Health Care is So Broken - 3 Typical Patient Cases

Transcript

The medical care system in the United States is broken. Today I’m going to do something a little different. I’m going
to tell you my philosophy on why I think this is happening and exactly what we need to do to fix it. I am so frustrated,
not only as a patient, but also as a provider, in the lack of preventative care that we have in the United States. So I’m
going to talk about this, and I’m also going to talk about how we are harming people. I’m going to go through three
cases a 19 year old girl with PCOS, a woman in her 30s who had fatigue and severe brain fog and was gaslit forever
but had significant thyroid issues. And then a woman in her mid 40s perimenopausal who was being denied
progesterone and hormones because she wasn’t completely menopausal. I’m going to walk through these basic
patient scenarios that I see over and over and over in my practice, because I want you guys to hear this. Maybe this
is you. Maybe maybe this will resonate. And I’m going to teach you why this is not correct, the harm that we’re
actually doing people. But I’m also just going to kind of start by telling you the unfortunate truth about the fact that
the medical system in this country is reactive. It’s not proactive, and no one is coming to save you. So buckle up. This
is going to be a different episode, but you need to hear this.
So it’s just me. There’s no one else here. But I think it’s really important that we start shedding some light on the fact
that the medical care in the United States is broken. It is so broken. We pay all this money for insurance. I pay for my
family, my husband and I, almost $1,500 a month to Blue Cross. And they deny labs, they deny medications. They
want prescribers to change medications. I mean, it is just crazy. And God forbid we want to do something like a GI
map or insulin levels or things that are proactive. They want to deny all those things as well. And so it’s very
frustrating for me as a patient, but also as a provider, because I’m going to tell you from a patient perspective, I pay
a lot of money. I expect to be able to go and do what I want to do blood work, take a medication, and they pay for it.
That doesn’t happen. And, you know, there’s lots of theories as to why, but it’s a business. And so my theory is we
pay in premiums. If they can deny things and keep our premiums longer, they’re letting our money sit there and
they’re probably making money off of it. If they deny something and you as the patient don’t fight or the provider
doesn’t fight, they’re hoping that you don’t come back around and they don’t have to pay for it.
And it’s kind of silly. I don’t really understand the long term business model because if we’re well and we don’t go to
the hospital and we don’t need chronic medications, then they win over time. But it’s like they’re always kicking the
ball or the can down the road and just not paying right now. So as a patient, it’s frustrating because if I go to pick up
a medication, like I take Ren thyroid, you guys know that if you follow me on social media, when I go to try to pick it
up at CVS, they will try to substitute it for a different medication. I don’t want a different medication. I want the
medication that works for me so that I’m not having symptoms, so that I don’t develop insulin resistance so that, you
know, my antibodies don’t go up so that I can get out of bed and be a productive member of society. But the
pharmacy and the insurance company will try to deny me a medication that the provider that’s taking care of me
notes works. It’s just insane. And the only thing I can tell you, after being in this industry now for over ten years, is
that nobody’s coming to save you, including your insurance company. Definitely not the government. And you have
to advocate for yourself. And I’ve just gotten so sick of it that I just pay for my labs.

You can get very low cost labs through things like Quest Diagnostics. And, you know, I a lot of times have to go to
other pharmacies, like go directly to a pharmacy that just provides rent thyroid so that I don’t get a substitution in
that medication. And that is frustrating for me as the patient. I promise it’s frustrating for your provider too. I get
multiple letters in the mail, multiple letters, you guys every month saying you need to remove this patient from this
desiccated thyroid medication because it could cause them harm. I got one from CVS today. It’s like you know
nothing about this patient. You just know that they’re 60 and that they’re on a desiccated thyroid. You didn’t ask
about their symptoms, their labs, how they’re doing, and what gives CVS the right to come at me as a provider and
tell me how to treat a patient. So it’s very frustrating. And we’re just in this really icky place in medicine because also
we’re getting sicker. Patients in this country are on more medications. We’re spending more money on healthcare.
We’re fatter than we’ve ever been. We are, you know, sicker than we’ve ever been. And so it just is so ridiculous that
we’re not practicing proactive health care. But, you know, if I wanted to do a GI map on you as a patient. Your
insurance isn’t going to pay for that, because I might find something that is going to help you actually fix your insulin
and fix your thyroid and fix disease processes that you’re going to get, which then you’re not going to require
pharmaceutical medications.
And so they have an issue with that, but then they want to dictate which pharmaceutical medication you take. And so
it’s just in a really bad place. And then unfortunately, providers don’t get good training. Like I am a board certified
endocrinologist. I went to the highest level of training you can for hormone metabolism, diabetes. And we don’t get
trained that diseases are not in silos. We get trained that if you have this symptom, then you must have this disease
and this is the way to treat it, period. Full stop. It’s not like, oh, this person has hypothyroidism and maybe we should
step back and think the thyroid medicine we’re giving them is not actually converting, and we need to give them a
different medicine. That’s not how it works in training. It’s just like, oh, if this diagnosis is this, this symptom leads
you to do this test. And if this test shows they have this diagnosis, then you treat them with this period full stop. And
we don’t even step back in training and say, if you have this diagnosis, it could also affect these other things, which is
insane because our body works like a symphony and not like a silo. And so providers are getting training like this.
