The Thyroid Debacle: Understanding the Issues

Eric Balcavage, DC

Sure. So I am a chiropractor by initial training and then because of family issues, I got back into my early training, which was blood chemistry to help a family member who was diagnosed with hypothyroidism. So they got diagnosed with hypothyroidism, fibroids, and anemia. And the solution was to hysterectomy, thyroid medication for the rest of your life, and iron for the rest of your life. And it did not seem like a great strategy for somebody in their twenties. So I started digging back into the blood chemistry and realized what you probably had going on with some type of immune-related disorder and that drove me back into the blood chemistry and studying functional medicine and which is what I have been doing for the last three decades now. Along the way, as I was doing all my training in functional medicine and studied, a lot of Datis Kharrazian’s work who is kind of like the godfather of functional medicine when it comes to thyroid physiology. 

I realized something still was not right with the way we were assessing and evaluating things. And that led me to take a deeper look into cell physiology. And once I started looking at thyroid physiology from the peripheral cell perspective away from the thyroid gland and I started to realize that what we were probably seeing in most of our clients was not physiology that was broken but adaptive physiology. And that the hypothyroid state was more of a response to excessive stress than it was an immune system out of control. And I thought that message was being missed completely in allopathic medicine and I thought it was being misunderstood in functional medicine as well. So that led me to start my podcast, Thyroid Answers podcast, where I have this discussion quite a bit and then eventually led me to write the book with a friend of mine, Dr. Kelly Halderman, called The Thyroid Debacle.

Jen Pfleghaar, DO, FACEP

Yes, I love it. And a lot of us that come into the integrative and functional world, we have either ourselves or someone close to us that really conventional medicine has missed the mark on it because it is not just treating one organ like you said, it is not just the thyroid. You looked at the other cells and how they were affecting the thyroid. So what do you see as the most pressing problems that the allopathic and the functional models, thyroid care?

Eric Balcavage, DC

Well, I think the biggest problem with the allopathic model is that they do not have the tools to deal with altered thyroid physiology until we have got all our gland dysfunction. So by the time, somebody is actually diagnosed with primary hypothyroidism. They have lost more than 90% of their thyroid gland. So that would be like saying, “Hey, we are not going to try and help somebody with cardiovascular disease until they have had their heart attack. We are not going to help somebody who is diabetic until they are full-blown diabetic and they need insulin.” So the issue is allopathic medicine just does not have tools for assessment of what is going on at the cell level. And they do not have a tool to intervene sooner. So the only real solution is to wait until the gland is diseased enough that the body does not produce T4 and then just give it.

And then the other part of that is even though it was early on, I think they were concerned about what was happening at the cell level. They did not know how to interpret the labs T3 and reverse T3 when they started trying to use those as tools to evaluate the treatment of giving the T4. And so they just scrapped the whole process and really at this point almost ignore what is happening at the peripheral cell level. And I do not think it is because they are bad people. It is just the way the training is. And that is, so we do not have tools. So if we do not measure it, we do not have to manage it. If we manage this, this makes it look good. And we all consider everything else a different condition. 

In functional medicine I think a big part of our problem is that we look at what the allopathic community does with only measuring TSH, T3, and T4 and say, well, that is very short-sighted. T4 needs to convert to T3 or it can convert to reverse T3. And we need to look at antibodies. They never look at antibodies. Well, I think most allopathic physicians at this point realize that the vast majority of cases of primary hypothyroidism are probably caused by an immune-driven process. So they already assume that that is the case. So they do not run it. And because they do not have a tool to do anything other than give T4, nothing else really matters to them. 

