The Dr. Hyman Show - The Functional Medicine Approach To Hair Loss

Episode Date: September 26, 2022

This episode is brought to you by Rupa Health, InsideTracker, and Pique Tea. Hair loss is a commonly experienced issue and often signals something deeper going on in the body. And as there are many different types of hair loss, there are also many various drivers of hair loss, including hormonal imbalance, metabolic dysfunction, or even autoimmune disease. This is why Functional Medicine practitioners look at gut and metabolic health, nutrient status, and much more to find the root cause of hair loss. In today’s episode, I talk with Dr. Elizabeth Boham, Dhru Purohit, and Dr. Cynthia Li about the many different types of hair loss and their associated underlying causes.   Dr. Elizabeth Boham is a physician and nutritionist who practices Functional Medicine at The UltraWellness Center in Lenox, MA. Through her practice and lecturing, she has helped thousands of people achieve their goals of optimum health and wellness. She witnesses the power of nutrition every day in her practice and is committed to training other physicians to utilize nutrition in healing. Dhru Purohit is a podcast host, serial entrepreneur, and investor in the health and wellness industry. His podcast, The Dhru Purohit Podcast, is a top 50 global health podcast with over 30 million unique downloads. His interviews focus on the inner workings of the brain and the body and feature the brightest minds in wellness, medicine, and mindset. Dr. Cynthia Li received her medical degree from the University of Texas Southwestern Medical Center in Dallas. She has practiced as an internist in settings as diverse as Kaiser Permanente Medical Center, San Francisco General Hospital, and St. Anthony Medical Clinic serving the homeless. Her personal health challenges led her to integrative and Functional Medicine, and she currently has a private practice in Berkeley, CA. She serves on the faculty of the Healer’s Art program at the University of California San Francisco School of Medicine, and she is the author of Brave New Medicine: A Doctor’s Unconventional Path to Healing Her Autoimmune Illness. This episode is brought to you by Rupa Health, InsideTracker, and Pique Tea. Rupa Health is a place where Functional Medicine practitioners can access more than 2,000 specialty lab tests from over 20 labs like DUTCH, Vibrant America, Genova, and Great Plains. You can check out a free, live demo with a Q&A or create an account at RupaHealth.com. InsideTracker is a personalized health and wellness platform like no other. Right now they’re offering my community 20% off at insidetracker.com/drhyman. Pique is offering up to 20% off plus free shipping on their Pu'er bundles. Just go to piquelife.com/farmacy for up to 20% off plus free shipping. Full-length episodes of these interviews can be found here: Dr. Elizabeth Boham Dhru Purohit Dr. Cynthia Li

Coming up on this episode of The Doctor's Pharmacy. One of the most common signs of an underactive thyroid is shifts in your hair. So we see more thinning of the hair, the hair can become more dry and brittle, and, you know, the eyebrows can shift. Hey everyone, it's Dr. Mark. Now, I know there are a lot of functional medicine practitioners out there like I am, and we're all trying to get the best data we can to help our patients optimize their health.

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Right now, they're offering my community a 31% discount at InsideTracker.com forward slash Dr. Hyman, that's D-R-H-Y-M-A-N, that's I-N-S-I-D-E-T-R-A-C-K-E-R.com slash Dr. Hyman, that's D-R-H-Y-M-A-N, and you'll see the discount code in your cart. Now, let's get back to this week's episode of The Doctor's Pharmacy. Hi, this is Lauren Fee and one of the producers of The Doctor's Pharmacy podcast. Hair loss can be a very difficult condition to deal with on the surface and is often a sign that there is an underlying hormonal or metabolic imbalance that needs to be addressed. Whether you are noticing patches of hair loss or an overall thinning,

working with a doctor can help you determine the root cause, whether it be insulin resistance, Hashimoto's, or another driver of hair loss. In today's episode, we feature three conversations from the doctor's pharmacy on the functional medicine approach to determining why someone is experiencing hair loss and the best way to treat it. Dr. Hyman speaks with Dr. Elizabeth Bohm on the different types of hair loss and why they occur, with Drew Prowett on how diet may affect hair loss, as well as the autoimmune condition alopecia areata, and with Dr. Cynthia Lee on looking at the whole body to uncover the root cause of hair loss. Let's jump in. Let's talk about the different types of hair loss because there's male hair loss and male pattern baldness, which is common and obvious, a little hard to deal with.

But then there's all the other kinds of hair loss, which are often really responsive that occur in men and women to a functional medicine approach, which is looking at the root cause. So you want to look to see if somebody has a diffuse hair loss or do they have patches of hair loss, right? So, if there's a patch of hair loss, like there's a circular area where the scalp is really smooth and you've lost hair in patches like that, then you're thinking more of an autoimmune process. And then the more common that people come in with is a more diffuse hair loss or either a male or female pattern hair loss. And so with male pattern hair loss, it's more you see the receding hairline, maybe the crown of their head. There's hair loss because our hair follicles, some of them are more impacted by our hormones. So the androgens, testosterone and DHEA can impact hair for certain hair follicles more than others.

And then female pattern hair loss is more of a, you know, what women will notice is that part in their hair is getting wider. So, they'll notice this, their part, it seems to be getting wider on the top of their head and they're like, that's strange. So, it can be a slow process like that as well. So we really delve in- Or just thinning all over. Thinning all over. We see thinning all over a lot. And then of course we can see hair breakage. We pay attention to that as well. There's all sorts of different causes depending on how that person is losing their hair. Or quality hair too. It's not just hair loss, but the quality of your hair depends so much on nutrition and other factors. And then like you mentioned, the autoimmune diseases,

those are more severe hair loss where like the case I mentioned, which is total body loss or just loss on your head. And those are autoimmune issues. And so typically, how are doctors treating these problems with traditional medicine you know i mean i think that sometimes they're recommending steroid injections for certain types of hair loss they're recommending rogaine if it's more of a diffuse hair loss or as i said before sometimes they're saying well you know that's just it looks like you're just aging hair loss so they use propicia for guys which is like a prostate medication that they relabeled for hair loss because it blocks testosterone. Yes. Right. Yes. Yeah. And for women, it's kind of hard, right? There's not a lot of options. Yeah. I mean, and I think it's really important to get a good history from our patients to get a good timeline. You know, that's what we always focus on with functional

