Podcast Episode #317: The Adrenal Thyroid Revolution with Aviva Romm

Topics

1. Introducing our guest, Dr. Aviva Romm [2:35]
2. Returning to school [5:10]
3. The Adrenal Thyroid Revolution [11:47]
4. Pushing the boundaries of Survival Overdrive Syndrome [21:05]
5. The roots of hysteria [26:46]
6. The impacts of cortisol [28:42]
7. Stealth infections [37:20]
8. Lab testing and symptoms [40:27]
9. Final comments [48:58]

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You’re listening to the Balanced Bites podcast episode 317.

Liz Wolfe: Welcome to the Balanced Bites podcast. I’m Liz; a nutritional therapy practitioner, and author of the Wall Street Journal best-seller Eat the Yolks; The Purely Primal Skincare Guide; and the online program Baby Making and Beyond. I live on a farm in the mystical land of the Midwest, outside of Kansas City.

My usual cohost, Diane, is a certified nutrition consultant, and the New York Times bestselling author of Practical Paleo and the 21-Day Sugar Detox. She lives in San Francisco with her husband and fur kids.

We’re the co-creators of the Balanced Bites Master Class, and we’ve been bringing you this award-winning podcast for nearly 6 years. We’re here to share our take on modern paleo living, answer your questions, and chat with leading health and wellness experts. Enjoy this week’s episode, and submit your questions at http://blog.balancedbites.com or watch the Balanced Bites podcast Instagram account for our weekly calls for questions. You can ask us anything in the comments.

Remember our disclaimer: The materials and content within this podcast are intended as general information only, and are not to be considered a substitute for professional medical advice, diagnosis, or treatment.

Hey everyone! Liz here, about to record a really exciting interview with one of my favorite resources on women’s health, Dr. Aviva Romm. Before I introduce this integrative medical powerhouse, let’s hear from one of our sponsors.

Liz Wolfe: This episode of the Balanced Bites podcast is sponsored by our friends at Primally Pure Skincare. Primally Pure makes 100% natural and nontoxic skincare products that support radiant skin, a healthy body, and a happy self. They use ingredients like tallow from grass-fed cows; organic and fair trade coconut oil, and organic oils, herbs, and extracts to formulate effective products that also smell amazing and look beautiful sitting on your bathroom counter.

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1. Introducing our guest, Dr. Aviva Romm [2:34]

Liz Wolfe: Aviva Romm, MD, spent 25 years as a midwife and herbalist before going back to school to Yale University, as a mom of four, no less, to become a medical doctor specializing in women’s integrative health care and obstetrics. She’s the author of the number one best seller, the Adrenal Thyroid Revolution, as well as multiple other books, like Naturally Healthy Babies and Children, The Natural Pregnancy Book, and online courses including Herbal Medicine for Women, Healthiest Kids University, and Healthy All Year. All of which have been amazingly helpful to me personally.

Her natural MD radio podcast is available on iTunes. I highly recommend it. And you can read the first chapter of The Adrenal-Thyroid Revolution for free by going to AvivaRomm.com and entering your email. The Adrenal Thyroid Revolution is a phenomenal book that connects all the dots between your health, stress levels, immune function, hormone balance and beyond. It is a must-read. And it includes not just a detailed explanation of what’s going on physically when you're in SOS mode; survival overdrive syndrome. That’s Dr. Aviva’s term. But it also contains symptom quizzes and a comprehensive quiz for healing and thriving. And I cannot recommend it highly enough. I devoured that book. Every single page is dog-eared and highlighted, and notes in the margins. I love it.

So without further ado, I would like to welcome Dr. Aviva Romm to the Balanced Bites podcast.

Aviva Romm: Thank you so much for your wonderful introduction. I love that your book is dog-eared and probably sticky noted. That’s how I do all my books.

Liz Wolfe: Oh yes. All of it. Yes. We’ve got pens for notes, and different colored highlights, and sticky notes, and dog ears and writing notes on either side on the blank papers. It was so amazing to me. And you know, I expected no less, obviously because I’ve been following your work for some time. But listeners to our podcast, they like to really understand the why. And you don’t just go in and give a comprehensive lifestyle plan for fixing what’s going on. You also really connect all these dots between cortisol and estrogen and immunity. It’s phenomenal. So thank you so much for writing it.

Aviva Romm: Thank you so much.

Liz Wolfe: Absolutely. And we’ll talk a little bit more about the Adrenal Thyroid Revolution in a moment. But I wanted to ask you a little bit more of a personal question first, if you don’t mind.

Aviva Romm: Of course.

2. Returning to school [5:10]

Liz Wolfe: How, and why, does a midwife herbalist choose to go back to school to become a family physician specializing in obstetrics? Please share where your heart was leading you.

Aviva Romm: So, there were a few things that were at play. My backstory in a nutshell is that I had actually gone to college when I was 15 to become a doctor.

Liz Wolfe: Wow.

Aviva Romm: And then during that first few months, I got exposed to herbal medicine, and midwifery, and loved it. I walked away from school, and apprenticed myself and had this whole really thriving, not just career, but livelihood. It was really my life. And as midwifery and herbal medicine started to get a little bit more; mainstream would not be the word. But more kind of in the public radar, I felt that there were more and more fantastic women, like me, going into those fields. So women could find women like me.

