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#105 How to treat PCOS, Synthroid for Hypothyroidism, and does taking birth control pills regulate your period? With Dr. Brooke Kalancick

Welcome back to another episode of the Waist Away podcast! Today’s guest is Dr. Brooke Kalanick. She is a licensed Naturopathic Doctor and functional medicine practitioner, and author of a book titled Hangry that she wrote with Sarah Fragoso. She also co-hosts a podcast with Sarah called The Sarah and Dr. Brooke Show. Dr. Brooke’s areas of expertise include female health, hypothyroidism, and autoimmunity with specialties in PCOS, Hashimoto’s, menopause and weight loss. Let’s welcome her to the show. Enjoy!

video version: https://youtu.be/stBavTPcu2o

Dr. Brooke’s website: https://betterbydrbrooke.com/

Dr. Brooke’s podcast: https://betterbydrbrooke.com/podcasts/

 

Chantel Ray:                 Hey, guys. Welcome to this week’s podcast. Today’s guest is Dr. Brooke Kalanick, and she is a licensed naturopathic doctor. She’s a functional medicine practitioner. You have a book, Hangry with Sarah Fragoso. Also, you guys both have a podcast together, Better Every Day with Sarah and Dr. Brooke. We’re so glad to have you on the show. Welcome.

Dr. Brooke:                   Thank you. We actually fairly recently changed the name of our show.

Chantel Ray:                 Oh, you did?

Dr. Brooke:                   Yes, the Sarah and Dr. Brooke Show.

Chantel Ray:                 Oh, okay. Perfect. Love it.

Dr. Brooke:                   I think it still comes up when you search that other one, but yes, thanks for having me.

Chantel Ray:                 Talk about some of your areas of expertise. I know you do hypothyroidism, autoimmunity, PCOS. What else do you guys specialize in?

Dr. Brooke:                   Yeah. In my clinical practice, I mostly work with women that have some sort of hormonal issue or some sort of autoimmune issue. I’m often not the first person. Many women have been through the conventional route, and just aren’t really getting the answers, or the full scope of help that they need, so they make their way to me, and then we really do that kind of high level functional medicine approach, where we look at how everything’s connected. Women are not sure how they’re bloating, or how they feel after they eat, how that could possibly be connected to anything going on with their female hormones.

There tends to be a variety of female hormone issues, whether that’s menopause, endometriosis, things like that, or PCOS, autoimmune, thyroid, menopause, all of those things are… just a lot of times, women are just tired, they’re just tired, and worn out, and not doing well, and their tests per their doctor are like, “I don’t know. Everything’s fine.” They’re really left with not a lot of answers for why they’re not thriving. Sometimes women don’t necessarily have, let’s say, PCOS, or a diagnosis like that, but they’re just not doing as well as they would like to be doing.

Chantel Ray:                 Tell us a little bit about your journey personally, and how you embraced your own health, and your own weight loss, and struggling with losing weight.

Dr. Brooke:                   When I was a teen, I was immediately put on the pill for some difficult periods. I was told I had PCOS, but no one really explained what that was, or what that meant, or really informed me about anything that the pill was going to be doing. I was just told, “This will sort of regulate your cycle,” which it doesn’t, it gives you an artificial cycle, and it doesn’t really empower any of our young women that are on the pill so early to understand anything that’s really going on for them, or what other options there might be. I never felt great on the pill, but that was really my only option.

I sort of came on and off the pill into my 20s, not really knowing what else to do, and at the time, I was in pharmacy school, and in that world, that was our answer. I was really not feeling well, and I think that PCOS is one of the things that sort of predisposes me to having difficult fat loss, but I feel like that’s been kind of another piece of my journey that’s a little bit different. As I was kind of looking for more answers in my own health, why I couldn’t really tolerate the pill, but I didn’t really know what else to do for this erratic cycle where I just felt crazy, and my skin’s breaking out.

I stumbled upon working with my mom’s naturopathic doctor actually, and she was so helpful. The things she had me do were relatively easy. I know now. I was young, and pretty healthy, so the things we did were not like rocket science, and they weren’t crazy, but it really changed my life. I migrated to doing this. I felt like there was a lot more good I could do to help women be a little bit more empowered, and have more options. Should they choose the pill, great, but at least not be presented with, “That’s the only thing that we’ve got for you.”

Weight loss has been kind of an interesting thing. I feel like something that I’ve had to do for my own self was really embrace the fact that I do have PCOS. Fat loss is difficult, fat gain is easy, putting on muscle mass is really easy for me, and so I’ve had to really kind of shift to working more with the physiology, and the body that I have instead of always trying to make myself fit into some smaller idea. That has really helped me not do stuff that wrecks my hormones. I think that when you’re dealt a certain set of hormone stuff, and we are constantly doing things for the sake of weight loss that just really put the heat on our hormones. It just never ends well.

