Welcome to Episode 484 of The Intermittent Fasting Podcast, hosted by Melanie Avalon, biohacker, founder of AvalonX, and author of What When Wine Diet: Lose Weight And Feel Great With Paleo-Style Meals, Intermittent Fasting, And Wine, and Barry Conrad, actor, singer-songwriter, and creator and host of Banter with BC.
SHOW NOTES
McCall McPherson, PA-CA – Founder of Modern Thyroid Clinic
McCall McPherson is a licensed Physician Associate and women’s health expert focused on thyroid health, hormones, and metabolic health. She is the founder of the Modern Thyroid Clinic, a thyroid-centered functional medicine practice based in Austin, TX.
McCall became a thyroid health expert by way of being a thyroid patient herself. Her passion for perfecting thyroid treatment for her patients stemmed from years of personal suffering due to the mismanagement of her own hypothyroidism. She now lives, breathes, and thrives in understanding the proper nuances of thyroid care, combining her medical expertise and her personal experience to offer innovative solutions and a balanced approach to wellness.
McCall is a TEDx speaker, has been honored in the top 200 fastest growing health companies on the 2024 Inc. 5000 list and is a 2025 Top 500 Inc. Female Founder.
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TRANSCRIPT
(Note: This is generated by AI with 98% accuracy. However, any errors may cause unintended changes in meaning.)
Welcome to Episode 484 of the Intermittent Fasting Podcast. If you want to burn fat, gain energy, and enhance your health by changing when you eat, not what you eat, with no calorie counting, then this show is for you. I'm Melanie Avalon, biohacker, founder of AvalonX, and author of What, When, Wine. Lose weight and feel great with paleo-style meals, intermittent fasting, and wine. And I'm joined by my co-hosts, Barry Conrad, actor, singer-songwriter, and creator and host of Banter with B.C. For more on us, check out MelanieAvalon.com and BarryConradOfficial.com. You can submit questions for the show by emailing questions at iapodcast.com or by going to iapodcast.com. We would love to hear from you. Please remember, the thoughts and opinions on this show do not constitute medical advice or treatment. So pour yourself a mug of black coffee, a cup of tea, or even a glass of wine if it's that time, and get ready for the Intermittent Fasting Podcast.
Hi, friends. Welcome back to the show. I am so incredibly excited about the conversation I am about to have. It is with an expert on a topic, well, multiple topics, that I know you guys have so many questions about. And it's also crazy timing because I just crossed paths indirectly with this fabulous human being at Dave Asprey's Beyond biohacking conference, where she was actually a speaker twice, including on the main stage, which is amazing. I'm here with McCall McPherson. She is the founder of the Modern Thyroid Clinic. She is a licensed physician associate and a women's health expert. And she focuses on thyroid health, hormones, and metabolic health. So again, topics that I know all of you guys love. And like I said, she has the Modern Thyroid Clinic, which is based in Austin. She's a TEDx speaker. She's been honored in the top 200 fastest growing health companies on the 2024 Inc. 5000 list and is a 2025 top 500 Inc. female founder. And friends, when I had the opportunity to interview her, which I am just so honored about, I asked you guys for questions and they just came rolling in. So many things, thyroid, so many things, GLP ones, perimenopause, hormones, all the things. So I'm sure we will touch on a lot of amazing topics in today's show. Just to I definitely want to hear about your personal story, McCall . But just to start things off, I will say that I as well have had my own crazy journey trying to understand my own thyroid and being diagnosed with hypothyroidism and the amount of switching around and testing and different opinions I have interacted with when it comes to T4 versus T3 and compounded or NDT or T4 only or reverse T3. All the things is just absolutely insane. I feel like it's been the journey of a lifetime. So yes.
It really is. It really is.
And it's so common for people, I think, to experience that. And that was something that your personal story. So what was your story with your thyroid and that whole world and mismanaging of that?
Yeah. You know, so my most recent bump in the road was when I was 27, quite some time ago now, but I was on Synthroid. I'd been moved from Levithyroxine to Synthroid. I was already practicing medicine and I was debilitated. I mean, I was spending 16 hours a day in bed, no exaggeration during the work week, and then just all day, all night in bed on the weekends, stuck in that cycle of trying to rest enough to recover and rest enough for what was coming the following day or the following week and was overweight. I was losing my hair. I was depressed. I couldn't think straight. All the things, low, no libido. And of course, I was like, oh gosh, it's just simple. I just need to go back to my clinician. He'll increase my medication. Surely it's just my thyroid meds are off. And so naturally, like so many women, that's what I did. And I was turned away after he ran only a TSH panel, told, hey, we actually need to reduce your medication.
Oh, and by the way, here's a prescription for Lipitor for your high cholesterol. That was simply a manifestation of my thyroid problem and kind of left out in the cold and gaslit and dismissed. And through the brain fog, thankfully, I found someone who could help me waited months and months to see him. He took a progressive approach and looked at more labs and used more progressive medications. And I was on my way to get my life back. And that began my journey in the world of thyroid. And over years, eventually, Modern Thyroid Clinic was born out of it. So now I'm grateful. I get to help women who are on the same journey I was once on and help them to get their lives back.
Yeah, it's so powerful to hear. And it's honestly shocking to me that conventional medicine still relies so heavily on TSH only.
And even for me, so my, I first, I guess went on thyroid medication and I don't even know when, maybe like 2014 or so, the journey has been, like I said, like crazy with just changing around dosages and things. And even now, like most recently, like this happened, like even when I think I'm out of the woods, this is a couple months ago, because I am seeing a conventional endocrinologist because I finally got on a dosage that worked for me and my endocrinologist was down with like keeping me on it. But even recently he was like, well, your TSH is suppressed because I'm on T3 and T4. And he's like, so I think we need to pull you off T3. And I was like, whoa, I'm actually feeling okay. Let us please not rock the boat. So, but I almost had like a panic attack. I was like, not actually mentally, but just because I was like, wait, no, no, I'm actually stable, like I'm not symptomatic, but you're gonna change everything because of the TSH. So, and I realized we're using a lot of like letters and if people aren't familiar, maybe we can give them some definitions. But why is it that everything just revolves around this TSH factor, like still even today?
I know it's wild, isn't it? So research shows about 80 to 85% of the time when people get thyroid labs drawn, the only thing that's being checked is a TSH, which is wild, still, that's the stat in America. And in medicine, we are trained that TSH or your thyroid stimulating hormone, which is actually a hormone that your brain secretes and sends it to your thyroid to stimulate your thyroid. So hence the term thyroid stimulating hormone, it's supposed to be on a feedback mechanism. So, you know, when your thyroid is producing actual thyroid hormones, because again, TSH is a brain hormone, it should send a message back to your brain and say, oh my gosh, like we have plenty of thyroid hormone lower this person's TSH. Or inversely, when you don't have enough output hormones, theoretically, a message should be sent back to your brain that says increased TSH in cases of not enough thyroid hormone production or reduced TSH in cases of enough, right? So it's all dependent on the feedback loop, the message being clear to your brain, whether you do or do not have enough thyroid hormones. The reality is medicine's assumption that that is intact and actually working is what's flawed.
So research shows about 35% of the time that feedback mechanism doesn't work well. I've found data that shows it only accurately reflects thyroid hormones 1% of the time, which is crazy. So 99% of the time it can be wrong. And, you know, medicine's just not really in an era of evolving thyroid care. Guidelines haven't changed since 2014 from the American Thyroid Association. And so clinicians are just operating on this really outdated antiquated system, assuming that everything is working just fine. And in fact, we're working with flawed data.
Wow. So an analogy that I think is often used is it's kind of like if the TSH was the thermostat and it's saying that it's a certain, you know, temperature in the room, but it may or may not be that temperature in the room, like changing the thermostat may or may not actually, if the air conditioner is broken, for example. So, okay, some questions there.
