Thyroid Hacks with Dr. Ruben Valdes: Rational Wellness Podcast 154
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Dr. Ruben Valdes talks about Thyroid Health and How to Improve it with Dr. Ben Weitz.
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4:08 Thyroid hormone is the master hormone and is the only hormone that is received by cells at the nuclear level.
5:40 The thyroid produces the inactive form of T4 which then has to be converted into T3, the active form. In severe cases of Hashimoto’s, patients can go through a thyroid storm when the body starts destroying the thyroid and all the stored thyroid hormone gets released and they end up with too much of the active form of thyroid hormone, T3. They may get strong palpitations and they will get very hot and this is very damaging to the other organs in the body. Therefore, you don’t want too much of the active form of thyroid T3 floating around the blood stream. It is much safer for the body to produce T4, the inactive form, and let the various tissues convert the T4 to the active T3 form as needed. 60% of the thyroid hormone conversion takes place in the liver, 20% in the intestines by our gut microbiota, and the other 20% in various tissues thoughout the body like the skin and bones.
8:26 There are various nutrients that are required for synthesizing thyroid hormone, and then for this T4 to T3 conversion, including iodine. The thyroid always needs iodine but taking too much iodine can make Hashimoto’s worse. It can be an immune trigger and taking a high dosage, like 12.5 or 25 mg found in Iodoral, can be especially dangerous. Diagnosing Hashimoto’s can be tricky since sometimes the patient can be negative for TPO and TGB antibodies and there is a third set of antibodies, alpha and beta tubulin, which are measured as part of the Cyrex Array 5, which is the multiple autoimmune reactivity screen. Alpha and beta tubulin are structural cross fibers that are found in different tissues, including the brain and also the thyroid, though it is much more rare than TPO and TGB.
14:02 Dr. Valdes has a standard thyroid panel that he likes to run that includes the following: 1. TSH, 2. Total T4, 3. Free T4, 4. Total T3, 5. Free T3, 6. Reverse T3, 7. TGB antibodies, 8. TPO antibodies, 9. Thyroid binding protein, 10. Thyroid binding globulin, 11. Alpha tubulin, 12. Beta tubulin. It is important to compare Total T3 to Free T3. For example, if your Free T3 is in range, say 2.4, which is on the high end of the range, but their total T3 is 71, which is on the low end. This indicates that not enough of the T3 is bound, which indicates an issue with thyroid binding protein. If you don’t measure reverse T3, then you will not know that some of your free T3 is actually reverse, inactive T3.
17:20 Most traditional MDs usually just run TSH and TSH is important and a high TSH will drive thyroid gland hypertrophy and can even drive thyroid cancer. So it is important to suppress TSH. Dr. Valdes likes to see TSH between 1 and 1.5, which is a bit extreme, whereas most experts look at normal as being between .4 and 4.0 or 3.5.
20:58 Reverse T3. When the body is converting T4 to T3 it removes one of the 4 iodines from the carbon ring. It is supposed to remove the iodine from the outer ring, but if it removes an iodine from the inner ring, then it becomes an inactive form of T3 known as reverse T3. You can have a patient that has a high T3 but yet feels badly, their hair is falling out, they are tired, and they’re moody. High cortisol, chronic stress, chronic inflammation, and infections will drive cortisol up and impair liver detoxification, which can result in forming more reverse T3 when the T4 to T3 conversion is happening in the liver.
25:19 Dr. Valdes said that his experience is that when you just place patients on Cytomel, which is just T3 alone, patients may feel amazing for the first few months and then they start to tank because they develop thyroid resistance. Dr. Valdes likes to use GTA Forte from Biotics as the preferred thyroid medication, which is actually a nutritional supplement. It is a glandular with some added cofactors, including the minerals zinc, copper, rubidium and selenium, and the antioxidant Superoxide Dismutase. Dr. Valdes pointed out that Armour thyroid has a portion that is synthetic, so a purely glandular product like GTA Forte is to be preferred. He also likes the prescription product Nature Throid.
33:40 Thyroid Binding Globulin. If you have a high Total T3 and a low Free T3, this indicates an overproduction of thyroid binding globulin (TBG). TBG usually follows Sex Hormone Binding Globulin (SHBG). Dr. Valdes then likes to run a DUTCH test, which is a Dried Urine Hormone test to look at how well they are metabolizing or clearing their estrogen. If they are not clearing their estrogen or metabolizing it safely, then you need to address metabolism and detoxification issues. If it’s a male, DUTCH can tell you if they are aromatizing some of their testosterone into estrogen, and if so, is it primarily estrone, estradiol or estriol. You also want to see if men are overconverting their testosterone into estrogen.
36.55 The underlying causes of Hashimoto’s thyroiditis (primary hypothyroid) can include HLA DR-DQ susceptibility to biotoxins, heavy metals, leaky gut, chronic infections, insulin surges, estrogen surges, cortisol surges, food sensitivities. Which direction to pursue will have to do with the history.
40:55 Dr. Valdes does a very detailed history on every patient and he uses the Living Matrix software that uses the history taking model developed by the Institute of Functional Medicine. This model helps him to see which direction to go when trying to discover the underlying, root causes of the thyroid problem. Should he focus on defense and repair, assimilation, communication, their energy system, or the structural integrity of their organs? Then he will use detailed testing to help zero in on possible causes based on the history.
42:54 If he suspects biotoxins, like mold, Lyme, cauatera, bloom, spider bites, and snake bites, he will run a HLA DR-DQ. Lyme starts out as an infection but the Borrelia produces a biotoxin. Other markers are C4A, TGFB1, MMP9, and VEGF, which are part of the Richie Shoemaker protocol. Dr. Valdes does not find the urine mycotoxin tests that helpful.
