Stress, The Thyroid and Adrenals Connection


Dr. Joel Rosen: Alright, Hello, everyone. And welcome back to another edition of the less stress life podcast where we teach exhausted and burnt-out adults the truth about adrenal fatigue so that they can get their energy back quickly. And today I am joined by a buddy of mine, and a leader and pioneer in the world of functional medicine, Dr. Eric Balcavage. This is our third interview, and I told them, hey, Eric, we haven’t talked for a while, I want to hear what’s new on your radar.

And we can just kind of geek out in front of the audience and tell them what’s going on. He’s the owner and founder of Rejuvagen. Jen is widely recognized around the world as a leader in functional medicine. He’s been in practice for over 20 years, and he sees he has successfully helped 1000s of people suffering from thyroid problems and other chronic health conditions all over the world. So Eric, thank you so much for spending some time with us today.


Dr. Eric Balcavage: Well, thanks, Joel. We should I was down in Florida with you. But you know, we’ll do it from I’ll do it the distance. I’m gonna be there next month.


Dr. Joel Rosen: Oh, okay. Yeah, I tell people look, the roads are open. So you’re free to come here as much as you want and make that change. You know, you’re old enough now where you can,


Dr. Eric Balcavage: hey, hey, hey, hey, hey, just because I don’t have much hair. Don’t be calling me old?


Dr. Joel Rosen: Well, that’s true. So Alright, Eric, give us sort of a, I guess, with a common question is a little bit about yourself, but kind of give us where you’ve evolved to because you’ve had a huge journey. You were a brick and mortar, you were a hands-on guy, and then you found your passion for helping people going deeper. And here we are in 2021. What would you sort of give us as if I asked you, Hey, what do you do for your life? If you were to give us sort of your elevator sort of sentence of what it is that you do? Why don’t you tell the listeners? What is it that you do now, given the evolution and transition that you’ve you’ve been through?


Dr. Eric Balcavage: At this point? I mean, my 32nd elevator speech is I help people recover from chronic illness. I mean,

I think that’s what really what it comes down to. And I think most people come to me because they have some type

of thyroid physiology problem. They see my, my information or my posts, or they’re referred to me, and that starts the journey of, Hey, can you help me fix my thyroid physiology. And I think most of those people that come to see me, I’m rarely ever trying to manipulate their thyroid physiology, I’m always looking at a whole bunch of these other things.

And so whether somebody comes to see me and they’ve got a thyroid problem that they’ve been diagnosed with, or they have gi issues, or they have adrenal issues, or they have sleep issues or weight issues, you know, that the diagnosis to me means very little. Ultimately, anybody with chronic health issues can benefit from what I think is an inappropriate functional medicine, philosophy, and strategy.

And so I help people with all kinds of issues, but what it what kind of is attracted to me are people with thyroid issues, specifically looking to try and fix it, like what’s the secret sauce that fixes my chronic hypothyroidism, hypothyroidism, and chronic hypothyroid symptoms? And I think many times those people are, they’re kind of taken aback when I say, listen, we’re not going to try and manipulate your ti for your TSH, 83. We’re going to try and get to the foundational issues of why your body is reacting the way it is.


Dr. Joel Rosen: Yeah, that’s awesome. And I find the same thing with myself as well. And I, I tell people, like, you know, I want to ask you this question. I look at it as if we’re golf pros. It’d be so much easier if you came to us and you haven’t swung a golf club before, versus all the crappy forms that you’ve learned. We have to unlearn that, and we have to relearn the actual skill set.

And I kind of liken that to what you just said is I don’t work on diagnoses, because a lot of clients that must be hard for them to listen to where, hey, you’re the thyroid guy, I got thyroid issues, and then you tell them like, okay, I don’t care about your thyroid issues. So how do you have them unlearn their bad swing from an educational standpoint?


Dr. Eric Balcavage: Well, I think that’s right. So a couple of things is that sometimes the easiest people to help are the people that aren’t coming in with their preconceived biases, right. They’ve, they, they say, Well, I’m a limey. I’m a moldy this and they start to explain to you why they have their health crisis. Like they’re dumping their diagnosis or preconceived diagnosis. These are preconceived ideas as to what’s wrong and saying, Hey, I, here’s what’s wrong with me. And I want you to fix it. And I think well, and I, and I don’t blame them for that they’ve probably been to a bunch of different physicians, they read a lot of blogs, they’re searching and searching for answers. But they want to give us their perceived idea of what’s actually wrong. and expect us to fix what they think is wrong, right, if you’re getting what I’m saying. So they think that I might have some special way to fix their line that the 10th line specialists they went to didn’t fix it.

But I’m going to have this solution. It’s probably the thyroid because I’ve been to 10 Lyme specialists, and it didn’t get better. I’m a limey. And so if that hasn’t that treatment hasn’t worked. So maybe it’s the thyroid, and maybe it’s just, that’s the little thing I need to fix. And then everything else gets better. Or I’m a moldy or I’m an EBV person, or I’m a whatever. So I think those are the hardest people to get better at.

And to be fair, some of the sickest people I meet and some of the most over supplemented people I meet are functional medicine practitioners and functional medicine coaches, because they are, they’re trying to fix signs and symptoms, they have access to all the supplements, they say no and have a lot of connections and they go to a seminar to learn about Lyme, I probably have Lyme, I’m taking cheap taking this. And so for me, those are the people that I have to have that kind of come to Jesus conversations like, hey, look, I know what you think is wrong. And you might be right. But we’re going to turn all that noise off right now.