Then they’re going into medicine, which the government and insurance companies, etc.
dictate how they are practicing. So they are told you’re going to see a patient every ten minutes, and in that ten
minutes, you’re going to make sure they have a colonoscopy and a mammogram. And there are vaccines that we
force upon people, and their blood pressure has to be a certain range. And if not, you’re going to give this medication
and this medication. And, you know, they have all these guidelines that they have to practice by, which is crazy and
infuriating. That’s why I got out of the insurance game years ago, because the insurance companies and these big
institutions and hospitals tell a provider exactly how they’re going to spend a minimal amount of time with you. And
then we wonder why we have patients with all of these symptoms getting worse because the provider can’t even use
their brain. They are literally like a stringed puppet between the insurance company and the hospital system. And
like, you’re never going to get better in that system. Period. Full stop. You’re not like the provider is pulled in so many
different ways to do things, to force vaccines upon you, to force screening upon you, to force medication upon you if
you don’t fit in certain boxes. But not everyone’s blood pressure is going to be the same. Not everyone’s lab is going
to be the same. So it is just such a broken system.
And I have laid awake at night a lot, trying to figure out how do you fix this system? And I don’t know what to tell you
guys. Unfortunately, other than you be your own best advocate. You start learning about yourself. You get things like
my book, fix your gut, fix your hormones, and you get the lab guide from there and you compare your labs to it. I
mean, you just have to start providing yourself with better education and finding providers who are not in that
system. And so that’s where I say like your insurance company, the government is not coming to save you. And so we
do a really good job of that at Modern Endocrine. I know we, you know, we think outside the box. We look at you as a
whole, but we do it because we want to make you better. I don’t want you in a system and sick all the time. You
know, I probably don’t have a great business model, but I’m okay with that. I want you to come to me. I want you to
get better, and I want you to not need us every three months for the rest of your life. Maybe check in once a year,
make sure your check engine lights aren’t on and keep living your life. But this system that we have created, that we
call medicine in this country is not working. And I know that because I see we see hundreds of people every month at
Modern Endocrine who have been in that system on that hamster wheel, and they come to us and they are so sick,
and they’ve been sick for years and complaining of symptoms for years and just have been told everything is fine
and it’s infuriating because the longer you allow someone to tell you you’re fine and not fix this, the more disease
impact you’re going to have.

If it just starts with thyroid issues and you don’t fix that, hey, guess what? Your thyroid also affects your insulin. It
also affects your metabolism. It affects your gut because you become constipated. Now you develop Sibo. Once you
get Sibo, you can’t metabolize your estrogen and progesterone correctly. Now we’re in perimenopause, our estrogens
making bad estrogen. So we’re more likely to develop breast cancer. Oh, now we’re not sleeping well. So our growth
hormone is tanked. Our cortisol is elevated. It is just a perpetual again, we are not in silos here, y’all. All of our body’s
hormones work together. And so we are literally creating sicker human beings by ignoring these disease processes
and treating them appropriately, because our doctors are too busy checking off boxes to make sure you’ve gotten a
vaccine or make sure you’ve gotten a screening test. It is absurd. So you go to a doctor with an agenda. I’m tired. I’m
gaining weight. I’m losing my hair.
And their agenda is did they get their vaccines? Are they on all the medications they’re supposed to be on? So I get
reimbursed. And do they have their screening? They don’t care or don’t have the time. I guess I should say to go
through your symptoms. So they are completely missing that you actually have a medical issues and they’re not
being addressed until it comes up on your blood work, which our lab values are so crazy that it takes years to show
abnormal on your blood work, because our normal lab ranges are of sick people, not well, people. So by the time your
lab actually flips and they’re like, oh my gosh, I should address this. We’ve lost five, ten, 15 years. And you’ve
developed other disease processes. How does that make sense? But that is exactly how healthcare works in this
country. And I promise because I’ve lived it, I lived it in. I was a resident fellow. I worked for Mercy Hospital, a big
hospital system, and then I got out of the hospital system and I went into private practice. I thought, this will be
better, but I still live by the insurance rules. And it was like, do this and this and this, or we’re not reimbursing you.
I’ve lived every bit of it, and now, thankfully, I’ve been in a practice where I don’t play by anybody else’s rules. I listen
to my patients. I figure out what symptoms they have.
I take a step back, figure out how they’re all interconnected, and then how we fix the patient before they end up
really ill. And that is the way to practice medicine. That is medicine, preventative health. That is not where we’ve
gone to, unfortunately, in this country. But that’s where we need to get back to, is we are a whole human. We
function as a entire symphony, and we have to look at all parts of that symphony, and we have to listen to patients
novel concept. I know, but we actually have to listen to you. We have to use our brain to take the symptoms that
you’re having, plus, look at all of your labs and realize not everyone fits into a box. And we look at all of the ranges
and we make a story out of the symptoms you’re giving us in your labs, and then we figure out a path forward. It’s
kind of like playing chess. Like, okay, here’s where you are. Here are the symptoms you’re having. Here are the labs.
This tells me what’s going on. We try to deduce, okay, what is the root cause? Is it your gut? Is it stress? And then we
just go with, okay, let’s rebuild the foundation. That’s it. That’s all my book is about. Do I explain all of this in fixture
got fixture hormones, but this is how modern endocrine practices. And we’ve been doing this for several years.
And shockingly, our patients get better. We have people that feel better and they get better and their labs improve.