medicine is really getting their full story. When did this start? How long has it been going on? What kind of patterns have you seen? You know, And then really looking at what else is going on in the body. What is their diet like? How is their digestive system working? How are they digesting and absorbing? Is there concerns that there may be issues with digestion and absorption? And is there other signs of inflammation going on in their body do they have if it's signs of autoimmunity then there's a whole cascade of things you're looking at you know you're you're questioning the microbiome you're questioning intestinal permeability you're questioning exposure to certain toxins and chemicals from the environment that can be triggers and these can be

triggers for all autoimmune disease absolutely and you know you're depending on you your genetics whatever you might get one autoimmune disease and somebody. And you know, you're depending on you, your genetics, whatever, you might get one autoimmune disease and somebody else might get a different one from the same causes. Yes. Yes. Right. You know, there's always that triad of autoimmunity we're paying attention to. Are you genetically predisposed?

Do you have increased intestinal permeability or leaky gut? And has there been some trigger that may have triggered this autoimmune process to occur? So, you know, that's not as common as what we see all the time. You know, we're seeing what we're most commonly seeing is, you know, that diffuse hair loss where people are coming in and they're, or male pattern hair loss in women. We see that a lot too. And we'll review some case on that as well. And those are things we can really do a lot to improve pretty quickly. So when you see someone come in with, like, let's say, let's just take a woman, for example, which is often more common to see hair issues than other than male pattern baldness.

You know, what is the list that goes through your head from a functional medicine perspective of things that you need to think about? Like, what is the diagnostic list and how would we approach these patients differently than just saying, take Rogaine or, you know, good luck or get a hair transplant or, you know, take steroids. I'm thinking about their hormones, right? Right. We're thinking about their hormones and how is their hormones balanced or unbalanced? What's going on with their thyroid? What's going on with their digestion, digestive system? What's going on with their thyroid? What's going on with their digestive system? What's going on with their nutritional status? You know, what's their iron like?

We're wondering about levels of iron. Iron deficiency. Yeah, iron deficiency, which is really common. You know, we're worried about issues with gluten. So sometimes, you know, anything and then other inflammatory foods that can cause inflammation and impact digestion and absorption. We see that pretty frequently actually. So there's so many, so many aspects that we're looking at. We're taking a really good- Yeah, problems like digestion, absorption, low protein intake often. Yes.

If you're vegan, sometimes this can be an issue over time. And you mentioned hormones. I want to loop back to that. So we've got, you know, we've got thyroid, you mentioned, you mentioned hormones, you mentioned the gut, you mentioned gluten, you mentioned hormones. I want to loop back to that. So we've got thyroid, you mentioned hormones, you mentioned the gut, you mentioned gluten, you mentioned inflammatory foods, you mentioned nutritional levels like iron, and there's other things like diet that may be relevant. Let's go back to the hormones because this is, I think, probably one of the biggest drivers, particularly in women. And to talk about the main hormonal changes.

Let's get to thyroid in a minute, but let's start with the other major hormonal changes you see, what's driving it. I mean, one of the most common reasons that women have hair loss that's hormonally related with in terms of their female hormones is when they develop this process of polycystic ovarian syndrome or PCOS and insulin resistance,

because their hormones shift in their body and they start to have higher levels of testosterone and DHEA. And so then their hair starts to change. They'll notice that they may have a receding hairline. They'll notice some thinning on the top of their head. They also may notice that they're growing hair in places that they don't want to, right? On their chin, on their belly, their normal fine hair on their chin and belly is starting to get darker and harder. And they, you know, so that can be a sign.

Go bald and grow a beard. That's just no fun. It's terrible. It's no fun. It's terrible. You get it in the places you don't want it and you lose it in the place you want it. Yeah, it's no fun. And so what you're saying is that this thing of insulin resistance, and we'll get to about

what's causing that in a minute, causes your testosterone to go up if you're a woman and your DHEA, which is another hormone that's like an androgenic or male-like hormone, that actually causes hair loss. So this isn't really a hormonal ovarian problem per se, right? It's not like a sex hormone problem, although it becomes that, right? We call it polycystic ovarian syndrome, but it's really a dietary problem. Right, because it's driven by insulin resistance. It's driven by that high level of insulin that occurs when we're eating the wrong foods're when we're eating the wrong foods when

we're eating that really processed refined carbohydrate diet where we're eating a lot of high sugar foods um there are also some toxins that are associated with insulin resistance like bpa certain pesticides um so changes in the microbiome have been associated with insulin resistance, which is fascinating. But a very common reason in this country is the poor diet. So the sugar and the starch, which we eat about 152 pounds of sugar and 133 pounds of flour, which is almost a pound a day per person per year. If you're doing that and you have this belly fat, it's causing your insulin levels to go up, which then screws up your sex hormones and leads to the hair loss.

Right. And it causes this polycystic ovarian syndrome, which is this whole bunch of stuff going on where women will notice they're losing hair on the top of their head. They're growing hair where they don't want it. But it also messes up their period. They'll notice their periods are all out of whack. They're irregular. And then for some women women they have problems with fertility yes and it's this cascade um so the hair loss is telling us you know i mean they're they may be most concerned about the hair

loss but there's all sorts of other issues that this can that this can lead to it's a real issue for a lot of people and i yeah and it's so fixable and it's it's often the stage is often set when they're so young, right? So we see this a lot when at a young age, they're getting fed, they're being given food for whatever reason that's really refined and processed or too high in sugar. And then it just leads to this cascade that is hard in terms of, like you said, their self-esteem and causes the weight gain around the belly and the hair loss. And it can be, that stage can be set at such a young age, unfortunately.

Yeah. And there's really a way to diagnose it that we use in functional medicine because sometimes it's a little tricky to diagnose. They're not all following the same pattern. But if you do a glucose tolerance test measuring insulin, you can see high insulin levels. That's the most sensitive. You can look at testosterone, free testosterone, DHA,

other things that we look at to help, something called DHT. So we look at a very comprehensive hormone panel that looks at your risk of having this PCOS issue. We look at your FSH, LH, which are hormone levels from your brain, and they can be altered. So we basically get a very different picture. And then we kind of dig into why.