And we’re just going to take a look at things from a fundamental standpoint. And that’s hard for people because they’ve spent a lot of time and effort researching what they think is wrong and have some good ideas and concepts. The problem is, the way they’ve gone about it or the way they’ve gone about it with other physicians hasn’t worked. So if we keep looking at what’s wrong with them to that same bias lenses, the problem is we’re probably going to want to do the same things.

And we have to as a good functional medicine practitioner stand back many times look at the 30,000-foot view and say, Okay, you’ve got all these different diagnoses and you’re treating the diagnoses, a, maybe you’ve got the wrong diagnosis, right? And B, are you really doing anything different than we give allopathic medicine a hard time for doing right? So we say, Well, I have Lyme, but I’m not going to use antibiotics, or I’m not going to use this method. I’m going to use these because they’re natural. Well, okay, but aren’t you still treating the disorder, instead of saying, Let’s take a step back, you’ve treated it 10 times and you still have Lyme? Maybe we need to take a step back and say, why is Lyme have such a great time hanging out in your body?

If that’s actually the case? or Why are you so susceptible to mold when nobody else in your family or your residence is maybe there is mold in your home? Maybe it’s contributing to the problem. But maybe it’s not the problem. So trying to talk those people kind of back a little bit and say, Hey, just let’s take a broad look at it. Let’s see what’s maybe going on? Let’s leave the preconceived notions behind. Because if we come back into it, if you come to another practitioner within that practitioner are going to assume everything you said is optimal and right and accurate. And assume that everybody else you saw was a good physician.

Why would they do anything differently? Right, so we have to take a look at things differently. And then the other part of that is sometimes we have people that are so kind of married to the treatment strategies that they’ve done so far that isn’t working, that we have to

we have to get them to divorce some of those strategies to have success. So you, you know this you see people come in, I’m chronic health issues. I’ve seen 10 functional medicine practitioners, my medical doctors who aren’t able to help me they have been able to help me. And then you look at what’s going on, they have 15 diagnoses and they’re taking 18 2025 different supplements.

And you’re like and they want the next supplement that’s going to fix them and you have to be hard. I mean, you have to be kind of rough with them to some degree and say look, if you need 25 supplements, cat bottles, not individual capsules per day, but 25 different bottles of supplements every day to survive and to function. And this is your function. You probably don’t need any because they’re probably part of the problem. And I think we make that mistake in medicine. times that we’re in hell in functional medicine, we give allopathic medicine a hard time because they’re prescribing medications. And we say, hey, that’s not good, we’re gonna give you supplements instead. And we switch out, you know, five medications for 25 supplements, and we assume that that’s better. It’s just greenwashing of medicine.

It’s not any better, it’s the same print, it’s the same principles, right, I’m going to treat the sign or treat the symptom, we’re just using maybe natural supplements, but it’s not necessarily a healthier change. So getting people off of those things is hard. The person who comes in who’s a fresh palate is like, I’m chronically tired. I’ve never heard of functional medicine before. Dang, those people are easy, because you just get you to start talking to them and tell them, Hey, this is how it works. They have no preconceived notion, this is a whole new world for them. So they’re like, hey, that makes sense. And there, those are the easiest people sometimes to work with.


Dr. Joel Rosen: Yeah, that’s a good point, in terms of they, I think it’s a double-edged sword with a diagnosis because I agree with you in terms of, I don’t want to hear your old diagnosis. After all, you are in a paradigm that you’ve locked into. And like you always say, trying something different is not going to get different results. You know, trying something the same, sorry, it’s not gonna give you different results. But at the same time, like we kind of have a diagnosis in terms of, okay, foundationally, there’s low-grade inflammation, there is supply and demand problem, your blood sugar is not being stable.

It’s signaling a cell danger response in your body, all of these dominoes are falling. And we want to get as far upstream as possible. And we find that I’m sure you find this to as well, even the ones that are married to a diagnosis, they always are looking for root causes, I found I find, you know, like, even if they know I have a thyroid issue, and I, you know, I take this medication or that medication, I really, most of them don’t want to take the medication, they would like to get to the root cause, and maybe just put that fuse in the fuse box that fixes the thyroid,

and then all will be done and all will be happy. So I echo that with you as well. As far as now let’s say you are working with someone, and they’ve bought into the idea that it’s not a reductionistic just fix the thyroid thing. And you’re educating them in terms of the consequences of supply and demand or cell danger in the body. How do you typically go from there in terms of strategies? And I guess this is a general question, but how will you go from Okay, having someone except that you need to find out what’s going on physiologically foundationally fundamentally in their body? How do you convey that or what do you do going forward? I know it’s a general question. But maybe you can kind of sum up how you go about that.


Dr. Eric Balcavage: Yeah, well, I think the first part is to get them to realize there are two different operating systems, right one when we’re in homeostasis are in a low-stress state and one when we’re analysis aces, which is an excessive stress state where we were in kind of in danger mode, right? And so for most people, I try and make sure they understand that concept. And I usually come analogy, like if, if they were cooking in their kitchen, right? And they had like four burners on their kids are at the island, and they’re all having a great conversation. And somebody broke into your home and started attacking one of your kids, right? Are you going to continue to cook? And most people will like, No, I’m gonna go protect my child. Right? So you’re gonna take the time to turn off the burners? No, so all the food’s gonna burn, right?