And if you don’t believe me, go to our Google reviews. I mean, people leave them every day and I know what we’re
doing is right. I know this is the way medicine should be practiced. It’s just not. And it’s very unfortunate. And again, I
don’t know how to fix it. I am very passionate about trying to teach you to be your own advocate, to find a provider
that listens to you that can actually help you. I’m also very active on trying to help providers learn, but we have got
to do better, you guys, because we are costing people monetary issues money. We’re costing them time in their life,
or they’re not able to be functional and do the things they want and be with their family and be with their kids and
psychologically as well. When you don’t feel well and you haven’t felt well for a long time and nobody gives you an
answer, you start to almost be depressed and like, is it in my head what is going on? And so we have a lot of work to
do from a medicine standpoint. And, you know, all I can do is go out there and try to teach and try to preach. But
things like this, like send this to everyone that, you know, make sure they listen to this episode, make sure people
that have symptoms, they hear this and they’re like, oh my gosh, this makes sense.
Like, that’s all I know to do because I don’t know how to fix this reactive problem that we have. But all I know is that I
know better, so I try to do better. Now, I don’t want to leave you with this gloomy issue. Like all health care is bad. It’s
not. There are people out there who understand this. There’s a ton of people that I collaborate with that are good
providers, and they want to help you. I thought what would be interesting to do, though, is to go through three kind
of patient scenarios that I see all the time. Like this is the bread and butter that we see all the time. We see lots of
patients, but three scenarios where people come to me and they have complaints or concerns and just give you kind
of some labs that they have and talk you through quickly why this is not normal. All three of these patient scenarios,
I’m going to give you, like a 19 year old with some hormonal weight issues, a 30 year old that just all of a sudden now
is having some body composition, sleep issues, you know, some fatigue, etc., and then a 40 year old. So we’re going
to kind of talk about some, some different things. So make sure you stay with me till the end.

But if you see yourself in any of this, If this has been you, you’re like, man, I’m having these symptoms. I’m pulled.
My labs are normal. Make sure that you listen to this, but also get my lab interpretation guide. It’s free. So follow me
on social comment lab on any of those posts, get my lab interpretation guide, look at your labs against my guide or
get my book. Fix your gut, fix your hormones. I literally give it to you in there. You guys look at your labs with it. And
if if your labs are not optimal, then find a provider to help you. Because if you don’t, you are going to continue to get
sicker and sicker and sicker and nobody’s coming to save you. Unfortunately, not your insurance company, not your
provider, not your government. You have to do it yourself. And that’s, I think, was my biggest problem and why I
stayed sick for a really long time. I thought, surely I’m in this system and I have an insurance provider and I have a
doctor. Surely they’re going to help me get better. But that doctor that I had was in that system. We talked about
where they had ten minutes to see me and all these people dictating that plan of care, and it wasn’t to make me
better. So let’s talk about these people. So one of the things that we see a lot at Modern Endocrine is, you know, 19,
20, 21 year old female who comes to us and says, you know what? I’ve been gaining weight like crazy.
Now all of a sudden, my periods are irregular. Maybe they got off birth control or maybe they just were never on it.
They’re having some acne issues and they’re just really tired. They’re like, you know, I’m 19 and I saw my primary
care doctor and I asked them to do my thyroid and they probably got a TSH, and that was it. They said my thyroid
was normal. They tell me I don’t need my hormones checked. That happens a lot. I’m only 19. I don’t need my
hormones checked, but I’m really just having a lot of issues with my period, gaining a lot of weight and I don’t know
what to do. And so they’ll bring me labs a lot of times and they’ll run like an A, one C and their A one C is normal.
Well, your A one C is going to be normal until you develop diabetes. It takes ten years to get diabetes, at least after
insulin resistance. But nobody’s checked an insulin level in these girls. Nobody’s checked their cortisol, especially if
they’re on birth control. No one’s looked at their progesterone or their FSH, LH balance estrogen to see their insulin.
Do they have PCOS? Because a lot of these girls do. Now, I talk to these girls about stress.
A lot of times when we go to college, right, things change. And so our diet changes, our stress amount changes, our
sleep changes. And that can all impact your gut. And then when our gut is changed because of stress, it does affect
our insulin and our cortisol and our hormones. But in these girls, I mean, I see this time and time and time again, it’s
like they come and we get an actual full panel of labs. And I’m going to give you an example of one I just saw, but
this is what I see in this 19 year old girl. She had PCOS or now PMOs. And I asked her, has anyone ever talked to you
about this? Because she said, you know, I’ve had really irregular periods. They’ve been painful. I’m gaining weight.
No, nobody’s ever talked to her about this. So I got the privilege of telling her that she had that along with other
issues. But here are the labs that I typically see in these girls. A lot of times they’ll have elevated testosterone levels
because they’ve started to gain weight. So her level was 63, a little high. Her free testosterone was nine, though,
which was very high. So androgen excess, which is causing the acne a lot of times. In addition to gut symptoms,
androgen excess is also suppressing your body’s ability to make estrogen correctly. And so then that’s going to throw
your period off.