So the 99%, is that 99% of patients you work with or just in general, that you've noticed that.
Yeah, I know, I found a study that shows TSH, and even when clinicians check TSH plus free T4, which is checked about 15% of the time, 11 to 15% of the time, it accurately predicts your most important hormone level, which is called free T3, 1.7% of the time.
So it reflects T3 variation very, very rarely, even when we look at both of those hormones together, which honestly, I think is one of the single-handedly biggest reasons that people are persistently having thyroid symptoms, because just imagine they're going to the doctor, they're only checking TSH or maybe TSH plus free T4, the vast majority of the time, and it's not giving us a picture of our most important hormone or what's called free T3, which I'm happy to go into those hormones as well, so people can have a little bit of an understanding.
Yeah. And also I would love to go into that. And one more quick question.
So like in my situation where I'm on, you know, I'm taking T3 and T4. So my TSH, I mean, maybe my TSH is working correctly because it's going down because I'm on the hormones. But then my endocrinologist, he gets, he freaks out a little bit when it goes too low because he says it's suppressed. When I just think about it logically, I'm like, but shouldn't it be suppressed? Like, if I'm getting enough, if I'm taking hormones exogenously, wouldn't it go down?
So here's how I describe TSH. So think about, for some reason, Melanie, I use automotive analogies, even though I serve like 99% women, but I've done it for so long, I'm fully committed at this point. So think about TSH, like how hard your body's pushing on the gas pedal of your car, okay? So we can push our gas pedal all the way down and go 100 miles an hour, or we can push it all the way down to get to 20 miles an hour. We can't use how hard we're pushing on the gas pedal to infer the rate of speed of our car, right? And that's what TSH is.
So when you have great output hormones, right? When your car is coasting and you're cruising and everything's good and your free T4 and your free T3 are great, well, you don't have to push hard on the gas pedal anymore. You can almost take your foot completely off the gas pedal and just barely touch it to coast. That's what TSH is reflecting. It's reflecting the energy going in to make your thyroid energy, AKA your thyroid hormones. So of course it's not high. And where medicine is continuing to get this flawed is they think a low TSH means that you're hyperthyroid. And when you're hyperthyroid, bad things can happen, right? You can increase risk for cardiovascular events, heart attacks, stroke, osteoporosis, but there's a very safe, effective way to ensure that that's not happening. And it's simply to check your TSH, but also check your output hormones, check your free T4, check your free T3. And if those are in normal range, TSH is independent of those risk factors in and of itself, but medicine is getting its wires crossed and thinking that that low TSH reflects high output hormones, even if they're checking the output hormones and they're fine, it still makes them nervous. So you're spot on. You should not ever, in my opinion, reduce someone's medication if their output hormones are great, simply to try to increase TSH. You're fixing an unbroken system at that point.
What's completely ironic about my situation is when this happens, because that's pretty much how I tend to present. My other hormones are always low too.
So like my T3 and my T4 will be low, my TSH will be low though as well. And so when he's like, let's just pull you off T3, I'm like, no, no, no, let's not do that. It's funny, I thought I had hacked the system. I was like, oh, I'm gonna use a conventional doctor and get my insurance benefits and I'll just kind of guide the prescription to where I want it to be until I hit this wall. So yeah, I'm not gonna do that anymore.
not uncommon. Like we have patients too that are like, well, I'm stable and I'll just have this person carry on my prescription.
But either the hiccup comes where they become, you know, nervous or God forbid you need a dose increase and they just are not equipped and trained how to effectively do that. My one question to ask you, since we're talking about your case and it's always fun to do that, is when you have your labs drawn, if you're on T3, T4, are you taking your medication before you have your labs drawn or are you withholding it and having your labs drawn? Because that dictates a lot in how your labs appear.
Yes, and I am so curious to hear your thoughts on this because I know the conventional idea is to not take them. Ironically, I actually, and I've been doing this for a few years now, I take mine in the evening, so I'd be curious your thoughts on that as well.
So I have not taken it when I do the draw because the draw is during the day.
right? I just need to overhaul your thyroid, my friend. You need to come to us. Let us help you because your productivity is really good.
I can't even imagine what it would be with proper thyroid support. So a couple things. Number one, well, they inherently go together. T3, or active thyroid hormone, I describe it as like gasoline for your body, is short acting. So depending on which medication you're on, it's actually going to peak and trough in about three to eight hours after you take it. So if you're taking it at night, you're using the time that you should feel the best, the clearest, the most productive, the most engaged, and you're sleeping during that window. So one, I think you'd feel better if you moved it to the day, and I'm happy to talk through that with you on or off the air.
But number two, there is a pervasive myth that is perpetuated in medicine, which is have people skip their thyroid medication before labs. And this is particularly important in people on a T3 based med. These are drugs like CITAML, lyothyronine, armor, renthyroid, and pthyroid. And the reason that it's so important not to do that is because think about it. Let's say you did take your, I'm
I'm so happy you said this. Okay, I'm like so happy right now. It doesn't make sense logically to me.
It makes no sense. So like, let's say you did take it in the morning and on a Monday you took your thyroid medication and Tuesday morning you went to have your labs drawn. If your T3 peaks in three to eight hours and you haven't taken it for 24 hours, how are your labs going to look when you get them drawn? Because TSH is a stable hormone. It doesn't fluctuate like the others.
Your T3 is in and out of your system a long time before you had that lab drawn. So what ends up happening is people present, their hormones are low. Let's say their clinician increases them because in the functional medicine world that is what happens. You get a dose increase when that occurs and three months later you do the same thing. Well, it will always appear low if you don't take it before you have your labs drawn because it's out of your system. So that's actually how bad things can happen on T3-based meds because people unendingly get dose increases over and over and over. But even aside from that, and I love that you understand this question, if we are trying to figure out what to do with your medication, we should probably have it on board to test it, to see what it's doing, to determine what to do next, but we can't do that if no one takes it before they have their labs drawn.
Literally this question has bothered me for so long because interestingly enough even like non-conventional people in this in the thyroid world Some of them will say to skip. Can I tell you how that happened?
Please do because I have wondered this for so long
Yeah, I know exactly how it happened because I traced it back to the source. And I won't say specifically who it is, but one of the oldest thyroid advocacy platforms around kind of started this dialogue and this rhetoric. And it has since been repeated so many times that everyone in the functional and integrative world accepted it as truth, which was always skip meds, pre-labs.
And this is a progressive thyroid advocacy platform that is huge. So honestly, almost 10 years ago, eight years ago, I went to the person who founded that platform. And I said, look, this is who I am. This is what I do. This is all I do. And this construct of keeping people off meds before labs is dangerous. Not only could it, I'm sure it has caused heart attacks and strokes, it can potentially kill people, but it's also damaging the evolution of progressive thyroid care because it's propagating this idea that thyroid meds are dangerous, that they're unpredictable, that they're uncontrollable because all of a sudden these people are going into atrial fibrillation and having a stroke, right?
So this person came back to me and she said, McCall, we can't depend on clinicians to increase people's thyroid medication. So we have to manipulate the data to ensure that people can get more. And I still have that email to this day.
Oh my goodness. Okay. This is wild. It's like this like an FBI episode. And what's so funny is I have literally contemplated doing this myself. Like, I shouldn't say that.
But I've like, I've thought about it before, especially when I've had the, you know, the hesitancy to properly up my medicine. I thought before I've like, you know what, maybe I should just stop my meds for like three days before the test. And then everything will be super low. And then they'll give me more, which is horrible.
don't do that. No, just find someone who really can partner with you on this for sure.
That's crazy. Oh my goodness.
