A Personal Note from Orion

Happy Tuesday!

In this Episode

• [02:44] – Dr. Caplan starts off by sharing a little about herself. She walks us through her career, from her conventional training in medicine to how she decided to shift into dealing with hormonal issues.
• [06:03] – What is the biggest issue that Dr. Caplan tends to see with women and hormones? She most often sees perimenopausal women, she answers.
• [09:12] – Dr. Caplan discusses whether perimenopause can start as early as a woman’s 20s. She also explains that menopause is a retroactive diagnosis.
• [13:15] – We learn about the main hormones and the powerful effects that they can have on us, especially when their levels are off.
• [17:16] – How fast can Dr. Caplan diagnose a patient and be able to treat them with the correct hormones?
• [19:02] – Orion points out that Dr. Caplan is nonjudgmental and works with her clients where they are, instead of trying to make them do more than they’re ready for.
• [19:47] – What is the difference between bioidentical hormones and synthetic hormones?
• [22:26] – Dr. Caplan talks about how she figures out exactly what to give each of her patients. It’s complicated, she explains, because it’s a moving target.
• [26:00] – Dr. Caplan discusses the role of detoxification pathways in what she does.
• [27:11] – Does Dr. Caplan think that hormonal imbalance affects the same percentages of men and women? As she answers, Dr. Caplan discusses some of the differences between men and women in this regard.
• [29:22] – We learn more about what Dr. Caplan meant about women coming to her with different kinds of stories.
• [30:25] – Can you restore your hormonal balance, or do you need to take supplements for the rest of your life?
• [31:12] – Dr. Caplan talks about some of the supplements and herbs she recommends for certain patients.
• [34:35] – We hear about thyroid issues, with Dr. Caplan explaining some of the symptoms of having low thyroid. She then explains how doctors check for this, and why the standard blood test may not give you the full picture.
• [37:50] – Dr. Caplan offers a visual metaphor to explain why you can have low thyroid function even if you have normal test results.
• [39:13] – Orion talks about her mom’s thyroid condition, then Dr. Caplan explains why one might have symptoms despite being treated.
• [41:01] – Is it possible to cure your thyroid naturally?
• [42:22] – Dr. Caplan talks about what adrenal fatigue is, and how you can combat it.
• [46:09] – Orion takes a moment to rave about the breadth of services available at Dr. Caplan’s clinic. Dr. Caplan then talks about her vision for the future of her clinics.
• [47:13] – What types of IVs does Dr. Caplan use at her clinic?
• [48:21] – You have to pick and choose your supplements, Dr. Caplan explains, and it can be a rotating system.
• [49:19] –  What are Dr. Caplan’s three top tips for living a stellar life? 1. Follow your dreams. 2. Do something you’re passionate about. 3. Optimize your health through diet, nutrition,and stress management.
• [49:38] – If people want to learn more about Dr. Caplan or her clinic, where can they go?

About Today’s Show

‏‏Hello and welcome to Stellar Life Podcast. I’m your host Orion and I have a question for you. Lately, have you been gaining weight, maybe you’re feeling irritable, you feel fatigue, loss of energy, or lack of libido? That may be because you may have hormonal imbalance. I invited Dr. Shari Caplan today to talk about bioidentical hormones and thyroid, adrenal fatigue, and even vitamin IVs, all those things that you, my dear, need to know about in order to keep your health in check and so you can feel alive and awake and happy. Hormonal imbalance can really affect your life for the worst. It can create brain fog, it can also make you feel like you don’t even know who you are. It is reversible, you can take supplements and bioidentical hormones to treat it so there’s hope. Dr. Shari Caplan, my guest today, is the medical director and founder of the first physician ran integrative medicine lifestyle center using both conventional and alternative treatment options. Her goal is to find safe solutions to treat hormonal imbalance while modulating genes to reduce the risk of breast cancer and improve vitality. Dr. Shari is so smart. She knows a lot about a lot and she will share with you her wisdom today. Are you ready? Onto the show. Hey Dr. Shari, and welcome to Stellar Life Podcast. How are you doing?

‏‏I’m doing great, thank you very much for having me on your show.

‏‏I’m so excited to be talking to you because we’re going to be talking about topics that are near and dear to me which is health, hormonal balance, and all kinds of great things. Before we start, why don’t you share a little bit about yourself?