She also had an LH level of ten and an FSH of 2.7. That is a mismatch. So basically her body is trying to make
progesterone not making estrogen that balance the FSH or LH twice the amount of FSH should make you think of
PMS. That’s going to further drive more androgen production, which then further increases your testosterone, which
is going to lower your estrogen progesterone and cause irregular menstrual cycles, cause more acne. When I looked
at her, cortisol was 32, which is so high, you guys saw her. Adrenals were so stressed because it realized she had too
much testosterone. Her insulin was 34, which is also astronomically high, so her adrenals were stressed out about
that. When you have high insulin levels, again, it’s when insulin is high. We’re going to store food as fat in our fat
cells. When we store food as in our fat cells, and we get more adipose tissue, that causes more aromatization of
testosterone. So now her high insulin is driving more fat storage and weight gain, which is driving her testosterone to
be even higher, which is then driving her progesterone and estrogen to be lower, which is causing more irregular
cycles. Oh, by the way, that high insulin and cortisol is also affecting her gut. So we’re not even metabolizing the
estrogen we’re making correctly. So now we have more bad estrogen circulating which worsens her PMS symptoms.

So she’s getting terrible PMS symptoms, terrible cramps, a lot of acne. All of this lowering of her progesterone and
estrogen levels are then driving more gut dysfunction, making her cortisol and insulin even higher, and this process
continues to repeat. When I looked at her estrogen, she actually, although had estrogen deficiency symptoms, had a
very high estrogen levels. Her estrogen was 400. And that’s because she was recirculating that estrogen, which was
causing her breasts to be tender, making her acne even worse, causing her to have worse cramps, increasing her
insulin even further. I looked at her DHEA and it was high. It was 530 because her adrenal levels, her her cortisol was
high. And so this is just her hormones. Then I look at her thyroid because she’d been told her thyroid is normal. Her
TSH was 3.2 that although is normal on a lab is not normal. That tells me, oh my gosh, something’s off. They didn’t
even check her T4 because her TSH came back normal. Her T4 was 0.9, which was low, and her T3 was 3.0 and a 19
year old. That is so low. When your T3 is low like that, that can affect your periods and make them irregular. So this
poor girl had undiagnosed hypothyroidism. She also had a very high antibody level. I forgot to mention that her TPO
antibodies were in excess of 300. So she has Hashimoto’s hypothyroidism. She has insulin resistance, which is pretty
significant.
She has high androgens with high DHEA. She has PMOs, which is causing her irregular menstrual cycles. So she has
all these issues. She’s been told for a couple of years that everything is fine. Left untreated, this poor girl in 2 to 3
years will have gained 3,040 pounds. Become overtly hypothyroid. This will affect her fertility, multiple issues and
she’s been told for two years she’s fine. When your menstrual cycles are irregular, you are not fine when you are
gaining weight excessively more than 10 pounds in three months and you have not changed your diet or lifestyle,
you are not fine when your eyebrows are falling out, you’re losing hair and you’re so tired you cannot make it through
your day, especially at 19. You are not fine. So PMS and PCOS, when you are younger and you are very stressed. I
see this all the time and this girl had just gone to college. The stress probably that of just the change, affected her
gut. She was already predisposed to having thyroid issues because she had high TPO antibodies. She started to
develop hypothyroidism because her stress in her gut, her cortisol, went up. This caused her insulin to go up, the
insulin and cortisol being high further, and decreased her body’s ability to convert thyroid hormone. Her
hypothyroidism gets worse. All of this causes gut issues to be worse. Constipation. Now, we’re not circulating our
hormones correctly. Our estrogen is not metabolizing our progesterones not metabolizing.
Insulin continues to rise, gaining more weight, more testosterone is being made. I mean, it’s a cycle. Very common
cycle. And this girl goes to her doctor who refuses to check her hormones, which was a huge red flag. So it helped me
realize what was going on. Checked a TSH and that was it. Totally. She has hypothyroidism and Hashimoto’s.
Checked in a onesie and no insulin level. Overtly insulin resistant. This girl will get diabetes if this is not fixed, but she
just didn’t get the right laughs. And then she’s having acne and they’re like oh teenagers have acne. Let’s put you on
Accutane. It was her gut and her insulin. I see it so much and I don’t want to say it’s common. It is common. People
have these symptoms, but it’s treatable. And you do not have to live like this. And so that’s something we very
commonly see at Modern Endocrine. So if any of this resonates with, you know that if you didn’t get a full workup of
all of those labs, you probably don’t have all of the answers. And will you continue to get sicker? You will. And so go
get my lab guide right now. Get on Instagram at modern endocrine underscore. Find one on my lab post comment
lab, get my lab guide, put your labs up next to it. I even give you a list of every lab you should have in my book.
Fix Your Gut, fix Your Hormones. There’s a PCOS chapter. If you go to gut hormone fix.com and you put your name in,
I’ll give you all the free resources. With my book, you can literally see every lab you need as a PCOS or PMS patient
and what your level should be. And I also walk you through, if this is you, exactly how to fix this, even if you don’t
want to see us, there’s dietary, there’s nutrition, But you need to know this. So if this is you, if this resonates with
you, if this resonates with someone you know or love, please send them this episode right now because they need to
hear this. This is not normal. So this is a very common patient that we see at modern endocrine. And we can help
these people. You got to know what’s going on in their gut. You have to have the full picture of their thyroid and
hormones. And then you start implementing lifestyle sleep. Sometimes you need micronutrients. She actually had a
deficiency in vitamin D, B12, iron. So we fix those things. These are fixable things. Sometimes we use microdose GLP
one, sometimes we use a little bit of metformin. It depends on what’s going on with you. But know that although this
is very common, this is not normal. Okay, so that’s one. It’s our 19 year old patient. Okay, now let’s transition to my I
get a lot of 30 year olds.

