Amy Myers MD. All rights reserved. 1

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1 Understanding Graves Disease and Hypothyroidism Guest: Dr. Eric Osansky The contents of presentation are for informational purposes only and are not intended to be a substitute for professional medical advice, diagnosis, or treatment. This presentation does not provide medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. Dr. Myers: Hey, everybody. It s Dr. Amy Myers with The Thyroid Connection Summit: Why You Feel Tired, Brain-Fogged, Overweight, and How to Get Your Life Back. Today, we have Dr. Eric Osansky with us, who is a chiropractic physician, a nutritionist, and a certified medicine practitioner, and he focuses mostly on Graves disease, as well as Hashimoto s. He himself had Graves disease just like I did. He was super fortunate that he was able to put his in remission by natural means and not have to take the terrible medications that I had to have or to have his thyroid ablated through Iodine-131 or taken out by surgery. So I m very excited to talk with him about everything he did to reverse his Graves disease. I ve read his book, which is Natural Treatment Solutions for Hyperthyroidism and Graves. And he also has created a website, naturalendocrinesolutions.com. So welcome, Eric. How are you? Dr. Osansky: I m doing great, Dr. Myers. Thank you for having me. I m excited to be here. Dr. Myers: Yeah. Well, we re really happy to have you. As you know, being one of the few people not few. There are plenty of people with Graves out there. But what really gets its glory and its time in the press, typically, is Hashimoto s. So when I was writing my book The Thyroid Connection, I didn t want to limit it Amy Myers MD. All rights reserved. 1

2 to just Hashimoto s being that I myself had Graves. And so, definitely, a whole host of the book is about how to treat different thyroid conditions. And so I wanted to talk with you today about Graves, your story, and what you did to reverse that and how you re working with patients to help reverse that. So I guess, just sort of starting off, do you mind sharing your personal story with us? Dr. Osansky: No, not at all. It actually started or at least I started finding out about it at a Sam s Club. I was walking right at Sam s Club and they had one of those automated blood pressure machines. And I decided to sit down and take my blood pressure. And blood pressure was fine but my pulse rate was elevated, which wasn t common. So I thought maybe it was just because I was walking around. And so I check my pulse manually later that night and the next few days. And it remained elevated. At that time, I wasn t really familiar with hyperthyroidism and Graves disease. But as I did a little bit more digging, I was experiencing a good amount of weight loss and increased appetite. But at the same time, I was also dieting and detoxifying for a few months. So I just attributed it to the diet and didn t think twice about it. But then, once I had the increased pulse rate and started putting the pieces of the puzzle together but eventually, I went to a primary care physician who ran some blood work: the TSH, the thyroid hormones. And so he diagnosed me with hyperthyroidism at the time. And he recommended a beta blocker, which I didn t take. And looking back, I probably should ve done something because it was a couple of months. And so I saw the endocrinologist after that and I didn t do anything to manage the symptoms. And we could talk more about that. But long story short, I saw an endocrinologist about two months later. And she diagnosed me with Graves disease. And she was actually pretty conservative. She didn t recommend radioactive iodine, surprisingly. I actually had to talk her into giving me an ultrasound just because I wanted to make sure I didn t have any thyroid nodules, which I didn t. She recommended methimazole, which is, you re familiar with, an antithyroid medication. And I didn t take that either. The reason is I knew I was going to do something naturally. And I was also skeptical about natural methods. I didn t know if they would help. But when I was getting my continuing education credits, I would always go and attend nutrition courses. So I attended in the past some functional endocrinology courses. Amy Myers MD. All rights reserved. 2

3 So I knew there was some hope even though I didn t know much about it. So I didn t take the methimazole. I started working with someone else on helping me get my Graves disease into remission and I saw the benefits relatively quickly. I took some herbs. Of course, cleaned up my diet. Managed my stress levels. We did a good amount of testing. And just overtime, my symptoms improved. My blood tests improved. So I did saliva testing and my adrenals were shot in the beginning. The adrenals improved. And then I also slowly got into remission. And then overtime, I just decided that I was going to help others with thyroid and autoimmune thyroid conditions. And so I started helping people with Graves disease as well as Hashimoto s. And as you said and as you know, there are a lot more people with Hashimoto s but I probably see an equal amount just because there s more Hashimoto s but there s the affinity with Graves. Since I have Graves, I see a good amount people with Graves disease and that s why I wrote the book as well, The Natural Treatment Solutions for Hyper thyroidism and Graves Disease, and that pretty much is my story. Dr. Myers: So that s great and just so encouraging. And we ll dig a little bit deeper into the specifics of that. I wanted to know, so you were practicing chiropractor at the time. Were you doing any type of functional chiropractic or was this kind of your first foray into something and then you changed your practice from there? Dr. Osansky: Yeah. I wasn t doing much from a functional medicine perspective. It was pretty much just a typical chiropractic practice. I did, at one time, have a naturopath working with me. And so I delegated the functional medicine duties to her. And I did speak about nutrition. As I mentioned, I did 10 nutritional conferences but I didn t incorporate too much nutrition into the practice. So it wasn t until I was diagnosed with Graves and then just restored my health and got into remission that I started focusing on other people with these conditions. Dr. Myers: Great. Yeah. It s like the proof is in the pudding, right? I had the opposite story in a sense of having gone through and had a very terrible experience with conventional medicine. I searched and searched and searched. Of course, this was more than 10 years ago now, about 12 years ago or 13 years ago when I had mine and nobody was talking about anything like this. So I searched and searched and found nothing. So as most people know, I went through PTU, which I then got toxic hepatitis and then the Iodine-131. Amy Myers MD. All rights reserved. 3