That was the last thing I expected her to respond like, but she did. And it's been, like, it's fascinating. When you repeat things in medicine long enough, people believe them, right?
and that's what's happened. Yeah, and it's just, and I'll let it go, but it's just so interesting that, because every time I think about it, I'm like, it does not make sense logically.
And it's interesting that so many functional practitioners haven't questioned it a little bit more like you did. Wow.
we change that little by little.
Okay, so so many, so many ways we can go here. It's interesting. I asked listeners for questions about this and what they're taking and it was, it was all over the place.
So let's see, like Valerie says she takes natural thyroid armor. Karen says she has a functional medicine doctor. She takes Levo and Liah, Levo and Liah and her thyroid levels are optimal. Alyssa, she took Levo for a few years until her labs tested normal and then no issues. Erin, she has a whole thing about, she says, you know, the first step is to realize that your doctor isn't there to heal you. It's your job to educate yourself so that you know what to test for and to understand what your diagnosis means and then she says that she's started Levo four months ago. It didn't resolve anything so now she's switching to natural T4, T3 combo. Okay and what I'm just gonna ask from all of this is there's just so many, so especially with what you just said. So you can understand, you know, the potential problem but then the way you go about addressing it and like even for me like I've tried so many different things throughout the years. So what do you find when it comes to actually treating patients? Is it that some people, it could like, could two people have identical, I mean I know that's like very rare but completely identical labs and one is gonna benefit from like natural thyroid and one will benefit from synthetic and one will benefit from a combo and one T4 only. Like how do you know what to do? Honestly.
you know, so much that determines our plan for patients at Modern Thyroid Clinic is their labs. We obviously talk with patients too, like what is your preference? And we educate and explain pros and cons of each, because there are nuances. Like more than anything, what I want people to know is it's a two-sided coin.
Number one, this is incredibly complicated in real life. Like medicine grossly, negligently oversimplifies it. It is so much more nuanced than even 99% of functional medicine clinicians can grasp or fathom. Labs need to be perfect. People need to be very properly treated and managed. And the flip side of that coin is when they are, they get their life back in a very short period of time. Like days, people generally feel better. But we can't be guessing. We can't just be trying things to see what happens. Each person's unique biochemistry dictates a lot about their plan. And so let's take the person on levothyroxine with, you know, persistent symptoms. They don't feel better. Now they're switching to desiccated thyroid, just as an example, right? Because that's a lot of people that have persistent symptoms on levothyroxine. Levothyroxine-based medications, so levosynthroid, unithroid, t-rescent, levoxel, that is all an inactive hormone. It's crude oil. It doesn't actually help us at all until we convert it to gasoline. And most people do not ever convert enough of it to gasoline to feel good. So they're walking around with persistent hypothyroid symptoms. Their labs look fine to their regular doctor because they're not looking at them correctly and not writing the right labs. When in fact, you know, it's all crude oil, right? We don't put crude oil in our car. T4, levothyroxine-based meds are crude oil. We have to convert it to gasoline and free T3 is your gasoline. Cytomel, lyothyronine are pure T3-based medications. And then there's combinations like armor, renthyroid, NP, that's part crude oil, part T4, and part T3. So when someone presents at Modern Thyroid Clinic with persistent symptoms on levothyroxine or synthroid, what we don't do 99.9% of the time is switch them to a desiccated thyroid. So switch them to that NP, armor, renthyroid because the half-lives of those two medications are so wildly different, meaning if you stop levothyroxine today, half of it is still in your system in seven to 10 days. Whereas armor is in and out of your system in a few hours, right? So that is a complicated switch, but what we can do easily, and what I often encourage people in that situation, and there's tens of millions of them, is stay on your levothyroxine-based medication and add T3 to it. What you're missing is gasoline. You have a house, a garage full of crude oil, and your gas tank and your car's on empty. We can simply add cytomel and lyothyronine to that plan. On day one, most people feel better. Whereas if you switch them and titrate them to NP thyroid or armor or whatever, it's weeks of feeling bad before they start to rebuild again and get back to where they need to be. So all that to say is it's incredibly nuanced.
You need someone who isn't committed to one class, one type of medication, because every single person's needs in biochemistry are different. For example, with the woman switching to armor, let's say the activation of her hormones, her ability to convert crude oil T4 to T3 is low, well, armor has too much T4 in it for her. The ratio of crude oil to gasoline is too high. So she's not gonna get, or a lot of people will never get where they need to be with that ratio.
If their conversion, if their activation of their hormones is so poor, they can't efficiently convert enough to feel well. Does that make sense?
Yes, it does. So you said armor, even though it contains, quote, natural T4, it's still fast in and out the T4.
from it? It's way faster. Yeah, way, way, way faster than Levothyroxine for sure.
Do you know why? You know, I think that when they created Levothyroxine, like 50 years after armor was in existence, they were aiming to make it have a long half-life. That was the goal. It was, well, if people don't miss doses, if they forget a dose, if they skip whatever, if they take it at a different time, it's so stable that we don't have to deal with this whole problem we've had with armor for half of the century, with the peaks and the troughs and things. So I think that was top of mind when it was created.
Is there way more incentive financially and like with pharma to prescribe like that levo instead of armor?
It's an interesting question. So I'll say kind of two thoughts on that. Number one, I think the real reason people are always getting prescribed T4 is our medical training. Mine is a PA, but I've interviewed dozens of physicians. I met with two this morning on another podcast interview and even our board certified endocrinologist that's our clinical director at Modern Thyroid. I've asked them their training as well. And it is as follows to a T. Do not use meds with T3 in them. Only use T4 based medications like levothyroxine, synthroid, et cetera. If you put your patients on T3, you'll give them a heart attack or a stroke. So the real problem is number one, we are trained to be very afraid of these medications. And number two, we are actually not trained how to efficiently, effectively, safely use them.
So they are not an option in our treatment algorithms because no one knows what in the world we're doing. And second, I think years ago, I can't find this data anymore, but years ago, we started as a brick and mortar in Austin, Texas. We're now a nationwide telemedicine practice, but there's a huge endocrinology clinic here in Austin. The biggest one, it's like a group. I looked at the main physician there and how much money he got from various pharma groups. And the last year I could see, I believe it might've been 2019, but I could be wrong. He made $178,000 from the makers of Synthroid that year. So, you know, who knows? Could have been other things I don't really know, but gosh, it seems like, you know, where there's smoke, there's fire.
Yes, I just know my experience. It's almost aggressive, the desire to, like if I've like gone into a practice on something that was, you know, working at least enough. And then the message is like, well, how about we try switching to Levo? I'm like, why? Like, I'm, like I feel okay right now. I don't want, I don't, why?
So, um, that's, that's really, really interesting. But what about just one quick rabbit hole tangent question? I think the worst, the worst moment I ever had was switching around or playing with my thyroid medication was I had really high reverse T3. And at the time I was working with a functional practitioner, but she, to reduce my reverse T3, pulled me completely off of T4. And I thought I was going to die. Like I literally, it was a horrible, horrible experience.
Do you, and I also know some, like I've worked with some, or I don't know if I've worked with them, but I've had them on the show, even in the functional world who don't test reverse T3. So do you have, do you have thoughts on reverse T3?
Yeah, I love this tangent. So just to level the playing field a little bit to give people a concept and a construct of what reverse T3 is. So in the thyroid biochemical cascade, right, TSH stimulates your thyroid, your thyroid secretes this hormone free T4. That's your crude oil hormone. Again, doesn't do anything until we activate it and convert it to gasoline, which is your free T3. So T4, your crude oil can just sit there, kind of stockpile in your garage, especially if you're on a levothyroxine based medication like you are, or it can activate, which is what we want, or it can shunt to an inhibitory hormone called reverse T3. And reverse T3 is shaped just like T3, but in reverse, that's hence the name, right? And what that allows it to do is bind to the same landing spot as T3, but instead of binding and activating things like your energy, your cognition, your metabolism, it just binds and it sits there and it occupies the landing spot for T3. So it keeps T3 from being able to bind. So they compete for absorption. Therefore, the higher your reverse T3 is, the less T3 absorption you're going to get. And one of the most quickest ways to get elevations in reverse T3 is to over medicate people on a levothyroxine based med that can't convert it, that can't make it into gasoline, because they just create an enormous reservoir for reverse T3.