‏‏I’m a medical doctor who’s been actually trained conventionally, worked in the teaching hospital. Basically, originally was trained to do family practice, women’s health, did obstetrics and whatnot. When I started having my own perimenopausal issues, I realized that the conventional system wasn’t addressing things the way I would like. My mother had died from breast cancer at the age of 44, I kind of was always a little hesitant about taking hormones myself. Several years ago, there was a study that came out, the WHI study that scared a lot of women about taking hormone replacement because it increased the risk of breast cancer and increased heart attacks, strokes after being on it for more than five years. The last thing I wanted to do was take something that was going to increase my risk, but at the same token, I didn’t really feel that I want to live the rest of my life feeling the way I did. The things that I was feeling was like my brain wasn’t working as well. I’d read something, learn it and teach it and whatnot, and then it was like oh, what did I read? I have to write it down. I started having some flashes, started gaining weight. I had to start figuring things out for myself and there was this big meeting, the year that I started having my issues, that was by the Society of Obstetrician Gynecologists who came out and said all hormones have the same risk. I stood up and went hey wait a minute, weren’t there all these studies way back when that showed that natural progesterone was different? They have different breast profiles. Now, there’s a statement coming out that they’re all the same. Has there been a study that showed that? They said, “No, there hasn’t been.” I was like I need to go learn things for myself. In Canada, there wasn’t a lot of education going on so I went to the States and started learning about bioidentical hormones and that was a tipping point. When I realized that hormones was only one little piece of the puzzle, but it was really about how to eat right, exercise, de-stress, modulate your genes, and that different hormones had different risks. I guess that’s a lot in a nutshell but essentially I started practicing and learning about integrative medicine and now I have this large clinic in Toronto where my slogan is Optimize Your Health. Basically, I teach people how to eat right, exercise, balance their hormones, replace deficient nutrients and manage their stress.

‏‏Nice, wow, that was a lot. Every topic can be a whole few years of talking to you. My husband, he’s got his own podcast. Actually, two, there’s Marketing Speak and then Get Yourself Optimized. He talks all about optimization of your mind, body, and spirit, and so do I. What is the  issue that you see, especially with women and hormones?

‏‏I tend to see people in different stages of their lives. I think the biggest one that brings a lot of women in is starting with their perimenopause and going into their menopause. Partly, a lot of it has to do with our environment. Every man made chemical now essentially looks like an estrogen. Right off the get go, women are hormonally imbalanced because their environment has all this excess estrogen or xenoestrogens. Then, when we start going into perimenopause, that also causes this hormonal shift or imbalance where women start producing crazy amounts of estrogen and it’s peaks and troughs and it’s all over the place. We don’t make as much progesterone as we used to, and that can cause a lot of symptoms. When we have a lot of estrogen, we tend to be moody and irritable. Progesterone is your natural tranquilizer and sleeping pills. If you start losing that, people will start having sleeping problems and might start having anxiety and mood problems when we’re otherwise fine. Conventional doctors don’t always seem to appreciate the symptoms that women go through, they totally get the hot flashes and heavy periods but the irritability, the sleeplessness, waking is a huge thing that happens around perimenopause. That totally relates to the hormone shift. Now in hindsight, I would laugh that a lot of my patients in their 40s would come in to see me and complain about weight gain, feeling tired, all their usual tricks to help keep them fit wasn’t working. I would say you’re not eating right, you’re not exercising right. But of course when it started happening to me, it was like oh, I am eating right and I am exercising right. Holy shit, it’s hormones. That was a big eye opener. The one thing that I learned is that when women are low on progesterone, they burn about 300 calories less a day.

‏‏Really?!

‏‏Yes.

‏‏No!

‏‏You could be doing exactly everything you were doing and you’ll start gaining weight.

‏‏Wow.

‏‏Yeah. Sometimes, giving progesterone actually can help improve your metabolism. In fact, a lot of women, when they come into the clinic, I have them fill up this questionnaire that looks at different hormone deficiencies. A lot of people will have thyroid symptoms as well as low progesterone symptoms. Lo and behold, all I do is treat their low progesterone and their thyroid symptoms go away.

‏‏Really? Wow.

‏‏It’s really cool. What I found is that every hormone is intimately connected with another one. When one’s off, it can actually cause problems with the other ones.

‏‏Is that true that perimenopause can start in our 20s?

‏‏I don’t think that perimenopause starts in your 20s, I think the definition of menopause is not accurate.

‏‏Okay, yeah, what is menopause exactly?

‏‏Menopause is a diagnosis after the fact. It means a woman had one year without her period. Once she surpassed that one year, now she’s considered menopausal. But, if on the 11th month where she had no period for 11 months and then gets a period, guess what, she’s not menopausal. We would call her late perimenopause. Perimenopause means the timing around menopause. Most doctors would think of that about two years, maybe max five years. But in fact, it’s more like 12 to 15 years before you actually have your final menstrual cycle. If you go back, the average age of menopause, it keeps shifting but let’s say it’s around 50, 54. If you go back 15 years, you might be talking to a 35 year old. In today’s day and age, 35 year olds are just trying to get pregnant. If you already have hormonal imbalances and more low progesterone, then those women who are trying to get pregnant have a harder time getting pregnant, they have a higher risk of miscarriage because progesterone is the hormone to help sustain a pregnancy.

‏‏Right. Do you give them the progesterone during the pregnancy as well?