But, when women like us; you and me, had to interface with the medical model, there were some serious limitations that women were facing. So it became a really scary thing for a lot of women who wanted natural, needed medical, and felt like they were just kind of walking into the wolves’ den, if you will.

Liz Wolfe: Mm-hmm.

Aviva Romm: So I wanted to go in and be on the inside, and be someone who could try to be a voice and source of comfort and education and help for those women. But I also realized that as popular, in a way, as midwifery, herbal medicine, and natural healing were becoming, they were still quite marginalized. So I also wanted to give more validity to those.

It’s funny. You know, we live in a culture where as much as we might sort of dis conventional medicine and pharma, we still kind of weirdly deify the knowledge of the doctor. And there’s still this sort of pinnacle of authority that MDs carry. Which is why I think you see a lot of people who are in the alternative medicine space, even if they’re not doctors, putting on white coats for their websites and their marketing strategies. Right? There’s this belief we have that somehow that means authority.

So I wanted to combine sort of the power of that believe with what I could learn actually by becoming a physician and the reach that I could have with that credential in order to really start to affect some greater systemic change. In medicine, but also for women who were look for alternatives, but really still wanted to hear those alternatives maybe from someone they felt like they could trust with that authoritative credential.

Liz Wolfe: So you just thought you’d spend 10-plus years doing that. {laughs}

Aviva Romm: Oh my gosh. Well, it’s funny. Before I went, I told my husband, “This is going to be really hard.” He’s like, “Oh no, we’ve got this. We can handle this.” You know. And there he was home with three teenage girls while I was in medical school and residency. {laughs}

Liz Wolfe: Oh my.

Aviva Romm: So there were days where he just looked at me cross-eyed. You know, many, many years ago, when my kids were still young. My kids were tweens. My oldest was actually in college when I went back to school to go to medical school. I had a woman I knew in my life. She was actually the mother of one of the kids that my husband was a high school teacher for at that time. She was an African American woman. She worked at the Centers for Disease Control. She was one of the early HIV researchers doing HIV research, particularly in women’s health. And this was in, maybe the late 1980s, early 1990s. Dawn Smith. And I looked at Dawn, and I said, “I’m thinking of doing this.” And she just looked at me, and she just said, “Go for it girl. It will be the best decision you ever make.”

And it really felt empowering to hear that. And feel like, you know what? Yeah, it’s going to be a sacrifice, but I’m going to be 10 years older if I don’t go. And I feel like this is just so much part of my path and what I want to contribute. So I did it. It had its hardships. I won’t deny that. It definitely had a big impact on my family, and my family’s structure, and my availability. I had been homeschooling until then. And I actually homeschooled into the first two years of medical school. As crazy as that sounds, I did.

But it was a big shift for my family. And a lot of things I couldn’t do. There were family weddings I couldn’t go to, because you can’t leave med school or residency when you’re told you can’t go. There were just big events that kind of came and went in my life.

Liz Wolfe: Yeah.

Aviva Romm: So it’s a little bit like going through labor. I think if somebody asked you the next day, “Would you do that again?” You’d probably say no way!

Liz Wolfe: {laughs}

Aviva Romm: But then, a few years later, you might be ready to have another baby.

Liz Wolfe: Yeah. Yeah.

Aviva Romm: Yeah, it’s a little like that. And I’m so glad that I did it.

Liz Wolfe: Well, many of us; thousands upon thousands of us are so glad you did it, as well. You are just an absolutely gem, and a leader in this field. I’m wondering how difficult it is; or maybe how easy it is, for you to mix that midwife/herbalist in you with the MD in you? Has it been pretty seamless, or was it a struggle at first?

Aviva Romm: No. It’s been entirely seamless. The medical part, and the science part was pretty easy for me to add in. Because one, I’m just a wicked science geek, it’s hilarious.

Liz Wolfe: {laughs}

Aviva Romm: So it was actually really fun. It was fun to have all these aha moments, and kind of almost validating what I was doing. For example, there’s this whole kind of thing I talk about in the book; root cause medicine. And doing the deep dive in the science, and learning there’s this whole scientific field of the exposome that really lends so much strength. I mean, it’s really what root cause medicine comes from. It’s a powerful thing.

So if anything, I feel like the MD knowledge and training and credential amplified what I was already doing. And if anything gave me even more strength and confidence in it. And it’s also been really beautiful. Because there are times when a woman or child does need something conventional; a pharmaceutical or a referral for something that previously I might not have been able to provide. So now I can provide this sort of seamless continuum of care and information in a really loving way.

So I kind of think about it that I practice midwifery and herbal medicine still; that’s really the heart of what I do. But I do it with the knowledge of an MD.

3. The Adrenal Thyroid Revolution [11:47]

Liz Wolfe: Amazing. So, what led you, then, to write the Adrenal Thyroid Revolution?

Aviva Romm: Well, I was really not planning on writing that book particularly. I wouldn’t have said, “Oh, I’m an adrenal expert. I’m a thyroid expert.” But what I was seeing in my medical practice was so confounding and confusing. I was seeing women who were in their 20s, and 30s, and 40s, and 50s, and 60s, with these symptoms that didn’t make sense. Like brain fog in women in their 20s. Or fatigue all the time in women who are otherwise pretty healthy. Or weight gain when you wouldn’t expect it.

