Conquer Your Weight

Dr. Sarah Stombaugh: This is Dr. Sarah Stombaugh, and you are listening to the Conquer Your Weight Podcast, episode number 52. Announcer: Welcome to the Conquer Your Weight podcast, where you will learn to understand your mind and body so you can achieve long-term weight loss. Here's your host, obesity medicine physician and life coach, Dr. Sarah Stombaugh. Dr. Sarah Stombaugh: All right. Hello everyone. Today I have a very special guest with me. I'm so excited to introduce her. I would apologize before we get started though, I have a terrible cold and everyone is going to have to listen to that. Dr. Gibbs included. So I'm going to make her do a lot of talking today so that you could enjoy everything she has to say and not listen to my nasal voice. But I have Dr. Dana Gibbs with me. She is an otolaryngologist and ear, nose, and throat physician, turned into an integrative thyroid and hormone specialist, which is a question that my patients have all the time. What can I do about my thyroid? What can I do about my hormones? And so I am so excited to have you here today, Dr. Gibbs, thank you for joining us to tell my patients a bit about hormones and thyroid and what we can do about it. Dr. Dana Gibbs: Alright, well, thank you so much for having me. This is going to be great fun, and your voice doesn't sound nearly as awful as you think it does. I can say that honestly, coming from the ENT world. So yeah, it doesn't actually sound that bad. Dr. Sarah Stombaugh: I love that. Yeah, very objective opinion there. Thank you. So tell us a little bit about you. How did you come to do what you do and what would you like to share with my listeners today? Dr. Dana Gibbs: Sure. So yeah, I get that a lot. It's like why isn't ENT doing hormone management? And it's a legit question. So anyway, I have been out of residency since 1999, so I did ENT for 22 plus years, so pretty full career doing that. But along the way, a bunch of stuff happened that really got me interested in hormones, and it started out with just thyroid. But then the endocrine system is such that everyone, it's like, it's like a seesaw. It's everything balances everything else. And you can't necessarily be complete working on hormones. If you just work on one hormone only. You're never going to get the results that you want if you do that. And so as I figured out, okay, I can help these people with their thyroid, but then that's going to unbalance these other things, and more and more people were asking me, and this is while I was still doing ENT, because ENT also involves thyroid. I mean, we do a lot of thyroid surgery, of course, and I would get patients in and I'm like, I don't think you really need thyroid surgery, but it seems like you're having a lot of symptoms. Let me see if I can help you out. And gradually I got kind of a reputation for doing that, and I got more and more patients who wanted me to do that. And then after a while, those same folks would start getting towards menopause age and they'd go, well, can't you give me menopause hormones? And I'm like, I am an ENT working in an ENT office. No, I can't do that. Well, now that I've retired from doing ENT and can focus on filling the educational gaps where I didn't really know as much about the rest of the endocrine system, I really feel like I've got that handled now. And so I'm ready to just handle every aspect of hormone management. So that's kind of where I'm at. Part of it really came, and part of the reason why I feel like this is so important came from my own personal story. So I went through from my teen years all the way to my thirties with symptoms that were definitely low thyroid symptoms and a normal TSH and normal hormones levels on blood tests. And Dr. Sarah Stombaugh: I feel like I should say she did some air quotes. No one can see, I did air quotes. Dr. Dana Gibbs: Normal hormone levels and just continued to feel exhausted and tired. And I was cold all the time, and I would faint if I got up too early in the morning or if I did something too strenuous. And there was all this stuff. And I went in to the health clinic and in medical school and again in residency, and they tried to give me antidepressants and I'm like, I'm not depressed, I'm tired. And it was not until I was out in practice and I'd been out a few years and I spent a lot of time learning allergy while I was in ENT. It goes right along with it. And I went to a conference where they were doing allergy and other peripherally related topics. And I went into a lecture and they were talking about thyroid and the lecturer listed this big long list of symptoms that were all thyroid symptoms. And when I was in med school, it was like you had to be fat to be thyroid. It was like if you're not overweight, you don't have thyroid problems. And so I kind of had that in my mind and he started listing these symptoms, and overweight was a tiny little thing at the bottom, but all the other stuff that I had, the dry skin, the thin hair, the tiredness, the paleness, the brittle fingernails, I was cold all the time. I mean, those are some stuff. He listed this whole thing and I went, oh my God, he's talking about me. And he suggested some unconventional stuff to try if your labs were normal. And I tried it and it was like this miracle for me. And from then on my curiosity was peaked. I wanted to know more, more and more and more. And I kept looking until I found the answers. And I feel like I've really come up with the answers, not me personally come up with them, but found somebody who knew in some publications that made sense to me. And it's not just a woo woo, okay, I'm going to guess and give you some stuff, even though your labs don't indicate it. I've found a way to figure that out for people is super helpful. Dr. Sarah Stombaugh: Let me ask you, when you say some of the