Yeah. Okay. So you’re going to protect your kids, right? That’s the only thing on your mind. Absolutely. I say I say is the food’s gonna burn. is the kitchen getting cleaned? up? No. is the wash getting done? No. Are you having sex with your spouse? No. Are you taking a nap? No. Okay, so then we could look at you at what’s going on in your house. If I don’t see that somebody is attacking your child and just say, Oh, I know exactly what’s wrong with Joel. He’s a terrible cook. He’s a terrible housekeeper. He’s a terrible spouse. Right? And so what I’m going to do is I’m going to just, you know, get it to get a housekeeper to get a cook, get a chef right. But is it fair for me to say that Joel’s just all these? He’s just terrible at all these things? Or is it unfair that well, it’s unfair because I’m attacked, protecting my child? I’m like, right? When you are innocent, when you see danger, you’re going to address the danger. Everything else that’s not important to survival and protection is going to be ignored.

And that’s when the light bulb goes on to people is like, Oh, so is that what’s going on? Is that why I mean, I’m in danger mode. I’m like, right? So if you’re in danger mode, you’re not stopping to have sex right now. Well, that’s why your hormones are probably going to become dysregulated. The longer you’re in danger mode, that hormone physiology is going to have to essentially return down the dimmer switch on normal hormone regulation. And in a time, we’re going to see abnormal hormone regulation. And in time, we may actually see dysfunction and disease. If it’s there long enough. Why am I not sleeping? Well, if you’re in danger mode, and you’re protecting your child, are you going to take a nap while you’re in this person’s attacking your child? Absolutely not. Okay. Well, then why do you think when your body’s in danger mode? Do you think you’re going to take deep restorative sleep? No. Okay. So now they start to get the idea that the body does have two mechanisms.

And so what I try and tell them like, we’ve got to identify what’s creating that stress, stress response, or that excessive stress response, that danger response. And we need to reduce the stressors so that your body comes out of danger and protective mode and can go into healing and restorative mode. And I tell them, it’s almost like if you had two cinder blocks and a plank, right, and think about stress, like five-pound weights or any weight, right? If I start stacking weight on that plank like that plank can hold a certain amount of weight, just like you and I can manage a certain amount of stress. But if I put it that stress, if I keep stacking five-point weight pound weights on there, I get to 100 pounds, that thing’s balling. And five more pounds, I put on there the whole thing snaps, right?

And that’s how stress is for us. Because we were always trying to identify what’s the one thing? Is it lime? Is it mold? Is it my heavy metal toxicity? The reality is what’s creating the chronic danger response? For most of us, it’s not an acute thing. Typically, we think it is, but it typically isn’t. But it’s chronic stress. It’s antibiotic use, we started early on in life, it’s chronic infections. It’s disrupted sleep patterns, its hormones, its medications, right? It’s the accumulation of emotional stress past trauma. And it’s these five-pound weights that keep building up. And eventually, that breaks us down puts us into danger mode. And I tried to tell people,


Dr. Eric Balcavage: if the other option is is that it could be acute stress, I could drop 100 pounds on that board. And guess what it’s gonna break, right? Because it’s too much too quickly. So you can have acute stress that creates a danger mode, where you can just have chronic long-term stress, and you never, it’s really hard to figure it out. We always think it’s the last thing like, well, I went into this moldy house, and that’s when everything got terrible. Well, that was probably the least that’s the thing that broke the board.

And so now what we need to do to fix you, is we need to reduce the stress, rebuild the board, and then you’re going to be stronger, and people are like because I’ll ask them which stressor? Which five-pound weight? Do I need to take off the broken boards to fix you? But the last one, okay, so if the last thing that you recognized as the problem was gluten and you stop eating gluten, and that’s one of my that was the last five-pound weight on that board? Is the board fixed? No. Can I even get to the board? If I have 100 pounds laying on that broken board? Can I even get to it? Probably not.

So what do I got to do? I got to start pulling lots of stressors out of the system, right? I got to fix sleep, I got to reduce emotional stress, I got to have better exercise habits. I got to start pulling lots of stressors off those broken boards so that the danger response essentially goes away. Right? And they can rebuild and rehab the system, I got to take all the weights off the board, rebuild the board, put it back on. And now I can slowly start stacking stress or weights back on that board.

And I think people start to get the idea. All right. So I tell them my goal with everybody. I don’t care what your diagnosis is, is to take a 30,000-foot view of what’s going on. Look at your health history, your health timeline, your signs and symptoms, and a good comprehensive blood chemistry panel as the starting point and say, All right, here’s how you got to where you are, right? There’s an I think two famous philosophers Shrek and donkey, right. And they’re walking through the field. And I think it’s donkey says, you know, people are like onions, right? You got to peel back the layers. And he’s right or ogres are like onions, you got to pull back the layers and we’re like layers typically are the things that caused us to break down aren’t the new things. They’re the things from years ago that we just kind of either placated, medicated, or ignored, that never really went away, but just became part of that stress load. And so hey, we’re gonna, we’re gonna identify what’s current that we can address. And then so we’re going to reduce the current stress load of what’s active that we can actually address, sleep fitness breathing, organisms try and get those in check.

And then we got to also take a look at what systems have now become compromised, we know the adrenal system is going to become has become compromised gi, thyroid neurotransmitter. And I tell people all the time, you should expect lots of systems to become compromised under chronic stress, it’s what I call a multi-system adaptive disorder. When I’m in chronic stress like we were talking about, I’m when I’m trying to protect my child, I’m gonna have food burning, I’m not gonna wash, it’s not getting done, I’m gonna have cleaned, that’s not getting done, right, all those things aren’t going to get done, they’re not getting attention, because my attention is elsewhere, right? So we should expect the adrenal system is going to become changed, our hormone physiology is going to change our thyroid physiology is going to change.