Dr. Ruben Valdes is a Doctor of Chiropractic and an expert in Functional Medicine. He is the Chief Content and Marketing Officer of Novis Health Systems, a Functional Medicine franchise. He wrote 3 books, including The Chiropractic Entrepeneur, From Diabetic to Non-Diabetic, and The Thyroid Hack. Dr. Valdes can be contacted through Novis-Health.com.
Dr. Ben Weitz is available for nutrition consultations, including remote consults via video or phone, specializing in Functional Gastrointestinal Disorders like IBS/SIBO and Reflux and also specializing in Cardiometabolic Risk Factors like elevated lipids, high blood sugar, and high blood pressure and also weight loss, as well as sports chiropractic work by calling his Santa Monica office 310-395-3111 or go to www.drweitz.com. Phone or video consulting with Dr. Weitz is available.
Dr. Weitz: Hey, this is Dr. Ben Weitz, host of the Rational Wellness Podcast. I talk to the leading health and nutrition experts and researchers in the field to bring you the latest in cutting-edge health information. Subscribe to the Rational Wellness Podcast for weekly updates, and to learn more, check out my website, drweitz.com. Thanks for joining me and let’s jump into the podcast. Hello, Rational Wellness podcasters. Thank you so much for joining me again today. For those of you who enjoy listening to our Rational Wellness Podcast, I would very much appreciate it if you could go to Apple Podcasts and give us a ratings and review. For those who’d like to see a video version, you can go to my YouTube page, Weitz Chiro, and if you go to my website, drweitz.com, you can find detailed show notes and a complete transcript.
Today, our topic is a Functional Medicine approach to thyroid health with Dr. Ruben Valdes. The thyroid is the master regulatory gland and it’s found in the front of the neck below the Adam’s apple. The thyroid produces three main hormones, T4, T3 and calcitonin. Calcitonin plays a role in regulating blood calcium levels. T4 and especially T3, which is a more active form, affect metabolism, appetite, gut motility, heartbeat, breathing rate, the mitochondria and many other functions in the body. Too little thyroid production, hypothyroidism, including Hashimoto’s autoimmune hypothyroidism, which accounts for 90% of cases of hypothyroidism in the US, can result in weight gain, a lack of energy, brain fog, feeling cold, constipation, hair loss, infertility, et cetera. Too much thought production, hyperthyroidism, including autoimmune hypothyroidism called graves, will speed up the metabolism and cause weight loss, hair loss, et cetera.
The traditional medical treatment for hypothyroid is to prescribe synthetic T4 thyroid hormone, also known as synthroid, and that’s pretty much the extent of the treatment. Occasionally, some T3 may also be prescribed as well, but there is never any attempt to figure out the underlying causes for the thyroid to determine why this thyroid stopped functioning properly. Similarly, for the traditional medical approach, in cases of Hashimoto’s thyroiditis, there’s virtually no focus on the autoimmune condition that’s causing the thyroid to malfunction, with all the focus being on reducing TSH levels using thyroid hormone, but from a functional medicine approach, we want to discover some of the underlying triggers and causes for hypothyroid and correct these. When there is autoimmune thyroiditis, we need to look for some of the reasons why our immune system has gotten so out of balance and make some changes so we don’t see a continued destruction of the thyroid gland.
Our goal today is get a better understanding of what some of the mechanisms of hypothyroid are, including autoimmune, how to properly analyze and improve thyroid health with the proper thyroid panel, and then figure out some of the root causes and how to correct them using a functional medicine approach. Dr. Ruben Valdes is a doctor of chiropractic and an expert in functional medicine. He’s the Chief Content and Marketing Officer of Novus Health Systems, a functional medicine franchise. He wrote three books, including From Diabetic to Non-diabetic, The Thyroid Hack, and his newest book is Awakening from Alzheimer’s. Dr. Valdes, thank you so much for joining me today.
Dr. Valdes: Thank you so much for having me, Dr. Weitz.
Dr. Weitz: Dr. Valdes, can you explain, what’s the role that the thyroid plays in our metabolic functions and our overall health?
Dr. Valdes: Absolutely. Thyroid hormone is what I like to call the master hormone. It’s the only hormone that is received at the nuclear level. You know that every other hormone has receptors on the surface cell of the wall, whether it’s insulin, testosterone, estrogen, cortisol, you name it. They’re all received and affect the outer membrane of the cell. Thyroid hormone, specifically activated T3, is the only hormone that makes it all the way in through the cell wall and stimulates nuclear activity. If you remember, obviously DNA is what lives in the nucleus of the cell, so it initiates transcription and translation. Everything in our body is dependent on transcription and translation, from our ability to grow hair, to our ability to grow nails, to our ability to produce cells to repair, to regenerate, to produce oil in our skins to regulate our metabolism. Everything is DNA dependent. Imagine what the consequences long term of having your master hormone become disordered, diseased and dysregulated are and can be.
Dr. Weitz: Interesting. The thyroid produces the inactive form of T4, which then has to get converted into T3, which is the active form. I wonder why the body has set that up? What’s the evolutionary advantage of producing an inactive form that has to be converted into an active form? Wouldn’t it be easier if the thyroid just produced the active form of T3?
Dr. Valdes: Well, that’s a great question actually, and a very smart question. The reason why that would be catastrophic is because what would happen is the moment that that active hormone is immediately released from its origin site, the thyroid, everything around it would immediately absorbed and uptake this very critical master hormone. We actually see that in very severe cases of Hashimoto’s, when people are going through something called thyroid storm. When that happens, there’s very aggressive, very active destruction of the thyroid, and all of that stored T4 and the little T3 that’s stored is released, and you’ll see a lot of metabolic activity centrally. They’ll get very, very strong palpitations. This will get very, very hot, and it just puts all this tissues that are around the thyroid in danger. The body being as brilliant as it is, is going to first create primarily the inactive form so it can be bound, transported, converted, and then taken to the sites where it’s actually needed.
Dr. Weitz: Cool. Where does most of the conversion of T4 to T3 take place?
