Latest / Health with Hashimoto’s - Thyroid or Immune Education for Autoimmune Thyroid Disease / 188 // Why Good Doctors Give Bad Advice and What Hashimoto's Patients Can Do About It

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188 // Why Good Doctors Give Bad Advice and What Hashimoto's Patients Can Do About It · Health with Hashimoto’s - Thyroid or Immune Education for Autoimmune Thyroid Disease

0:00
If you have Hashimoto's, chances are that you've been told your labs look fine,
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here's your medication, and see you next year.
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You walk out still exhausted, still foggy, still searching for answers.
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The problem is not always a bad doctor.
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Sometimes it's a system that was never designed to look at root causes.
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So today, Dr. Erin Hartman is here to explain why that happens and what you can ask for instead.
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Welcome to the Health with Hashimoto's podcast. This is where you will find
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clarity and simple, sustainable strategies to feel better.
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I want to help you figure out your root causes.
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My name is Esther Yunkin. I am a registered nurse.
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I know how exhausting it is to live with fatigue, brain fog,
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and the ups and downs of Hashimoto's. And that is why I'm here.
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I'm here to cut through the confusion and to give you practical steps that support
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your body, calm your immune system, so that you can regain your energy and feel
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like yourself again. Welcome back to another episode of Health with Hashimoto's.
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I am joined today by Dr. Aaron Hartman.
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His journey into functional medicine started in a very personal way.
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When he and his wife adopted their daughter, she had cerebral palsy and major health challenges.
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And even as a doctor, he felt frustrated and stuck when the traditional medical
1:14
system did not have answers.
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But his wife refused to give up.
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Her determination led their family to functional medicine, and the transformation
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they saw changed everything from their family's health to how he helps patients.
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Today, Dr. Hartman helps patients uncover the root causes of their symptoms
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so they can live vibrant, healthy lives.
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He's a clinical researcher, the founder of Richmond Integrative and Functional
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Medicine, and assistant clinical professor of family medicine at VCU.
1:40
Welcome, Dr. Hartman. Tell us a little bit about yourself.
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Super excited to be here. A little bit about myself. I'm a triple board certified
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physician who started the typical academic route, serving the military,
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started a research company and interacting with the healthcare systems,
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especially with my daughter and her special needs.
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Took me off the path by necessity, not because I wanted to because I had to
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in order to get her the care she needed.
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And that's kind of been my story for the last 18 years, plus or minus. Wow.
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So, you talk about protecting yourself from medical harm and understanding that
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there are good doctors in the system, but sometimes they give bad advice.
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Can you tell us about that?
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You know, the concept of medical harm, it's not an old concept.
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I mean, the Hippocratic Oath, I mean, what was that?
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You know, back in the B.C. somewhere, maybe it was 500s, 600s.
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I mean, back then they knew, you know, healers would come in sometimes to hurt.
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And so part of the Hippocratic Oath was, first and foremost, do no harm.
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And that's something you learn about. But we forget, we think because we're
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healers, we're trained to help people, that we only can do good.
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But according to current research, you know, maybe medical error is the third
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most common cause of death in our country.
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So all of a sudden, things we do potentially can be harmful to a lot of people.
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When I was doing my initial training in 1996 to 2000, I was told that iatrogenesis,
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which is side effects from procedures, medications, was the fifth most common cause of death.
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And potentially now, all things we do are the third.
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So just navigating the system and avoiding mistakes and complications from procedures
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by itself can eliminate potentially the third most common cause of death,
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which if you think about it, it's a big deal.
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Right. So if somebody is diagnosed with hypothyroidism or Hashimoto's,
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what do they want to look for so they can avoid those medical mistakes or the
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side effects or anything like that?
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I think with Hashimoto's, you know, that's hypothyroidism. Well,
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Hashimoto's thyroiditis is, and you can have a normal thyroid function initially,
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most people do, is you have autoantibodies to your thyroid, right?