And as I started to explore what kind of connected the dots on all of these different conditions, what I started to really research was this field called psychoneuroimmunology. Which had already had my interest for about 10 years. Which is this field of science which shows how so many different parts of our body, or systems in our body that we tend to think of as separate because of the way that conventional medicine and science puts everything in the silo. Right?

You’ve got your endocrine system, which is your hormones, and your endocrinologist deals with that. And you’ve got your cardiovascular system with your heart, and your circulation, and your cholesterol, and your blood pressure. And your cardiologist deals with that. And you’ve got your mental health, and your psychologist and psychiatrist deal with that. And you’ve got your GYN; and on and on and on. It’s all separated.

The science behind this field called psychoneuroimmunology shows how what’s going on in your immune system is not at all separated from what’s going on in your, let’s say, nervous system. In fact, they are literally connected. You have cells in your nervous system that trigger your immune system. You have receptors on your immune cells for nerve chemicals, that are informing each other all the time. So it kind of starts to put the language behind why we might get more sick when we feel really stressed over a long period of time. Or conversely, why some people don’t get sick when they’re stressed. Because they get a little bit of oomph in their immune system.

Liz Wolfe: Mm-hmm.

Aviva Romm: It shows how none of these systems are disconnected from our menstrual cycle in our women’s hormones. So for example, we all have probably had some experience where we’ve traveled or been under a lot of stress and our period just didn’t come that month. But when you kind of amplify that with stress over time, it starts to explain why women are having so many problems with infertility and PMS and PCOS and endometriosis. It just really brings all these powerful connections together. It shows why what’s going on in your gut can cause anxiety and depression. Or why anxiety and depression can affect your gut.

And it breaks it down to this really kind of molecular level; which again, science geeks like me love. But in a bigger picture, it also helps our patients. It helps me to help other women understand, “Hey, you know what? This is not your fault.” This is just sort of a cluster-you-know-what of situations that have kind of conspired together and maybe had some impact on genetics too that now have led you to where you are, which is an autoimmune disease at 35. Or breast cancer at 42. Or Hashimoto’s at 28. Or brain fog at 22.

And so what I started to do was when I see things in my clinical practice, I tend to ask my audience, my tribe on Facebook, “hey are you guys seeing this and experiencing this too?” And I was asking other practitioners. And low and behold, the few hundreds of women in my practice in the past couple of years became tens of thousands of women on social media, telling me, “Yeah, we’re all going through this. And not only that, but our doctors keep telling us this is all in our head.”

I was hearing from women in my practice, but also online. Some of them have gone years. Years of debilitating, sometimes, symptoms without a diagnosis. Or the diagnosis was, it’s stress. Or it’s anxiety/depression, here take this prescription.

So I really realized that what I was seeing was an extension of a phenomenon that I really already understood, based on my work as an herbalist studying the stress response. And because so many women were going through it, I realized I needed to write about it. And that’s really how the book came about.

Liz Wolfe: What really struck me about the book was realizing that; and this was very much through kind of my own lens, my own experience. Realizing that we will often think we’re ok, so we don’t quite understand why we’re having fertility issues, or whatever it might be. But what the reality is, we’ve actually just gotten used to living in what you call survival overdrive syndrome. We get so used to that that it becomes our normal, and then we don’t understand why this autoimmune condition just starts up. Because we thought we were fine, right?

Aviva Romm: It’s really true. I had a personal experience maybe 5 years ago now, where I left a job that was very high influence, sort of high prestige. And it was a good job. But it was a little bit toxic for me, for certain interpersonal reasons. And limiting for me. And I went through this really intense internal struggle over whether to leave it, what it would mean publicly and socially and also economically. I was the primary breadwinner in my family, and that was my primary income. And I really struggled with; “Ok. I’m making a decision to do something that’s really feeling very unhealthy for me.” And granted, we can’t all walk away from a job. And I took a big risk doing it, but I did, and it worked out beautifully.

But what was really interesting was when I hung up the phone with my boss, who was very angry at me for letting go of this job. Which I did respectively, and not precipitously. I gave months of ample notice. But it was so interesting. I had this feeling inside my body, where; do you know that feeling where you're in an electrical storm and all the lights; all the electricity, all the power goes out in your house, and it’s totally quiet. And all of a sudden you realize that you're not hearing the refrigerator. You're not hearing the hum of your generator. It’s totally quiet.

I had that feeling inside my body. Like it was just totally quiet. I and I realized all of these sorts of things that I took for granted as normal. This internal motor that I always had to sort of be achieving more or doing more were actually signs that I was high functioning person with anxiety. And I think a lot of us get used to, as you say, whether it’s emotional patterns that we have. For me, it was recognizing, “Wow, I don’t have to live like that all the time.” Kind of always on the hunt for the next thing that’s sort of going to validate myself or whatever. Or make me feel more income secure, or whatever it is.