Dr. Valdes: 60% of that conversion happens at the liver by an enzyme called 3,5 deiodinase. Another 20% is happening in the lining of our guts, primarily by our gut microbiota, and then another 20%, which is not really very effectable, or alterable, happens at the level of our bone and skin, and other peripheral tissues. Now, when you look at a panel and you look at where their total T3 levels are, sometimes it can be a dead giveaway. People that normally would have, or typically would have very, very low levels of T3, I’m talking maybe in the 70s or less, almost always you can immediately assume that that’s liver, right, because when it’s gut that 20% usually won’t drive it that low. Sometimes the levels themselves can immediately begin to tell you where some of these under conversion patterns might be happening, even before you look at the rest of the lab work.
Dr. Weitz: Interesting. What are some of the nutrients required for synthesizing thyroid hormone, and then for this T4 to T3 conversion?
Dr. Valdes: Yeah, so nutritionally, the thyroid always needs iodine and this is such a controversial topic, as you already know, because for patients with Hashimoto’s thyroiditis, and Hashimoto’s thyrotoxicity, iodine becomes extremely toxic. As a matter of fact, it can be an immune trigger that makes the Hashimoto’s worse, right? There’s all this information out there and all these people talking about, “Hey, low thyroid. Take iodine,” and they’re unfortunately making the primary reason why they have hypothyroidism worse, crazily.
Dr. Weitz: In fact, in certain Functional Medicine circles, very high dose iodine supplement called Iodoral at 12.5 or 25 milligrams, whereas the average dosage of iodine in the diet’s supposed to be about 150 micrograms, which is what you usually see in a multi, they’re promoting the use of these super high dosages of iodine.
Dr. Valdes: Yeah, and it’s very, very sad. It’s very sad to see because before that… it’s not a wrong intervention. It can be a good intervention, but at the right time. Way before somebody would jump on that wagon, being primary hypothyroid, meaning they have Hashimoto’s disease, we first have to confirm that the immune system is going into remission, that it stopped its attack on the thyroid, so then the thyroid can utilize that nutrient effectively. If you’re uptaking those high doses, you’re getting a surge. Those surges are very, very immuno activating, and you’re making the primary condition worse. There is a time and a place for an intervention like that. It just has to be done at the right time.
Now, we can speak a little bit, as we move forward, about secondary hypothyroidism, which is not that commonly talked about, meaning the gland itself is healthy, but there’s other factors in the body that are ultimately influencing how effectively and successfully that gland is creating hormone, and how the body’s converting the hormone. For those patients, if it is confirmed that in fact it is not Hashimoto’s, then we have to talk a lot about how many people are tested, and since they test negative for TPO or TGB, they’re told, “No, you don’t have Hashimoto’s,” when in fact the majority of them actually do. We’re now even discovering and learning about a third form, about a third set of antibodies that are more rare, but that can also be diagnostic of Hashimoto’s disease called alpha and beta tubulin. The prevalence of true secondary hypothyroidism is actually very small 3 to 4%. For those patients, iodine intervention right off the bat might not be a good… might not be a bad idea, but for the majority of people, if you’re not going into that level of depth, then you’re actually placing the patient at risk of having… re-triggering of their autoimmunity.
Dr. Weitz: That’s interesting. That’s the first time I’ve heard about these two new antibodies to look for autoimmune thyroid.
Dr. Valdes: Yeah.
Dr. Weitz: Can you repeat what those are again? Where is that testing available?
Dr. Valdes: Yeah. They’re called alpha and beta tubulin. Alpha and Beta tubulin are cross fibers, structural cross fibers that are found in different tissues. They can, at times, be found in the brain. They can be found in other areas of the body, but they’re very prevalent in the thyroid. The best place to run those is through an RA-5 from Cyrex Labs. They’re included in their multiple autoimmune reactivity serum.
Dr. Weitz: No wonder I’ve heard of it. Okay.
Dr. Valdes: Yep. Yeah, so they’re in there and we’re now learning that it is a rare form, and it can act very similar to thyroglobulin, which clinically we tend to see people with elevated thyroglobulin antibodies that have autoimmune thyroid tend to have a more severe version of the problem than just the TPO antibody itself, because TPO is just attack on the enzyme which alters hormonal production, versus TGB is actually going after the structural components of the thyroid. When those patients are under attack, their ups and downs are a lot more severe. The severity of the condition tends to progress very rapidly. Patients with alpha and beta tubulin tend to present more like TGB than TPO. Interestingly, I had a case of this recently in a young girl, and 31, losing her hair, her hormones all over the place, very dry skin, always cold. We ran the classic 11 markers and everything looked good. I was like, “You look fine.” Her TSH at 1.8, her TPO, TGB normal, everything else normal, but it looks so much like Hashimoto’s. We dug deeper and it came back positive for alpha and beta tubulin. It was interesting.
Dr. Weitz: Interesting.
Dr. Valdes: Yeah very.
Dr. Weitz: Why don’t we go through testing now? Why don’t you tell us what your standard profile is? You mentioned 11 standard tests that you do.
Dr. Valdes: Yeah. For most patients, we’ll run the classic TSH, T4 total, T4 free, T3 total, T3 free reverse. We’ll run both antibodies, TGB, TPO. We’re going to run thyroid binding protein, sometimes sex binding protein, and then if necessary, alpha and beta tubulin. That puts us at 12.
Dr. Weitz: Right.
Dr. Valdes: If we don’t run the sex binding globulin, that’ll put us at 11.
Dr. Weitz: Now, it’s become a standard in some of the functional medicine circles to just run a panel that includes free T3 and free T4. What does adding a total T4 and total T3 give you?