Is it your diet? Like you said, is it the BPA from all the plastics that we consume? Is it gut issues? There may be other factors that are driving it, but it's really important to sort of dig into that. And then it's easy to treat with diet and lifestyle, sometimes some supplements. Let's talk about thyroid, because that's a big issue. We've covered thyroid before, but I would like really to sort of dive

into this issue, because it's often overlooked, and it's often subtle, and it's often confused with just sort of aging or normal decline that we see in people. So how common is thyroid and how do we do it differently in functional medicine and how is it related to hair loss? Yeah. One of the most common signs of an underactive thyroid is shifts in your hair. So we see more thinning of the hair. The hair can become more dry and brittle and the eyebrows can shift. So when you see that loss of the outer third of somebody's eyebrows, you're thinking thyroid. But a lot of part of your eyebrow just kind of disappears. Yeah. Yeah. And you're like, okay, I've got to really pay attention to this. I've got to look

deeper at this person's thyroid. And like you said, it can be really subtle because sometimes if you just do a TSH for screening and you don't get a good enough detailed history, TSH might look fine, which is the thyroid stimulating hormone, which is the standard screening test. Sometimes thyroid issues are missed. And so we often- Sometimes or- Often. I mean, listen, it affects one in five women. Yes. And one in 10 men. Yes. And 50% are undiagnosed. Crazy. And of those who are diagnosed, I would say probably half of them are not adequately treated. Right. And so we're seeing a pandemic, honestly, of thyroid

issues in this country. And the causes are many, right? It could be gluten, it could be environmental toxins, it could be genetics, there's a lot of factors, nutritional deficiencies, vitamin D, selenium, so forth. But we know how to deal with these differently in functional medicine. We look at it differently. And so if you go to your doctor and you get your TSH level, which is all they'll do, if it's quote normal, even if it's in the high normal range, they'll go, you're fine, nothing to do. If it's quote normal, even if it's in the high normal range, they'll go, you're fine, nothing to do. But it may cause a lot of really vague symptoms, including thinning of the hair, hair loss, cracked nails, dry nails, brittle nails, dry skin, constipation, fluid

retention, muscle cramps, fatigue, morning tiredness, low sex drive, high cholesterol, you know, depression, cognitive function issues. I mean, you just go on and on and on. That was a good list. I mean, they're all like big, subtle little things. And it's sort of like the frog that gets put in cold water and you turn the heat up slowly and they boil to death because they just feel like they slowly kind of accumulate the heat. That's what's happening with thyroid. People just don't, it's not sort of obvious, right?

It's not like you have an obvious, dramatic not always obvious symptom right and giving people the right treatment often can not only help their hair but everything else yes uh so so it's really important to get the right test which now includes the thyroid uh tsh but what other things will we look at we'll look at the free t3 we'll look at the free t4 so the t4 is one thyroid hormone, but then your body has to convert it into T3, which is the active thyroid hormone. And so we want to look and see how much T3 do you have? Are you making that conversion well? Because we know that when people have deficiencies in selenium, iodine, vitamin A, just to name a few, that conversion won't happen appropriately. And then there's also genetic reasons why people a few, that conversion won't happen appropriately. And then there's

also genetic reasons why people don't make that conversion. So their thyroid levels may, their T4 and their TSH may look okay, but that active form of thyroid may be low. We look at thyroid antibodies too. Absolutely. So the doctors won't often look at thyroid antibody until the TSH is high. Right. Which is kind of late. Because I see people with normal levels of thyroid on the test,

but their antibody levels are really high. I had a patient like that yesterday. Yep. I showed all these vague symptoms and the doctor's like, oh, you don't really need to treat it. I'm like, no, no, you are symptomatic because you're having an autoimmune disease against your thyroid. So, in treating the thyroid, we sometimes use thyroid replacement, but we often look

at what the cause is, right? Is it the gut? Is it right? Is it the gut? Is it toxins? Is it heavy metals? Is it pesticides? Is it low levels of, you know, vitamin A, D, selenium, and iodine? Is it something else like gluten, which can cause autoimmune disease for thyroid in many, many patients? So we do a really deep dive in functional medicine.

And I've written a little report called the Ultra Thyroid Solution years ago, probably still up to date, which looks at how we can actually deal with this differently. But it's so important to think not just, oh, it's normal. Because, you know, even our lab tests aren't showing us what's optimal, right? You know, if you're two years old or 92 years old, it's kind of the same range, right? And it's very different. And even the traditional endocrinologists go, well, you know, we used to have a level of five being abnormal for TSH, now it's three and a half. But what's really optimal? Is it one? Is it two? You know, is it 0.7? I don't know. It's probably not three, right?

So how do we tweak everything to be ideal? And I think you can do that and you sometimes don't need to give thyroid replacement. You can use other functional medicine approaches, but sometimes you do and it can make a huge difference with hair loss. Absolutely. So, let's talk about another factor, which I think is so important, which is diet and hair loss. So, you mentioned some nutritional deficiencies. We'll get to those, but let's talk about diet and the role it plays and some of the

big triggers that you could be eating and also things you're not eating that you need that also could trigger hair loss. Yeah. I mean, I think that one of the biggest triggers is gluten. Gluten can definitely be associated with hair loss, especially when people have celiac disease or early celiac disease or a lot of inflammation because of the gluten that they're eating. You know, this is not everybody who's eating gluten, but for some people it's resulting in them not having optimal digestion and absorption of their food. And so then hair loss is just one of the side effects that we see.

So it can be you have a full-on autoimmune disease like alopecia areata, which is hair loss everywhere, totalis, and that can be from gluten that's causing autoimmune disease like alopecia areata, which is hair loss everywhere, totalis, and that can be from gluten. It's causing autoimmune disease, one of the manifestations of celiac. But you don't actually have to have celiac in order to have this problem. You can have non-celiac gluten sensitivity and still have the hair loss. Absolutely. And then the other thing we see is if you're not eating enough protein, we often, or if you're not digesting and absorbing it

well enough, which is actually something I see probably more frequently, is that people might be eating enough, but they're just not absorbing it because of an autoimmune disease in their stomach, parietal cell antibodies, or because they've got inflammation in their gut and that's- A leaky gut. Yeah, that's resulting in their digestive enzymes not working well. And so in a sense,

they have low protein levels in their body. When we check for amino acids, we see low amino acid levels. And so when somebody, that's probably one of the biggest benefits I see with hair is when I treat people with amino acids. Yeah. Then your regular doctor is not measuring your amino acid level, right?