But it can be something else. It can be the chronic joint pain that somebody thinks, “Oh, well I’m 45. That’s normal.” My patient recently told me that she, in her early 40s had gained about 15 pounds pretty quickly, in a few months. Was having joint pains. Was not sleeping as well. And her doctor, who is actually an integrative doctor, said, “Oh, well it’s because you're in your 40s.” And we have this myth. I’m not saying we all feel 100% perfectly great all the time. We all get a little ache and pain here or there. But you're right. We take for granted that feeling unwell is normal.

It’s really interesting, because I will have patients who come to me, and they will say things like, “Yeah, my health is great.” And then when I start to look in their medical history, they have chronic migraines. They’ve had a couple of surgeries. They have high cholesterol. Maybe they’ve even had a heart attack. And they’re like, “Yeah, my health is great.”

It also shows me that there’s two different sorts of forces going on. There’s how we feel as human beings, and then there’s what physically going on in our body. And we can feel really great, and have stuff going on in our body. Or not identify as being unwell. Which I think is actually powerful. I think there’s a lot of danger that can happen when you start to identify with your diagnosis. How do we help people to keep that sense of wellness while also recognizing that physically we were meant to feel pretty good most of the time?

Liz Wolfe: Yeah. Kind of reconnecting with your intuition about your body and your ability to kind of tell what’s going on. Which I think a lot of us lose probably very early. I think a lot of us kind of wait for someone else to tell us what’s wrong with us, versus really trusting our own instincts. But I mean, there are just so many pieces that need to be moved around. I’m sure that’s a huge challenge for you, and this book, I feel like, is just one of those very profound piece movers. I feel like a lot of things aligned in my head after I read it.

4. Pushing the boundaries of Survival Overdrive Syndrome [21:05]

I want to tell you quickly; when you were talking just now about pushing the boundaries of anxiety and things like that. It occurred to me that I feel like most women maybe don’t feel they’re doing enough unless they’re pushing the boundaries of survival overdrive syndrome. You mention in the book; checking email first thing in the morning before you even get out of bed. And you’re lying in bed trying to sleep, and just worrying and thinking. And it’s not until maybe something pops up as wrong. For me, it was actually heart palpitations.

Aviva Romm: Yeah.

Liz Wolfe: Where you realize; ok. I have pushed the boundaries to the point that my body is saying no, in one way or another. Do you see that a lot?

Aviva Romm: I see it all the time. It’s just; we live in a really complicated society. Right? As women, we read books and articles and hear statistics about one illness and a woman’s husband died, and she was economically wiped out. Or we’ve just come through this major economic depression of sorts, culturally, and we saw people losing their homes and losing their jobs.

So I think, as a culture, we have a lot of economic insecurity that drives us to create that security. And the way that our culture demands that we create that security is by being the one that shows up. By working extra. It’s kind of like some of the work ethic that’s ingrained in us.

If you look at other countries. If you look at some of the Scandinavian or western European countries, the ethic around work is completely different. Sweden has, I think a 4-day work week with a 6-hour work day. Many European countries have 6 weeks of summer vacation. We’re the only country in the world where most of our workers in our country don’t even use up all of our paid work vacation.

Liz Wolfe: Mm-hmm.

Aviva Romm: We have that pressure, right? If there are 4 people on a team and someone says, “Who’s going to do the extra work tonight.” That person who does the extra work is often the one that also gets the next promotion and the raise.

So there are some external pressures that drive us. I think another thing is, as women, we not only feel the pressure, but there is actually demonstrable pressure on us. This is measurable pressure on us to work harder, do more, and say yes to more than male employees. And yet we’re still getting basically 70 cents on the dollar. So it’s very typical in a meeting, for example, if there’s a task that needs to be done, not only for the woman herself to volunteer herself, but for gender stereotypes to have the men at the meeting put that on the woman. Or, if a woman is in leadership, to put that on another woman. So there’s that tremendous pressure.

I think we’re also a culture that likes to validate ourselves on being busy. Being busy is a sign of success or something to impress other people with. And I do think we all, or many of us, have various past experiences of some form of whether it’s trauma or behavioral adaptation that leads to certain patterns. So for example, if you had a family where perhaps your role was to be the good girl. Or your role was to be the peace maker. Or your role was to be the martyr. To keep the family dynamics safe for you or for others. I see this a lot where there’s been a family with abuse, or mental illness in a parent. Or alcoholism in a parent, which of course is a form of mental illness. Adaptations for women when they’re older that tend to drive never feeling like enough, or always needing to take on more, or never be able to say no.

Liz Wolfe: Those words; trauma and behavioral adaptation. So powerful. It takes a lot of introspection, I think. Maybe sometimes you're forced to do the work of introspection after your body fails you. Maybe, hopefully folks can start doing it now before their body fails them. But that’s such a powerful term.

Aviva Romm: Yeah, thank you. I like to think about our symptoms as SOS signals, if you will. It’s our body saying, “I need some help.” And that’s another thing. As women; men as well. As women, we kind of have been labeled as complainers. So I think as a reaction to that, we tend to not want to complain. When women do go to the medical doctor appointment, we’re often told that anything we are “complaining about”, because that’s what symptoms are called. Chief complaints. So our concerns are relegated to, often, anxiety or stress or depression or something else.