But in functional medicine, we say, hey, “Well, what is happening to that T4? Is it being converted to T3 or is it being converted to reverse T3.” T3 being the active form of thyroid hormone in the cell, and reverse T3 being a deactivated form of T3 in the cell. And I think that is good because we are looking at what is happening at the tissue level and saying, hey, the cells are either activating it or deactivating it. But I think a lot of people are getting the next decision wrong. They are looking at that and saying that the body is not able to convert T4 to T3, therefore we must give it T3. Or they are saying, “Oh, you are deficient in the cofactors to convert T4 to T3.” So, therefore we just need to load you with cofactors. So they do not know really how to interpret thyroid physiology appropriately. My opinion, my bias. Because if it was a deficiency in selenium B-6 or cofactors, then we should expect that their reverse T3 would be low as well as the T3 because there are not enough cofactors to run the DNA enzymes. But if T3 is low and reverse T3 is high, then it can not be a cofactor deficiency because the enzymes use the same cofactors. So the next thing that should be considered is the lack of conversion of T4 to T3 and the increased conversion to reverse T3 that is broken physiology or is that more adaptive physiology? And I do not think that questions being asked in functional medicine and integrative medicine to some degree, we are just saying, “Hey, if the body is not doing it, let us just jam more T3 into the system.”  But the question that needs to be asked is if that is truly broken physiology, maybe we should look into why it is not working. And if it is adaptive physiology and the body did not want the T4 converted into T3, why would we think just blasting the body with more T3 is the solution if it did not want it to begin with? So I think that is where things really start to break down and that is where we see a real frustration in both these physicians that are doing T4, T3 therapy and it is not working in the patients who are trying T4, T3, or T3 only and it does not provide the long term results they want. And in the scientific literature where they are beating the heck out of each other to try to determine what is the right drug for everybody, there is not a simple answer. 

Jen Pfleghaar, DO, FACEP

Right. I love that. And as you said, it is kind of a debacle because the allopathic world, conventional medicine, I know I was told when they told me I had Hashimoto’s through a frozen biopsy to rule out cancer. They probably should have checked my antibodies before. But they told me there is nothing you can do about it. And I was in medical school at the time and I just believe them. But to this day I will get patients that come into my integrative medicine office and we are in the 20, and 22 here. And they are still telling patients, if you have Hashimoto’s, there is nothing you can do. And like you said, by the time their T4 finally shows up low in the labs, they have lost the function of their thyroid from the autoimmune disease. So we are missing that point in the allopathic. And then like you said in the functional, I can not tell you the number of times patients have come into my office and they are on a high, high dose of Armour or NP thyroid, and they still do not feel good. Their numbers are still a little wonky, right? So, you can not just blanket treat these patients, I think it comes down to some finesse of how you are thinking about them and taking a step back and not treating it as a thyroid disease, but the whole body. So this kind of gets us into the cell danger response. And this is kind of something that you think plays a big role in the thyroid. So can you talk a little bit more about this all-danger response and the role that the thyroid hormone plays?

Eric Balcavage, DC

Sure. So let us say the cells in the body are like people. They are either in low-stress manufacturing mode or when they are perceiving high stress, they go into cell-defense or self-defense, cell-defense. And so the dimmer switch that determines whether we are in manufacturing mode or cell-defense mode is actually the amount of T3 inside the cell. So the cell danger response is an evolutionary kind of agreed-upon response that when cells feel threatened, they do a number of things to protect themselves. So let us say a bacteria enters a cell, that cell is going to sense the change in energy and say, whoa, there is danger inside here and it goes through a number of steps, stiffens the cell membranes, decreases the transport of nutrients across the cells, releases a whole bunch of inflammatory chemicals out into the bloodstream, all in an effort to kill the threat and to warn all the other surrounding cells that, “Hey, there is danger going on.” And one of the things the cell wants to do when there is a threat inside the cell, bacteria, viruses, trauma, toxin, whatever, is it wants to slow down the manufacturing process. It wants to make less stuff. 

And you might say why would it want to do that? Well, if I am a cell and I am making more peptides, then I am providing resources for this bacteria or organism to use to grow, and develop. If I am bringing more nutrients and that organism can use it, if I bring more glucose in, that organism can use it. So what the cell is trying to do is slow down the manufacturing process and then shift the attention away from manufacturing to try and find the threat and kill it and get rid of it so it goes back to normal. Kind of like if you had a widget factory, Jen. And you are busy making widgets, if there is a fire in the widget factory, are our people going to continue to make the widgets or are they going to go run for the fire extinguisher? Some people are going to run out, some people are going to fire extinguishers to try to fire. The cells of the body are so intelligent that they have the ability to self-regulate which is so cool. 