And we look at those changes like they’re broken. In reality, it’s adaptive, right? The body’s saying, hey, initially, I’ve got to adapt, I’ve got to help this danger process out, I got to help that protective mode, I’m going to take energy away from here and put it to here. And when it’s short-term, it works fantastic. The problem is when it becomes chronic, that’s when we start to see the dysfunction of those tissues in the disease. So we have to assess, reduce the stress, reduce the danger response, then we have to say, Okay, what systems we have a need, we need to work on to help those systems actually recover. And so the recovery piece is building those systems back up, nurturing them, helping them start to function again. And then the last piece of the process is restoring kind of cell to cell communication, that normal cell to cell communication. I think most people don’t hang in there long enough, they start to feel better. And then they go back to habits before they’ve really restored cell to cell communication. And for to go back to that analogy, like,

why do we need to get really reduced that stressors and make the danger response go away is because like, even if you’re somebody’s broken house, and it was attacking your kids, and you fought off that attacker, or you go right back to normal? Or do you kind of stay like, hey, there’s somebody else break in here, and you’re on edge for weeks or months on edge, because you’re not certain convinced that danger response, many times where people are, the stress goes down, they’re sitting there threshold response, meaning the dangerous bond starts to ease, they feel a little bit better. And they think, Oh, I can go right back and do all those things.

And it comes right back, but you don’t go right back to his normal physiology. Really, the last pay phase of healing, which is where people need to hang in the longest is when we have that cell to cell communication restored. And I usually explain that like in a fight, if we’re getting in a fight with somebody and you and I are hanging around at a bar or having a good time having dinner and we got there’s a fight breaks out. You know, we’re not going to have that Hollywood, as a jokey conversation. While we’re in a fight, we’re going to be focused on ourselves, nothing else matters. And we’re not going to restore, just sit down, we’re going to have a beer and drink conversation until we’re convinced the dangers are gone. So we have to hang in there long enough that we get that normal communication cell-to-cell communication back.


Dr. Joel Rosen: Yeah, it’s awesome. And not only that, Eric, it’s also I mean, inherent in our, in the, in our evolution, and terms of the millennia in terms of our reptilian brain and our limbic center and our parasympathetic stuff, where you can’t just avoid, like, end the situation. It’s like that great book, why zebras don’t get ulcers. When a zebra is running from a lion, you just have to be the second slow, you know, second slowest, you can’t be the slowest. But when you go to the watering hole after they don’t have like zebra conventions for hay almost being eaten by the lion, I mean, they’re just on with it.

And they don’t have that other center in their brain where it really puts, an emotional component to it. But I love your analogy as well. I tell people, Eric, that, you know, think of me as a business consultant to your body. And you’re asking me how do I increase my income? And a lot of the times you’re thinking of that in ways of what more supplements can I take that the 10 other guys that I told them, the same thing was wrong with me, gave me maybe you have that secret supplement to increase my income, that secret business thing. But really, as business consultants, our job is to address all your expenses.

And then you eliminate those expenses so that you have more disposable income. So that’s what I tell them as well. So it’s interesting that you say that. So as far as where does the form, from a system failure you’re talked about, and that’s where you and I kind of went down set Roads, which are really the same, I mean, the HPA axis, the HPT axis, the hypothalamus, pituitary adrenals, the hypothalamus, pituitary thyroid, maybe speak to that a little bit in terms of how that does involve the thyroid or the adrenals, and how you may want to address what they’re already bringing to you in terms of medication. So it’s a two-fold question. So number one is how are the systems involved from the feedback loops that initiate thyroid and you can just go with thyroid or adrenal or however you want to go? And then how do you kind of tweak what they’re already doing with? Specifically medications?


Dr. Eric Balcavage: Well, okay, so a couple of things is, I think, I think you said is, you know, we went down to different roads, thyroid, whatever, I think you and I know, and I think that your listeners should know, too. I mean, one of the things that happen is, we need to have a talking point, right. So while you’re done you talk a lot about adrenal physiology, and I talk a lot about thyroid physiology. A good functional medicine practitioner, in my opinion, is not a specialist, like like, I only do thyroid, or I only do adrenal. Typically, what we’re doing is we’re talking about a subject that we’re passionate about, but beyond that initial subject, thyroid physiology, we have to be a great generalist, right to be able to address because you’re not necessarily going into to somebody who’s got an adrenal issue and saying, let’s just load you up with the things that are gonna stimulate more cortisol, or we’re gonna give you a bunch of things that inhibit cortisol, right.

That’s more of a medical allopathic philosophy. And really, in functional medicine, philosophy, we want to say, hey, look, we’re talking about thyroid physiology because that’s what catches that person’s attention. And then we can have a conversation with them about what, what how that relates to their chronic illness. It’s not the issue, but part of a bigger web of dysfunction. So I think that thing is important, because I did discuss with somebody who’s, who’s a functional medicine practitioner, and they were talking about, I think it’s terrible, that we see all these people in functional medicine being specialists, because that’s what we gave allopathic medicine a hard time for.

And I’m like, I don’t think I said that. I agree. There are people in functional medicine, they say that I just treat a dream, they just, I let in, I’ll talk about thyroid physiology, in that they just address thyroid physiology, and they just take their like, they’re only focused on thyroid physiology. So they’re either trying saying, Hey, we’re medicine bad, we’re given t four and T three instead, t four only, which is what allopathic medicine often does. Or I’m an even better physician, because I’m going to give t three only, or I’ve got a magic supplement that helps convert t 43. Or I have something that’s going to reduce your reverse t three. And they’re doing the same thing that allopathic medicine is which is trying to manipulate numbers and doing whack a mole type stuff. But I think most of the people that I kind of resonate with and I’m sure you do, we talk about our physiology as not the problem but an adaptation by the body and say, okay, your thyroid physiology isn’t working, how it would in homeostasis in a non stressed state, which means you’re in a stress state. So let’s figure out why. Oh, but somebody told me I have adrenal issues. Well, you do and you should expect to have adrenal issues. And I’m sure in your conversation, you’re somebody says, I have an adrenal issue, I have adrenal fatigue, you have Geno consequences. And you’re probably going to have those because you have some type of chronic stress response or acute reset stress response.