It’s not good for our hormones, it’s usually not very effective for very long, and so that became a big part of what I do with women, just because I know I’m not alone in that. We do a lot of crazy stuff in order to lose weight, simply for the sake of losing weight, and not necessarily the impact it has on our health, or our hormones, or our happiness.

Chantel Ray:                 Awesome. Well, in your book Hangry, you talk about five simple steps to balance your hormones, and restore your joy. Talk to us a little bit about those five steps.

Dr. Brooke:                   Yeah. We based everything on the idea that most women, especially after age 30, have more than one hormone issue. You read something on the internet, like for me, that I have PCOS. So, I’m supposed to go really low-carb, maybe keto, maybe lots of fasting, and exercise a lot. What if I also have adrenal issues, or low blood sugar, or a thyroid problem, or autoimmunity? Those are saying, “Well, you can walk, but you can’t really do anything else. You need to eat several times a day.” Many women have both of those issues, so they’re sort of left with the, “Well, this hormone advice is completely contradicting each other, so what do I do as a woman with a thyroid, and ovaries, and insulin, and cortisol, and all of these other hormones that we need to honor?”

We teach it in a way that… what I call the hormone hierarchy, so addressing those more delicate hormone issues first. So, the low cortisol, the low thyroid, then high cortisol, then insulin resistance, which is where part of the PCOS kind of stuff comes in, and that can come in… insulin resistance can be part of other issues, as well. Then, kind of last on the list, even though this is a book for women with female hormones, is estrogen and progesterone. Honoring those sort of in that order allows us to kind of filter all of the advice out there, the fasting, the keto, the intermittent, the interval training, the strength training, the yoga. Where do we put all of that?

So, honoring yourself in that order helps you sort of heal these more delicate issues, and just kind of move on down the list when you still have issues lower down, but we also know… So, that’s the advice to a woman who is like, “How do I know what works for me?” That’s kind of become the buzz thing in fitness and health right now is like, “We’ll do what works for you.” Most women are like, “Great. I’d be happy to do that. I have no idea what will work for me. There’s all this information, and I don’t know what to do.”

We know that while women need to ultimately figure out that it’s not a cookie cutter, it’s not like an off-the-shelf plan that’s going to work. We’ve all had that, right? What you do might not work for me, what my girlfriend does might fail miserably for me, or it might work really great, and we just sort of don’t understand why this plan that promises such great results isn’t working for us. Ultimately, we need to find, and work with our own hormones, and find what works for us, but we also need a template. You need a starting place.

The five steps in our book, we have five mindset tools, which I could talk about later, but the five steps we’re talking about are what we call our five habits, so it’s five walks per week. We usually start women on four meals a day, roughly the same size, then you migrate from there, you might need more, you might need less. Three strength training sessions a week, at least two liters of water a day, and then one commitment every day to what we call real self-care, and that’s the mindset stuff that we work with.

It’s kind of a simple system. Of course, it’s going to be tweaked slightly as you kind of work your way through our book, and get different hormones in balance. I hope that you wouldn’t have adrenal issues forever, you won’t be dealing with low thyroid forever, kind of work through some of those, and then that’s another really important thing for women to remember is what’s working right now may not work very well in a year, in five years. We go through so many hormone changes as women, we go through perimenopause, we have babies, we go through a big stressful event, we get a new diagnosis. What may be working great for us today, just might fall apart, and not work at all.

As you learn through the program and the book what your hormones are actually telling you, then you’ll be able to know, “Okay. I need to make some adjustments to those five steps for where I’m at now.” I think we… I mean, how many of us have said, “Well, when I was 25, I just started jogging, and I ate lettuce and chicken all day, and I lost tons of weight, so I’ll just do that.” Completely ignoring the fact that we have an entirely different hormone landscape now in our 30s and 40s.

Chantel Ray:                 You referred in your book to your thyroid as the gas pedal of your metabolism, and so talk to us on what tips you give people who do deal with hyperthyroidism.

Dr. Brooke:                   Yeah. Every cell in your body has got a hormone for thyroid receptor, so this is why the thyroid symptoms are so far reaching. Your hair falls out, your digestion slows, your skin’s dry, your reflexes are slow, you have brain fog, your metabolism slows down as far as weight gain. It’s got its hand in a lot of things. The repercussions are pretty significant, so that’s why that hormone’s at the top of the hierarchy. We want to make sure that, first thing’s first, you’re getting a thorough thyroid panel. So many women are getting just a TSH, some are getting the TSH, and maybe a T4, and we’re not looking at that whole cascade.

Real quick, high level thyroid physiology, your brain is going to tell your thyroid what to do, your thyroid is going to make a hormone that then has to be converted into its active form, that’s going to get shuttled around on a protein, it has to come off the protein, [inaudible 00:09:45]. So, that’s a lot of steps. There’s about 10 things that can go wrong in that cascade, and so when we look at the testing, we want to make sure that we are looking at that whole piece of it, because your TSH might be okay, you might be making plenty of T4, but you don’t convert it well. If we don’t get those other tests, we don’t necessarily see that.