Now in the medical literature, reverse T3 is largely studied in ICU patients because the mechanism of it is purposeful. When you're sick, when you're stressed, when you're inflamed, when you're micronutrient depleted, calorically restricted, over exercising, pregnant, nursing, insomnia, all of these things drive up your reverse T3 on purpose so that you get tired, so that you lay down rest and recover. It's one of the mechanisms of forced recovery of your body. In the ICU, that's amplified by 10, right? Like you get crazy reverse T3 levels because you're in crisis physiologically. So medicine just assumes this isn't useful unless you're in an ICU setting, but that isn't true. It's actually incredibly useful. Will it be 100 or 200 like it is in the ICU? No. But it can be 25. It can be 30. It can be 20. And those numbers do matter and they actually do inhibit enough free T3 absorption to impact how people feel on an everyday basis. So people that don't believe in reverse T3 or they don't check it, they're just not educated on it. It's not a tool in their toolbox. So instead of kind of digging in, understanding the data and kind of analyzing and reanalyzing their own patient population, they just say, nah, it's not worth it. It's not important. It really is. It impacts a lot about how I treat patients, especially in reasonably elevated situations. Now, the last thing I want to do though is deplete someone's T4. Like people need T4. It's the lowest level that our thyroid gets on a 24 hour basis because T3 again is so up and down. We need enough T4 to pull from to convert 24 hours a day, but especially when we don't have enough T3.
So any change that I would ever make into a patient's levothyroxine or synthroid to reduce their reverse T3, because think about it, we're draining the source of it. If we reduce T4 and that's the source, naturally reverse T3 will drop. I would do that in a 12 microgram increment to give you an idea. Like I'm not dropping people more than that in one treatment cycle.
So to completely remove you off of that medication sounds terrifying.
It was, I literally felt like I lost my brain and I was quite young and I have one, oh, one quick clarification question. So I've actually never been on the branded like Levo or Lio or Lio. I've done compounded T4, T3. Are those similar, the same, different?
Yeah, do you want me to be candid? Oh, yes. This has like been the most epic thyroid episode ever, please.
So I'm an opinionated girl, right? But I have like 10 years and hundreds of thousands of pieces of data to back me up. So yes, when you get a compounded med, it's basically the same thing as a synthetic version of Synthroid Levothyroxine ground up, of Cytomel, Liothyridine ground up, it's usually the generic form. And the reason people advocate for compounds is you can make it into these unique doses, okay? Sure, that's valuable, kind of.
You can also just make unique doses with the standard medication doses that are available. I have patients split five micrograms of Liothyridine, which is 2.5 micrograms, that's how we increase and decrease, that's the doses we use, that is tiny. Now, well, there's a couple meds that we don't prescribe at Modern Thyroid Clinic, we prescribe no compounds. And the reason for thyroid meds, we prescribe hormone compounds all day, every day. The difference is this, is hormones come in milligrams. When you take progesterone, estrogen, testosterone, you're taking three milligrams, whatever it is. When you're dealing with milligrams, it's like baking muffins, a dozen of them, and trying to get an even amount of blueberries in every blueberry muffin. It's kind of possible, like you can actually get pretty close, right? When you're dealing with micrograms, which is what thyroid medications are in, T3 and T4 are microgram doses, it's like baking a dozen muffins and trying to get an even amount of poppy seeds in every muffin in that dozen. It's not really gonna happen. And in fact, what I've found is inevitably, it's not a matter of if, but when. A patient's compounded prescription is going to be inaccurate. And a three month supply of inaccurate compound thyroid medication is enough to completely derail a person for months and months and months, and backtrack them so much in terms of their quality of life, that modern thyroid clinic is all built on predictability and control. The reason we have such good outcomes is we don't allow any variables.
We're not guessing, we know exactly where a patient's labs are gonna land in three months after we change their medication with each of their labs within about a 0.2 variance. Every variable is accounted for. And because of the volatility and the inability for compounded pharmacies to do this extremely well, it creates variables that compromise people's outcomes. My last patient I prescribed a compound to was 2018. She had been my patient for years, years and years. She was stable for like three years. She came back after not seeing me for three months and her TSH was 12. That's like debilitating. Her dose had not changed at all. It's simply a flawed compound. And the better the pharmacy, the less frequent, less severe, but inevitably, and people, they get really riled up at me about this, inevitably it does happen. And again, I'm not anti-compound. We prescribe them all day every day for hormones. But for thyroid, you can accomplish individual dosing of T3 and T4 with standardized medications that are going to prove to be so much more predictable, controllable and stable.
Can I tell you a story related to this?
Absolutely. I'm loving this conversation.
So when did this happen? Maybe, I don't know, two years ago or so. So I've been using a certain compounding pharmacy and I was on, so I've been doing compounded NDT, so natural desiccated thyroid, and then compounded T3 additional. And I got my refill, like all my symptoms just started coming back, like I just started feeling pretty hypothyroid.
And so I went to the pharmacy and I was like, can you just like check this? Or I was like, I feel like it's, I don't know, it just doesn't feel right. And they're like, you just need to, they're like, maybe you just need to change your dose. Like they completely gas lit me. So I took the T3, I sent it off to a lab, I had it tested, it cost me like $400. And then I got the results and it was, the T3 was 30% of what it should have been. And I went back to the pharmacy with the paperwork and I was like, I was like, it's 30%. And then they still told me to my face, he said, well, maybe you just need to change your dose. And I was like, no, you need to make your medication correctly. I am so proud of you for that. It was crazy though. I've never, and I don't want to make it like, I don't want to make it too sexist or political or anything. But the way he was taught, I felt talked down to a lot, like as a woman, I was funny, I was actually on the phone with my business partner and he didn't know that because I had headphones in. And my business partner was hearing the whole conversation and he was furious and he's actually has a history in pharma. So he was like telling me what to say back to the guy. But it was a very mind blowing experience. I was like, I can't believe this is happening. Like I'm literally showing you the paper and you're saying I'm the problem.
Like, no. So I know this is a pervasive issue with compounding pharmacies. So I like that approach. So the standardized medication coming from like Levo and stuff, it's tightly, tightly controlled and tested.
It really is. Yeah. Most of the time, I don't even need people to be on brand name, to be honest.
With Levo and Liothyronine, there are some filler intolerances that will kind of tailor per person. Like vegans need to be on Cytomel. Liothyronine isn't certified vegan, et cetera, because there's so many different manufacturers. But for the most part, they're incredibly stable. The same with desiccated thyroid. There's one particular brand of desiccated thyroid that we don't use that we do find variants in. And that also, that's kind of backed up with testing validity measures as well. But for the most part, these thyroid meds are incredibly controlled, predictable. There's just not a lot of reason to compound them. I understand some people compound T3 to create a sustained release situation, which in theory, I agree with. We use T3 twice a day in the morning and in the late afternoon to mimic our natural body's rhythm of T3, which actually does an even better job than the sustained release form and is obviously more predictable and tightly controlled.
So that actually reminds me, going back to what you were talking about earlier, about me taking it in the evening. One of the reasons I do that, which I have been doing that for quite a while, is, well, I'm like a night person anyway. So even me taking it at, I usually go to bed at like 4am. So if I take it at 7pm, that's like my prime productive time after that anyways.
