa.com, click get started, and um, book a time with one of our awesome coordinators. Uh, with that said, Dr. Rose, anything else you want to add or you feel like we're all good? No, this was great. Cool. All right. Well, thank you again. All right, everyone. Uh, like, share, comment, subscribe, check out the website. Thanks for listening.