Dr. Valdes: Well, it tells us a lot. I don’t know who would do that and why because thyroid binding protein is a very important player. You want to know, even if the T3 levels look good and they’re in the functional range, it’s like, okay, great, you have enough free, but you really can’t make assumptions based just on that. Number one, you really want to know how much of that hormone is actually bound anyways. Having a comparison of total T3 to your free T3 is going to speak into how well your thyroid binding protein is binding. Let’s give you an example. What if your T3 is in range, I don’t know, at 2.4 on the high end of the range? You’re like, okay, this is good. Their symptoms are going to be okay, but you look at their total T3 and they’re 71. Right? There’s a problem right there because your total T3 levels are low, and there’s probably some type of issue with thyroid binding protein where not enough of it is bound.
Yeah, you’re having enough to three, but your overall production and conversion is crappy. Right? I want to know that. In addition to that, we can never assume that all that free T3 is active, because part of that free T3 that’s being counted is actually reverse T3 that’s being reported just this T3. When you look at your total T3 value, that includes active and reverse T3. It’s all bundled in the total T3 count. When you look at free T3, you’re getting active and you’re getting reverse. You don’t know, just by looking at free T3, that all of it is active together. I would say to a certain extent, it is a disservice and it takes us back to the very thing that we’re trying to get away from in Functional Medicine, which is just dealing with symptoms, which is the whole conventional approach. Our idea is to get a full picture of everything that’s going on with that patient, with that pattern in order to be able to promote health to the highest level.
Dr. Weitz: Right. Traditional doctors a lot of times just run the TSH. That’s all they’re really concerned about.
Dr. Valdes: Yeah. I mean, let’s be fair, that’s important. A high TSH is going to drive hypertrophy in the gland. It can drive cancer. Yeah, they’re trained in pathology. They’re trained in disease. Suppressing TSH is, in fairness, important. It’s a good thing. However, baby, If we begin to talk about the things that also matter, like quality of life for these patients, the elimination of the very symptoms that took them into their doctor’s office in the first place, right?
Dr. Weitz: Right.
Dr. Valdes: The things that they actually want help with, they’re untouched by just looking and treating their TSH. Yes, it’s a very incomplete picture and on top of that, most doctors are utilizing the reference range which, pardon my French is absolute garbage.
Dr. Weitz: What range do you like to use for TSH?
Dr. Valdes: Well, I’m a little bit of a Nazi. I like it to be one to 1.5, and that’s not really…
Dr. Weitz: That’s extreme.
Dr. Valdes: It is extreme. Yeah, it is extreme. Most of the time they’ll say from point A to 2.3 is acceptable. If somebody is above the age of…
Dr. Weitz: Most traditional doctors have a range of up to four or 4.5.
Dr. Valdes: That’s right. Yeah, and by the time someone’s anywhere close to four, their life is collapsing, man. They feel so terrible. They’re being told… and I see it all the time, they’re like, “Yeah, my thyroid was checked and I was told I was good. Go home. Don’t worry about it.” Until you go up that extra fraction of a point. “Wait, now it’s time to put you on a drug for the rest of your life,” which, surprise, surprise, is the number one selling drug in America. Synthroid and Levothyroxine.
Dr. Weitz: Yeah. What about when patients get older? I heard one prominent functional medicine doctor say that once you’re past 60 and you… TSH up to 10 is still okay.
Dr. Valdes: Okay, wow. Yeah, I find myself challenged by that statement. Absolutely. As we age, there’s a lot less concern about that range. Normally, I’m typically pretty comfortable with patients around the age of 65 being three, 3.2, I’m a lot less strict, and primarily because now you begin to enter the risk of arrhythmia’s and cardiovascular stuff. Yes, allowing that range to be broader and less strict in people that are older is most of the time okay. 10? I don’t know that I would ever be comfortable with. I would honestly have to see the research that would support that, but up to date, I haven’t seen studies that would support allowing a TSH to be that high again because of the risk that that poses to the thyroid around nodulation, and that’s a risk that will be present until somebody is 80 or 90.
Dr. Weitz: Right. You mentioned reverse T3. Let’s talk about reverse T3 and what the significance is.
Dr. Valdes: Yeah. Reverse T3 is like an isomer. That means a mirror molecule. When the enzymes that create the conversion into T3 are working, sometimes they’re working very rapidly, and they’re going to remove the wrong iodine from the ring. T4 is called T4 because there’s four iodine around the ring. Normally, if my memory doesn’t fail me, the iodine that we want to remove is on the fifth carbon, but sometimes if the iodine on the third carbon is removed, it creates this mirror molecule. The problem with it is that it looks identical. It’ll be bound to protein. It’ll be transported, but it can’t fit in the nucleus. It can’t fit on the receptor, so making it ineffective, an ineffective, inactive form of T3. There’s a lot of people that, for one reason or another, too much of that conversion goes the wrong way and they start over making this reverse form of the hormone.
Now, a lot of times, you might look at their total T3 and you’re like, “Wow, it’s 120, 125. This is fantastic,” and you look at them and they look like garbage, right? They’re exhausted, their hair’s falling, they’re tired, they’re moody. Their husband or their wives are ready to kick them out of the house, and it’s because it’s because when you dig deeper, more than 20% of that total hormonal conversion is becoming this inactive form. There’s a lot of things that drive that. The most common, historically, is high cortisol. High cortisol, chronic stress, chronic inflammation, infections will drive cortisol up, and it’ll impair or alter phase one, phase two detoxification pathways. It can also alter gut inflammation, gut microbiota, also altering the conversion into reverse T3. Yeah, definitely a very important piece to look at.
Dr. Weitz: If you see an alteration, do you look at the T3 to reverse T3 ratio? Is that how you analyze it?