Inflammation, and cortisol can really impact your thyroid, and again, without a full panel you might not be able to see all those issues. The other thing is the thyroid antibodies. Hashimoto’s is incredibly common, it’s the most common reason for a woman to have low thyroid, and a lot of women don’t get those antibodies checked. Their doctor is not running those, and to be fair, it does not change what your doctor is going to do. For the most part, they have the medication to treat the T4, that’s what they’ve got. So, in their model, it doesn’t make a lot of sense.

There’s no extra treatment if you have Hashimoto’s, however, in the functional medicine world, or with your own nutrition, and stress management, and things like that, then we really want to make sure that we do know that, because autoimmune diseases tend to… if a woman gets one, she tends to get on average three. So, we do want to know if you’re someone predisposed to that. We want to keep an eye out for that, quiet your immune system down, but we also want to protect that thyroid, and keep it as healthy as possible for as long as we can.

Getting a full panel is going to be your first thing. Now, beyond that, it’s going to depend a little bit on what’s going on. For example, if you don’t convert well, you’re going to need to make sure you’re getting selenium, and zinc, but the two things that are going to impact your thyroid probably, and I’ll say three things, probably the most as far as your other hormones, are going to be cortisol. It impacts [inaudible 00:11:24] to active hormone, it impacts what we call reverse T3, where you lose it down this other pathway. It spurs the autoimmune problem, it disrupts your gut. Your gut is really important for thyroid health.

Anything you can do to manage stress, anything you can do to better manage your overwhelm, the working too much, the not getting enough rest, and recovery. Maybe under eating, maybe over exercising, worry, all of that stuff. Cortisol and inflammation are like hormone mess makers. They’re going to mess up everything from start to finish, so anything you can do to improve your stress response, to get more rest, to take care of yourself, to practice real self-care, and then anything you can do to lower inflammation… I would say if you have Hashimoto’s, there’s good research to back up the idea that a paleo lifestyle, especially gluten and dairy free can be really helpful for many women, not necessarily all, but there’s a lot of correlation with that.

Estrogen can have an impact on your thyroid too, it’s a little bit further down. If you’re a woman who is having what we call estrogen dominance, where your breasts are getting tender, you’re having really bad PMS, maybe a shorter cycle, heavy cycle, headaches with ovulation, or with your period, that could be impacting… or if you’re taking any kind of birth control pill, or HRT, any kind of estrogen medications, that can impact the level of free hormones that you have around, so that might be something you want to look into too.

Then, with all your hormones, I’ll say one more thing about inflammation. Again, I call that the hormone mess maker, because many times women will say, “I’ve got all the symptoms of low thyroid, I’ve got all the symptoms of low estrogen, but I went to my doctor, and they checked it, and my levels are fine, so maybe you’re making the hormone, but inflammation is one of the things that can take a totally normal level or hormone, and it really messes up the efficacy in how that hormone works in your body, like inside of a cell.

Sometimes, if your tests are normal, let’s say your thyroid’s normal, but you’re like, “I have every symptom of this in the book, all of it,” that might be something to really think about. Inflammation comes from a lot of things that stress us out. It kind of goes back to cortisol. If you’re not getting enough rest, or eating foods that don’t work for us, we’re overly stressed, or maybe we’re exercising in a way that we don’t tolerate very well, all of those things are going to lead to inflammation.

Chantel Ray:                 I want everyone, if you’d like to see what a full panel of… I’d like for you to email me your suggestion on the thyroid panel. I’ve got a suggestion, as well, chantelrayway.com/bloodwork. They can go there, and see, because absolutely, these doctors are checking their TSH only, and that’s it, and then they’re going, “Yeah. Your thyroid’s fine,” when it in fact, is not. One of the things we always like to ask people is what does the day in the life of Brooke look like? What did you eat yesterday? Are there any foods that are off-limits? Talk to us about any supplements you take, and even for yourself personally, are you on thyroid medicine? Are there any supplements you take? Talk about yourself for just a second.

Dr. Brooke:                   Yeah. This question always throws me, because I’m a mom of two little girls, and I’ve got a husband who has an interesting job, he’s a comedian. We have a very-

Chantel Ray:                 Really? Tell me about that. What kind of comedian is he?

Dr. Brooke:                   He’s a standup comedian. We live in New York City, that’s why we live here. His schedule is not normal, and it’s different every day. It’s not like he works every night from, let’s say, seven to 10. Some nights, he has a show, and sometimes he doesn’t, and sometimes he’s gone Thursday through Saturday, and sometimes he’s just working close by over the weekend, sometimes he’s gone for a week on a cruise ship. His schedule can be really crazy. Our life is a little bit… I feel like our days are never quite the same, and then again, having little ones that we’re shuttling around, or now… we’re still on summer break, and it’s August, but New York goes back to school very late.