And I think for the most part that is what is happening when we start to have hypothyroid signs and symptoms long before there is anything wrong with a TSH or a T4. How long before we see a change in the bloodstream? When somebody is saying, hey, I am gaining weight, I am tired of fatigue, I feel like I am a little bit more constipated, I just do not feel like I have the energy. Then they Google, they go to Dr. Google and look for what that means and they go, “Oh, I think I have a thyroid problem. Let me go talk to my doc.” The doc runs a TSH and a reflex to free T4 and it is probably normal. Why? Because the gland has not had enough damage. And so they are told, hey, you are just not so crazy or you eat too much, you do not exercise enough or you are stressed out, or whatever. But it is happening at the cell level and it is early on in that period. So they actually do have the signs and symptoms. 

They actually do have a thyroid problem, but it is not a gland problem at this point. It is a cellular defense mechanism at that point. We do not feel good, it is not broken physiology, it is adapting. And what I think happens as that stays is that becomes more chronic then what happens? These cells that are in danger, physiology release signaling chemicals to alert the immune system as to what is going on, alert the immune system is what is causing the problem. And these particles that are out there as signaling molecules are called DAMPs, damage-associated molecular peptides, and there are pams which are pathogens or organisms-associated peptides. These are in circulation. That is what activates your immune cells to know what to go get, to know where tissues to go to. But it is interesting that the thyroid gland also has receptors for these damps in pams. And when those damps and pams bind to the thyroid cells, it initiates thyroid cell damage and thyroiditis. So it is not that the immune system probably woke up one day and said, hey, I do not recognize that thyroid gland anymore. I think I will go destroy it. It is probably more likely that, hey, I have got this chronic ongoing stress. If I need to turn down the metabolism in one cell, I can do it locally, and in one tissue, I do it locally but if it is chronic and I need to turn down the metabolism globally, where is the best place to do that? At the source. And so then the thyroid gland itself is sending out its signaling molecules that is triggering the immune cells to come in. And as those lymphocytes come in into that gland, they cause more damage. And there is our thyroiditis that goes on and then you start to have the antibodies that develop as a result of that. 

So what I want people to understand is that what is happening with thyroid physiology is oftentimes not broken. It is an adaptive response which is a great thing for somebody like you or somebody like me who has had the diagnosis. If it is all your immune system is totally out of control, that is a helpless situation. But if you take it from a different perspective and say, hey, your immune system is trying to adapt to some type of chronic stress, then what we need to do then is say, okay, let me go back and look at my life, my health, my habits, my diet, my lifestyle. What is creating that excessive stress? And let me reduce or eliminate that. And if I do, then maybe the cell danger physiology goes away. Maybe the immune cascade slows down or stops. And maybe this damages the gland will start to calm down and the gland starts to recover. And now you start to make more thyroid hormone from the tissue that you have left or the tissue starts to regenerate. It takes about eight years for a thyroid gland to turn over. And we get better conversion of the T4 or T3 and better utilization with a lower dose as that recovery process is going on.

Jen Pfleghaar, DO, FACEP

Yeah, and I have seen that in my patients. They start to work on their pillars of health or their stress or we uncover things that would activate this overactive immune response like stealth infections or viruses. And they start to come down on their meds a little bit. Now, sometimes it is kind of beyond help but a lot of times we can get that back. In my case, half of my thyroid is taken out. So that was a bummer. But when we look at these things that you are talking about, this is hard work. I mean, it is not easy. 

It is not an easy conversation for practitioners to have with their patients to ask them to make life changes or maybe to cut out toxic people or you do not change jobs. I have had patients where I am like, you need to change jobs. This is stress. So I mean, this is not always easy. I mean, I think that is probably why this is hard to comprehend for some people. They are like, wait, what? We just can not add T3 in. And I mean, how do you encourage patients when you are telling them about the cell danger response?

Eric Balcavage, DC

Yeah. I mean, it is not. I think we have to balance the discussion with not having it feel like finger-pointing. Like, oh, it is my fault. Well, to some degree, yeah. Not that you knew it was your fault. I mean, if you look around, everybody’s doing the same thing. So what you are doing does not seem wrong but we kind of do not realize the impact of stress on the system. And to some degree should be like, well, you need to be stress-free. Well, that is never going to happen. What you need to be was have stress, adapt to it and get stronger and be more resilient. I mean, that is what working out and lifting weights is all about as I break my muscle tissue down so that is bigger and stronger tomorrow, and then I can go lift more weight. Same thing with stress. You are never going to get rid of all the stress. So what we need to do is have stress. It is important to have some type of stress, good or bad will allow for recovery. And then we can take more. 