Dr. Valdes: Possibly I mean, if I’m going after symptoms and you’ve had those patients where you’re like, they need to start feeling better yesterday, right? Because we want them in care. This is the patient that’s been to six other doctors and nobody’s been able to help me feel better. That’s the patient where you take that approach. You want to increase their free T3 right out the gate as much as possible. However, for a long term strategy, for a long term plan, again, we have to go back to the entire panel and just make sure that things balance out the way that they need to. Reverse T3 is always going to be there and it’s not a problem as long as it represents less than 20% of their total T3. Yes, I would say absolutely. Looking at that ratio, especially initially, to clear symptoms is going to be very valuable, but down the road, you always want to look at the entire cascade of fibroid conversion, clearing, transport. You want to look at all the pieces to have a sustained recovery.
Dr. Weitz: I’ve heard a few docs talk about this reverse T3 and this reverse T3 ratio and say that when that’s out of whack, they basically add T3 to the patient.
Dr. Valdes: Yeah, and I have mixed feelings about that for numerous reasons. A lot of the T3 that’s out there, like Armour Thyroid and Cytomel specifically… Cytomel and I don’t get along.
Dr. Weitz: Yeah, Cytomel is specifically T3 because Armour is basically a combination of T4 and T3, and maybe T2 and T1 as well because it’s coming from desiccated pig thyroid, right?
Dr. Valdes: Yeah, absolutely. My experience has been that when you supplement or when you replace primarily T3 and only T3, the first two to three months the patient is going to have this… it’s like they come back to life. They’re like, “My god, this is amazing. You’re the best doctor in the world,” and then all of a sudden they start tanking. They start tanking and keep tanking and keep tanking. What I have learned is that they begin to develop thyroid hormone resistance, almost every single time, and that’s one of the reasons why Cytomel is no longer prescribed willy-nilly. When that thing came out originally, It was like, “Cytomel for you. Cytomel for you.” That’s gone away. It’s rare that you would see rarely any patients, and when I have somebody that comes into my office, they’re like, “Yeah, I’m on Cytomel.” I’m like, “Man, your doctor’s probably from the 19th century.” The problem with it… yeah. The problem is that the body, again, did this, designed this…
This was designed very specifically from conversion to T4, to binding, to transport, to delivery into the cell. There’s something. I’m almost sure that at some point, we’re going to find that there’s probably some type of tag or something that’s going on the hormone once it’s converted to gate it or allow it through the membrane. I haven’t seen that yet, but I have a feeling that as we continue to learn more about this, and we continue to learn more about Transcriptomics, I’m almost sure we’re going to find some type of tag that is placed on that hormone once there’s conversion. I think that’s really what it boils down to. We always need to go back to conversion. Conversion is the key. If we’re just replacing T3, it can be very beneficial to get the patient out of the dump for that initial two to three month window, but over time they’ll start getting worse because of thyroid hormone resistance. The nucleus will stop uptaking it.
Dr. Weitz: What form of thyroid medication do you find most effective?
Dr. Valdes: Yeah, so we’ve used GTA from Biotics for a long, long time. It’s tested, and one of the things I like about it is that it really is primarily T4. It does have a little bit of T3, T2, T1, but it is primarily T4. In addition to that, I’ve also…
Dr. Weitz: You’re saying, instead of a prescription medication like Synthroid, you’re using a nutritional supplement?
Dr. Valdes: Yep, absolutely.
Dr. Weitz: Wow.
Dr. Valdes: Patients love that for many reasons. I still haven’t seen…
Dr. Weitz: Now, the critique probably is going to be, “Hey, this is not really standardized. You can’t count on this like a prescription medication.”
Dr. Valdes: Yeah, I mean, if… I’ve heard that a few times, and if you go to Biotics, they will literally stab you if you make a statement like that because it is very standardized. We know very, very well what the dosage that’s going into that patient consistently, and we see it be consistent over time. We can see it both in the way that they respond to it clinically and through their labs.
Dr. Weitz: What is this product? Because I’m not familiar with it.
Dr. Valdes: Yeah. Biotics has something called GTA.
Dr. Weitz: Right.
Dr. Valdes: They have simple GTA-Forte and GTA-Forte II. It was just…
Dr. Weitz: I’m assuming this is a glandular product.
Dr. Valdes: It is. Yeah, it is primarily a glandular and they’ve added a few cofactors that are also important for transport conversion. It’s a very, very good product.
Dr. Weitz: Now, why would this be better than an Armour?
Dr. Valdes: There is a portion of Armour that is synthetic and when you run… anytime, when you run into a synthetic, you’re going to have transport and conversion.
Dr. Weitz: What part of Armour is synthetic? I thought it was…
Dr. Valdes: No. Part of the T4 in Armour is actually synthetic. From my understanding, and in addition to that, it’s also my understanding that there are some binders or fillers in the encapsulation. I can only speak into my clinical experience with both products, what I’ve seen, and historically I’ve seen a much better result from GTA. There’s also another one that is prescription called Nature Throid. I’ve also seen very comparable results from Nature Throid to GTA. Those are the two-
Dr. Weitz: Nature Throid and WP Thyroid is another popular product.
Dr. Valdes: Correct. Yeah. Clinically, they’re the two that I’ve seen the best outcomes with historically, as far as thyroid hormone replacement.
Dr. Weitz: Now have you actually taken patients off of Synthroid and put them on this product from Biotics?
Dr. Valdes: You’re funny. Legally…
Dr. Weitz: Sorry doc, didn’t mean to put you on the spot there.
Dr. Valdes: The answer to that is threefold.
Dr. Weitz: You and I are both doctors of chiropractic and we don’t prescribe medication.
Dr. Valdes: In conjunction with their prescribing physician, the answer to that question is absolutely yes. 97 or 98% of my cases come off of Synthroid or Levothyroxine and permanently to then utilize a bio identical or a glandular.
Dr. Weitz: This product from Biotics, it contains T4 and T3.
Dr. Valdes: Yes. Yeah. It just, it just follows thyroid composition, right? The thyroid is roughly 92, 93%, depending on the research. Then there’s a small percentage in there of T3, so that’s exactly what you’re gonna find in the glandular product.
Dr. Weitz: What kind of dosages are you typically using for this product?