I get a lot of mid 30 year old women. And these are usually women that are killing it. Not always, but these are my
women that are killing it. Their moms, their doctors, their attorneys, they’re running companies. They’re out there,
you know, doing, doing, doing teachers, taking care of work and taking care of home. And all of a sudden in their mid
30s, what they used to do in their 20s stopped working. So they’re like, I’ve been able to fast, do intermittent fasting
or, or go on this diet and I will lose weight. And now I just keep gaining weight. I’ve gained 10 pounds. I can’t get it off
now. I’ve gained 12. All of a sudden, I’m so tired. Like I used to be able to take a day on the weekend and recover
because I ran hard for six days straight. I could recover one day and get right back into it. I can’t do that now. So the
diets that I used to use and the ways that I used to try to reset, it’s not working. And so I’m tired, I’m gaining weight.
And then a lot of them will tell you, I may even have like, I have some sleep issues here or there. So the weight gain,
the fatigue. But then now my sleep starting to kind of be off, which is weird. I used to always sleep great.
And oh, by the way, now a lot of times they’ll throw in, I’m losing some hair or I’m losing my eyebrows or I’m really
cold. And they’re like, I’m in my 30s. And so I went to my primary care doctor and they said, oh, well, it can’t be your
hormones like you’re too young, so we’re not going to check your hormones. And I checked your TSH and everything
was fine. And I think it’s probably that you’re just stressed and you’re living your life. Okay. I did a post about this
recently. One of the women that came to me with her labs. I was appalled. She was told by her primary care doctor,
you know, she had lost quite a bit of weight and was feeling great. And then all of a sudden, the weight started
creeping back on. She was doing the same thing. She was tired, went to her primary care doctor, they did a TSH.
They even did a T3 because she was in this space in the functional medicine space, and she begged them to do a T4
and T3. So they did. They checked her B12, they checked her folic acid, they told her everything was fine. She was
not fine. You guys not even close to fine. And so if you’re listening to this and you’re in your mid 30s and you’re
starting to realize the things that you used to do to drop 10 pounds don’t work the way you used to recover one day a
week is not cutting it.
Maybe you’re cold, you’re losing your hair. Know that hypothyroidism is rampant in females. The American Thyroid
Association says that 5% of people 12 and older have hypothyroidism. If you look at subclinical hypothyroidism,
meaning that your labs look normal, but you have every symptom, and we treat people like that at modern endocrine
because you should be treated. They say that up to 20% of the population can have thyroid issues. I’m going to tell
you that people in the functional medicine space like myself, Mark Hyman, people that see this every day when we
look at you as a whole, not as a silo, and we look at your inflammatory markers, your insulin, how much inflammation
you have in a cell membrane level to know, is your T4 actually converting to T3? And we take into account your
symptoms. I’m going to tell you, I think about 50 million people in the United States. That’s about 1 in 7 have
hypothyroidism. Tens of millions of them are not diagnosed and may not ever be diagnosed unless we get
information like this out there. That is scary because your thyroid controls every system in your body. It controls your
metabolism, your cognition, your weight, your hormone production, your sleep, your mood. And so this is
unacceptable. So if you’re listening to this and you think this could be you again, get my lab panels.
You guys like get my lab guide or consider being a patient like, let’s fix this. But let me tell you about this patient who
came to me. So this is what her lab showed. Okay, so her primary care doctor, she has every symptom of
hypothyroidism. And again, she’s kind of in this space. So she’s like, I’m pretty sure I need some progesterone. I’m
not sleeping well. I have all the symptoms of low progesterone. I have a thyroid issue. And her doctor literally told
her, your labs are fine. I’m not sure why you’re gaining weight. You can just eat less, exercise more. Everything looks
great. You’re good. That is so frustrating because if she would have listened to this doctor and not come to me, she
would have continued to gain weight. She would have become insulin resistant like this would have cost her years of
her life. And so this is what her lab showed her. Tsh was 1.6. Not great, especially when you’re having symptoms. Her
T4 was 0.9. Also not great. We like it closer to 1.2. Her T3 was 2.7. Yes, that is considered normal. We get normal lab
ranges from six people. That is not optimal. And she had every symptom of hypothyroidism not normal. Her B12 was
313 also low. We need B12 in order to make thyroid hormone function. So that was part of her problem. Her folic acid
was 4.2.

I need you guys to hear this. If you are an adult in the United States and you eat animal products, if your folic acid is
not above six, you have Mthfr. Full stop. Huge problem because Mthfr causes you to not metabolize your hormones
correctly. So it’s going to cause you to have cognitive impairment, brain fog, fatigue. It’s going to mess with how you
metabolize estrogen and progesterone, which can be dangerous. Estrogen and progesterone are not dangerous
hormones, but how they are metabolized in the environment that they are put in can make them dangerous. Mthfr
will affect that. It will affect thyroid hormone. So this poor woman, her doctor, literally looked at this folic acid of 4.3
and said, you are fine. Didn’t mention anything about we need to fix your folic acid. You have Mthfr, anything. So
frustrating guys. And this is just from a thyroid perspective and I’m going to focus on that also. Her progesterone was
0.8 which came up as normal. Now you have to look at the timing of your cycle. If you are in the back half of your
cycle, or your luteal phase at 0.8 is not normal, it should be higher than that. She was in the back half of her cycle,
but her doctor didn’t even care to ask and looked that in your beginning of your cycle, your follicular phase at her age
at 0.8 could be normal, although I would say that’s pretty low as well.