But if you are in a constant state of overwhelming stress, we have to reduce that somehow to get you to heal and repair. Because the body if we just give you a bunch of supplements but the same environment is there that created the dysfunction to begin with. It is a temporary treatment at best. So I think sometimes people just assume, oh, it is a gut problem that triggered it. Okay, but why do you have a gut problem? And usually, you have to have that conversation and sometimes it is not easy to have on day one, but on day two or three of your visit strategy, it is like, all right, let us dig into your life a little bit. What is creating the most stress in your life? And I recently had a conversation with one of my clients and I am not her first functional medicine practitioner. 

She has seen a bunch before me and has not done well. And always kind of considered that maybe it was the practitioner who did not know enough but somebody sent her to me. And we are finding problems and trying to address them. And she is very always pretty stoic about, hey, I got it. There is not much stress. And then in one of our more recent visits, we had to come to Jesus conversation. And it was like, it was work stress and job stress and boss stress and all this stuff. And like, that is why you are not getting better. If that is the constant and it is creating this constant load of stress, you are not going to shift out of defense mode just because you eat differently. You have to deal with the thing that is the biggest elephant in the room. 

And then in a most recent conversation, hey, things are much better. Hey, what happened? Oh, my boss got fired. How about that? Things start getting better. Not long after the most the biggest stressor is gone. So in functional medicine, we like to use supplementation strategies to help people. And I think it is a great tool but it can not be the tool. We have to look at your sleep habits and patterns. We have to look at your respiratory habits and patterns. We have got to look at your emotional stress, the trauma, like what is going on between the six inches of your ears. We can talk about your dietary strategy but we got to look at all of those things to get somebody better. And you hear this, I am sure, where people say, I just want to get this fixed so I can go back to my normal life. Well, wait a minute. You are not going back to the life that created this if you do not want to be back to where you are today. You can not go back to that life because that life created this. We have got to make a new lifestyle, a new set of habits that are going to create 

a healthier or not life. Not the same stress you just laughed about.

Jen Pfleghaar, DO, FACEP

Oh, absolutely. And I like your analogy about the fire. If there is a fire at the factory, everything stops. So whether it is a bad boss, a bad job, or whether you had trauma as a child and that is still manifesting, and that comes up a lot. And these are not fun conversations. And just today with my patients, I had a conversation with a patient and we had to go back again to a childhood event. And that is because their gut health was not getting better, it was getting better but it is still there. 

And you are not going to create that healing space like you were saying, Dr. Eric, if you keep doing the same habits and it is not a blink. Things happen, and life is very stressful but building that resilience is something that people do on and on again. I have noticed so many thyroid patients are women and you add on this new life of being pregnant, having children, and having a spouse. And I am sure you have tons of patients that are women in their late 20s to early 40s. And you have to be adaptive to those situations because you can not always go back to what it was like. Like being a bachelor, even men too. So I think that these are such important conversations to have with the patients. So can you talk about the hypothyroid factor? I mean, I really want you to tell everyone listening that it is not just one thing or one box. That it is more of a spectrum.

Eric Balcavage, DC

Yeah, I think this goes back to what we have kind of talked about before. Like the initial, I do not think thyroid hypothyroidism often starts in the thyroid gland. I think that what is considered in allopathic medicine is that, hey, it all starts in the gland and you can not have hypothyroid signs and symptoms unless you are deficient and gland production. But all we have to do is look at our clients and we can see they are hyperthyroid sometimes long before the gland becomes dysfunctional. So I think the hypothyroid spectrum is like, where are you at in this cascade? Are you at just the beginning process where you have cellular hypothyroidism? It is just happening in some local tissues and it is impacting maybe your blood sugar regulation. It is impacting your ability to get cholesterol out of the bloodstream. 