4 So I ve now practiced how I practice and nobody has to go through what I went through. So it s kind of the same disease, different outcomes or different pathways but same outcome that we re both here with the desire to help people with autoimmunity and Graves. Well, let s kind of go over you talked about some symptoms for you. There s higher heart rate and weight loss. Why don t we kind of go through some of the symptoms of maybe Graves disease and how they re different or even similar to those with Hashimoto s. Because I think you probably see this as well that there are certainly people who can have some of the symptoms in both categories or even have opposite symptoms and think, well, how could I I have Hashimoto s patients who are losing weight. And so I when I want to put them on thyroid replacement hormone, they re leery because they re already losing weight. But then once they go on the hormone, their weight stabilizes. So why don t we just walk through, quickly, just some of the sort of characteristics or symptoms that somebody might have, in case they re listening out there, wondering if maybe they do have Graves disease or hyperthyroidism? Dr. Osansky: Sure. Well, some of the symptoms: Increased pulse rate, heart palpitations, again, the weight loss that I experienced, and tremors also are common. And then sometimes, loose stools because, again, this is increasing the metabolic rate. So as a far as comparing what Hashimoto s, a lot times it will be opposite symptoms. So with Hashimoto s, you might get constipation. Graves disease, even though some people with Graves are constipated, a lot of times you get the loose stools, sometimes even diarrhea, depending on the condition. And the elevated thyroid hormone levels could sometimes cause insomnia, problem sleeping, which of course people with Hashimoto s also experience insomnia, as well. But the classic symptoms typically are the weight loss, increased appetite, the tremors, increased heart rate, palpitations, loose stool, hair loss is pretty common with Graves disease. And I know with Hashimoto s, a lot of people with Hashimoto s as well experience the hair loss. Energy levels vary. With Hashimoto s, you typically see the lower energy levels, more fatigue related. When I was dealing with Graves, I didn t feel low energy. In fact, even though my adrenals were shot, which if you look on my adrenals, you would think that I would fatigued all the time. But the increased metabolism I think kind of offset that and so I Dr. Myers: Or all the adrenaline from your yeah. Amy Myers MD. All rights reserved. 4

5 Dr. Osansky: Exactly. So my energy was pretty good but it varies. I ll speak with some people with Graves. And, usually, if they ve had it for a prolonged period of time, for years, then the fatigue is more likely. But it does depend on the person, as you know. There are some people that have had it recently and got diagnosed recently and their energy levels are low. And those who have had it for years and their energy levels are okay. So those are some the classic symptoms. And again, yeah, sometimes you get the non-classic symptoms someone with Graves disease who s actually gaining weight, which frequently is due if they re taken the PTU or mithemazole, although every now and then they re not taking that and their gaining weight what makes it a little bit challenging to determine why. But, yeah, so those are some of the more common symptoms associated with Graves. Dr. Myers: Yeah. I was kind of the tired and wired. I had really, really bad insomnia. And so I couldn t sleep but then I would like wake up and was exhausted. But then all the adrenaline and the high heart rate. And I was losing weight. And I was warm. And I definitely had tremors. And then I started having like weakness and stuff too because I think I was even burning through what fat I had on my body and going into my muscles, so, yeah. And why don t we talk about some of the lab testing, kind of trying to distinguish between Hashimoto s and Graves, as well. Dr. Osansky: Sure. Well, with Graves disease, typically, you will have depressed TSH levels, thyroid stimulating hormone, whereas Hashimoto s in most cases that ll be elevated. And the reason for that is because in Graves you have the elevated thyroid hormone levels. So if you do the free T4 or free T3 is what I typically would recommend and probably what you recommend. And so with those being elevated, typically, the TSH, not only depressed, but in most cases, undetectable. And again, with Hashimoto s, it ll vary. As you know, TSH frequently will be elevated. The degree of elevation will vary but not everybody has low thyroid hormone levels with Hashimoto s. Sometimes, it might look fine with the blood test take that silent autoimmunity phase could take a lot longer with Hashimoto s when compared with Graves disease. And then, there are autoantibodies involved as well. With Hashimoto s, you have the thyroid peroxidase antibodies and thyroglobulin antibodies. Those are more commonly associated with Hashimoto s. With Graves disease, you have TSH receptor antibodies or thyroid-stimulating immunoglobulin is the most common type. And what that means is just different areas of the body are being attacked by the immune system. Amy Myers MD. All rights reserved. 5