We check that in functional medicine here at the Ultra Wellness Center. It's not a test you're going to get at your regular doctor, but I do see that. And I see low amino acids. And like you said, it's either they're not eating adequate protein or more likely they're not absorbing and digesting it very well because their guts are. Yeah. And, and, and so for those people, when we give them amino acids, like a complex or sometimes specific amino acids and you give them between meals, I see huge benefits for their hair. Like that's where they

go, oh my gosh, my hair is so much better because, um, because, because of those amino acids. Absolutely. Absolutely. And there are other nutrients that are also important. One of them is biotin, which is produced by bacteria in your gut. So if you're not healthy, you might not be getting adequate levels, but that can also be helpful, right? Yeah, when biotin is low,

a lot of times people will see that their hair is breaking or they also notice their nails are breaking because they're more fragile or dry in a sense. And biotin, that's why biotin is helpful for some people with problems with their hair. Hey everyone, it's Dr. Mark. Now, we all know how important gut health is. It's key to our immune function, our brain health, mental performance, and even our emotional health. And that's why I want to tell you about a new product from our friends over at Peak. Their fermented pu-erh tea contains naturally occurring prebiotics and probiotics to support

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It may be related to your gut, amino acid intake, whether you're doing enough protein on a ketogenic diet. Sometimes amino acids are critical for hair growth. So you kind of got to look at the whole picture of what you're doing enough protein on a ketogenic diet. Sometimes amino acids are critical for hair growth. So you kind of got to look at the whole picture of what you're doing. When someone has hair loss, I tend to look at a number of different things. One, I look at thyroid. That's a big one. First, easy one to do. And often most doctors miss thyroid.

It affects one in five women, one in 10 men. Most of them are poorly diagnosed or not diagnosed, about half of them. And the ones who are diagnosed often are not treated optimally. Doctors don't tend to check T3, which is really important, free T3. And that can be off even if you're on Synthroid or level of thyroxine, which is the most common treatment. It may not be enough. You may need to add T3 and that can often be a miracle worker. It can be gluten. Gluten is a huge cause. I just ran into someone at a conference, and they're like, my daughter has alopecia, which is a more serious autoimmune hair loss, but that can be a huge cause of it. And she's like, well, my doctor says food

has nothing to do with it. And I said, look, go on the National Library of Medicine. Don't listen to me. Look at the National Library of Medicine, all the research ever published, basically, that's fit to print, that's been peer-reviewed, and have a look. Just put gluten and hair loss and see what you find. And it was like hundreds of articles or celiac disease and hair loss. So I think many doctors aren't aware

of the connection between food and hair loss. So it's important to look for leaky gut, for gluten issues. Biotin can play a big role. Biotin is made by the bacteria in your gut. So if you have a bad microbiome, you might not be making enough biotin, which a big role. Biotin is made by the bacteria in your gut. So if you have a bad microbiome, you might not be making enough biotin, which is necessary for hair loss.

Amino acids are critical. You might make sure you're getting a protein and the right amino acids. And if you're doing a ketogenic diet, there may be something going on with your microbiome or there might be something going on with, you know, different factors of what you're choosing to eat or not eat

because you can be a healthy ketogenic diet, you can be on an unhealthy ketogenic diet. So I need more information to actually determine what your cause of your hair loss is, but it's important to look at all these factors as you begin to think about it. Also for women, it can often be a problem with their endocrine system hormones. For example, PCOS, which we've covered on the podcast, polycystic ovarian syndrome, is a common symptom of hair, is a common cause of hair loss. Women will get high levels of androgens or male hormones. They'll get male pattern kind of hair loss on the top of their head. And that's very concerning for women. They might get hair growth on their face. If that's happening, it may be a hormonal issue. You don't always have to be overweight for that. It can be

often caused by insulin resistance or prediabetes or sugar. So there's a lot of things to think about when hair loss, but you kind of got to go dig down the rabbit hole and really take a comprehensive view. LFPCher, for those who are listening to us, it means you lose all the hair on your body. No eyebrows, no eyelashes, no pubic hair, no hair obviously on your head. you lose all the hair on your body. That is an autoimmune disease. And that is usually because of gluten. Now, it can be other reasons, leaky gut, other factors, and there's other causes of inflammation, autoimmune disease. But we approach it the same way we approach autoimmune disease.

And I remember I had a patient come in once years ago. I agree with it. Like, I do a lot of virtual consults over the years. I would see people in person and then I would talk to them on the phone. This was before Zoom. And I would, you know, help them with their health over the year. Then after this year, this woman came back and she'd gotten off gluten. We'd fixed her gut.

We'd done all the normal functional medicine things. And she was wearing a hat, you know, and she came in wearing a hat. And like halfway through the consult, she pulled off her hat and she had a full head of hair. And I was like, what happened here? It was pretty wild. And I've seen this many, many times. And then restless leg syndrome is kind of inflammation of the brain. So it can be often caused by magnesium deficiency, but it's come kind of neurologic irritability. And it can be other things like heavy metals, mold, Lyme, other things. And it's very horrible for people who have it and they can't get comfortable at night. They don't sleep well. You can detect it by sleep studies. Often I'd start out with magnesium as a sort of

initial treatment. But there are many other things that can cause it that I would check with your functional medicine doctor about. About 15 years ago, I was a few years out of residency. So I was at this place in my professional life where I felt a sense of mastery, right? I just, I knew the studies, Pat. I knew the protocols, Pat. You know, I was running ERs and just feeling like, okay, I've got this. You were a master of your craft. Yes, yes. And I felt really proud of where I had come to in my life. And I had married the love of my life. I did something really radical. I had always been sort of the good girl, the conventional girl, which is funny why I ended

up taking this very unconventional path as far as this culture is concerned. Yeah, I had a very conventional upbringing, and my husband and I, shortly after we got married, I did something radical, and I quit my job, and we traveled the world for six months. No itinerary, just a backpack with a few necessaries in them, and I felt so free and so alive. And after we returned, I started a job at the county hospital where I was working with underserved patients and really found my calling. So it was during this time that I got pregnant. And again, you know, the pregnancy was

easy. Nine months later, we had this miracle of a baby. We were thrilled. But it was three months after that, that I started feeling off. And, you know, started feeling really tired. My hair was falling out. I was losing weight. I mean, like super rapidly. And again, it's just one of those things that I think as not wanting to complain, as our culture tends to do, is normalize, you know, unwellness to where you sort of tolerate it. And so I thought it was all postpartum stuff. Suck it up and push through. Exactly. Suck it up. And, you know, and a lot of times things resolve and, you know, life goes on, which I had learned in residency, right? What doesn't best healer is time. Everything goes away. Right. What doesn't kill you makes you stronger. Right. I didn't realize at the time that only works for acute things, not chronic.