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You have TPO, thyroid gland antibodies.
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And so your body's attacking itself. And eventually you can develop hypothyroidism
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overtly where your numbers are off and then you need some kind of hormone supplementation.
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But if you have that, the question is what's below the surface, so to speak?
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In order to have an autoimmune disease, you have to have four things.
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Genetic predisposition, a triggering event, leaky gut, and a chronic infection.
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So I can't fix genetic predisposition, so I usually ignore that depending on certain things.
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Triggering event. So what's the triggering event for Hashimoto's?
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I've had patients that their tick-borne illness was the start for their concussion.
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Massive life stress, or sometimes after having a baby, whatnot.
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And so depending on the trigger, let's go down that pathway.
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And then chronic infections, do you have a root canal that didn't quite take.
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Do you have gut issues like bacterial overgrowth, yeast overgrowth, and then leaky gut?
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And so all of a sudden, just going to, here's your medication,
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let's normalize your TSH and have a good life, is not adequate if your reverse
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T3, for example, is up, your mitochondria putting the brakes on your cells.
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So just throwing down thyroid hormone actually could be detrimental to your health.
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And so I think understanding the underlying behind Hashimoto's,
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what else could be going on?
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For example, there's an association with mercury and positive thyroid products as antibodies.
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So if you have silver fillings, you eat lots of tuna, all of a sudden there's
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other things you can do that might potentially have a positive impact on your
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hypothyroidism, autoimmune process.
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And just doing the one problem, one treatment will treat your symptoms initially,
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but long-term, you actually will do worse, not better. Oh, what do you mean by that?
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Well, if we just give you thyroid medication, I ignore everything else.
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Let's say your vitamin D level's low and you have leaky gut.
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And the other thing about that's commonly seen is once you have one thyroid antibody,
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You're more prone to a second and a third. So fire begets fire, right?
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So if you have one part of your system that's flared up, how many times will
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you see a celiac antibodies pop up? Will you see an ANA pop up?
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Will you see rheumatoid factor or other inflammatory markers come up?
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And the answer is if you watch these people long enough, it will happen.
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And so regardless, looking at inflammation and trying to go downstream or upstream,
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depending on where you're at, can have massive positive impacts on your health,
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which typically in a traditional model,
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we wait till the disease is there before we do anything, which preventive health
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is supposed to be what we're about.
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And it's more than just preventing early detection.
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There's a whole field of medicine called predictive autoimmunity,
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which is literally doing antibody testing.
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And if you have a positive level, like a thyroid globulin or a TPO,
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you can have that for eight or 10 years before you develop a low thyroid.
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So if you catch it early enough, maybe you can even avert it entirely.
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Then we stop the disease progress. So there's so many things that can be done
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besides wait until you have a full disease, then treat that.
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Right. So what I hear you saying is people go to the doctor with their symptoms.
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They're diagnosed with hypothyroid and maybe Hashimoto's.
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And the doctor says, let's put you on levothyroxine, but they don't do anything else.
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So that doctor is following their protocol, trying to do a good job.
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But meanwhile, the patient is...
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There's more harm being done because they're not addressing the root cause.
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So they're just going to go on to probably develop multiple autoimmune conditions.
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Correct. And the younger you get Hashimoto's, which is getting younger and younger,
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right, then the more chance you have as you age to develop another autoimmune process.
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And so even if you have full-blown hypothyroidism, you've been on medication
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for years, as long as you still have positive autoantibodies,
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the fire is still going and that still needs to be looked at.
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And the typical specialist will be like, we treated you, move on.
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And wait for the lupus and the joint pains, wait for the other issue.
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And then the whole part about chronic infection.
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If you have chronic fatigue, maybe you have an Epstein-Barr reactivation.
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What do you do about that? So there's a lot of things that can be done besides watchful waiting.
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Yeah. So if a patient or a person is listening, they're like,
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okay, I have Hashimoto's.