For us, our lifestyle, as far as our days go, are not super predictable, but for me, right now, and this is very different than what I was doing six months ago, because six months ago, I was in the middle of wrapping up the book, finishing edits, marketing the book, and I was not doing very well. I wasn’t sleeping well, super stressed out, not in a great place for my hormones. So, what I was doing then, I was probably eating a little more frequently, I was walking a lot, and strength training, not doing any metabolic work, or extra cardio. That was sort of what that looked like.

Now, I’m doing a little more fasting. I’m not usually eating in the morning until like noon, and having two meals a day. I’ve been gluten free now for about 10 years. That’s one that I never… That one just is out. The way I like to think of food, I think coming from somebody, and many women can probably relate to this, so many years of dieting, you just think of food as good or bad. You’re good or bad if you can eat those foods or not, and so I really like to think of it as there’s food that works for me, that’s protein, vegetables, water, whole foods. Those are things that really work.

There’s things that don’t work well, that’s like alcohol, sugar. I just really can’t do a lot of carbs, can’t do a lot of sugar, it really affects me personally. Then, there’s foods that don’t work at all. I would put dairy for me in the doesn’t work well. The foods that don’t work at all for me are… that would be gluten for me. That one I just don’t go near. That’s kind of the main things, I guess, that I’m doing.

I get up every day, and work a little bit, because I usually have my kids in the morning. I go for a walk in the morning for an hour. Sometimes I run, but most of the time I’m just walking, and I’m still strength training, but I am able to do a little bit more. Like I said, I can do some sprints, I can do some running, I can do some other activity, because right now I’m sleeping well, I’m not so stressed out, I’m not spread so thin, and I think that’s not something I used to know. I used to just think I had to do all the things all the time, terrified if I have a carb, or miss a workout, I’m going to gain weight.

Learning again to kind of work with where I’m at, and know that most of us, wherever we’re at is temporary to some degree. There are a few things, like having a lower carb diet, and being gluten free, those are kind of longterm strategies for me as a woman with PCOS. I don’t have any autoimmune diseases now, but there’s tons of it in my family, so being kind of proactive about some of the things I know that could be helpful to me, taking care of those things.

Supplement-wise, I take a few things for my PCOS, but not a lot. Things are pretty well under control right now. In the mornings, I take some vitamin C, and a B complex, then my adrenal support, because even at my best, my life’s… I’m self-employed, running my practice, doing the book, doing the podcast, taking care of my kids, solo parenting about half the time just due to my husband’s crazy schedule. For me, sleep is my biggest challenge. I love working out, so that’s not usually a thing I struggle with getting done. I like eating healthy, that’s not super hard for me.

Making sure I get sleep, and making sure that my lifestyle is not negatively impacting my sleep, that’s probably, that and stress management are my biggest challenges that I have to really make sure that I employ the meditation, and the mantras, and the walking, and all the stuff that I do to try to keep my mindset in check.

Chantel Ray:                 Got you. Well, let’s jump right into the listener questions. This one’s from Melissa in Dayton, “When I was younger, in my 20s, my doctor diagnosed me with PCOS. I’m 31 now, and recently had an ultrasound to get things looked at. I was pleasantly surprised after the ultrasound that my PCOS had ‘cleared up’. She said this often happens with age. I’ve never heard of this before. Is it really true, and how can you tell?”

Dr. Brooke:                   Okay. Well, I don’t want to rain on the parade here, because that sounds exciting that it would go away. There’s a couple things to think about. First of all, PCOS cannot be diagnosed, or really assessed with an ultrasound, so that’s just older information. Part of the problem, when you got diagnosed initially, we’re starting to think that we should not diagnose PCOS via ultrasound at all, because there’s other things like hypothyroidism. There’s other things that can look like PCOS on an ultrasound. That’s one problem.

The other one is there’s a lot of fluctuation that goes on in puberty, and with getting our cycles synced up, and it takes about eight to 10 years to do that. So, experts are now saying that we really shouldn’t diagnose PCOS within eight years of when your period started, so depending on when that started, something may have shifted that looked like PCOS, but really it wasn’t. We really want to make sure you’re being evaluated in other ways. How is your hemoglobin A1C, how’s your LH hormone, what’s your period doing, is it regular?

Now, PCOS can… I wouldn’t say women grow out of it the way that your doctor sort of implied, but I would say perhaps you were misdiagnosed. If your cycle was irregular, and they were looking at an ultrasound to see if perhaps this is PCOS, many young women… puberty comes with just syncing up your cycle. PCOS is going to present then, so you may have PCOS looking stuff, you could have elevated androgens breaking out, you may have had elevated androgens, like testosterone on a blood test, you might have had cysts on your ovaries. Some of that could have just been puberty.