So I was in very much in that mentality of invincibility, both because I was young and both. And then the other reason, because I was a doctor, there was this strange sense that because I understood chronic diseases, I mean, I was an internist after all, an expert in chronic diseases, that I was somehow immune to it. You know, my patients were over there and I was over here. Yeah. Since you knew all the diseases, you couldn't get them. Exactly. And it took me a while to even recognize the signs. And I remember very clearly that I was, you know, I'd been kind of slogging through my day-to-day life, you know, with this new baby and an active husband and my job. And I was seeing a patient

and she was a single mom, had like three kids, was working two jobs. She was exhausted. And she came to me for fatigue. And I was looking at her and I was just going through the checklist, you know, all the review systems. And I said, oh, my God, you're a the review of systems and i said oh my god you're a textbook case of hyperthyroidism you know i'm going to run these tests and it dawned on me that oh my god her palpitations her insomnia her fatigue you know her weight loss her hair loss and i was like oh my god i am a textbook case too so that was a that was a really big eye opener for me yeah you saw yourself in her. Yes, and also that I had a chronic disease, most likely, because thyroid diseases are usually chronic. So that was the beginning, and I had what was... Which, by the way, low thyroid and thyroid problems in women affects one in five women,

and half of them are undiagnosed. Yes. And many who are diagnosed aren't properly treated. Absolutely. Absolutely. And I think it goes to the fact that we dismiss symptoms that are, I mean, they're seemingly vague, right? Fatigue. I mean. I'm tired. I'm a little depressed. I'm not functioning in sex. My skin's a little dry. My hair's thinning. Right exactly so constipated whatever it's like a normal absolutely and oh so for me though my initial presentation was hyperthyroid yeah and then i fell hypo so i was kind of on this thyroid roller coaster and what i had was hashimoto's an autoimmune thyroid condition and when it happens in the postpartum period most of those cases resolve

in about a year and so i followed actually that textbook trajectory and about a year after i was diagnosed i wasn't feeling well but i saw my endocrinologist who was a top-notch specialist and he said yeah you know i think it's time for you to try tapering off your levothyroxine. And I did. And my numbers stayed normal. And I was by his book and by my book, I was cured. But you still felt like crap. I still felt exactly the same.

So that it goes to show, you know, where I was in my mindset was what the paradigm that we're trained in superseded my own experience. And what we're trained in is that everything hinges on the diagnosis. Yeah. If you don't have a diagnosis, you have no treatment. And the lab test, right? Right. And the diagnosis is a set of criteria or it's a lab test or it's a pathology report.

It's something very, very concrete. So I'm living my life and I was still living a full life. So I was also basing health on functionality. Yeah. You were managing. Yes. Yes. You weren't thriving. I was managing quite well. So then a couple of years later, my husband, our then toddler, and I take a trip to Beijing. And my parents and my sister were living there at the time.

So I had taken these trips annually. And we went and I had a very dramatic experience there. Before you go on, I just want to sort of clarify for people. For those who haven't been to Beijing, it's been cleaned up a little bit. But on a sunny day, you can't see a building across the street because the air is so thick with pollution. And most of it is from coal, raw coal that they burn. And from some of the inversions that come from the weather patterns from the Gobi Desert.

And it's so bad that many people in Beijing walk around with masks, literally with face masks. You might have seen those pictures. So we're not talking about just a little pollution. We're talking about air so thick that you can basically cut it with a knife on a sunny day and can't see the sun. Yes. Yeah. I mean, my sister taught elementary school when she was there and every day they

would get these color signals about whether or not they could go out. And there were many days where they couldn't even go out at all. Stay indoors with high, heavy-duty air purifiers going on. So, yes, it was very polluted. So it was in Beijing. On a nice family trip. Nice family trip. And, you know, I will say we took a hike on the wild wall. So, right, the un-

Unrestored. Yes, the beautiful sort of rustic but crumbling wall, of the Great Wall. And it was a really beautiful hike. And I stood at this lookout tower, and I said to my husband, I said, I feel like myself again. So I was feeling like, oh, I'm coming back, right? My stamina was back, um, the aches and the pains and just that low

grade fatigue was gone. Um, so I felt, um, an ounce of, of real hope there. And then we went to a dumpling house to celebrate and you know you had asked me before this like you know what might have triggered this turning point I don't I was eating disease I don't know but I was eating a ton of things some of which were like tons of different kinds of fungus, like mushrooms, like things that are, you know, can be immunologically triggering as well. So I have no idea if that had anything to do with it, if it was just the foreign food proteins.