‏‏What happens is when someone is coming in and having issues with getting pregnant, I often measure their progesterone levels. If they’re commonly on the low end, then we’re going to support giving them progesterone while they’re trying to get pregnant, usually we’ll do it from the mid-cycle, from when they’ve ovulated. Once they are pregnant, we’ll actually keep them on progesterone for about 10 or 12 weeks because some people are at higher risk of miscarriage because of their history either of low progesterone or Luteal Phase Defect, or they might have polycystic ovaries which again causes the hormonal imbalance and low progesterone in that second half. Giving them progesterone for that time period helps sustain the pregnancy until the placenta’s grown enough or mature enough to make its own progesterone.

‏‏Wow, that’s amazing. There’s so much to it.

‏‏You actually asked me—I would say I see a lot of patients coming in perimenopause, menopause. But then I also see a lot of infertility as well, people trying to get pregnant. Basically, that’s another time to look for this hormonal imbalance, but also replacing nutrients to make their body work better. And then I see a lot of patients who have polycystic ovaries, these are girls who have a genetic predisposition, they tend to have more of this estrogen progesterone mismatch, but they also produce a lot more testosterone. They tend to have weight gain, and also there’s an insulin resistant component, meaning that they have problems managing their sugars. Great tool is teaching them how to eat right, exercise, using certain supplements that help manage the insulin resistance and help with the hormonal balance, and then sometimes giving them progesterone as well.

‏‏What are the major hormones and what kind of effect do they have on our bodies?

‏‏Again, a lot of regular doctors, when they talk about cycles or women’s health, they’re most often just talking about estrogen, progesterone. But really, all our hormones have an effect. Yes, estrogen, progesterone is crucial but women also have testosterone. In polycystic ovaries, they tend to have excess testosterone. They get acne or hair loss. Also, as women go through perimenopause and menopause, they also can have low testosterone and they want replacement because testosterone has the same effect in women as men. It’s responsible for libido, energy, brain function, body composition, and whatnot. Another hormone that I often look at is thyroid. I think thyroid is huge. Women are more prone to having thyroid dysfunction compared to men. I think there’s a lot of environmental toxins in our environment that also affect our thyroid. Everybody’s heard the term endocrine disruptors which we all think about. It’s all about the estrogen, which a lot of them are, but a lot of them have to be thyroid disruptors as well. You can actually have normal lab tests but have something still affect your thyroid function that we can’t measure and people may not feel well because of that. It’s kind of like thinking outside the box, how can I help this person, what are their symptoms, do they have exposures that we can mitigate. I think that’s an interesting concept because a lot of doctors don’t appreciate that. And then the hormone cortisol is huge. If you are stressed out and burnt out, I think in today’s world, most people are stressed. When you’re stressed, basically, it actually causes a whole bunch of different things. One, specifically, you actually can get higher estrogen levels and you could actually steal your progesterone to make cortisol. If you ever noticed that when you’re stressed, your periods get wonky or you might get heavier periods, or your PMS might be worse. That has to do with this one hormone stealing from the other and it’s causing imbalance.

If you ever noticed that when you’re stressed, your periods get wonky or you might get heavier periods, or your PMS might be worse.

‏‏Wow.

‏‏And then when your hormones are off, that again can cause cortisol to be high. When cortisol is high, it causes carb cravings, causes weight gain, sleep problems, and everything else. All of a sudden, okay, that can cause a problem. Oh well, insulin plays into that too. If you’re eating a lot of carbs, then eventually you can get a little bit of insulin resistance. In polycystic ovaries, it’s actually because they’re genetically prone to not manage their sugars well, they have higher insulins, and that messes up their cycle. I didn’t even think that insulin can affect my period but it can. I’m just trying to show you how all those hormones can be tied together and that when you’re highly stressed, it can pull off from your thyroid.

‏‏Wow.

‏‏This is a little naughty game, but this is what I play with when clients are coming in to see me. Trying to figure out what was the chicken or the egg, what was the starting piece, how do we fix the root cause, how do we balance the hormones. Again, a lot of times, people are genetically predisposed to being lower on certain nutrients. When you’re stressed, you tend to burn through B vitamins, your Omega and your magnesium. That affects our adrenals and how we cope with stress. It’s important to replace those nutrients. Again, it becomes like putting the pieces of the puzzle together and saying okay, what can I do to help this patient feel her best?

‏‏How fast do you get to really diagnosing the patient? How fast will you know exactly what to give them, what will work for them?