unconventional advice that you had gotten even at this very first conference that you went to, tell me a little bit about what you did even back then that helped you to feel so much better. Dr. Dana Gibbs: Well, what I did back then was I took something called armour thyroid, and I took it even though my blood tests were, once again, air quotes normal, and I didn't know why it was helping me, and I don't generally recommend that for patients now, but what I found out later was that the reason it was helping me was because I had a deficiency of something called T3. And T3 is the active form of the hormone. And not that many doctors test it, but you can also have normal levels of T3 and have high levels of something else called reverse T3 that will block the T3. There's a lot of reasons why that can happen. It's like there's a genetic defect. About 15% of people of British descent actually have a genetic defect that makes you have an impaired conversion of T4, which is the regular in your thyroid gland to that active form T3 inside your body cells. So 15% of people in the United States have that defect. But there's a bunch of other reasons why people get that. And there's something called Hashimoto's disease, which is an autoimmune disease that damages your thyroid, that can cause people to have really high levels of this reverse T3 and extreme levels of stress can do that. Calorie restricted dieting can do that. Your body can't tell the difference between I want to lose weight, I'm not going to eat, and oh my god, there's a famine. We're starving to death, and so Dr. Sarah Stombaugh: Let's go into survival mode. Dr. Dana Gibbs: Yeah, the way your body handles that is it slows down your metabolism by building up this reverse T3. And what that does is it goes into your cells and it blocks the action of your thyroid hormone. So all those symptoms that happen, and you can check all the normal thyroid hormones, and if you don't check the reverse T3, you'll never know it. You'll never find it. Dr. Sarah Stombaugh: I think to take a big step back, so for a lot of my listeners who have maybe heard these things or had certain aspects of it tested over time, a lot of times if you go into your to see your primary care physician, you go in either complaining of symptoms or I will say some primary care physicians may test a screening TSH. So TSH is the thyroid stimulating hormone. That hormone comes from our brain. It's a signal that sends down to our thyroid gland, which sits in our neck, and our thyroid gland produces T4, which is the sort of storage form of the thyroid hormone. And there is this assumption, which may be true in a lot of people, that if you have normal levels of T4, then therefore it is being converted into T3. T is our active thyroid hormone, and that is properly functioning in your body. So the most common testing that I may do or that a primary care physician may do is looking at your TSH, that brain to thyroid hormone, and then looking at your T4 or your free T4, which is your storage thyroid hormone. But a lot of what you're talking about is Wait, wait, wait. That's not the whole picture. And that's when you and I first met and you were telling me about some of this stuff, and that makes so much sense to me because there are so many people who have normal labs yet are experiencing hypothyroid type symptoms. And so it sounds like you've gotten into understanding some of these different reasons why. Dr. Dana Gibbs: Yeah. So what you said was exactly correct. Yeah. Most doctors check TSH, and then if you're complaining of the symptoms, they may also check the T4 and they go, oh, okay, your T4 is fine. I guess you don't need anything. And they stop there. And that leaves a lot of, and it's probably as many as 20% of people with low thyroid have this problem. And it leaves people feeling not validated, not heard, and it's not the fault of the doctors. They weren't taught any different. No, Dr. Sarah Stombaugh: He certainly wasn't. Dr. Dana Gibbs: This is unusual data. You might even want to call it fringy. It has really been mostly up until very, very recently ignored by mainstream endocrinologists even. But slowly but surely, the evidence is really accumulating that treating that is helpful and that you can get it to maybe not permanently go away because the underlying cause doesn't always go away, but that you can treat it and get it back to balance. Dr. Sarah Stombaugh: Yeah. Tell me, so the typical patient who comes into your clinic, what are they presenting with? What sort of things are they saying to you, and then what are the next steps that you're taking based on that? Dr. Dana Gibbs: Sure. So I would say that the typical patient is exactly like I was tired, cold, been told by their doctor that nothing's wrong with their thyroid, or maybe they are in their mid forties or sometimes even in their late thirties and they've started to gain weight around their middle, and they are trying all the stuff that used to help them and it isn't working anymore. And they think maybe something's wrong with my thyroid. And so they come to me to get worked up. And depending on the age and some more of the details of the history, I basically choose some judicious labs and generally more complete in regards to thyroid than other hormone levels than what you would get generally from your primary care or even from your GYN, because it seems like the GYNs get a lot of this as well. Dr. Sarah Stombaugh: Yeah, absolutely. Well, and tell me, we're talking a little bit about thyroid, but when we think about the hormones, I assume we're talking about hormones that are coming from our pituitary gland. So within our brain we have hormones like the thyroid stimulating hormone, but a lot of other hormones that may be regulated based on menopause, things that are regulating our adrenals, our