But I was having the feast of my life when I suddenly felt like I was going to pass out. You know, and I was going through all the going through all the differential diagnoses in my head and heat stroke, dehydration, I was drinking water. But suddenly, I mean, before I know it, my life flashes before me and I think I'm going to die and then I pass out. So I come to an emergency room in downtown Beijing. And when I came to,

I just came to a body that really wasn't my own. I didn't recognize myself. I could barely move my muscles. The entire room was spinning around as if I was on a boat that was really, really being tossed around in the high seas yes and that was something that was completely outside of my own box as a doctor I was calling the shots in the ER because the doctor overseeing me was a resident yeah and I've had that experience being in a a hospital in thailand with severe gastroenteritis

telling him what to do yes i mean it is it is it's challenging being sick but it's challenging being a doctor who's sick because people are still looking to you to number one stay calm and number two figure out what's going on and i was using my really um you know basic mandarin too trying to communicate um i also realized that i had brain fog i didn't know it at the time i just i couldn't remember things um i was looking at my own ekg and which was normal but i couldn't quite read it you had a broken brain i had read yeah thousands of those right yeah so um i was uh you know kind of in a state of shock um but really just trying to push through the misery of it and in the smattering of tests um they did stabilize my blood pressure which was low i got iv saline and um

but all the tests turned out normal as they so often do in these conditions. Must be all in your head, right, Dr. Lee? And the one that did not turn out normal was one that I really ordered as a precautionary test that we do for all young women. It was a pregnancy test and that came back positive. So that was, again, a huge shock. And my husband and I were really trying to wrap

our heads around the fact that I felt like I was going to die. But then, oh my God, wait a minute, like I'm pregnant. And I'm miserable. So at the time, I did not realize that this was going to be a decade-long journey. And you mentioned that you had a GI problem then, right? Yes, well, that didn't manifest until the very next day. The next day, I started having nausea, vomiting, and diarrhea. And people said, well, it's probably the pregnancy, and whatever you got, this dehydration, you just overdid it. But then my husband and my daughter got it too so i realized

okay you know what there's a gastroenteritis going on all of this was in hindsight though you know i wasn't you went from like literally the top of the mountain on the great wall feeling the best you felt in years to like the worst you could possibly feel yes yes in a matter of days yes and we were we were scheduled to get on our plane trip home like three days later after the ER visit. And it was some miracle that I made it. But I had my first full-blown panic attack as we boarded the plane because I was so weak

and I barely made it on. I was in a wheelchair and I was thinking, 13 hours, 13 hours. What if something happens? I can't do this. But I made it. I made it back home. And I remember calling my medical director and saying, I got a gastroenteritis and I am in the early throes of pregnancy. I'm going to need an extra week to recover, but I'll be back. Yeah. Or so you thought.

So I thought. And I never did. I never returned. So that was really the beginning of the rest of my life. and it took me being housebound for two years to break out of that that paradigm that I knew so you were still looking at traditional medicine to solve the problem they weren't answers I'm going to see everybody yes I went to see specialist after specialist and again another sort of mystery. You're depressed, take Prozac, right?

Yes. Well, I mean, even things like I was afraid to say I was depressed because I was like, I don't want to kill myself. I'm just miserable. You know, like I'm miserable. You're physically depressed. I'm not depressed. Yes, yes. But I knew from the other side what doctors did with patients like me.

So I had a lot of symptoms that I kept to myself. What they did meaning? Meaning, yeah, antidepressants or potential, you know, a major psychiatric evaluation or getting stigmatized as a difficult patient. Yeah. We have a very, you know, in the medical world, we have a very pejorative way of talking about these patients. We use a fancy medical word. We say it's super tentorial, which means it's in your brain. It's in your head. And it's very nasty and not true.

And I think your experience is very important because I think most of us who suffer aren't doctors. And so we don't have that insight but um when you actually are a physician and you get that uh you know i had someone say to me the other day oh you know i don't believe all this fatigue stuff when i want energy i just jump up and down and run up the stairs i get energy i'm like no you don't get it like when you get your tank emptied and you don't know how to refill it it's real it's not in your head it's not psychiatric it's it's your biology and i had exactly the same experience so i i get it and it's sort of what led me to be a functional medicine physician and to so be passionate about telling

the world which i think also why you write your book, sort of share with the world, look, look, like I'm a physician. I know the science, but I hit a dead end when it comes to the paradigm that we were trained in and I needed to find a different way. So, so tell us about how. Can I ask you, were you as hardheaded as I was? I mean, did it take you? Oh, well, first of all, too, for me, I think partly it took so long was because I was pregnant and all the specialists told me that this is a difficult pregnancy and part of me wanted to believe it or that a lot of it would resolve. And amazingly, I had this baby who's, she's healthy and she's the strongest one actually in the whole family. So, um, there was that piece, but I was, I'm just curious,

did it take you as long as it took me to realize there was another path? Well, it was interesting. I mean, I literally went down hard. I mean, I was the same story. I lived in China. I was exposed to mercury. I came back from China, and I was up in a lake in Maine, and I got some kind of bug, some kind of stomach bug,

and I never had anything like it. I thought it would get better and it didn't. So the mercury was sort of like the sort of underlying problem. And then the straw that broke the camel's back was getting an acute stomach issue, which caused a leaky gut and this massive inflammation. And my whole system collapsed you know i not only did i then i had the stomach issues and diarrhea and pain and bloating i also had immune issues my rashes all over my tongue would swell up when i ate certain foods i get rashes around my eyes i have all sorts of abnormal blood tests my low white count positive a and a which is like autoimmunity i had elevated liver

function tests i had severe cognitive problems i couldn't focus i couldn't remember anything i couldn't really barely work i had trouble sleeping i mean just my whole system was down and was called chronic fatigue syndrome which you know for a long time we thought was psychological and and now there's real good data that there are a lot of biological markers of what's going on in chronic fatigue syndrome that's not just some fabricated thing we call it a syndrome in medicine when we don't actually understand it it's like oh you have irritable bowel syndrome what does that mean it means your stomach hurts and you have diarrhea or constipation or bloating it's like that doesn't mean anything so for me it took me a while because this was 25 years ago and there wasn't like a big functional medicine movement but thank god i was working at

a place called canyon ranch where there was a nutritionist kathy swift who introduced me to this guy jeff bland who's the father of functional medicine and i heard him speak and it was like the light went on i'm like oh okay there's a different way of thinking I said well if he's either crazy or he's a genius and I better figure out which one so I started to learn read about it experimented myself so I was working part-time experiment with my patients they would get better I wouldn't get better I couldn't figure it out I mean it took me years and years and years uh if I know what I knew now then I would have gotten better a lot faster but i didn't have all the information i didn't have all the tools i didn't know but i did

find a huge level of mercury and all sorts of other issues so i think um for me you know i was i don't even not stubborn but i knew i knew like you going to special after specialist after specialist that this wasn't in my head. Like I knew I wasn't depressed, like you said, although I felt depressed, I felt fatigued, I felt unable to cope or manage, but I knew it wasn't in my head. Yes, it was affecting my brain,