But I do intermittent fasting every day, which I do have questions about how that affects the thyroid. But I had a concern, personally, about taking my thyroid medication and then taking T3 and being fasted all day. I was thinking it would be better to take it closer to before I'm about to eat my big meal. So fasting in the thyroid, which I think somebody, we had questions about diet and the thyroid, but how does it affect the thyroid?
Yeah. So I'm a huge proponent of intermittent fasting. You know, there are people online that say if you have a thyroid problem, you can't intermittent fast. It's kind of a similar mechanism where if you repeat something long enough, people start to believe that it's true. You know, does fasting can fasting impact your adrenal glands, which impact your thyroid? Yes. Right. Does it not need to be done in extremes for people early on in their thyroid journey? Yeah. But like if women want to intermittent fast, a 16 hour fast four or five days a week, it can be incredibly beneficial for their body from a thyroid perspective.
Number one, it can reduce antibodies for hushy motos, the autoimmune component of thyroid disorders, where your body attacks your thyroid gland, because it is incredibly potent at reducing inflammation. And inflammation is a key driver of autoimmune disease, right? So it does that. It can help mitigate, prevent and reverse insulin resistance, leptin resistance, blood sugar dysregulation, metabolic dysfunction that is so highly correlated and associated with people, even in early, early thyroid dysfunction. So incredibly, incredibly powerful for that as well. You know, if someone is intermittent fasting, let's say like a normal fasting window, maybe they eat from, you know, 11 to seven and they wake up and they take their morning T3 in the morning. That's fine. Like they can absolutely do that. They can eat lunch, you know, at noon and take their second dose of T3 at two or three. The one thing is, I'm sure your listeners too, who do a lot of fasting, probably have noticed our body becomes more efficient when we're fasting. We're not like bogged down with all the excess things that are associated with breaking down, assimilating, excreting food, nutrients, et cetera. Everything starts to run a little bit quicker, a little bit lighter. And so sometimes people need a small dose reduction in their T3, especially initially when they're starting their fasting journey, not always, but hey, if you've got a great partner with you on your thyroid journey, they can be along for that ride and kind of tailor it to you and your newly adapted lifestyle. But for the most part, there's no reason that you can't fast and take your T3 during the day at, you know, normal hours. Though I know your circadian pattern is a little shifted.
Okay, so being in a facet state pretty much all day and taking T3 upon awakening, that could still potentially work for me.
Oh, absolutely. Like you might need a five to 8% reduction in your dose over time if you begin to feel a little stimulated and jittery.
Honestly, I'm just so darn curious what you'd feel like in general because I think it would shift your circadian pattern a little bit and make you feel better earlier in the day. And then you probably honestly do need a second dose, right? If T3 peaks and troughs in three to eight hours, we wanna occupy the bulk of your waking hours with access to T3 because that is our normal physiological response. So most people need a second dose, six to eight hours after their morning dose.
I did do that for a bit. I think it actually was one of the thyroid experts I was talking with said that he was reading about evening dosing maybe being more ideal. And then I think I switched and I just never switched back. I've done McCall, I've done like everything. I've done it all. Yeah, it's crazy how many different things I've done.
Well, speaking of the antibodies, so Becky, and you addressed this a little bit with the fasting, but Becky said, how can people get their TPO antibodies down to zero with Hashimoto's? And then Kelly said, are they supposed to be zero?
Good question. Okay. So let's frame this a little bit. So, you know, medicine views Hashimoto's as like the reverse lottery in conventional medicine. Like you've got this thing, there's nothing you can do about it. We actually never need to even worry about it or check it again.
All we need to deal with is your hypothyroidism that we replace with thyroid medications. We supplement those missing hormones. It couldn't be further from the truth. Hashimoto's is actually able to be influenced. I've been in remission for over 12 years myself. And at Modern Thyroid Clinic, we work to reduce antibodies as much as possible or ideally get people into remission. And what that means is measurably TPO and thyroglobulin antibodies reduce down. Remission is technically less than 34. It doesn't need to be zero. There's not a loss of thyroid function and meaningful autoimmune response if TPO is less than 34 and thyroglobulin is less than one. There are various ways that you can do this, but the benefits of reducing those antibodies are you preserve more thyroid function because you're losing it in real time with an autoimmune attack. And the higher your antibodies are, the higher the rate of destruction of your thyroid, you can also assume the higher your antibodies are, the more at risk you are of developing another additional potentially more serious autoimmune disease that can be life threatening, et cetera. So if we can reverse engineer that, reduce your antibodies, you can infer a risk reduction for developing another autoimmune disease, which is pretty remarkable, right? You can infer that risk reduction even before you're in remission. Maybe you're not all the way reduced risk, but as those antibodies drop, you are less likely to get another autoimmune disease. So I think some people get hung up on full remission. Any reduction is meaningful, especially a meaningful reduction. Some of the, you know, best ways in the scientific literature to reduce antibodies are supplementing with selenium, selenomethionine, 200 micrograms of selenium, vitamin D is a great one as well, and red light therapy. About 10 minutes of red light, six inches from your thyroid, 10 minutes once or twice a day has been shown to reduce antibodies in both Hashimoto's and Graves disease and can even improve thyroid activation of your hormones. That conversion from crude oil to gasoline. Some of my favorite ways that I found in my own data points over the last 12 years are low dose naltrexone. And I know you've spoken with someone on your podcast about this before. Incredibly, incredibly powerful. I've seen it reduced antibodies, TPO 500 points in three months with no other changes, intermittent fasting, glutathione, our body's most potent antioxidant and anti-inflammatory agent, either orally or just a cream directly placed on the thyroid gland. And then GLP ones are an incredibly, incredibly powerful way to reduce Hashimoto's antibodies. So what I tell people is also reducing dairy is the number one food that drives Hashi and number two is gluten, reducing one of those.
And I tell people, look, the goal is to build tools in your toolbox that are objectively measurably changing things in your body so that you can pull them and use them again in the future. If you go into a flare, and the way that you do that is you pick an intervention.
Let's say it's low dose naltrexone or LDN. You test your TPO and thyroglobulin antibodies on day zero. You do that intervention for 90 days and you recheck those antibodies 90 days later and you've seen if they've changed. And if they do, you carry on. If they don't, you layer in an additional tool and repeat and rinse until your antibodies are moving in the right direction in a consistent basis over the course of time.
Oh my goodness. Okay, so quite a few things. I know that's a lot to unpack.
No, no, I you hit you hit on so many topics So one I completely forgot about this McCall like completely so I've been in this biohacking world for so long And I use red light like all the time. I forgot that I Originally got a red light device to treat to try to self-treat my hypothyroidism like forever ago. That's why I first like got one That's so funny. Okay, and then so a few different things the the selenium Maris, she actually said she said I would really really like a definitive answer about an appropriate dose of iodine and selenium To support thyroid function. The data is exceedingly confusing. Amen
So for selenium, it's 200 micrograms for three months. So that's easy, right? Like that's a lot of the standard dose. It can even be down to 150, but between 150 and 200 micrograms period, it's extremely safe. Most people should try that intervention. I don't want to say all because I don't want to give medical advice, but it's harmless.
Oh, the data on iodine is, it is confusing. And here's where I stand, right? You can cherry pick data however you want, but I found the data that supports supplementing high doses of iodine is circular in nature, meaning it's coming from and being cited by the same two people over and over and over again. And what I have found in fact, and what also is supported in the literature, is if someone has Hashimoto's and you give them iodine, most likely their Hashimoto's is getting worse. Their antibodies will actually increase. And one of the most effective ways, especially when people have stalled on their other interventions and they can't move a needle with their antibodies anymore, one of the most effective ways to get them to reduce is to remove iodine exposure. It's to remove iodine from their diet, from their salt, eat low iodine foods, avoid iodine rich foods, put an air purifier in your house if you're somewhat close to the ocean where iodine is even inhaled. So it is the opposite that what so many people think they should be doing. And I am incredibly diligent and careful with people, even if I put them on a hair loss supplement that contains iodine, you better believe I'm checking their antibodies even with low iodine dosages, because in all likelihood, their antibodies are going to increase. So I avoid it completely.