6 So with Hashimoto s, the thyroglobulin protein of the thyroid gland and thyroid peroxidase enzymes, those are being attacked. And then with Graves, you have the TSH receptors being stimulated by the immune system and attacked by the immune system and that is what results in the increase of thyroid hormone. And so those I don t know if you just wanted to go over the basics as far as thyroid related tests involving Graves and Hashimoto s but Dr. Myers: Yeah. There s certainly I m pretty sure you talk about it in your book as well. There s certainly a whole host of nutritional tests that can be off as well. So, is that what you re wanting to speak to next? Dr. Osansky: Well, just in general, you and most functional medicine practitioners will run just the complete blood counts and the comprehensive metabolic panels and lipid panels and CRP. So, yeah, it just doesn t stop I see a lot of people, all they get is the free T3. And also a lot of people don t even get that. Some people just get the TSH. But a lot of people will get the TSH and the thyroid hormones. Some will get the antibodies. Some won t. But oftentimes, they ll just stop with the metabolic panel. And the reason that a lot of endocrinologists will do the metabolic panel is you could share your experience, you had the elevated liver enzymes. So they will frequently monitor those. But as far as doing other tests, vitamin D very rarely. Will they test for vitamin D, even though that s important for healthy immune system? I run an iron panel on many of my patients, B12. So, yeah, there s definitely a lot of tests that I think could give some good information. Dr. Myers: Yeah. In addition to, and I think you mentioned these as well, selenium and zinc and vitamin A, D. Iodine, that s somewhat controversial as to how to test iodine and what someone s needs for iodine are. But all of that is definitely important because it helps make the thyroid hormone and then helps make these conversions. Dr. Osansky: Exactly. Dr. Myers: Yeah. Well, I guess, since we re kind of on the topic of iodine, what is your feeling about iodine for those with Graves disease and Hashimoto s? Dr. Osansky: Well, as you said, it s definitely controversial. And probably the best thing to do is to give my story when it comes to iodine. Because when I was diagnosed with Graves disease, I didn t really know much iodine. I knew, of course, it was a mineral and all minerals are important. But with regards to thyroid health, I really didn t have a good understanding of iodine. So the natural health care professional that I worked with, she was big into Amy Myers MD. All rights reserved. 6

7 recommending iodine for Graves,as well as for Hashimoto s. And so when I was diagnosed with Graves disease, I went through the urinary testing for iodine and was found to be deficient. And so I was put on an iodine protocol and was told to take larger doses of iodine, not quite as high as some people take. I know some people will take 50 mg of Iodoral, some people will take larger than that. But it was around 25 mg. I was taking a good dose of iodine. And honestly, I had a good experience with iodine. So I had a positive experience. And you know how it works sometimes, if you have a positive experience with something, it s like, Oh, yeah. I ve got to tell everybody about iodine and test everybody for iodine. And that s how I was with my patients. I pretty much, initially, would test just about everyone for iodine. And again, a lot of people did receive some good benefits. But then, I realized that there are also risks. Of course, research has come out where it could be a potential trigger for thyroid autoimmunity, as well. So again, it is one of those double-edged swords where I still like iodine. And I still, at times, recommend iodine but I m cautious about iodine. So I have changed my approach in the past. I don t have everybody test for iodine, everybody take iodine. I think if someone is thinking about taking iodine, first of all, it s important to work with someone because I think part of the problem is, yeah, people are just self-treating their condition. And then I think besides getting tested, which, again, someone who you work with hopefully will test. But I think it s important to have healthy levels of antioxidants. I think that s part of the problem too. Not to say that people could take 50 mg of iodine even if they have healthy level of antioxidants. But if you re having deficiencies in selenium, which is a cofactor for glutathione, that s going to create more problems because with iodine, it s involved in, as you said, the production of thyroid hormone and there is oxidative stress involve. So you definitely need antioxidants. Dr. Myers: And you know, nowadays, with all the bromides, fluorides, the rest of the halides, if you go in to taking large dosage of iodine for some people, you re detoxing or it s displacing all of those toxins; the fluorides, bromides, and chlorides. And so if you don t have your antioxidants up or your glutathione levels up, a lot of people can have bad reactions or feel bad like a detox reaction. Dr. Osansky: Exactly. Yeah, that s a good point. Some people do feel bad and it s more of a detox reaction. So, yeah, you definitely need to weigh the benefits and the risks. And again, if you take iodine, besides working with someone and, hopefully, the person you re working with will start with Amy Myers MD. All rights reserved. 7

8 smaller doses. So again, I like iodine. Iodine has some great benefits but I m more cautious with iodine than I was in the past. Dr. Myers: And just for our listeners because they might not know a lot about it, how exactly were you testing? Dr. Osansky: So I was testing when I received the test myself, I had it was called the iodine loading test and I m sure you re familiar with that. So what that is that s actually taking a 50 mg table of Iodoral or a potassium iodide and measuring the excretion of the iodine over 24 hours. So again, let s say if someone with Hashimoto s wants to test for iodine. And again, I prefer improving the health of their immune system first in most cases than those with Hashimoto s. With Graves, one could also make the same argument too but it seems with Hashimoto s, it s more problematic. But if they want to do it though, a lot of times, I ll have them do the spot test. And you mentioned bromide, you could actually test for bromide, do an iodine spot test and because I don t completely trust the iodine spot test. Let s say if it s low, I think someone will eventually need to correct that deficiency. But even if it s looking good, but if bromide is high because bromide competes with iodine that s a pretty good sign that you also have an iodine deficiency. So again, if someone were to test, those at a different I don t usually recommend testing in the blood. I don t think that s a good method. So I would recommend urine. But again, the risk of the loading test that you do have to take, the potassium iodide in a fairly large amount before collecting the urine sample. So a lot of people are more comfortable in a safer option would be to do the spot test and then testing bromide. Although, again, I did iodine loading test and was fine. And in the past, I ve had numerous patients who did the iodine loading test also that Dr. Myers: Have you had anybody have any bad reactions? Dr. Osansky: I haven t had any patients, really, have any bad at least none that told me that they came back and had a bad reaction, a negative reaction. I did once have a person me, who said they were taking iodine and they had thyroid eye disease and it flared up their thyroid eye disease. So I had that. And there have been other stories through . You get different stories. People who had some bad experiences but that s probably the worst experience I ve heard as far as someone who just said, Yeah, I took iodine. My thyroid eye disease got worse. And I forgot to mention thyroid eye disease is Amy Myers MD. All rights reserved. 8