Dr. Valdes: Yeah, so when you look at the equivalent there’s GTA single is the equivalent of about a 0.33 Synthroid or Levo. You can kind of play around with that if they’re on 0.75 and if they’re on 0.50, you can play around with that dosing. It’s also always very important to understand that a glandular is going to convert better and transport better than a synthetic every single time. And so sometimes the equivalent has to be a little bit lower on the glandular side in comparison to the synthetic side. From there, they have the GTA-Forte, which is basically two times stronger than the GTA basic. You just double that. It would be 0.66, which in reality is the equivalent of a 0.75 functionally. They have the GTA-Forte II, which doubles the strength. I think they add a little bit of copper into that one. I’m not super in love with that. We get so much copper exposure from environment, from water from food, that I don’t really tend to find that I need to be giving these patients more copper especially, because of how prevalent copper has become.
Dr. Weitz: Copper piping-
Dr. Valdes: Yep.
Dr. Weitz: … leading to copper in the water.
Dr. Valdes: Yep, yeah. And then in the food too. Most people really need to be on a ton of zinc to redox the copper out of their body. I’m never a fan of throwing stuff at people that has more copper, especially because of all the work that I’m now doing on the cognitive side of things and finding copper is such a huge player in cognitive decline. So yeah, most of the time I’ll stick to either GTA, GTA-Forte, and then I’ll dose two capsules. One capsule based on where they are with their synthetic.
Dr. Weitz: Okay. You mentioned thyroid binding globulin as far as the testing, and I don’t think most practitioners pay a lot of importance to this marker. Maybe you could talk about that for a minute.
Dr. Valdes: Yeah, so it is and can be a very important marker to look at. When you start seeing ratios of total T3 and 3T3 that are off. Example a person that has a very high total T3 and then a free… Sorry, yeah, high total T3 and a low 3T3, then you know that there’s probably going to be an overproduction of thyroid binding protein. That’s the time that you might want to go and check it. Most of the time it follows sex binding globulin, so they either rise or drop together. They respond to the same factor. A male that’s estrogen dominant, you’ll see that they’re going to have higher sex binding proteins, higher thyroid binding proteins. A female that’s estrogen dominant, you’re gonna see the same thing. Then you start kind of seeing more of the endocrine picture of this unique patient. It’s not a determining mark, but it can be a very indicative marker of the overall picture of what’s going on with that thyroid. I like to have it, I like to see it instead of just going back to it and running it at a later…
Dr. Weitz: If you see a higher load thyroid binding globulin, so if the binding globulin is high, what do you think and what do you do?
Dr. Valdes: Yeah, most of the time you want to think estrogen. When I see it, the next step that I take is I run a DUTCH test, which is the Dried Urinary Hormone test. The DUTCH test will tell me if they’re aromatizing, they’re over converting… If it’s a male over converting their testosterone into estrogen, which type of estrogen is predominant estrone, estradiol or estriol. It’ll also show me the metabolites. A lot of people, whether male or female, might not be producing a ton of estrogen, but they might be having a problem clearing estrogen. If you don’t look at the metabolites, you don’t have a clear picture of what’s going on with estrogen. All of a sudden estradiol is maybe on the low end of the range, but you look at their metabolites and they’re accumulating, they’re bio accumulating, and these metabolites have effect. They’re doing the same thing that estrogen would be doing. All of that stuff is really important because now we begin to talk about clearance and detoxification issues, or we talk about hormonal production issues, or we are now jumping into adrenal issues with the HEA and pregnenolone steal and all of those things, so the picture just keeps getting broader as to why this person is having that symptom that every thyroid person has, but the reasons why they have it are very unique to them.
Dr. Weitz: Interesting. Let’s go through some of the underlying causes of hypothyroid especially of Hashimoto’s autoimmune. And then how do you work it up, and what do you do about it?
Dr. Valdes: Yeah. So we are very keen on testing. We do believe you know that just to test as much as we can, as much as we can and I’ll give you an insight of how my brain works. When you look at primary hypothyroidism, Hashimoto’s. 97% of cases that are hypothyroid are Hashimoto’s. There’s going to be varying severities. Recently I had a kid 19 years old, most of his hair had gone, eyebrows gone, fatigued out of his mind, moody, gaining a ton of weight, very rapid, very severe progression. Then you’ll see this female that the problem started when they were 23, and they’re now in their 50s, they’re still somewhat lean. Their energy weans and waves but for the most part is good. So all of that is already speaking into the severity of the immune triggers.
Most of the time when somebody is progressing very rapidly, it usually will be things that make the immune system insane, right? We’ve been looking a lot into the world of biotoxin illness. People that are HLA DR-DQ susceptible to some of these bio toxins, because these people can’t clear the thing that is making their immune system bananas. Certain heavy metals also have the ability to drive the immune system bananas too. Especially in people that might be genetically susceptible to autoimmune disease. From there, if you take it a notch down, almost always you’re going to be looking at gut. The gut, if it’s super permeable, they’re going to have that molecular mimicry mechanism, and that’s just going to be driving this thing like a bat out of hell.
From there, then we can go into the infections layer, we can talk about viruses, we can talk about Epstein-Barr, we can talk about all that stuff that predispose to a baby born, C-section, no breastfeeding, whatever, you know, that type of stuff? Pregnancy being another huge trigger, I would say almost right below that. And from there the rest of the factors from, insulin surges, estrogen surges, cortisol surges, food sensitivities, lesser toxic exposures. The reality is to be able to really assess what is driving the immune system to do what it’s doing, it’s impossible to do without really testing the crap out of the patient. That’s one of the biggest barriers for a lot of patients into care, and also for a lot of doctors in being able to deliver.
Dr. Weitz: You mean because the testing is expensive?