Wow, okay. I mean, that tracks with Dr. Alan Christensen on the show a while ago for his thyroid book, which is all about removing iodine. And yeah, I mean, I agree with Maris and you and that it's confusing because, you know, there's that approach.
And then people will say the complete opposite. They'll say add iodine. And it's like, how can two completely opposite things be the treatment? Do you often put patients on a zero iodine protocol?
So, I do when we're stalled, mainly because my goal is always like, what's the shortest path that I can get this person in their life back with the least amount of effort on their part, right? And my patients are motivated, but when they come in, they can hardly get up and put on real clothes every day. They are truly struggling, and you've probably been in that place on your own journey, that trying to make them do wild, crazy things, jump through all these hoops every day and live in this teeny tiny box kind of sets them up for failure. So we start with the things that are the least effort for them that move the needle the most, and we work backwards from that.
And then if we stall, I will put them on a low iodine diet. And I started trying that after Dr. Christensen's book came out, and I was curious. It always starts with my own curiosity and then analyzing the data to see what happens, and I got to tell you, it worked.
Okay, that's really, really good to hear. And fun fact, he was actually on the biohacking podcast, the first episode of that show. He's such a kind man. He's so nice. He's like the kindest. Okay, I love that.
I remember when I met him, I was really in the throes of trying to figure out my thyroid stuff and I think we were emailing and I sent him an email. It might have been when they pulled me off of the T4 and he literally called me and was like, I got to help you. Like the second he read the email, he's so kind. He's a good human. Yeah, no, completely. And then to comment on the LDN. So I've been on that since also, probably also around since 2014. Another just really, really quick story. And again, this is all about advocating for yourself and understanding that doctors are not always like the conventional system, not to put down all doctors, but the system I don't think is always set up to listen to the patient or look at the whole picture. I had anemia in the past and listeners who have heard this story, apologies, but I was actually, I was hospitalized for it. It was not good. They asked me, like, you know, they were asking me about all my different habits and I was on LDN and at the, when I got discharged at the end, I asked for all the like the doctor's notes and I read all of them. There was like pages and pages. And one of them said, one of the notes said, like patient says she, you know, doesn't drink excessively, but she's on naltrexone. And I was like, Oh my goodness, because basically so low dose naltrexone, you know, in the form that we're talking about it, it's used for autoimmune conditions and you know, it's used in our world in a low dose because it temporarily blocks your endorphin receptors and then your body rebounds and makes its own endorphins. But the naltrexone form is used to treat alcoholism. So I just felt so misunderstood not seen. I was like, Oh my goodness. So nobody's believing anything I say here is the point.
Right, I got found out I was on it before applying for life insurance. Lot of hoops to jump through after that, for sure.
It's a similar thing where they think it's an altrex zone. Oh, yeah.
they think it's for substance abuse, you know? And I'm like, actually, it's going to make me live longer. So it's the total opposite of what you guys are thinking. But
So Kelly, she wanted to know about nodules because she said she's trying red light to treat them.
So I have seen nodules fade and I've never done one intervention, right? Like we've done multiple things. A lot of it is reducing inflammation. A lot of it is trying to reduce antibodies. I've used things like LDN, definitely use things like red light. And so I would continue the tools in your toolbox.
It's kind of like the antibodies. You have to test and retest and see what's working for nodules depending on how they appear and how aggressive they look. If they're benign, I would say, look, if you are my patient, I'd have you go every year to get an ultrasound and see if they're reducing in size, which is very, very possible. Sometimes they can go away.
Okay. And then you mentioned GLP ones, and I know those are still all the controversy and rage and all the things these days.
So how often, well, first of all, what has been your personal perspective and opinion and experience? Like when they first started becoming, like were you using them before they became a big thing? And then when they really became a big thing, and now I feel like just a lot of people are on them, and I have a lot of questions. But just your perspective of them all and your experience with your patients, what has that been like?
Yeah, so you can completely optimize a woman's thyroid and turn around her entire life in pretty much every way with the exception of her metabolism. So when a woman has had thyroid dysfunction for 10, 15, 20 years, and you fix her hormones, that magically does not unravel two decades of metabolic dysfunction that has made her left and resistant, insulin resistant, and metabolically disadvantaged.
And it doesn't matter when they get to that point what their lifestyle is, there is a point of no return where you cannot lifestyle your way out of that anymore. How do I know? Because I've seen thousands of people do it. Like crazy things that they should not be having to do just to maintain their weight. There gets a point where, you know, obviously I don't believe calories in versus calories out is real anyway because metabolically we all are unique. But truly, truly these people in this sector of medicine, they can do all the things and they can't move the needle. And it really contributes to a heavy, heavy chronic disease burden. So I was an extreme early adopter of GLP ones and ran them with beta groups in my practice and captured as much data as humanly possible so early on. I met with these women myself every week for years, just so I could understand everything, ran labs, an obscene amount of labs way too often. And I gotta tell you, the data that is just now been coming out in the last few months, I was screaming from the rooftop four years ago when I first started running inflammatory data on these patients. I was like, wow, their inflammatory markers are plummeting in three months. And a year later, the data came out that said in two years, their inflammation was reduced. Then I started running it in six weeks. Then I started running it after one microdose injection and saw the inflammatory markers reduced by often like 80%. So I really, truly believe. Now I can speak in this niche in the world of thyroid combined with GLPs. I think I have the largest data set in the world on those patients for lab data. Like I really do, I'd be shocked if someone else had more data points than I did. And so, I can tell you firsthand GLPs are great, they help people lose weight, that's wonderful. That is, we are scratching the surface of this and that is not gonna be the thing that people take these meds for for long. GLPs have infinite other beneficial usages. And I can tell you from practicing conventional, functional medicine, there is nothing I've ever seen, lifestyle, supplement, medication, LDN, whatever it is, nothing holds a candle to the inflammatory reductions that GLPs elicit in like 48 hours. It is crazy. And with that comes, you know, benefits from a longevity perspective of autoimmune disease reduction, dementia, Alzheimer's reduction, fatty liver, cancer. There's so many cancer risk reductions with GLPs, 19% colon cancer, 13% breast cancer, 9% pancreatic cancer, increased mortality in people diagnosed with cancer on GLPs compared to people that don't.
And then lastly, for my people in general, it does a really unique thing in that, hey, it allows thyroid patients to lose weight, but it also reverses metabolic dysfunction so that long-term they can actually come off of these meds and successfully influence their weight with effort, which is something they could not do before.
And what's been really cool for years, I was so frustrated with so many of my functional medicine colleagues that were kind of poo-pooing on this and just looking at them in such a small narrow-minded focus point. And I've watched almost all of them turn around and come around and see the benefits because they're undeniable. They're every day in my inbox in the literature.
those impressive stats about, you know, inflammation and cancer and potential longevity benefits. Are those in people who start off with metabolic dysfunction? Or if you're metabolically healthy, could you also experience those benefits?
It's a good
question. So the data is run on people metabolically disadvantaged, right? Because that's how we pull that's that's who's been on these meds for decades already, right? That's how we can get effective long term data because they started as diabetes medications. So they've been around for 25 years at this point.
Now, the analysis that I do in my practice is irrespective, like we run analysis on, you know, a simple thing like HSCRP and inflammatory marker in patients metabolically disadvantaged or people who are stable, who've done well, who don't have weight gain that just want longevity benefits and we still see improvements. So what I think is the future is, you know, not only will these meds be around to treat and protect people from cardiovascular disease, but from a longevity perspective, your chance of dying if you're on a GLP is reduced by 13 to 18%. For any reason, your chance of dying is reduced by that much. People will absolutely and they have started taking them just for the longevity benefits in healthy populations of people.