9 one of the symptoms of Graves disease. So yeah, that s maybe also something to keep in mind if someone has very high thyroid-stimulating immunoglobulins. I do see a correlation between that and a higher incidence of thyroid eye disease and maybe you do want to be more cautious with the iodine in that case. Dr. Myers: Right. So just to put it in perspective for people, most people are getting on the microgram level of iodine a day. So just trying to kind of put all this in perspective, for most people they are taking microgram dosages of iodine. So just through your diet or maybe like I have a multivitamin that has what I perceive as kind of everything you need in one multivitamin to support your thyroid. And I have microgram dosages of iodine in it. But what you re referring to and what is the controversial aspect is not do we need iodine in our diet. It s how much do we need. And there are certain people out there recommending these milligram dosages. So hundreds if not thousands of times larger than what someone is getting in their diet. And the thought behind that is, one, we took iodine out of your salt. We re not eating shellfish and seafood as often. We re not eating seaweed. And then we ve bombarded our systems with bromides and halides and chlorides and fluoride. And so it s displacing all this iodine so just for people to put that in perspective. And I personally don t use the super high dosages of iodine. It s just too controversial for me. But I ve had people like yourself who ve come in and just swear it was really one of the biggest factors that got them well. And then I ve also had people coming in swearing that it was the thing that some a practitioner recommended it to them and it s why they have their thyroid dysfunction. So I think the bottom line is the jury is out. And if you re using that and you feel comfortable with and you re having success, that s great. That s how we learn about these things is that you took high dosages. You had success. You ve tried it with your patients. It s just not something that I ve tried it on myself. But I don t have a thyroid. So I don t really have something to mess up if it s doing something bad for me. So I have taken the very high dosages briefly. I kind of felt liked I felt better. Maybe, it was getting some of those other halides out of my system. But I didn t notice anything in terms of thyroid function because I m on desiccated thyroid hormone every day. I don t have a thyroid. So I don t think I m a good example of does it work or does it not work. Amy Myers MD. All rights reserved. 9

10 Dr. Osansky: Yeah. And I think part of what iodine, it s not just the effects it has on the thyroid gland. From a positive perspective, it s an antimicrobial so it might help some people. Because, again, infections could be a potential trigger with autoimmunity so that could help in some cases. It also helps with estrogen metabolism. So it does have other benefits. But, again, there definitely are risks, as well. It s not like avoiding gluten. If you avoid gluten, there s no risk really in getting rid of the gluten. Or if you re taking vitamin D, minimal risks unless you re taking really high doses, maybe, if you re taking 10,000 or 20,000 IUs for many, many, many months. But otherwise, with iodine, yeah, I agree that you do need to be cautious. Dr. Myers: Yeah. Well, so you brought up some great points, which is really getting to the root cause of how this happened in the first place. And certainly, some of that can be nutrition or nutrient deficiencies but you ve also hinted at infections and diet. I know in my book and I think you talked about each one of these, if not, it s okay. But maybe we can walk through these. I talk about the diet, leaky gut, infection, stress, and toxins. So maybe we can kind of walk through each one of those and hit things that you ve seen that seemed to correlate with Graves disease. And then we can kind of walk through the herbs that people can be doing to calm their thyroid while they re working to find their root cause. So I don t know where you you had mentioned, I think, first that you changed your diet. So maybe you want to talk about what you changed your diet to and what you have your patients do. Dr. Osansky: Okay. Well, when I was dealing with Graves, there really wasn t much out there as far as autoimmune Paleo diet. So I probably followed more of a standard Paleo diet. So as far as like nightshades, for example, even though I ve never been big into eating tomatoes. And I don t think I did eat the white potatoes anyway at the time. So I essentially was eliminating the nightshades but not because I was trying to follow an autoimmune Paleo diet but, of course, the whole foods. I mean that s all I ate. I stuck with the whole foods, increased my vegetable intake. And again, I did eat, in my case, a good amount of meat at the time. But I made sure that I ate plenty of vegetables, which was hard because I grew up not eating vegetables. I didn t live a healthy lifestyle and I didn t like vegetables. So it was a challenge making those changes, but I knew what I had to do. But pretty much, it was whole food based and with my current patients, what Amy Myers MD. All rights reserved. 10

