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  • Ep. 448 Hair Loss in Women: Causes, Fixes & Expert Tips with Dr. Omer Ibrahim

    Today, I am delighted to connect with Dr. Omer Ibrahim, a board-certified, fellowship-trained dermatologist and the Co-director of Research at Chicago Cosmetics Surgery and Dermatology. Dr. Ibrahim completed his residency at the Cleveland Clinic.  In our discussion today, we dive into the concept of hair loss in women, exploring how our hair follicles change during perimenopause and menopause, the prevalence of hair loss and hair thinning, and the many factors that contribute to it, including nutritional deficiencies, chronic stress, heat damage, weight loss (especially with GLP-1 medications), alcohol, and smoking. We discuss the benefits of hormone replacement therapy, essential supplements, red light therapy, PRP, exosomes, and topical and oral medications, and we also cover specific lab tests to request, the impact of endocrine-mimicking chemicals, and how to find qualified hair specialists or dermatologists in your area.  You will not want to miss this conversation with Dr. Omer Ibrahim, and I look forward to having him back on the podcast in the future. IN THIS EPISODE YOU WILL LEARN: The two most common reasons for hair thinning and hair loss How pattern hair loss, or TE, is linked to hormonal changes in perimenopause and menopause How hair loss patterns are not inherited directly, and how they can vary, even within the same family Why early treatment for hair loss is essential How weight loss and GLP-1 agonists can impact hair loss Vitamin deficiencies that could contribute to hair loss Why it’s important to avoid harsh hair care practices to prevent hair damage How stress could lead to hair loss and thinning How alcohol and smoking impact hair loss Various prescription medications available for hair loss Bio: Dr. Omer Ibrahim Omer Ibrahim, MD FAAD, is a board-certified, fellowship-trained dermatologist and co-director of research at Chicago Cosmetic Surgery and Dermatology. He completed his residency at Cleveland Clinic, followed by an ASDS-accredited fellowship in cosmetic, laser, and dermatologic surgery at SkinCare Physicians in Boston. Dr. Ibrahim serves as adjunct faculty at Cleveland Clinic and Rush University, where he teaches residents the fundamentals of cosmetic and surgical dermatology. “Vitamin D deficiencies can lead to hair thinning and hair shedding.” -Dr. Omer Ibrahim Connect with Cynthia Thurlow    Follow on Twitter Instagram LinkedIn Check out Cynthia’s website Submit your questions to support@cynthiathurlow.com Connect with Dr. Stephen Hussey On his website On Facebook , Instagram , Twitter , and LinkedIn Connect with Dr. Omer Ibrahim Chicago Cosmetic Surgery and Dermatology On   Instagram Transcript:

  • Ep. 154 Thyroid & Intermittent Fasting Reset: How to Normalize Your Thyroid Function with Dr. Alan Christianson

    I am delighted to have Dr. Alan Christianson joining me as my guest for today’s show! Dr. Christianson is a Board-Certified Naturopathic Endocrinologist who focuses on thyroid care. He is also a New York Times bestselling author whose recent titles include The Thyroid Reset Diet . Dr. Christianson is the founding president behind the Endocrine Association of Naturopathic Physicians and the American College of Thyroidology. He has featured in countless media appearances, including Dr. Oz, The Doctors, and The Today Show. Although tons of information about thyroid conditions is available out there, it can be confusing because so much of it is conflicting. Recent findings have shown that much of what we believed to be true in the past has changed. Thyroid disease has also changed. Thyroid cancers, the prevalence of thyroid treatment, and diagnoses for chronic disease have all tripled over the last couple of decades. Fortunately, Dr. Christianson is an incredible resource! He is joining us today to dive into some of the recent discoveries about the causes of thyroid disease and share some encouraging findings. Stay tuned to learn more! IN THIS EPISODE YOU WILL LEARN Dr. Christianson talks about the changes that have been happening regarding thyroid disease over the last twenty years. Dr. Christianson talks about the most important factor for the increase in thyroid disease over the last couple of decades. Understanding it can offer a solution for many people. How the thyroid works, its physiology, and how iodine interacts with it. Why there is so much iodine in dairy products. Dr. Christianson talks about the shift that took place around the mid-1980s that is relevant to thyroid disease. Everything related to iodine in our body gets filtered through the thyroid function. What you need to be aware of and understand to make educated decisions about the products you use. What almost everyone with thyroid problems can do to normalize their thyroid function in a very short time. Dr. Christianson shares some encouraging findings regarding over and underactive thyroid function. Dr. Christianson talks about thyroid medicines. Things you should take into account when having a thyroid test. What you can do to help support your body. The various factors work that together to exacerbate thyroid function. Lifestyle factors that impact thyroid function. “Thyroid cancers have tripled in the last couple of decades, and the prevalence of thyroid treatment and diagnosis for chronic disease has also tripled over this time frame.” -    Dr. Alan Christianson Connect with Cynthia Thurlow    Follow on  Twitter Instagram LinkedIn Check out Cynthia’s  website Submit your questions to  support@cynthiathurlow.com Connect with Dr. Alan Christianson On Facebook On Instagram On Pinterest On YouTube On his website Transcript: Presenter:  This is Everyday Wellness, a podcast dedicated to helping you achieve your health and wellness goals and provide practical strategies that you can use in your real life. And now, here's your host, nurse practitioner, Cynthia Thurlow. Cynthia:  Today, I'm delighted to have Dr. Alan Christianson. He's a board-certified naturopathic endocrinologist who focuses on thyroid care. He's also a New York Times bestselling author whose recent titles include The Thyroid Reset Diet , and for which I am so excited to have you joining us this afternoon, largely because there's just so much information out there about thyroid that's so conflicting, and yet I know you're just this incredible resource. So, let's really dive into some of the new findings about the causes of thyroid disease, because even as a clinician myself, I was really surprised that I was explaining to my husband, this makes so much sense when I was really diving into the book and doing research for our interview today. Dr. Christianson:  Yeah. So much of what we've learned has changed in the recent past. So much of thyroid disease has changed recently. Thyroid cancers have tripled in the last couple decades. Prevalence of thyroid treatment and diagnosis for chronic disease has also tripled over this timeframe. There's been a lot of new initiatives trying to answer the question of, why is this happening, what's going on? One large group of medical reviewers, their conclusion was that many factors are responsible. However, the biggest single one by far is the change in our iodine intake. They argued that it was not only the most important, but it was more important than all the other factors combined. So, yeah. [chuckles]  Cynthia:  Well, and it's interesting, because if we think about how much our health as a nation and most westernized countries has really shifted over the last 20 to 30 years, less people cooking at home, more consumption of processed foods, where I'm assuming there is more exposure to iodine. There's so much of it in the processed food industry, and interestingly enough, I was always feeling badly, because every time I had a urinary iodine checked by my functional medicine provider, they're like, “Oh, you're so low. Eat more sea vegetables.”  [laughter]  I'm grateful that I never actually took an iodine supplement, but I know that there's so much conflict about this particular micronutrient in particular-- I think for so many people, we would not have made those connections that you've been able to make when you were piecing together all this research behind the book. Dr. Christianson:  Yeah. Big picture, there's some ideas that have become prevalent in functional medicine that we could tie, I could talk in great detail, but where it came from, why and why things are plausible with iodine, but it's not true. Where we think about nutrients in general is that vitamin C, magnesium, calcium, zinc, they're work with countless parts of our bodies, and they do a myriad of important roles. We may get low in them, but there's really not a common issue of getting too much, your body can regulate that pretty well. None of those things are true for iodine. [laughs] All the ways we're used to thinking about nutrients do not apply to iodine. And it's important, we need it, it's not the bad guy at the story. Most people, probably a slight majority, they can tolerate the normal occasional excesses of iodine, and with no issue. Just like water off a duck's back, no big deal. But they're not the ones prone to thyroid disease.  So yeah, it's something that the amounts in play are so tiny, the body concentrates it many-fold over requirements. Just because of that variable, the whole relationship changes. There was a lot of times historically, or if we went back to pre-1990, a lot of times globally, in which people were getting just less than they need. But now, it's much easier to get above a threshold that those who are sensitive can tolerate. The really exciting part of it is that, it's cool to know why things happen, but an explanation is not always a solution. Humpty-Dumpty might have fallen off the wall because a gust of wind came along, but that wouldn't fix him necessarily. So, the exciting thing is, this can also offer a solution for many people that even if this were the thing that caused their disease, a really high percent of them can see their disease go away by correcting the problem. Cynthia:  I think this is profoundly encouraging, because when I talk to middle-aged women, women that are in perimenopause and menopause, nearly all of them are either on thyroid replacement, or they're told they have a lagging thyroid, and people are feeling anxious, because for many of them, maybe this is the first time they've needed to go on a prescription medication to understand that there could be a reason for why this has transpired beyond just being “middle aged” and highly encouraging. Now, one of the things that I think is really important to talk about those that are not familiarized with thyroid physiology and how iodine fits into that, I think that it's important people understand there's just need very small amounts of iodine, it's not a proliferative amount that we need, but let's dive into the physiology of the thyroid, because I think even understanding on a very basic level, the way the thyroid works and how iodine interacts, but that will help people understand why we have to be conscientious about this. Dr. Christianson:  Yeah. Iodine is a really powerful substance. The form that it circulates in the body is generally a more dormant one. But it gets activated within the thyroid. Iodine has been used forever as an antiseptic. So, in a lot of ways you can think about it like you would think about like bleach or hydrogen peroxide solution. It massively generates free radicals. That's great killing infections. That's useful in some chemical reactions, but it's exacting. There's a protein that the thyroid makes, and this protein is, I don't know, like a big coat hanger. Then, iodine comes along, and it's various coats that fit on these hooks at the hanger. Once you get the right number of iodine atoms in place, now you've got an active thyroid hormone.  So, it's essential. You can't have hormones without the iodine. However, I don't know you're in a cool part of the country too. I grew up in northern Minnesota, and we've got family over and soon the coat hangers overloaded, [laughs] coats laying on the bed and stuff on the floor around it, and mittens and scarves. So, that's what happens with a little bit extra iodine, is that there's places for-- to be really precise, each molecule of thyroid globulin has special residues to hold up to 13 iodine atoms. But if we get just a little more than our bodies tolerate, we might have 50 or 60 iodine atoms all jammed around that molecule. It's like the coats exploding all over the coat rack. That by itself makes the thyroid proteins look weird. Your immune cells come in and say, “What's going on?” They start to attack them, and now there's an autoimmune process. So, the thyroid is slowed down, and that's the main trigger for it. This very thing that you need to work a little bit too much of that, shuts the whole thing down. Cynthia:  I think that balance is really critically important that people understand that iodine is not needed, that it's not absolutely necessary for appropriate thyroid function, but too much of any one thing is no good. Now, one of the things I found really interesting was that in the book, you talk about how our bodies need anywhere from 50 to 200 micrograms, so we're talking about a very small amount to make thyroglo-- Or to actually make healthy thyroid hormone. It's the exposure that we go about on a day-to-day basis like, people may be thinking, “Well, I'm not taking iodine supplement. I don't like sea vegetables.” But there are things in our environment in particular, and what I found really disturbing, and I'm not a dairy drinker, I don't eat cheese, I don't do any of that, but you’ve talk about the sanitization properties of iodine, and one of the things that and one of the reasons why there is so much iodine empirically in dairy products is that that's what the farmers or dairy farmers will use to sanitize the cow's teats. So actually, when they're going into actually-- I'm not even sure the technical terminology. When someone's milking a cow, I don't know the other way to put it. When someone's milking a cow, the cow’s udders have been sanitized with iodine. So, you're getting it just from there. There's so many ways that we're exposed iodine without even realizing it. Dr. Christianson:  Yeah. We get some, we need some, and what happens is, this is a story that's really about to change. A change took place around the mid to late 80s. There's other eras that are relevant to thyroid disease, the rates were lower, but around then it started really picking up, and there's been a constant amount in certain food types like I've always had some in iodized salt, there's always been some egg yolks, will always have some iodine in seafood. Those things haven't changed all that much. Sea vegetables are really high sources. Most westerners don't consume that many of them. Some do. They're certainly relevant. But yeah, the big shift has been dairy processed foods, and cosmetics is being changed and in supplements. So, dairy food and processed grain products, they comprise the top 25 sources of iodine in the average American diet. 23 of those 25 top sources, the amount they contribute has doubled or tripled in the last several decades. So, yeah, this is a big source, and it's really picked up. Cynthia:  What do you attribute that to? I always talk about the rise of the processed food industry, but I think it's also the mentality, a lot of people-- maybe take COVID out of it. People are home much more than they were before, but how the processed food industry in many ways has convinced families and individuals that they don't know how to cook. I've got an easier faster way to get food on your table, but the untoward effect, whether it's exposure to seed oils, processed sugars, all these other micronutrients that we think of as being fairly benign really aren't cumulatively over time. Dr. Christianson:  Definitely a big factor. We also see micronutrients with high amounts of cosmetics, and somehow really, this combination has been a big shift. Yeah, globally, in 1990, we had 112 nations that were severely deficient. Now, there's none. But we've got 52 nations categorized as at risk for thyroid disease due to iodine excess. We are one of those.  