And depending on how well your body’s adapting to that stress, you could be hypo or hyper, and it is going to impact other tissues. So you don’t have just an adrenal issue. You have a web of dysfunction that’s going on due to some type of cell stress. And that’s what we’re going to work on. the same person, the same person walked into my office, like, Hey, I have adrenal fatigue. Or I’m seeing Joel because I have adrenal fatigue. Now, I want to see you because I have a thyroid problem. You don’t need both of us, what you need is one of us to help you address the root issues that are going to cause your thyroid to be dysfunctional, that’s going to cause your adrenal to be dysfunctional to create cause you’ve got to be dysfunctional over time. So you really need one person who’s a good generalist, and while we might, on our blogs, or post have a theme that we talk about, most of us in functional medicine should be pretty really good generalists, right? So go ahead. No, you go, Okay, well,


Dr. Joel Rosen: no, I was just gonna say that’s awesome. I tell people that all the time. And as far as well, you know, if Finish your sentence because I was waiting.


Dr. Eric Balcavage: I was gonna go into the next thing you were wanting to talk about. So but go ahead.


Dr. Joel RosenYeah, do that. Do that. Go ahead. Yeah.


Dr. Eric Balcavage: So I think the next question you had was how does thyroid physiology maybe change? Or and how and maybe other systems change and result in an excessive stress response? Right. So my perspective, okay, based on what I’ve read research papers, and I’ve read a couple of papers. So, my did typically, I think the current theme, I think, for the general population, from an allopathic approach is that, hey, the thyroid, hypothyroidism starts when the gland becomes dysfunctional when TSH goes above range, T, four drops below range, you have primary hypothyroidism, and that’s when a thyroid condition begins. Maybe, but I’d say that’s a very small percentage of the cases, okay? Then you’ve got kind of maybe the alternative or functional approach and where they say, hey, and this is a blend, I think sometimes between allopathic and functional medicine, where we say, Hey, no, no, what’s really going on here is you have an autoimmune condition called Hashimoto’s. And that’s creating damage to your thyroid gland.

And so your, your allopathic doctor doesn’t know what they’re doing, or they’re looking at TSH in free t four. And so they don’t even know this is going on. And the, I’d argue that point, I’m like, probably most of the allopathic physicians know that the vast majority of people, at least in the US have Hashimoto’s, the issue is, who cares? in their MA in their model, you diagnose you don’t provide thyroid hormone to somebody until their tissues are exhausted, right, until they can’t make enough anymore. And, I agree that that’s probably a good strategy, you shouldn’t be overloading thyroid hormone into a system that doesn’t need it yet. Okay.

And but from there, they don’t care if you have Hashimoto’s, they just know that your thyroid gland is being damaged is at some point, we don’t know what causes Hashimoto’s. And your immune system is out of control, and it’s going to destroy your gland, you’re gonna need thyroid hormone simple, and all you got to do is put enough thyroid hormone into the system. And then it’s going to get into the tissues, like all we have to do is put enough gas in the gas tank and your thyroid physiology is going to work. And the idea is good, you have to have some gas in your car for it to even start running. And so you have to have a certain amount of thyroid hormone a tissue for it to run. But just because you have thyroid hormone in the bloodstream doesn’t mean that your thyroid physiology is going to be optimized.

Instead, what I try and get people to think about is what causes chronic hypothyroid set any root causes hypothyroid symptoms, hyperthyroid symptoms is typically what’s happening at the cell and tissue level. So if you are experiencing hyperthyroid symptoms, it’s not it. Yeah, you might have too much thyroid hormone being made by the gland. Yep, absolutely you could be taking too much thyroid medication. Because what happens is, it’s what how much thyroid hormone t three is getting to that cell and tissue. And binding to receptors is what’s either causing hypo or hyperthyroid symptoms. Okay, so I think most of the issues started to sell. So I think, well, from what I’ve learned, I’m sure you’ve learned from the cell danger response is when we have excessive stress, the body needs to switch its function like we were talking about with the person cooking, they go from cooking mode, and, and, and, and parent mode to protect her right? In the, in this in the cells in the tissues. If, if I’m a cell and I’m perceiving stress, excessive stress, or danger, I’m going to stop making hormones.

And I’m going to reduce the production of proteins and enzymes. And I’m going to reduce bringing glucose into a cell because that would if there’s danger inside the cell, there’s a bacteria, a virus, a toxin, that cell is going Hey, wall myself off, separate me from everybody else, find this thing that’s creating the stress and fight it and get rid of it. And by the way, the next thing I’m gonna do is I’m going to send out warning signs to all the surrounding cells and tissues to say, Hey, I’m in danger, look out for this guy he’s coming to get yet. And so what the cell uses as kind of the dimmer switch to either turn on normal metabolism, or turn on cell defense is t three, and thyroid hormone that’s converted some of its brought in from the bloodstream, some of its converted inside the cell. So when we think about what’s happening in a cell t three, most people understand a T three. The primary hormone made by the thyroid gland is t four, the primary active hormone is t three. So there’s t three and T For in the bloodstream, the vast majority of its t four cells bring t four into the cell. And if they want to increase their metabolism, they’re converting that T four to T three, which binds to receptors. And that turns on metabolism growth makes you feel good, you make energy Life is good hair grows, right, not constipated.