11 usually do is I will start them on an autoimmune Paleo-type diet, which is similar to standard Paleo diet except, again, the nightshades are avoided. The eggs are avoided. The nuts and seeds are avoided. And I usually will have someone with Graves try that out for at least 30 days. Same thing with Hashimoto s, at least give it 30 days. If after 30 days they re doing great with the autoimmune Paleo diet, then, of course, I m fine with them continuing with it and I ll encourage them to continue with the autoimmune Paleo diet. If they re struggling, I am open to them reintroducing some foods. Of course, it depends what the food is. I prefer for them to continue to avoid the common allergens like gluten and dairy. Eggs are a good example. So if after 30 days, someone especially with Graves disease, because, again, Graves you have the increased appetite. You have the weight loss. And a lot of times, it s a mental game too. Even though the goal with the autoimmune Paleo diet, you re not trying to restrict calories. But still, a lot of people with Graves disease feel like they re not eating enough, that they need more. So sometimes just introducing eggs alone can help a great deal. But, of course, you got to remember why eggs are excluded from an autoimmune Paleo diet. And that s because eggs are a common allergen. And also the egg whites have compounds, which could potentially affect the permeability of the gut. So it does sometimes become challenging. If someone reintroduces eggs and if they re feeling fine, if they re progressing well, then that s great. Keep on eating the eggs. Of course, if they re not doing well, if they re symptomatic at all or even if they re not symptomatic but they just hit a roadblock and they re not improving, then they probably will have to give up the eggs. Dr. Myers: And they could also try I personally eat egg yolks but not the whites. So that s another option. Dr. Osansky: Yeah. That is true. If you re allergic to eggs, that might not help. But as far as affecting the Dr. Myers: Right, of course. The lysozyme, yeah. Dr. Osansky: Exactly. So yeah. So that is an option too. That s eating the that s what I do too. I add the egg yolks to my smoothie, the raw egg yolks, and I have eggs that way. So everybody is different. I don t think everybody needs to follow a strict autoimmune Paleo diet for a prolonged period time and it s definitely, in my opinion, it s not a forever diet. Amy Myers MD. All rights reserved. 11

12 I know some people, if someone is sensitive to or if someone has problems with eggs or nightshades, then they might need to avoid these foods on a permanent basis. And usually, I try to get people, when they re in remission, just to try to follow more of a standard Paleo diet. So that s my ultimate goal. And maybe even like kind of Mediterranean. So I m fine if they re eating some rice. Again, this is once they re healthy. Now, everybody is different. Not everybody obeys the rules as you know. So some people will add some of these foods sooner than later. So there will be some people who will add rice sooner than later. Some people even will try to add dairy. I mean everybody is different. There are some people who have had added raw dairy for example and they do fine. That s not something that I encourage. I don t tell them, Okay, let s go ahead. But some people are asking me, Well, can I add it, over and over again and the only thing I could say is Well, if you really want to, you could try. I just don t know how you ll respond. You might do fine. You might not. Of course, the problem also is sometimes if someone is sensitive and it causes gut inflammation. That inflammation might last a while. It might not just be a day or two thing where it goes away. So that s the challenge with that. But I do offer some flexibility depending on the person. Dr. Myers: Yeah. I agree. In The Autoimmune Solution that I wrote, I talk about a spectrum. And I think once we re on this spectrum of having been diagnosed with autoimmunity, I do feel like it s a little bit like cancer. You can go in remission, but it s always there, kind of potential to come back out. And so you re kind of sliding up the spectrum. And if you do, you got to hone more in on the diet. Or if it s the stress or you went travelling and picked up a gut infection, and then you can slide back down that spectrum. And you might then be able to eat a gluten free, dairy free cookie or a piece of cake for your birthday. But for me, I do feel like there are some absolute no s, which is typically gluten and dairy. Now, when I say dairy, it s like you re saying. Some people might be able to raw or might be able to do raw goat or sheep. And those are all things that people have to figure out on an individual basis. Okay, so we have diet. And then how about gut? Do you want to mention anything about gut and its relation to Graves and autoimmunity? Dr. Osansky: Sure. Well, as you know, the theory is that there s a threelegged stool of autoimmunity where you have the genetic predisposition, the environmental trigger, and then a leaky gut. Yeah, I do find that most of my patients have a leaky gut. And the reason I know is because I used to do a lot Amy Myers MD. All rights reserved. 12

13 of testing using the Cyrex Lab s Array 2, the intestinal antigenic permeability screen. And I ve also used the lactulose mannitol test. And I have found that when I did use it now, I pretty much assume that most people have a leaky gut. But I will say, in the past, I have found people who did the leaky gut testing and they had elevated autoantibodies and they came back negative for a leaky gut. So that did bring up a little bit of controversy in my mind or the test maybe not as accurate and maybe they re giving false negatives or maybe not everybody really does have a leaky gut. So again, I m not sure but I do usually assume that someone has gut issues and I will do things to support the gut. Obviously, if someone is presenting with gastrointestinal symptoms, then I might get even more aggressive. But as you know, you can t always go by symptoms. So it s not uncommon for someone to say, Oh, you know, I m not experiencing any bloating or gas or any other digestive symptoms. So they think that their gut health is fine. But, again, you can t just go by the symptoms or sometimes it might not be digestive symptoms. Leaky gut can cause other symptoms. It might cause headaches, neurological symptoms. So yeah, I think in most cases and possibly all, I m still not 100% convinced. But as far as that intestinal permeability component, I have to guess, I would say yes just because it does make sense. Dr. Myers: Yeah. For sure. Dr. Osansky: If you look at the physiology behind it, it does make a lot of sense. But just from the testing I ve done, there s been a small percentage who tested negative with both lactulose mannitol and Cyrex Lab testing, yet, had the elevated antibodies. And again, that might have been a flaw of the testing itself. Dr. Myers: Yeah, I know. I completely agree with you. I mean people come in and they hear me talking about leaky gut so everybody wants the test. And it s like, well, I m just going to assume you have it. And if you don t, there s some dysfunction because we have immune dysfunction. So I d rather you spend your money on a stool test where I can see what s going on in the gut rather than this test of whether you have leaky gut. I ve done it on myself and I think it s helpful if you want a baseline. And if you do have leaky gut, then you can see that it s healed. But most people just don t have money that they want to throw around like that. So I make the assumption. Amy Myers MD. All rights reserved. 13