Cynthia:  So, when that initiative went through, and I also found this really interesting, the role of iodine and having an appropriately functioning thyroid is so critical for neurocognitive function. I'm presuming that was the impetus for actually creating that initiative to begin with, that it was a concern that there are these at-risk nations that are severely impacted by these deficiencies.  Dr. Christianson:  For sure. Yeah, congenital hypothyroidism, cretinism, there's many ways that-- basically, all things iodine, as far as human health, they're filtered through thyroid function. If there's ever the wrong amount, that plays out by changing how the thyroid works before almost anything else happens. So, places that were severely deficient, they would have people developing with varying problems. Pediatric goiter, enlargement of the thyroid, probably one of the most benign of the problems. Funny thing is most of those problems are more pronounced in younger populations and children. If someone does make it through adulthood, this is less of an issue. It's less common. But yeah, pediatric greater congenital hypothyroidism, neurocognitive development impairment as you mentioned, those are big factors. If we were to go back even to the 70s and the early 80s, there was times in which almost 2 billion people on the planet didn't have proper brain function due to a lack of that. So, it was a big public health problem, and they fixed it. It was successful. It was a good thing. But now, we've gone a little too far in some areas. [laughs]  Cynthia: Yeah, the pendulum has really swung me opposite direction. If we've addressed the iodine deficiency, and now we have this overabundance in many ways, there’s overabundance in so many levels, what are the things that people need to understand so that they can be proactive or be in a position where they can make more educated decisions about the products they're exposed to you mentioned the cosmetic industry is a huge contributor to why we've got this iodine excess, as well as the nutritional component. But what are the things that people need to be aware of so that they can screen, obviously, you've got a lot of great information in your book. I strongly encourage people to go check it out, but what are the things the big thing, the high-level things that people need to be aware of? Dr. Christianson:  Yeah, the most important thing I want listeners to take away from this is just a sense about how much change is possible and how likely that change can be. There was one paper, which didn't make it in the book, because it hadn't come out yet. It was completed in May of 2020, and this was a paper looking at the role of deprescribing, which basically means someone who's-- not prescribing but deprescribing, where someone will not need our medications any longer. And in this study, they took people and they did the most cursory level of iodine avoidance. They said, here's some really obvious sources that have too much iodine, like sea veggies like you mentioned, some supplements. Don't do these things. And let's see if you can stop taking your thyroid medication. Just doing that, 40% of people who were on longer-term treatment were successfully able to deprescribe. They could stop their medications, they can maintain normal thyroid function, and they could maintain free-- no symptoms. They felt fine. They had normal thyroid function. So that was those on treatment.  Now, those not yet on treatment, one of the studies that I cited in the book took those with Hashimoto’s. They'd had it for about four to five years, they were severely hypothyroid. We could talk about numbers, but they were way outside the normal range by a factor of four. All they did with them was a more thorough avoidance of obvious sources of iodine. In three months, 78.3% had perfectly normal thyroid function again. And of those who didn't get better, most of them either didn't really follow all the instructions, there was still a lot of iodine coming out of their bodies, or they were improving, but they started so far off that they just didn't yet have time to normalize. So, they looked at the numbers and said, “Okay, so who in this study did do things right, but just didn't respond at all? To whom did this not make any difference for?” That was about 3% of participants. Almost everyone got totally normal, or was heading that way. This is something that doesn't help some people here and there maybe, and this is something that doesn't help by a subtle amount that you got to squint to see it. This is a big deal. This is almost all people with thyroid problems can see their function radically improve or normalize in short periods of time. Cynthia:  Really incredibly encouraging. For listeners that aren't aware of this, the bulk of those have an underactive thyroid, it's generally-- and I've seen statistics anywhere from %70 to 85%, so somewhere in between is probably correct, are impacted by the auto immune so body attacking self, Hashimoto’s. Then, there are the gray area maybe of 10% to 15% of us who have non-autoimmune hypothyroidism and then an even smaller percentage of people have hyperthyroidism, the overactive thyroid. In those studies, was there any differentiation between each one of those groups or was it just a normal elevation just overall? Dr. Christianson:  Yeah. Those that clearly have autoimmunity and then those that don't, hypothyroidism and Hashimoto’s were both studied pretty much the same numbers. They also showed subclinical disease where part of the labs are off, part of them aren't. Same numbers basically. Funny brief aside, so non-autoimmune hypothyroidism is we think now is really, really rare. Most-- not most, but right around half of people that have autoimmune thyroid disease may never have measurable thyroid antibodies. A lot of doctors say, “Oh, you don't have thyroid antibodies present, you must not have autoimmune thyroid disease. Nope, that's not a rule out.” [laughs]  Cynthia:  That's really significant, because even for clinicians who've been diagnosed with hypothyroidism, I thought I was always safe from Hashimoto’s, because my thyroid antibodies were always negative. They were 0. But that's suggesting that there are a lot of people who may indeed have autoimmune Hashimoto’s without realizing it. Dr. Christianson:  Honestly, the trend clinically has been to assume unless there's a clear reason otherwise. A lot of the other reasons for hypothyroidism are more historical than present. If someone had their tonsils irradiated back when for a sore throat, that doesn't go on anymore, or the couple, a handful of medications that might directly slow the thyroid, or some other surgery or procedure that affected it, that barring that stuff, it's pretty much all autoimmune. Then, you asked about hyperthyroidism Graves' disease. There have been trials looking at this approach. Now, with Graves’ disease, there's a fascinating feedback cycle between too much thyroid hormone and then the autoimmunity that causes one to release too much thyroid hormone. We call this the autoimmune hyperthyroidism loop. Someone really first has to break that loop. If they don't, if they can't lower their thyroid output by stopping their thyroid, it'll keep cranking on and keep escalating all by itself.  However, once that loop is broken, whether that's by the glands spontaneously slowing as it does for some, or medications to slow it, or other procedures to slow it, once the loop is broken, then there's a lot of data showing that iodine regulation makes things go a lot quicker. Funny thing about Graves’ is that in the moment, it can be more acute and more dangerous for cardiac effects. However, the rate of full remission, full disease remission is actually a lot higher than it is for Hashimoto’s. So, once someone can get stabilized, they have and this is not based on new data, this is just old data, that they've got about a 95% chance of normal thyroid function within 18 months just by stabilizing. Cynthia:  That's incredible, because my whole background as a nurse practitioner was in cardiology. I saw quite a bit of thyroid storm, which is of course, the worst-case impact of overactive thyroid function and people that would have months and months and months of lots of palpitations, lots of arrhythmias, and then things would settle down. Obviously, I didn't work in endocrinology, but I think that's very encouraging for people to understand that if you have Graves’, you're much more likely to be able to get to a point where you were healed from your thyroid, whereas I think that the vast majority of individuals impacted by a dysfunctional thyroid, they've been told convinced that they'll need to be on medication for the rest of their lives. Probably, this is a good segue, because there were a lot of questions that came in about thyroid medications, and for listeners that are not aware, if you've been, if you haven't, we're not impacted by this recall some of the desiccated products that many of us more naturally mimicked the way that our thyroid should ideally function were pulled off the market, which is what should happen when they test lots, and maybe you can touch on that process. When people are looking at strategies for how to address looking at the thyroid with medication, there are synthetic variations, there are compound and variations, and there are desiccated variations. So, differentiating what these represent, how they work, and I can tell everyone, and I'll be happy to answer this. I get asked this a lot. I've tried all of them in the past year, just trying to get back to some degree of normal thyroid function. Dr. Christianson:  Yeah. In terms of medications available, you mentioned that and there are many people that can do the most common approaches, which is synthetic T4 and do fine from that, stable blood levels, manage symptoms, and that's great. There's none of those options-- I'm sorry. I should expand. The ones that are manufactured by factories, none of them are inherently bad options. The question is really what's going to work best an individual. Of those I've been exposed to a biased population for the last 25 years, the people that have done the common approaches and felt great have not come to see me and my doctors. They've not needed to.  [laughter]  They exist and if you're on something and doing well with it, there's not really a big reason to change. When one does embark upon the thyroid reset diet, however, it's smart to know that your needs may change and those that fits for you may not fit in the future. Now, thyroid medications and iodine, we're talking about microscopic stuff. No for analogies. If we go down by orders of a million, let's start with a cow.  [laughter]  Black and White Holstein full-on adult cow. So, that's one piece to think about. That's about 1000 kilograms. Now, if we go down by a million, we come down to a ground, and that's a paperclip. Factor of a million a cow to a paperclip.  Let's go down by another factor of a million. Well, that's a microgram. What a paperclip is to a cow is what a microgram is to a paperclip. [laughs] So, it's dang tiny to be precise. [laughs] Yeah, that's the quantities in which we think about thyroid hormones. Now, most medications, most supplements, they really are things that are in the milligram and gram potency range, so there are a whole lot easier to make. Imagine that you're making muffins at home, and you’re making blueberry muffins. So, you're going to make a dozen muffins, you put them in the tin and bake them. [unintelligible [00:21:03]  stirring up. Now, you can easily get close to a cup of batter per muffin, that's not too hard to do. And if you really watch closely, you might be able to get six blueberries per muffin. That's possible. So, imagine you’ve got poppy seed muffins. [laughs] [unintelligible [00:21:24]  1000 poppy seeds in every muffin, and not 1010, or not 900 poppy seeds. Now, we're talking about making things thinking about a smaller level. If we go thousand-fold smaller than poppy seeds, you can see why it's hard to get pills to all have the right number of micrograms. It's just not easy. With our best technology, with our best machinery and quality control methods, it's not perfect. There's a lot of processes that require checks and balances and they should. So, in a period between 2012 to 2017, there was 99 recalls on synthetic thyroid medication throughout many different brands. And they should check. We've had four recalls-- Four or five, there's been one mandatory recall on natural thyroid and four or five voluntary recalls in the last two decades. So, when it's your medicine you're on and it happens, it's frustrating. It's it might not be 100%. But in the big scheme of things, medicine recalls, they do happen. There's medicines that are made by factories, medicines that are made by compounding pharmacies, and medicines that are just nonprescription. There are thyroid glandulars that come from cows that have active hormones that people can buy without prescription. So, yeah, when the factories make it, they use the best techniques, they test-- They don't always come out perfect, and we know that. Now, the compounding idea, I love the idea of being able to choose the exact hormone, the exact amount, the ratio, but nobody checks. They never have recalls, not because they're perfect, but because nobody checks. There have been about a dozen published case studies in the last several years of people who've been hospitalized from compounded thyroid medications. So, we know they can go wrong by a big degree, but we have no data on how often they go wrong to smaller degrees because no one checks. Then, over the counter third medicines, they do exist, but the problems that I’ve mentioned are just amplified hundreds of fold. There have been times in which people have went and just bought those and then assayed them in laboratories. Yeah, they've got active hormone, but it's all over the place from build a pill from bottle to bottle, so, not a viable option. Categories of manufactured medications, we have natural desiccated thyroid, which has T4, T3, T2, some of the thyroid proteins. We have T4 and T3 in isolate. We used to have a T4, T3 combo not in the market anymore. So, most people that goes all the way to see someone like myself or someone else in natural medicine, they've probably tried T4 and not done well with that. In those cases, I see many do well on natural desiccated thyroid, there are different brands out there, and the brand differences are not huge.  