periods and menstrual cycles. Tell me a little bit about what are some of the other things that you're checking and what do you mean by some of the other hormones here? Dr. Dana Gibbs: Okay, so as far as adrenals go, there are a few tests that you can do. I really don't generally do a whole lot of adrenal testing, but based on a patient's history of stress and maybe even early life stress, I will a lot of time and history elements. So for example, one history element that really, really gets my antenna twitching about adrenal problems is if somebody doesn't remember their dreams. And I know that sounds weird, but if I find a patient who is not remembering their dreams, that really tells me very, very strongly that they are not robust with their adrenal glands, and they could probably use some supplementation. And with regards to adrenals, I almost never have to give people prescription hormones when it comes to adrenals. I can almost always use over the counter supplements, and a lot of 'em are a particular form of vitamins or a particular form of a glandular that I like to send people out with. And then hormonal precursors, like adrenal hormone precursors. And if it comes back and it seems like it's really, really helpful, then fabulous. That's what they needed. And if it doesn't seem all that helpful, then there's almost, I mean, they're vitamins. There's really very little side effects or danger to doing it. And so a lot of times I won't even, unless I'm just really, really worried, I won't do any specific adrenal hormone checks. Some that I will do if I'm suspecting someone's going into the per menopausal time would be to check estradiol and FSH, and FSH is one of those pituitary signals to your ovaries to release eggs and increase estrogen and that sort of thing. So I will check those. And then I very, very frequently will check people's insulin levels, their fasting insulin levels, and sometimes I'll check that multiple times over the course of a day just to see if they might have something called insulin resistance, which is a condition that leads up to pre-diabetes and diabetes. But it's also seen a lot in people who are just stressed out and people who are headed into menopause. And it's really one of the prime reasons why people gain weight around their middle. Dr. Sarah Stombaugh: It's one of the main things that I talk to people about over and over again. My listeners will know. I'm always talking about insulin and insulin resistance, and so I'm glad to hear that that's part of what you're checking. Dr. Dana Gibbs: Yeah. Well, and as far as adrenals go, I mean people don't realize how much stress raises your insulin resistance because it raises your level of body cortisol, and those two go right together up, the higher the stress level goes, the higher the insulin resistance goes. And then people don't realize that the loss of estrogen also really promotes that insulin resistance. Dr. Sarah Stombaugh: Absolutely. So we think about our adrenals. We've got these teeny tiny little glands sitting on our kidneys or on top of our kidneys, and when we are feeling stressed, our adrenals respond by releasing that stress hormone. And as you were saying, we can't imagine that any of it happens in a vacuum. All of these hormones end up interacting with one another and can sometimes compound those type of issues. So you can't just be addressing this as really one or the other. It has to be looking at that comprehensive picture. Dr. Dana Gibbs: Correct. And generally, when I address a patient, if we're looking at a comprehensive hormone management system, basically, I generally will always start with the stress and adrenals and then move to the thyroid and then move to the sex hormones with the insulin resistance, kind of in the back of my mind all the way along. Dr. Sarah Stombaugh: But that may be sort of the downstream effect of some of those other things. Dr. Dana Gibbs: Well, and exactly, because when you get your thyroid right, then it accentuates the lack of estrogen. And when you get your estrogen right, then you probably need more thyroid, and it just goes back and forth, back and forth. Yeah, that was what was so frustrating about being an ENT and just saying, oh, no, I can't do anything that's out of my lane. I must not venture where I'm not an expert. And I feel like now I have become much more of an expert on those things. Dr. Sarah Stombaugh: Absolutely. Made it your business to become an expert, which Dr. Dana Gibbs: Exactly Dr. Sarah Stombaugh: Is important. Well, and I think there's probably, I imagine a lot of my listeners are listening thinking, oh, I wonder if that could be me. What are the things that people should be looking out for to know if they might be struggling in this way? And what are the things that they should either bring to their doctor or what should they be looking for in a physician in order to get the support that they need to adjust their health issues in a more comprehensive way? Sure. Dr. Dana Gibbs: Yeah. So boy, this is a tough one because this way of looking at thyroid is pretty new, and there are not a whole lot of doctors that know this, but a lot of your, if you look for a doctor's and they say that they do integrative medicine, a lot of 'em are going to know way more about it than your run of the mill primary care doctor may know about it, but there's a caution. And that caution is that there are all kinds of people on the internet peddling miracle cures for your thyroid and miracle weight loss, this and that. And they're chiropractors and they are kinesiologists, and they are other kinds of people who are not medical doctors. They are not trained to analyze science and really know what's legit and what isn't. And a lot of 'em are just out there because they want to sell you a $6,000 coaching program or a $200 a month