but it wasn't emotional or psychological. I think you were, yeah, a step ahead of me. So I ended up referring myself to a psychiatrist because... Well, I went there too. By that point, I wanted a diagnosis, right? I wanted something I could hang my hat on. And I hear this a lot from my patients too. It's giving a name to something somehow makes it more real. And I had a moment in the bathroom. I remember I was coming out of the shower and I was feeling, you know, my heart rate racing and my blood pressure dropping,

feeling like I was going to faint. And I was going through all my symptoms. And I basically diagnosed myself in the bathroom with chronic fatigue syndrome and dysautonomia, the total dysfunction of the autonomic nervous system, right, which is the branch that controls largely unconscious vital body functions like heart rate, blood pressure, digestion. It's like I really say, well, it's like air traffic control. Well, but worse, but more serious because as soon as it's gone, you realize what it was sort of keeping together, managing all these moving parts.

So nothing really felt like it was working within myself. And, you know, like you said, though, I mean, these are syndromes and which kind of mean nothing. So I didn't want that. I wanted something to say it's treatable. I would say the name of your disease isn't the cause of your disease. Right. Exactly. This autonomia just means your nervous system isn't working.

Right. Chronic fatigue syndrome just means you're tired all the time. Right. Right. Exactly. It doesn't tell you why. Yeah. So I did.

I went to a psychiatrist. I think, you know, where a lot of patients like us end up one day. And she said, you know, something that made me almost laugh. You know, she said, this is not, you're not depressed. You're not anxious. I think it's your hormones. I think it's your immune system. I mean, she was really actually going into the systems.

But at the time, like I was like, well, but my endocrinologist, you know, said it's not immune system. I mean, she was really actually going into the systems. But at the time, like I was like, well, my endocrinologist, you know, said it's not my thyroid. And, you know, an immunologist, like why would I go to an immunologist, you know? And so I kind of exited. And had I known about functional medicine or even integrative medicine at the time, it would have been a much smoother path. But because I had to rebuild the paradigm from the bottom up in order to even get there,

it took me many more years. Yeah. So how did you come out of it? So the first thing I did was I went back to basics. And so I did not suddenly just start seeing an acupuncturist or start, you know, trying energy medicine or anything that's really alternative. I was like, okay, no, I'm a doctor.

You didn't start off with crystals? No, I didn't. I didn't. And oh God, meditation was like pulling teeth. So no, I went back to basics and I took out my pathology 101 textbook. Yeah. Right?

Pathologic basis of disease. Robbins and Cotran. Exactly. That's what we all take in second year medical school. Right. And Kumar. Kumar was my pathology teacher. Oh, wow.

So, I took it out. I still had it. It was highlighted, dog-eared. I mean, and it actually was good for me. Like if I know neuroplasticity, right, it kind of brought me back to this time where I had more of a sense of agency over my life. So in that sense, it was also healing.

I didn't recognize it at the time. But I started reading about how diseases, how chronic disease develops and, you you know about cellular repair and cellular injury and I was like yeah and and they actually talk about this was you know this was published I don't even know which edition but 20 years ago yeah where they say the one cause one effect paradigm does not work anymore yeah right we We're in this complex living environment

where nutrition matters, where environmental toxins. I mean, this is 20 years ago. And they probably wrote that several years before that was published, right? So I started reading that and I thought, well, wait a minute. And then that diseases are not defined by a set of criteria. They're this continuum, this process. And that- Yeah. So I remember going back and reading chapter one and it said, any pathologic change is always preceded by a biochemical change.

Yes. Which means that anything you see like on a microscope, there's got to be a lot of years of stuff going wrong with your biochemistry and physiology before that happens. Yes, years. And we don't know how to look at that in Western medicine. We just wait till you have something wrong and then we go, oh yeah, now I don't know what it is. Right, right.

Because in the way that we've been trained, inflammation, which is what I had, right? Widespread inflammation in my nerves, inflammation in my right widespread inflammation in my nerves inflammation in my gut inflammation in your brain in my thyroid exactly um it doesn't qualify as a treatable disease inflammation right that's what i was joking say functional medicine doctors are inflammologists you know yes i love that i remember that from the first functional medicine conference i went to yeah i gave a talk on that right right right so um and but so that was a really big aha moment for me was wait a minute okay i understand this sudden disturbance would i call it in beijing but then i had the thyroiditis before that, which was sort of the preceding trigger.

And then before that, okay, wait a minute, you know what, when I was in residency, post-call, 36-hour shifts, my muscles would feel really crampy. Like I felt like I'd run a marathon. And I was dizzy. And I just assumed, well, of course, everyone feels this way because they're

exhausted right and so I started going backwards and realizing okay this has been going on for a long time and for some people that can be really you know sort of disheartening but for me at where I was it was a little ounce of hope because it meant that I could sort of stepwise, piecemeal address inflammation in a way that I could tolerate. What I was really afraid of, because I was so brittle, was having any kind of setback that would push me down further. And so if I could do it in a way that was more controlled and gentle, then it felt like something I could move forward with.

So what did you do? What were the things that helped you recover? So one of the things was, yeah, was identifying. Because by the way, chronic fatigue syndrome is not something most people recover from, right? Right. Fibromyalgia is not something people recover from. Absolutely. Unless you see a functional medicine doctor right right or have some kind of some one of those you know spontaneous remissions which is one in a

million yeah yeah so so what I ended up doing also was distancing myself from the diagnosis and the prognosis because it was more despairing. My marriage was held together by a single thread. You know, I had two young kids. I had everything to lose. So I was like, if I don't get my act together and start trying differently, then I'm going to lose whatever, you know, what little I have left. um i was really motivated and you know the first thing i did was really um i started reading about well i knew i had to get sleep if i can't get sleep i'm gonna not have enough energy so really looking understanding the circadian clock and you know i learned things that i was surprised i didn't know already you know i knew about the

pineal gland and the hypothalamus and we have this master clock and we have jet lag and that's why, but I didn't know about every organ having its own clock, its own rhythm. And that- And even a whole field of chronobiology where the different kinds of chemo is better given

at different times of the day to work better. Yes, I know. This is in conventional medicine. Right. And it makes, I mean, it makes like complete rational sense, right? So I started, first of all, being more regimented about just, okay, you know, I'm going to wake up, you know, and get up out of bed. Even if I feel kind of miserable, but I'm going to, my body needs to know that it's awake and that it's alive. So really basic fundamental steps. And I learned that when we deviate,

I mean, particularly when you're brittle like that, I mean, of course, when we are more resilient, like now I have much more flexibility. But when I was brittle, you know, when you stray away so often from a routine, it causes stress on the body. So I was like, oh, okay, this is maybe an easier way where I can reduce stress on my body. Yeah, rhythm. Yeah. We all live dysrhythmic lives. I feed my dog at the same times every day. Why don't I do that for myself? And he gets walks now at the same time. Why don't I do that for myself?