There are some all things that are medication, changing brands can be difficult, because even if the active ingredients are consistent from brand to brand, the inactive ones may not be. And how your body breaks down these inactive things may not be the same way your body breaks down those other inactive things. So, if you change brands or if you're on a generic and you can get different manufacturers from batch to batch, in those cases, it's hard to calibrate because it's always shifting for you. So, the number one rule is, try to maintain one brand as much as possible. I do see many do better subjectively on natural thyroid. There was a big paper done in California two years ago about whether natural thyroid could give as stable blood levels as synthetic hormones. It does. There's no big differences that way. So, that's really not an issue anymore. Then, there are those who do fine on T4 only or some T4 plus some T3, but those the real main approaches that are out there, Cynthia:  I think it really comes down to bio individuality, because if I were to take 10 women that were relatively the same age dealing with hypothyroidism, they might all have very differing experiences with each one of the options that you've discussed. I've been very open with the listeners that Nature-Throid got recalled, boohoo, in September, and I then went on a six-month journey to figure out what would work best me. I started with compound and thinking naively, even as a clinician that was going to work best, because someone in a pharmacy put it all together. What it made me was hyperthyroid, which for anyone who's been a little underactive to be overactive, I think is probably worse. Then, I had a washout, and then I was put on Armour, which was one of the very few other natural desiccated products that was still on the market. That didn't work well. Now, surprisingly, I've been doing well on Synthroid and Cytomel, which are synthetic T4 and T3, but I got to a point where my functional medicine provider was indicating to me that it really is a trial-and-error process. So, if you're on something now that's not working well for you, maybe changing your healthcare provider is one option, but just acknowledging that it may take quite a bit of time, it may not be instantaneous. Dr. Christianson:  Well, and there's common pitfalls people often go through. In almost all cases, I see more problems with dosage than I see with medication. Very commonly, if someone's on the wrong amount, doesn't matter which medicine they're on. They're going to do horribly from that.  Cynthia:  Mm-hmm. Dr. Christianson:   But that's honestly, in my experience, a bigger driver. Yeah, I would argue that that one and then also testing, so, I see countless examples. People are tested in ways that are just setting them up to yield inconsistent results. If your blood tests do not take into account where you are and your period, what time of day the test was done, when you took your last thyroid tablet, when you took your last supplements? On three days after all supplements, you're going to get goofy results and whether or not you're fasting. If you don't take those five things into account when you test your thyroid, you will not have meaningful results on your thyroid tests. Cynthia:  I think this is really important listeners to hear a little bit more about you do talk about this in your book. But so, what are the things or the instructions that you provide to your own patients when they are going to be tested for whether or not they're on the right dosage of medication? Dr. Christianson:  Yeah, so these are circadian hormones. They do fluctuate throughout the day. You got a test in the morning, and 7 AM to 9 AM is ideal. That's what everyone's there to get their fasting blood test. It's a busy time, but that's the reality. [laughs] Fasting does matter. Having food in your system does change your levels. The timing of your medication is a big one. So, you want to do your blood tests before you've taken your thyroid pill. After you take your thyroid pill, your T3, your T4 to a smaller extent, your TSH, these things are all changed in ways that cannot be well calibrated for supplements. By it, it affects almost any blood test you can imagine. It doesn't so much affect you, but it affects the blood tests. It's part of how they register many of them.  Then, probiotics can skew thyroid antibodies. There's actually a few more connections that are relevant. Simple rule is no supplements for three days before thyroid tests. That's an easy way to get more clear data. Then, menstrual cycle, so, if a woman is not-- if this is a guy or a woman who's not currently having menstrual cycles, this is not relevant. If you are having periods, you want to have your thyroid tested either the first week of your period or the last week. If your periods are totally erratic and goofy, just gets your test done while you're on your period. That's the simplest way because you know when that's happening. [laughs] But if you're mid cycle, the increase in proteins that bind thyroid hormones are very high, and they can change your scores significant amounts. Cynthia:  That's really interesting. I've actually never heard that before, but it makes complete sense. I think that we're now in a position whether it's the functional realm, but we're really acknowledging that circadian biology and how critically important it is in order to get an accurate depiction of what's going on, not only with our thyroid, but with other hormone levels. Now, you're working with your health care provider, you now have these great instructions in terms of when to get tested and what to do before you get tested. What are the labs that you like to use? If someone is on thyroid replacement right now, or is listening and is concerned about their thyroid, what are the labs that they want to have checked when they go to their healthcare provider? Because there seems to be-- I always look at it is, when I think back to when I was working traditional allopathic medicine and cardiology, we were very focused on just a few tests. I now acknowledge that we didn't look at enough testing to really get an accurate view of what was going on with the thyroid, but what are the things that you like to see when you're looking at labs for your patients to get a full evaluation? Dr. Christianson:  I guess, even a question back is what is the purpose of testing? There's a couple different reasons for that. One of which is, to make sure people are safe. Prior to 1970, understood a bit less than we do now. We didn't have TSH tests available and people with thyroid disease had rampant rates of cardiovascular death. It wasn't clear why. We thought that was just part of being on the retreatment part of having thyroid disease. Once we learned about TSH testing and the importance of it, that basically stopped. It went to almost nothing. But yeah, one purpose of testing is to make sure you're safe. To make sure you're not in some unsafe level of treatment.  Symptoms don't always show when you're getting too much. You can feel fine or normal when you're getting enough that could be unsafe. So, one goal is safety. One Goal can also be making sure that you're getting all the possible benefit from your treatment. And to answer that question, the thought is, to make sure that your thyroid function mimics how it would look in healthy people. We know that people are free of thyroid disease, and then people with thyroid disease who have the lowest rate of early death, the lowest rate of chronic disease, the lowest rate of complications like obesity, and the lowest rate of symptoms. There's been data looking at all those populations, and if you crunch them all together, you get something that sometimes is different than what the normal ranges. The biggest difference comes up with TSH scores. So, if you pick those considerations like healthy people, they're going to have normal but lower normal TSH scores. There are ways that one can personalize that further based upon age, gender, pregnancy status, cardiovascular health, kidney health, other variables, but as a generalization somewhere between the low end of the normal range, 0.4, 0.5, and maybe to a little above 2, somewhere in there, which can be personalized further is about where TSH scores fall in those healthy populations.  Now, a funny thing is that many have looked at this and said, if it's good to have your TSH low normal, you would think it might be good to have your free T3, free T4. These things high normal. And that sounds logical. But when we look at healthy populations and we map out their levels, it just doesn't show up that way. We actually see a lot of the opposite, that people that consistently have high T3 levels don't have good health outcomes. No, oftentimes quite the opposite. So, healthy people have a large range of T3 levels with normal no problems, and they actually have low normal T4 most consistently. Yeah, so, toward the question of, at what levels will you best manage health and best control symptoms? It's something like that. If someone is in a good state of their symptoms, and no apparent health risks, then the question is just are they safe or not? You know, are they at levels that would be not causing harm for them over time. And as far as which tests, there are long list of tests available. Honestly, they're not all useful. I never run reverse T3 tests. I could talk for days about why but TSH is helpful. When someone's first being diagnosed, it's nice to screen their antibodies. The antibodies, if they're extremely high, they can be relevant in ways that don't apply even if everything else is good. But that's rather limited. There are many times in which the thyroid antibodies are not relevant, which some symptoms they don't affect. Some of their levels are not significant.  So, they're good to screen at once. They're not things I really check all the time, and then the free circulating hormones and then finally, thyroid globulin. If someone has structural issues, and also, we get ultrasounds on them, then thyroid globulin, which is not the same as anti-thyroid globulin can be one more piece of data to track any structural problems with the thyroid. But for many people we see for just safety dose adjustments, a TSH can be quite helpful with a deeper understanding of how that should look for that individual. Cynthia:  That's really helpful although for the listeners, just broad basics. T4 is the inactive form of thyroid hormone, T3 is active. Curious to know why you are not testing for reverse T3, largely because I was always taught it's the “brakes.” So, T4 can merge into free T3 or into reverse T3, but curious to know and really just for my own knowledge and selfishness honestly. Dr. Christianson:  Yeah. I'm all for it, [unintelligible [00:33:51]  as well. But it is the brakes, but it's normal brakes. [laughs] We actually drive with the parking brake on. So, we need reverse T3 in our brain. We can't repair cells without it. It's an important hormone as well. And most T4 that we secrete is made under reverse T3, 60% to 80%, it's the normal byproduct. There's been a story told that reverse T3 makes an out-of-control reaction that blocks the formation of T3. Just simply not true. We know all the chemical pathways around those enzymes and they just don't work that way. If that were true, we would never make any T3, because we mostly make reverse T3.  So, we do see high reverse T3 in a thing called euthyroid sick syndrome. People that have severe-- by severe like hospitalized intensive care levels severe, level of disease, in some cases, their body will suppress their third output, we think in a strategy to just to slow everything down. Like if your car is got the engine light flashing and it's sputtering, you're going to drive slowly to the garage. [laughs] You're not going to drive fast to the garage. When someone's really, really sick, we think their body intentionally slows things down. It does that by decreasing the stimulation on their thyroid and also decreasing the potency of the thyroid hormones in circulation. In those cases, we see that it seems to be adaptive, and even tested to see if people are better off in those cases, if we override that and add in more thyroid hormone, and they're not, so we think that's an adaptive response. But there's honestly a large range of reverse T3 in healthy people, that's probably not relevant. A low, normal, high all over the place, there's no clear consensus on any situations in which when it is higher in healthy person, that it's a problem.  Clinically, when I see people who have been seeing various doctors that are testing reverse T3, in almost all cases when it's high, it's because they're taking too much thyroid medication. That's a simple thing that makes it too high, and I'll hear a lot of convoluted explanations about how they have resistance or all these things, but they're just on too much. If someone does stop taking everything with T4 and only take T3, then yes, reverse T3 will lower just because there's nothing that can make it out of it. That doesn't mean that someone's healthier for that, just means there's no substrate for it.  Cynthia:  That's really fascinating. For the listeners, I love to learn. Now, I'm going to dive down that rabbit hole after we're-- [crosstalk]  Dr. Christianson:  I’m going to send you a 16,000-word blog I wrote about that out. [laughs]  Cynthia:  Awesome. I look forward to it. We've talked about medications, we've talked about testing, now, let's turn back to the focus of the book and iodine. What are the things people can do to help support their bodies and to do it proactively, now that we acknowledged that we're very likely all of us are getting, thank you, getting way too much iodine and our diet and our environment as well? Dr. Christianson:  Well, yeah. One more high-level piece that you brought up in your story is iodine testing. This creates a lot of confusion. It seems logical that if you test for something and you're low in it, you need more of it. But a lot of things we test for can be tested are accurate at population levels, but not at individual levels. That's just the case of iodine. So, the test for it, if you were to test your urine about 350 times, you could know within 90% accuracy, what your actual status is. But one test has no relevance at all. We have iodine in our blood, that's only there after our body has controlled it. The amount that matters is what's in the thyroid, and there's no simple tests for that unfortunately.  