14 And I agree with you, is it a problem with the test? I have very few but I have had people who have autoimmunity and they don t have a positive leaky gut test. Is it a problem with the test or is it that we know that they re celiacs that don t have the genes for celiac? I was speaking with Ritchie Shoemaker about a patient that I had who I know has SIRS in a mold, water-damaged building but she doesn t have the genes for it. So should she get out and cannot be the reason for her SIRS or it could be something else. It s like no, I mean, that could still be her reason. I think it s probably two-fold. Maybe the tests are not 100% perfect because no test is, right? Dr. Osansky: Yes. I agree. Dr. Myers: And then, two, that not 100% of people have to have a leaky gut or leaky enough that it s showing up on a test in order to have autoimmunity. I mean that makes sense too, right? That it could be a genetic component could be stress that s causing it. So we re on the same page there. Okay. So we ve talked about diet. We ve talked about gut. How about we talk about toxins? Any toxins, we ve briefly mentioned some with the halides, but toxins related specifically to thyroid or Graves disease? Dr. Osansky: Well, in the literature, specific to Graves, there s not a lot of literature linking specific toxins with Graves. Now, as far as Bisphenol A, which is BPA, so there is a lot of research on that. And there are some links with autoimmunity and being an endocrine disruptor. So I think it s safe to say that you want to avoid, the best that you can, the BPA. Dr. Myers: Probably plastics, in general. Dr. Osansky: Yeah. Well, I was about to say. A lot of people would say, well Dr. Myers: Yeah. Because even though it says BPA free, it s like there s going to be BP Dr. Osansky: BPS, the Bisphenol S, and the BPF. So you re right. So you want to try to avoid the plastics. And even the receipts, the receipts are a big deal these days, as well. And then, of course, the toxic metals, so mercury. Again, in the literature, it s more closely correlated with Hashimoto s. And even that, there s not a ton of studies but there are some studies that link it with Hashimoto s more so than with Graves. But it can t be a coincidence. When you look, there are tens of thousands of chemical in our environment that weren t present decades ago and you get that increase in autoimmunity. Plus, as you know, when they do this testing, Amy Myers MD. All rights reserved. 14

15 they test these chemicals in isolation. Especially when you re using a skin care product or cosmetics or eating process foods and you have multiple chemicals, we don t know the combined effects of these different chemicals. So again, yeah, I think there s definitely a correlation. And as a result, yeah, I definitely have people do things for detoxification. Dr. Myers: Yeah. So not only do they test them in isolation, they also leave it up to the manufacturer to test the chemicals. So most people don t really realize that most chemicals get approved by the EPA within three weeks or less. And they rely on the company to test the chemical. And then, as you said, they test the chemical in isolation. So whether it be something to fix your car, to clean your home, to clean your body, if something has five or six ingredients in it, they re only checking one ingredient at a time. And they re not looking to see how that interacts with the five other ingredients in that particular product. And then, nobody s using just one product to clean their home or their car or their body. They re using five to 10 different ones. And so then, with all those different products and how do those correlate and then the levels of all the different that you re using 10 different products, not just one in a day. So that s why toxins are really a problem but also somewhat of a mystery or they re able to get by with it. Because in isolation, one those things doesn t cause a problem. But it s really this effect, over time, of multiple different ones. Okay. So then, why don t we talk about some infections that might be specific to thyroid or certainly Graves? Dr. Osansky: Sure. Well, H. pylori, there s definitely a correlation between H. pylori and Graves disease in the literature. And I ve also seen in my practice too. That s something I do commonly test for. And I ve seen people test positive for H. pylori and then we get rid of the H. pylori. And of course, there are different ways of doing that. Some will choose antibiotics. There are natural methods. But either way, I ve had some people get into remission by getting rid of the H. pylori. Yersinia enterocolitica, at least in the literature, is associated with Graves and Hashimoto s. And it s something I haven t seen too commonly. Now, to be fair, I don t run a comprehensive stool panel on every single patient but I ve done enough where I ve figured I d see more of it over the years. And I ve seen a few cases but, again, not as much as I would think. Dr. Myers: Yeah. I m the same. And I don t know if that s, again, a testing Amy Myers MD. All rights reserved. 15