Okay, so a few quick questions. So you did mention people coming off of them and Michelle said, well, she said, she said, why is everyone on it? Just kidding, kind of.
Then she said, do you have to be on it for life? How about are the side effects? And then Joelle said, is it a lifelong drug or can you come off the drug without gaining the weight back? So people, when they come off of it, what is that transition like?
So I'll share with you what I can. In my practice of medicine and in my educating the masses, I basically hold everything open. I share everything freely and I don't hold anything back, including our optimal ranges at Modern Theory Clinic that are just ours. It took us 10 years to develop them.
The only thing I don't publicly share is the algorithm, the numbers that we are looking for that predicts that people can successfully come off of GLPs. But we are looking for very particular things in their labs that show metabolic sensitivity. And for people that are familiar with this, they could probably try to guess and get to some optimal ranges. But what that tells us is, hey, when these people come off in all likelihood, they will not regain weight. They will be able to, if in six months or six years, they need to lose 10 pounds, they'll be able to lose that with effort without needing a GLP. Basically, the effort that they put in will now be equal to the outcome, which is what is inherently lost in this community. The effort that these people put in does not yield the appropriate outcome at some point. And GLPs unravel that.
Now, regular medicine that deals with chronic obesity, people who probably are not willing and invested in their ability to influence their metabolism, weight, and their lifestyle, if those people and research backs it up, if those people go on a GLP, they diet exercise, they come off of the GLP, they don't diet exercise. Guess what? They gain weight back, right? It's not crazy. It's just predictable. It's science. But if we get, and honestly, too, 99% of them probably have a thyroid disorder that has never been appropriately addressed and is the root cause of their chronic obesity to begin with and their metabolic dysfunction. If you unravel that, you balance their thyroid, you balance their hormones, you resensitize their metabolism. About 85% of our patients come off.
About 15% don't want to come off. It's been life changing. Maybe that might even be up to 20% by now. It's changed their life. It's changed their relationship with food, their inflammation, their joint pain, their psoriatic arthritis, whatever it is. And so they want to stay on it and not necessarily metabolically, but for all the other benefits that come along with it. So that is possible too. Some strategies that we use, we reduce dosing to the lowest possible dose over time. Every month or so we reduce the dose. We spread out the dose more and more to rehabilitate their own GLP sensitivity. We also use metformin to do the same thing, to sustain low insulin, low leptin levels after they discontinue. And then in regards to the questions about side effects, when we first started, we had significant side effects. We were using standardized dosing. Pretty much every side effect that people hear about in the media is from not the medication itself. It's from over medicating people, overdosing, and rapid weight loss.
So muscle loss comes from rapid weight loss. Collagen loss comes from rapid weight loss. Gallbladder pancreatic issues come from rapid weight loss. Vision loss comes from a rapid change in blood pressure due to rapid weight loss.
And so if you slow that process down and you put people on to micro doses of medication, not only are they not nauseous, they're not vomiting, but all those other side effects associated with over medication and rapid weight loss also go away. And that's been our experience. I used to write 10 Zofran anti-nausea prescriptions every day. I think I've written one in the last three years. We adopted micro dosing very, very quickly before it was, had a term called micro dosing. We were already doing it. And keeping people on the lowest possible dose of these medications, not increasing them every four weeks is absolutely key to avoiding side effects and just beneficial outcomes.
Awesome. Yeah, I remember when when they first became really popular everybody was talking about the muscle loss and I I just kept thinking well It's probably a lot of it because people are just not eating Like they're like, of course, they're losing muscle and fat
And they're not moving their body, they're not doing anything to preserve muscle mass. Right?
The math is math thing. And there are inherent compounds in GLP ones that are muscle mass preserving, but they can't outpace eating 400 calories a day and sitting on your booty all day, you know?
And to the point of the microdosing, what Maria wanted to know about microdosing, Pamela said I would like to know how to properly microdose, and she said it also helps her alcohol cravings as well.
So the actual like microdose amounts, how micro of a microdose is this?
Yeah, so basically there is no standardized definition of what a microdose is because it's been created by people to solve a problem, right? Everyone's tolerance to these medications is individualized as well. So some people need less, some people need more. To give people some perspective, we start people on a quarter to an eighth of the lowest available dose of semaglutide or terzepatide. A quarter to an eighth, so that is a tiny bit.
And when medicine standardizes dose increases every four weeks, we absolutely do not do not do that. People will stay at that eighth of a dose for sometimes three, six, eight months because it continues to be effective. So a microdose is the lowest possible dose that you can get that is efficacious, that is lower than the starting dose of these medications.
Okay, and to that point, you mentioned trisepatide and semaglutide. So an anonymous listener literally just wanted to know the difference between those two.
Yeah. So, you know, somaglutide was kind of the more first-generation weight loss drug for this. Obviously, they were both around for diabetes. Terzepatide acts on more than one receptor. And, you know, supposedly in the media, people are like, oh, we love terzepatide because it has less side effects. And that's wonderful.
But what I'll tell you in my experience with my own patients is in microdosing, they both have very little side effects like nausea, vomiting. When you microdose, they're both very, very low. I prefer, personally, people to always start, 98% of them on somaglutide. And the reason and nuance behind this is because it only hits on one major receptor and people can retain enough appetite to fuel their body. The biggest risk with all of this is you don't eat enough food, you don't get enough micronutrients, and you don't get enough micronutrients every day. So you're in this depleted, devoid nutrient state. Terzepatide tends to bomb out people's appetite even at these tiny, tiny doses. And so people are not getting enough food, micronacronutrients, and it's causing issues.
So I always start my patients generally on somaglutide, see how they do, especially they have a lot of weight to lose. Let's say they have 80 pounds to lose. You can titrate them up over years and years and years, and eventually they're going to stall out and it's going to be less effective. Then I'll bring in terzepatide because it hits on that secondary receptor and can rebuild and continue to create weight loss and improved metabolic function even after they've stalled out on somaglutide.
And this is an interesting question. I kind of thought about this.
Anna Maurice wanted to know about the various shot locations and is there a better spot for each person? She said, some people prefer left thigh over right side abdomen, for example. I've seen a few posts actually that the left underside of the arm is good. Does it really matter or is it just preference?
Good question. So there's two reasons I have people change injection site location. Number one, most commonly, is nausea. So for whatever reason, when people move from injecting in their abdomen to their outer thigh, for example, nausea rates reduce. And that was more of the thing when we used higher dosing, but it persists, you know, even with microdosing, if they have a little bit of that, it's equally reflected.
And the second is stalling. So if they stall and they're not able to lose weight, and I mean, small amounts, our goal is very slow weight loss. We do not want people losing 10 pounds every month, you know? If they start to stall and a stall is like three weeks in a row of less than a half a pound of weight loss, we have them move injection sites, and it kind of spurs again, it reignites a little bit more potential for weight loss.
But that's a really interesting question. But ultimately you can do it anywhere. But I usually have people start with the abdomen and deviate out from there.
Okay, awesome. And did you experiment with them or do you take them?
You know what? I did for about the first year. Then to be honest and candid with you, my daughter had a health crisis and I just was having trouble eating on my own and lost an insane amount of weight in a short period of time. And so I had to stop them for the last three years.
I just restarted them about six weeks ago for heart disease prevention. And I'm inflamed too. I'm an inflamed person, but I started them for heart disease prevention because of some issues in my family.
Oh, wow. I'm sorry about your daughter.