So I started syncing myself also with my kids. Like, okay, I'm going to take care of my kids. I can take care of myself at the same time. So I think that also in that caretaker mentality, as a mother or a partner or a doctor is we we tend to put ourselves last and so it was kind of time to put myself first you know as my first patient that's good and so you did the rhythm and what else change your diet and then um yeah and you know a lot of it was just asking new questions. The diet piece, I thought I was eating, quote, healthy, you know, which was largely vegetarian.

I was cooking meals, but also doing a lot of prepackaged meals, but, you know, not a lot of processed stuff. And it wasn't until I saw an acupuncturist. So the acupuncturist that I saw, Robert Levine, who's in Berkeley, California, he was brilliant, really brilliant. And he's still practicing. And he's a dear friend of mine, a mentor of mine. I learned a ton from him about understanding the body in terms of systems. So when my thyroid was out of whack, it wasn't just my thyroid. It was my whole hormone system, which is tied then to the digestive system, which is tied to the immune system. Like it suddenly started making sense. The knee bone is connected to the thigh bone, right?

Yeah, exactly. And the body is connected to the brain. Which is actually amazing in medicine that our entire training teaches us the opposite. That there's all these organ systems, right? We take the GI system and the liver and the lungs and the brain and the heart and the hormone. And you go to specialists for every different part of you and nobody connects the dots. Right.

Right. And traditional Chinese medicine is actually a system thinking of the body as a system. And that's what functional medicine is. It's a systems thinking approach. Yes, absolutely. And so, you know, we can extrapolate that to any size system, right? We look at our communities and our world, right? And, you know, one of the things I feel like that drives almost everything, if not everything, that we do as individuals and that we do as societies is how do i get more energy yeah right my qigong teacher was talking about that how do we get more energy you know whether it's through you know chi means energy yeah whether it's through solar energy you know

fossil fuels whether it's yeah i mean it's food um nature movement um so you know i began to shift my thinking in relationship to health and disease in a much more living sort of embodied way so the but the diet thing he was the first one he was like you know you're so deficient right now like i think you need more meat you know and you need more of these heavier foods like you're doing lots of salads and you're doing which are great but not for you right now so i hadn't even thought about a personalized diet yeah and i was like more meats what are you talking about you know and this is before paleo days and all that um so i began researching ancestral diets and the work of dentist Weston A. Price.

Price and Alvin Connors. Right, and it suddenly made sense. Like, oh yeah, okay, I'm gonna eat like my ancestors ate. I'm gonna prepare food the way my ancestors prepared so I can maximize nutrient density. Nutrient density equals more energy. Yeah.

And then the gluten issue came up. I was really skeptical of it. It's one of the biggest drivers of thyroid disease, Hashimoto's. Yes, yes. And the celiac experts know that, but the endocrinologists don't. So there's no crosstalk there either.

And this is in conventional medicine, right so and I do remember asking my endocrinologist like what can I do what can I do and he said nothing you know it's genetic oh gosh no it's not right it's a genetic predisposition but not predetermination so but the gluten thing

didn't actually arise I think I was partly in denial about it. There were lots of rabbit holes that I knew about, and I just didn't want to go down. As long as I was steadily getting better. It was my older daughter, who she was five at the time. I was taking her to her first dentist visit. And I felt like, as a family, we ate pretty well.

She didn't do a lot of sweets. But she had not just one cavity at her visit she had six cavities wow yeah and i was floored so uh you know and the dentist kept saying well don't feel guilty don't feel guilty you know and i was like wait a minute i wasn't feeling guilty until you just said that. But it made me investigate, like, something else is going on. Like, I know how we eat. I know how she brushes. And I know cavities happen.

But, like, six? It just didn't compute. So I started researching. And that's when I came across Weston A. Price's work around the condition of teeth tied directly to diet, but then going deeper. And then in my research, I came across gluten and gluten causing enamel defects, gluten causing inflammation in the gut,

which therefore could translate into poor oral hygiene or just conditioning of the gums and the teeth. And so that was just kind of another step in that process when i realized oh i got to go back and again this is not unconventional this is just traditional socrates said all diseases begin in the gut right so we're just kind of going back and i realized i have to learn i have to learn how to heal my gut as another step did you still have digestive symptoms after that initial gastroenteritis in China or did it get better it was they were largely quiescent until I removed gluten and I removed gluten and I had

massive withdrawal diarrhea irritable bowel and you know and again this was kind of before the time that i realized i understood about detox and how healing happens is that often it gets a lot worse before it gets better and that it could be a good sign so i um i was really frightened by how severe my my reaction was when i stopped gluten so I was thinking it was a bad thing. But then, you know what, I stuck with it. And a week later, it calmed down. And then my health improved a notch. And not only that, but we changed the way that our whole family ate.

And my younger daughter, so my older daughter's teeth really basically resolved. I mean, they became really strong. Some of her cavities even filled, like they recalcified and didn't have to get filled. My younger daughter, who didn't really have anything that was alarming, but she had like this perioral eczema, which is this dermatitis, which is very difficult to treat with steroids, which is how we treat most dermatitis. Anything red on the skin, they put steroids on it.

Exactly. Why is the skin irritated? Right, right. Coming from the inside, not the outside. So she had that and she would get asthma when she got colds. And both of those are totally, totally resolved. I hope you enjoyed today's episode. One of the best ways you can support this podcast

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