Cysts on your ovaries, as far as the ultrasound could also appear in hypothalamic amenorrhea, where you’re not having a period, but it’s not because of PCOS, it’s because you’re maybe under-eating, or overexercising, and a lot of young women are going through that. Many are athletic, or they’re gymnastics, or they’re doing something where their caloric expenditure is high, they start going through puberty, and maybe because of pressure to keep their body smaller for their sport, or just society, or maybe they just don’t know, and they could be under-eating. That’s really common in that timeframe.

It could’ve been a misdiagnosis. It could be now that you just didn’t have cysts on your ovary at that time when she looked at it. I would be looking still at… is your cycle normal? Are you doing great? Now, if you’ve got PCOS, or don’t have PCOS, like right now, I don’t a lot beyond my lifestyle for PCOS, because I know how to… my particular flavor of PCOS, I know how to manage that mostly with what I eat, and how I exercise. Other women, they struggle more with it, and so they need more nutrient intervention, they need to take things to help deal with the excess testosterone, other women really need to look at their adrenals, other women need to really support their progesterone. There’s a lot of things to look at.

So, I would say mine, I would call it in remission. Certainly, if I ate differently or lived my life differently, all that stuff would come back. My cycle would get really long, I’d be breaking out, all the things. You may be in remission, you may not have had PCOS in the first place, so I would say if you’re doing great, you’re getting a normal period, your skin’s clear, your hair’s not falling out, you’re feeling great, I wouldn’t worry too much about whether you have it, or not, just keep an eye out for things to change, but you might want to reconsider even if the PCOS diagnosis was even accurate in the first place.

Chantel Ray:                 All right. This next one is from Anonymous. “For hypothyroid, what do you consider to be a higher than normal level of TSH? I can’t seem to find a straight answer online. They’re all different and all over the place. Mine is currently 2.5, which the doctor said isn’t crazy high. What are your thoughts?”

Dr. Brooke:                   I can give you guys a link, I can send it to you. I have a lab guide that’s like a really full lab guide for women to get their testing done, and take a look at some of the values. The full thyroid panel is in there. There is some disagreement. On the conventional model, it can be a 4.5 or a 5.5 before it’s considered high. I’ve definitely seen TSHs on patients, and they’re… it’s like seven, or 7.5, and they’re doctor’s like, “Well, you don’t really feel bad, so we’ll just watch it.” It depends on who you’re seeing. If your doctor is saying it’s a little bit high at 2.5, I’m assuming you’re working perhaps with somebody’s who’s looking at it a little more functionally or naturopathically minded.

So, typically 2.5, up, we would start looking at… that’s a possible… Again, I would agree, not crazy high. There might be something going on there. It would be really important to look at those other hormones, because regardless of what your TSH is, if your T4 or T3 is low, we should intervene somehow. Not necessarily with a medication, but again, you’ve got to look at that whole cascade. TSH fluctuates, it fluctuates throughout your cycle, it’s not a super stable hormone. It’s funny that is the one that’s considered the best way to monitor your thyroid. It will move around, so I would also keep an eye on it.

Testing it the second half of your cycle is not as accurate, you can have some impact of estrogen, and progesterone on that, as well. I would agree that it’s a little high, but I’d be more curious of everything else that’s been going on, and we also don’t want to treat the lab value, we want to treat you. If you’re coming to my office, and you’re like, “My hair’s falling out, can’t get out of bed, I’m losing my eyebrows, gaining weight, brain fog, can’t form a sentence, can’t find a word,” if you’ve got all that stuff, we’re going to want to make sure that we’re… there are other things that can cause fatigue, and things like that, so you just want to make sure that you look at the whole picture, and for sure look at a full thyroid panel.

Chantel Ray:                 All right. This next one is Jordan in Washington. “Something I’ve always struggled with is acne. I’ve tried about every face wash, lotion, everything, and it just doesn’t work. I’ve heard breakouts are caused by birth control, stress, and an unhealthy diet. What are your go-to things to help with breakouts, and what tips do you have to clear up acne?”

Dr. Brooke:                   Acne has very little to do with what we’re putting on our face. Now, there might be things that are clogging your pores that are making it worse, but it’s a symptom that something is going on. There’s hormonal causes, so we can have… like in the PCOS picture, excess androgens. It doesn’t have to be testosterone, so perhaps you’ve had your testosterone checked, but it could be DHEA, or Anderson and Dione, or one of the other androgens. If you’re looking at hormonal causes, the PCOS realm has a lot of… acne is one of the things, because the blood sugar disrupts the testosterone, and we end up with some of these elevated androgen fallout.

The other thing though, especially with PCOS, some of us are more sensitive to… our follicles are more sensitive to androgens, so you might have a normal test, but you still have androgen related breakouts, because it doesn’t take as much, per se, me to break out, as it would for someone else. That’s kind of in the PCOS world. You’d want to look at are any of those androgens elevated, make sure you get them tested. Again, I can give you the link to that lab guide on how to go through got to go through all those different tests and the ranges.