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So obviously these four things are going on.
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You said the genetic component, the leaky gut, the triggering event,
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and an infection, what is the first thing that they can do on their own just
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after listening to this podcast without going into testing? Are there things that they can do?
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100%. There's an interesting article that maybe eight years ago I read that
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said if you have positive thyroid antibodies, TPO antibodies,
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and you go gluten-free, roughly 80% of people will have their antibodies normalized in a year.
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So just a dietary change, gluten-free.
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Now, obviously, and there's an 80% correlation with dairy and gluten.
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So if you want to be really hardcore, hardcore, you'd be gluten dairy,
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and then I always add in processed foods, sorry, et cetera, et cetera.
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But just the gluten-free, in a year, 70% or 80% of people will have their thyroid
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antibodies normalized.
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So diet alone can be a massive, massive disease process reverser, so to speak.
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And once you realize that gluten actually, there's this thing called molecular mimicry, and it's,
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things that look like other things, right? You ever seen the picture of like
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the young lady, it's attractive from the side, but then you realize it's a witch
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because you see the big nose, that kind of face.
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Well, that's kind of like what gluten is for your body.
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You know, is it this attractive young lady that, oh, it's going to help nourish
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my body? Or is it the older person that your body attacks?
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And so gluten actually has that with your thyroid tissues.
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It can actually activate or trigger an increasing in this autoimmune process.
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So if you have positive thyroid antibodies, you 100% need to be gluten-free.
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And then, depending on how you respond, you can add on more things.
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And the most powerful diet would be an autoimmune paleo diet,
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which removes all of the foods that we know, so major foods we know that, including lectins,
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that can actually be inflammatory and trigger this molecular mimicry confusion
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thing where your body sees the older woman versus the attractive one and attacks
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that one, not that one. Right.
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So you talk about blind spots a lot. What are blind spots in current medicine,
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especially associated with thyroid?
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And what can a patient do to not get caught in one of those blind spots?
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I mean, the basic definition I have for blind spots are things we think that
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are right that just aren't right, they're wrong, or things we think to be true that just aren't true.
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And so, and there's a lot of things like that, you know, a common one that's
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just come to light, you know, literally two weeks ago, the FDA removed the black
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box warning on bioidentical hormones.
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For almost a quarter of a century, we've thought that they're bad for young
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ladies, women, et cetera.
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So we've undertreated half population for a quarter of a decade.
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So it's that kind of stuff that happens all the time.
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In the world of thyroid, I think the biggest thing, the biggest blind spot is
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the reality that these four things I mentioned, and there's things you can do about it.
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If you talk to your traditional endocrinologist, your traditional autoimmune
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specialist, you have an autoimmune disease.
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Once you have it, you can't ever get rid of it. And it's your life.
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It's your existence. It's kind of what it is.
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And that's not true. I mean, that's a massive blind spot. You can reverse inflammation.
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Even if you want to be even fancier, you can take the gluten-free and add on
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low-dose naltrexone, which I'm not sure if you've talked about that before.
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That is a powerful immune modulator that can lower inflammation.
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Just imagine if you're a young female in their 30s, you had a baby,
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you had positive antibodies after the baby, and you want to have more children, but you're scared.
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Low-dose naltrexone, gluten-free, can massively change your health trajectory
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and forming your family. That's a big blind spot in that individual's life that
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our current system is just missing.
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Yeah. I had a pharmacist come on the show to talk about LDN and how helpful it is.
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And he was, I learned so much in that interview. He was talking about not just
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autoimmune problems, but inflammation in general.
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So is that something that you put all your patients on is LDN?
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You come in with a positive antibody of any type, period.
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You automatically get low-dose naltrexone. If you have a post-concussive syndrome,
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brain inflammatory, long COVID, you get on low-dose naltrexone.
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If you're a kid with autism painless pans, you get on low-dose naltrexone.
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It's a brain anti-inflammatory and it balances your immune system.