Yeah, as far as being aware of it, someone with thyroid disease, the recommendation then is that if they wish to improve their function or improve their symptoms, then they can get on the low end of that range, like somewhere below 100 micrograms. This is a point I want to expand on too. So, some see their thyroid physically regrow, they get new cells, they can get larger, it can take over again. There are those that lack a thyroid. It's been taken out. So, the other side of the equation that iodine affects is how thyroid hormones are used in circulation. Many people who lack a thyroid, they're on medication, it should theoretically be what all they would need. But many of them still have symptoms. That's because they're not using those hormones in ways that are ideal. Iodine can be part of that. So, yes, even those that lack a thyroid, they can stand to benefit in most cases. They'll still need medicine, but they can get more of that, better control symptoms and possibly need less of it. Cynthia:  I think that's really encouraging because that was a frequent question that came up either people who have had their thyroid partially removed, there were a couple people who had thyroidectomies related to cancer, a partial thyroidectomy is they wanted to know, “Do I have to be on medication forever?” It also speaks to the fact that and I say, we as clinicians, we, as a large group of individuals, we’re not doing a good job explaining to our patients that in some instances, they may need to be on medication long term, and other instances that might be temporary, because I'm consistently hearing throughout social media, whether it was Instagram, Facebook, by messages and emails, responses to messages we had sent out to our community that there's so much confusion, and do you think that that has a lot to do with the fact that I think the thyroid is being this very elusive organ. Even though, we've all trained and obviously, I'm not a trained endocrinologist, but we obviously all had training, but I don't think we had enough understanding/respect for this part of our physiology in our bodies, because we fail to recognize or remember that the thyroid impacts everything in our bodies. So, it's no surprise that when it's not functioning properly, we don't feel well, whether it's underfunctioning, underperforming, which is statistically more likely, or it's over performing, and we're feeling the effects of that as well. Dr. Christianson:  It's a big deal, and you're right. Hormones act on receptors, and generally hormones have receptors in some parts of the body, yes, and some parts, no. But the only one that has receptors in every cell of the thyroid hormones and yeah, the amounts that's needed for them-- I had an analogy. I think I put in the book about, it's the concentration in your blood that matters that makes you function well or not. Yeah, an Olympic-sized swimming pool-- a teaspoon of vanilla extract in an Olympic sized swimming pool, that's pretty much the concentration of thyroid hormones in your bloodstream. Now, a tablespoon, that could be fatal. A drop or two might be fatal. So, the concentration is ridiculous how exacting that is. But yeah, it's just-- So, if those slight excesses can be fatal, you can imagine that the tiniest variation could be a good day or a bad day. Cynthia:  Absolutely. I think that it also comes down to the understanding that, this is a journey and not a race, and for many people that are impacted by underactive or overactive thyroid function, you may go on a journey of sorts. It's taken six months to get my thyroid back to feeling somewhat normal, being able to wake up without an alarm clock. Feeling like I'm back to my normal, my normal body composition. So, let's pivot a little bit and talk specifically about the bulk of the individuals that listen to this podcast are predominantly women, late 30s, early 40s, and beyond, so perimenopause and menopause. And a lot of the questions that came through were specific to medication, which we've already addressed, but many others were specific to what starts happening to our bodies as we're making this transitional period that, no pun intended, that all of a sudden, we develop underactive thyroid, or all of a sudden we start becoming insulin resistant, or as we have this waxing and waning estrogen and progesterone, so, obviously, the sex hormone piece, how did these all work together, or don't work together that exacerbates thyroid function? Dr. Christianson:  Yeah. They totally work together. Of the three irrefutable drivers of thyroid disease, two are not things that can be done anything with. They're called the existential causes. Age and female gender are the two other large causes for that. Age is just that, the more chance something can go wrong, the more time that's passed, more likely bad things show up. It was just more opportunities, and there's also some level of wear and tear that can be cumulative. But gender, there's several factors, pregnancy is one. We know that there are foreign cells that can form and cross the placenta and move into mom's circulation. This is called fetal isochimerism. Basically, these cells can trigger an autoimmune response, and some of them can be thyroid related. So, that's one factor.  There are also variations on iodine clearance. Now, iodine requirements don't really differ per age or gender. They do differ per body size, but pretty predictably. But iodine tolerance can differ greatly from person to person. I allude to that where people can get too much, and it's not a big deal. But the genes that determine iodine tolerance are primarily X linked. So, women have 2 X chromosomes, men have one, so, if there are things that are X linked that are more latent, they're not going to show up as much for a guy but they will more so for a woman. So, those are a couple of the big drivers. The other big thing is just the interplay. This came down to why’ve you got to know where you are in your period where you get your thyroid test on, because estrogen interacts with thyroid hormones. Now, not in ways that are deal breakers, but just in ways that change the balance. So, especially coming into or out of pregnancy, into perimenopause and then into menopause, there's a big shift in your body's overall estrogen status. Especially moving through perimenopause, that's fluctuating so much. What that does is it changes your net thyroid needs at a cellular level. If someone's thyroid is getting by, but hanging on by a thread, and now you're telling it, “Okay, speed up, slow down and speed up, speed up a lot, slow down a whole bunch,” that can just push it over. [laughs]  Cynthia:  Well, it certainly helps explain a lot of the symptoms that women will experience during this transitional period. I feel until I developed an underactive thyroid, which may or may not be related to latent autoimmunity that I'm unaware of now, I think it's really speaking to the fact that on so many levels our hormones, and I didn't have a healthy enough respect for hormones until I went through perimenopause that our hormones impact everything that goes on with our lives. The lifestyle’s piece is undeniable. I know that you speak quite a bit about this, that the sleep quality is important, the food we eat is important, and so, I want to make sure that we wrap up our conversation and being respectful of your time. But let's talk about the lifestyle piece and how that impacts thyroid functioning in a positive or negative way? Because for everyone that's listening, all of us can benefit from being kinder to our endocrine system and our brain without question. Dr. Christianson:  For sure. All these things are relevant. Sleep, stress reduction, exercise, community, overall diet quality, they're all huge, huge factors. The shocking thing is that study that I cited that 78.3%, I honestly didn't do that stuff. I didn’t do anything other than just iodine regulation. So, I think it all matters for countless reasons, and I think that anything you do to help yourself will only do better if your overall stress response and global adaptation and big picture needs are better matched and better dressed. So, I do encourage all about. In this last book, I didn't go into those things in as much detail. Keep following Cynthia, listening to her, you'll get a lot of good advice on these important points. The message I want to to get out is that one small little change has an 80% chance of reversing thyroid disease. So, this is the thing I'm saying. This one thing on top of all the rest can make a big difference. Cynthia:  I think it's really exciting. I know that probably later this summer, my monthly group and I will be doing the thyroid reset diet, because so many people in that group are struggling with thyroid issues. I actually did a quick little video for them before I jumped on to record with you to say, this is one of those books that I think everyone needs to own, especially for those that are trying to think proactively, but I can't think of many women I know at this stage of life on that that are not impacted by an underactive thyroid, smaller percentage of which are have had some issues of Graves, but I think it's really critically important that everyone even if you have had a partial thyroidectomy or you've had your thyroid removed, that everyone can benefit from some of the tenets. I think the hardest thing for me to give up for a thyroid reset is going to be egg yolks, because I love eggs. I eat a lot of eggs. But I know I can have egg whites, that was the big takeaway. I was like, “I can have egg whites. So, that's good.” Is there anything that you would like to leave the listeners with as it pertains to iodine function that we haven't touched on during our conversation today? Dr. Christianson:  I guess just one to your last point to make sure things aren't daunting. We think about a reset phase and making things deliberate to where there's chance to heal. They do, and then you're good. Once they've done so, you could do a mega amount of iodine and screw things up again. That's always possible. But you're not as delicate as you were before. So, you can get to where you tolerate some with no big problems. I guide people through a reset into a maintenance phase and then you even do some egg yolks. You can phase these things back in, but for a deliberate time, your body can just amazingly heal and recover when it gets right opportunities. Cynthia:  Well, thank you, Dr. Christianson. It's been so nice to have you on today. We'll definitely have to bring you back, because as I've told you before thyroid is a hot topic for my listeners.  Dr. Christianson:  That’d be a lot of fun I'd love to.  Cynthia:  Yeah, please, let the listeners know the easiest way to connect with you, obviously we're going to have a book giveaway when this goes live, but how can they easiest connect with you on social media or through your website? Dr. Christianson:  Easiest thing, social media at dralanchristianson.com .   DrAChristianson , Instagram Facebook. I do an office hours live most Mondays. So, if someone has specific questions, they can often come on and just jump on there and ask that. Usually, those are 3 o'clock Pacific, 6 o'clock eastern. But yeah, just jump on social media with me live, and you can ask particular things, and happy to help out. Cynthia:  Thank you so much. Have a great rest of your day.  Dr. Christianson:  You too, Cynthia. Presenter:  Thanks for listening to Everyday Wellness. If you loved this episode, please leave us a rating and review, subscribe, and remember tell a friend. If you want to connect with us online, visit the link in the show notes.

  • Ep. 432 Breast Cancer Prevention & Hidden Truths About Mammograms with Dr. Jenn Simmons

    Today, I am honored to connect with my friend and colleague, Dr. Jenn Simmons. Dr. Simmons is an integrative oncologist, breast surgeon, author, podcast host, and the founder of Perfect Cutie Imaging.  In our discussion today, we dive into breast cancer statistics and the fact that most cases of breast cancer are preventable. We tackle the confusion caused by overdiagnosis, explain why mammograms can be problematic, and outline which breast cancer diagnoses are true emergencies. We provide clarity on the differences between various breast cancer types, the state of normal breast health, and how we have both estrogen and progesterone receptors. Dr. Simmons sheds light on DCIS (ductal carcinoma in situ) and explains why treatments like radiation may not always impact survival. We also examine the roles of trauma and alcohol in breast cancer risk, and we begin answering questions from listeners.  Don’t miss this engaging, helpful, and proactive discussion with Dr. Jenn Simmons. We were wonderfully overwhelmed with all the questions we received, and with so much still to cover, I want to reassure everyone that we are already planning a follow-up AMA episode with Dr. Jenn. IN THIS EPISODE YOU WILL LEARN: The shift from reactive to proactive health and the need to build health rather than just treating diseases The role of lifestyle choices in reducing the risk of breast cancer Why mammograms are problematic, and how the incidence of breast cancer has increased in screened populations The carcinogenic effects of radiation The harmful effects of unnecessary breast cancer treatments The long-term effects of chemotherapy and radiation The different types of breast cancer The limitations of traditional cancer treatments and the importance of addressing the root causes of the disease How chronic stress and trauma can increase the risk of breast cancer. Why self-examining the breasts is essential Dr. Jenn introduces her clinician training program to equip providers with the knowledge to use alternative imaging “Be preventative, be proactive, look at that list of things that cause breast cancer, see what applies to you, and make the changes you need to drive health.” - Dr. Jenn Simmons Connect with Cynthia Thurlow    Follow on Twitter Instagram LinkedIn Check out Cynthia’s website Submit your questions to support@cynthiathurlow.com Connect with Dr. Jenn Simmons On her   website Keeping Abreast with Dr. Jenn  (podcast) On all social media: @Dr Jenn Simmons Dr. Jenn’s new book, The Smart Woman's Guide to Breast Cancer, is available on   Amazon . Transcript: Cynthia Thurlow: [00:00:02]  Welcome to Everyday Wellness Podcast. I'm your host, Nurse Practitioner, Cynthia Thurlow. This podcast is designed to educate, empower and inspire you to achieve your health and wellness goals. My goal and intent is to provide you with the best content and conversations from leaders in the health and wellness industry each week and impact over a million lives. [00:00:29]  Today, I had the honor of connecting with friend and colleague Dr. Jenn Simmons. She's an integrative oncologist, breast surgeon, author, podcast host and the founder of PerfeQTion Imaging. Today, we spoke at length about breast cancer statistics and how most breast cancer is preventable and how overdiagnosis confuses women and providers, why mammograms are problematic, what types of breast cancer diagnoses are an actual emergency, descriptions of differentiators between other types of breast cancer, the state of normal breasts having both estrogen and progesterone receptors, the distinction of DCIS, which is ductal carcinoma in situ, the impact of treatment including radiation not impacting survival, the role of trauma, the impact of alcohol. And lastly, we started with listeners questions. [00:01:25] To be reassured, we will be having Dr. Jenn back for an additional AMA episode where we will get through all of your questions. We were wonderfully overwhelmed, but impossible to get them all in one podcast episode. I know you will find this to be an invaluable, helpful and proactive conversation. [00:01:45] Welcome back Dr. Jenn. Such a pleasure to be reconnected with you. And as I was texting you over the weekend, your book is a book that every woman needs to own because even as a clinician there is stuff in this book I did not know. And it's so important to be proactive as opposed to reactive. And so, thank you for the gift of your work and thank you for writing this book that I think is going to help millions of women. Dr. Jenn Simmons: [00:02:13] Thank you. I have to tell you, just shortly after my book was published, I was on a podcast with three physicians and they were all interviewing me and one apologized immediately for her appearance. She had only gotten my book the day before and she stayed up all night reading it and couldn't put it down. And she was literally like bleary-eyed and crying saying, “You must feel so good because you're going to save millions of lives with this book.” And it really is something that I agree with you. You don't have to have breast cancer to have an appreciation and get tremendous value out of this book because this is how to live proactively. Cynthia Thurlow: [00:02:56] Yeah.  