So maybe it is affecting the liver or maybe it is affecting the adrenal gland. Are you into the next phase which would be the thyroiditis phase, where now the immune system is having the damage at the gland? Or are you at full on glandular damage destruction? You are at that 90% loss of function of the gland which would be what they call primary hypothyroidism. And there are lots of first if somebody wants to dig into this, there is a whole bunch of what they call hypothyroid patterns. Yeah, primary hypothyroidism. Secondary hypothyroidism. I think it is the easiest thing to think about is, whether is it affecting my cells. Do I have it damaging the gland and I am at the point where I have lost so much functional gland, I really do need some type of support because the treatment strategy is going to be a bit different based on where you are at in that spectrum. While allopathic medicine will not jump in or maybe sometimes even acknowledge that it is a thyroid issue until they can give T4. Functional medicine should be all about saying, all right, let us identify why this is and if we do, there is a good chance we may stop this from becoming a glandular problem. We may begin with stopping the immune system from having damage or resulting in damage to other tissues. And we may have you improve the biggest signs, symptoms, and concerns and this have your physiology go back to normal. So the spectrum is really just about where they are and how to determine that is a little bit more complicated. But that is where somebody who is really trying to do what I think functional medicine is which is getting to the root cause and not just trying to give a different medication if they understand thyroid physiology they should be able to help you with that answer. 

And I think a good sign that somebody is looking for the cause and is really doing more functional medicine by what tests they look at when they first look at you. If they are only looking at a thyroid panel to assess what is your thyroid physiology, that is probably not somebody who is doing a true functional medicine approach because you could have normal TSH, normal T4, normal T3, and even normal reverse T3 but still have tissue hypothyroidism going on. 

You could have normal T4 low T3 and somebody might say, Oh, I just need to give you T3. But really what we need to do is look at those values and determine what is going on. Are those values normal? Are they appropriate? Are they abnormal and inappropriate? And then what is driving that process? So how do we determine if there is tissue hypothyroidism going on? We have to look at the rest of the panel. what are the lipids look like? what is the insulin glucose markers look like? what are the mitochondrial markers look like? what is renal function look like? When we look at broader panels besides just the thyroid panel, not only can we see whether thyroid physiology is working at the gland but we can also get an idea of how is it working in the peripheral tissues in which tissues are involved. And we might even get a clue as to what tissues might be potentially creating some of the problems that are changing thyroid physiology.

Jen Pfleghaar, DO, FACEP

So how many times have you had a patient who went to their primary care doctor and just ordered a TSH and that is the problem, like you said, you have to look at the whole person in front of you, get all the lab orders because the thyroid is a function of the whole body. It affects so many organ systems. The other interesting thing is TSH the normal laterals, they have brought in the range of four point five which is so high for a TSH that I like to see it between one and two around one point five to one is my favorite. But I think that another pet peeve is that it makes patients feel defeated when they go and they know they really feel like they have a thyroid problem. They are in that clinical hypothyroidism space. They have the symptoms you are talking about. They are at that place where you could actually make a difference and stop the thyroid from getting damaged and they are kind of dismissed. So that is why I am glad everyone is at the summit learning about this which makes me feel happy. But I mean, we really have to change the thyroid labs.

Eric Balcavage, DC

Well.

Jen Pfleghaar, DO, FACEP

Get the word out.

Eric Balcavage, DC

Well, I think part of the problem is we need to learn how to do a better job of interpreting labs. And I do not think we are going to change that allopathically and that is okay because that leaves space for us in functional medicine. But I will bring up the TSH and it is a point that comes up a lot where people are like, what is what do you want TSH to be? Should not it be between one and two? And the answer to that is, I do not know. It depends. So if you are a person who has got a TSH between one and two but your T3 is low. Is that okay? Right. So the values are normal, but it is not appropriate because I got a person with a low T3. Technically what I should have in that situation is a higher T3 in that situation because the higher T3 is going to drive more T4 to T3 production. 

So one of the things we need to do as physicians is we need to interpret the labs. We have to look at a value, a lab value, and determine if is it normal and appropriate, is it normal and inappropriate? So if I have a patient who is all happy because of their TSH which is one point five but their hair is falling out, they are overweight, they are chronically tired, chronically fatigued, and their T3 is low. Yeah, it is normal, but it is inappropriate. It is not where it should be. And so it is definitely not appropriate for the person sitting in front of me. And that is where looking at the rest of the labs becomes really important. If you do not have a T3 or free T3 to look at, you would not see the problem. If you do not have inflammatory markers to understand that those inflammatory tasks could be the thing that is suppressing TSH. 