16 issue because it s very difficult to test for or if that it s in the literature. If people don t really know what s in the literature is not always what meets what is in the clinic. So it s always great to talk to another clinician because what we see every day with our patients often does not match what the scientists are seeing in the lab. Dr. Osansky: Yeah, you re right. And then viruses, there are certain viruses. You know Epstein-Barr, Cytomegalovirus probably more commonly associated with Hashimoto s. And I do see those also with some Graves disease patients. Now, whether those are triggers, we don t know for sure. Because, again, a lot of people test positive for Epstein-Barr and maybe it s not a trigger. But there s hepatitis C. there s actually in the literature some research correlating hepatitis C with Graves. But again not something I commonly see in practice. I do see a lot of people with Candida as I m sure you see. So, again, whether or not that s a cause or effect of Graves disease or Hashimoto s, I m not sure. But if I see it, I am going to try to address it. And then Lyme disease, I don t focus specifically on Lyme disease. So if someone comes to see me for the Lyme disease, especially if it s chronic Lyme disease or even acute, I ll refer them out to someone else. But I ll get some people who have Graves disease or Hashimoto s and they also have Lyme disease. Probably, I more commonly see people with Hashimoto s who have Lyme. But I ve also worked with patients with Graves disease also have Lyme disease as well. So again, that could be a potential trigger, as well. Not a whole lot in the literature showing that it s a trigger. And that s a thing with these infections, sometimes you re not sure if they are the actual trigger or because someone had problems, a compromise immune system, maybe that led to them having not Lyme, of course, because Lyme is due to a tick bite. But with Candida, getting back to Candida, that s one where I wonder is that a potential trigger because there s not a lot in the literatures. I don t know what your thoughts are with Candida and autoimmunity. Dr. Myers: Yeah. I think of it. Personally, my thought about it has been mostly that autoimmunity is secondary to Candida and that Candida is there creating the leaky gut. And then the leaky gut creates the autoimmunity. I mean certainly for some, I see it, antibodies towards Candida. I mean that their immune system is actually fighting the Candida. There really is nothing that I ve seen in the literature about the actual Candida infection like the others creating the hijacking or creating situations where it itself is causing the immune system to attack it through like Amy Myers MD. All rights reserved. 16

17 molecular mimicry or something like that. So I haven t seen anything like that. So my own thought about it just by seeing patients is that it probably was more creating the leaky gut and some inflammation that led to the opening of the floodgates, so to speak. Dr. Osansky: And that s probably similar with SIBO, small intestinal bacterial overgrowth. I d seen and I m sure you see more and more cases of that these days, as well. And that s probably a similar mechanism in that there s definitely a correlation between SIBO and increased intestinal permeability. Dr. Myers: And there s definitely some literature out there about that with Hashimoto s and hypothyroidism. So yeah, that s kind of my thought about it as well. And then the only thing I want to bring up when we re talking about toxins, one thing that we didn t discuss and I have a whole talk with Ritchie Shoemaker on this. But just as you know, the water-damaged buildings and SIRS and mycotoxins and molds being a toxin, so a lot of people don t think about that as a toxin and it s one that is commonly missed. In functional medicine, I think it s getting more widely suspected and people are beginning to test for it more or consider it. But it s not even something that I was ever taught in functional medicine. It was just through my own personal experience. So people definitely need to think about that when we re talking about the toxic category. And then stress, probably save the biggest one for last. I know that was definitely a big factor for me for my autoimmunity. I had returned from the Peace Corps and the adjustment back to the United States was far more difficult than it was to adjust to the Peace Corps being out in the middle of nowhere. For some reason, coming back was just much more difficult. They say that can be the case. And then I moved to Seattle and was taking post back premed classes. Then moved back to New Orleans, my mother passed away. And then I was doing all the finishing up my prereqs for med school and then in med school. So I had lots of stress going on. So I know that that was a big trigger for me and then in first year of med school getting diagnosed with Graves. So what s kind of your experience with patients or even personally in stress? Dr. Osansky: Well, stress, without question, was a factor when I was diagnosed with Graves. I mentioned earlier how I had adrenal testing through the saliva and that showed both suppressed cortisol levels, depressed DHEA levels. The funny thing is though I didn t think stress was a problem. I always Amy Myers MD. All rights reserved. 17