And so when T three binds on to some receptors, it turns on a lot of those actions of metabolism. But t three can also bind to receptors and turn off systems, it can turn off the cell defense mechanisms, it can turn off the inflammatory mechanisms, it can turn off my toffee, G, and autophagy. And it can slow down, it can make sure those systems aren’t always on. But if I’m in a cell danger response, a cell stress response, how do I turn How do I activate that thing, I turned down the amount of T three inside the cell, which means there’s less t three to bind to the receptors that are going to activate normal metabolism.

And I’m going to not have T three binding to the receptors that turn off cell defense. And so now cell defense and inflammatory mechanisms can kick into gear, and I slow down cell metabolism. The problem is it makes us feel like crap, right? We’re tired, we’re fatigued, we have a fever, we got shaky, we got inflammatory issues going on. And we think that we’re sick in reality, what our tissues are doing is actually doing exactly what they should do. I sense danger, I turn off the things that aren’t really important right now. And I turn on to really important things. So that’s what I call cell or tissue. hypothyroidism has been written up in the literature for over 30 years now, it’s just virtually ignored. But we’ve forgotten that this can happen. And we’ve just said, hey, let’s just dump more hormone into the system and try and force the system to work the way we want it to. And it just hasn’t panned out.

Well, it’s like if your car wasn’t running well, and you went to something like, hey, just fill up the tank? Well, it is. Okay, I’ll put gas in the tank. It’s still not running. Well, well, put more gas in the tank. But yeah, yep, we put 86 octane in, it didn’t work. So we’re gonna put, we’re gonna put a blend of 86 and 93 octave, it’ll run better. That’s not working either. And we have to start to take a step back instead of how much is in the tank and say, maybe there’s something else that the engine, right that’s not working well spark plugs, bad fuel filter, bad, something wrong. The same thing in the body, if you get diagnosed with hypothyroidism, you take t four and you feel fantastic and your levels normalize, and other markers in your blood work that would indicate tissue hypothyroidism go away. That’s probably the right treatment. But if you take the T for your TSH normalizes or drops low and your T for TSH drops lower is normal and T four is normalized and you still have chronic hypothyroid symptoms. It’s probably not being converted to active t three into tissues. And we have to start to ask better questions, not how do I force it in? But why is the body with its intimate wisdom, trying to slow down metabolism. And when we if we can we look at physiology from that perspective, like, hey, the body’s not screwing up. It’s trying to protect you from something that opens up a whole new world because now we don’t look at maybe the immune system is lost control and it’s out of control, and it can’t recover. Instead, we say, Hey, this is a cell.

This is part of that cell stress cell danger response, the immune system is upregulated. It’s trying to slow down the metabolism globally by shutting down this thing called the thyroid gland, hey, if I don’t need if I’m in a chronic state of trying to slow down metabolism, I can either turn it off at a bunch of cells, or I could turn it off at the source. And after 2726 years of clinical practice. That to me makes way more sense than the immune system is out of control. Because if it’s just an immune system out of control, I’m screwed. If it’s an immune system acting adaptively and inflammatory system acting and thyroid hormone being regulated adaptively that makes tons more sense because now I can recover because all I got to do is figure out what the stressors were reduced those to a point that the danger response goes away. And now my immune system calms down. And I’m sure you’ve seen the same thing as you’re working with your patients. And you start reducing those things that are driving the stress homeless oh my gosh, my autoimmunity is getting better. How could this possibly happen? Because your immune system probably wasn’t as screwed up as you thought it was.


Dr. Joel Rosen: Yeah, yeah, there’s awesome a lot of awesome things in there. And it makes me think number one because I’ve seen you I’ve known you for a long time. And I was going to a lot of those. Why am I thyroids? You know, why do I have thyroid symptoms, even though my blood tests are normal, and I’ve seen the evolution with you and my Self and also in terms of just Zen in the art of functional medicine, you know, in terms of initially you use the information that you have you have autoimmunity, your body’s attacking itself, and then you get into Well, it’s common sense. I mean, your body is in an allostatic overload state, and you’re not cooking your food while your family is being attacked. Right.

And that makes so much common sense. So as far as and also, I also think what’s we work against is the way we’ve been conditioned, in terms of what medical doctors do, going back to the days where you would have the guy with his doctor bag and going to the home and making a doctor visit and giving you the thing that your body needs. And then, you know, next thing, you know, it’s a reductionistic approach. And we’ve taken that into alternative medicine and people inherently, I don’t think they want to be lazy, but I think they want that pot of gold solution where jack in the beanstalk, you go to bed, you wake up, there’s a pot of gold at the end of the rainbow when you wake up the next morning, you know, and it’s at the end of the day, at the end of the day, it’s a cold, hard reality in terms of Okay, Mrs. Jones, we need to really make some lifestyle changes, we need to identify the elephant in the room.

And we need to realize that reductionistic Lee, we can’t just get off gluten and take thyroid medication, and expect that those major drainers of the battery are going to be addressed just because you know, you’re doing these other things over here. So let’s get into that. Then, Eric, in terms of and I’m like you as well, I remember you saying last time like if you’re taking all those supplements, and you’re still feeling as crappy as you are, then why are we taking all those supplements? So how have you changed in terms of now that you teach this model, and you understand that the body is in a cell danger response? And all of these accompany changes that are happening in the body? are normal responses by your body to abnormal stressors? What do you do in turn? What do you do about it now?