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And this is the thing about low-dose naltrexone. What I'm saying right now is
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controversial, et cetera, et cetera, except for the fact that there is a weight loss drug called,
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Contrave, which has a low dose of naltrexone in it, and it's FDA approved,
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except for the fact that right now they're putting Narcan in bathrooms and pharmacies
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across the country to protect from drug overdose.
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And you can literally, I was at a conference and they literally gave everybody their own nasal spray.
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And they're saying, hey, if you see someone on the ground laying around,
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just spray their nose and wake up, you save their life, right? Right.
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It's that safe that we can literally put it out there. And yet,
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if I talk about these ways, that's controversial.
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I don't know. What's the risks? And literally, we're like throwing it around on one side.
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And yet, when I talk about treating actual illnesses and diseases,
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we're totally overlooking it. And for those of you who want to learn more,
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there's a thing called the LDN Trust.
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You could spend hours and hours and hours just looking at the literature of what it can be used for.
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There's so much data out there. chronic pain syndromes, chronic fatigue and fibromyalgia.
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I now have local spine surgeons in my area with their pain patients asking me
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about this because it's in their literature now.
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So it's a really cool tool, fairly inexpensive that has been around for decades.
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Yeah, very cool. For somebody who hasn't listened to the previous episodes or
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learned, you mentioned low-dose naltrexone and Narcan.
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Can you tell how those two are the same or different?
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Okay, so you have these drugs that block opioids.
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And you have ones that you can absorb through your mouth and ones you can't.
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And so naltrexone and naltrexone are the generic terms.
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Notice naltrexone is the one you can absorb through your mouth.
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The naloxone, which is not absorbable through your mouth, is the one we used
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to put into narcotics to keep people from overdoses.
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It helped block the euphoria and stuff. They've used different versions of that
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to actually treat opioid-induced constipation. There's, again,
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FDA-approved utilities for that.
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But the big difference is one is absorbable by mouth and one's not.
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So you have to get it in other ways, like a nasal spray is the basic gist.
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But they work very similar.
13:57
Cool. Thank you. So the standard of care, let's talk about that.
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What is the standard of care for hypothyroid?
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You mentioned somebody's going to their endocrinologist.
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What is an endocrinologist supposed to do? Yeah.
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I guess going back to that medical harm, a good doctor not intending to do anything,
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how does that standard of care set somebody up for harm?
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And of course, we've already talked about addressing your root causes and doing that.
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I'm not sure what they're supposed to do. I can just tell you what I would do.
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Yeah. But standard of care is basically what a group of physicians in your local
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community have agreed upon.
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It's an unwritten rule. This is kind of what we do here. The standard of care
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for different conditions does differ around the country.
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So the standard of care for delivering a child in Mississippi is radically different
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than it is up in Boston, for example.
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We do have some national guidelines that give us a look at that,
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but there is some wiggle room between localities.
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So for a typical currently, and this is actually changing with endocrinologists,
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a couple of years ago, standard of care was a TSH, maybe a free T4.
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If the TSH was high, you know, you probably have hypothyroidism and you just
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start someone on medication.
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Now we're starting to see, I'm starting to see local endocrinologists check
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a TSH and a free T4, and maybe thyroid antibodies, sometimes they do, sometimes they don't.
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It's kind of tricky depending on, you know, which special it is.
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In my local environment, it depends, in Richmond, which endocrinologist you
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see. So I think it is evolving a little bit.
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What I do is what is related to the most up-to-date literature,
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and I literally just finished a certification course at the University of South
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Florida, which was just ranked one of top five percentile of medical schools in the country.
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They have now a personalized medicine.
15:45
Fellowship thing you can do. And this is what they're teaching at that level, right?
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And it is you check TSH, free T4, free T3, reverse T3, and thyroid antibodies.
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I will sometimes, based on the patient, throw in a thyroid globulin antibody,
16:00
which is a protein your body makes to actually a stores thyroid hormone,
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and check total T4, total T3.