supplement for the rest of your life. And it's just like, oh my goodness. There's a lot of people preying on people who have not gotten relief for their symptoms from their usual sources. Dr. Sarah Stombaugh: Yeah, no, absolutely. Dr. Dana Gibbs: You just really have to watch out and be careful. So one of the things that I have done recently earlier this summer is I put together a six part course for patients on stress and then thyroid and then menopause and PCOS and some other nutritional deficiencies that you can actually address pretty simply without a doctor's help. And it then has a section on particularly how you can advocate for yourself with your doctor. I really am pretty proud of what I've managed to put together. And so that is Dr. Sarah Stombaugh: Tell us more. How could my listeners come find that? Dr. Dana Gibbs: Okay. Well, if you'll check out my website, which is danagibbsmd.com, and it's in there under courses and it's called Take Control of Your Hormones. So very accessible. It's not really expensive and should be super useful or somebody who really wants to advocate for themselves and really make a change. Dr. Sarah Stombaugh: Yeah. Well, thank you. I think a lot of times we learn information, but we don't necessarily know what the next steps are. And it sounds like this can be a really good step for some of my listeners. I will put the link to that in my show notes. So for any of my listeners, you can check out the show notes, all the information about Dana Gibbs or Dr. Dana Gibbs will be there as well as the link to her course. Excellent. Well, let me ask you, before we wrap up today, is there anything else you want to make sure that my listeners know? Things that we should all be aware of? Dr. Dana Gibbs: Well, okay, so the main thing, and this is actually about stress. So the main thing that it's important to remember is that the stress that we experience on a day-to-day basis, bills, money problems, kids, parents, and then what am I going to eat for dinner? I don't have a plan. All of these kinds of stressors are perceived by our body in the exact same way as if we were literally in physical danger of dying. And so one of the things that I really, really encourage people to do is to look at anything that they can do that activates their parasympathetic nervous system. And let me explain what that means, because your sympathetic nervous system sounds like it ought to be a good thing. But in our day-to-day lives, your sympathetic nervous system is what revs up and gives you a jolt of adrenaline when you nearly have a car wreck or something like that. But it also does it when your boss yells at you or when you're $5 short at the grocery store or all these other things that cause embarrassment or feeling like you've done something wrong or out there. But anyway, and that elevated sympathetic tone eventually causes a level of raised cortisol, which is harmful to your body. And you need cortisol. You have an acute emergency when you have that, oh my God, I nearly had a car wreck. And you're sitting there and you're shaking, you need that cortisol because what happens is your blood sugar will drop, boom down to the floor, and if you didn't have cortisol, you could go into basically insulin shock because of low cortisol. But the same thing chronically happening over and over and over, keeps that cortisol high. And that cortisol raises your blood pressure and it raises your insulin resistance and it makes you anxious and it keeps you from sleeping, and it does all kinds of things that are terrible for your health. And so if you can activate the opposite part of your nervous system, which is the parasympathetic, the calm, the restful, the digest, your food, that kind of thing, if you can activate your parasympathetic nervous system on a daily basis, and I don't just mean go to a spa, get your nails done once a month or whatever. I'm talking about, go for a walk, do some kind of light exercise, do something that calms your mind and pleases your soul. Even meditate, for example, one of these apps like 10% Happier or Calm or whatever. I mean, there is lots and lots of research that shows that even doing something like that for 10 minutes a day lowers your cortisol and really can help you with all kinds of health issues, not just your weight. But many, many things. And so I really do focus for my patients, and this is something that you can go on the internet and just go, how do I improve my parasympathetic nervous system? And you can find it, and there's so much that you can do. Dr. Sarah Stombaugh: Yeah, boy, I love that because we think of physical illness, but so often we're really tight. We're not thinking about how that ties into our mental health and being able to have mental wellness building in these pauses, these breaks, these opportunities to take deep breaths, to feel calm, to feel safe. All of that plays out into our physical health. And so often, I often say that the body's going to tell you one way or another. So when we hold all of that in, when we don't take those opportunities to rest, to relax, to allow us to come into that calm state, your body will rebel. And so it will rebel a lot of times with physical illness. And so being able to take that pause, I could not agree more. Dr. Dana Gibbs: Alright. Dr. Sarah Stombaugh: Excellent. Well you so much for coming on today. It was really fun to have you Dr. Gibbs. I know my listeners will really appreciate hearing this perspective, and some of my patients will know. I've started to implement some of this with them as well, which is such a valuable thing to be able to add to comprehensive weight loss care. Dr. Dana Gibbs: Awesome. Well, thank you so much for having me. This has really been great, and it sounds like your clients are super lucky to have you. Anyway, I hope we get to talk again more soon.