And I think we’ve all been taught from a young age to ignore our bodies. Whether it’s being a little girl in school who doesn’t want to raise your hand because you need to go to the bathroom; or you have to wait until you're told you can go to the bathroom, to any number of symptoms that we’ve been taught to suppress. I was doing some research for my next book. And I was over on the Kotex website, where there is information for young women. I’m talking, you know, early 10 to 14 years old who are menstruating. And the biggest piece of advice there is to start taking ibuprofen a couple of days before your period so you don’t have any period pain.

Liz Wolfe: Oh my.

Aviva Romm: You know? So it’s from a young age. And women are really taught to not express pain. Which is why women, for example, with endometriosis can go years without a diagnosis.

Liz Wolfe: Wow. Wow.

Aviva Romm: Yeah.

5. The roots of hysteria [26:46]

Liz Wolfe: And you talk a little bit, I believe, the beginning of the book kind of the roots; I think the word hysteria. You tackled that at the beginning.

Aviva Romm: Yes. {laughs}

Liz Wolfe: Yeah. That was really; I mean, really just captured my attention. Not to say that men don’t have some of these same struggles. But I think in many ways it is uniquely female to go through some of this.

Aviva Romm: Yes. Men definitely have their own struggles, as well. The medical gender bias, though, is well documented to affect women more. And interestingly, and I talk about this in the book. There have been quite a number of studies on the impact of cortisol on health. And for whatever reason; and I have some theories around this. Women do seem to be more physiologically and physically impacted. So we have more symptoms as a result of stress and our cortisol tends to get dysregulated more readily than men in relationship and in life circumstances.

The word “hysteria” as you mentioned, for listeners, comes from the Greek word hysterikos, and that means uterus. And even back into ancient Greek medicine; but this actually persisted into the early 1900s, even in the United States. There was a belief that women’s mental illnesses and emotions stemmed from the uterus. Particularly, the uterus getting loose and wandering around the body.

Liz Wolfe: {laughs}

Aviva Romm: When I say mental illness, I don’t just mean actual mental illness. But mental illness in the late 1800s and early 1900s in the United States could have been anything from somebody who masturbates to somebody who had a baby outside of her marriage, who may have been institutionalized for that and the child taken from her. So social morays could also be diagnosed as hysteria. And a woman could be treated quite aggressively for those.

Liz Wolfe: Wow.

Aviva Romm: Yeah.

6. The impacts of cortisol [28:42]

Liz Wolfe: So you talk about cortisol. And this is a huge thing that I wanted to talk to you about in particular. On page 54, you discuss cortisol exposure and what sounded to me like mom brain; given I’m the mom of a 2 and a half-year-old. And you said over time, cortisol exposure alters nerve connections in parts of your brain. And also impacts word findings. When you're talking to someone; and you're like, “The thing. The thing. You know; the thing.”

Aviva Romm: Yeah. I know I know that word, but.

Liz Wolfe: Yes!

Aviva Romm: And you start pantomiming.

Liz Wolfe: Exactly. And that just blew my mind. I think we think of cortisol as a villain. But one of the things that you state, that was also fascinating, is that it’s also, and this is a direct quote, “Responsible for regulating major biological processes, including metabolism of fats, carbohydrates, and protein. The responsiveness of your immune system to infection and inflammation; your hormonal balance, sex drive, and reproduction as well as your thyroid hormone production.”

Which is like, whoa. Drawing; connecting the dots there. So I would love for you to talk a little bit about cortisol, thyroid, any of those major themes of your book that we can kind of illuminate for folks.

Aviva Romm: Yeah. So cortisol we tend to call the stress hormone. But I actually think about it as the survival hormone. Because it’s really the one hormone that, if it suddenly plummeted, you could actually die. So your estrogen can go down, your progesterone can go down, your insulin can go down over time; but if your cortisol is gone, you can’t function because you can’t maintain your blood pressure. You can’t maintain your immune response. Critical life functions.

But it’s activated; it’s produced and released. And we’re all producing cortisol all the time. We’re supposed to be. It’s what keeps inflammation in check. It’s what gets our immune system responding when we are exposed to an infection. It serves numerous roles. It regulates blood sugar, insulin release. So many, so many things. Really if you think about your brain, and certain glands in your brain. Like your hypothalamus and your pituitary as the conductor of an orchestra, and you think about every cell in your body as the musicians in the orchestra, the cortisol is really the sheet music. It is the notes of the music that are telling each of the different cells and organs what notes to play, what sounds to make. At what time, at what frequency, at what pitch. It’s really amazing.

So what happens is that cortisol, we’re producing it, we’re just humming along in our life, and we’re producing a normal amount. But if we are either under chronic pretty unrelenting stress for a period of time. Weeks to months; usually not just days. You get imbalances if it happens just for prolonged days. But we’re pretty resilient; human beings are amazingly resilient. So we bounce back.

But if the cortisol is getting overly produced for a prolonged period of time. Or if you're having kind of a lot of stress frequently. It’s kind of stop and start, stop and start, stop and start stress. What happens is your body starts to overproduce cortisol.