Now, the other thing that causes breakouts is inflammation which can come from an unhealthy gut, it can come from things like excess histamine, anything that’s driving inflammation. It could also be you’re not clearing stuff out… Your liver is one of those things that’s just constantly working to deal with all the gunk in our environment, and certain pathways can just get a little bogged down, so we might need to support that whole pathway, but I would say, thinking about androgens, inflammation, and a healthy gut. It very easily could be tied to something you’re eating at least as part of the problem.

Gluten and dairy are kind of like the go-tos as far as decreasing food sensitivities, but one of the other ones that comes up a lot with acne is eggs, which is something that most of us eat. Remember with a food sensitivity, you don’t have to have digestive symptoms. I think sometimes we think, “Well, I eat that, and I don’t get a stomach ache, so it’s not that.” You could have brain fog, you could have acne, you can have eczema, a racing heart, you can have all kinds of things.

For me personally, I not only have PCOS, but I also have histamine intolerance, so if you recently started eating a lot of avocados, and fermented foods, and things like that, and it got worse, that might point to some histamine issues. I could probably talk for an hour about-

Chantel Ray:                 Let’s talk about that, because we’ve just recently got a bunch of questions about histamine. Talk about that. I got a wasp bite about literally almost six weeks ago, two wasp bites on my leg, and I’m not joking, if you look at my leg right now, I still have like a breakout where those two wasp bites are. I was thinking, “Oh, my goodness. This is ridiculous, my immune system is definitely not working. Six weeks later from a wasp bite, and I’m still in a pickle here,” but talk about histamines for just a second.

Dr. Brooke:                   Yeah. I think when we hear histamine, we think of itchy, runny eyes with allergies, we might think of a bee sting, or a bug bite, but histamine is an important brain chemical, it’s one of our alert chemicals that keeps us awake. It’s also important in uterine contraction, and sexual arousal. It’s really important in gut motility. It’s one of the things that stimulates the cells in your stomach to secrete acid, so it’s got its hand in a lot of things, and it’s really intricately related to female hormones. Estrogen tends to make histamine stuff go up, whereas progesterone tends to make it go down, so it’s got its hand in a lot of things, and if you’re somebody who gets migraines, or your allergies are worse, or your digestion is worse, or your energy is worse with ovulation when estrogen rises, that might be an indication that you’re dealing with some histamine issues.

There’s a really good article on my blog. We talk about histamine in Hangry. It’s hard, because the symptoms are so… you might have seasonal allergies, or you might have bloating, or you might have really painful periods, or you might have acne. Those could all be related to histamine, they could all be related to other things. When you look at the list, there’s a lot of symptoms, and you don’t have to have all of them, but if you have any of them, histamine could be a part of it. Having an exaggerated reaction to a bug bite could be a histamine issue.

Now, why do you have this? We’ve got a couple things. Some of us are sort of genetically predisposed to this, like me personally, when I look at my [inaudible 00:29:48], every way that you process histamine in your body, we’ve got about four ways, I have one or two variations in all of them, so I’m sort of already predisposed for this. There’s nutrients that help all of those enzymes run like B6, copper, magnesium. There’s a number of things that can help, so supporting myself with those are things that… I should have probably talked about that. Those are foods I have to watch in my day-to-day. When I’m talking about what I do, I have to be careful not to have too many histamine foods at one time.

Chantel Ray:                 Let’s talk about, for people who don’t know, I’ll name some of the histamine foods that I can think of off the top of my head that kind of trigger your histamine. I would say probably alcohol, tomatoes, bananas, chocolate, dairy, cheese. Would you agree with that?

Dr. Brooke:                   Yeah. So, there’s different… some of them just have histamine in them, like fermented foods, or leftovers just have more histamine in them. If you don’t process that well, you’re going to not do as well with those foods. Other foods cause a histamine release, like bananas, and avocados, dairy, grains-

Chantel Ray:                 Spinach.

Dr. Brooke:                   Spinach, yeah. Spinach, and tomatoes. Those are “healthy” foods, right? We’re telling you to eat fermented foods, and vegetables, and avocados, and things like that, and it’s just if you’re not able to process it. That’s when a healthy food may not be perfect for you right now. Some of the things like… Again, I’m sort of genetically predisposed to that, but if I have wine too often, I’m going to deplete by B6, and that’s going to block my DAO enzyme, and it’s going to get worse. If you have chronic infections, so Epstein–Barr, Candida, SIBO, any sort of gut disruption, those infections can kick off a lot of histamines, so you might just have a higher histamine burden.

There’s other conditions that… when you… the cells that store, and then release histamine are called mast cells, and if you have too many of those, or they’re just unstable, that’s a little bit more not necessarily something we can clear. If you’ve got SIBO, like a gut infection, we should be able to treat that, and you should be able to eat histamine foods again without an issue. With some of those other things, those mast cell activation syndrome, that might be a little bit more of a longer term issue.