Because when we have an inflammatory stress state in the body, the brain increases the conversion of T4 to T3 while the peripheral body decreases the conversion of T4 to T3. So we get a TSH that may be normal or low and yet we have decreased production of thyroid hormone or low levels of T3 specifically. So we need to do a better job of being able to interpret those and understand that the value is not always like if it is in one to two range, that is not always okay. If I have a patient who is in their 50s or 60s, I probably want their TSH to stay a little bit higher so the TSH will drive more T3 production from their gland. Because they are probably going to struggle a little bit with that peripheral conversion because as we get older, we have more inflammation and more oxidative stress. So I do want that TSH to be a little bit higher. So we need to understand and interpret versus just go for a range. And I think we see that that is a problem in both allopathic medicine and to some degree functional medicine as well, where we are trying to hit a sweet spot with a number but maybe we do not have to do that now. We just manage it. If we saw that TSH is at three point two but T4 is higher and T3 is lower. Well, it is great. Let us keep an eye on that and let us get busy reducing the stressors. And guess what? We come back and look at that 30 to 60 days and that TSH is now maybe it comes down a little bit, maybe T4 is going up, maybe the conversion of T4 to T3 has gone up. We did not have to do anything to thyroid physiology. What we needed to do was address what was causing that inflammation to begin with. And we do that the values locks because that is what the body is supposed to do as flux based on what is going on with the physiology.

Jen Pfleghaar, DO, FACEP

Absolutely. We do not want to just treat a number, that is for sure. And I have seen that a lot in different patients that have come to me like I have said before that are on high doses of T3 and maybe they do not need to be or it is suppressing their thyroid. So yes, definitely looking at all the numbers, looking at the patient as a whole, and identifying those stressors. So one thing oftentimes people are told that they have hypothyroidism or it is a gut problem and an adrenal problem and so on. So they have all these things. So do you think that these are all separate conditions or more adaptive changes in response to the cell danger? And you have defined something called Multi-system Adaptive Disorder. Can you tell us more about that?

Eric Balcavage, DC

Yeah, I think everything is related. I mean, it is nice to separate the systems to learn them but that is not how the physiology works. So I think what we see and what we should expect when somebody has a cell danger physiology going on is that they are going to have changes in their adrenal function, they are going to have changes in their GI function, they are going to have changes in their sleep cycle. They are going to have changes in their system. Their blood pressure is probably going to go up. And that is not broken physiology at least at the onset. That is adaptive physiology to the threat. So people always like to have a label for what I have. Like if they can hang their hat on? Well, the reason I am like this is because I have fibromyalgia, which we made up. It is this. We make up names that way people have a diagnosis. 

They can say, and now I know what is wrong. I have a diagnosis, or now somebody knows what to treat. They are not treating the client. They are treating the diagnosis. So when people would ask me like, Okay, so what is wrong with me? To tell them they had a cell danger response was like, okay, well, what is wrong with me? So I do have adrenal, I have my doctors. This guy says I have adrenal. This guy says I have a GI. This guy says I have a hormone, I have PCOS, whatever. I said you have a multi-system adaptive disorder. So you are going to turn down the physiology to all the non-important systems and you are going to shift that energy to defending yourself. And the best example or analogy I give to my patients. Doctor Jen, if you were, are you a mom?

Jen Pfleghaar, DO, FACEP

Yes.

Eric Balcavage, DC

Okay. So let us say you have got a big Christmas get-together coming up this weekend. You have got all four burners on the stove going. You are cooking multiple foods. You are doing wash your vacuuming, you are cleaning the house, like it is like Tuesday. And so one of your kids is sitting at your kitchen aisle and let us say somebody breaks into your home and starts attacking your child. Are you going to continue to cook?

Jen Pfleghaar, DO, FACEP

No.

Eric Balcavage, DC

Okay. Are you going to take time to turn the burners off and pack everything up in nice glass tupperware?

Jen Pfleghaar, DO, FACEP

Nope.

Eric Balcavage, DC

Are you going to try and slide a little to wash in really quick?

Jen Pfleghaar, DO, FACEP

Maybe. No.

Eric Balcavage, DC

You are not going to finish vacuuming. You are probably not even going to turn it off. You are not going to finish watching. You are not going to go to the bathroom. You are not going to take a nap. You are not going to have sex. You are not going to do any of that stuff. They are all important things to do. I think we would both agree. But at this moment, the most important thing is to defend your child. So if I walked into your home while you are sets down in your basement to defend off the attacker, I could make some assumptions. I could say, well, here is the problem. Jen is a terrible cook. 