Cortisol, in the vernacular of medicine, is called the wear and tear hormone. So all the good things that cortisol is supposed to do, when it starts to; let’s say you're in a car. And your tires are supposed to turn, and they’re supposed to move you forward on the road. But if you're stuck in the mud, and you start spinning your tires, you're just going to dig a deeper, and deeper, and deeper rut. You're not going to get out. Cortisol is kind of like spinning those tires. When you are chronically burning cortisol, it starts to have kind of almost rebound effect on the body. So all that good blood sugar regulation starts to become problematic. You end up with high blood sugar, and eventually you can end up with low insulin production. So you can end up with insulin resistance and diabetes.

Cortisol is supposed to make your brain more instinctive in a way by blunting your sort of intentional though process, and then adrenaline is kicking in and making you kind of hypervigilant and reactive. But if you're constantly exposed to cortisol, and it’s constantly blunting your intentional will, you actually get blunting of your willpower over time. So you can’t get motivated. You can’t stick to a diet. It’s harder to stick to an exercise program. You might want to go back to school, but you just find that you can’t get up the sort of energy to do it. But also, it can actually start to change the neurons in your brain, as you mentioned before. And it can affect your immune system, so that you have a harder time fighting infection.

So one of the rebound effects that can also happen is that too much cortisol has a number of different impacts on your thyroid. And not only does cortisol itself cause you to pack weight around your middle; which is kind of a survival energy storage mechanism. It’s a very primitive way of getting our body to hold onto extra weight in case we need it in a famine. Quite literally, that’s what your brain is sort of interpreting. It tells your thyroid to turn down the thermostat.

Your thyroid is like the thermostat of your body. And one of the things that might be going on as you're in this stress response, is your body is saying, “I don’t know what the crisis is. Maybe the crisis is that there’s not going to be enough food. There’s not going to be enough resources.” So instead of burning up so much energy, we have to go into energy conservation mode. And it does that by having cortisol impact the production of thyroid hormone and the conversion of the inactive form of the thyroid hormone to the active thyroid hormone. So you're just not getting as much thyroid function. And then you gain more weight, and get more tired, and get more sick.

So it’s really complex what happens. And the beautiful thing is, if you think about a piece of elastic. Think about elastic in a waist band. You can stretch it. You can put on that skirt, and you can take off that skirt. You can do that for years. But if you put that elastic under pressure for a long time, eventually it loses its elasticity and it doesn’t bounce back. And we’re really meant to be like that piece of elastic. We stretch, and we relax. We stretch, and we relax. And if we do that, we can keep our resilience. It’s when we are constantly stretching more and more and more and more, and just don’t hit the pause button. Emotionally or psychologically.

And here’s the interesting thing. And this, I think probably shocked me more than anything else as I was doing my research for the book. We think about things like environmental toxins affecting our liver, or affecting our cells. We think about infections causing us risk. But what I discovered is there is very substantial and extensive research that shows that anything that causes our body to be under threat, even if we’re not conscious of it. So environmental toxins cause inflammation. Certain food additives or herbicides and pesticides; agricultural residues that we pick up in our food. Certain infections that we might be exposed to, or more triggered by, because we’re chronically exhausted. These can all be subtle, or even hidden triggers, that get your body in this chronically activated stress response.

So, it’s really amazing how many connections there were that dial back to cortisol. Poor sleep, that’s another one that gets cortisol really activated. Low blood sugar. So chronically skipping meals. Really, really interesting.

Liz Wolfe: The Balanced Bites podcast is sponsored in part by the Nutritional Therapy Association. The NTA trains and certifies nutritional therapy practitioners and consultants (including me; I’m an NTP), emphasizing bio-individuality and the range of dietary strategies that support wellness. The NTA emphasizes local, whole, properly prepared nutrient dense foods as the key to restoring balance and enhancing the body’s ability to heal. Nutritional therapy practitioners and consultants learn a wide range of tools and techniques to assess and correct nutritional imbalances. To learn lots more about the nutritional therapy program, go to http://www.NutritionalTherapy.com. There are workshop venues in the US, Canada, and Australia, so chances are you’ll be able to find a venue that works for you.

7. Stealth infections [37:20]

Liz Wolfe: So, I’m totally remiss in not having mentioned that five root causes that you go through in your book. I think folks will love this. Can I list them, is that ok?

Aviva Romm: Of course, please.

Liz Wolfe: Ok. Chronic emotional and mental stress, which I think we’ve really touched on today. Food triggers; and our audience is pretty familiar with things like food triggers, and the third one, gut imbalances. What you're talking about now; toxic overload. And then what you just mentioned; stealth infections. Which was so fascinating to me. And I feel like you're one of the first to really talk about this, that I’ve been aware of.

We know that stress is bad; now we understand better why and exactly how biologically it affects you, thanks to your  book. Food triggers, gut imbalances; this is something that doctors like you are talking about now. Toxic overload. But I haven’t heard people talk that much about stealth infections. And it’s really fascinating to me. Do you have a few minutes just to give us an idea of what that means?

Aviva Romm: Yeah, I do. So what happens is when we’re under chronic stress; we’ve all kind of seen this happen. We’re really, really stressed. We’re really tired. We’re burning the candle at both ends. And then the first day of our vacation; boom. We’re sick, right? We finally get that flu that everyone else has had that we’ve been fighting off. Or, maybe we’re so tired that we just can’t shake the cold sores, or the chronic little cough that we have. Or some little infection, that cold, that we just can’t seem to get rid of.