‏‏I think that I’ve been doing this for a while. I can now start listening to people’s stories and appreciate what their hormone problems may be, and also what nutrients they may be low in based on their history. Also, I guess cause I started doing a lot of genetic testing. I can see patterns. I would say within one, two, or three visits, that we can make huge strides in making people feel better. It’s a little bit of an art because we’re all genetically different and very unique. It’s not a one size fits all, it’s sort of let’s try this and let’s work on this. Everybody’s different as to how much they buy in. Some people are like, “I’ll do anything you say because I want to look and feel the way you do, I want to feel better.” They’re going to listen to me when I tell them about what I want them to do in terms of their diet and taking certain supplements or taking hormones. Or maybe it’s actually not hormones but the nutrients to help make them make their own hormones work better. Those type of people, those are great because they get a lot of bang for their buck and they feel better sooner. And then you have those people who are okay, I’m not feeling well, I want to get an understanding of what you’re talking about, and we do baby steps. Perhaps it’s playing with their hormones first, and now that they’re feeling a little bit better, let’s talk about what other nutrients might take you to the next level. Now that you’re feeling better, can we talk about your diet? Everybody’s different.

‏‏What I love about your tone of voice is there is no judgment there. You work with your clients exactly where they are. Of course, as a doctor or as a coach like I am, it’s really nice to have those clients that do exactly what you say and beyond. And then you have success stories right and left. But it’s also so important, and I love your heart, I love your non-judgmental approach to your clients.

‏‏Thank you. The thing is is that’s what I learned over time. At first, it was like okay I want you to do all this. It could be overwhelming for someone. Appreciating what are you able to do, what can we do to move you forward.

‏‏What is the difference between synthetic hormones and bioidentical hormones?

‏‏There’s a lot of misnomer around what bioidentical hormones mean. A lot of people think bioidentical hormones means natural, and that’s not necessarily true. Bioidentical means it’s the same molecular structure that our own body produces. Basically, if I give you a bioidentical hormone and then your body looks at it, it’s not going to know whether it was exogenous, meaning coming from the outside, or endogenous, coming from within ourselves. It’s the same molecule, we have the enzymes to break it down, our body knows what to do with it. It’s not necessarily natural because they are synthetically made in a lab or pharmacy or whatever. That’s where there’s a bit of a misunderstanding. The synthetic ones, the way I call them, they’re synthetic altered molecules. Premarin, which comes from horses, you can say it’s natural, but it’s just not natural to humans. In fact, Premarin has 114 different types of estrogens, not one is really similar to the estradiol that we produce. That’s why it has different risk profiles than estradiol. Even the estradiol that we have, we make different metabolites of it. It’s actually not just one hormone but a group of hormones. And then when we talk about progesterone, that’s what we make every month, that’s what we make in pregnancy. When we talk about bioidentical progesterone, it’s the exact same. But when we talk of Provera or the component of the birth control that’s called the Progestin, that’s an altered molecule. Our body doesn’t know how to necessarily break it down. It has higher risks. It has a higher risk of breast cancer in menopausal women after using it more than five years. It increases clotting factors. It increases cardiovascular risk. Compared to natural progesterone, natural progesterone makes you calm and helps you with sleep, whereas Provera doesn’t. In fact, people feel anxious and have difficulty sleeping with it. Very different molecules.

‏‏Wow. How do you know what to give someone exactly?

‏‏I spent a long time trying to figure that one out because when I started learning about bio identical hormones, you go to see different lectures and different lectures where you’re using different doses and different methods of administration. Oral, lozenge, topical, there’s so many different ways that you can do it and it became very frustrating for me. I try to figure it out for myself. How much estradiol does a woman make in a day, or in a month, and how much do we do in progesterone? The thing is we’re moving targets. If you were to look at the menstrual cycle, it’s not like we have a static dose every single day. In fact, estrogen is low, it peaks really high around ovulation, it comes down, there’s another little peak a little bit afterwards, and then it goes low right before your period. If we averaged it out, we can figure it out. I try to play with different doses and see at the end of the day what the patients feel best on. I kind of don’t have a number, but a range that I will use with people. That’s for all the hormones. My philosophy is lowest effective dose that controls symptoms but still has an effect. What I would say is that progesterone is extremely safe and it doesn’t increase a woman’s risk of breast cancer. It’s based on data from Europe. Whereas estrogen is a little bit of a double edged sword, I’m talking more specifically to the menopausal women. Pre-menopausal women have very high estrogen levels, naturally. And then when they’re going through menopause when it starts lowering, and then when I’m replacing it I’m not going to replace it to a woman who was 25. That’s way too much. I’m going to replace it to a lower dose, but more than what they would have menopausally, to help their cardiovascular system, brain, and bone, and help the flashes and menopausal symptoms. Back to the estrogen, it’s a bit of a double edged sword because we need it to have these benefits. Too much can stimulate our breasts and can be genotoxic, meaning toxic at the DNA level.

‏‏Oh, wow.