So she was like, you’re fine. Even though she had symptoms of sleep issues. This is progesterone deficiency starts in
our 30s. The number one symptom is sleep issues. And so also when we have high cortisol it drives our progesterone
down. And then that can cause us to gain weight. So she had weight gain and sleep issues. Her doctor just looks at
the lab and says, it’s fine. You’re fine. I literally like wanted to cry for her because she was asking for help. She knows
that she lost weight and had gotten healthy. And then now something was different and she just was told, you’re fine.
And there are so many people that hear this and it’s not true. Literally, she has multiple things stacked against her.
She needs some progesterone that will help her sleep, that will lower her cortisol, which will then lower her insulin,
which will help her not be so inflamed so that she can lose weight and it will help her thyroid work better. It will also
help her mood. So she did have a progesterone deficiency but was told she was fine, easy to fix. We take
progesterone at bedtime, no harm. Also very inexpensive. She had Mthfr, which can literally be devastating to you,
by the way, that you metabolize your hormones. It can cause brain fog. It can cause thyroid issues easily fixed. We
have a supplement called Methylfolate at modern endocrine has all your methylated B vitamins and tetrahydrofolate
easily fixed.
So that was causing fatigue as well. And then her thyroid you guys was underperforming. She has hypothyroidism
subclinical hypothyroidism. Her T3 was 2.7 causing every symptom she had. She needs thyroid medication. We love
read thyroid at Modern Endocrine. So we got her on desiccated thyroid medication. We gave her a little bit of thyroid,
gave her some progesterone, we gave her mighty methylfolate. And guess what? Within two weeks she already felt
better. And this is just talking about her thyroid, like already giving her life back within 1 to 2 weeks. Because guess
what? Now she can metabolize her hormones. Her brain is actually able to receive those hormones. Mthfr also affects
your mood tremendously because you need methylated B vitamins to help with dopamine and serotonin production.
So her mood got better, her sleep got better, her energy got better, and she was already less inflamed. Because
when your T3 levels get higher, you’re going to feel better. So just that little snippet of labs that this patient came to
me and said, my primary care doctor said everything was normal. I wanted to cry for her. I was so frustrated. And I
get it. I get why thousands of you are in the system and get frustrated because your primary care doctor looks at that
and just says everything is fine. That is not fine. You have to put the symptom with the patient.
And we also have to think about timing. And so although these labs were normal, again, not normal for this patient
had every symptom they need to be optimized. So I see a lot of people in their 30s gaining weight. Diets aren’t
working like they used to. Very tired sleep issues. Remember that we lose progesterone in our 30s that can drive our
cortisol up. Once our cortisol goes up, that drives our insulin up, we do start gaining weight and no amount of eating
less and dieting more will fix that. It actually will make it worse because it will drive your cortisol even higher, lower
your progesterone even worse, mess with your sleep more. The cycle continues. So if you know anyone or that
sounds familiar to you, that make sure that you share this with them like this is not okay. Get my lab guide. Know
what your progesterone level is. Many women need progesterone in their 30s. Know what your thyroid hormone level
is. I’m not even going to get into her insulin with you guys. But it was high as well, like or her micronutrients, just
having Mthfr and having a thyroid issue. I mean, this is not okay. So I see this all the time as well. We did go ahead
and replete her iron. She had iron issues, B issues, d issues. Repleting those micronutrients make you feel better
instantly as well. Those things cause fatigue.

So that’s another patient that we see pretty commonly at modern endocrine. And the third subset of patient is the
mid 40s. And I’m here y’all 40s. Perimenopause is wild. It is a wild ride. As a board certified endocrinologist, I know
what’s happening. I know how to fix it. And I’m still just like, oh my gosh, when is this going to be over? So the other
patient we see is that person in their mid 40s, and it’s the woman who, you know, all of a sudden like sleeps kind of
been off, but now it’s bad. Like waking up at 3 a.m., can’t go back to sleep wired or can’t even fall asleep. Then once
we waken up at 3 a.m. now the whole day is shot. We’re tired throughout the day. We’re very foggy. That affects our
food cravings. We’re wanting to eat everything. Our body composition is changing. Like I’m just like doughy and
shaky in places I never was, despite the fact that I’m eating my protein and I’m weight training. You know, that’s not
fair. Brain is just like wrapped in cotton. Like no matter how much I sleep, sometimes I’m just so tired. And so also,
we know we don’t feel good, but we’re like, we can’t, we can’t put our finger on it. It’s like some weeks we feel okay
and then some weeks we don’t. And it’s like different cycles. We feel differently. And it’s just really frustrating for us
too.