But there are other infections that many of us have been exposed to. The most common one is probably Epstein Barr virus. Most of us know it as mono. But actually, it’s so common that most of us have had exposure to it, even if we’ve never gotten sick by the time we’re like 10 years old. 75% of us, if you tested our blood, would show evidence of having been exposed to and mounted antibodies against this virus.

But like cold sores, Epstein Barr virus is in the same family as cold sores, which is herpes and chicken pox and a few other infections. Much like people who are under a lot of stress, or really, really tired, could get an outbreak of herpes or get a reactivation of cold sores, the same thing can happen with that Epstein Barr virus that’s hidden in our cells and just waiting for us to be fatigued enough for it to mount an attack.

The evidence connecting Epstein Barr virus and Hashimoto’s is actually not that robust in the medical literature. But there is robust evidence connecting Epstein Barr virus, cytomegalovirus, and a few other viruses with other autoimmune diseases. For example, ulcerative colitis, lupus, and rheumatoid arthritis.

So when I have a patient who comes in who is really exhausted, maybe having some joint aches and pains, I will do specific tests. I might look for Lyme disease, if they're in a Lyme endemic area, or have traveled to a Lyme endemic area. I will look for a thyroid problem, because that can cause symptoms like that too. But I will also check for an Epstein Barr virus panel to see if that has been reactivated. Or if they have gotten the infection at any time.

Liz Wolfe: Wow, fascinating.

Aviva Romm: Yeah.

8. Lab testing and symptoms [40:27]

Liz Wolfe: I’d also like to talk about lab testing. One of the really fascinating topics in your book to me is thyroid health. And I feel like a lot of times folks know something is wrong maybe with regards to the thyroid, or it could be something else. But their practitioners say their tests are in range, or normal. Can you tell me what that means, and maybe how we can push that a little bit?

Aviva Romm: Yeah. So in conventional medicine, we have a very set range of labs that are considered either normal or abnormal findings or values. To give you an example, I had a patient who came in, a young woman, early 30s. Young to me.

Liz Wolfe: {laughing}

Aviva Romm: Early 30s, came in, and had been tired for the longest time. She has been tired for a couple of years. I mean really tired. And she’s had her thyroid checked, and she was put on some thyroid medication. But actually, her thyroid numbers were normal. I looked at all of her thyroid numbers, and they were normal. But she was borderline anemic. She has been borderline anemic for three years. Meaning, that she is at the lowest possible number. So if the lowest possible number is 33, and under that you would be considered anemic. She’s at like 33.1. So the range is 33 up to 46. She’s as low as she could possibly be. It’s like a pot of water, and it’s simmering, and you check the temperature, and you say, “OH, it’s 211 degrees Fahrenheit. It’s not boiling.” Well, at 212, it’s going to be boiling, right?

Liz Wolfe: Yeah.

Aviva Romm: She’s had a really major medical problem. Anemia is no joke. It can cause all kinds of serious health problems. Aside from the fatigue, and was being treated for the wrong thing because somebody was looking for thyroid. Right? In their mind, they wanted to diagnose thyroid. And totally missed the anemia.

With thyroid health, it’s a specific and unique interesting problem in that in the US, there are two competing thoughts of where thyroid TSH, particularly, which is thyroid stimulating hormone. It’s the main lab that doctors check to see whether your thyroid is normal or not. And these two competing ranges say, in one camp, you do not have hypothyroidism until you have reached over 4.8 of the TSH.

But in this other competing camp, they say, look. Numerous studies show that if you were to take a population of Americans, or anywhere in the world, who are totally healthy with no thyroid symptoms whatsoever, their numbers are actually more like 1.5 to 2.5. So at 4.8, you're almost double the upper range of what a healthy population has.

But when those other numbers were done, that gave you the 4.8 before you can get diagnosed, that was a broad swath of Americans. So some of them may have actually had thyroid disease and it was just an average of that. So what happens is if you go to an endocrinologist, or an internist, or an OB/GYN, or a family doc, or anyone who doesn’t know about this discrepancy, they’re going to only treat you when you're 4.8 or over.

And in fact, here’s the other rub. In conventional medicine, it’s thought that even between 5 and 10 you don’t have to treat because that’s called subclinical hypothyroidism. So somebody could be unable to get of bed, their hair falling out, have gained 45 pounds in three months, and your doctor can actually say, “Yeah, but you're only 5.2.” And they’re not looking at you and what’s going on.

And it’s really important. Because studies have shown that particularly for women where studies have been done, having a TSH or even a subclinical thyroid problem. One that’s sort of on that fringe of diagnosable, can lead to cognitive problems, dementia, and congestive heart failure. So we’re talking no joke stuff here.

Liz Wolfe: So in your practice, you would take; obviously, this is clearly what you would do. You would look at the person as well as the lab numbers.

Aviva Romm: Absolutely. I wouldn’t treat if the lab normal were completely within normal, within the more narrow range. Because that would be inappropriate. If I’m treating, and something’s looking fine on a lab, and somebody is having symptoms, I’m missing something else that’s going on. So I would need to do a full range of thyroid labs. Which I talk about in the book. And listeners can get that same information just over at my website and blog. So you don’t even have to buy the book to get that. There’s an eBook on my website that’s totally free, no obligation. It’s called Thyroid Insights. And you can see all those numbers in there.