‏‏That’s why you have to be careful how you do it. Basically, you want to do it in the safest environment possible. That’s where you want to make sure your Vitamin D is optimal, your magnesium is optimal, you’re eating right, you’re less stressed so that you’re manipulating what’s called epigenetic. You’re trying to turn on all the good genes and turn off bad genes. Going back to the estrogen, progesterone thing, if you think about it, estrogen is kind of that fertilizer. It makes things grow. Progesterone is the halt, the lawnmower that keeps things in check. The fertilizer part of it in terms of breasts, estrogen causes the breast to multiply. When cells multiply, that’s where they’re at risk for getting a cell division that potentially can go to cancer. The progesterone actually reduces breast cell division, so that’s why you want to give both. That keeps things in check and lowers the woman’s risk of breast cancer. Plus, another piece that a lot of people who do hormones don’t really appreciate is the detoxification pathway. We essentially want to use our estrogen, but then we want to get it out. We want to make sure our detox pathways are working well, and how do we know that. It’s again certain things via history, weights, and blood tests that I look for to see, or someone accumulating their estrogen, are they producing a lot more estrone which is a bad estrogen. I’ll often incorporate certain supplements to help the detoxification and also excreting estrogen.

‏‏This is mind blowing, the delicate science of the hormones is just wow. It’s so complicated.

‏‏It is, but I think if you take a practitioner who knows what they’re doing and understands all of this, not just here’s your hormone see you in a year, you can do it very safely and effectively.

‏‏That’s wonderful. Do you think that hormonal balance affects men and women the same levels, or same percentages?

‏‏I would say that we’re more sensitive.

‏‏We’re more emotional and more sensitive, and that’s amazing.

‏‏I mean we’re also more sensitive to the flux because of the xenoestrogens and the environment. We, because of our lifestyle, it always puts us in this shift that we have a lot more estrogen relative to progesterone. Men are being exposed to the same chemicals, they are being exposed to all these xenoestrogens as well.

‏‏Tons of plastic.

‏‏What we’re seeing is men have lower testosterone levels, lower sperm counts. I see a lot more male infertility happening over time, I see men with low testosterone at a much younger age. Originally, bioidentical hormones was mostly about women, but no, there’s certainly a lot of men seeking out hormone replacement now. When a man has it, we call it andropause. They can have a lot of similar symptoms, they can be moody, irritable, fatigue, and gaining weight, and having problems with their sugars, and they also start getting erectile dysfunction.

‏‏A lot of men, they carry their cell phone near their part. That can lower sperm count and all that, right?

‏‏Yeah. All of it affects us. If they’re not sleeping, certain drugs can contribute to lowering levels as well. It’s kind of the whole thing, looking at all the hormones, not just testosterone, that we need to manipulate to help them be more hormonally balanced. For some men, that is because they have high estrogen that they have low testosterone. In fact, giving them ways to reduce their estrogen load will help normalize testosterone without actually giving them testosterone.

‏‏That’s fascinating. You said that women come to you with different stories, what type of stories do they come to you with and what type of story will be linked to a certain diagnostic?

‏‏A lot of women, perimenopause, starting to have hot flashes, gaining weight, and fatigue I guess are the big things, and then libido going out the window as well. That’s the most common thing that comes through, but it’s interesting because originally, it started out as oh, I’m a hormone doctor. But really, I end up seeing all walks of life because the approach that I have fixes so many other problems. They may come in thinking that it’s a hormonal problem, which they may have contributing to their problem, but it may also have to do with the way they’re eating and they’re stressed, or mitochondrial health. I see a lot of patients with fibromyalgia. It’s working on the same type of protocol to fix them up. There are certain nutrients that might target it for mitochondrial health that make a big difference.

‏‏Can you restore your hormonal balance or do you have to take those pills or creams for the rest of your life?

‏‏I think it really depends what the initial cause is. If you are sedentary and stressed out, not sleeping, eating all the wrong foods, things are going to be off whack and you might need some assistance initially. But if we can cap that person, lower how much carbs they’re eating and get them to start exercising and maybe taking a few vitamins to make their body work better, then no, they don’t actually. Sometimes, I don’t even use hormones to balance, sometimes we might use some herbs or adaptogens or other things. Again, it really goes to what is the root cause for that hormone problem in the first place.

‏‏What are some herbs and adaptogens that you’re using?

‏‏Basically, I tend to use Vitex or Chasteberry. Let’s say someone is hesitant about whether or not they want to use hormones or want to try herbs first, we might use that.

‏‏Do you refer to the over the counter Vitex or do you use a higher potency?

‏‏Again, because I get certain supplements, I sell supplements in my office but they’re professional grade or good quality. I don’t tell my clients buy them. I want a good quality. They go to a really good health food store, often they might be able to get it. Or a lot of compounding pharmacies sell the better quality supplements. There are certain companies that are better than others, there’s different grades of supplements. I tend to use the good quality ones to get the best effect. Sometimes, if someone is unable to get them, then trying whatever they can may be an option. Obviously, always working with a provider is the best solution than just going I’m going to try this. Everything we do in life is a risk-benefit ratio. We think we’re doing a good job.