Dr. Valdes: Exactly, yeah. Because it can be very expensive. we can talk about this some other time. But that kind of took us back to the drawing board. And it’s how do we redesign this functional medicine model, so we’re not placing the patient in front of exorbitant costs, and we can get them into care successfully and affordably. That’s kind of… As doctors, we have to think about that, as much as we don’t want to, we have to think about that, and how to really deliver highly successful care.
Dr. Weitz: Right. So your first layer obviously depends on the history and everything else, but is to look at… If I understand what you just said, is to look especially at toxins. Is that first things you start to rule out?
Dr. Valdes: Yeah, so it depends. Let me let me explain myself. Every patient that comes into the practice is going to go through a software called the LivingMatrix. The LivingMatrix was developed in partnership with the IFM and Cleveland clinic’s, and it’s a very rigorous process of gathering-
Dr. Weitz: IFM is the Institute of Functional Medicine. Yeah.
Dr. Valdes: Yeah, exactly. And so, this is the tool that’s now being used to publish studies like the promise study and all that.
Dr. Weitz: As a way to organize their history.
Dr. Valdes: Correct. Once I gathered data, I see the health history timeline, that converts into the functional medicine matrix. It tells me, it begins to tell me what are the areas that this patient is having major difficulties with? Is it defense and repair? Is it assimilation? Is it communication? Is that their energy system? Is it structural integrity of organs? Once I see that I can begin to make the best decisions I can about their testing. Again, this will also help me understand the severity and the velocity of the progression. When I see defense and repair issues, when I see assimilation issues, when I see communication issues, and this person went from zero to 60, in five minutes, I’m immediately thinking either biotoxin or metals, right? Because it’s one of those things that just drives the immune system bananas. If I’m seeing defense or repair assimilation, but the progression is going slower, then I’m kind of shifting my thinking a little bit. I always want to come in with the most likely diagnostic test, and that’s kind of my entry point. From there, I continue to test based on those initial findings.
Dr. Weitz: How do you test for toxins? What kind of studying do you do?
Dr. Valdes: Yeah, so if it’s going to be biotoxin, the first layer is running a test called HLA DR-DQ. It’s a genetic test.
Dr. Weitz: Biotoxin we’re talking about like mold?
Dr. Valdes: Correct, yeah. Mold, Lyme, ciguatera, bloom. Rare certain types of spider bites or snake bites.
Dr. Weitz: You consider Lyme a toxin, isn’t that more of an infection?
Dr. Valdes: It’s both. Yeah. When you get bitten by a tick you, you contract the Borrelia infection. But the Borrelia infection produces a biotoxin, and that’s what makes people very sick. In Lyme, when you look at people that get Lyme, 22% of them can go on to develop post Lyme syndrome, which is that long term drawn out disease that people can get. That’s very consistent with mold. That’s very consistent with MARCoNS, which is multiple antibiotic resistance stuff in the sinuses. That’s very consistent with people that are exposed to Ciguatera toxin in deep water fish. We’re learning that for this percentage of the population that have these genetic susceptibilities. These things are huge deal. They’re a huge deal, because what happens is HLA DR-DQ codes for the antigen presenting cell. That cell that’s going to bind the antigen and then present it to the immune system. What happens is the site where biotoxins would bind to is misshapen. Biotoxins are very small, they’re smaller than point three microns, they can’t bind so the immune system can never clear the toxin. The body’s very smart, it’s going to still try and get rid of it, so it’ll go through the liver, it’ll be pushed through the bile. But bile emulsifies it, reabsorbs it and it goes back into the body and it just keeps circulating in the body. There’s a very specific domain of the immune system that becomes chronically activated because of these toxins. Markers for that are C4A, TGFB1, MMP9, VEGF. That part of the immune system just starts going… We are learning that this category of patient is incredibly susceptible to not just Hashimoto’s really any and every autoimmune disease in the spectrum of autoimmune disease.
Dr. Weitz: For those who are practitioners who are listening to this, you may recognize that I… believe you’re talking about like Ritchie Shoemaker’s Protocol?
Dr. Valdes: That’s right. Yeah, absolutely. Yeah. I had the privilege of learning from Ritchie Shoemaker. Two years ago, he had a kind of like, really cool workshop down in Miami and I got to meet him and learn. Brilliant, brilliant dude. I really believe that his work is on the tip of the arrow for what we’re going to be doing as Functional Medicine doctors in the next 20 years because of this understanding of transcriptomics, and how signaling into our genetics is really what drives health or disease.
Dr. Weitz: Can we screen for mold without doing these markers? What if we just did like a Great Plains urine mycotoxin test or something like that?
Dr. Valdes: Man, you’re going to get me in all kinds of trouble. Well, there’s a lot of people that promote these tests like that however, unfortunately when we look at the hard data, there’s really no major validity to that type of approach. And it pains me to say it because there’s a great practitioners that live and die by it, and I hate being that guy that, but when we look at…
Dr. Weitz: The urine mycotoxins testing is not accurate you’re saying?
Dr. Valdes: I mean, I’m not saying that, I’m saying…
Dr. Weitz: There’s no science to back it at this time.
Dr. Valdes: No, there is some science, it’s just the clinical relevance. The type of assumption that we can make based on that data is not very solid. Let me say that a different way. You could be living in a home that’s full of mold, but if your genetics do not make you susceptible to that exposure, the reality is it’s not really a major threat, for the most part because you have the ability to clear it. So…
Dr. Weitz: Right, but this is a way to test your body excreting these mold toxins. No?
Dr. Valdes: I’m going to kindly turn down my response on it simply because the validity of those tests is just not all the way there. And…
Dr. Weitz: Those serum markers that you mentioned are indication of the body having this inflammatory reaction?
Dr. Valdes: Yep. One of the things is the problem with molds is the toxins that they produce, number one. The toxins they produce are 0.3 microns small. No test that’s out there currently, yet has the ability to detect these particulates, even though we know they exist, we know they’re there. First step, from a clinical point of view, if I’m going… If me, this is my thought process. If I’m going after an autoimmunity, I need to know if this person has the predisposition, the genetic factors that would make them vulnerable to this problem?