We’re gaining weight. We can’t sleep. And so in your 40s, please know that your hormones change drastically. And in
your 40s it is okay to get your hormones checked. And also it is okay to take progesterone and low doses of estrogen
if you need it, if you have symptoms and testosterone. Also, most women lose testosterone in their 30s. So the lady I
was telling you about prior also had very low testosterone. And so these things are important because now not only is
our insulin not working right and our cortisol, and we probably have gut issues and thyroid, but now our hormones
are in the mix. So if you’re in your mid 40s, like this lady I saw, this is I want to tell you about these labs because this
was also infuriating. And I got a big section of labs on her. Her FSH was 11 and her estradiol was 32. She was
complaining of some hot flashes and some vaginal dryness, but was told, you’re too young to be in menopause. Fsh
of 11 and estradiol of 32 is not normal. Her brain was screaming for estrogen. We do not want to deprive women of
estrogen. You want your estrogen unless you want your skin to look old and saggy. Your vagina to be extremely dry.
Have painful intercourse. Lots of UTIs. We want to protect our heart. We want to protect our bones and our brain.
This 43 year old needed a little bit of estrogen. You can take a little bit of estrogen. You don’t have to take an
astronomical amount. It’s not fair to say, oh, you can’t have any until you have none. It helps your symptoms. Also,
when your estrogen is low, guess what. It makes your insulin high. So she was having estrogen issues and was told
you can’t have any estrogen until you go through menopause. You’re too young. Crazy. Her testosterone was nine.
Her free testosterone was 0.9. Both were very low. She was having muscle mass issues. Very doughy. Feeling tired
right? No. No sex drive. Vaginal dryness. Testosterone helps all of these things. Her DHEA was 210, which was low
because her adrenals were shot. They couldn’t make the hormones that she needed. Her insulin was 8.4. So this lady
in particular very fit working out a lot runs does Pilates. Her insulin was 8.4 because she was developing insulin
resistance despite eating well and exercising well because she was losing estrogen. Estrogen and insulin are on a
teeter totter. And so she was developing insulin resistance, which wasn’t making her cortisol any better, wasn’t
making her sleep any better, wasn’t making her body composition any better. So she had a DHEA level that was low.
Low testosterone, low estrogen, high insulin. She also had a low progesterone. Her progesterone was extremely low.
It was less than one and was told all of this is normal, not done.
Her TPO antibody was 176. So she has Hashimoto’s. She was told her thyroid is fine. Tsh was 3.2 not fine. T4 0.8 not
fine. T3 2.4 normal is 2.3. So she was told everything is fine. On top of that, her ferritin was 17, which is incredibly
low. You need ferritin in order to make your thyroid hormone work. A ferritin level under 20 can literally make you
fatigued and give you shortness of breath. Also give you restless legs at night and make you cold. Her vitamin D was
25, her B12 was 350, her folic acid was six. Her CRP, which is an inflammatory marker and a sign of inflammation,
was 5.5, which is really high. And her iodine was 45, which was also low. She brought all of these labs to me from her
primary care doctor and said, I was told everything was pretty good to take a little bit of vitamin D. I did not need
hormones because I’m not old enough to need hormones. My thyroid was fine and all the symptoms I am having are
because I’m in my mid 40s and that is just a part of life. And I literally wanted to scream, cry, and punch someone for
her because I am in the same boat and none of that is normal. You guys and this system, this broken system that we
live in where everyone’s trying to check off their boxes, that is why this happens.

And I promise you that if this person stays in this system for very much longer, her systems are going to start
breaking because they’re all at a breaking point already, and nobody is seeing it because the lab hasn’t switched to
abnormal. But none of this is normal. It’s not optimal. And so I’m frustrated for her as well. And we see people like
this all the time who like, if you put this in ChatGPT, it’s probably going to tell you, well, some of this is abnormal. My
lab guide is going to walk you through every bit of it. But there’s so many things wrong here. And this person just told
by her primary care doctor and she saw her gynecologist, everything is fine. So what did we do in this person?
Because she had multiple symptoms. You guys, we fixed all of this. I mean, this is crazy. We had her do a gut study
because I was like, all this is coming from somewhere. It’s got to be your gut. And she did. She had some gut
dysfunction from probably the years of this being not treated correctly. I mean, this has been going on for a while. So
we went to the core, her gut to start fixing her gut because her body’s not helping her gut. Her thyroid is not working
well. She’s not making estrogen or progesterone. So none of these things are going to help her gut.
So we literally went to the source of her gut and we said, okay, let’s start where all the inflammation is starting. I
mean, this is a 43 year old with a CRP of 5.5. Crp is a longevity marker. Anything above one is high. This is
concerning. Like I was concerned about her and and she doesn’t have estrogen. So this is like a cardiac marker as
well. Like we need to get you estrogen back and we need to fix your CRP. So we went to the source, which was her
gut. And we started cleaning out her gut. Her gut was a wreck. She had dysbiosis. She had no akkermansia. She
wasn’t digesting her food correctly because she didn’t have working hormones. Guess what? Our hormones help our
gut. So we started fixing her gut. But we cleaned this mess up too. We just started giving her things, hormones or
micronutrients to help support her hormone production. And then it’s not like you have to be on this forever. Maybe
we can replace or remove some of this as we fix your gut. But in her case, oh my gosh, you guys, we had to fix her
iron like immediately 17 doing two iron infusions. She felt better in two weeks. She was like, I’m less cold, my feet
don’t hurt at night. And I do have more energy just from fixing her ferritin. We also gave her thyroid medication
because she needed it.