Yeah, I'm really intrigued by it. A quick question, because you just said like a really inflamed person. It's funny, I've had this fear of inflammation for so long. It's funny, I'll be with my therapist and she'll be like, Melanie, not everything is inflammation. I'm like, but it is. She's just not inflamed. I know. I know. So here's the irony though. So like, I know there are other markers of inflammation, but like my CRP, for example, is a literal flat line. Like it's never even had a bump. I remember I was talking, I used to work with inside tracker and they were like, we've never seen a flat line like that for like years and years and years. So at least that inflammatory markers is not present for me.
Can you be inflamed and not like, are there other lab markers that indicate inflammation that you look at?
Yeah. So we don't run routine like every three-month lab markers outside of CRP for inflammation other than antibodies, right? Because that's just another manifestation. ANA is another one that's easy to run. There are some others, you know, IGF, things like that. For me personally, I want to have ran my genetics, but I've been inflamed my whole life. Like I'll gain eight pounds overnight if I don't eat well. You know what I mean? And people who are inflamed know what inflammation feels and looks like in their body. My husband, for example, has never been inflamed a day in his life. He has no idea what I mean. Your therapist might be the same, right?
But it's the foggy, malaise, weighed-down puffy that I think a lot of people don't realize is inflammation. But some of us are genetically hardwired for inflammation, and that is absolutely me. I have to reel in a lot of my life to manage it. Intermittent fasting is one of the most powerful ways I've been able to, actually. But I think it's discounted. I think it's heavily, heavily discounted, and people don't know it's happening or it's being written off as something else entirely.
Yeah, I'm really fascinated by it. The way I feel like it is for me is I just feel very reacty.
Like I feel like I react to stuff. And that's why, well, a reason that, like you said, with the fasting and reason I love fasting so much is it feels so anti-inflammatory for me when I'm in the fasted state. I actually had a holistic minded practitioner when she saw my CRP history say that maybe I should go off of LDN because maybe that was maybe it was being too suppressive of inflammation for me. Do you ever have people go, can you be on LDN for too long or do people go off of it? Should they go off of it?
I think most people honestly should be on LDN for the rest of their lives. It has anti-cancer benefits, anti-aging benefits.
If that were the case, then that would manifest as being immunocompromised, but LDN doesn't do that. It's a potent anti-inflammatory mechanism that actually improves your immune function while simultaneously reversing inflammation. So I do not think that that's accurate at all.
Do you have a dosage that you find that you work up to because I've actually been only I only do 1.5 milligrams Like do you try to find I know people go up to like four. Yeah, four
4.5 is the dose that research is done on. So that's where we pulled data from. I don't think it's necessarily one size fits all.
I have patients who definitely need more than that, specifically Graves patients. I think they burn through the mechanism of action really quickly, hyperthyroid people. But I think most people, I try to get them up to 4.5 if they can tolerate it, only because, hey, that's where we have the literature that's supportive of this. Okay.
Yeah, I wonder if I... It's been so long. Every time I have a conversation about it on the podcast, I'm like, maybe I should try bumping up my dose just to see.
Okay, wow. And when you work with patients, what is your model like? Do you work at all with insurance? Do you take new patients? Lab works, how does it all work at your practice?
Yeah, good question. Thanks for asking. So we are a completely cash pay practice for our time. We bill insurance for labs, we bill insurance for medication. But basically, you know, like, for example, our clinicians spend an hour with patients on their first visit. If we took insurance, we would charge between 35 and $64 for that hour. That's what we get paid from insurance. And that's just not realistic. We couldn't pay the admin staff to support the clinician for that hour for that amount. So we do completely cash pay.
All of our pricing is listed on our website. I personally am not taking new patients right now, mainly because I have a book coming out next year. I didn't know this. Oh my goodness. I know. It's very exciting. February 9. Take back your thyroid with Penguin Random House actually will have to have you back. I would love that. Oh my gosh. Is it about the thyroid? It totally is. It's about thyroid. It basically, you know, offers people the full, there is so much nuance to this and people deserve to have access to the nuance. They deserve to be able to navigate this complex landscape. Kind of like you touched on earlier, we are not in terms of thyroid in an era that we can sit back and passively just trust whatever our clinician says and expect to get our lives back. That's like a recipe for debilitating symptoms for the rest of your life. So I've given people through the book, start to finish the research, the daily habits, what to do when you get your labs back, how to interpret them, everything from A to Z that will allow people to successfully navigate this and truly get their lives back.
So for the next several months, I'm not taking new patients, but we have clinicians at Modern Thyroid Clinic that, you know, this isn't just my mission anymore. It's theirs too. This is their life's work. They all have a thyroid condition themselves. They've sat in the patient chair. They've been gaslit. They've been dismissed. They're just incredible, incredible clinicians. And because we have access to them, we can see patients nationwide. So when people come in, yeah, they would see one of our clinicians that are like just ours. We don't license this out to telemedicine network, like nothing. These are our people that deeply, deeply care about this work.
Oh my goodness. Amazing. And yeah, okay.
So I think for sure we'll, we'll air this on the intermittent fasting podcast. And then if you'd like to come back for your book, we can do that on the biohacking podcast.
I would love that.
much thank you and congratulations you must be what what phase of the book writing process are you in right now or publishing process
So we are done. We started pre-orders at the Beyond Biohacking conference this last weekend. So I can totally share the link with you that people can also go to Amazon and look up take back your thyroid and they can actually pre-order it. And we have some specials and things going on to support that that I can totally send you a link for too that you can put in the show notes.
But we are officially in pre-order med sister. I'm so excited.
Oh my goodness. Congratulations. And also, it must feel good.
I know like the actual the writing process and editing process is a lot. So probably not the best for a person's thyroid or they need extra support during that time. Oh my goodness. Well, was there anything else you wanted to touch on with listeners before we go? This has been so amazing. You had like all the answers to all the like all the controversy and all the things I've wondered for years and years. So just thank you for everything.
Absolutely. I feel like that's where I live, right? Getting clarity in all of that.
The last thing that I would just really want people to know is hypothyroidism is one of the most common endocrine disruptors in our country. And sadly, I think women think that because they have it, this is just what life looks like. They're condemned to a life of kind of suffering because of it. And that's not true. Our whole motto at Modern Thyroid Clinic is there's no reason to still have thyroid symptoms. And that's the message I want women to understand. There are all these barriers in medicine that can keep them from reaching their full potential, but that does not have to be their story. There is true, predictable algorithms and outcomes that can really intervene to change the rest of someone's life in a very short period of time. And in essence, there's so much hope.
Well, thank you so, so much for what you're doing. It's just absolutely beyond incredible. And yeah, when I told listeners that you were coming on, they were just, as you can tell from all these questions, so excited to, um, you know, ask them to you. So thank you.
And I'm so sad that I didn't meet you in person at the Beyond conference, but next, next year, for sure. Next year.
for sure. Absolutely. I'm looking forward to it. Please keep me posted too if you come to Austin.
Oh, I will. I will. Well, enjoy the rest of your day. Oh, and again, so sorry, one last time, the links. So how can people, if they want to be a patient, where do they go?
Thank you. So you'll go to modernthyroidclinic.com and you can find out about being a patient.
You can tune into my podcast at Modern Thyroid and Wellness and find me on all the social media platforms.
Awesome. Awesome.
and then pre-order. Take back your thyroid. Take back your thyroid. Well, thank you, McCall. This has been so wonderful, and we will talk again soon.
Thank you so much for having me, bye. Thank you so much for listening to the Intermittent Fasting Podcast. Please remember, everything we discussed on this show does not constitute medical advice, and no patient-doctor relationship is formed. If you enjoyed the show, please consider writing a review on iTunes. We couldn't do this without our amazing team. Editing by podcast doctors, show notes and artwork by Brianna Joyner, and original theme composed by Leland Cox, and recomposed by Steve Saunders. See you next week.