Dr. Weitz: Okay.
Dr. Valdes: If they are, then there’s more important questions to answer than if they’re peeing fungal metabolites right?
Dr. Weitz: Okay.
Dr. Valdes: There’s more important questions to answer that.
Dr. Weitz: Okay, I don’t want to go too far down the mold rabbit hole. I realized we could spend another hour on that. Let’s move on. How about nutrient status? Which are some of the most important nutrients, and how do you test for these?
Dr. Valdes: Yeah, I’ve actually gotten away a little bit, and I want to get your opinion on this too, because I’ve kind of moved away a little bit from testing nutrient status for a few reasons. One of them is I’m going to be supplementing and replacing most nutrients that are going to be important therapeutically. There is value to that. There is a lot of value in understanding nutritional status, because there can be issues around absorption, around transport. Because of the cost, I’ve opted to prioritize some of the more heavy hitting tests initially, before jumping into that especially because I am going to be intervening with a very broad spectrum set of nutrients.
It’s kind of give and take. Now, to the defense of that, let me say that a lot of people that have Hashimoto’s, all autoimmune diseases have little families, they’re called serotypes. The two closest family members to Hashimoto’s disease are celiac and pernicious anemia. With celiac, there’s going to be a ton of nutritional deficiencies because of absorption issues, and with pernicious anemia, you’re going to have methylcobalamin, methylfolate absorption issues. So it’s like, there can be. If my concern level is heightened this person is developing more autoimmunities, I have a suspicion of celiac, I have a suspicion of pernicious, probably, I’ll go down that route. Outside of that I look at organic acids from the DUTCH test, which is going to give me all of their B metabolites. I’m going to look at other neurotransmitter precursors too that are important to me. I’ll look at vitamin D, and I’m always going to work with the fat soluble vitamins A, D, E, K in addition to the rest of them. I don’t know, that’s kind of how I handle it. Are you currently doing full nutritional testing?
Dr. Weitz: We do include some nutritional testing. We’ve got a bunch of serum markers in one of our initial panels, and then some of the patients I’ll have them do like a NutrEval. I have found it to be helpful. I had one patient recently that has Hashimoto’s and the zinc was really a high marker, and also had a genetic SNP that made it difficult to absorb zinc. Even though zinc was already in the diet and in the multi… I might have been hesitant about really beefing up the zinc, and really beefing up the zinc for this patient made a huge difference.
Dr. Valdes: Excellent. Yeah, well, that’s truly cool to hear. Let me rephrase that. We do test metals, both nutritional minerals and heavy metals. We do that through Quicksilver. For a nutrient like zinc, I would have data but I was thinking more like… Oh, and we also check for-
Dr. Weitz: Selenium, or vitamin D, or…
Dr. Valdes: Right. Well that we check through serum. We also get glutathione metabolites through urine. So yeah, I think that to a certain degree, we [crosstalk 00:53:12] do get a lot of them just not all of them.
Dr. Weitz: You do some nutrients through serum?
Dr. Valdes: Yeah. Well, I mean, yes, we do some of the basic nutrients vitamin D and the…
Dr. Weitz: Right. Iron is super important for thyroid.
Dr. Valdes: Right. Iron and Ferritin, the works, of course.
Dr. Weitz: Yeah, okay. I think we’re closing in on an hour and I have a patient coming up so-
Dr. Valdes: Okay.
Dr. Weitz: … I know there’s a lot more we could talk about, but I think we’re gonna have to bring this to a close in the next couple of minutes. Where should we go to end this?
Dr. Valdes: I don’t know, man. I think we-
Dr. Weitz: I know there’s a ton stuff still to talk about, but…
Dr. Valdes: Yeah, I think that maybe two things. If you and your audience like the conversation, we can continue it. We were starting to talk about the triggers of Hashimoto’s and how to go about those. We didn’t really dive into secondary hypothyroidism if that would be something of interest for your-
Dr. Weitz: Okay, why don’t we plan to do a part two, and we’ll go into those things.
Dr. Valdes: Excellent. Would love to be back if your listenership is excited about this stuff.
Dr. Weitz: No, I think so. I think you’ve really delivered some good, interesting takes on some of this information, so I think it would be helpful. Let’s give your information about how listeners and viewers can contact you and find out about some of your programs that you offer. For practitioners, you’re also… have this functional medicine franchise that’s-
Dr. Valdes: Yeah, that’s correct.
Dr. Weitz: … available.
Dr. Valdes: Yeah, so our company is Novis Health for consumers and patients dealing with hypothyroidism. We have two centers currently on our way to have four before the end of the year. Very excited about that. We deal primarily with hypothyroidism and some other metabolic disorders. Our website is www.novis.health. We are beefing that site up big time to become an authority site pretty soon. Then for doctors, our mission and our belief is to have functional medicine available to everyone that needs it. We want a functional medicine facility in every corner, just like we have these days massage and all those things. We want to make it available. We know that the main hospital systems are never going to make that happen, so it’s up to us to join forces and really all drive in the same direction. One of the things that frustrates me a little bit about Functional Medicine is that everybody wants to be a voice and everybody wants to be heard as a provider, and that’s super important to become that expert, to become that celebrity. But we can only succeed long term to the degree that we’re unified and all fighting for the same thing, and that’s really what we’re trying to do. We’ve built very strong business models around our doctors in order to make sure that they can do what they love doing, which is taking care of their patients, taking care of their practice, having freedom of time, having freedom of practice, having financial freedom. If you’re interested in that it’s novishealthsystems.com. Very successful model for those that are wanting to really grow and expand in the world of functional medicine.
Dr. Weitz: Excellent. Thank you, doc.
Dr. Valdes: Thank you. Have a great day, and thank you for having me.
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