She has got food burning disorder. She is a terrible housekeeper. She has got undone wash disorder. She has got dysfunctional vacuum disorder. She has got all of these disorders because that is what I see. I see a messy house. I see food burning. So I can easily provide a solution which is I hired Jen a chef. I hire her a cleaning person. The chef cooks food every day. There is never anything boutique burning and the house is clean and it looks better.

Jen Pfleghaar, DO, FACEP

Yeah, but we are treating it like. Yeah, they are treating the lab numbers. That is kind of what in the allopathic world. It looks pretty like you said it looks pretty but there is still feel like crap.

Eric Balcavage, DC

Right. So the messy, the burning food, the messy house, the everything that was not broken stuff. But hey, I have taken attention away from these things because it is not important. So, yes, the food is going to burn. It is a problem. But that is not the root issue. And our job has to be to find that root issue for people. And that is really the difference between allopathic medicine and functional medicine. Instead of saying, oh, you have got all these separate conditions. I think it is better to say to somebody, hey, look, you do not have 25 separate conditions. You have got one issue, you have got excessive stress that is affecting physiology. You are not putting it in your body. Let us say, I am not putting any attention to those things right now. I need to survive. I need to fight whatever the threat is. 

And those things are failing not because they are broken but because you are not putting attention to them. So if we can get to address the root issue. Find what those stressors are, reduce them or eliminate them. That is when the body is going to shift physiology from, oh, I do not need to be in danger mode anymore. Now that it can start healing. Because one of the hardest things that we started to talk about this before is somebody comes in with a chronic gut issue. We give them something for their gut. It feels better. They go back to the same lifestyle, the same poor relationship, and two months later they call you back up. Well, my gut is bad. That protocol did not work. No, the protocol did work. 

The problem is you are back in the same environment that created the problem. We have to change whatever the stressors are. If you do not, the problem does not go away. Your gut is a symptom of the chronic stress response. So let us fix it. I mean, it is good to get this got under control but we got to fix whatever is driving that. And that is what we want to do whether it is thyroid physiology, gut physiology, sex hormone physiology, identify the excessive stress load, reduce the stress load, get the body out of that danger physiology, so the body can heal and adapt naturally. And we are way more resilient next time we get excessive stress. we get the excessive stress we can manage it better. We do not have this big breakdown experience and we recover.

Jen Pfleghaar, DO, FACEP

Absolutely. I love that so much. And we see it again and again. With patients and if they go back. And I even warn them some of the time I am like, we are going to fix your gut health. You have a problem here. I think we need to fix it. But if you do not take care of that trauma, if you do not take care of your stress at work, if you do not take care of your running around like crazy with your kids, then it could come back. So I think letting people know that we got to identify the stressor like you said, so your body can heal and ultimately your thyroid can function properly because it is so important and that is what we want. So, Dr. Eric, thank you so much for joining us at the summit. I would love for you to share about your podcast, your book, and how everyone can find you.

Eric Balcavage, DC

Sure. So my website is rejuvagencenter.com. I have a podcast called Thyroid Answers Podcast where we answer a whole bunch of questions that people have about why thyroid physiology is not working appropriately. We talk a lot about the cell danger response, tissue, hypothyroidism, and this kind of adaptive physiology. It boiled over to the point that I had to put a book together to try and explain this. And that book is called The Thyroid Debacle and it is out on Amazon and wherever you buy your books. And the nice thing about the book is it is not about thyroid physiology. It is about thyroid physiology but it is not. If you once you understand this whole cell danger response, you realize this is not a thyroid-specific issue. It is about the thyroid physiology kind of being the gauge to help say, whoa, I am in danger mode, decrease the amount of T3 in the cell. So it is an adaptive process. But how do we get better with part three the book is all about it is like each chapter is kind of simple strategies or what we call parts of your fitness that you need to take a look at address and adapt. So this is a good book. I do not care if you have a thyroid problem or not. If you are not as healthy as you want to be. This is kind of a guidebook on how to get yourself healthier.

Jen Pfleghaar, DO, FACEP

Awesome. Love it so much. Thanks again, Dr. Eric.

Eric Balcavage, DC

Well, thanks for having me on. Good luck with the rest of the summit.