‏‏It’s so complicated and wonderful. I know that Vitex is good to regular progesterone, and the other thing I know about Vitex is that it’s very good with regulating the periods.

‏‏Yup, it works in quite a lot of people. Again, it depends how off your hormones are. If you’re a little bit off and whatnot and you’re using them, then that’s helpful. Different companies sometimes have different ways to dose it, so that’s where sometimes you end up needing to work with a practitioner. That’s a good choice. I use a lot in that, especially in people who have polycystic ovaries because it’s an insulin sensitizer, helps with detox, it helps get rid of that excess estrogen, and it can help regulate cycles. In a study that looked at using a drug called Metformin, which we often use in polycystic ovaries and diabetes with clomid versus using nag and clomid to help get a patient pregnant with polycystic ovaries. They show the exact same thing and the nac had less side effects.

‏‏What is NAC?

‏‏It stands for N-Acetyl Cysteine. You can go into any health food store, they have it.

‏‏That can replace clomid?

‏‏No, it can’t replace clomid. What I’m saying is that in certain patients who have polycystic ovaries, that clomid alone doesn’t always work and sometimes they’ll do clomid with Metformin or you can use clomid and nac because they work by reducing the insulin. They help with cycle regulation and make you more sensitive to the clomid.

‏‏Wow, that’s amazing. You’re so smart.

‏‏Yeah, I don’t know.

‏‏Let’s talk a little bit about thyroid. What are the symptoms of low thyroid and what type of tests do people do to test thyroid? I know that when you just go to your regular physician, they only check a few of the thyroids but not all of them. Can you talk a little bit about that?

‏‏Let’s first talk about low thyroid or low thyroid symptoms. Often, people complain of fatigue or being exhausted. You can be sad or depressed, weight gain, that’s commonly what people will complain of. Or, they’re having difficulty losing weight, their hands are often cold or they feel cold all the time. A big one that people don’t appreciate is that I feel more tired at rest than when active. Meaning if I’m running around, I’m good. But the minute I sit down, I can’t get off my ass. That’s a thyroid symptom. Also, it could be a little bit of adrenal. A lot of people sometimes if you look at them, they might be missing the lateral third of their eyebrows, puffy face, forced voice, constipation.There’s a whole bunch of different symptoms from hypothyroid because your thyroid affects every organ in your body. When it’s off, you can present with almost anything. That’s low thyroid. Often, patients will go in and their doctor often just measure the TSH. The TSH is a hormone produced by the brain that assesses what the thyroid function is in the body. Sometimes, there is a bit of a disconnect. Actually, there’s different thyroid requirements throughout your body, so your heart might need a certain amount compared to your brain. Or your fat cells, or what not. Sometimes, looking at a blood test doesn’t tell you the whole picture. Often, when patients come in to see me, I want to look at all their thyroid parameters, so that would be TSH which is the one the brain puts out. T3 and T4, T4 is the storage form of thyroid, and then it needs to be converted in the cell to T3. T3 is the actual act of thyroid hormone that’s responsible for function. And then I like to look at thyroid antibodies because sometimes you’re going to have high thyroid antibodies have high symptoms but the actual labs are normal. Part of the reason why that is, at least I think, is that those antibodies could be stimulating the receptor, both negatively and positively, could be giving these symptoms. And then sometimes I’ll order something called Reverse T3, which again, a lot of doctors, we got taught about Reverse T3 in med school but then we never really hear about it again. Essentially, when you go from T4 which was that storage hormone to the active hormone T3, it can go down to also Reverse T3. Reverse T3 looks exactly like T3 except for when it hits the receptor, it’s like a dud. When the T3 hits the receptor, it’s like a green light, things work. We tend to make more Reverse T3 when we’re low iron, low B12, stressed out, zinc. There can actually be certain nutrients that actually predispose us to go down that Reverse T3 pathway. Can you imagine if we didn’t measure Reverse T3 and all we were looking at is T3 as being the active thyroid, let’s give you a visual analogy. Imagine T3 is is green balls, and then Reverse T3 is red balls. You’re playing on a basketball net and you have way more red balls because you’re low in iron, you’re stressed, low B12, or whatever. Now, you’re going to pick up any ball and throw it towards the net. If you have more red balls than green balls, what ball is going to hit the net more often?

There’s a whole bunch of different symptoms from hypothyroid because your thyroid affects every organ in your body.

‏‏Red.