Dr. Jenn Simmons: [00:02:57] That's what we all need to be doing. We need to shift that focus away from being reactive. We need to shift that focus away from only dealing with treatment. And it's not that hard, if we are able to think about health in a proactive way and building health, it actually does replace these disease states so we could all benefit from. My program isn't unique in that there are so many programs out there that are thinking about life from a health building perspective rather than reacting to illness. Cynthia Thurlow: [00:03:35] Well. And I think people feel as if breast cancer is such a random entity, and yet I would be the first person to say that there's so much emphasis on breast cancer awareness, appropriately so and breast cancer screenings, but yet for many individuals, they don't realize the contributory portion in many instances of our lifestyle, kind of benignly. We don't even think about how day to day choices can put us at greater risk. And I wouldn't say that every single person listening per se has just had this random event, but I do think it's important for people to realize there are things they can do proactively to lessen the likelihood they will ever hear that diagnosis.  Dr. Jenn Simmons: [00:04:17] Without question and I first feel kind of obligated to say, and this is not about blame or shame, but that 80% of breast cancer diagnoses are preventable. So that is a large, large percentage of people who are suffering and almost suffering unnecessarily. So, between the diagnoses that are truly preventable and the over diagnosing, because we are over diagnosing because we're using a very inferior testing model to diagnose breast cancer. So, we're over diagnosing by somewhere between 20% to 30%, depending on the study that you look at. And we're talking about hundreds of thousands of people, maybe even millions of women who are either unnecessarily diagnosed or over diagnosed, but this is having a tremendous impact.  [00:05:21]  And if treatment for breast cancer were benign, it would be one thing, but treatment for breast cancer is not benign, and in fact, it's quite harmful. And we are thrusting nearly 100% of women who are diagnosed with breast cancer into menopause, whether they were there or not. And if they were already there, we're making it worse for them. And this is a horrible state to exist in. And this is actually the topic for my next book.  [00:05:50] My next book is called the Forgotten Woman  and it's the woman who has had breast cancer. And she's completed treatment and she's told afterwards that she should be grateful to be alive and she is grateful. But it's very hard to feel grateful when you can't think, when you're depressed, when you're anxious, when you can't sleep, you can't formulate a sentence, you can't do what you used to do, you don't feel like yourself, you've gained weight, and even if you haven't gained weight, your weight has redistributed around the middle, your clothes don't fit, you feel uncomfortable in your own skin, you're having palpitations, your bones ache, your joints ache, you have no libido, sex is unwanted and painful, your relationship as a result is suffering, you're having problems with continence, you're leaking urine, you can't do what you used to do, you don't have energy.  [00:06:46]  It's really hard to feel grateful when all of that is happening and yet that is how we're leaving most women who have been treated for breast cancer, and they have no access to support, no access to help. And so, this is the focus of the rest of my medical practice is helping these women who have already recovered from the breast cancer diagnosis, but are left in this state of life that is just, it's not life, it's not what life should be.  Cynthia Thurlow: [00:07:19]  I have several nurse practitioner friends that have been diagnosed with breast cancer. And one of them said to me, “I feel like I'm living in purgatory.” And for anyone that's listening, they're not in heaven, they're not in hell, they're in this in between. And the way that you described the way that their life is right now, they're so grateful that they got through their diagnosis. Most of them have gotten to the five-year survival mark.  Dr. Jenn Simmons: [00:07:42]  Yeah.  Cynthia Thurlow: [00:07:43]  But when they think about how they feel physically, they don't feel like themselves. And it's, imagine a woman going into menopause. Many of us with that transitional period, don't feel like ourselves. But this is magnified a hundredfold, every single-  Dr. Jenn Simmons: [00:07:59]  That’s right.  Cynthia Thurlow: [00:08:00] -symptom because of that loss of hormones. Now one thing--  Dr. Jenn Simmons: [00:08:05]  Because they don't have the access to care that everyone else has. Because if you don't have a breast cancer diagnosis, at least if you have all of those symptoms and you are talking to someone who is hormone literate, they will offer you hormone replacement. Hopefully, they will offer it to you in a responsible, bioidentical way. But if you even hint, whisper that you have had a breast abnormality in the past, God forbid, breast cancer, those options aren't available to you unless you come to my office.  Cynthia Thurlow: [00:08:40]  Well, as I stated before, I'm so grateful for the work that you do and the awareness that you bring to these issues. Let's talk about mammograms. I fervently believe that this diagnostic modality was well intentioned. What are your concerns about mammography? How does it put us at greater risk of damaging breast tissue because of this ionizing radiation? Let's talk about mammograms.  Dr. Jenn Simmons: [00:09:11]  Yeah, so I agree with you. I think when the mammographic screening program started in the 1970s, it was absolutely, positively well intentioned. I agree with you. And it was built on these foundational understandings, which are logical, absolutely. It was built on these foundational understandings that breast cancer growth is both linear and predictable. And without belief, if you could identify a cancer that was small and in its earliest stage, you could both save lives and save breasts because you were finding it before this kind of critical moment, at which point it was more likely to metastasize. And it is a logical theory, it just doesn't happen to be true.  [00:10:13]  Breast cancer is what it is from the beginning and it is not a function of size, it's a function of biology. So even if you find a biologically aggressive tumor when it's small, it does not change the trajectory of the disease for that person. Conversely, there are some really big tumors that have no tendency to metastasize and it doesn't matter when you find that one, because those people are going to do the same. And then there's everything in between. So, we rolled out the mammographic screening program based on this understanding that growth was linear and predictable. And what we didn't do, what we never did, was impact survival. So, what happens is that no matter how many mammograms we do every year, the same number of women die of breast cancer every year. We do not impact the bottom line. No matter how many mammograms we do every year, the same exact number of women present with aggressive disease, disease that is not impacted by our treatment. These are the women that go on to die of breast cancer.  [00:11:28]  So, when we look at very large population studies, we actually see what the true impact of mammography is. And this is where it gets really scary. So, when you look at large populations where everything else is controlled, the age is controlled, access to treatment is controlled, the kind of treatment is controlled. When you look at the Swedish studies, we're talking about 600,000 women. So, these are not small studies. And you look and compare at the population that screens as compared to the population that doesn't. All have access to the same care. All have equal access to care. When you look at these groups over time, the same exact number of women die of breast cancer in each group. There is no survival benefit. The difference between the two groups is that when you look at the population of women that screen with mammogram, you have a 20% to 30% increased incidence of breast cancer.  [00:12:40]  Now, I am not saying that those breast cancers are caused by mammogram, but it's undeniable. And in every other situation and in every other circumstance, if you are to ask if radiation causes cancer, the answer is a resounding yes. It is a known carcinogen. Radiation is a known carcinogen. And yet when we talk about it in the context of mammogram, we are repeatedly told that mammograms are safe and mammograms do not cause breast cancer. Now, how is that possible, how?  [00:13:17]  Now people often say, “Well, it's not a lot of radiation.” Actually, it's not true. The amount of radiation that is delivered during a mammogram depends on the size and the density of the breast, because the amount of radiation that is delivered is linearly related to how much tissue it has to go through and how dense that tissue is. So, the more dense your breast is and the larger your breast is, the more radiation you're getting in the course of your mammogram. So, it's not like everyone gets this dose. It's simply not true. Some people with large, dense breasts are getting ten times the amount of radiation that someone with the small, fatty breast would get.  [00:13:57]  So, that's the first thing is that there really isn't-- and can't be standardization of how much radiation is delivered because the amount is contingent on what the quality of the breast is. So that's the first thing. The second thing is that, with rare exception, who's getting one mammogram? Now, sometimes on that first mammogram, someone is diagnosed with breast cancer. So, I am not saying that all cancers are caused by mammogram far from it, far from it. And there's going to be a lot of those stories of people who on their first mammogram were diagnosed with breast cancer, so obviously that is not the cause of their breast cancer. But for the women who are lifetime screeners, and they're starting screening at 40, and they're screening every year for 10, 20, 30, some even 40 or 50 years. That radiation is without question adding up, and that radiation is without question contributing to breast cancer diagnoses.  [00:15:01]  And we know that the more mammograms that you have in your lifetime, the higher your risk is of being diagnosed with breast cancer. So, some of that 20% to 30% increase that we see in the screening population is caused by mammogram. And some of it is because we are picking up lesions that would have never developed into clinical disease. And again, some of that are in the form of calcifications that we're detecting that are associated with DCIS or ductal carcinoma in situ. And that is something that at least I could easily argue does not need to be picked up. And the only benefit to picking that up is that we have the opportunity to help that woman understand that she does have inflammation, that she does have pre-cancerous changes in her breast, and this is an opportunity. An opportunity to figure out why she has precancerous changes in her breast and change the trajectory of that disease. And we can intervene and we can change the trajectory of disease, but not if we treat it just like it's breast cancer. Which is what's happening in almost every hospital across this great country of ours, is that the hospitals and the physicians and the programs are using it as an opportunity to treat more people for breast cancer, even though that's not breast cancer. So that's one place that we're definitely, without question, over diagnosing.  [00:16:45]  And still there are small invasive cancers that-- Everyone makes cancer cells, from the very young to the very old, everyone in between. And if you have an intact immune system, it can recognize that cancer cell in its infancy and not allow it to go on to become a cancer or a tumor or whatever name you want to give to that entity, it most will not go on to become clinically relevant disease. However, if we are going to pick up all of these 3 and 4 and 5 mm lesions and treat these women like they have breast cancer, then we're not giving the body the opportunity to do that. And this is happening a significant amount of the time. 20% to 30% of these breast cancers that we're diagnosing don't need treatment because they would never have gone on to develop anything. And we know that because we compare them to the people that don't screen. That is the control, that is the true incidence of breast cancer, but we're just inflating it by using mammography, because mammography is both detecting things that don't need to be detected and contributing to breast cancer incidence because it is radiation. And we should have long ago stopped using a test that causes cancer to screen for cancer.  Cynthia Thurlow: [00:18:16]  How many women in your clinical experience, when you were working in your still kind of traditional allopathic model of care, came to you and out of an abundance of fear, were making decisions when they could have done watchful waiting? I know that in the traditional model of care, it's like cut it out, burn it, do chemo, do surgery. How many people would have benefited from having this pause to reflect on careful monitoring versus this kind of reflexive modality of addressing it immediately? And I am by no means-- I have so many friends, colleagues, etc., that have been impacted by a cancer diagnosis, I know that it's terrifying, I'm not minimizing that at all. But as a breast surgeon, was it challenging for you in instances when you knew a patient was making a decision that if she perhaps had taken a pause or had taken an opportunity to kind of process what was happening, as opposed to reflexively saying, “Just cut it out, just take it out. I don't want to deal with it.”  Dr. Jenn Simmons: [00:19:25] I would like to think that I was that intuitive when I was a breast cancer surgeon, but I wasn't. It wasn't until I got my own diagnosis that I even began to understand any of this and to look outside of what I had been trained to do and trained to think. Because as a conventional medical doctor and as a breast cancer surgeon, I was taught to diagnose and treat, that was it, like never, ever, ever were we to think about the why. And in fact, I think that's by design, because if we started to think about the why, we would think the way that I think, like, are we really doing the right thing by screening with mammogram? Are we really doing the right thing by exposing all these women to radiation year after year after year? [00:20:18] So, I don't think that I was that intuitive. But we can look at the numbers now and just know that, in 2024, there were over 300,000 women diagnosed with invasive breast cancer and over 56,000 women diagnosed with DCIS. So just off of the top, those 56,000 women who were diagnosed with DCIS. They should all have been in a watch and wait. But not just watch and wait, be preventative, be proactive, look at that list of things that actually cause breast cancer, see what applies to you and make the necessary changes that you need to drive health, because that is ultimately what this is about. It's about being preventative and proactive.  [00:21:14]  We can reverse disease too. But isn't it wonderful to not have to reverse disease, to not have the burden of all of that fear mixed in with it when you can really skip a couple of steps if you're not already dealing with a diagnosis. And of that 310,000 women who were diagnosed in 2024 with invasive breast cancer, if you look at the numbers and just say 20% to 30% of them are unnecessarily diagnosed, we're talking about 60,000 to 90,000 women. This is obscene, this is immoral, this is unethical. And we can't continue to do this because as we started off talking about, when we treat these women for breast cancer, and especially the ones with noninvasive disease who are being treated just like they have invasive disease, we're really ruining their lives. We're forever changing their lives and not in a good way.  [00:22:24] And instead, if we took this opportunity. The first thing that I talk about in my book-- The Smart Woman's Guide to Breast Cancer , the very first thing that I talk about in my book is take a breath, take a pause, you have time, you have time to think about the diagnosis, to learn about the diagnosis, to learn about treatments, to actually make an informed decision because most people are not. Most people are not given the opportunity to make an informed decision, most people are not given the information to make an informed decision. They are immediately thrust on this runaway train of sign up for surgery, sign up for chemo, sign up for radiation. And they're actually pressured. It's like a high-pitch sales.  [00:23:14]  They are pressured and they are led to believe that they're going to have an adverse outcome if they don't get right in the operating room or if they don't sign up for radiation right away. They're really pressured to do these things and they're so scared. And think about how easy it is to think when you're scared, it's not. I don't have to tell you about it. You're in this total cortisol-driven state which actually shunts blood away from the thinking part of your brain, because we really only understand two states. We understand safety, we understand danger and that's it. And when you're in that danger state that fight or flight state, we don't understand that we're faced with a difficult decision and that is what is making us feel as if we're in danger. We're not that sophisticated. We are modern beings, but we're living on a very old gene code. And the dangers we understand are saber-toothed tigers on our tails. So, we're sending this wrong signaling at the time because our danger, our perceived danger is our diagnosis. It's not a saber-toothed tiger, so we're having this response where we're flooding our bodies with cortisol and we can't think because our bodies think that we just need to run away from a tiger, and yet this is the time when we need to think the most. [00:24:44]  And so that's why, with very rare exception, and I can easily talk about those exceptions, if you have inflammatory breast cancer, and you know that you have inflammatory breast cancer because you go from having a normal breast to one that is filled with tumor and red and swollen in the course of a week, at the most a month, so it's really dramatic cancer growth. So, if you have inflammatory breast cancer, if you have metastasis, breast cancer that has spread to your bones and caused fracture, not just spread to your bones, but and caused a fracture, because that is a very painful situation and it's impossible to heal if you're in pain, so that needs to be dealt with right away. And then the last thing is if you have brain mets, because if you have metastasis, if you have breast cancer that spread to your brain, the brain is in a fixed space, it's in your skull in a fixed space, so you can't afford for too much swelling, so that has to be treated right away.  [00:25:44]  And all the other situations, you have time, you have the opportunity to learn, to educate yourself, to be able to understand what these treatments do and what they don't do. And part of what they do is have tremendous side effects. And what we all have to remember is that breast cancer, no cancer, but breast cancer is not a surgery deficiency, it's not a chemotherapy deficiency, it's not a radiation deficiency, and it's not a hormonal blockade deficiency. And despite the fact that these are things that are used all day, every day, they leave a wake of destruction. And it is very important to understand that before you do these things and not after. And that's the major reason why I wrote my book, so that people could understand this before they entered into treatment and actually make an educated decision as to what they wanted to do and what felt right for them, because there is no treatment out there that's going to work if you don't believe that it's going to work. And so many people dive into treatment with great trepidation and without real hope or belief. And that is my main goal, is to give people hope and allow them to understand what these things do so that they can make a decision that really feels right to them, that they believe in, that they trust in, and that they're motivated by because that's really important.  Cynthia Thurlow: [00:27:24]  It really is. And I'm so glad that you touched on some of the emergent diagnoses. When I was an ER nurse in my past life, there was nothing more sad to me than a patient and I trained in the Intercity. Patient coming in that had an abrupt onset of changes to how her breasts looked. And there's something called Peau d’orange, which is a very distinctive pattern on the breast, very suggestive of inflammatory breast cancer, or patients that came in with shoulder pain. And I saw far too many of them who had breast cancer or lung cancer. And you're sitting in an emergency room, it's loud, and you're having to call oncology, you're having to call bring in-- These people think that maybe they just bumped themselves and they find out that they have metastatic breast cancer is one example. Dr. Jenn Simmons: [00:28:11]  I know.   Cynthia Thurlow: [00:28:12] Or they have a headache and they come in and we do a CAT scan and we realize they've got metastatic disease. So, I agree with you concurrently, and the types of breast cancer that allow us to have a pause to think about treatment options, getting second opinions, let's run through the more common types of breast cancer, because I think many people probably don't realize that you can have cancers just in the ducts, you can have cancer in the lobes of the breast as well as, you hear this term triple negative breast cancer or HER2-positive breast cancer. Help us understand how these are differentiated. And from your perspective as a surgeon, when you hear some of these diagnoses, which are the ones that for you give you pause to say, “Okay, we have a little bit of time to think about this,” versus “We know that this tends to be a more aggressive type of cancer.”  Dr. Jenn Simmons: [00:29:04] Yeah. So, let's get the aggressive ones out of the way first. And most of them are just descriptions of what we see under the microscope. That's how the different types go. So, an inflammatory breast cancer, however, is a breast cancer in the breast with inflammatory changes in the skin. And that is the only one that is truly a clinical diagnosis. So, if you have someone with a mass in their breast and inflammatory changes in the skin, that's inflammatory breast cancer until proven otherwise. And you do not have to prove that there's tumor in the skin. All you have to prove is that there's cancer in the breast and that they have what are visual changes, red skin, Peau d’orange, skin of an orange. It's that dimpled kind of thickened skin. That is an emergency. That needs to be treated right away and that needs systemic treatment. [00:30:19]  So, I am not someone who does not believe in conventional medical treatment anymore. Yes, I left surgery. I haven't done surgery since 2019. But I spend my time now acting as the bridge between the conventional medical world and the integrative oncology world. So, I'm not throwing the baby out with the bathwater. And I think that there's a time and a place, and I'm very clear about that for people because when people come to work with me with a preconceived notion that they're coming to work with me because they don't want to have chemotherapy or they don't want to have surgery, or they don't want to have radiation, I make no promises. [00:31:02] So, if you come to me and you have a bone met causing a fracture, I'm going to tell you need radiation, like that's what we need to do. We need to do whatever we need to do to set the stage to start to create wellness. So, if you come to me and you have inflammatory breast cancer, I'm going to tell you that you need chemotherapy because your proverbial sink is overflowing. And yes, we certainly need to turn off the faucet. We need to figure out the why. But in the meantime, we can't work in a flood. We need to mop up the floor and surgery, chemotherapy, and radiation, these are our mops. Yes, we will get to why your sink is overflowing, but right now we need to clean up the mess. I never say no. I say, “Let's look at you, at what you need and design a program for you.”  [00:32:01] So, there is another very aggressive form of breast cancer. It's called metaplastic breast cancer. So, this is a very undifferentiated breast cancer, meaning that it's barely recognizable as breast tissue under the microscope. And again, aside from inflammatory breast cancer, all of these other diagnoses are made underneath the microscope. And how we judge breast cancer is how much of a departure it has made from normal breast tissue. So, let's take what normal breast tissue looks like under the microscope. It looks like a normal cell. And these cells are arranging themselves into ducts and lobules. And they're not crowded, they're touching each other, but they're not piling up on each other. And the nuclei are normal. So that's what a normal breast cell looks like.  [00:32:59] And a normal breast cell is going to have estrogen and progesterone receptors on them. That is normal. I'm going to say that again, a normal breast cell has estrogen and progesterone receptors on them. That's how they know what to do. They are signaled by the hormones in our body to what to do, what to do in the beginning of the month, what to do in the end of the month, what to do to transition to the next month, what to do when there's been conception, implantation, like they need these receptors for signaling.  [00:33:42]  So, as we get further and further away, like a normal cell and a cancer cell looks different and we can recognize the difference. Now, sometimes those abnormal cells are just a little bit abnormal, and they're just growing up on top of each other a little bit, and we call that atypia. And I talk about all of this in my book. So, we're going to run through it right now, but it's all there in my book so that you can understand it. So, we call that atypical ductal hyperplasia. Now, if those atypical or abnormal cells then fill the duct, then we call that DCIS or ductal carcinoma in situ.  [00:34:24] Now, the thing about DCIS is that it is completely a process that is contained within the ducts. And the way that cancer spreads to the rest of the body is that it either uses the blood vessels or the lymphatic system, neither of which exist inside of the duct. So, if all these abnormal cells are contained within the duct, this has absolutely no potential to spread and therefore cannot by definition be life threatening. So, no one dies of DCIS, no one. And if you have someone that died with DCIS, it wasn't because of the DCIS. So, they either had another issue or they had invasive cancer that was not recognized. Because no one dies of DCIS alone, it's impossible, it has no ability to spread.  [00:35:19] Now, if it does grow outside of the ducts, that's when we start to call it invasive cancer. And we call it either invasive ductal carcinoma if the pattern that tumor is making, is forming ducts. Even if they're not forming normal ducts, if they start to make a ductal pattern, then we call it invasive ductal carcinoma. If they start to line up, then they're lining up in a lobular pattern, we call that invasive lobular carcinoma. Some people have features of ductal, some people have features of lobular. Some people have mixed. But it's all according to what it looks like under the microscope. Now, the other things that we look for in a breast cancer is does it have estrogen and progesterone receptors on it? Because if it does, it's still resembling normal tissue. If it's making ducts, it still is resembling normal tissue. So, these are the less aggressive cancers because they have not made such a big departure from normal.  [00:36:36] And then there's something you refer to as a triple-negative cancer. So, this is something, this cancer has lost its estrogen receptors, has lost its progesterone receptors, so it's mutated. And these tend to be more aggressive cancers because they've made a bigger departure from the normal tissue. People think it's because we have less treatment options. It's not because we have less treatment options because we can no longer target the estrogen receptor, it's because it is a different disease. It is a further departure from normal. This is a big mutation, a big change. And these tend to be more aggressive cancers. So, most of what we talk about, most of what we describe is just what we're seeing on the microscope and how far from normal have you gone. So, the Grade I cancers tend to be very unaggressive, whereas the Grade III cancers are the more aggressive of that type. [00:37:48] And so, if you start to understand the pathology, I do think that that is important. But more importantly, we need to understand the treatments because that is what ends up having the biggest impact down the road. And people often think in this short-term window, like, “I just have to get through this, I just have to have the tumor removed, I just have to have the treatment and then I can go back to normal.” And what they don't realize is that, yes, that treatment has short-term misery for sure, but it also has a lot of long-term misery. And if we just take that 20% to 30% off of the top from the very beginning, those are people who are having any treatment for no reason.  [00:38:39] And it's hard to understand that and understand why our system would put us through all of this unnecessarily. But sadly, it's a very broken system. And it's really hard to know what to do. And again, why I wrote my book so that I could help empower people to make the right decisions for them. And our system right now operates in a very checklist kind of way where everyone who gets the diagnosis gets the same treatment, the whole treatment. So, I've had so many people come to me and say, “Listen, I had a lot of disease, but I had two cycles of chemotherapy and the disease is all gone, but they want me to finish and have 12.” So, there's no thought given to, “Have you responded? Have you completely responded? Can we do something different with you?” There's no thought given to that. It's either all or nothing in our system right now. And it puts people in a really difficult place because the ones that have had a complete response after a treatment or two and want to walk away, they are really not treated nicely by the providers at all. And they're basically abandoned by them. It's very much my way or the highway. And it's frightening to be abandoned by your physician, by your provider.  