One thing that’s a little bit different about histamine to remember, because people will say, “Well, Dr. Brooke, I went on your website, and I got your histamine food list, and I stopped eating all those, and I felt a little bit better. Then, I ate avocado one day, and it made my mouth itch, and then I ate it another day, and I was fine, so you’re wrong. I don’t understand what’s going on here.” The thing with histamine is you want to think of it like a bucket. You can put in the histamine, and as long as you can process it, and clear it out, you’re fine, but because you’re overly stressed out right now, because the infection has ramped up for some reason, or whatever’s going on, or you’ve also got seasonal allergies, so you’re dealing with more histamine, or maybe you just went on a paleo diet, and started doing bone broth, and collagen, and fermented foods, and now your histamine bucket is high.

You do want to think of it more like a bucket versus a food sensitivity when you’re like, “When I eat that food, I get a stomach ache. When I eat that food, I get a headache.” This is more like on this particular day, how full is your bucket? It’s kind of a complex issue. It’s becoming… The other thing is environmental toxins. We may not be processing just the normal stuff, the produce that’s not organic, the pollution in our air, the stuff in our water, the medications we take, the glass of wine. All of those things just put a burden on our system, and it’s not necessarily that there’s anything “wrong” with your liver, it’s just that pathway is over burdened, and that can create a lot of histamine issues, as well. It’s becoming just increasingly more common, it is something you can usually get to the bottom of, and resolve, or at least learn how… like for me, I just have to be kind of a little bit mindful of it.

Chantel Ray:                 All right. I have two questions on detoxes from Becky in New York. “Many people have been telling me I should go on a two-day juice cleanse, or a fasting detox. I really want you to tell me the benefits of what are your best detox options. If I do this for two days or so, am I going right back to eating how i normally do, or how often should I do these cleanses or detoxes?” The second question is, “I’m considering doing a salt water flush, but you have to add two teaspoons of salt. Does it make you bloated from the salt? Have you ever done one, and can you explain how to do it?”

Dr. Brooke:                   Okay. Detoxes and cleanses have this kind of buzz around them. Let’s just talk… I kind of mentioned it just recently, like what is detox? Detox, there’s three phases in your body, and without getting too into that, you basically have to take the gunk in our environment, and put it through these different phases. What essentially not eating for a couple of days… takes out any garbage that’s coming in, in your nutrition, right? That can give your digestion a rest. Again, think of detox like a bucket. As long as… if you think of a hole, or a spigot at the bottom of the bucket, as long as what’s coming in is going through fine, so all those phases are working, and there’s not too much coming in, it should be going in, and coming out.

Now, there’s a lot of reasons why we might have compromised detox in our modern world. Stress, inflammation, again, I just feel like so often we’re just doing things to kind of cope with the stress, like maybe we’re eating things that don’t work for us, or we’re drinking wine every night, or whatever it is, so it’s kind of a coping mechanism, or just again, our overly burdened environment, medications that we’re taking can slow down, can deplete nutrients that are important for those detox processes to run.

Detoxification is something that’s always happening. You need a healthy liver processing it all, you need a healthy gut. There’s a lot of things that have to happen, so there’s the idea of just lowering the bucket. If you just took out packaged foods, and some of the common food allergens, and you ate more vegetables, most of the nutrients that we need to… well, the nutrients we need to run those detox pathways to support the enzymes that do the work to convert toxic chemical A into other chemicals that are safer, and help you excrete them, they’re found in vegetables, they’re also found… you need a lot of sulfur containing amino acids, so you need a lot of eggs, and meat. That’s where a lot of those enzymes come from, and then plants.

So, could you just think about maybe incorporating more… decreasing the stuff that’s coming in, and increasing the good stuff. So, eat more vegetables, eat a little bit higher quality animal protein. If we’re doing stuff every day, like our diet’s not good, our stress is not good, we’re rubbing common beauty products all over us that are loaded with endocrine disruptors, and things that we’re finding out are really, really bad for us. Doing a cleanse for two days is going to give you a couple days of reprieve, but it’s not on the whole going to do anything to change your health.

I would be much more hopeful that we could have a conversation about what are the things you can do to kind of move yourself towards just having better detoxification on the whole. To me, going on two days of a detox, or 30 days of a plan, and going right back to what you’re doing, that doesn’t really solve anything. So, it’s really always about what’s the next day, what’s day three for you, what’s day 31 for you, and making some real changes. So, I would say getting our book is a really good place to start. I wouldn’t advise the salt cleanse at all.

I’m really… Detoxification, as a naturopathic doctor, liver health is something we’re like cheerleaders for. We all need to have really good gut health, and really good detoxification, but the way to do that, in my opinion, is just to… is not necessarily to just take everything out for a day or two, and a juice cleanse can be just a nightmare for your blood sugar, because you go from eating some protein and some fiber to just having sugar for a couple of days. So, yeah, not a fan of that.