Liz Wolfe: Nice.

Aviva Romm: So you can look at that range. But if it’s normal, and my patient, like the one I was just talking about, is feeling exhausted; there are a lot of reasons that can cause fatigue. And I actually talk about that; there’s an article on that on my website too.

What starts to happen is we can, as a culture, and especially in the alternative and integrative kind of functional medicine world, people grab onto trends. So now everyone who comes in has got thyroid. Or everyone who is tired and stressed out has adrenal. And that’s not always the case.

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Liz Wolfe: Yes. I noticed that. And I’m not in the trenches, as you are, but I definitely see; having done this podcast for about 6 years, you see waves of everybody is talking about this, and so everybody has this. But really, you can’t take any of the other stuff for granted. You have to look at all of it to make sure you're helping people appropriately, I would imagine.

Aviva Romm: Yeah. I mean, sometimes we’re just really tired and overwhelmed, because we have a one and a half-year-old and we’re running around.

Liz Wolfe: Oh my gosh.

Aviva Romm: I mean, it’s like sometimes we’re sad just because we’re sad. Or sometimes we’re angry just because we’re angry. It doesn’t mean there’s always something wrong in our gut, or our labs.

Liz Wolfe: Yes.

Aviva Romm: But you asked about pushing the envelope, a little bit. And it is actually really important. Statistically, women have been shown in the medical literature to, for example, go as long as 5 years without a proper diagnosis in autoimmune disease. And this is significant. Autoimmune disease affect; if you think about this statistically, about 24 million people are affected by an autoimmune disease, by a conservative estimate. About 9 million people are affected by all forms of cancer in the US, and about 22 million by all forms of cardiovascular disease. And yet, women can go 5 years without a diagnosis.

So having an honest conversation with your primary care provider is so powerfully important. If you can’t have that honest conversation, either kind of doing a deep dive into your own ability to get confident, writing out and scripting out exactly what you want to say before you go into the doctor’s office. Bringing an advocate. Or if you really can’t have the conversation or get satisfaction, I mean look. Your life actually can depend on it. So finding another doctor might be the answer.

And there are other practitioners besides doctors. Like nurse practitioners, nurse midwifes, who may be more women centered and more women friendly.

I have a blog over on my website that I kind of just want every woman to read. Which is, How Being a Good Girl Can Be Hazardous to Your Health. And it talks about this phenomenon of exactly that. How not speaking up for ourselves can cost us our wellbeing. It can cost us our lives. It can cost us our confidence. There’s a lot of impact there.

Liz Wolfe: I know that will resonate with so many people. And that, as well as your Medically Hexed blog post.

Aviva Romm: {laughs} Yes.

Liz Wolfe: I think; required reading. Loved that.

Aviva Romm: Thank you.

9. Final comments [48:58]

Liz Wolfe: Well I would love, before we close out, if you could just let us know what you want people to know about your work and your book, The Adrenal Thyroid Revolution.

Aviva Romm: That’s a great question. I think that what comes to mind is how do we make stress our friend? And stress and the stress response are actually powerful allies. A little tiny bit of stress; I talk about that in the book, under the U curve. A little tiny bit of stress actually stimulates us emotionally, cognitively, our immune system, our digestive system. It really gets us going. It’s learning when we’ve crossed over from stress into distress. That sense that we’re taking on a lot, and we’re juggling a lot, but we’re managing to that sense of, ok, I’m crossing into the danger zone and I feel it affecting my sleep. Or I’m snapping at people. Or I’m eating more sugar because I’m stressed out and tired. Really I think that comes down to listening to our bodies. Honoring how we feel. And paying attention and responding.

I think if we can do that, we can actually harness the power of stress in our lives and not go into distress or SOS, where it starts to make us sick.

Liz Wolfe: Perfect. Well, thank you so much for being on with us today, Dr. Aviva. I cannot thank you enough.

Aviva Romm: It is a pleasure. You're a wonderful interviewer. Thank you for these great questions, and for sharing my work with your tribe.

Liz Wolfe: Absolutely. It’s my pleasure. So to learn more about your thyroid health and numbers, managing estrogen, harmonizing the interaction of cortisol, estrogen, thyroid, other hormones. Bringing your life back into balance with common sense strategies you can integrate into your life. And everything else that we talked about today. Grab the Adrenal Thyroid Revolution. Visit AvivaRomm.com. Check out all of her free resources. Check out her courses, her other books. You are just such a rich resource of information, Dr. Aviva, so thank you for that, as well.

Aviva Romm: Thank you so much.

Liz Wolfe: Again, you can read the first chapter of The Adrenal Thyroid Revolution for free by going to avivaromm.com and entering your email. Aviva Romm is the author of the number one best seller, the Adrenal Thyroid Revolution, and a multitude of other books, programs, and free resources you can find on her website.

That’s it for this week. You can find me, Liz, at http://realfoodliz.com/ and Diane at http://dianesanfilippo.com. Join our email lists for free goodies and updates that you don’t find anywhere else on our website or on the podcast. While you’re on the internet, leave us an iTunes review. See you next week.