So let’s like in terms of incorporating lifestyle changes, nutritional changes, activity changes. Also to in terms of not, you know, not in terms of when you look at a blood test, there’s so many mechanisms where the body compensates where we get into trouble when we make interpretations on blood works and make reductionistic approaches. So I guess it’s a multi-fold. Question number one is, what’s your new protocol? Not protocols? What are the new strategies that you incorporate to give people the overall general approach to helping themselves? That’s the first question.


Dr. Eric Balcavage: So the first thing we want to do with somebody new is is kind of let them know that, hey, we’re, there are a couple of things we’re going to need to do here. One, we need to know how we got here. So that’s why it’s so important to do a health timeline on somebody, look at their health history, look at their symptoms, and look at their and look at a good comprehensive blood chemistry panel. You know, when somebody says to me, hey, I’ve got a full thyroid panel, where I can you look at my blood, I have good blood work done, and all they have is a TSH 84. My standard answer is you can’t assess thyroid physiology by looking at a TSH 94, you really can’t even assess thyroid physiology by looking at a comprehensive thyroid panel. I think what we need to do when we take a look at somebody is look at blood work from a pattern perspective, not an individual marker perspective. So what I always try and do is say to somebody look, based on your health history, your timeline, here’s likely the mechanism of action.

And here are the current stressors that are having an impact on your life. And these are the things we’re going to have to make some modifications to your diet, we’re going to take a look at your we’re gonna have to take a look at your respiration, do you breathe too much do you breathe in properly, we’re gonna have to remove, we’re gonna have to address those things. If you’re not sleeping, well, we’re gonna have to address those things, why you don’t sleep well, and how to help you improve your sleep. We look at your habits, what are the habits that you have are those habits that are helping you promote health are those habits that you have promoting more illness and disease, we’re gonna have to make some changes there. So I go through what I call my fitness factors and say, Hey, we’re going to have to raise your level of fitness in each of these categories over the next, you know, six months or so so that we can get you to a higher state of health. The other thing we need to do is we need to look at, like, what we need to address and what systems are compromised by looking for patterns in the blood work and so, like, I look at it, I’ll look at somebody labs and look for Okay, this person’s coming to see me So do they have a tissue or cellular hypothyroid issue going on? Are they already diagnosed with glandular or gliac glandular primary hypothyroidism? Are they already on medication? Do we already know? Like, what’s their history is going to tell us stuff? But regardless of whether they have been diagnosed or not? Do I see a tissue hypothyroid pattern on their thyroid panel?

And if I do, or I think I do, then I want to go look, are there other things in the lab that will help me understand that? So if I don’t see it in the thyroid panel may look All good? Do I have a potential tissue hypothyroid pattern, even though I can’t see it in the labs, and you might say, well, when you see it in the labs, what all depends on what medication they’re taking, because we’re really, really looking for it, they’ve been medic, if they have already diagnosed with primary hypothyroidism, and their TSH is normal or low and their t fours normal, what we’re going to look for is there a convert, are they having a reduced conversion of T four to T three, and an increased conversion of T four, to reverse t three? Well, if the person is taking t three, those values are out the window, because now they’re taking t three, which is going to raise t three values and lower t four values. So already, I’m out of the game if they’re already taking just t three. Now those t three values are totally invalid as to whether there’s a good conversation because they’re artificially loading lots of T three into the system. So you may not be able to see it in a traditional thyroid panel. So we have to keep our eyes open. But we have the symptoms that we can see, then we start to look for patterns, do I have an inflammatory pattern in bloodwork that might if I have an inflammatory pattern, we know that when there’s increased inflammation, we get suppression of TSH early on. And we get decreased conversion of T 43.

And we see an increased revert conversion of T four to reverse t three. So we know that those mechanisms are going to start to occur. So do I have inflammatory markers? So we look for those inflammatory markers on the bloodwork and say, Yep, I’ve got inflammatory markers going on. So yeah, I probably have a level of tissue hypothyroidism that’s going to kind of confer with the chronic hypothyroid sentence signs and symptoms my patient has, then I look for patterns in other for more patterns. And one of those patterns I will look for is a dysglycemia pattern. So do they have elevated fasting blood sugar? Do they have elevated insulin? Do they have elevated hemoglobin a one c? Do they maybe have a problem with LDH? Do they have lower creatine levels? So are they do they have good blood sugar control? Are they making appropriate energy?

And if those values are out, I’m like, Okay, we got a blood sugar issue. And you might say, Well, what, what’s the relationship there? Well, you to get glucose into cells, whether it’s a fasted or non fasted state, you need, you need t three. And so if you don’t have sufficient t three in the tissues, you’re going to start to see insulin resistance. And then I’ll look for a cholesterol pattern. So if I have elevated or a liver, so I looked for the lipid pattern where I see elevated cholesterol and LDL, what does that tell me that tells me I’m not getting enough t3 at the liver to activate the LDL receptors. So now LDL stays elevated because he’s got to carry cholesterol around and cholesterol gets elevated. That’s another pattern, I look for a pattern of early fatty liver issues going on. So I’ll see a rise in triglycerides and a rise in VLDL.

And probably a lot rise in cholesterol, and LDL as well. So I’ll look for that. And they’ll just keep looking for different patterns in the bloodwork that kind of confirms that there’s some level of tissue hypothyroidism going on. And then once I see that I’ll say, then I’ll sit down with the patient. And listen, you definitely have a tissue hypothyroid pattern going on, you definitely you have a multi-system adaptive disorder going on where now you’re starting to have changes in your hormone regulation, you’re starting to have problems with blood sugar regulation, you’re starting to have problems with renal function, you’re starting to have problems with liver function.