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Sometimes if the patient's on a natural thyroid, because you have to kind of
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figure out some nuances and a thyroid globulin level.
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But everybody gets TSH, free T4, free T3, reverse T3, and thyroid antibodies when I look at them.
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But that's, and the reason for that is I don't just, I want to know what your
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brain is saying, what your pituitary is saying to your thyroid.
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I want to know what your thyroid is putting out. And I want to know what your
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cells are doing and then the feedback that goes back to your brain.
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And that whole loop, when you look at, you can see all your TSH is,
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you know, two, but your reverse T3 is 20.
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All of a sudden I know the mitochondria are putting the brakes on your system
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and you might feel low thyroid even though your TSH is normal and you might see oh wait a second my.
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Reverse T, my total T4, my free T4, my free T3 is a little low because your
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body is turning into reverse T3 to put these brakes on.
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So all of a sudden I can see where in the system there's a hiccup.
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And the answer isn't always more thyroid.
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It might be, what's going on? What's your cortisol? Do you have mitochondrial issues?
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But your gut converts about 25% of all T4 to T3 in your body.
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Maybe you have a gut problem.
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So doing all those allows me to be more nuanced in my approach,
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not just, you know, high TSH, low free T4, here's your medication.
17:25
Right. So somebody, you know, I hear from so many people, they are waiting three,
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six months to get into their endocrinologist, especially for the first time.
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They finally get into that appointment. They're super excited because they're going to get answers.
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And the endocrinologist just does those two tests that you mentioned, just the TSH and free T4.
17:44
What is a standard person's next step? Yeah.
17:47
That's a great question. I wish I could tell you there's another specialty,
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specialty in quotes, air quotes, for those who can't see it,
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to go to. But the endocrinologist is a thyroid person.
17:57
Your GYN, which a lot of GYNs, because they obviously see lots of women and
18:01
most thyroid issues are women, will do thyroid stuff as well.
18:04
But you really need to see a functional practitioner because those are the people
18:07
that actually train to what I just mentioned.
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That was one of the first times I was like, wait a second, there's a different world out there.
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Ignore the man behind the curtain kind of thing. And like, no,
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there's a whole different world out there.
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And I was taught that by some of the top endocrinologists in the country and
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from coming from places like Harvard, Hopkins, Vanderbilt.
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And you really need to see someone who's trained that way if you want to get that kind of treatment.
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And those are functional medicine practitioners, either trained to the A4M,
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IFM. And as of the first class, we'll be coming through.
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I'm not sure when that finishes that stuff through USF here soon as well. Okay.
18:44
So, does somebody have to see a functional doctor or are there functional medicine endocrinologists?
18:52
That'd be a really great thing, wouldn't it? I'd get to meet one.
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I'm sure they're out there somewhere because there's millions of them.
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But typically...
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I don't know if, I'm sure there are somewhere, I've just not met a functional
19:03
medicine endocrinologist.
19:05
Usually when you think about the hormonal experts that look at,
19:07
there's a thing called the hormonal hierarchy, okay?
19:10
And when you look at thyroid, you have to look at cortisol and you have to look
19:12
at insulin, okay? So if your thyroid's off, you have to look at your cortisol
19:15
levels. It's a four-point cortisol.
19:17
You have to look at your insulin levels, your A1C.
19:20
Sometimes you have to look at C-peptide and other things related to that.
19:24
Gut health, you have to look at your gut health because your gut actually is
19:27
where a lot of this T4, T3 conversion is happening. and about a quarter to a
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third of all medications are detoxified or broken down by your gut microbiome.
19:36
So if you're having medication issues or problems, all of a sudden you have
19:38
to look at that as well. Like the people that are trained like that are functional
19:41
medicine practitioners.