‏‏Right. When red hits the net, does it do anything? No. You can actually have normal thyroid labs, including a normal T3, but have low thyroid function because there’s a lot of red balls around hitting that receptor and preventing that T3 from getting into the mat. That’s how a lot of people complain that I feel like I have all these hypothyroid symptoms but they go to their doctor, the doctor says they’re normal. Really, it’s trying to address those deficiencies or those nutrients that might be low and improve them. Also, stress management may improve them, plus back to those antibodies could be sitting on those receptors also and blocking them, as well as endocrine disruptors. That’s why thyroid function isn’t as simple as a lot of doctors make it. They’re like oh, you have hypothyroid symptoms, you’re exhausted, your labs are normal, something else.

‏‏Yeah, my mom’s got I think a heavy condition of thyroid because she takes the medication but she still sleeps for hours in the middle of the day. I don’t know, maybe they’re just not checking her correctly.

‏‏The other thing is most doctors, when they replace thyroid hormone, they give T4. It needs to be converted to T3. Again, if you’re low B12, zinc, iron, whatever, or some people are genetically prone not to metabolize that T4 to T3 as effectively, that’s why they still might have hypothyroid symptoms. That’s why you actually have to look at all those other little nutrients.

‏‏You said B12, zinc, iron, anything else that is really important for thyroid health?

‏‏Stress management and iodine is really important too. If you’re iodine deficient, you can’t make—T3 and T4 actually means T4 has four iodine molecules on it, T3 has three iodine molecules on it. If you have no iodine in your body because there’s a lot of places that the soil is iodine deficient, and then we’re also not having table salt, that was one of the original corrections for iodine deficiency was the iodine, table salt, but now no one’s eating table salt. You can see iodine deficiency, and therefore hypothyroidism.

‏‏Wow. I’m going to tell my mom to take Vitamin B12, zinc, iron and iodine.

‏‏I’m not sure about the iodine. It’s better that she gets tested. That would be good. There are things out there called thyroid support, they have a mix of those micronutrients to help improve the thyroid function.

‏‏And will you supplement that with medication?

‏‏Yeah.

‏‏Okay, that’s good to know, thank you. Is it possible to cure thyroid naturally?

‏‏It depends what the problem was in the first place. Again, if your thyroid is deficient because you’re missing those little nutrients, yes, replacing them will make you feel better. If your low thyroid function is because you’re totally stressed out, yes, you can make your thyroid better. If you had a thyroiditis, which is an inflammatory condition that sometimes happens after having a baby or after getting a virus where your thyroid function can go wonky for a period of time and then resolved, yes. If you have Hashimoto’s Thyroiditis, again, depending on where you are in the phase, sometimes you have little blips and you recover. But often, it’s a process that keeps going. That’s a whole other story, how to address Hashimoto’s or autoimmunity. I usually feel that once the thyroid has totally petered out that you definitely need to replace it with hormone. The question is do you replace it with just T4 or do you give a combo of T3 and T4 which is a combination that I tend to give more often. In the States, that would be like nature’s thyroid or desiccated thyroid, you have different companies at West [00:43:51], you have a whole bunch of different companies.

‏‏Cool. What is adrenal fatigue and how can you combat it?

‏‏We’re going to cover everything, aren’t we?

‏‏Yeah, why not? We’re not covering everything in depth, people have to see you or somebody like you to learn more about their own condition. I just would love to create the awareness. People will even be familiar with the terms bioidentical hormones or thyroid or what is adrenal fatigue and can I have that?

‏‏Right. Conventional doctors, or before I started doing integrative medicine, really didn’t appreciate what adrenal fatigue is.

‏‏It’s only at the top, right? You were at the leading edge and people were kind of behind you. You’re like yeah, now what? Come join me, finally they kind of did.

‏‏Right, exactly. Basically, doctors know about adrenal insufficiency which is an extreme case, it happens to be an autoimmune condition where the adrenals don’t produce the hormones. In your adrenals, you produce the hormones, we call it salt sex. They’ll do the hormones that have to do with fluid balance. They do the hormones that deal with norepinephrine and epinephrine, as well as cortisol. Then, they also can make DHEA and estrogen, progesterone, and other sex hormones, believe it or not. Your adrenals are basically the gland that helps to create hormones to deal with our stress management. I’ll give you an example. Originally, let’s say if you’re being chased by a tiger, your adrenals were going to produce epinephrine and norepinephrine so you can run from the tiger. And then it shuts off your stomach from eating and what not. It shoots out cortisol. That’s normal, but if in today’s world we’re chronically stressed, we’re always shunting and pushing and flogging our adrenals to work. After a while, they go, “I can’t keep doing this.” Then, they stop functioning as effectively as they should. They’re not functioning at all, which would be adrenal insufficiency, which is actually a medical emergency. It’s just that they petered out and they’re not performing the way they should. People will complain of fatigue and sugar cravings and having trouble managing their blood sugar or their blood pressure. They bruise easily, there’s a whole bunch of different things. A lot of people in perimenopause suffer from perimenopause and adrenal fatigue. The more adrenal fatigued you are, the more perimenopausal symptoms you have because everything’s on the body. It’s like one more thing is going to break the camel’s back.