We gave her Ren derived desiccated T3 thyroid medication. The ferritin helps the T3 work. We fixed her vitamin D, it
was 25. You have to have vitamin D levels around 60 for your thyroid to work. We gave her some dynamic D from
Modern Endocrine. Her B12 was low also 350. Her folic acid was six, still a little low. I wanted to make sure she was
methylating and metabolizing her hormones correctly. Make sure that that thyroid medication I gave her could work.
So we gave her some mighty methylfolate. So we fixed her ferritin. Her d her b her iodine was 45. A lot of people
have iodine deficiency in this country. It is important for thyroid hormone. It is important for people with Hashimoto’s.
We need iodine. So we gave her some iodine support as well. Iodine is very critical. It actually helps displace toxic
bromide chloride and fluoride in our body that we get from toothpaste from water. There are studies ongoing right
now showing that iodine deficiency increases our risk of breast cancer. So we fixed that. And then we started talking
to her about ways we could lower her TPO antibody. Again, we supported her thyroid with some desiccated thyroid
medication. That T3 of 2.4 is atrocious. Then we worked on her hormones. I gave her some progesterone. Oh my
gosh, I want her to sleep. I want her to feel better. I want her mood to be better.
I gave her a little bit of estrogen. You can do that sometimes in the form of an estrogen patch. Because guess what?
If she starts making estrogen and she’s like, whoa, this is too much. She can take the estrogen patch off and she’ll
know that because her breasts will get tender. And so not everyone fits in a box. My point was this lady needed
estrogen. She needed progesterone. Dear God, she needed testosterone. We gave her testosterone as well. And then
all of these things helped calm her cortisol down. Her DHEA come up on its own. Sometimes we give people DHEA,
but within three months you all. She felt like a new person, obviously, because we fixed her thyroid and we fixed her
hormones and we fixed her gut and we fixed her micronutrients. Her fatigue was so much better. She could make it
through the day. She did not need a nap again. Her restless legs went away. She wasn’t cold. She said that her
energy was so much improved. She lost 7 pounds in like six weeks by the time we made it to 12 weeks, she had lost
about 10 pounds. And she was like, it was all just fluffy water weight I couldn’t get rid of. Great. She didn’t lose any
muscle. We know because we do. In body scans. She was able to exercise, feeling better, not having to take so long
to recover. I mean, she was so much better.

But this lady in her 40s went to two doctors, her primary care doctor and her ob gyn, and was told her hormones
were fine. Her thyroid is fine and everything’s fine. It just wasn’t the case. And the sad thing is, if she wouldn’t have
come to us and somebody wouldn’t have picked this out, I promise you, in 2 or 3 years, it would have been really bad
because all this just would have continued to compound, and her micronutrient deficiency would have gotten worse,
and her hormone issues would have gotten worse, and her thyroid would have gotten worse. And it’s not fair that you
have to wait until everything breaks. The car completely explodes instead of listening to the check engine light.
That’s not fair. But unfortunately, that’s what’s happening in this country. So if any of this resonated with you, please,
please, please send this to anyone that you know that this would help because I don’t want people to struggle. I don’t
want them to feel bad for a long period of time. Like, this is not fair. So send this to your mom, your sister, your
girlfriend, your daughter, anyone that you know that’s been complaining of fatigue and issues, losing weight and
losing their hair and being tired and wired and their doctor isn’t listening. Send them this episode because I promise
you, there’s so much you can get from this if you don’t want to work with Modern Endocrine.
Get the book. If you don’t even want to get the book, get the live the lab guide. It’s completely free. Like download
my lab guide just so you have a reference of what is truly normal and where you need to get to what is optimal so
that you feel better. Because what I want for everyone is for them to be able to feel their best so that they can do
what they were put on this world to do. Because everyone knows when we don’t feel well, we’re not going to achieve
our highest calling in life. So we have so many ways that we can help you completely for free. And I want you to take
advantage of this, share this podcast with anyone that you think would like it. Consider getting my book fix Your gut,
fix your hormones. Tons of free resources in there. It’s on Amazon. You can go to gut hormone fix.com, download all
the free resources. My book is available on audible as well. Also, if you want, go to our website www.endocrine.com.
There’s a book, a discovery call link there if you want to consider being a patient, we’ll talk to you and you tell us
your symptoms and what you’re struggling with, and we’ll tell you whether we can help you or not. If we’re not a
good fit for you, we’re going to tell you, but we want to be able to help guide you and help you get better.
You can order a gut study from our website and just look at your gut, but so many ways to support you in your
journey. Follow us at Modern Endocrine underscore. That’s on Instagram. I put a ton of free information there. Make
sure you’re following the podcast. I drop new podcast every week. I have a pretty active YouTube channel now as
well where I’m putting longer content, not content like this podcast, but also longer content than on social media. So
like ten minute scripts where I just talk about things and explain them. But I would love to help support you in any
way that I can on your journey, because I am so fed up with the terrible sick care system that we have in this
country. And I honestly don’t think anyone is ever going to come to save us. The system is so broken. So please,
please, please be your own best advocate. Get the lab guide, find someone who will order all the labs that you need.
Don’t take. It’s normal. It’s a normal part of aging. You’re fine when you know that you’re not. And join us next week
for the next episode. I can’t wait to have you back and just keep learning. Also, if you’re interested in any of our
supplements, I always forget this shop modern endocrine.com. If you use code listen ten. I’ll give you 10% off of any
of our supplements. Have a wonderful week. Keep advocating for yourself.