19:43
I usually recommend seeing a licensed practitioner, whether it's a medical doctor,
19:47
a DO, a nurse practitioner, a PA,
19:49
someone who knows medications, who's actually already trained in drugs and already
19:52
trained in allopathic medicine, who then has the extra icing on the cake of the functional side.
19:58
All right. So somebody, if they have a choice between a regular,
20:02
in quotes, regular endocrinologist or a functional medicine provider,
20:06
you're saying pick the functional medicine person.
20:10
Yeah. And Mike, with my training, which my first board certification was in
20:13
family medicine, I was trained to take care of 90% of hormonal related issues.
20:17
I will refer to an endocrinologist when I think when someone has a prolactinoma
20:21
or a pituitary tumor, or if someone has like type 1 diabetes who has issues
20:26
with DKA, I'll refer them on.
20:28
But 90% of all that stuff, a well-trained primary care person can take care of.
20:33
All right. That's the way it's supposed to be, actually.
20:37
That's true. Before our broken medical system divided everything up into,
20:42
you can only see this little piece of the person, you can only see this little
20:45
person. Yeah, totally broken.
20:47
Now, you wrote a book. Can you tell us about your book?
20:50
A book is Uncurable, From Hopeless Diagnosis to Defying All Odds.
20:54
And it's basically the story of my daughter that my wife and I adopted 18 years ago now.
20:59
Her birth mother did crystal meth throughout the entire pregnancy.
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She had a stroke before she was born, functionally blind, in a drug coma for
21:07
the first six months of her life.
21:09
And the health care system said she's going to be a vegetable, not a lot of hope for her.
21:13
So just kind of put her in the corner and that's going to be her existence.
21:16
And we didn't really accept that. And the book is our story of what the system
21:19
said when we decided to not put a feeding tube into her and feed her real food.
21:23
And we decided not to do surgical procedures. And the system didn't like it.
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And we also found the system was wrong. They actually made bad recommendations to my daughter.
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And that changed my entire view of medicine because she was my daughter and
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I had to figure out a way. And I did. And that's changed into affecting my other kids.
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It's affected my wife's health, my family's health, and ultimately changed my
21:43
entire practice of medicine. And through her struggle and her trials,
21:48
literally thousands of people have been helped on a better path.
21:51
And so the book kind of outlines that and walks through that.
21:54
Great. I'll have a link for that book down in the show notes so everybody can just hop down there.
21:59
Dr. Hartman, thank you so much for coming on the Health with Hashimoto's podcast
22:02
and sharing all of this information.
22:04
If there is one thing somebody can remember from our conversation,
22:08
because we've covered a lot of stuff, what is the most important thing you want
22:11
somebody to walk away with?
22:13
I'll tell people just never give up. Just because someone says there's nothing
22:17
else they can do for you doesn't mean there's nothing else that can be done.
22:19
That typically means there's nothing else they can do for you.
22:22
So what I tell people is after three board certifications.
22:27
Assistant clinical professor for like 12 to 13 years now, starting a research
22:31
company, I don't know how new. I'm still learning. I'm still practicing, right?
22:35
And I learn something new every day. And so the point is that there's something out there.
22:40
And just because you haven't found it or the person you're working with hasn't
22:43
found it yet doesn't mean there aren't answers out there.
22:45
I'm learning new things after 25 years of practicing. I'm learning new things
22:49
every day, every week, every month.
22:51
I'm changing what I do all the time. So there are answers. There is hope.
22:54
Don't give up. You might just need a bigger team. And you can put your team
22:58
together, put your, you know, group around you and just find your answers because
23:02
they're out there. They just need to be found. They're waiting for you to find them.
23:05
This podcast is for informational and educational purposes only.
23:09
Please discuss any changes with your trusted healthcare provider.
23:12
To take your next step, join our school community and explore the courses available there.
23:16
You do not have to figure your health out alone.
23:19
So that is school, S-K-O-O-L.com, and it is the Health with Hashimoto's community.
23:25
I'll see you next time on the Health with.