And all of these things aren’t broken at this point, because your doctor hasn’t seen disease there are there their function is adaptive, because of some type of stress response. Now we got to get busy addressing those stress responses that are and reducing that stress response. Some of those things that caused it are gone. As they happen, they’re gone. But you’ve you adapted to those things and never, never recovered from those. So you have an adaptive change that’s kind of stuck, and other things are current. And all you got to do is start working on reducing that load. So that way the danger response goes away. So I’ll look for the patterns in the blood work, and be able to help them understand why they have multiple issues going on and is part of a web or an adaptive disorder versus individual things. And then that blood work also helps us understand where we need to go next. To assess the rest of their physiology, it may direct me to look at their GI tract, it may direct me to look at their hormones, it may direct me to look at what’s happening with the adrenal function so that we can work on it, but foundationally that’s the foundational start for me, then we start working on, okay, let’s die, it is so important and got so important.

And then each time I meet with them, we’re working on a different lifestyle factor. So we can work on, they have time to Oh, breathing, you don’t want to I don’t want to dump all those things onto my patient at one time. So for the next few weeks, we’re going to be working on this kind of cleaner diet, get you off the standard American diet, get you on to this cleaner diet, we’re going to see how this diet impacts you, then we’re going to see if we have some good stuff going on, we’re gonna start addressing it, then we’re going to start moving through the systems and start working on them. Those are the things I’m going to help you do with diet and nutritional supplementation. And then I’m same time you’re going to one at a time start working on incorporating how to improve your individual fitness in each of these lifestyle categories.


Dr. Joel Rosen: Yeah, that’s an awesome answer. And just to kind of recap, we’ll just one thing that you said which maybe the novice listening to this doesn’t understand. But you said I’ll look to tell them if there is evidence in terms of cellular hypothyroidism. Or if there isn’t, then all of the trends that I see in the other labs suggest t three issues at the cellular level. So we’re just talking about the traditional approaches looking at t four and TSH, which is telling us about what the gland is doing, versus t three at the level of the cell, which may not directly be shown from the lab work but can be inferred with other things, which is saying, Hey, we’re not really so much concerned about what the gland is doing. Yes, it’s important. But what is going on at the level where the tissues use it? What’s going on there?

I guess in, in, the last question I want to ask you is What do you feel is your biggest clinical pearl that will help move the needle the most? given everything that you’ve said, because you’ve shared a wealth of information that helps your clients the most? I mean, is it breathing? Is it dietary changes? Is it all of the above? Is that mindset? What do you find that will always make a difference with someone that you’re working with a combination of things?


Dr. Eric Balcavage: Well, I think the most important thing is to get the person to understand they’re not broken. Okay, I think that’s we have to get away from the um, the broken I’m broken men mentality, and that they have a disease association that that because if you identify as your disease or disorder, or think you’re broken, it’s hard to get better. And then the second thing is, I want to get across to them, that the most important things that they can do are often the free things. improving their diet, improving their sleep patterns, and habits improve improving their daily habits, improving breathing. It’s funny, I just had a discovery call with a new client.

And he had listened to the podcast where we talked about breathing and the significance of breathing. We talked about nose taping and mouth taping, controlled hold breathing, and really getting control of the breath and doing breathwork. And he said I was taking like 30 different supplements per day. And I learned I listened to that podcast. And you, he said you said, if you need to take all these supplements, and

you don’t feel good, you probably don’t need to. So I started weaning him off and working on the breathing exercise. He said,

I can’t believe how much better I feel. And I was trying to find the magic supplement in a bottle. And I didn’t realize the magic supplement I needed was oxygen. He goes, I can’t believe how I didn’t get it. I didn’t understand it. And they said it’s it sounded so like, like when you talked about like tech, that can’t be right. But he’s like, it’s made the world of difference. He said I’m taking half the supplements. But I’m working on breathing.

And I feel dramatically better. I cannot believe how something as simple as getting is working on breathing can be so beneficial. So, you know, I think that’s the most important concept that we can help somebody do. It’s not sexy, working on breathing exercises, not sexy. That’s super fun. popping a bottle, you know, pop in a couple of capsules is a lot easier, saying hey, maybe really getting involved with maybe a Facebook group that talks about Lyme and mold and all those things that may be a little bit more exciting and enticing than somebody saying, Hey, you got to work on your breathing. But man, it’s often the stuff that’s free that is the most impactful in our physiology.


Dr. Joel Rosen: Yeah, no, that’s awesome answers and I echo that too when someone labels themselves as being broken, it’s hard to unfix that bad golf swing for sure. And then number two is ironically You know, one for energy storage and metabolism and oxygen uptake to the cell. That’s what the thyroid function is charged to do amongst other things, and it would make sense that at the 30,000 view foot if you can slow down your breathing not be as quick but get a lot deeper breath work and a lot more exchange of gases, how that’s going to help you immensely and it’s free. So co-host of podcast thyroid answers, where else can people get in contact with you, Eric?


Dr. Eric Balcavage: You know, they can always reach out to me at my website Rejuvagen center calm and you know, I’d say where I’m most is obviously I got a Rejuvagen YouTube site so they can see a lot of my videos there and then I guess you know, um, Instagram probably the most I also mean have some posts on Facebook but I think I do most I probably a daily post on Instagram and Facebook, I guess. But Instagram is where I kind of do most of those things.


Dr. Joel Rosen:
Awesome. Well, listen, this is part I think this is part three or Part Four, but we’ll get you back for Part Five sometime soon again, and thank you so much for your time and I appreciate all the information that you’ve been providing not just me, but everyone in the world and moving the chains forward for the profession. So thank you so much for everything you do. Thanks, Joel. Thanks for having me. Awesome.

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