Cynthia Thurlow: [00:40:15] Well, think about how many patients get diagnosed or they get labeled rather noncompliant.  Dr. Jenn Simmons: [00:40:22] Yeah. [crosstalk] Cynthia Thurlow: [00:40:23] And it's not that they're noncompliant. It's that they are asking questions. They are advocating for themselves. They are really looking for what I refer to as a bio individual perspective. And I know that's something that you and I both share in terms of looking at patients as individuals. What do you think is one of the biggest misconceptions about traditional cancer treatment? And by this, I mean radiation. What are the limitations of radiation because I think most people probably do not realize this?  Dr. Jenn Simmons: [00:40:52] Yeah. So, there is no survival advantage to having radiation. And I would venture to guess that nearly 0% of people who sign up for radiation realize that. I don't think they're told that. I don't think that's a discussion that they have. Now, radiation does serve a purpose and it does prevent local recurrence, meaning that if you had a lumpectomy and you have radiation afterwards, the likelihood that the cancer will come back in that breast is reduced by radiation. But what isn't happening, which most people believe is happening, is that survival is not increased by undergoing radiation. So, you do not have a greater chance of living after having undergone radiation.  [00:41:53] And in fact, depending on which side your tumor is on, there are some very serious long-term consequences of having undergone radiation beyond the cosmesis, beyond the fact that it will deform your breast, beyond the fact that it will make the texture of the breast different and hard and firm, beyond the fact that it will darken your skin and thicken your skin. I'm not talking about the cosmetic effects of radiation. I'm talking about the fact that beneath your breast are some really important structures. So, beyond what it will do to the muscles of your chest wall because it will make them fibrotic and firm and able to tear. But the ribs are there and it actually makes the ribs brittle and fragile. So from a sneeze, you can have a rib fracture. There are significant mortality and morbidity complications when you fracture your rib. People die of rib fractures all the time.  Cynthia Thurlow: [00:43:05] Mm-hmm.  Dr. Jenn Simmons: [00:43:06] So that's a problem if we are going to change the quality of the bone in the rib, but that is what's happening with radiation. Beyond that, what's behind your ribs. Well, on the left side is your heart. So, if you have radiation, you have both an increase in the incidence of coronary artery disease because it affects the vessels of the heart, but you also have an increase of cardiomyopathy because it affects the actual muscle of the heart. These are very serious consequences which, incidentally, if you are treated for breast cancer, you are two to three times more likely to develop heart disease and die of heart disease than if you are not treated for breast cancer.  [00:43:52] And what happens with those deaths? Even when they're caused by the complications of breast cancer treatment, they are not attributed to breast cancer, they're attributed to cardiovascular disease. So, we are actually decreasing survival when we use these treatment modalities like chemotherapy, like radiation. Now, for some people who have imminently life-threatening breast cancer, it is worth that trade off. But this is not true for most people. It's not true at all for most people. And I think if they knew the long-term risks and long-term ramifications of radiation, it's unlikely that they would choose it. They would take the risk of the cancer coming back in that breast and dealing with it if that happened knowing that there are so many things that we can do to prevent recurrence, things that are 100% in our control.  Cynthia Thurlow: [00:44:59] I think that for so many people, getting fully informed consent and again, it goes back to, are you making decisions from a place of fear? Are you in a position where you're able to think clearly? And trust me, I understand when we are fearful, we override our prefrontal cortex, which is our thinking brain, we are left dependent on the amygdala, which is our lizard brain, which is a survival mechanism in our bodies. We can't make good decisions when we can't think clearly. And so, I love that you touched on so many of these things.  [00:45:35] One thing that really stood out to me when I was going through your book was the issue of trauma. And not just trauma, but the risk that it puts us at in terms of a diagnosis, but also a reoccurrence. Can we speak to this? Because I think that chronic stress, whether you are cognizant of it or not, whether you are aware of it or not, because I think there are many of us that are very high functioning, that had high adverse childhood event scores, who appear from the outside, we've got everything together. But in many instances, that chronic stress pattern that we are exposing our bodies to can make us more susceptible to reoccurrence and even an initial diagnosis. Dr. Jenn Simmons: [00:46:27] Without question. And, actually, when we look at the data, when you look at women who are diagnosed with early breast cancer, about 30% of them will have known trauma in their past. And when we look at the people diagnosed with metastatic breast cancer, 80% of them will report known trauma in their past. And then 100% of them have the trauma of a breast cancer diagnosis. So, without question, the body is keeping score. And when we don't deal properly with that trauma, and believe me, I am not judging and I am not saying that this is easy, but that if we do not deal with it properly, it will manifest as physical illness. Because when we don't listen to the whispers of the body, the body gives us screams. And this is your body's way of messaging you, of saying, “I'm not okay and I need your help here.”  [00:47:39] And it always amazes me, the people that tell me that “I'm not stressed, I have nothing to feel stressed about, everything is great.” And then you actually measure 5-point cortisol’s on them and they're off the charts. And so, they're so not in touch with how their life is affecting them. And when we are in these chronic stress states, we do have tremendous manifestations of these that end in breast cancer because of what that chronic stress means from a chemical perspective in our body. So, we talked a little bit about, we only understand safety and danger.  [00:48:28] So, if we're in this dangerous state, we were only designed to be in this dangerous state less than 5% of our day, less than 5%, because if you think about it, if you come out of the cave in the morning and there's a saber-toothed tiger there, you're either meant to run away or get eaten in seconds. You cannot run away from a saber-toothed tiger for three hours or three days or three weeks or three months or three years, you can't. And so, but unfortunately, so many of us have these perceived saber-toothed tigers that are just there constantly, every day. [00:49:13] And the interesting thing that I talked about with my friend Tricia Pringle recently was that if you have-- I have a patient who was studying for the Bar exam. And so, every single day, that's all she did. She gave up exercising, she gave up eating healthy. All she did was sit all day and sit in the stress of studying for the Bar exam and had tremendous anxiety about the bar exam and took said Bar exam and failed and decided that she was going to just give it one more try. So, did the same thing and studied every day, all day, didn't eat well, didn't move her body, had no stress management, just plugged into that and she failed. And she decided that was it, she wasn't going to do it anymore, she wrote it off. And she told me six months later when she came to me for help, she can't lose weight. She feels fine, she feels relaxed, she feels everything, but she can't lose weight and she can't understand why, because she doesn't feel stressed about this. She's put that behind her.  [00:50:24] And then you measure her cortisol levels and they're off the charts. Because if you have a saber-toothed tiger every day at your door for two years and suddenly the saber-toothed tiger is no longer there. Well, someone needs to tell your body that, because you're on autopilot. And these people that experience their trauma year after year after year after year and suddenly think that they've forgotten it, but the body hasn't. And the body is still experiencing that day after day after day. And so, when it is not dealt with, the body is going to give you something that you understand to deal with.  [00:51:11] And then, at that point, certainly trauma is one of the causes of breast cancer. But when you have a breast cancer diagnosis, we have to think about all of the causes of breast cancer. We have to think about chronic inflammation from the diet, we have to think about processed foods, we have to think about sedentary lifestyle, but also overexercise, you can't run away from a saber-toothed tiger all the time. So, these people that are exercising for hours and hours and hours a day, we can't do it, we're not built for it.  [00:51:40] Radiation exposure, repeated mammograms, x-rays, radiation in childhood. Chronic inflammatory conditions like obesity, diabetes, thyroid disease, and celiac disease. I diagnosed several women every single year with their first diagnosis of celiac disease. They have no GI disease. 40% of people with celiac disease will have no gastrointestinal issues that they know of and their first inclination that they have celiac disease at their breast cancer diagnosis. So, chronic inflammatory diseases like inflammatory bowel disease or MS or anything like that. Chronic infections, we're surrounded by them. Think about the number of people that have parasites or viruses, fungus, mold, Lyme, yeast, bacteria.  [00:52:30] Chronic infections can lead to a breast cancer diagnosis. Heavy metals in our drinking water. Dental amalgams are a great example of heavy metals that we are repeatedly exposed to that we don't appreciate or we underappreciate. But it's also in our food, our cosmetics, chemical exposures, plastics, pesticides, herbicides, fungicides, phthalates, xenoestrogens, chronic antibiotic use, antibiotics. The more antibiotics you have in your life, the higher your risk is of getting breast cancer. Chronic dental infections. People don't realize that like root canals are a dead tooth in your mouth and they collect inflammation and infection. Frequent toxin exposures. I mean, have we normalized? Alcohol. look at alcohol use, it is directly related to breast cancer incidence. Chronic constipation, because if you're not getting rid of the toxins from your gut, then they're just being reabsorbed in your body. Nightshift work, short sleepers, insomniacs. Sleep is where the healing happens. So, if you're not sleeping, you're not healing.  [00:53:35] The electromagnetic field is another example of something that causes DNA damage. It is so invisible to most of us. Chronic stress from a difficult relationship, a bad marriage, a horrible boss, being a caregiver to a sick parent or spouse or partner or friend or God forbid, a child. And then there are other huge stressors like a divorce, a job loss, an unwanted move. And of course, as we started off, unresolved trauma. And we have to think about all of these things because they're having a tremendous impact on our bodies.  [00:54:12] And cancer is a normal response to an abnormal environment. And it's all of these things that are creating this environmental shift within us and allowing for this transformation, this cancer to start to form. And then we are living in a time where our immune systems are so challenged by everything that is in our environment and by the busyness of our lives. I mean we are just overworked and overscheduled and running ourselves ragged, and this is an immune suppressant. Our immune system simply cannot keep up with it. And this is the perfect storm. This is the recipe, this is the formula for breast cancer.  Cynthia Thurlow: [00:54:57] It's so interesting to me because there are so many contributory factors that can make us more susceptible. And certainly, you've run the gamut being so thorough. I want to make sure that we leave aside some time to address some listeners questions. And there were so many questions that I'll just have to have Dr. Jenn back because there's no way we'll get through all of them. First, thinking about thermography, someone mentioned thoughts on thermography versus mammogram, especially for dense breasts. Do you feel like there's any utility for thermography? I know we didn't touch on QT imaging. I know that is the next frontier. Do you think there's any utility to thermography?  Dr. Jenn Simmons: [00:55:39] So, I love thermography as a screening tool for inflammation, but most breast cancers, a significant number of breast cancers, are so slow growing that they're really not going to trigger very much inflammation. And so, I do not use it as a screening tool for breast cancer. And the reason why it is not gaining acceptance is because it's not a good screening tool for breast cancer. It is a great tool to screen for inflammation, but inflammation and breast cancer are not the same thing. And so, I do not use it and I do not rely on it. And when people bring me their thermography results and it says, no increased risk of breast cancer, that is not even worth the paper that it's on.  Cynthia Thurlow: [00:56:35] So, save your money.  Dr. Jenn Simmons: [00:56:36] Save your money. But if you want to use it once a year to know if you have a problem in your mouth, a problem in your thyroid, I do use it to look for inflammation. And if your CRP is elevated, if your sed rate is elevated, this can be a useful tool to look for where the issue is, but I don't use it as a screening tool for breast cancer because it's not reliable, so save your money if that's what you're using it for. Cynthia Thurlow: [00:57:08] That's really helpful. The next couple of questions are all centered around mammography. And so, I pretty much know the answers to this, but I want to make sure we get them asked. People that are at higher risk for breast cancer, that are alternating between mammograms versus a breast MRI every six months, what are your thoughts about in terms of people that are at higher risk. What would be your suggestion for a patient that maybe has a terrible family history or is at greater risk? What do you feel like is a superior diagnostic tool?  Dr. Jenn Simmons: [00:57:44] Yeah. So, let's first talk about why they're at higher risk. So, they're either at higher risk because they have a family history, which probably means that they either have a genetic predisposition where they have bad detox genes. But there's something that's putting them at higher risk. And in general, people that are at higher risk for breast cancer have difficulty detoxifying, have difficulty with things like radiation. So, we're taking a population of people who already have proven to us that they suffer more toxicity and more damage and struggle with DNA repair, and we are exposing them to more radiation than most. So, to me, I think that it is unethical to screen high-risk people with mammogram because we are basically ensuring that they are going to develop that disease.  [00:58:50] Now, it's interesting that you asked about MRI, because most people think, “Oh, well, MRI, no radiation, so that's a good test.” And it's true, there is no radiation, but there are plenty of problems with MRI, starting with, in order for the MRI to have the sensitivity and specificity that it has, it requires gadolinium. And gadolinium is a heavy metal which is stored in the tissues of our body and has its own issues. So, I cannot get behind screening people with MRI because I can't get behind giving these same high-risk people gadolinium because they can't clear the toxins. They've already proven that they struggle with that. So how can we give them a bigger toxic load and expect to be helping them? We're not.  [00:59:50] So, and the reason that QT-- which is the technology that you brought up, the reason that QT was invented, was because the NIH knew that we needed something for high-risk screening, we needed something for dense tissue screening that wasn't harmful, that didn't put people in harm's way, which was more accessible, less expensive, affordable, but at the same time they didn't want to sacrifice the sensitivity because for people with dense breasts for young women, for high-risk women, this is a real issue. And mammogram will miss 40% of cancers in this population. So, it's not a good test anyway for those people. And so that's really why QT was invented. It was invented to help these high-risk women and give them a screening solution.  [01:00:53] So what QT is, it's sound waves transmitted through a water bath that collects 200,000 times more data points than MRI and creates a true 3D reconstruction of the breast. So, this is safe and painless. There's no compression. You just lie down on a table and your breast gets submerged in a warm water bath. So, no pain, no compression, no radiation, no gadolinium. And at the same time, we're getting an accurate image of the breast. So, this will without question, forever change how we screen for breast cancer. The main problem with it now is that it's just not that accessible because there's only six centers. But I'm working on that. I'm going to put up 50 in the next God willing, two years. I don't know that I'll sleep much, but I'm going to put up 50, God willing in the next two years and I hope to put 100 up. And by the time I do that, this will have universal adoption and forever change how we screen for breast cancer.  Cynthia Thurlow: [01:02:00] I think that's really exciting. So, a couple questions. One was when are you opening an imaging center in New Jersey or New York? That came up multiple times.  Dr. Jenn Simmons: [01:02:08]  Yeah. So that's 2025.  Cynthia Thurlow: [01:02:09] Okay. Dr. Jenn Simmons: [01:02:10] So, stay tuned.  Cynthia Thurlow:   [01:02:11]  Okay, so it is coming up.  Dr. Jenn Simmons:   [01:02:11] It is coming up.  Cynthia Thurlow: [01:02:12] The six locations right now, I know Philadelphia. Where else are the other locations right now?  Dr. Jenn Simmons: [01:02:16] Philadelphia. I also have one in the San Francisco area, Nevada, California. So those are the PerfeQTion Imaging Centers. And then there is a center in Irvine, there's a center-- These are all in doctor's offices that also offer this service. There's a center in El Dorado Hills, California. There are two centers in Illinois, one is in Crystal Lake and I think the other one is in Chicago proper.  Cynthia Thurlow: [01:02:46]  Okay, that's helpful.  Dr.   Jenn Simmons: [01:02:47] But I have many many more coming this year. So, in 2025, you'll be able to go Florida, you'll be able to go to New York, you'll be able to go to LA if it ever stops burning. And hopefully we'll be also in Texas, in Colorado, in Massachusetts. I have a lot planned.  Cynthia Thurlow:   [01:03:05]  That's really exciting.  Dr. Jenn Simmons: [01:03:06]  Yeah.  Cynthia Thurlow: [01:03:07] Several providers wrote questions centering around resources for providers to be able to recommend alternative form of imaging as providers themselves. Do you have resources or recommendations, because it sounds like the ship is starting to turn in terms of the conventionality of these alternatives. Do you have specific recommendations or do you mentor clinicians?  Dr. Jenn Simmons: [01:03:29] Well, I am introducing a clinician training program this year in 2025. I'm doing it along with the brilliant Lindsey Berkson.  [crosstalk] So, stay tuned for that because-- Cynthia Thurlow: [01:03:40] Very, very popular guest.  Dr. Jenn Simmons: - we are going to both offer a patient facing program, but we're also offering clinician training. Because the truth is that I'm going to have to step away from my role as a provider in the breast cancer space. But I come along with enormous experience because I spent 20 years as a breast cancer surgeon, so I want to be able to impart my experience onto people so that they can comfortably treat people for breast cancer with all of their foundational knowledge that they have in their functional medicine practices. And I'm going to give you the oncologic piece.  Cynthia Thurlow: [01:04:23] I love it. That's fantastic.  Dr. Jenn Simmons: [01:04:25] So that will happen this year. Until then, I do have a screening paradigm. There's three things involved. The first is everyone should be doing self-breast examination. No one is ever going to know you better than yourself ever, ever, ever. So once a month, if you are premenopausal, you're doing it one week after your cycle starts. If you are postmenopausal, just do it. You can feel them on the first. Whenever you remember to do it, I want you to do it. And it is a combination of both looking at your breasts to make sure that they haven't changed in size and shape. Make sure there's no skin dimpling or anything like that, nipple retraction, that's what you're looking for. And then you're going to feel your breasts.  [01:05:06] If you are large breasted, you have to lie down and take gravity out of the picture. If you're small breasted, you can do it standing up, but you should elevate your arm over your head and use the opposite arm to examine. Always put something on your hand, be it oil or lotion or whatever to take friction out of it. And then you're just going to run your fingers from the outside towards your nipple around. Use your fingertips, they are the most sensitive part, okay, so that's step one. Everyone's doing self-breast examinations.  [01:05:39] Step two is you're going to do the Auria test. This is the tears test. There's a tiny piece of litmus paper that you put inside of the corner of your eye. And you just close your eyes, let it sit there for five minutes. That little piece of paper gets mailed off and it comes back with a result that is either normal or clinically significant. And if it's clinically significant, it means that it found these proteins, the S100A8 and S100A9 proteins. These are inflammatory proteins that are fairly specific to the very early stages of breast cancer. So, it has a 93% sensitivity, which is better than any mammogram ever. And done in the comfort of your own home. It's 100% safe and 100% painless. If you have a clinically significant result, that means that you have the inflammatory risk for breast cancer if you don't have breast cancer already. But what it is, if you don't have breast cancer already, and it means that you need to go have imaging, but if you don't have anything on imaging, you know that you have the opportunity to figure out why you have this inflammation and reverse it so that you don't have to get a diagnosis. So, I love this test because to me it's preventative. To me, it's the ability to know if you have inflammation and intervene before you have disease.  [01:07:09] And then for imaging, because I feel very strongly about not exposing normal, healthy women. That is the screening population. Because if we're screening, we're talking about the population of women who we have no reason to believe that they have disease. If you have a lump in your breast, if you have a symptom, if you have a finding, that is the diagnostic population. I am not saying women will never have another mammogram again. I'm saying that you should not use mammogram for screening, but for diagnostic, if you have something wrong, you need everything. We are not throwing the baby out with the bathwater. If you have something that we have a reason to believe that you have breast cancer, we need to do whatever we need to do to diagnose you. However, if we are talking about the pure screening population, then a QT scan, if you have access to either PerfeQTion Imaging or any of the other centers or an ultrasound, this will suffice.  [01:08:13] Ultrasound is very low-resolution technology as compared to QT, but it is way better than exposing yourself to radiation or gadolinium. I do not believe in putting normal, healthy women in harm's way. It's wrong, it's unethical. It should have been abandoned many, many years ago. There are countries around the world that have abandoned it, that have abolished it, and we should follow in their footsteps.  Cynthia Thurlow: [01:08:39] Well. Dr. Jenn, I'm hoping I can entice you to come back to do an Ask Me Anything because we had so many questions. And I think that if you're open to it, I would love for you to continue with the AMA piece because I think it'll touch on many of these issues. Thank you for the work that you're doing. Please let listeners know how to connect with you, listen to your podcast, purchase your book, or work with you or your team directly.  Dr. Jenn Simmons: [01:09:02] Yes. So, my website to work with me there, join my group, or work with me one on one. My website is called realhealtmd  and you can learn all about our programs there. I too have a podcast like you and mine is called Keeping Abreast with Dr. Jenn. We put out a new episode every Monday so please tune into that. You can find me on all the social channels, I’m @drjennsimmons  and then my book, The Smart Woman's Guide to Breast Cancer  is available on Amazon and it truly-- You do not need to have breast cancer to get great value from this book. This book is for anyone who has breasts and wants them to be healthy because at the end of the day, as I always say, breast health is health and the same exact things that are going to give you healthy breasts are going to give you a healthy brain, a healthy heart, healthy skin, healthy bones, healthy gut, healthy everything.  Cynthia Thurlow: [01:10:02] Well, thank you again.  [01:10:05] If you love this podcast episode, please leave a rating in review, subscribe and tell a friend.

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  • Intermittent Fasting Expert | Cynthia Thurlow

    Discover a holistic approach to health and wellness with Intermittent Fasting Expert, TEDx Speaker, Host of the Everyday Wellness Podcast, and Nurse Practitioner Cynthia Thurlow. Explore expert advice on intermittent fasting, nutrition, and more to optimize your well-being. Helping Women Live Happy & Healthy Lives I do not believe nor do I support the limiting belief that women have to accept weight gain as a normal function of aging. Become Happier & Healthier As Featured On Wellness Starts From Within Hi, I'm Cynthia Thurlow! As a firm believer in the transformative power of nutrition, I know that changing how you fuel your body is one of the best steps toward a healthier life. With years of experience as a nurse practitioner and metabolic health expert, I help women achieve their wellness goals through personalized nutrition and holistic healing. My approach is rooted in the concept of bio-individuality, recognizing that each person has unique needs. I am dedicated to empowering women to feel their best and live the quality of life they deserve. Learn More About Me "Cynthia has changed my life through her programs, through her guests and podcasts, through her product and supplement recommendations, through her food guides, through her safer home tips. I knew things weren’t right in my body, but I couldn’t find a doctor that understood—they just met me once a year and ran simple blood panels. With the Wholistic Blueprint programs, Cynthia used other tests to really drill down and see what was going on in my body, what was going on in my gut, what was going on with my sex hormones. She was diligent and knowledgeable in how to begin to fix how my body functioned. She answered my questions promptly in an understanding and encouraging manner. She didn’t overwhelm me, but she supported me. I just am so thankful and grateful for her knowledge, wisdom, insight, compassion and courage. It will be your greatest gift to yourself to make the decision to work with Cynthia.” -Mandy H. Begin Your Intermittent Fasting Transformation Discover the customized fasting nutrition plan that will help you be lean, fit, more youthful, sexier, and full of energy—at every stage of life in my book! Get My Book "I first heard Cynthia on a podcast of Megyn Kelly. Everything she discussed made so much sense to me. I started following her on social media, and immediately subscribed to her podcast. I listen to her podcast every week. I purchased her book and applied nearly everything she talks about. I completely changed all my skin care and got rid of all scented things. I prioritized my sleep. I had been using lorazepam for 11 years to help with sleep, and have been able to get myself off of that. I started seeing a functional Dr. Had a dutch test done and found I needed progesterone. This made all the difference in the world for my sleep. I changed my exercise routine from lots of cardio to lots of strength training. I've literally done a 180 on my lifestyle. Lol. But I'm so happy I did, because at 56 I feel amazing." -Lisa J. Shop My E- Books Quick View Sleep Strategies Price $9.99 Add to Cart Quick View Simple Smoothie Recipes and More Price $9.99 Add to Cart Quick View Set It and Forget It: Pressure Cooker Recipes Price $9.99 Add to Cart Quick View Primal Eating Price $9.99 Add to Cart Quick View Emergency Weight Loss Plan Price $25.00 Add to Cart Quick View DETOX Guide Price $9.99 Add to Cart Quick View Balance and Thrive: A Guide to Healthy Hormones Price $9.99 Add to Cart Quick View Anti-Inflammatory Recipes Price $9.99 Add to Cart Shop Other Items Explore My Blog Collagen Peptides and Midlife Health: What the Science Says Aging is inevitable, but how you age? That’s something you have more control over than you think. Collagen… the powerhouse protein... 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Watch Now Learn More The Midlife Pause Learn More IF:45 Masterclass Learn More IF:45 Coaching Certification Programs Built to Help You Thrive As a nurse practitioner, intermittent fasting and nutrition expert, and a two-time TEDx speaker, I am here to apply my experience in helping you find wellness through the healing power of nutrition and fasting. I believe it is possible to feel better tomorrow than you do today and want to equip you to experience that freedom! Explore my wellness programs and 1:1 coaching support led by my trusted team to learn how we can work together to reach your health goals! Explore Programs & Coaching Click here to learn more and to purchase. The Midlife PAUSE™ supplement line is now available!

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