18 consider myself to be good at handling the stress even though I wasn t doing anything with stress. Dr. Myers: You seem fairly mellow. You seem like a pretty chill guy. Dr. Osansky: Yeah. I am pretty laid back. But the saliva test showed it all. But I mean looking back, the saliva test just gave me some answers and just made me look back. And I wasn t doing meditation or yoga. But I was working out. I was exercising regularly. So I thought that was enough to help manage the stress. And then I just realized that it s not. And then of course, over the years, learning more about mind-body medicine and so now, I incorporate deep breathing and HeartMath, which I know you re familiar with HeartMath. I use my inner balance every night for stress management. Yeah, well, my patients are very similar. I have everyone fill out the health questionnaires to rate their stress levels and stress handling and a good amount of people put the stress almost high, stress handling low. And of course, you can t always go by that. Even if someone puts their stress levels low well, how were your stress levels? Maybe it s low now, but how was it a few years ago? Because, again, it takes time for this condition to develop and, often times, the answer will be, it was high in the past if it s not high now. And the same thing goes with the stress handling. If they put high with stress handling, I ll use my experience. Because if I had to fill out one of those questionnaires, and I probably did because I was working with someone. I probably did fill out the questionnaires and I don t remember what I put. But I probably put like a 7 or 8 as far as stress handling because I always thought I did a good job of managing the stress. So if someone does put a high number for stress handling, I m going to ask them, What are you doing to manage your stress? in a laidback way and not really trying to put them on the spot. But a lot of people like myself, they think just exercising regularly or just having the mindset that, Okay, I m doing a good job and managing the stress is enough. But I find that most people do need to incorporate some type of mind-body medicine every day. And even if they don t, it s not going to hurt to do it. So I do recommend even if it s only 5 or 10 minutes, because that s the big issue these days, it s time. Well, I don t have time spend half an hour doing yoga or half an hour doing deep breathing. But most people could spare five minutes. So at least start with five minutes. And then of course, you want to try to increase the duration of the stress management. Amy Myers MD. All rights reserved. 18

19 But, yeah, I agree. Stress is not only and my personal situation was a big factor, but with my patients. And I do adrenal testing for my patients to show them that not only to look and see what their adrenals look like but just looking at my experience because, again, I know some people I think you don t do a whole lot of adrenal testing in your practice, correct? Dr. Myers: I don t do as much. Just, again, it s kind of back to that leaky gut scenario that I just kind of feel like if you re there with autoimmunity, the likelihood is that your adrenals are stressed or compromised in some kind of way. And so trying to find out what that is and managing it. Again, if somebody wants it, it s a great tool and I ve checked it on myself. Certainly, it s a great tool to see when that person says, Oh, well, my job isn t getting in the way. And then you see that their adrenals are bottomed out or that they re on the high end where they re still in the overload and they haven t gotten to the burnout yet. It s a good tool to say, Look, you re in the red. You are not managing this. So there are those people who really need to see that number. But I try to be as conscientious as I can and get the labs that I can t guess what s going on. I mean I can t guess what somebody s heavy metal level is. I can t guess if somebody has mycotoxins in their system. But I can assume that your adrenals at least have dysfunction and that you have some amount of leaky gut and is not going to hurt to support and repair those two things. Dr. Osansky: Yeah. I agree that most people have adrenal problems. I think what you said, the latter, and the same situation with me and I didn t I needed to see the adrenal testing. That s one reason I do that. It s just because even I would ask the person. Again, there are some people will say, Yeah, I know my adrenals are shot. But, again, not everybody has the same pattern that I had. Some people will think that they re in a state of so-called adrenal fatigue, but they ll have to elevate their cortisol levels and not suppressed. And I do treat that a little bit differently. But I also do think what you said that a lot of people can benefit or at least some people could benefit. But I find a good amount of people could benefit from actually seeing it. And it serves as motivation that, Well, wow, my adrenals are But again, different approaches. Dr. Myers: Well, that s the thing. I had a toxic mold experience. So definitely it s on my radar. You maybe never have. A lot of people never have. So prior to that, it wasn t really on my radar. Lyme and thankfully I haven t had Lyme Amy Myers MD. All rights reserved. 19

20 but I just didn t want it to be on my radar because I didn t want to have to start dealing with Lyme. Now that it s on my radar and I have a good test that can go through the insurance and test for it, I m picking up all kinds of Lyme. So it s just you had great success with that. And so that s what s going to work for you. And people are going to come to you because they re going to feel that like, Oh, that s my issue. And I really resonate with Dr. Osansky because I know that the adrenals are my issue. He tested or whatever. And somebody else is going to listen to me and think, I think I have Lyme or toxic mold in my house. That s who I want to go to. And so that s also what I think makes the world go around and why you maybe have patients that you re finding that in. And I have patients that I find what I m looking for. And because they re also reading your book and reading my book and listening to these and feeling like they re drawn to you or they re drawn to me or they re drawn to someone else. And that s why the world is great because we just attract what we re looking for. And they re getting attracted to what they need. Dr. Osansky: Yeah. You re right. And I will say, I don t do a whole lot of testing from mycotoxins. But I did learn about RealTime Labs from you. So that listened to a past podcast that s what you use or So that s something. You re right. So I consider you the mold expert. Dr. Myers: Yeah. So just kind of wrapping that thought up that people are obviously attracted to the practitioner that they sense is going to help them. And I think that we attract the patients that we can certainly help. So I think before we wrap up, definitely want to talk about some of the herbs. So that s something I definitely have incorporated in my practice after reading your book. Some of the herbs that you used and had recommended while someone s working with a practitioner or reading your book or reading my book and working through finding their root cause. What can they do to get some symptom relief without having to do what I did, which is take really harsh medication? So you want to walk us through some of the herbs that you typically use in our practice. Dr. Osansky: Sure. Well, probably the most common herb I use for Graves disease is bugleweed, which is an antithyroid herb. And so bugleweed obviously not as potent as methimazole or PTU but it helps to lower the thyroid hormone levels. Whereas, motherwort is an herb that think of it as a natural beta blocker. Again, not as powerful as a beta blocker such as propanolol or atenolol. But, again, that focuses more on the cardiac symptoms. Amy Myers MD. All rights reserved. 20