‏‏Oh, wow.

‏‏Basically, what we try to do is replace nutrients. Often, those nutrients are B vitamins, Vitamin C and magnesium. We can do that through supplementation or we can do IV therapy. Some people will use adaptogenic herbs like ashwagandha, robiola, there’s a whole bunch of different ones. Sometimes, people actually need cortisol to help boost them back up while they’re recovering. Obviously, stress management and meditation and learning to say no is a really important thing because otherwise, what we do is we fix you up and then you just go and bring yourself out again.

‏‏I really like Ashwagandha and Mucuna and Maca. They’re so good for you.

‏‏Yeah, and there’s a lot of great studies on ashwagandha. I’ve been on ashwagandha for about a year and I think my brain’s better now.

‏‏Really? Wow, amazing. When I looked at the description for your facility, it’s almost like you built your dream facility. You just put everything in one place, it is so fantastic. There is conventional, functional medicine, bioidentical hormone replacement therapy, neutropenic care, IV vitamin therapy, chiropractic treatment, weight loss, dietitians, stress management, massage therapy, reiki.

‏‏We do pilates and yoga and dance and cooking classes and patient education.

‏‏That sounds like a really nice place to go and retreat in. Do people travel to your facility for a few days just to get a little more balanced?

‏‏For now, I have a lot of people coming across Canada to come and see me and the odd person from the States. My view is down the road to have somewhere for clients to sleep. Yeah, they can come and get a medical assessment, get a few IVs, learn how to eat better. In the works.

‏‏Nice. What type of IVs do you use?

‏‏We do a whole bunch of different ones. We do IV mineral drip, that’s how we’re replenishing people. We do one called adrenal restore which is awesome to help with the adrenal fatigue. We have brain booster to help improve your brain cognition. We do IV therapy for weight loss. It helps increase detoxification and increase fat burning. We do [00:49:45] as well which can help with cardiovascular health, weight loss, gut health, a whole bunch of different things. We do pre- and post- IVs to help recover from surgery and cosmetic surgery.

‏‏It sounds like I have to be connected to IV everyday. In the world of supplements and herbs, I experiment with herbs. I also like stuff to improve brain function, like silk tab for [00:50:25] and stuff like that. At the end of the day, it just seems like I have too many supplements. It’s almost like I’m a supplement hoarder.

‏‏I think you’ve got to pick and choose. Sometimes, it’s about rotating. Sometimes, you have to want to have your base that makes your body work well all the time. Then, you target different problems at different times. Yes, if you ran about every supplement in the book, you’re like wow, I’ll take that, I’ll take that.

‏‏I need all of it, and now, and together, just give me. You know what, just connect me to 7,000 IVs at the same time, I want to be a super woman, a wonder woman.

‏‏But really it’s about finding those key ones that you notice that they make the world of difference for you. If you keep taking something and really haven’t noticed anything, then yeah, done, next.

‏‏That’s beautiful. This was such an honor and a pleasure. Before we go, I have two last questions for you. The first one is what are your three top tips to living a stellar life?

‏‏Follow your dreams, do something you’re passionate about, and optimize your health through diet, nutrition, stress management.

‏‏Yay, and contact you. If people want to learn more about you, about the facility and contact you, learn about what you guys are doing, where can they go?

‏‏I’m VitalityMD and my website is vitalitymd.com. All our contact information is there, there’s a Contact Me page. It’s a great way to connect, you get to see the place, we have a Google tour online, we have hormone questionnaires that people can fill up to get a sense of what they might be suffering from. If anybody is in Toronto, come and check us out.

‏‏Wonderful. Thank you so much, Dr. Shari.

‏‏Thank you, it was really nice having this time with you.

‏‏Thank you.

Your Checklist Actions to Take

✓ Have your progesterone levels checked if you are experiencing unusual weight gain, thyroid symptoms, or trouble getting pregnant.

✓ Keep your stress levels under control because excessive cortisol can disrupt and affect hormone levels. 

✓ Optimize your vitamin D levels by taking supplements and getting healthy sun exposure. 

✓ Make sure you are getting enough magnesium by taking supplements or by soaking in a salt bath.

✓ Give your body essential nutrients through your diet. Take supplements if your body still lacks proper nutrition. 

✓ Exercise, get enough rest and eat right to turn on good genes and lay a foundation for health and hormonal balance.

✓ Determine if you are excreting estrogen properly by taking blood tests. If necessary, take supplements to keep your detox pathways working well.

✓ Find a reputable doctor to check your hormone levels because fixing hormones can solve many other health problems.

✓ Walk,move, and avoid a sedentary life. Exercise and movement will make your body work better. 

✓ Look into herbs and adaptogens such as the amino acid NAC to help with hormone balance. Specialists can help put together an individualized health plan.

Links and Resources:

About Dr. Shari Caplan