Sometimes, people do need supplements to nurture their detox. They need to take B vitamins, or things that support… glutathione, or something, and that’s something I’d probably recommend you work with somebody to kind of figure out what you really need.

Chantel Ray:                 Talk about the salt water flush. Why aren’t you a fan of that?

Dr. Brooke:                   Again, to me, the only thing that taking out everything does is that gives your gut a break, and there’s something merit to that. If you’re somebody with a super inflamed gut, doing a water fast, I would say was probably fine. The salt water flush to me is just a little bit gimmicky. You’re not really necessarily doing anything. If you’re somebody that needs more sodium, and things like that, I would recommend a good electrolyte blend so that you get the other minerals. It’s just not something that has a lot of good science behind it.

Chantel Ray:                 All right. Grace in New Hampshire. “I recently found out that I’m hypothyroid, and have been exploring my options. I talked to some people who take Synthroid, and they say it’s the best thing that has happened to them. Others say taking Synthroid was the worst thing they ever did for their thyroid. A few have recommended Armour Thyroid as a more natural alternative. Some tell me that I shouldn’t take anything at all. I’m so confused. Help.”

Dr. Brooke:                   Yeah. I would say this is-

Chantel Ray:                 I love this question, because it’s-

Dr. Brooke:                   Yeah. You really want to be working with somebody who knows what they’re doing with your thyroid, so again, making sure that you’re… when you look at why are you hypothyroid, why are you not converting, are you not getting the nutrients? Do you have inflammation? Do you have autoimmunity, do you have estrogen dominance, is there inflammation impacting your pituitary gland to even secrete the TSH to stimulate your thyroid? You really need to know where the breakdown is, and that will help dictate, are you ready for medication? Which medication is best for you?

Now, if you’re somebody who is just starting out, the Armour Thyroid, or the natural desiccated thyroid is often times a first starting point, because it is more like what your body makes. That would be probably the place to start, unless you’re somebody… When you take Armour Thyroid, you are getting T4 and T3, and if you’re somebody who converts really well, those people do exist, we talk about under-conversion all the time, but some people are overly stimulated by the T3, so that’s not a great option for them, and something like T4 might be better.

Now, Synthroid is synthetic, it is by far the most commonly prescribed, and it is the go-to in the conventional model. I do have women that do great on Synthroid, but many, many do not. It’s really hard to say what I would give you, because I haven’t looked at your labs, but the most important thing is do you really need it? Where’s the breakdown? That’s where you want to intervene. It’s not just about a Synthroid deficiency, it’s about where on that cascade are you having trouble, and what else do you need to do? I’m not against thyroid medicine, again, every cell in your body needs thyroid hormones. If you can’t make it, taking it is a good thing, but you do want to make sure that you’ve evaluated the whole cascade to A, decide if you need it, if you need it right now, you might need it later, what else you can do, and what’s the cause?

You can have multiple causes. You can have Hashimoto’s antibodies attacking your thyroid causing there to be not enough healthy thyroid to make hormone… you can also not convert, and you can also have an unhealthy gut, and you can also have other things going on. We spent a lot of time talking about thyroid in the book, because it’s just so complicated. I would say your most important thing is to probably be working with someone who is looking at this really holistically.

Chantel Ray:                 All right. I know I did take Synthroid at one time, and it was awful for me. I did not do well on it, but I do know some people who do, do well on it, but for the majority of people, I would say I haven’t seen… I’ve seen more people do better with the natural desiccated-

Dr. Brooke:                   If you take Synthroid, you still have to convert it, so you’re still going to get the-

Chantel Ray:                 If you can’t convert it-

Dr. Brooke:                   You’re still going to get the [inaudible 00:41:48], so sometimes it’s the Synthroid, and sometimes it’s like that just didn’t solve their whole problem, right?

Chantel Ray:                 That was my problem. I couldn’t convert my T4 to my T3, so just giving me more T4 with Synthroid is not going to solve my problem.

Dr. Brooke:                   Right. There’s also fillers, and additives, and you might be sensitive to brand name Synthroid, or you might be sensitive to this version of the generic. There’s really a lot to think about, and it’s more complicated than just, again, watching the TSH, and giving you the Synthroid for sure.

Chantel Ray:                 Where can our listeners go to follow you, and your work?

Dr. Brooke:                   My website is betterbydrbrooke.com. I do, do a weekly, or sometimes more often emails that my people really love. They’re not just health newsletters. You can get signed up for those, those are free. I do the podcast with Sarah, that’s the Sarah and Dr. Brooke Show. You can find that anywhere. Hangry is the name of our book, which you can get anywhere. It was out in June, and on social media, Facebook, and Instagram, I’m also @betterbydrbrooke.

Chantel Ray:                 That’s awesome. Well, thank you so much for coming on our show today, you are amazing. If you have a question that you want answered, go to questions@chantelrayway.com. We’ll see you next time. Bye-bye.